Cryolipolysis for submental fat reduction in Asians

Background: Cryolipolysis is a noninvasive method for the selective reduction of fat, especially proven to be safe and effective in body contouring. There is a demand for reduction in submental fat, which is related not only with a favorable appearance but also with signs of aging. Objective: This study evaluated the efficacy and safety of cryolipolysis for subcutaneous fat reduction in the submental area in Asians. Materials and methods: Ten healthy Koreans were treated using a cryolipolysis contact device (CoolMini applicator, Zeltiq Aesthetics). The device was applied on the participant’s neck twice via two lateral approaches. Patient’s body weight was measured, and photographs were taken at baseline and during the follow-up visit after 8 weeks. Participants were examined with ultrasound and the depth of the subcutaneous fat layer was measured. Results: The subjective reduction of submental fat was noted in most of the participants. Reduction of the subcutaneous fat layer depth was confirmed by ultrasound after 8 weeks of treatment. Conclusion: The results of this study indicate that submental fat can be safely and effectively reduced with use of a cryolipolysis applicator. The present study shows that cryolipolysis can be an option for nonsurgical facial contouring.     

Successful treatment of submental fat using a non-focused pulsed ultrasound

Background

The prevalence of non-invasive aesthetic treatments is increasing, with patients demanding easier, safer, and more effective non-invasive cosmetic procedures. Submental fat is usually addressed using liposuction, which is associated with significant adverse events and a long recovery. Although newer, non-invasive submental fat treatments are gaining popularity, they are often complex, require frequent injections, or have adverse side effects.

Aims

Assess the safety and efficacy of vacuum-assisted acoustic wave technology for treating submental.

Patients/Methods

Fourteen female patients underwent a total of three weekly 15-min treatments using ultrasound with a 40 mm bell-shaped sonotrode. Improvement in submental fat was assessed 3 months after the final treatment using questionnaires for the patients and physicians. Two blinded dermatologists rated each patient using the Clinician-Reported Submental Fat Rating Scale (CR-SMFRS) 5-point scale.

Results

Both physicians rated a significant improvement in all 14 patients. Furthermore, self-evaluation of the 14 patients on a 1 to 5 satisfaction scale averaged 2.14, indicating that most patients were somewhat satisfied.

Conclusion

This study demonstrates that a three-treatment course with an acoustic wave ultrasound applicator with 1-week intervals leads to a significant reduction in submental fat and can be used as a novel, efficient treatment paradigm.     

Surgical management for large chest keloids with internal mammary artery perforator flap

Therapy for large symptomatic keloids is often plagued with complicated reconstruction manner and recurrence. This article reports a rare treatment combination for a chest keloid with internal mammary artery perforator flap reconstruction and radiation therapy. We excised the keloid and covered the defect with an internal mammary artery perforator flap. Immediate electron-beam irradiation therapy was applied on the second postoperative day. There was no sign of recurrence over the follow-up period of 18 months. The combination of internal mammary artery perforator flap and immediate radiation therapy is useful when faced with chest keloids of similar magnitude and intractability.     

Comparative effectiveness study between negative pressure wound therapy and conventional wound dressing on perforator flap at the Chinese tertiary referral teaching hospital

Background

Perforator flap techniques with conventional wound dressing have being extensively used in the management of soft-tissue defects. However; the flap's survival rate is not always guaranteed and the wound healing time always long. The aim of this study was to investigate the clinical effectiveness use of a freshly transplanted perforator flap in conjunction with Vacuum-assisted closure (VAC) for better clinical outcomes.

Recurrent skin ulcer cross-repair and sensory reconstruction in a WRN gene mutational patient

A 37-year-old man complained of a refractory posterior malleolar ulceration on his left ankle. He was diagnosed with Werner syndrome according to the progeroid clinical features and genetic testing. To approach the ulceration, a free flow-through right anterolateral thigh perforator flap with anterolateral thigh cutaneous nerve was harvested. One year later, he was readmitted due to a new ulceration on his right ankle. We harvested the left anterolateral thigh perforator flap with anterolateral thigh cutaneous nerve to reconstruct the defect. After one more year of follow-up, there was no recurrence of ulcers, and the sensation of the flap recovered partially after 6 months. We conclude that free flow-through anterolateral thigh perforator flap is a feasible choice for the repair of foot ulcers in Werner syndrome.     

Angular artery perforator‐based transposition flap for the reconstruction of midface defect

Background Midface defect is often seen due to trauma, neoplasm, and infection. It is important to avoid tension and distortion of the local structures and to provide skin color and texture match. We present the technique of angular artery perforator‐based transposition flap for small to moderate size defect of the midface. Materials and methods Between 2002 and 2009, 17 patients underwent operations for the reconstruction of midface defect. After tumor excision, perforators were found at the medial aspect of the defect along the nasolabial fold. Considering the change of the defect shape and primary closure of the donor site, the width and length of the flap was determined. The flap elevated disto‐proximally and transposed to the defect without tension. The donor site was closed first with partial undermining. Results Besides one patient with partial wound dehiscence of the donor site, all the flaps healed uneventfully. The patients were satisfied with the final result esthetically and functionally. Conclusion The angular artery perforator‐based transposition flap takes advantage of the nasolabial flap and perforator flap, and it is a simple and fast procedure. Therefore, it may be an alternative for the reconstruction of midface defect.     

Ptosis of submental skin

BACKGROUND/PURPOSE: Sagging of the face skin is a visible and unattractive characteristic of skin ageing. This phenomenon, due to both gravitational force and age-related alterations in the mechanical properties of skin, has never been quantitatively studied. The aim of this paper was, first, to define a method and a precise procedure allowing the objective measurement of this phenomenon and, second,to study how it is related to age. METHODS: We used an electronically controlled bed that allows the comparison of submental skin profiles in both the reclined and the upright positions. A parameter that characterises the sagging amplitude for an individual was defined and the reproducibility of measurement of this parameter was verified. RESULTS: Results, obtained from 66 female volunteers, demonstrated a statistically significant positive correlation between this new parameter and age, and also between this new parameter and the elastic recovery parameter of skin, as measured by torquemeter. CONCLUSION: Age-related changes of the skin's mechanical properties and of the various underlying skin tissues would explain this phenomenon. This new method and procedure should allow objective evaluation of the efficacy of any treatments (cosmetic, medical or surgical) proposed for rendering the appearance of people younger.     

Evaluation of safety and efficacy of 980-nm diode laser-assisted lipolysis versus traditional liposuction for submental rejuvenation: A randomized clinical trial

Background: Submental fat accumulation and skin laxity is a frequent concern of cosmetic patients. Objective: The aim of this randomized prospective controlled clinical trial was to compare the efficacy and safety of laser-assisted lipolysis and liposuction in the submental rejuvenation. Material and methods: Thirty-six female adults were enrolled in this clinical trial and were categorized into two groups: group 1 underwent 980-nm diode laser with the power of 6–8 W and group 2 underwent traditional liposuction. Patients were evaluated with ultrasonography 2 weeks and 2 months after the procedures. Results: Ultrasonographic evaluation reported the significant reduction of fat thickness in each group compared with the baseline (p value < 0.001). At the 2 weeks and 2 months follow-up visit, fat thickness reduction was significantly higher in the lipolysis group (p value < 0.05). Overall patients’ satisfaction in lipolysis group was higher than liposuction with 11 (61%) of lipolysis patients being very satisfied in contrast to 10 (55.5%) of liposuction patients reporting “dissatisfied or neutral” results. Conclusion: Laser-assisted lipolysis using 980-nm diode is approved to be safe and effective for skin tightening and rejuvenation of the submental area and seems to be a better option than traditional techniques for treatment of this cosmetic problem.     

The effect of postoperative closed incision negative pressure therapy on the incidence of donor site wound dehiscence in breast reconstruction patients: DEhiscence PREvention Study (DEPRES), pilot randomized controlled trial

AimWound dehiscence is a serious postoperative complication associated both with high morbidity and mortality. It has a significant rate of occurrence in breast reconstruction surgeries with a deep internal epigastric perforator (DIEP) and with a profunda artery perforator (PAP) flap. Risk factors for wound dehiscence include smoking, diabetes mellitus, chronic obstructive pulmonary disease, and obesity. The aim of this pilot study was to assess whether postoperative treatment with closed incision negative pressure therapy (ciNPT) decreases the incidence of donor site wound dehiscence in breast reconstruction patients.MethodWomen undergoing a breast reconstruction with a DIEP or PAP flap were enrolled in a pilot randomized controlled trial and assigned treatment with either ciNPT or adhesive strips. The primary outcome was wound dehiscence upon follow-up after four weeks. Secondary outcomes that were evaluated included wound infection, pain, and allergy. There was no loss to follow-up.ResultsThis pilot study included 51 women (n = 25 ciNPT, n = 26 adhesive strips). The two groups did not differ significantly in patients demographics or comorbidities. Wound dehiscence occurred in 11 patients (n = 2 ciNPT, n = 9 adhesive strips). This difference was statistically significant: p = 0.038. There were no statistically significant differences in secondary outcomes between the two groups.ConclusionIn this pilot study, postoperative treatment with ciNPT decreased the incidence of donor site wound dehiscence in breast reconstruction patients. Further research is ongoing by the same hospital.This trial was registered in the Netherlands Trial Register (NTR) under ID no. NTR5808.     

具有味觉和运动功能的一期全舌再造探索(随访18年病例报告)

目的探索一项具有味觉和舌自主运动功能的全舌再造技术。方法将完整保存神经血管并含有舌外肌的口底组织,沿下颌骨后缘整块切开、自下颌舌骨肌浅面分离后,向上、向前抬起作为再造舌,用岛状颈阔肌肌皮瓣经颏下转入口腔,分别覆盖再造舌的腹侧创面和口底的口腔侧创面。颈部供瓣区中厚植皮。结果对1例曾被切去全舌的患者,应用该法再造全舌,术后获得完全的味觉感觉及良好的吞咽、语言等自主运动功能。结论在保存有完整神经血管及口底组织的情况下,该法是有效可行的舌再造方法之一。     

Freestyle perforator flaps: an innovative approach to soft tissue reconstruction

Resurfacing of soft tissue defects consequent to skin cancer, melanoma, or sarcoma excision in different anatomical districts represents a difficult challenge for the plastic surgeon. Classic reconstructive procedures are frequently charged by unsatisfactory results. The introduction of perforator flaps in the clinical practice represented a revolution in the field of reconstructive plastic surgery. The technique further evolved with the introduction of the freestyle concept, allowing one to harvest a skin flap from any region of the body where an appropriate and detectable Doppler signal is present and to resurface soft tissue defects mobilizing the surrounding tissues, which present similar features compared with the recipient site in terms of color and texture, on a consistent vascular source and in a tension‐free manner. The authors present their personal approach to the reconstruction of soft tissue defects after excision for a basal cell carcinoma involving the medial tibial region.     

阴股沟皮瓣在修复女性尿生殖三角区恶性肿瘤切除术后皮肤软组织缺损中的临床应用

【摘要】 目的 探讨阴股沟皮瓣在修复女性尿生殖三角区恶性肿瘤切除术后皮肤软组织缺损中的临床应用。方法 对2015年1月至2017年12月沈阳市第七人民医院皮肤外科收治的10例女性尿生殖三角区恶性肿瘤患者（乳房外湿疹样癌7例，鳞状细胞癌3例）行肿瘤Mohs显微描记扩大切除，术中采用以阴部内动脉穿支血管为蒂的穿支皮瓣（其中单侧8例，双侧2例）修复外阴缺损创面。结果 10例患者，12个皮瓣全部成活，其中2例切口有轻度感染，经换药完全愈合，其余切口均一期愈合。术后随访6个月至1年，患者外阴部形态丰满，富有弹性，阴道口无狭窄，瘢痕无明显挛缩，肿瘤无复发。结论 以阴部内动脉穿支血管为蒂的阴股沟皮瓣修复女性尿生殖三角区皮肤软组织缺损效果较好。     

Submental fat reduction by mesotherapy using phosphatidylcholine alone vs. phosphatidylcholine and organic silicium: a pilot study

Background Excess skin and fatty tissues beneath the jaw lead to a double chin deformity. Localized fat deposits in this area are a cause of discomfort and anguish, leading patients to undergo surgical procedures such as liposuction and dermolipectomy to improve the cosmetic effect. Both procedures require anesthesia and an operating room setting and are quite expensive. Fearful of extensive surgery and its complications, patients and physicians seek less invasive methods. Mesotherapy with phosphatidylcholine and other cocktails have been used to treat localized fat deposits. However, there are few published articles regarding its effectiveness and some are even anecdotal. Objective This study aims to determine the efficacy of phosphatidylcholine alone vs. phosphatidylcholine and organic silicium in submental fat reduction. Methods Twelve patients with submental fat deposit with no coexisting morbidity and with informed consent were included in the study. They were submitted to one to five treatment sessions with an average interval of 2 weeks between each session. The medication administered was injected, either pure phosphatidylcholine or a combination of phosphatidylcholine and organic silicium. Baseline measurements of submental fat using vernier caliper and digital photographs of the patients were taken during each treatment session. The occurrence of adverse effects was likewise noted. Results Among the 12 patients, 11 completed the treatment course, and 1 was excluded from the study because of failure to follow up. Both phosphatidylcholine and a combination of phosphatidylcholine and organic silicium were equally effective in reducing submental fat deposits. There was no significant difference as to the rate and degree of reduction. Significant reduction in the thickness of submental fat was achieved after three treatment sessions. Adverse reactions in both groups were mild and transitory ranging from heavy sensation, localized heat, nodulations, and slight bruising that abated 3 to 5 days after treatment. Limitations As of this writing, information on the use of both phosphatidylcholine and organic silicium for mesotherapy of localized fat such as the submental area is scarce. The exact mechanisms of action of both treatments are likewise unknown. Ultrasound and histopathological changes were not documented. The study did not involve a double‐blind, placebo‐controlled design, and the sample size was small. Conclusion Mesotherapy using phosphatidylcholine vs. phosphatidylcholine plus organic silicium was similarly effective in reducing submental fat. There was no significant difference between them in terms of rate and degree of reduction. Optimal reduction of submental fat was achieved after three treatment sessions. Adverse reactions were few, mild, and transitory. Therefore, both regimens are safe, efficacious, cost‐effective, and can be used as alternatives to invasive surgical procedures.     

Management of noninflammatory nodule in chin after a large volume bolus injection of hyaluronic acid filler

As most Asian women desire to have an “inverted triangle” appearance for face, there is an increasing trend to give a large volume bolus (LVB) injection in the submental region of the chin for its lengthening. Hyaluronic acid (HA) dermal fillers are very popular for facial contouring and reshaping, including the chin area. Filler injection in the submental area has been a popular method to lengthen the chin. Placing an LVB of HA filler material at one place can present as the formation of lump or nodule after injection. We present a case of formation of a nodule in the submental area after injection of a single LVB of filler. The nodule was injected with hyaluronidase 3 months after its formation, and a near‐complete resolution was seen immediately. Complete disappearance of the nodule was found at follow‐up after 10 days. LVB of HA filler can give rise to the formation of noninflammatory nodules after filler injection in the immediate post‐injection period. Knowledge of the type of filler material and presenting features can help in instituting the correct line of treatment for the resolution of signs and symptoms. Also 0.5 mL of filler can be recommended as maximum size of single LVB, based on the mathematical calculations.     

Successful Treatment of Lichen Spinulosus with Topical Tacalcitol Cream

Abstract: Lichen spinulosus (LS) is a rare idiopathic cutaneous eruption characterized by follicular keratotic spiny papules that are grouped in large patches. Here, we report two cases of LS in the submental area, an uncommon site, which were treated effectively and safely with topical tacalcitol cream.     

Inadvertent intra‐arterial injection of deoxycholic acid: A case report and proposed protocol for treatment

Deoxycholic acid (ATX‐101) is a secondary bile acid that was approved as an injectable drug for the reduction of submental fat. Necrosis, an uncommon but serious adverse event, can occur due to inadvertent superficial injection or intra‐arterial injection of the acid. The management of the intra‐arterial injection of deoxycholic acid has not been well characterized. Here, we discuss methods to decrease the risk of such injections and draw on existing protocols for the inadvertent intra‐arterial injection of sclerotherapy solutions and dermal fillers to propose a safe, practical approach to treatment. A case report is presented of a 42‐year‐old woman who received a deoxycholic acid injection for the correction of submental fullness, which was complicated by the inadvertent intra‐arterial injection of the acid. The adaptation of published treatment protocols for the inadvertent injection of sclerosing solutions and dermal fillers allowed for a good outcome in this patient. The inadvertent intra‐arterial injection of deoxycholic acid is a rare event. The risk of such injections can be reduced with attention to injection technique and can be managed successfully following the adaptation of protocols in the literature for similar events from vascular compromise due to dermal fillers and sclerosing solutions.     

Oral administration of milk‐derived phospholipids inhibits penetration of cutaneous nerve fibres into epidermis in a mouse model of acute dry skin

The density of intraepidermal nerve fibres has been shown to be higher in itchy dry skin than in healthy skin, suggesting that epidermal hyperinnervation is at least partly involved in peripheral itch sensitization. We investigated whether oral administration of milk‐derived phospholipids (MPLs) would inhibit epidermal hyperinnervation in a mouse model of dry skin. We found that the number of intraepidermal nerve fibres was significantly lower in the MPL group than in the control group. Expression of nerve growth factor (NGF) levels in the epidermis was significantly decreased by oral administration of MPLs, whereas expression of semaphorin (Sema)3A, a nerve repulsion factor, was increased in the MPL group. These results suggest that dietary MPLs attenuate the penetration of nerve fibres into the epidermis by reducing epidermal NGF levels and increasing Sema3A level. Thus, dietary MPLs may have beneficial effects in the prevention and/or alleviation of dry skin‐induced itch by reducing intraepidermal nerve fibre density.     

Birhombic flap,a modified bilobed flap,for repair of nasal defect

Background Reconstruction of longitudinal defects of the lateral nasal alar might be challenging. Reconstruction with a bilobed flap is common for round defects normally the bilobed flap is less suited for longitudinal defects. Objective We describe a birhombic flap for longitudinal defect. Methods Demonstration of the technique and practical application for this kind of reconstruction. Results The bilobed flap is a very useful flap for lateral nasal tip or distal alar reconstruction. We show that a small modification of the flap allows to cover also longitudinal defects on the lateral tip of the nose. As the first lobe movement corresponds more to the rhomboid transposition flap, we prefer to call it birhombic flap. Conclusion The birhombic flap has its place in reconstructive surgery. This flap has a specific indication and precise advantages to other repairs in particular to the bilobed flap.     

阴囊双蒂皮瓣联合拱顶石皮瓣修复6例男性阴部乳房外Paget病术后大面积缺损

【摘要】 目的 探讨阴囊双蒂皮瓣联合拱顶石皮瓣修复男性阴部乳房外Paget病术后大面积缺损的临床效果。方法 回顾分析2018年2月至2019年3月于江西省皮肤病专科医院收治的6例男性阴部乳房外Paget病患者的临床资料。患者年龄70 ~ 84（中位77.5）岁,病灶累及阴阜、阴茎及阴囊,术后缺损面积18 ~ 133（中位96） cm2。所有患者阴阜部缺损选择腹部拱顶石皮瓣修复,阴囊及阴茎部缺损利用残存阴囊组织设计阴囊双蒂皮瓣修复。术后1、3个月及之后每3个月随访。结果 6例患者随访3 ~ 36个月,平均10个月,皮瓣均成活,皮瓣色泽和质地较好,供皮区和受皮区在功能和外形上均达到良好效果。结论 阴囊双蒂皮瓣及拱顶石皮瓣联合使用可修复男性阴部乳房外Paget病切除术后大面积缺损,操作简单,血供良好。