Chin Augmentation and Treatment of Chin Retrusion with a Flexible Hyaluronic Acid Filler in Asian Subjects: A Randomized, Controlled, Evaluator-Blinded Study.

BACKGROUND: Aesthetic improvement of the chin is increasingly requested by patients, including those of Chinese origin. METHODS: A randomized, evaluator-blinded, no-treatment controlled study evaluated the effectiveness and safety of a flexible hyaluronic acid (HA) filler, Restylane® DefyneTM (HADEF), in the correction of chin retrusion in a Chinese adult population over 12 months after treatment. On Day 1, subjects were randomized 3:1 into two groups, HADEF or delayed-treatment controls, and those in the HADEF group were administered treatment. An optional touch-up treatment was administered 1 month after treatment to obtain optimal chin augmentation. The initially untreated control group was offered delayed-treatment after 6 months (including 1-month touch-up). RESULTS: HADEF was superior to no-treatment in improving chin retrusion according to the blinded evaluator at 6 months [Galderma Chin Retrusion Scale (GCRS) responder rate (≥ 1-point improvement from baseline) of 81% vs. 5% for untreated controls; p < 0.001, meeting the primary effectiveness objective. A majority of subjects maintained improvement at 12 months (61% in the HADEF group). All subjects reported satisfaction with results at 6 months after treatment with HADEF and aesthetic improvement rates per the global aesthetic improvement scale (GAIS) were high for 12 months following treatment, with an acceptable safety profile. CONCLUSIONS: These results demonstrated HADEF to be effective and safe for the correction of mild-to-moderate chin retrusion in Chinese subjects, confirming findings previously observed in a western population. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Anatomy Study of Temporal Region based on Ultrasound Investigation: A Spatial Structure Study.

BACKGROUND: With the growing popularity of rejuvenation, people are giving more concerns on their temporal depression which makes them look older and wishing to improve it by injection. The complex structure of the temporal region leads to a higher risk of failed injection. The temporal region is well understood based on cadaver anatomy, but few studies have described its spatial structure. The purpose of this study was to improve the efficacy and safety of temporal injection by studying the spatial structure of the soft tissues and major blood vessels in each layer of the temporal region. METHODS: A total of 30 volunteers (24 men and 6 women, 60 temporal regions) were investigated. Color Doppler ultrasound was used to measure the thickness of the temporal layers at the selected measurement points (A, B, C, D, E, and F). The maximum thickness of the temporal fat pads was also measured, and the layers, depths and diameters of the major temporal vessels (frontal branch of superficial temporal artery and vein, middle temporal vein and deep temporal artery) were measured. RESULTS: At the various measurement points, the thickness and position of the skin, subcutaneous fat superficial fascia, and temporalis muscle did not differ significantly, whereas the superficial temporal fat pad and deep temporal fat pad differed significantly. The diameter and depth of the superficial temporal artery, superficial temporal vein, and deep temporal artery did not differ significantly, whereas the diameter of the middle temporal vein differed slightly, whereas the depth differed more obviously. CONCLUSIONS: The temporal structure is very complex, and understanding the spatial position of each layer of tissue plays an important role in improving the efficacy and safety of temporal filler injection. Ultrasound can help us to understand this information and assist in therapy. LEVEL OF EVIDENCE: Level II.

Assessment of Blood Volume in Liposuction Fluids Using Colorimetry.

OBJECTIVE: The possibility of using a color contrast method to evaluate blood loss during liposuction was assessed. A color chart of blood-lipid content associated with different blood volumes was developed. METHODS: Three color cards with different concentrations of blood were developed based on clinical parameters. The color cards were used to evaluate the volume of blood present in liposuction solutions obtained from 60 clinical liposuction patients. The red blood cell count also was evaluated for each patient. The data obtained using each evaluation method were compared and statistically analyzed to determine the most accurate calculation formula. RESULTS: The red blood cell counts were compared to the color card results. The paired t test results for the calculated values for the 3:1, 2:1, and 1:1 color cards and the red blood cell count values were comparable (44.3 ± 22.1 ml vs. 53.6 ± 25.0 ml, t = 10.5; 45.4 ± 19.0 ml vs. 55.2 ± 20.7 ml, t = 18.1; 41.9 ± 25.6 ml vs. 52.8 ± 28.3 ml, t = 14.0). The P values were < 0.05, and the difference between the two groups was statistically significant. The average standard error of the mean was 0.90, 0.54, and 0.77, respectively. Sixty samples were evaluated in a scatter diagram using the two detection methods. Trend analysis revealed that the two results demonstrated a linear increase (y = 5.6 + 1.1x), R2 = 0.989, indicating that the two inspection methods were highly correlated with only small errors. CONCLUSION: The colorimetric card protocol developed in this study could quickly, accurately, and conveniently calculate blood volumes in liposuction fluids, which has considerable clinical significance. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Long-term Prognosis of Vision Loss Caused by Facial Hyaluronic Acid Injections and the Potential Approaches to Address This Catastrophic Event.

BACKGROUND: Vision loss is a serious complication of hyaluronic acid (HA) filler injections, and long-term observations regarding the prognosis, particularly with angiography, are rare. OBJECTIVES: This study aimed to investigate the long-term prognosis and living status of patients with visual defects due to HA filler injections. METHODS: Nine patients with vision loss caused by HA filler injections and receiving different treatments were included and followed up for 2 to 6 years after their accident. Follow-ups, including outpatient ophthalmologic examinations, were performed. RESULTS: In the follow-up observation, all patients had reintegrated into society and work. The prognosis was similar for all hyaluronidase treatments, including retrobulbar injections and superselective ophthalmic artery thrombolysis. The facial appearance was not remarkably affected, and only 3 patients reported slight scarring. Ptosis disappeared in all the patients, and slight strabismus was found in 5 patients. However, vision improvement was very limited, even in the patients whose occluded retinal central artery received reperfusion. CONCLUSIONS: This long-term follow-up showed that the patients with vision loss caused by HA filler injections could reintegrate into society after treatment. Although the embolization of the retinal central artery led to reperfusion, vision was not restored, which further demonstrated the difficulty of recovering vision with the current treatment and the importance of prophylaxis. Autohydrolysis of HA by incorporating hyaluronidase-containing stimuli-responsive nanoparticles and a dual-pipe syringe are potential future approaches to address this catastrophic event.

Deep Learning-Based CT Radiomics for Feature Representation and Analysis of Aging Characteristics of Asian Bony Orbit.

OBJECTIVE: This paper puts forward a new method for automatic segmentation of bony orbit as well as automatic extraction and classification of aging features of segmented orbit contour based on depth learning, with which the aging mode of bony orbit contour is preliminarily validated. METHOD: Three-dimensional reconstruction was carried out by using the craniofacial Computed Tomography scanning data of 595 adult Mongolians at different ages (119 young males, 78 young females, 109 middle-aged males, 89 middle-aged females, 95 elderly males, and 105 elderly females), the craniofacial images were exported, orbit contour images were obtained with U-Net segmentation network, and then the orbit contour features of young group, the middle-aged group and the elderly group were classified with the classification network. Next, contour area, height, and other features put forward in existing research were automatically calculated by using the connected component shape description method; and it was validated whether the aging features of the bony orbit only occur to partial or the whole orbit. RESULTS: With the method put forward in this paper, high-precision identification (97.94% and 99.18%) of 3 categories in the male and female group experiments. In the meanwhile, it was found in the comparison experiment with other features that bony orbit contour definitely has features relating to aging, but these features only occur to partial areas of the orbit, which enables the convolutional neural network to achieve good identification effects. And, bone resorption of the superior orbital rim of males is more obvious than that of the inferior orbital rim, but the overall shape features like the bony orbit area and height do not change significantly along with the increase of the age. CONCLUSIONS: U-Net can realize high-precision segmentation of the orbit contour, and with the Convolutional Neural Network-based orbit contour sorting algorithm, the aging degree of the bony orbit can be identified precisely. It is preliminarily validated that the aging mode of Mongolian bony orbit contour is that the bone resorption of the superior orbital rim is more obvious than that of the inferior orbital rim, and the change of the orbit area, perimeter, height and circularity is not obvious in the aging process.

Aging of Chinese bony orbit: automatic calculation based on UNet++ and connected component analysis.

PURPOSE: Current research on the aging of bony orbit is usually done manually, which is inefficient and has a large error. In this paper, automatic segmentation of bony orbit based on deep learning and automatic calculation of the parameters of the segmented orbital contour (area and height of bony orbit) are presented. METHODS: The craniofacial CT scanning data of 595 Chinese were used to carry out three-dimensional reconstruction and output the craniofacial images. The orbital contour images are obtained automatically by UNet++ segmentation network, and then the bony orbital area and height were calculated automatically by connected component analysis. RESULTS: The automatic segmentation method has an Intersection of Union of 95.41% in craniofacial CT images. During the aging, the bony orbital area of males increased with age, while that of females decreased, and the area in male was larger than that in female (P < 0.05). The distance from equal points 10 and 40-90 to the supraorbital rim was significantly larger (P < 0.05). Except for the equal point 90, the distance from equal points to the inferior orbital rim was obviously larger (P < 0.05). In the females, the distance from equal points 50-70 to inferior orbital rim was significantly lower (P < 0.05). CONCLUSION: The method proposed here can automatically and accurately study image dataset of large-scale bony orbital CT imaging. UNet++ can achieve high-precision segmentation of bony orbital contours. The bony orbital area of Chinese changes with aging, and the bony orbital height changes different between males and females, which may be caused by the different position and degree of orbital bone resorption of males and females in the process of aging.

Endovascular Hyaluronidase Application Through Superselective Angiography to Rescue Blindness Caused by Hyaluronic Acid Injection.

BACKGROUND: Blindness is a rare but catastrophic complication of facial hyaluronic acid (HA) injection. Although various means to rescue visual impairment have been employed, no consensus regarding effective treatment has yet been reached. We organized a multidisciplinary team to address this emergency situation by means of endovascular hyaluronidase application. OBJECTIVES: The aim of this study was to investigate the direct delivery of hyaluronidase to ophthalmic artery occlusion through endovascular cannulation to resolve HA-induced blindness. METHODS: Four patients with visual impairments caused by HA filler embolization were subjected to sequential treatments. Through superselective angiography, a microcatheter was introduced along a guidewire from the femoral artery to the ophthalmic artery to directly deliver hyaluronidase to the HA embolism. The safety and efficiency of this treatment were systematically analyzed. RESULTS: Selective cerebral angiography demonstrated that the endovascular application of hyaluronidase significantly alleviated occlusion in 3 patients. One patient showed slight visual improvement, whereas the other patients showed no improvement in their visual function during a follow-up period of more than 3 months. One patient suffered from cerebral infarction in the left middle cerebral artery during the intervention surgery. Moreover, 2 patients showed multiple lacunar cerebral infarctions after the operation, whereas none exhibited symptoms of hemiplegia during follow-up. CONCLUSIONS: Although the endovascular application of hyaluronidase could partially recanalize the occluded branches of the ophthalmic artery, it had limited effects on restoring vision. Considering the risks of vascular intervention surgery, this approach should be considered with caution.

Correction to: Clinical Observations and the Anatomical Basis of Blindness After Facial Hyaluronic Acid Injection.

The article Clinical Observations and the Anatomical Basis of Blindness After Facial Hyaluronic Acid Injection, written by Zhang et al was originally published Online First without Open Access.

Blindness After Facial Filler Injections: The Role of Extravascular Hyaluronidase on Intravascular Hyaluronic Acid Embolism in the Rabbit Experimental Model.

BACKGROUND: Blindness caused by ophthalmic artery embolism is the most catastrophic complication of facial hyaluronic acid (HA) injections. Extravascular (retrobulbar) injection of hyaluronidase has been suggested as a salvage in this calamitous situation. However, the effectiveness of this treatment still lacks consensus. OBJECTIVES: The aim of this study was to investigate the role of extravascular hyaluronidase in dissolving intravascular HA occlusion. METHODS: Two different animal experiments were performed: (1) isolated rabbit abdominal aorta segments filled with HA were treated with extravascular immersion of highly concentrated hyaluronidase for 90 minutes, followed by gross observation, microscopic examination, particle size analysis, and immunohistochemical staining; and (2) live rabbit auricular arteries were first occluded with HA and then immediately treated with extravascular injection of hyaluronidase. The ears were then evaluated by gross observation, microscopic examination, and perfusion studies after 60 minutes and again after 90 minutes. RESULTS: The HA within the aorta segments showed no gross or microscopic changes after treatment with extravascular hyaluronidase. Hyaluronidase could only be detected in adventitia of the aortae, instead of in vascular smooth muscle, tunica intima, or vascular lumen. The occluded auricular arteries showed no reperfusion after extravascular injection of hyaluronidase. CONCLUSIONS: In this rabbit model, extravascular hyaluronidase was unable to penetrate into the arterial lumen of the isolated abdominal aorta or the live auricular artery of the rabbit to dissolve intravascular HA within a 90-minute time limit, thus casting doubt on whether extravascular (retrobulbar) hyaluronidase injection has a role in treating ophthalmic artery embolism caused by HA injections.

A Flexible Suspension Technique of Blepharoplasty: Clinical Application and Comparison with Traditional Technique.

BACKGROUND: Double-eyelid blepharoplasty is one of the most popular aesthetic surgeries in China. But the traditional method produces a hidebound double eyelid due to its rigid suturing between the skin and the tarsus. The authors of this article concluded a novel technique of "flexible suspension technique" compared with traditional blepharoplasty which is considered as a "rigid fixation technique." METHODS: This is a retrospective study of two groups of 100 Chinese Han females, on whom double-eyelid blepharoplasty was performed, 50 cases by "flexible suspension technique" and the other 50 by "rigid fixation technique." The basic procedure of "flexible suspension technique" is suturing the orbicularis oculi muscle to the septal extension. Thus, the surgical connection between skin and tarsus is flexible. The surgical results were evaluated and compared using the Global Aesthetic Improvement Scale and Visual Analogue Scale/Score. RESULTS: The "very much improved" rate in the "flexible suspension technique" group was higher than that in the "rigid fixation technique" group (p < 0.05). Postoperative appearances of the "flexible suspension technique" group were also better than the "rigid fixation technique" group with less edema (p < 0.05) and slighter incision scars (p < 0.05). However, the incidences of asymmetry and fold loss were higher in the "flexible suspension technique" group (p < 0.05). CONCLUSION: The flexible suspension technique blepharoplasty can obtain a more natural appearance and has less adverse effects and shorter recovery time. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical Observations and the Anatomical Basis of Blindness After Facial Hyaluronic Acid Injection.

BACKGROUND: Blindness or visual loss is the most serious complication resulting from facial hyaluronic acid (HA) injection. In this study, three recent clinical cases were analyzed, and the relevant anatomy of cadavers was evaluated to investigate the mechanism behind visual impairment due to HA injection. METHODS: Three patients with different extents of visual loss after HA injection were studied. Ophthalmic testing and corresponding treatments were performed, and the clinical progress was observed. In addition, thirty-six fresh Asian cadaver hemifaces were anatomized to investigate the morphology of the ophthalmic artery and its branches. The minimum dose of HA for central retinal artery embolism was calculated based on the ophthalmic arterial volumes of cadavers. RESULTS: Visual impairment was more severe in central retinal artery occlusion and combined intraocular branch occlusion than in posterior ciliary artery occlusion. During follow-up, no improvement was observed in terms of visual impairment. Cadaver study reconfirmed that the ophthalmic artery included facial and intraocular branches. The ophthalmic arterial volumes running from the supraorbital artery and supratrochlear artery to the central retinal artery were 0.083 cm3 and 0.089 cm3, respectively. CONCLUSIONS: The severity of blindness caused by HA injection may be associated with the occlusion site. Our clinical observations indicate that conventional treatments, such as retrobulbar hyaluronidase injection, are insufficient to relieve visual impairment. Injecting as little as 0.08 ml of HA into the facial branch is enough to cause central retinal artery embolism. Limiting the volume per injection could represent a simple prophylactic strategy. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Repair of Large Full-Thickness Scalp Defects Using Biomaterial and Skin Grafting.

The reconstruction of large full-thickness scalp defects remains a surgical challenge, especially when the skull is exposed completely without periosteum. Surgical technique options for wound coverage have included tissue expansion, skin grafting, local or regional flaps, and microvascular free tissue transfer. In recent years, some authors have reported to use biological material as an alternative for repairing complex wounds. The authors report the successful reconstruction of a large defect with bare skull in bilateral temporal regions of a 3-year-old child. The patient was treated with artificial biomaterial followed by skin grafting, without making multiple cranial burr holes or burring out the outer bony cortex. The relevant literatures were reviewed and the vascular anatomy evidence of the blood supply at temporal region was also demonstrated on cadaver. This case suggests that artificial biomaterial followed by skin grafting is a potential alternative for the treatment of large full-thickness scalp defects in pediatric patients.

Anatomic Study of Ophthalmic Artery Embolism Following Cosmetic Injection.

INTRODUCTION: Cosmetic injections of dermal fillers or fat could cause ophthalmic artery embolism and even blindness, the high-risk regions of which are considered glabellar, nasal dorsum, and nasolabial fold. Understanding anatomy of the related arteries is important for a physician to safely perform filler injections. To investigate the mechanisms of ophthalmic artery embolism following the injections, cadaver anatomy was studied. METHODS: Ophthalmic artery, facial artery, their branches, and anastomoses among them were anatomized in 12 fresh cadavers. Mimetic injections of hyaluronic acid were performed in glabellar region, nasal dorsum, and nasolabial fold, the relationships between injected filler and related arteries were then investigated. RESULTS: It was clearly found that 4 arteries were located in common injection regions and connected to ophthalmic artery: supratrochlear artery, supraorbital artery, dorsal nasal artery, and angular artery. In the glabellar region, the deep injection on the periosteum will be risky to injure supratrochlear artery and supraorbital artery, whereas in nasal dorsum and nasolabial fold, the sub- superficial musculo aponeurotic system layer injection has the possibility to injure dorsal nasal artery, angular artery, and facial artery. CONCLUSION: The anatomic mechanism of ophthalmic artery embolism is the anastomoses among the related arteries and ophthalmic artery. Based on the findings of the study, injections in periosteum layer at glabellar region or sub-superficial musculo aponeurotic system layer of nasal dorsum and nasolabial fold are not advised.

Synthesis of Europium-Doped Fluorapatite Nanorods and Their Biomedical Applications in Drug Delivery.

Europium (Eu)-doped fluorapatite (FA) nanorods have a biocompatibility similar to that of hydroxyapatite (HA) for use as cell imaging biomaterials due to their luminescent property. Here, we discuss the new application of europium-doped fluorapatite (Eu-FA) nanorods as an anticancer drug carrier. The Eu-FA nanorods were prepared by using a hydrothermal method. The morphology, crystal structure, fluorescence, and composition were investigated. The specific crystal structure enables the effective loading of drug molecules. Doxorubicin (DOX), which was used as a model anticancer drug, effectively loaded onto the surface of the nanorods. The DOX release was pH-dependent and occurred more rapidly at pH 5.5 than at pH 7.4. The intracellular penetration of the DOX-loaded Eu-FA nanorods (Eu-FA/DOX) can be imaged in situ due to the self-fluorescence property. Treatment of melanoma A375 cells with Eu-FA/DOX elicited a more effective apoptosis rate than direct DOX treatment. Overall, Eu-FA exhibits potential for tracking and treating tumors and may be potentially useful as a multifunctional carrier system to effectively load and sustainably deliver drugs.

Microgels for bioprinting: recent advancements and challenges.

Microgels have become a popular and powerful structural unit in the bioprinting field due to their advanced properties, ranging from the tiny size and well-connected hydrogel (nutrient) network to special rheological properties. Different microgels can be fabricated by a variety of fabrication methods including bulk crushing, auxiliary dripping, multiphase emulsion, and lithography technology. Traditionally, microgels can encapsulate specific cells and are used for in vitro disease models and in vivo organ regeneration. Furthermore, microgels can serve as a drug carrier to realize controlled release of drug molecules. Apart from being used as an independent application unit, recently, these microgels are widely applied as a specific bioink component in 3D bioprinting for in situ tissue repair or building special 3D structures. In this review, we introduce different methods used to generate microgels and the microgel-based bioink for bioprinting. Besides, the further tendency of microgel development in future is introduced and predicted to provide guidance for related researchers in exploring more effective ways to fabricate microgels and more potential bioprinting application cases as multifunctional bioink components.

Cell-free adipose tissue extracts as a novel treatment for rosacea by downregulating TRPV1.

Rosacea is a chronic inflammatory skin disease that typically affects the central facial area. Its main clinical symptoms include paroxysmal flushing, telangiectasia, and non-temporary erythema. Cell-free adipose tissue extracts (ATEs) are liquid components extracted from human adipose tissue that contain large amounts of growth factors. Despite the scar-reducing, anti-aging, and wound-healing effects of ATEs, the efficacy of ATEs in rosacea remains unknown. Therefore, the anti-rosacea effects of ATEs were investigated in human cathelicidin peptide (LL-37) induced rosacea mice and capsaicin (CAP)-stimulated HaCaT keratinocytes. In vitro, ATEs significantly reduced TRPV1 expression, intracellular calcium ions influx and the release of inflammatory factors (such as KLK5, IL-6, IL-8 and TNF-α) after intervening in CAP-stimulated cells. The in vivo results revealed that ATEs alleviated rosacea symptoms, such as erythema score, erythema area, transepidermal water loss, abnormal epidermal thickness, mast cell infiltration and telangiectasia upon downregulating TRPV1 and CD31 expression. Moreover, the up-regulated TRPV1 protein expression was also recovered by ATEs administration in vivo and in vitro. Meanwhile, ATEs demonstrated good biocompatibility. In summary, ATEs could be a potential therapeutic agent for rosacea by regulating inflammation and alleviating telangiectasia.

Cell-free fat extract regulates oxidative stress and alleviates Th2-mediated inflammation in atopic dermatitis.

Atopic dermatitis (AD) is a common inflammatory skin disease that significantly affects patients' quality of life. This study aimed to evaluate the therapeutic potential of cell-free fat extract (FE) in AD. In this study, the therapeutic effect of DNCB-induced AD mouse models was investigated. Dermatitis scores and transepidermal water loss (TEWL) were recorded to evaluate the severity of dermatitis. Histological analysis and cytokines measurement were conducted to assess the therapeutic effect. Additionally, the ability of FE to protect cells from ROS-induced damage and its ROS scavenging capacity both in vitro and in vivo were investigated. Furthermore, we performed Th1/2 cell differentiation with and without FE to elucidate the underlying therapeutic mechanism. FE reduced apoptosis and cell death of HaCat cells exposed to oxidative stress. Moreover, FE exhibited concentration-dependent antioxidant activity and scavenged ROS both in vitro and vivo. Treatment with FE alleviated AD symptoms in mice, as evidenced by improved TEWL, restored epidermis thickness, reduced mast cell infiltration, decreased DNA oxidative damage and lower inflammatory cytokines like IFN-γ, IL-4, and IL-13. FE also inhibited the differentiation of Th2 cells in vitro. Our findings indicate that FE regulates oxidative stress and mitigates Th2-mediated inflammation in atopic dermatitis by inhibiting Th2 cell differentiation, suggesting that FE has the potential as a future treatment option for AD.

3D-Printed Breast Prosthesis that Smartly Senses and Targets Breast Cancer Relapse.

Breast reconstruction is essential for improving the appearance of patients after cancer surgery. Traditional breast prostheses are not appropriate for those undergoing partial resections and cannot detect and treat locoregional recurrence. Personalized shape prostheses that can smartly sense tumor relapse and deliver therapeutics are needed. A 3D-printed prosthesis that contains a therapeutic hydrogel is developed. The hydrogel, which is fabricated by crosslinking the polyvinyl alcohol with N1-(4-boronobenzyl)-N3-(4-boronophenyl)-N1, N1, N3, N3-tetramethylpropane-1,3-diaminium, is responsive to reactive oxygen species (ROS) in the tumor microenvironment. Specifically, RSL3, a ferroptosis inducer that is loaded in hydrogels, can trigger tumor ferroptosis. Intriguingly, RSL3 encapsulated in the ROS-responsive hydrogel exerts antitumor effects by increasing the numbers of tumor-infiltrated CD4+ T cells, CD8+ T cells, and M1 macrophages while reducing the number of M2 macrophages. Therefore, this new prosthesis not only allows personalized shape reconstruction, but also detects and inhibits tumor recurrence. This combination of aesthetic appearance and therapeutic function can be very beneficial for breast cancer patients undergoing surgery.

Botulinum Toxin Type A for the Treatment of Masseter Muscle Prominence in Asian Populations.

In Asian populations, an oval face shape with a slimmer lower face is considered favorable. Botulinum toxin type A (BoNT-A) treatment of the lower face for aesthetic purposes is widely performed in Asia, although it is not officially approved for this indication in any country. In this review, the authors highlight recent research describing injection techniques, mechanism of action, clinical efficacy, and key learning points to safely treat benign masseter muscle prominence (MMP) in Asian populations using BoNT-A. To support the existing literature, clinical examples are provided that demonstrate individualized treatment plans for patients with asymmetric vs symmetric MMP and an observed complication after treatment. This review provides insights for optimizing clinical outcomes and for designing future studies investigating the safety and efficacy of BoNT-A for treating MMP.

Long-term Safety and Effectiveness of Hyaluronic Acid Fillers Correcting Nasolabial Folds in Chinese Patients.

Background: Soft-tissue fillers, specifically hyaluronic acid fillers, can reduce many signs of aging by treating the associated loss of subcutaneous fat and midfacial contour deficiencies. The objective of this study was to investigate whether the effectiveness and safety of Belotero Volume Lidocaine (BVL) compared with Restylane (RES, control) is noninferior in the treatment of severe nasolabial folds (NLFs) in Chinese patients. Methods: This was a prospective, randomized, controlled, split-face clinical study. Overall, 220 Chinese patients of both sexes with symmetrical NLFs of severe intensity (grade 4) on the Wrinkle Severity Rating Scale (WSRS) were treated with both fillers. Treatment outcomes were assessed by the WSRS, and other scales, at multiple time points up to 18 months postinjection. The co-primary effectiveness outcomes were based on the blinded evaluator ratings of NLFs according to the WSRS scale after 6 and 12 months. Adverse events were assessed during the whole study and patients' pain sensation at three time points after injection. Results: Noninferiority of BVL versus control based on the WSRS was demonstrated at month 6 and month 12. Response rates were slightly higher for BVL than control at all time points, and BVL had a sustained effect until month 18. Pain sensation scores were significantly lower for BVL compared with control. The incidence rates of treatment-related AEs were low and very similar for both treatments. Conclusions: This study demonstrates that BVL is a safe, long-lasting, and effective treatment to correct severe NLFs in Chinese patients while being noninferior to the control device.