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Background: Tear trough filling is a popular facial rejuvenation procedure, and hyaluronic acid is typically used as the filler of choice. However, Tyndall's phenomenon, a common complication following hyaluronic acid injection, can occur, leading to skin discoloration of the lower eyelid. Aims: This single‐center, prospective, comparative clinical study aimed to evaluate the efficacy of collagen and hyaluronic acid injections in treating tear trough deformity. Methods: Sixty patients were enrolled between June 2022 and January 2023. Patients were randomly allocated into three groups: Group A received hyaluronic acid, Group B received hyaluronic acid combined with collagen, and Group C received collagen alone. Baseline characteristics, including age, sex, and tear trough deformity grade were considered before therapy. Changes in tear trough deformity scores, Global Aesthetic Improvement Scores, and the presence of the Tyndall effect were analyzed at 1 and 3 months postinjection to determine differences among the three groups. Results: Baseline profiles of the three groups were similar. In the first month postinjection, there was no difference in the Global Aesthetic Improvement Scores and tear trough deformity between the three groups. However, in the third‐month postinjection, there was a significant difference in scores between patients in Group C and those in Groups A or B. The Tyndall effect manifested in three patients in Group A, which was significantly different from that in Groups B and C. Conclusion: The combined use of hyaluronic acid with collagen in injectable fillers corrected tear trough deformities and reduced the occurrence of the Tyndall phenomenon, which can be problematic with hyaluronic acid alone. Additionally, this combination may help overcome the disadvantage of a shorter retention period when using collagen alone. [ABSTRACT FROM AUTHOR]

Hypertrophic scar (HS) is a chronic inflammatory skin disorder characterized by excessive deposition of extracellular matrix, and the mechanisms underlying their formation remain poorly understood. We analysed scRNA‐seq data from samples of normal skin and HS. Using the hdWGCNA method, key gene modules of fibroblasts in HS were identified. Non‐negative matrix factorization was employed to perform subtype analysis of HS patients using these gene modules. Multiple machine learning algorithms were applied to screen and validate accurate gene signatures for identifying and predicting HS, and a convolutional neural network (CNN) based on deep learning was established and validated. Quantitative reverse transcription‐polymerase chain reaction and western blotting were performed to measure mRNA and protein expression. Immunofluorescence was used for gene localization analysis, and biological features were assessed through CCK8 and wound healing assay. Single‐cell sequencing revealed distinct subpopulations of fibroblasts in HS. HdWGCNA identified key gene characteristics of this population, and pseudotime analysis was conducted to investigate gene variation during fibroblast differentiation. By employing various machine learning algorithms, the gene range was narrowed down to three key genes. A CNN was trained using the expression of these key genes and immune cell infiltration, enabling diagnosis and prediction of HS. Functional experiments demonstrated that THBS2 is associated with fibroblast proliferation and migration in HS and affects the formation and development of HS through the TGFβ1/P‐Smad2/3 pathway. Our study identifies unique fibroblast subpopulations closely associated with HS and provides biomarkers for the diagnosis and treatment of HS. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic scar (HS) is caused by the abnormal proliferation of fibroblasts and excessive deposition of extracellular matrix (ECM). Emerging evidence demonstrates that c‐Maf positive M2 macrophages were mainly located in the hypertrophic scar tissues of proliferative phase. But whether c‐Maf positive M2 macrophages can promote hypertrophic scar formation through modulating hypertrophic scar fibroblasts remains elusive. Aims: The aim of this study is to investigate the effects of c‐Maf positive M2 macrophages on the biological behaviors and functions of hypertrophic scar fibroblasts and the potential mechanism. Methods: HE and Masson trichrome staining were used to examine the histological features of human hypertrophic scar. Immunofluorescence staining was employed to label and quantify the c‐Maf+/CD68+ M2 macrophages. CCK8, wound healing, and transwell assays were utilized to test the effects of c‐Maf overexpressed M2 macrophages or the cell culture supernatants on the proliferation and migration of hypertrophic scar derived fibroblasts (HFBs) and normal skin derived fibroblasts (NFBs). Western blot and qPCR were harnessed to test the expressions of COL1, COL3, and α‐SMA in the co‐cultivated fibroblasts and TGF‐β1 in the c‐Maf overexpressed M2 macrophages. Results: Increased number of c‐Maf+/CD68+ M2 macrophages were found in HS in contrast to the normal skin (NS). Elevated proliferation and migration were observed in the HFBs or NFBs co‐cultured with c‐Maf overexpressed macrophages or the cell culture supernatants. A higher mRNA and protein expressions of COL1, COL3, and α‐SMA were recorded in the HFBs co‐cultured with c‐Maf overexpressed macrophages or treated with its culture supernatants. In addition, augmented mRNA and protein expressions of TGF‐β1 were also investigated in the c‐Maf overexpressed macrophages. Conclusion: c‐Maf positive macrophages promote hypertrophic scar formation through regulating HFBs proliferation, migration, and ECM deposition via the secreted TGF‐β1. [ABSTRACT FROM AUTHOR]

Background Fat grafting is an effective procedure for breast augmentation, but the variations in this technique result in unpredictable fat retention. Therefore, animal models are needed to simulate the operation and the optimal layer for fat retention. Objectives An autologous fat grafting murine model for breast augmentation was built to detect a new layer for fat grafting in the chest. Methods The left side of the female rat inguinal fat flap was harvested, dissected into small pieces, and autotransplanted into 3 different layers of the breast. Retention rate and hematoxylin and eosin (H&E) staining were measured at 1, 4, 8 12, and 16 weeks. Immunofluorescence staining was utilized to detect adipocytes and endothelial cells, and immunohistochemistry was conducted to evaluate the expression of integrins β1 and α6. Results The volume of fat grafts slightly grew in the intramuscular and submuscular layers at Week 4. Retention rates in the subcutaneous layer and submuscular layer were significantly higher than the intramuscular layer at Week 16. H&E staining showed that oil cysts existed in the subcutaneous layer throughout the 16 weeks. At the terminal time point, well-vascularized mature adipose structures were observed in intramuscular and submuscular layers, with smaller adipocytes in intramuscular layers. Immunohistochemistry analysis showed that integrin β1 was identically expressed in every adipocyte in all the layers, whereas integrin α6 selectively expressed in bigger adipocytes in the intramuscular layer. The expression intensities of integrin β1 and α6 were significantly higher in the intramuscular layer than in the subcutaneous and submuscular layers. Conclusions The angiogenic and moderate mechanical environment makes the submuscular layer the optimal layer for fat retention. [ABSTRACT FROM AUTHOR]

Background Dorsal augmentation with costal cartilage is generally used for aesthetic rhinoplasty. However, the tendency of costal cartilage to warp may jeopardize the aesthetic outcome. Objectives The aim of this study was to describe a new "Z" technique to overcome the warping of costal cartilage after implantation and to evaluate the efficacy of this technique in vitro. Methods A total of 31 pairs of porcine costal cartilage grafts (40 mm × 10 mm × 5 mm) were obtained and kept in Dulbecco's Modified Eagle Medium (Sigma-Aldrich, St. Louis, MO) to maintain cell viability. Paired grafts were obtained and randomly allocated for preparation by the accordion technique and the "Z" technique. Standardized photographs (obtained immediately after operation and at 4 weeks) were used for warping analysis. Biomechanical testing was performed to measure the graft's capacity to resist deformation by an external force. Results Cell viability of the grafts at 4 weeks was comparably good in the accordion group and the Z group (61.88% ± 4.47% vs 67.48% ± 7.03%, P = 0.55). Warping angle was comparable between the 2 groups (P > 0.01). The capacity to resist external force was significantly better in the Z group; the force needed to cause deformation was 3.98 ± 1.04 N in the Z group vs 1.61 ± 0.47 N in the accordion group in lateral view (P < 0.0001), and 1.33 ± 0.41 N vs 0.96 ± 0.24 N, respectively, in frontal view (P = 0.0013). Conclusions The "Z" technique appears to be a simple and effective method to minimize the tendency of costal cartilage to warp after implantation. [ABSTRACT FROM AUTHOR]

Key Clinical Message: A neurovascular pedicled pudendal thigh flap was used to reconstruct labial defect after extensive vulvectomy for primary extramammary Paget's disease. The flap was reliable for the superior skin and ideal for large labial defect reconstruction. Extramammary Paget's disease (EMPD), a rare type of intraepidermal carcinoma, predominantly affects the genitalia. Generally, the treatment for primary EMPD is wide surgical excision; however, large tissue defects after resection necessitate customized reconstruction. Previously, several reconstruction techniques have been outlined, such as local skin flaps (V‐Y flaps), skin grafts, pedicled flaps, and free flaps. However, the complexity of EMPD management is due to the multiple flaps and techniques. In this case report, we applied a neurovascular pedicled pudendal thigh flap to reconstruct a labial defect in a 68‐year‐old woman using the technique of elevation and particularly the insetting of the flap. This pedicled flap was robust and reliable, producing a labium that was natural in appearance with good‐quality skin cover and a protective sensation. The patient was satisfied with both the cosmetic appearance and normal sensation of the reconstructed labia. Additionally, the linear scar at the donor site was located along the inguinal fold, and the flap was accepted by the patient as an ideal tissue for reconstruction of the large labial defect. [ABSTRACT FROM AUTHOR]

Background: The septal extension graft (SEG) has become the preferred augmentation rhinoplasty technique in Asia for its superiority in correcting tip projection and rotation.Objectives: The author sought to build a rabbit model for SEG surgery and compared the postoperative stability of the tip support between the bilateral batten costal and conchal cartilage extension grafts at the nasal tip.Methods: Twenty rabbits underwent SEG surgery with either bilateral batten costal cartilage graft (Group A) or bilateral batten conchal cartilage graft (Group B). Serial photographs were obtained to evaluate the change of the nasal tip shape and graft shape. The observed indices include tip projection, tip angle, shape of extension graft, and histological features of the extension graft.Results: Twelve weeks after the operation, one costal extension graft in group A (1/10) and three conchal extension grafts in group B (3/10) were reabsorbed. The costal cartilage graft showed better exterior results than conchal cartilage graft in terms of tip projection and angle relapse rate (13.01% vs. 25.02% and 15.18% vs. 28.73%, p < 0.05). The costal cartilage graft maintains its structure more than the conchal cartilage graft. A greater degree of calcification and more fibrous capsules around the extension graft were found in Group A.Conclusions: A rhinoplasty rabbit model was established to compare costal and conchal autologous cartilages for SEG. Additionally, this model may serve as a training tool for rhinoplasty surgeons. The costal cartilage extension graft is more reliable in terms of stability and may be paid more attention. [ABSTRACT FROM AUTHOR]

Objective: Hypertrophic scarring is a common skin fibro‐proliferative disease, but currently there has no satisfactory drugs for anti‐scar treatments. Previous study showed that epigallocatechin gallate (EGCG), the main catechin in green tea, improved wound healing and tissue fibrosis in both rats and mice. In the present study, the therapeutic effects of EGCG on hypertrophic scar were analyzed using a rabbit ear hypertrophic scar model. Materials: A rabbit ear model of hypertrophic scarring was used. DMSO, 0.5 mg EGCG/wound, 1.0 mg EGCG/wound or triamcinolone were injected subcutaneously once a week for 4 weeks. The scar elevation index (SEI) was measured using HE staining images, the collagen fibers were examined by Masson' trichrome staining images, and the number of capillaries in hypertrophic scar were calculated by CD31 staining images. The mRNA levels in the scar tissues were detected by quantitative real‐time polymerase chain reaction (qRT‐PCR). Results: Gross observation and histological evaluation showed the inhibitory effects of EGCG on hypertrophic scar formation at both doses, and decreased scar height and SEI were detected. EGCG also attenuated the mean collagen area fraction and decreased the number of capillaries in scar tissues. qRT‐PCR revealed that EGCG significantly inhibited the mRNA expression of TGF‐β1, Col I, Col III, α‐SMA, and eNOS. Conclusion: EGCG may serve as a useful candidate therapeutic drug for hypertrophic scar via inhibiting fibrotic gene expression and suppressing angiogenesis. [ABSTRACT FROM AUTHOR]

Skin grafting is an important method of wound repair and reconstruction. Skin grafting can be classified using multiple classification criteria. We often perform full‐thickness skin grafting (FTSG) for small wound areas; however, the traditional FTSG technique frequently causes postoperative scar depression at the donor site, especially in the abdomen. This study aimed to determine whether preserving the subcutaneous fat when performing FTSG can improve donor site prognosis. We reviewed 25 patients who underwent autologous FTSG in the last 3 years. Among them, subcutaneous fat was preserved in 11 patients (experimental group), whereas it was not preserved in 14 patients (control group). Using a 3D camera and the Patient and Observer Scar Assessment Scale (POSAS), we evaluated the donor site postoperatively. According to POSAS, vascularization was significantly more severe in the experimental group. The Antera 3D camera revealed more severe scar depression at the donor site in the control group. The processing time for graft take, subcutaneous fat trimming and donor site closure was less in the experimental group than in the control group. Preserving subcutaneous fat at the donor site improved patient outcomes by reducing donor site depression after FTSG. [ABSTRACT FROM AUTHOR]

Although the incidence of scalp avulsion has decreased in recent years, it remains a major concern among plastic surgeons. We therefore aimed to introduce an improved free flap technique for repairing scalp avulsion with less tissue from the donor site. This method can achieve maximum primary closure of the donor site and improve its appearance and function as well as reduce the donor-site morbidity by ensuring that a smaller free flap can completely cover the scalp defect. Eight patients with scalp avulsion who had undergone staggered placement of the free flaps were evaluated. Data on the age, cause of scalp avulsion, scalp defect size, degree of avulsion, postoperative complications, and follow-up duration were analyzed. The postoperative evaluation criteria were donor-site sensation, latissimus dorsi muscle strength, upper extremity function, and quality of life. Patients' mean age was 38.7 years. The main cause of scalp avulsion was occupation-related accidents. The mean scalp defect size and postoperative follow-up duration were 26 cm × 20.4 cm and 41.5 months, respectively. One patient developed flap congestion postoperatively. The wounds at the recipient site healed well in all patients. There was no significant difference in the sensation between the surgical and nonsurgical sides. However, the latissimus dorsi muscle strength significantly differed between both sides. The mental component score, which was used to assess quality of life, did not significantly differ between the patients and healthy population, whereas the physical component score significantly differed between the two groups. None of the included patients had severe upper extremity functional limitation. Staggered placement of free flaps achieved maximum primary closure of the donor site and greater scalp avulsion defect coverage with less tissue excised from the donor site. Importantly, donor-site appearance improved and some donor-site functions were preserved postoperatively. [ABSTRACT FROM AUTHOR]

With the continuous development of allograft surgery, penis transplantation has been applied worldwide. Thus far, four successful cases have been reported worldwide, with the prognosis being good. Herein, we described the four cases with detailed analyses in terms of patient selection, preoperative preparation, surgical method, postoperative treatment plan, complications, and ethics. We also described the current situation, developments in the field, and other related information. Furthermore, compared with other life-saving organ transplantation, penis transplantation may meet more troubles, such as the shortage of penis donation, lifelong immunosuppression therapy, even the issues that the recipients and their couples may not overcome the psychological barrier easily. All these issues deserve our attention. [ABSTRACT FROM AUTHOR]

Septal extension grafts (SEGs) are widely used to correct a short nose in Asians, but few studies to our knowledge have investigated the relationship between different graft materials and the stability of the aesthetic results in East Asians. In this review we discuss the performance of autologous cartilage grafts, with a focus on the critical factors for achieving a stable postoperative nose shape, and propose algorithms for graft material selection in treating Asian patients. Avoiding harvesting septal cartilage grafts and preserving the whole cartilage is helpful for maintaining tip support over the long term. For patients who have loose nasal skin, a cartilage framework with no significant defect, or a mildly short nose, autogenous conchal cartilage is an effective and stable material for primary rhinoplasty. Costal cartilage has good performance and is suitable for treating severe nasal deformities and revision surgery. [ABSTRACT FROM AUTHOR]

The insulin family consists of insulin, insulin-like growth factor 1 (IGF-1), insulin-like growth factor 2 (IGF-2), their receptors (IR, IGF-1R and IGF-2R), and their binding proteins. All three ligands are involved in cell proliferation, apoptosis, protein synthesis and metabolism due to their homologous sequences and structural similarities. Insulin-like growth factor 2, a member of the insulin family, plays an important role in embryonic development, metabolic disorders, and tumorigenesis by combining with three receptors with different degrees of affinity. The main pathological feature of various fibrotic diseases is the excessive deposition of extracellular matrix (ECM) after tissue and organ damage, which eventually results in organic dysfunction because scar formation replaces tissue parenchyma. As a mitogenic factor, IGF-2 is overexpressed in many fibrotic diseases. It can promote the proliferation of fibroblasts significantly, as well as the production of ECM in a time- and dose-dependent manner. This review aims to describe the expression changes and fibrosis-promoting effects of IGF-2 in the skin, oral cavity, heart, lung, liver, and kidney fibrotic tissues. [ABSTRACT FROM AUTHOR]