Background Port Wine Stain (PWS) is a congenital capillary malformation. Although multiple treatments are required, the gold standard treatment for PWS is Pulsed Dye Laser (PDL). Given its anti‐angiogenic effects, sirolimus can be considered as an adjuvant to PDL in PWS. Aim To evaluate the efficacy and safety of topical sirolimus (Rapamycin) 0.2% cream as adjuvant therapy for PDL for PWS. Methods In this randomized double‐blind placebo‐controlled trial, 15 patients with PWS were enrolled. Each lesion was divided into upper and lower parts, and each part was assigned randomly to receive PDL (4 sessions, 2 months apart) plus sirolimus vs PDL and placebo. The response was evaluated using colorimetry, investigator global assessment (IGA), and patient global assessment (PGA) every two months for eight continuous months. Results According to the colorimetric analysis, medial and lateral sides of the treatment and placebo parts did not differ significantly (both P‐value > .05). However, according to PGA and IGA, there was a significant difference in favor of sirolimus (P‐values = .041 and .039, respectively). Itching and dryness (86.7%), contact dermatitis (20%) were the most common adverse effects in the sirolimus group, while none of them were observed in placebo. Conclusion Although the improvement was significant subjectively, topical sirolimus 0.2% as an adjuvant to PDL does not appear to improve PWS erythema using calorimetric assessment.

Background Scars are inevitable results of surgical procedures, and prevention of them is still a major problem in the field of cosmetic surgery. Although various studies have been performed on botulinum toxin-A (BoNT-A) injection for the prevention of hypertrophic scars, the exact mechanism remains unclear. Methods This prospective, double-blinded, randomized study was performed on 19 patients who underwent mammoplasty and abdominoplasty surgery in Razi Hospital from October 2018 to December 2019. Single session of treatment was performed, where XEOMIN was allocated to one half of the scar and 0.9% saline to the control half. 3 and 6 months later, scars were assessed using the modified Stony Brook Scar Evaluation Scale (SBSES). Results In total, 19 patients who completed the study were analyzed. mSBSES at the third month (P value \ 0.001; 3.34 ± 1.59 vs 1.5 ± 1.36) and the sixth month (P value \ 0.001; 4.89 ± 1.83 vs 2.39 ± 1.82) showed a significant difference between the treatment and control groups. In the subset analysis, there was significant difference between BoNT-A and control in all four items including width, height, color, and scar visibility at months 3 and 6, and the BoNT-A-treated sides had higher scores in all items. Conclusion BoNT-A has a significant effect on scar prevention due to mammoplasty and abdominoplasty compared to placebo and results in decreased erythema, height, width and reduces incision line visibility. Moreover, its effect increases significantly over time from months 3 to 6.

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Background: Bleeding during rhinoplasty surgery has a negative effect on the quality of surgery; so, it is important to reduce bleeding during rhinoplasty. We aimed to evaluate the effect of injectable tranexamic acid (TXA) and nasal spray of desmopressin (DDAVP) on reduction in intraoperative bleeding and ecchymosis after open rhinoplasty. Methods: In a Randomized Clinical Trial ( RCT) prepared since 2020 to 2021 in Razi Hospital and Imam Khomeini Hospital, Tehran, Iran on 42 patients who underwent open rhinoplasty were divided into three groups. In the first group, TXA was injected one hour before surgery at a dose of 10 mg / kg with a placebo inhalation spray. In the second group, DDAVP was administered as a nasal spray at a dose of 40 mcg with a placebo injection. The third group received a placebo spray and placebo injection. All required data were gathered and analyzed. Results: In TXA group and DDAVP groups, the volume of bleeding during surgery significantly ( P =0.022) decreased compared to placebo group, also, the quality of the surgical field and the surgeon’s satisfaction significantly ( P =0.007) improved compared to the placebo group but not with each other. Unlike placebo group, there were no reports of postoperative bleeding in the TXA and DDAVP groups. Duration of surgery, ecchymosis on the day after surgery and coagulation tests before and after surgery were not significantly different in three groups. Conclusion: Use of DDAVP and TXA can both reduce the amount of bleeding during surgery and postoperative bleeding in rhinoplasty and improve the quality of the surgical field and the surgeon ‘s satisfaction during surgery.

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Introduction: lower lid malposition following malignancy surgery in infra- orbital area is often challenging and any way to reduce its chance is appreciated. Case presentation: 36 years old women with confirmed Basal Cell Carcinoma (BCC) of left cheek underwent tumor excision with free margins and remained skin defect reconstructed with adipocutaneous v-y advancement flap, which designed in a horizontally orientation. Patient had no signs of ectropion with good wound repair and obscured scar. Conclusion: v-y flaps are commonly used local flaps with minimal donor site morbidity, and if designed horizontally, not only may reduce chance of lower lid malposition, but also can remain more acceptable scars.