Structural and functional differences in skin of colour.

The term 'skin of colour' (SOC), refers to individuals of African, Latinx, Asian, Native Hawaiian, Pacific Islander and Indigenous descent. These individuals typically have darker skin tones compared with white individuals and they often present with unique disorders of the skin or with common disorders that have a unique appearance. Certain skin conditions commonly associated with SOC patients, in contrast to individuals with lighter skin tones, are explained by structural and functional differences between this population and the white population. Variations in functional differences between these two groups are dependent on structural differences in melanosomes, stratum corneum, epidermis and dermis. Understanding the structural distinctions between white populations and SOC populations will provide insight into common disorders in SOC patients, including hyperpigmentation, hypopigmentation, dry skin, scaliness, xerosis, sensitive skin and keloids. Furthermore, understanding structural and functional skin difference will encourage more research regarding aetiology of disease and therapeutic interventions.

The dermal armor of mylodontid sloths (Mammalia, Xenarthra) from Cueva del Milodón (Última Esperanza, Chile).

Dermal ossifications (osteoderms, dermal ossicles, osteoscutes) appear independently in various tetrapod lineages. In mammals, however, dermal ossifications are only present in some members of Xenarthra. This clade includes Cingulata (armadillos and their relatives), and Pilosa, including Vermilingua (anteaters) and Folivora (sloths). In extant xenarthrans, osteoderms are invariably present in cingulates whereas they are absent in pilosans. Among extinct sloths, however, a limited number of taxa possessed dermal ossifications. Records of mummified skins of ground sloths bearing osteoderms found in Cueva del Milodón (Southern Chile), with a late Pleistocene age, allowed us to analyze their micro- and macroscopic morphology. The main goal of this study is to closely examine a portion of a mylodontid skin portion using radiography. The arrangement, morphology and internal structure of the ossicles are analyzed and the results are discussed in the context of previous research. The results we obtained indicate that ossicles vary in shape and size, and the integument has four different patterns of arrangement of the ossicles: that is, areas without ossicles, disorganized ossicles, rows, and mosaic areas. The latter has two variants, with clusters of ossicles forming rosettes or stars. Thin sections of the ossicles allowed us to recognize and describe anatomical features of the bone and its mode of growth. Finally, paleobiological and functional considerations of the dermal armor are discussed along with its phylogenetic and chronological implications.

Anatomic Characteristics and Treatment of the Midcheek Groove by Deep Filling.

BACKGROUND: Because the anatomic mechanisms underlying the formation of the midcheek groove are unclear, treatments to date have resulted in unsatisfactory outcomes. OBJECTIVE: This study investigated the anatomical foundation of the midcheek groove and evaluated appropriate treatment methods. MATERIALS AND METHODS: Six cadaver hemifacial specimens were subjected to gross anatomic dissection and 6 to P45 sheet plastination. Based on the anatomic results, the area under the orbicularis oculi muscle (OOM) was selected for deep filling. Patients were evaluated by measuring 3D depth, regrading, and self-assessment. RESULTS: The medial band was observed to be an important structure of the OOM, with the facial projection overlapping the midcheek groove trace. Two of the 6 P45 specimens were found to have compact fibroelastic bundles (CFBs) between the medial band and the dermis. Deep filling of the area under the OOM significantly reduced the depth of each section in all 34 patients (p < .001). Grades 3 and 4 midcheek grooves were downgraded distinctively. Most subjects expressed satisfaction with outcomes. CONCLUSION: Formation of the midcheek groove is associated with the passage of CFBs. Deep filling of the area under the OOM effectively improves the midcheek grooves.

Morphological study of the integument and corporal skeletal muscles of two psammophilous members of Scincidae (Scincus scincus and Eumeces schneideri).

Sand deserts are common biotopes on the earth's surface. Numerous morphological and physiological adaptations have appeared to cope with the peculiar conditions imposed by sandy substrates, such as abrasion, mechanical resistance and the potential low oxygen levels. The psammophilous scincids (Lepidosauria) Scincus scincus and Eumeces schneideri are among those. S. scincus is a species frequently used to study displacement inside a sandy substrate. E. schneideri is a species phylogenetically closely related to S. scincus with a similar lifestyle. The aims of this study focus on the morphology of the integument and the muscular system. Briefly, we describe interspecific differences at the superficial architecture of the scales pattern and the thickness of the integument. We highlight a high cellular turnover rate at the level of the basal germinal layer of the epidermis, which, we suggest, corresponds to an adaptation to cutaneous wear caused by abrasion. We demonstrate the presence of numerous cutaneous holocrine glands whose secretion probably plays a role in the flow of sand along the integument. Several strata of osteoderms strengthen the skin. We characterize the corporal (M. longissimus dorsi and M. rectus abdominus) and caudal muscular fibers using immunohistochemistry, and quantify them using morphometry. The musculature exhibits a high proportion of glycolytic fast fibers that allow rapid burying and are well adapted to this mechanically resistant and oxygen-poor substrate. Oxidative slow fibers are low in abundance, less than 10% in S. scincus, but a little higher in E. schneideri.

A developmental basis for the anatomical diversity of dermis in homeostasis and wound repair.

The dermis has disparate embryonic origins; abdominal dermis develops from lateral plate mesoderm, dorsal dermis from paraxial mesoderm and facial dermis from neural crest. However, the cell and molecular differences and their functional implications have not been described. We hypothesise that the embryonic origin of the dermis underpins regional characteristics of skin, including its response to wounding. We have compared abdomen, back and cheek, three anatomical sites representing the distinct embryonic tissues from which the dermis can arise, during homeostasis and wound repair using RNA sequencing, histology and fibroblast cultures. Our transcriptional analyses demonstrate differences between body sites that reflect their diverse origins. Moreover, we report histological and transcriptional variations during a wound response, including site differences in ECM composition, cell migration and proliferation, and re-enactment of distinct developmental programmes. These findings reveal profound regional variation in the mechanisms of tissue repair. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.

Dermatosis purpúricas pigmentadas. Revisión de la literatura científica / Pigmented Purpuric Dermatosis: A Review of the Literature

Las dermatosis purpúricas pigmentadas son un grupo de enfermedades benignas y de curso crónico. Las variantes descritas representan distintas formas clínicas de una misma entidad con unas características histopatológicas comunes para todas ellas. Exponemos a continuación un resumen de las variedades más frecuentes, sus características clínicas, dermatopatológicas y de epiluminiscencia. Al tratarse de una entidad clínica poco frecuente, benigna, y no conocerse claramente los mecanismos patogénicos de la misma, no existen tratamientos estandarizados. Se revisan los tratamientos publicados hasta el momento, la mayoría de ellos basados en casos aislados o pequeñas series de casos, sin poder establecer un nivel de evidencia suficiente como para ser recomendado ninguno de ellos como tratamiento de elección

The pigmented purpuric dermatoses are a group of benign, chronic diseases. The variants described to date represent different clinical presentations of the same entity, all having similar histopathologic characteristics. We provide an overview of the most common PPDs and describe their clinical, dermatopathologic, and epiluminescence features. PPDs are both rare and benign, and this, together with an as yet poor understanding of the pathogenic mechanisms involved, means that no standardized treatments exist. We review the treatments described to date. However, because most of the descriptions are based on isolated cases or small series, there is insufficient evidence to support the use of any of these treatments as first-line therapy

Multimodal 3D Printing of Phantoms to Simulate Biological Tissue.

Biomedical optical imaging is playing an important role in diagnosis and treatment of various diseases. However, the accuracy and the reproducibility of an optical imaging device are greatly affected by the performance characteristics of its components, the test environment, and the operations. Therefore, it is necessary to calibrate these devices by traceable phantom standards. However, most of the currently available phantoms are homogeneous phantoms that cannot simulate multimodal and dynamic characteristics of biological tissue. Here, we show the fabrication of heterogeneous tissue-simulating phantoms using a production line integrating a spin coating module, a polyjet module, a fused deposition modeling (FDM) module, and an automatic control framework. The structural information and the optical parameters of a "digital optical phantom" are defined in a prototype file, imported to the production line, and fabricated layer-by-layer with sequential switch between different printing modalities. Technical capability of such a production line is exemplified by the automatic printing of skin-simulating phantoms that comprise the epidermis, dermis, subcutaneous tissue, and an embedded tumor.

A comparative histological study of the osteoderms in the lizards Heloderma suspectum (Squamata: Helodermatidae) and Varanus komodoensis (Squamata: Varanidae).

We describe the histological appearance of the osteoderms (ODs) of Heloderma suspectum and Varanus komodoensis using multiple staining and microscopy techniques to yield information about their morphology and development. Histological analysis showed that the ODs of H. suspectum are composed of three main tissue types, a superficial layer, herein identified as osteodermine, capping a base composed of Sharpey-fibre bone and lamellar bone rich in secondary osteons (Haversian bone tissue). In contrast, ODs in V. komodoensis are composed of a core of woven bone surrounded by parallel-fibred bone without a capping tissue. Thus, in these two species, ODs differ both in terms of their structural composition and in details of their skeletogenesis. The histology of the mineralised tissues observed in these two reptile taxa provides insights into the mechanism of formation of lizard ODs and presents a direct comparison of the histological properties between the ODs of the two species. These data allow greater understanding of the comparative histological appearance of the dermal bones of lizards and highlight their structural diversity.

Skin thickness measurements for optimal intradermal injections in children.

BACKGROUND: In the context of precision medicine and in response to the highly needed capacity of rapid interventions towards new infectious diseases and pandemic outbreaks, intradermal immunization is gaining increased attention. However, the currently used Mantoux technique for ID injection is difficult to standardize and requires training, especially when used in children. To allow determining the maximum penetration depth and needle characteristics for the development of a platform of medical devices suited for intradermal injection, VAX-ID® and to ensure an accurate ID injection in children, the epidermal and dermal thickness at the proximal ventral and dorsal forearm (PVF & PDF) and at the deltoid region in children aged 8 weeks to 18 years were assessed. The lateral part of the upper leg was assessed as well in children aged 8 weeks to 2 years since it is a commonly used injection site in this population. MATERIALS & METHODS: Mean thickness of the PVF, PDF, lateral part of the upper leg and deltoid were measured using high-frequency ultrasound. Association with gender, age and BMI was assessed using Mann-Whitney U Test, Spearman correlation and Wilcoxon Signed Ranks Test, respectively. RESULTS: Results showed an overall mean skin thickness of 0.99 mm (SD: 0.14 mm) at the PVF, 1.20 mm (SD: 0.17) at the PDF, 1.28 mm (SD: 0.16) at the lateral part of the upper leg and increasing to 1.32 mm (0.25) at the deltoid region. Age and BMI correlated significantly (p < 0.001) with skin thickness at all investigated body sites. Gender did not affect skin thickness in the investigated population. CONCLUSION: Significant differences in skin thickness at the PVF, PDF and deltoid region were seen according to age and BMI. An optimal needle length of 0.7 mm is advised to guarantee intradermal injection in children at all investigated injection sites. (NCT02727114).

The Making of a Flight Feather: Bio-architectural Principles and Adaptation.

The evolution of flight in feathered dinosaurs and early birds over millions of years required flight feathers whose architecture features hierarchical branches. While barb-based feather forms were investigated, feather shafts and vanes are understudied. Here, we take a multi-disciplinary approach to study their molecular control and bio-architectural organizations. In rachidial ridges, epidermal progenitors generate cortex and medullary keratinocytes, guided by Bmp and transforming growth factor ß (TGF-ß) signaling that convert rachides into adaptable bilayer composite beams. In barb ridges, epidermal progenitors generate cylindrical, plate-, or hooklet-shaped barbule cells that form fluffy branches or pennaceous vanes, mediated by asymmetric cell junction and keratin expression. Transcriptome analyses and functional studies show anterior-posterior Wnt2b signaling within the dermal papilla controls barbule cell fates with spatiotemporal collinearity. Quantitative bio-physical analyses of feathers from birds with different flight characteristics and feathers in Burmese amber reveal how multi-dimensional functionality can be achieved and may inspire future composite material designs. VIDEO ABSTRACT.

Commentaries on the publication entitled: "Structure and distribution of an unrecognized interstitium in human tissues" by Benias et al. (2018)

The claim made in this publication of the existence of a hitherto unknown interstitial space is based on studies with sample-based confocal laser endo-microscopy (pCLM). Due to postings on various web portals (New Cellvizio, EurekAlert, Google Scholar,...) the alleged discovery has found great resonance. Nevertheless, there are several critical issues in this publication, the most important being that this is not the discovery of an "unrecognized" interstitium as it has, in fact, been known for a long time

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Reply to "Commentaries on the publication entitled: 'Structure and distribution of an unrecognized interstitium in human tissues' by Benias et al. (2018)

We appreciate the time and attention paid to our paper by Prof. Mestres-Ventura and similarly appreciate the opportunity to respond to his concerns. We would like to address what we believe are several fundamental misunderstandings in his commentary.1. Scale: The most significant misunderstanding is one of scale. The schematic (Fig. 1) provided by Prof. Mestres-Ventura is (per personal communication) at the nano scale, while in vivo microscopy of extrahepatic bile duct and dermis shows that the collagen bundles we report are at the micron scale, each containing many individual fibrils at the nanometer scale. Indeed, examining the tissues described in our paper - submucosae, dermis and subcutaneous fascia - fresh in resected specimens or intraoperatively, we find that the structures we describe are visible at the macroscopic level (if one leans in closely enough). In other words, they are macroscopic, not microscopic. Prof. Mestres-Ventura, in summarizing the prior pCLE work of Wallace and Fockens, which he notes is similar to ours, states "the 'holes' shown under intravital microscopy and in cryofixed samples are huge (over 20 µm)" This is exactly our point - we were surprised as well at the scale of these structures, as this has not been well appreciated in the past

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The dermal skeleton of the jawless vertebrate Tremataspis mammillata (Osteostraci, stem-Gnathostomata).

Osteostracans are the closest jawless relatives of jawed vertebrates, informing the gradual assembly of the vertebrate mineralised skeleton. Conflicting interpretations of their dermal skeletal histology arise from failure to account for topological variation, obscuring their significance in elucidating vertebrate skeletal evolution. To resolve this, we characterize the cranial and trunk dermal skeleton of a single individual of Tremataspis mammillata (Osteostraci, Thyestiida) at submicron resolution using synchrotron- and computed- tomography. Our results show that the architecture of the Tremataspis dermal skeleton is, for the most part, conserved over the skeleton and is broadly consistent with previous histological hypotheses based on 2D thin section study. We resolve debate over the homology of the basal layer, identifying it as osteogenic acellular isopedin rather than odontogenic elasmodine or metaplastic ossification of the stratum compactum of the dermis. We find topological variation between all dermal skeletal elements studied, and particularly between the cranial and postcranial dermal skeleton. This variation can be largely explained by reduction in differentiation due to geometric constraints imposed within smaller skeletal elements, such as scales. Our description of the dermal skeleton of Tremataspis mammillata provides a foundation for interpreting data from cursory topological samples of dermal skeletal diversity obtained in other osteostracans. This reveals general aspects of histological structure that must be ancestral for osteostracans and, likely, ancestral jawed vertebrates. Finally, we draw the distinction between hypotheses and descriptions in palaeohistology.

The crocodylian skull and osteoderms: A functional exaptation to ectothermy?

The crocodylians are ectothermic semi-aquatic vertebrates which are assessed to have evolved from endothermic terrestrial forms during the Mesozoic. Such a physiological transition should have involved modifications in their cardio-vascular system allowing to increase the heat transfers with the surrounding environment by growing a peripheral vascularization which would be mainly located in the dermal skeleton: the dermatocranium and the osteoderms. In order to assess the implication of these anatomical regions in thermal exchanges, we have recorded the temperature above a set of representative skin areas in order to draw comparisons between the skull, the osteoderms, and the rest of the body parts which present either none or residual dermal ossification. We computed the data after the specimens were successively laid in different stereotyped environmental conditions which involved significant variations in the environmental temperature. Our results show that the osteoderms collect the external heat during the basking periods as they become significantly warmer than the surrounding skin; they further release the heat into the core of the organism as they turn out to be colder than the surrounding skin after a significant cooling period. In disregard of the environmental temperature variations, the skull table (which encloses the braincase) remains warmer than the rest of the cranial regions and shows less temperature variations than the osteoderms; a result which has lead us to think that the braincase temperature is monitored and controlled by a thermoregulatory system. Therefore, as hypothesized by previous authors regarding the ectothermic diapsids, we assume that the crocodylian skull possesses shunting blood pathways which tend to maintain both the braincase and the main sensory organs at the nearest to the optimal physiological temperature depending on the external temperature variations. Concerning the skin vascularization, the study of an albino Alligator mississippiensis specimen permitted to observe the repartition of the superficial blood vessels by transparency through the skin. We thus testify that the skin which covers either the skull or the osteoderms is more vascularized than the skin which does not present any subjacent dermal ossification. We consequently deduce that the significant contrast in the thermal behavior between the dermal skeleton and the rest of the body is indeed correlated with a difference in the relative degree of skin vascularization. This last assessment confirms that the development of the dermal skeleton should have played a functional role in the crocodylian transition from endothermy to ectothermy through the set-up of a peripheral vessel network.

Histological and functional comparisons of four anatomical regions of porcine skin with human abdominal skin.

Because of the shortage of human skin for research purposes, porcine skin has been used as a model of human skin. The aim of this study was to identify the region of German Landrace pig skin that could be used as the best possible substitute for human abdominal skin. Porcine samples were collected from the ear, flank, back and caudal abdomen; human abdominal skin samples were excised during plastic surgery. Histological and ultrastructural assessments were carried out on the epidermis and dermis, with emphasis on the dermo-epidermal interface length, dermo-epidermal thickness ratio as well as densities of; hair follicles, arrector pili muscles, blood vessels and sweat glands. In the pig, the barrier function of the four anatomical regions was assessed. Results showed that both histologically and ultrastructurally, all four regions of porcine skin were similar to human skin. These include the shapes of keratinocytes, structure of cell contacts and presence of Weibel Palade bodies in endothelial cells. Other parameters such as the thickness of epidermis, the thickness of stratum basale, spinosum and granulosum and the number of cell layers in the stratum corneum were similar in human abdominal and in all four regions of porcine skin. However, there were also significant differences especially in the thickness of the stratum corneum, the dermo-epidermal interface length and the blood vessel density.

Soft-tissue evidence for homeothermy and crypsis in a Jurassic ichthyosaur.

Ichthyosaurs are extinct marine reptiles that display a notable external similarity to modern toothed whales. Here we show that this resemblance is more than skin deep. We apply a multidisciplinary experimental approach to characterize the cellular and molecular composition of integumental tissues in an exceptionally preserved specimen of the Early Jurassic ichthyosaur Stenopterygius. Our analyses recovered still-flexible remnants of the original scaleless skin, which comprises morphologically distinct epidermal and dermal layers. These are underlain by insulating blubber that would have augmented streamlining, buoyancy and homeothermy. Additionally, we identify endogenous proteinaceous and lipid constituents, together with keratinocytes and branched melanophores that contain eumelanin pigment. Distributional variation of melanophores across the body suggests countershading, possibly enhanced by physiological adjustments of colour to enable photoprotection, concealment and/or thermoregulation. Convergence of ichthyosaurs with extant marine amniotes thus extends to the ultrastructural and molecular levels, reflecting the omnipresent constraints of their shared adaptation to pelagic life.

Relación entre el patrón dactiloscópico epidérmico y dérmico / Relationship between the epidermal and the dermal dactyloscopic pattern

El método más utilizado en identificación humana es el dactiloscópico, que registra, analiza y coteja los tipos fundamentales y puntos característicos de las figuras presentes en el dactilograma, determinando el grado de coincidencia, entre un patrón de identidad dubitada y uno de identidad indubitada. Debido a los procesos que afectan la piel de cadáveres, como la putrefacción entre otros, se utilizan las técnicas necropapiloscópicas que ocupan los patrones dérmicos para la identificación humana. El objetivo del presente trabajo es comparar registros epidérmicos con dérmicos, y validar científicamente, este método de identificación (epidérmico - dérmico). Para ello se utilizaron 32 dedos de cadáveres de individuos chilenos, de ambos sexos y de entre 40 y 80 años. Para obtener el registro físico artificial epidérmico y dérmico se utilizó la técnica de obtención de impresiones necrodactilares y se comparó a través de la técnica de cotejo dactiloscópico. Estos procedimientos fueron realizados por peritos criminalísticos de Carabineros de Chile. Se logró evidenciar diferencias importantes entre epidermis y dermis en cuanto a cantidad y calidad de puntos característicos y presencia de líneas seniles. En relación a tipos fundamentales, se evidenció que en dermis es difícil la observación de tipos fundamentales (borrosos) pero no se encontró ningún dígito que presentara tipo fundamental diferente entre epidermis y dermis. También se constataron diferencias por sexo y edad. Finalmente se pudo evidenciar, que existe una relación morfológica semejante entre registros físicos artificiales de patrones papiloscópicos epidérmicos con dérmicos provenientes del mismo individuo. Esto permite utilizar los registros dérmicos para la identificación humana positiva. Los resultados de este trabajo son importantes al aportar evidencia científica para la identificación humana en base al patrón dactiloscópico dérmico.

The most used method in human identification is the dactyloscopy, which registers, analyzes and collates the fundamental types and characteristic points of figures present in the dactylogram determining the degree of coincidence, between a pattern of identity that is dubious, and one that is indubious. Due to the processes that affect the skin of corpses, such as putrefaction, the necropapiloscopy techniques that occupy the dermal patterns for human identification are used. The objective of the present work is to compare epidermal with dermal records and validate scientifically, this method of identification (epidermal - dermal). For this purpose, 32 cadaveric fingers of Chilean individuals, of both sexes and between 40 and 80 years were used. In order to obtain the epidermal and dermal artificial physical record, the technique of obtaining necrodactyle impressions was used and compared through of the technique of dactyloscopic comparison. These procedures were carried out by criminalistic experts of Carabineros de Chile. It was possible to show important differences between epidermis and dermis in terms of quantity and quality of characteristic points and presence of senile lines. In relation to fundamental types, it was evidenced that in the dermis it is difficult to observe fundamental types (blurred) but no digit was found that presented a different of fundamental type between epidermis and dermis. There were also differences by sex and age. Finally, it was possible to demonstrate that there is a similar morphological relationship between artificial physical records of epidermal papiloscopic patterns with dermal patterns from the same individual. This allows the use of dermal records for positive human identification. The results of this work are important in providing scientific evidence for human identification based on the dermal fingerprint pattern.

Diversity of dermal denticle structure in sharks: Skin surface roughness and three-dimensional morphology.

Shark skin is covered with numerous placoid scales or dermal denticles. While previous research has used scanning electron microscopy and histology to demonstrate that denticles vary both around the body of a shark and among species, no previous study has quantified three-dimensional (3D) denticle structure and surface roughness to provide a quantitative analysis of skin surface texture. We quantified differences in denticle shape and size on the skin of three individual smooth dogfish sharks (Mustelus canis) using micro-CT scanning, gel-based surface profilometry, and histology. On each smooth dogfish, we imaged between 8 and 20 distinct areas on the body and fins, and obtained further comparative skin surface data from leopard, Atlantic sharpnose, shortfin mako, spiny dogfish, gulper, angel, and white sharks. We generated 3D images of individual denticles and measured denticle volume, surface area, and crown angle from the micro-CT scans. Surface profilometry was used to quantify metrology variables such as roughness, skew, kurtosis, and the height and spacing of surface features. These measurements confirmed that denticles on different body areas of smooth dogfish varied widely in size, shape, and spacing. Denticles near the snout are smooth, paver-like, and large relative to denticles on the body. Body denticles on smooth dogfish generally have between one and three distinct ridges, a diamond-like surface shape, and a dorsoventral gradient in spacing and roughness. Ridges were spaced on average 56 µm apart, and had a mean height of 6.5 µm, comparable to denticles from shortfin mako sharks, and with narrower spacing and lower heights than other species measured. We observed considerable variation in denticle structure among regions on the pectoral, dorsal, and caudal fins, including a leading-to-trailing edge gradient in roughness for each region. Surface roughness in smooth dogfish varied around the body from 3 to 42 microns.

Digital analysis yields more reliable and accurate measures of dermal and epidermal thickness in histologically processed specimens compared to traditional methods.

Changes in the thickness of the dermis and epidermis have been described in the scenario of tissue expansion as well as inflammatory skin processes (psoriasis, contact hypersensitivity and so on). These changes have previously been quantified using ocular micrometers to obtain and then average a limited number of spot measurements, leading to suboptimal accuracy. We describe a rapid method of using freely available ImageJ software to analyze digitized images of fixed skin specimens. By determining the cross-sectional area and surface length of a skin layer, a simple calculation produces more accurate and reproducible measurements of its thickness compared to historical methods, with excellent inter-rater reliability.

Sectioned images and 3D models of a cadaver head with reference to dermal filler injection.

The purpose of this study was to describe anatomical consideration with reference to dermal filler injection on sectioned images and three dimensional (3D) models using Visible Korean for medical education and clinical training purposes in the field of facial surgery. Serially sectioned images of the head were acquired from a cadaver. Anatomic structures related to dermal filler injection were 3D-reconstructed based on sectioned images, and additional structures were built on the basis of the established ones using a semi-automatic method. The anatomical 3D models were assembled and converted to a PDF file (66MB), which can be downloaded and used for free. In the PDF file, noticeable anatomical structures related with dermal filler injection can be identified on the 3D models as well as on the sectioned anatomical images. The 3D models in PDF were optimized and displayed in real time. These state-of-the-art sectioned images, outlined images, and 3D models will aid students and trainees to acquire a better understanding of the anatomy related to dermal filler injection, and will also improve medical understanding of patients and the general public. The 3D models in PDF files also can be used on dermal filler injection simulations.