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Background The depressor anguli oris muscle (DAO) is a pivotal treatment target when creating a harmonic jawline. However, evidence of its live morphology remains scarce. Objectives In this study we aimed to reevaluate the DAO with a facile ultrasound analysis and thereby guide safer and more effective botulinum toxin type A (BTX-A) injection. Methods A prospective ultrasound assessment was conducted in 41 patients. Morphology of the DAO and its relative position to neighboring structures were appraised at the ubiquitous facial landmark, the labiomandibular fold (LMF). Three-dimensional images were captured before and after the patient received the BTX-A injection based on sonographic evidence. Results The skin-to-muscle depths of the DAO on average (measured from the medial to lateral border) were 5.26, 5.61, and 8.42 mm. The DAO becomes thinner and wider from zone 1 to zone 3 (P <.001). Overlapping lengths of the DAO and the depressor labii inferioris increased from zone 1 to zone 3: 4.74, 9.68, 14.54 mm (P <.001). The medial border of the DAO was located at 4.33, 6.12, 8.90 mm medial to the LMF (zone 1-3), and no muscle fibers of the DAO were observed in zone 1 or zone 2 in nearly one-third of patients. Improvement of the mouth corner downturn angle upon receiving BTX-A injection at zones 2 and 3 were 88.3%, 32.3%, and 14.7% for the neutral, maximum smile, and down-turning mouth corner expressions. Conclusions This work established an informative ultrasound portrait of the DAO and structures in the perioral region, which suggested the LMF as a convenient landmark for locating the DAO. Injection at the middle and lower thirds of the LMF at a 4- to 5-mm depth is recommended. [ABSTRACT FROM AUTHOR]

Background: Nipple‐areola complex is a naturally hyperpigmented skin area which can be involved in vitiligo. But limited study focused on the treatment of nipple‐areola complex vitiligo, and few methods were proven to be effective. In this study, we aimed to explore the feasibility and efficacy of ReCell® on vitiligo in the nipple‐areola complex area. Methods: Medical records of patients with vitiligo involving nipple‐areola complex and underwent ReCell® treatment from October 2016 to April 2020 were retrospectively reviewed. The repigmentation rate of the nipple‐areola complex and other breast area were calculated under the Wood's light at each follow‐up. The grade of repigmentation and patient‐reported satisfaction rate were also evaluated to prove the effect of ReCell® on vitiligo of breast and especially in the nipple‐areola complex area. Results: A total of 18 patients were included in this study. No surgical complications were reported. The mean postoperative repigmentation rate in the nipple‐areola complex area (3rd‐month, 78.7 ± 5.8%; 6th‐month, 87.6 ± 5.1%; and 12th‐month, 96.1 ± 3.5%) was significantly higher than that in the other breast treatment area (3rd‐month, 70.4 ± 6.9%; 6th‐month, 84.2 ± 5.7%, and 12th‐month, 93.2 ± 3.6%). All patients showed good or excellent grades at the last follow‐up, and 94.4% of them considered the overall treatment results satisfactory. Conclusions: ReCell® is a feasible and efficient treatment strategy in the nipple‐areola complex vitiligo. [ABSTRACT FROM AUTHOR]

Background: With the growth in the popularity of facial filler injections, increased numbers of severe adverse events, such as cerebral embolism, have been reported.Objectives: The aim of this article was to summarize the clinical manifestations and proposed mechanisms of filler-induced cerebral embolism (FICE).Methods: A literature review was performed with the search keywords "filler injection," "hyaluronic acid," "fat graft," "cerebral infarction," "cerebral embolism," "stroke," "cerebrovascular infarction," "disorders of consciousness," and "hemiplegia."Results: Among the 43 cases of FICE enrolled from 35 articles, 37 patients were female, and 6 were male. Twenty-nine of these patients had received fat grafting, and 12 hyaluronic acid injection. Most FICE patients had been injected in the glabella, followed by the temporal, forehead, and nasal areas. Among 30 patients injected under local anesthesia, 43.33% presented with neurologic 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. 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 exhibited improved neurologic manifestations but not visual loss. Five patients died.Conclusions: FICE is a severe complication following facial filler injection. Careful prevention, timely identification, and treatment are crucial to decreasing the morbidity and mortality of FICE.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Background: Botulinum neurotoxin A injection is a popular noninvasive alternative for the treatment of masseter hypertrophy. This study was conducted to identify a safe injection volume to avoid sunken lateral cheek after botulinum neurotoxin A injection in the masseter muscle. Methods: One milliliter or 0.5 ml of indocyanine green was randomly injected into either side of the masseter muscles of 18 fresh cadaver heads. The bilateral spreads of indocyanine green within the masseter were observed by a fluorescence imager. The masseters were then dissected, and the spreading distance was measured. Results: Dye spreading showed an oval shape parallel to the long axis of the masseter muscle. The lower edges of the masseters were all stained with indocyanine green. The upward spreading exceeded the mouth corner‐tragus line in 94.44% (17/18) of the masseters on the 1‐ml side, and 11.11% (2/18) of the masseters on the 0.5‐ml side. The spreading area and upward spreading distance on the 1‐ml side (9.95 ± 0.48 cm2, 3.18 ± 0.31 cm) were significantly larger than the 0.5‐ml side (7.13 ± 0.80 cm2, 2.08 ± 0.32 cm). Conclusions: The spread of indocyanine green within the masseter occurs in direct proportion to its volume. A bolus of 1 ml easily exceeded the mouth corner‐tragus line and cause sunken cheek. [ABSTRACT FROM AUTHOR]

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: A total of 203 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 graft or a pretarsal orbicularis oculi flap.Results: Among the 105 patients with severe static folds, 67 received retro-orbicularis oculus fat grafts and 38 received orbicularis oculi muscle flaps. This technique converted a static fold into a dynamic fold. The surgery satisfaction rate was 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 retro-orbicularis oculus fat 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.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Background: No reports of the potential areas of surgeons' aesthetics in blepharoplasty. Aims: To explore the association between the surgeons' own double eyelid morphology and their aesthetics and surgical outcome. Methods: An investigation of 1605 patients was carried collecting the data of double eyelid shape, based on which to propose a preliminary double eyelid classification for analyzing the aesthetics of surgeons. Ten double eyelid surgical cases were randomly collected from each surgeon according to the inclusion criteria, whose double eyelid shape, ideal shape, the selection tendency of surgical approach, most cared factor during surgery, and design concept of eyelid shape were collected. Structural equation modeling (SEM) was performed to assess the association between participants' double eyelid shape, aesthetics, and blepharoplasty outcome. Results: Fifty‐three double eyelid surgeons were enrolled for study, whose double eyelids shapes mostly were obviously fan‐shaped (37.74%) and low‐parallel eyelid (26.42%), and the ideal shapes were obviously fan‐shaped (41.51%) and high‐parallel eyelid (24.53%). 54.72% of the subjects preferred to use the full‐incisional method. 45.28% cared for long‐term outcome most. Regarding blepharoplasty outcome style, 49.06% of the subjects preferred obviously fan‐shaped type and 24.53% for high‐parallel type. SEM showed that aesthetics rank increased by 0.692 points for surgeons' shape (P <.001), and surgical outcome rank increased by 0.861 points for aesthetics (P <.001). However, their eyelid shape had no direct contribution to surgical outcome (P =.96). Conclusions: The findings indicated that surgeons' double eyelid shape positively affected their aesthetics, which affected their surgical outcomes further, but their double eyelid shape failed to affect the surgical outcomes directly. [ABSTRACT FROM AUTHOR]

Objective: We retrospectively evaluated the efficacy and safety of keystone‐designed perforator island flaps for chest keloid reconstruction. Methods: We reviewed consecutive patients who received keystone flap reconstruction after chest keloid resection between January 2017 and February 2018. The patient demographic data, defect size, flap size, complications, and recurrence were recorded. Results: Thirty‐eight patients were evaluated in this retrospective case series. After keloid resection, dimension of wound defects was 5.5‐9.5 cm × 9.5‐12.5 cm, with an average dimension of 7.3 cm × 10.7 cm. The dimension of keystone flaps was between 6‐10 cm × 20‐34.5 cm, with an average dimension of 7.5 cm × 25.5 cm. The flaps healed smoothly without any complication. There was no keloid recurrence with 15 months of follow‐up. 89.4% of the patients had good outcome with no apparent scarring, and 10.6% patients had satisfactory outcome with localized scarring. Conclusions: Keystone‐designed perforator island flap is an effective and reliable method for reconstruction following chest keloid resection. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Full lips are beauty standards. Botulinum toxin A (BTA) paralyzes the orbicularis oris muscle to achieve the eversion of the lip, and thus makes the lip look plump. Aims: This study presents three cases of BTA injection to the lip and evaluates the possible changes in the labial morphology and the lip surface area. Methods: Three patients received a total of 4U BTA injection at the vermilion border of the upper lip. Vectra® H1 3D imaging system was used to capture 3D photographs of the lips before injection and two weeks after injection. Eight linear distances and the upper lip surface area were measured. Anthropometric measurements before and after injection were compared. Results: Patients displayed a larger upper vermillion height (P =.038) and a smaller cutaneous upper lip height (P =.024). There was a trend for a larger upper lip surface area, but not statistically significant (P =.109). Symptoms of slight perioral muscular palsy and mouth incompetence lasted about one month in three patients. Conclusion: BTA helps to enlarge the upper lip and shorten the philtrum. The BTA injection can be an option for lip enhancement with caution. [ABSTRACT FROM AUTHOR]

Background: Due to the relatively higher tendency of postsurgery scars, insufficient cartilage support, and low surgical acceptability, nasal defect repair with forehead flap in Asian patients needs further study. Objective: We aim to determine the necessity of tissue expansion, timing of pedicle division, and the importance of cartilage scaffold reinforcement and scar prevention at the donor site during nasal reconstruction in Asian patients with paramedian forehead flap. Methods: A retrospective analysis was performed on patients who underwent nasal reconstruction with forehead flap at our hospital from January 2013 to January 2018. The demographical information, surgery details, and postoperative complications of all patients were recorded. The reconstructed nose, scars, and eyebrow deformities were evaluated by digital photographs, and the overall satisfaction of the patients was documented. Results: The study included 15 patients (7 males and 8 females). All nasal defects involved at least two aesthetic units and included seven full‐thickness defects. Only one patient underwent two revision operations. Complications like hematoma, infection, and necrosis were not detected, except in one patient with partial necrosis of the flap. All patients were satisfied with the reconstructed nose and did not report any respiratory dysfunction. No obvious scars or eyebrow deformities were observed. Conclusion: Three‐stage full‐thickness forehead flap should be used to repair nasal defects in Asian patients, with immediate cartilage scaffold reconstruction at stage one and reinforcement at stage two. Botox injection into the forehead can refine the scar. [ABSTRACT FROM AUTHOR]

Background: The repair and reconstruction of the upper lip defects should focus on the important anatomical landmarks of the upper lip. In this investigation, double V‐Y advancement flaps were used to simultaneously repair the cutaneous and mucosal defects of the upper lip. It was especially suitable for young patients with tight skin and high‐risk scar hyperplasia in the donor sites. Objective: The objective was to examine the surgical outcomes following the simultaneous repairation of upper lip mucocutaneous defects using double V‐Y advancement flaps. Methods: A retrospective review of all patients with defects near the vermilion border who underwent double V‐Y flaps repair from July 2014 to November 2018 was performed. Transverse V‐Y advancement flaps were used to repair the cutaneous defects and longitudinal V‐Y advancement flaps to repair the mucosal defects. Results: Fifteen patients (six males, nine females) were retrospectively reviewed. Defects spanning the vermilion border ranged from 0.8 × 0.5 to 2.5 × 1.5 cm2. Follow‐up was for 3 months or longer. There were no perioperative complications or visible postoperative scars, and major anatomic landmarks were preserved and reconstructed. All patients were satisfied with the aesthetic outcome. Conclusion: Double V‐Y advancement flaps are suitable for the repair of superficial mucocutaneous defects smaller than 50% of the lateral upper lip, especially for younger patients with tight skin. [ABSTRACT FROM AUTHOR]

Inherited ichthyoses are a group of genodermatoses classified as either nonsyndromic or syndromic. Nonsyndromic ichthyoses and keratitis, ichthyosis and deafness (KID) syndrome predispose to fungal infection. The diagnosis and treatment of fungal infections underlying ichthyoses are challenging. In this review, we summarize reported cases of ichthyosis with fungal infection over the past 50 years. Atypical manifestations such as alopecia, papules and brittle nails occurred in patients with ichthyosis combined with fungal infection. Various pathogenic mechanisms have been implicated, including mutations of ichthyosis-related genes leading to disruption of the skin barrier via multiple pathways. Host immune disorders, including atopy and abnormal innate immunity also contribute to susceptibility. Specific fungi may escape the immune response. Extensive and recurrent fungal infections are not uncommon in patients with ichthyosis, making a cure more difficult and increasing the need for systemic antifungal therapy. Traditional and new ichthyosis treatments aiming to improve skin barrier function could help prevent fungal infection. In conclusion, the close relationship between ichthyosis and fungal infection is of vital importance in clinical practice and requires more attention from physicians. More studies are required to investigate the mechanisms and explore useful treatment strategies., (© 2021 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)