Background When treating horizontal forehead lines with botulinum toxin type A the traditional approach requires that injection points should stay 1.5 to 2 cm above the orbital rim to avoid brow ptosis. Failure to treat the lower frontalis may potentially cause worse rhytides in the lower forehead. Objectives The aim of this study was to present a refined injection pattern accommodating the lower frontalis and evaluate its clinical efficacy and safety. Methods Patients were categorized into 4 types according to the patterns of their forehead wrinkles. Moderate and severe wrinkles in the upper forehead were treated by the “safe zone” technique. Mild wrinkles and rhytides in the lower forehead were treated by the Microbotox technique. Standard photographs and measurements were taken before and after treatment. The effect on wrinkle reduction and changes in brow heights were assessed. Results In total, 330 treatments were followed up in the clinic, and 246 treatments were followed up by telephone. Among the 330 treatments, 213 were evaluated in our clinic 2 to 4 weeks later, and the patients who received these treatments were recruited for effect evaluation and brow height measurements. The posttreatment severity of forehead wrinkles was significantly reduced (P < 0.05), and brow heights remained unchanged (P > 0.05). No severe adverse events were documented. Patient satisfaction was quite high. Conclusions The refined injection pattern is an effective and safe technique to treat horizontal forehead lines. The Microbotox technique enables treatment of the lower frontalis without changes in brow position. Level of Evidence: 3

Background Over the past two decades, fat grafting has been extensively applied in the field of tissue regeneration. Objectives The authors investigated the therapeutic potential of microfat, nanofat and extracellular matrix/stromal vascular fraction gel (SVF-gel) in skin rejuvenation. Methods Microfat was harvested by a cannula with multiple 0.8 mm smooth side holes and processed with a fat stirrer to remove fibers. Nanofat and SVF-gel were prepared according to previously reported methods. We evaluated their structure and viability. Then, stromal vascular fraction (SVF) cells from the three types of samples were isolated and characterized, and the cell viability was compared. Results The microstructure of the three samples showed distinct differences. The microfat group showed a diameter of 100 to 120 .0μmunder the microscope and presented abotryoid shape under Calcein-AM/Propidium iodide (AM/PI) staining. Scanning electron microscopy (SEM) analysis showed that the microfat maintained integral histological structure.In the nanofat group, no viable adipocytes and no normal histological structure were observed, with high levels of free lipids.The SVF-gel group showed uniform dispersion of cells with different sizes and parts of the adipose histological structure. Cell count and culture revealed that the number of viable SVF cells decreased distinctly in the nanofat group compared with the microfat group. In contrast, the number of viable SVF cells in the SVF-gel group increased moderately. Clinical applications with microfat showed marked improvements in skin wrinkles. Conclusions The study showed that the microfat could preserve the integrity of the histological structure and presents the advantages of subcutaneous volumetric restoration and improvement of skin quality in skin rejuvenation compared with the nanofat and SVF-gel.

Background Minimally invasive or noninvasive skin-tightening procedures have become trends in facial and neck rejuvenation. Radiofrequency-assisted liposuction (RFAL) is a new choice for the treatment of skin relaxation that is more effective than noninvasive surgery without surgical incision. Objectives The authors recommend a 2-step method in which radiofrequency is applied after appropriate liposuction is performed. This approach is safer and more effective than traditional RFAL, and the authors detail the safety guidelines, operative techniques, postoperative satisfaction results, and complications. Methods A total of 227 patients with lower face and neck skin laxity underwent RFAL between April 2012 and June 2019. The following data were collected: age, body mass index, operative duration, volume of fat aspirated, amount of energy delivered, and number and type of complications. Patient satisfaction was surveyed postoperatively and assessed by third-party surgeons at 3 and 6 months. Results At 6 months after operation, 78.8% of patients considered the results moderate to excellent, whereas 21.2% of the patients considered the results to be poor or thought there was no change. The photograph evaluation performed by independent plastic surgeons showed moderate to excellent results in 89.1% of patients. There were no major complications that required further medical or surgical intervention. Conclusions This 2-step method is a safe and effective improvement in the application of radiofrequency for face and neck skin tightening. Patients can achieve significant contour correction via minimally invasive surgery with a lower risk of side effects. Level of Evidence: 4

No abstract

Temple volume plays an important role in facial symmetry and youthfulness. The temple can be considered a transitional subunit between the forehead and the cheek and between the temporal hairline and the lateral orbit. 1 Progressive aging causes a dramatic loss of the temple's fullness, 2 greatly impacting facial appearance.Therefore, temporal augmentation is an important aspect of facial rejuvenation. It aims to achieve an appropriate fullness in the temple and a smooth facial contour of the upper face. 3 In some subjects, an inward curve of the temporal hairline adds to the severity of temporal hollowing. The hairline, that is, the posterior border of the temple, is an important factor for a balanced, attractive face. 4 The temporal hairline includes the temporal peak

Severe atrophic acne scars (AAS) have serious negative effects on patients' mental health and quality of life. 1 Although many treatment options are available for mild-to-moderate AAS, such as laser therapy, radiofrequency therapy, subcision, dermal filler injection, dermabrasion, chemical peeling, punch excision, and platelet-rich plasma (PRP) therapy, 2 severe AAS remains the "Achilles's heel". 3 of acne scar treatment because of limited efficacy and side effects.Subcision is a common approach to release fibrous adhesions beneath the deep AAS, which bind the atrophic scars down.Neocollagenesis, followed by dermal trauma, contributes to scar elevation. 4 Therefore, subcision is effective for deep rolling scars.Dermal fillers provide direct and accurate augmentation to superficial AAS. Fillers raise the scar deficit to the level of the surrounding skin, making the scars less visible. [5][6][7] Adipose tissue has been successfully used as an ideal filling material for tissue augmentation because of its filling effect and regeneration potential. 8

Large container ships can only be berthed in hub ports with deep water, which requires a feeder ship service to transit and transport containers from the hub ports. This paper presents a feeder routing optimisation method for container ships through an intelligent Electronic Chart Display and Information System (ECDIS). ECDIS has been adopted to design routes and calculate the estimated time of arrival in two ports, and a mixed integer programming model is established for container vessel regional transportation where the shortest ship sailing time is designated as the objective function. In this paper, through using heuristic tour-route coding, the solution of the model based on genetic algorithms is presented to select ship capacities and routes simultaneously. Taking the Pearl River in China as an example, for different types of vessel capacity, vessel costs and fuel costs, 100 TEU and 150 TEU ship capacities with six optimal routes are selected to minimise sailing time and operating costs. K E Y WO R D S 1. Route optimisation.2. TAT calculation. 3. ECDIS. 4. Genetic algorithm.

Background Fat transplantation is a common method employed to treat soft-tissue defects. The dedifferentiation of mature adipocytes has been well documented, but whether it occurs after fat transplantation remains unclear. Objectives The major purpose of this project was to investigate the dedifferentiation of mature adipocytes after fat transplantation. Methods Human lipoaspirate tissue was obtained from 6 female patients who underwent esthetic liposuction. Mature adipocytes were extracted and labeled with PKH26, mixed with lipoaspirate, and injected into nude mice. In addition, PKH26+ adipocytes were subjected to a ceiling culture. Grafted fat was harvested from nude mice, and stromal vascular fragment cells were isolated. The immunophenotype of PKH26+ cells was detected by flow cytometry analysis at 2 days and 1 week. The PKH26+ cells were sorted and counted at 2 and 4 weeks to verify their proliferation and multilineage differentiation abilities. Results Two days after transplantation, almost no PKH26+ cells were found in the stromal vascular fragment cells. The PKH26+ cells found 1 week after transplantation showed a positive expression of cluster of differentiation (CD) 90 (CD90) and CD105 and a negative expression of CD45. This indicates that the labeled adipocytes were dedifferentiated. Its pluripotency was further demonstrated by fluorescent cell sorting and differentiation culture in vitro. In addition, the number of live PKH26+ cells at week 4 [(6.83 ± 1.67) × 104] was similar with that at week 2 [(7.11 ± 1.82) × 104]. Conclusions Human mature adipocytes can dedifferentiate into stem cell-like cells in vivo after fat transplantation.