In search of a universal and objective method to assess facial aging: The new face objective photo-numerical assessment scale

Most patients who undergo cosmetic rejuvenation treatment hope to appear younger and healthier. Although a number of scales have been put forward to assess facial aging, to date none has focused on predicting patients’ age. The purpose of our study was to validate a more complete version of the face - Objective assessment scale previously developed by the authors. Since patients with a photo-damaged skin can look older than others we created a new sub-scale: the facial photo-aging scale, in order to provide a more comprehensive method for the overall assessment of facial aging. The Rasch model was used as part of the validation process. We assigned a score to each patient based on the scales we have developed. The correlation between a patient's actual age and the obtained scores was analyzed; we also analyzed the inter-rater reliability and test-retest reliability. All the scales exceeded criteria for acceptability, reliability and validity. The facial aging scale we have developed may prove to be a valuable tool to assess patients before and after facial rejuvenation treatment or surgery, as well as for clinical research in the field of facial skin regeneration

Proposal of a Noninvasive Method to Reduce Injection-Related Bruising in Aesthetic Medicine: Transillumination

Background: Hyaluronic acid (HA) injections involve a risk of vascular complications. Transillumination (TL) is a noninvasive technique that appears to allow preliminary detection of superficial vascular structures of the face to avoid intravascular HA injection. The purpose of our study was to test the efficacy of TL in terms of its sensitivity to locate vessels in the areas undergoing treatment and to reduce post-injection vascular complications. Material and Methods: We conducted a prospective study enrolling 72 patients who consulted for HA injections to treat facial wrinkles. We used TL on one side of the face to obtain a vascular mapping of the face. The area undergoing testing was randomized for the TL technique. The primary study endpoint was sensitivity for identifying subcutaneous veins and the differences in complication rates between the side of the face where TL was used to guide the injection and the side of the face where no vascular exploration method was used. Results: TL sensitivity for locating the superficial temporal vein was 100%, 91% for the supratrochlear, supraorbital and infraorbital veins, and 95% for the dorsal nasal veins (p < 0.01). The complication rate was higher on the side of the face where no vascular exploration method was used (22.2% vs 2.7%; p = 0.010046). Conclusions: Our preliminary findings validate our hypothesis concerning the advantage of using TL to identify superficial veins before performing injections. This method is simple and affordable, and the learning curve is small. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

The Outcomes Assessment of the Plasma Blade Technology in Upper Blepharoplasties: A Prospective Study on a Series of 25 Patients

Background: The Dermo Ablation Surgery (DAS) Medical® (Technolux, Italy) device is a plasma blade which induces a plasma voltaic arc causing a retraction in the epidermis and superficial dermis. Objective: The aim of our study is to prove the efficacy and safety of the DAS Medical® device in dermatochalasis size reduction. Methods: Our prospective study included 25 adult patients presenting with upper eyelid dermatochalasis undergoing a two-session treatment protocol with the DAS Medical® device (with a month treatment-free interval). The primary end point was the reduction in the size of the dermatochalasis. The secondary end points were patient satisfaction, and a blinded assessment of the outcomes was carried out by 15 plastic surgery specialists on post-procedural pictures. Results: The mean reduction in the size of the dermatochalasis was estimated at 2.47 mm on a 6-month follow-up (13.5 mm at T0 vs. 11.03 mm at 6 months, p = 0.0002) and 1.97 mm on a 12-month follow-up ((13.5 mm at T0 vs. 11.53 mm at 12 months, p = 0.0055). Eighty per cent of the patients and 78% of the assessing clinicians were globally satisfied with the results on a 12-month follow-up. The mean visual analogue pain score reported during the treatment was 4.5/10; MEOPA® was used in 23% of cases. No irreversible post-procedural sequelae (complications) were observed. Conclusion: Voltaic plasma arc treatment with DAS Medical® is an effective technique for non-invasive blepharoplasty on moderate dermatochalasis patients not suffering from palpebral lipoptosis and is very well tolerated. It can be usefully and successfully associated with surgery. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

One-step facial feminization surgery: The importance of a custom-made preoperative planning and patient satisfaction assessment

Background: The availability of more accurate techniques used for transgender surgery has resulted in an increased number of patients requesting facial feminization surgery (FFS). The aim of this study was to present the FFS pre-operative planning of the authors’ male-to-female transsexual patients using photo-editing software, computer-aided design (CAD), modeling, and three-dimensional (3D) printing. Material and Methods: Twenty-five patients underwent FFS between November 2015 and May 2018. They were retrospectively included in this study, and their records were analyzed. Patients’ 3D facial models were printed and used for an accurate preoperative planning and shown to the patients. To assess patient satisfaction, the preoperative, six-month, and one-year postoperative scores obtained using Satisfaction With Life Scale (SWLS) and Subjective Happiness Scale (SHS) were compared. The scores following a normal distribution obtained for each patient were compared using a paired t-test. Results: The 3D model preparation mean time was 145±13.2 min. A total of 114 surgical procedures were carried out. The mean operative time was 420±23 min. Patients experienced no postoperative complication. All patients were very satisfied after surgery, with a significant difference between pre- and postoperative scores (p = 0.002; p = 0.03). Conclusion: With use of 3D modeling, surgeons are nearing a custom-made surgery era, especially required for complex procedures such as FFS. We suggest using 3D technology for a more accurate preoperative planning

Characterization of Contractile Forces Generated by Stretch Marks Fibroblasts: In Vitro Study

Abstract: Authors present a study about the contraction forces observed in striae distensae fibroblasts (SMF) in a collagen scaffold. Collagen lattices were used to study the mechanical behavior of SDF within the collagen matrix compared to the lattices produced using the healthy skin derived fibroblasts (NSF). A Forcebox device was used to measure the contractile forces. Striae Rubrae fibroblast’s contractile force was by 28% greater than that generated by the NSF and striae albae fibroblasts (P<0.05). Anomalies and especially differences in forces generated by SMF were observed through all our experiments. These findings complete and corroborate the results and information published in our previous studies. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Striae Distensae: In Vitro Study and Assessment of Combined Treatment With Sodium Ascorbate and Platelet-Rich Plasma on Fibroblasts

Introduction: Striae distensae (SD) appear clinically as parallel striae, lying perpendicular to the tension lines of the skin. SD evolve into two clinical phases, an initial inflammatory phase in which they are called “striae rubrae” (SR) and a chronic phase in which they are called striae albae (SA). Fibroblasts seem to play a key role in the pathogenesis of stretch marks. This study was aimed at describing and analyzing stretch marks-derived fibroblasts (SMF), the differences between SR- and SA-derived fibroblasts (SRF, SAF), testing two treatments in vitro (sodium ascorbate and PrP) on SAF. Material and Methods: To characterize the SMF, the expression of alpha smooth muscle actin (alpha SMA) was investigated. Type I collagen expression was measured in SAF, before and after adding different PrP concentrations and sodium ascorbate in the culture medium. Results were processed through statistical analysis models using the Student’s t-test. Results: A significant increase in alpha SMA (P <0.001) was observed in SRF. SAF treated with PrP and sodium ascorbate showed a resumption of their metabolic activity by an increase in collagen type I production and cell proliferation. After 24 h of incubation with PrP 1% and PrP 5% + sodium ascorbate, cell viability was increased by 140% and 151% and by 156 and 178% after 48 h, respectively, compared to the control. Conclusion: Our study shows that a biologically mediated improvement in SMF metabolic activity is possible. Our promising results require further trials to be able to confirm the reproducibility of this combined treatment, particularly in vivo. No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable

Assessment of Patient Satisfaction Using a New Augmented Reality Simulation Software for Breast Augmentation: A Prospective Study

Background: Breast augmentation is one of the most frequently performed plastic surgery procedures. Providing patients with realistic 3D simulations of breast augmentation outcomes is becoming increasingly common. Until recently, such programs were expensive and required significant equipment, training, and office space. New simple user-friendly programs have been developed, but to date there remains a paucity of objective evidence comparing these 3D simulations with post-operative outcomes. The aim of this study is to assess the aesthetic similarity between a preoperative 3D simulation generated using Arbrea breast simulation software and real post-operative outcomes, with a focus on patient satisfaction. Methods: The authors conducted a prospective study of patients requiring breast augmentation. Patients were asked to assess how realistic the simulation was compared to the one-year post-operative result using the authors’ grading scale for breast augmentation simulation assessment. Patient satisfaction with the simulations was assessed using a satisfaction visual analogue scale (VAS) ranging from 0 (not at all satisfied) to 10 (very satisfied). Patient satisfaction with the surgical outcome was assessed using the BREAST-Q Augmentation Module. Results: All patients were satisfied with the simulations and with the attained breast volume, with a mean VAS score of 8.2   1.2. The mean simulation time took 90 s on average. The differences between the pre-operative and one-year post-operative values of the three BREAST-Q assessments were found to be statistically significant (p &lt; 0.001). Conclusions: Three-dimensional simulation is becoming increasingly common in pre-operative planning for breast augmentation. The present study aimed to assess the degree of similarity of three-dimensional simulations generated using Arbrea Breast Software and found that the use of the software provided a very satisfying representation for patients undergoing breast augmentation. However, we recommend informing patients that only the volume simulation is extremely accurate. On the other hand, it is necessary to not guarantee an absolute correspondence regarding the breast shape between the simulation and the post-operative result

Immediate vaginal reconstruction following pelvic exenteration using the pedicled vertical Deep Inferior Epigastric Perforator (DIEP) flap: A technical note

La reconstruction vaginale immédiate est généralement réalisée à la suite d'une exentération pelvienne pour cancer du col de l'utérus, en cas de récidive (après radiothérapie) ou de fistules radiques sévères. Le prélèvement des lambeaux sur des vaisseaux perforants, tels que le lambeau perforant basé sur le pédicule épigastrique inférieur (DIEP), permet d'obtenir des tissus viables pour la reconstruction vaginale et est associé à une réduction de la morbidité du site donneur. Ce rapport décrit la technique chirurgicale, qui est l'une des procédures de choix pour la reconstruction vaginale. Il s'agit d'une technique fiable et avantageuse, en particulier chez les femmes pour qui il ne restait plus que l'option de l'exentération en cas d’échec de l'irradiation