Background Localized scleroderma (LoS) is a rare autoimmune disease characterized by skin fibrosis and subcutaneous tissue atrophy, resulting in aesthetic impairment on patients. Fat grafting has been used to treat LoS patients, achieving aesthetic and therapeutic improvement. Aims This article summarized the epidemiology and pathophysiology of LoS and the current progress and thorny questions of basic and clinical research on fat grafting treating LoS. Methods The literature of the last 20 years concerning fat grafting of treating LoS was reviewed. Results Fat grafting has been proved to produce aesthetic and therapeutic outcomes on LoS patients, including the improvement of soft tissue atrophy, skin fibrosis and pigmentation. Due to the inflammatory microenvironment of scleroderma, however, fat grafting still faces many difficulties, such as low fat retention. Novel fat grafting methods in order to supplement the deficiency of adipose‐derived stem cells and improve fat retention in LoS groups have been proposed whose effectiveness and feasibility is still needed further study. Conclusion Currently, fat grafting has been regarded as an effective treatment with a combination of aesthetic and therapeutic outcomes on LoS patients.
Background The lip is of important aesthetic value and highly subjected to aging. Collecting anthropometric baseline data and understanding age‐related changes of labial morphology can help with diagnosis of deformity, assessment of aging, and planning of cosmetic procedures. Many studies have focused on Caucasians, while there is a lack of anthropometric data on Chinese women. Methods A total of 169 women were enrolled in this cross‐sectional study and divided into four consecutive age groups. Linear distances, angles, and surface area data were obtained via stereophotogrammetry. Intergroup comparisons between different age groups were performed to find age‐related differences. Results Lip width significantly increased with age while philtrum width seemed to show no obvious change. Cutaneous upper and lower lip height increased, lengthening the lip in the vertical dimension. Decrease of upper vermilion height and changes in angles indicated that aging process shortened the upper vermilion and flattened the vermilion border. Surface area also showed age‐related changes. Intergroup comparison showed no statistical significance in most variables between 20s and 30s or 30s and 40s, while age‐related changes in some variables were significant between 40s and 50s. Conclusion This study provided anthropometric data of labial morphology across a wide age range. Aging process affected a variety of labial anthropometric variables. Age‐related changes accelerated after 40 among Chinese women.
Circulating proteomic signatures of age are closely associated with aging and age-related diseases; however, the utility of changes in secreted proteins in identifying therapeutic targets for diseases remains unclear. Serum proteomic profiling of an age-stratified healthy population and further community-based cohort together with heart failure patients study demonstrated that circulating C-C motif chemokine ligand 17 (CCL17) level increased with age and correlated with cardiac dysfunction. Subsequent animal experiments further revealed that Ccll7-KO significantly repressed aging and angiotensin II (Ang II)–induced cardiac hypertrophy and fibrosis, accompanied by the plasticity and differentiation of T cell subsets. Furthermore, the therapeutic administration of an anti-CCL17 neutralizing antibody inhibited Ang II–induced pathological cardiac remodeling. Our findings reveal that chemokine CCL17 is identifiable as a novel therapeutic target in age-related and Ang II–induced pathological cardiac hypertrophy and heart failure.
Background With the popularity of facial filler injections, increased severe adverse events, such as cerebral embolism, have been reported. Objectives This article aims to summarize the clinical manifestations, and proposed mechanism of the filler-induced cerebral embolism (FICE) cases. Methods A literature review was performed with the search keywords including “filler injection, hyaluronic acid, fat graft, cerebral infarction/embolism, stroke, cerebrovascular infarction, disorders of consciousness, and hemiplegia”. Results Among the 43 cases of FICE from 35 articles enrolled, 37 patients were female, and 6 were male. Twenty-nine of these patients received fat grafting, followed by 12 who received HA injection. Most of the injection sites of FICE patients were at the glabella, followed by temporal, forehead, and nasal areas. Among 30 patients receiving injection under local anesthesia, 43.33% presented with neurological symptoms during the procedure. The main symptoms were consciousness disorders and hemiplegia. Most of the embolization sites were in the middle cerebral artery, followed by frontal lobe infarction and anterior cerebral artery infarction. Three patients developed cerebral hemorrhage after embolism. Twenty-six patients presented with newly acquired vision loss, and 17 patients did not have newly acquired vision loss. The management for FICE cases included embolectomy, thrombolysis, decompressive craniectomy, antiplatelet/anticoagulant therapy and symptomatic and nutritional treatment. Nearly half of the patients recovered or improved in neurological manifestations but not the visual loss. Five patients died. Conclusions FICE is a severe complication following facial filler injection. Careful prevention, timely identification and treatment are crucial to decrease the morbidity and mortality of FICE.
A plump lip is the symbol of youth and glamorousness. Influenced by sun damage, genetic factors, and smoking, aging will cause volume loss and perioral wrinkles to the lip. 1 Lip augmentation with dermal filler is frequently performed to offset the age-related changes and provides a more attractive appearance. 2 Botulinum toxin A (BTA) is a naturally occurring polypeptide chain molecule derived from the Clostridium botulinum bacterium. By blocking the release of acetylcholine at the myoneural junction, BTA inhibits the contraction of orbicularis oris muscle and improves perioral wrinkles. 3 The paralyzed effect that BTA has on the orbicularis oris muscle results in the eversion of the lips and achieves an augmented outcome. 4 This study presents three cases of BTA injection to the lip and evaluates the possible changes in the labial morphology and surface area. 2 | C A S E REP ORT Three individuals (two females and one male) with no previous BTA treatment, with a mean age of 28.7 ± 5.5, received a total of 4U BTA (BOTOX ® , Allergan; 40 U/mL) with 1 unit at each site. The injection sites were located symmetrically at the vermilion border of the upper lip at the dermis level (Figure 1). Vectra ® H1 3D imaging system (Vectra M3, Canfield Scientific Inc) was used to capture 3D photographs of the patients with mouth gently closed in a neutral
Background Atopic dermatitis (AD) is a chronic, pruritic, immune‐mediated inflammatory disease. Developments in basic science and clinical research have increased our understanding of AD. Although pain as a symptom of AD is underemphasized in previous studies, multiple researchers address pain as a frequent burden of AD. However, the exact role of pain in AD is not fully understood. Aims Our review aimed to summarize the current evidence focusing on characteristics, mechanism, and management of pain in AD. Materials & Methods We conducted a thorough literature review in the PubMed database to figure out different aspects discussing pain in AD, including pain symptoms, burden, the relationship between pain and itch, mechanism, and pain management in AD. Results and Conclusion AD patients affected by skin pain vary from 42.7%‐92.2% with remarkable intensity and heavy burden. Skin pain and itch interacted both in symptoms and mechanisms. Atopic skin with the impaired barrier, neurogenic inflammation mediators, peripheral and central sensitization of pain may possibly explain pain mechanism in AD. Future research is needed to clarify the commonality and disparity of pain and itch in AD in order to seek efficacious medications and treatment.
Background For the patients seeking secondary upper blepharoplasty, a static double-eyelid fold featuring an immobile lower flap and depression of the fold is common. Objectives In this study, the authors propose a novel technique of reconstructing pretarsal tissue defects (PTDs) to converting static folds to dynamic folds. Methods Two hundred three patients with static folds underwent revision surgery. After complete adhesion release of the lower flap, a PTD was identified, which was defined as an area deficient of orbicularis oculi muscle in front of the tarsal plate. If the width of the PTD was over 2 mm tissue transfer was performed to reconstruct the PTD, usually with a free retro-orbicularis oculus fat (ROOF) graft or a pretarsal orbicularis oculi flap. Results Among the 105 patients with severe static folds, 67 received ROOF grafts, and 38 received orbicularis oculi muscle flaps. This technique converted a static fold into a dynamic fold. The surgery had a satisfaction rate of 86.7%. Complications included partial fold loss (n=7, 3.4%), complete fold loss (n=3, 1.5%), sunken upper eyelids (n=5, 2.5%), multiple folds (n=3, 1.5%), an unnatural curve of the double fold (n=5, 2.5%), and asymmetric folds (n=4, 2.0%). Conclusions To convert a static fold to a dynamic fold, we devised a technique that releases adhesion of the lower flap and reconstructs the PTD with ROOF graft or an orbicularis oculi muscle flap. Our study achieved a high patient satisfaction rate, and the resulting fold mimicked the dynamics of the congenital double-eyelid fold.
Botulinum toxin type A (BTA) has been widely used for therapeutic and cosmetic purposes including correction of dynamic wrinkles and improper muscular contraction. 1 "Cobblestone chin" is the nickname of an appearance of remarkable chin creases caused by mentalis contraction. 2 Some specialists recommended a 4-point strategy with the combination of deep-and superficial-layer mentalis BTA injections for severe cases. 3,4 Its common side effects, including unexpected relaxation of orbicular oris and depressor anguli oris, can be avoided by injecting close to the midline and away from the labiomental crease. 3,5 Here, we present a case of rare side effect, and put forward a revised injection recommendation for this specific site. | C A S E REP ORTA 26-year-old female visited our clinic complaining of her "cobblestone chin". Remarkable mental creases were observed both at rest and when elevating lower lip (Figure 1, A1-A2). To solve the problem, she received a total of 4 U of BTA (BOTOX ® , Allergan; with concentration of 40 U/mL) injection, with 1 U at each injection site in the Abstract Background: Botulinum toxin type A (BTA) injection is a widely-used procedure to correct cosmetic problems caused by muscular hyperactivity. "Cobblestone chin" refers to the appearance of remarkable chin creases caused by mentalis contraction. Aims:The aim of this case report is to raise the awareness of paradoxical bulging after BTA injection in mentalis. S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section.How to cite this article: Yu N, Liu Y, Chen C, Dong R, Yang E, Wang X. Paradoxical bulging of mentalis after botulinum toxin type A injection.
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