Background Most nasal cutaneous malignancies occur on the caudal third of the nose. Commonly, following resective surgery, the surgeon is requested to reconstruct the ala. Small skin defects of the nose may be left healing by secondary intention, although this may sometimes create an unpleasant scar. In the present paper we describe a 1-step reconstruction of the distal area of nasal ala, alar facial sulcus and cheek, with a segmented melolabial interpolated flap. Methods A 59-year-old man was operated for basal cell carcinoma involving the distal area of nasal ala and alar-cheek sulcus. The reconstruction was performed in 1-stage with a segmented melolabial interpolated flap used to reconstruct the anatomical missing subunits. Results Tumor-free margin was larger than the infiltrating region. No postoperative complications were observed. Conclusions The melolabial flap is a suitable option for the reconstruction of the nose, although the reconstruction of nasal ala is usually performed in 2-steps: the first one is performed to transfer the tissue and close the defect; the second, is performed to reshape the convexity of the ala and the concavity of the alar facial sulcus. In the present case, we do not perform a 2-steps reconstruction, we just reshaped the flap to perfectly fit the defect in 1-stage. The flap, supplied by collateral arteries from the facial and angular arteries, could be segmented for a better surgical outcome also during the harvesting stage if multiple anatomical subunits have to be reconstructed, with no need of a second surgical step that could be frustrating for the patient.

Objective: To observe the differences in normal facial skin thickness and echo density by different ages and sites of healthy adults of the same sex using 50 MHz high-frequency ultrasound. Methods: From January to June 2019, 200 healthy adult volunteers with normal facial skin who were from Sichuan, Yunnan, Guizhou, and Chongqing and met the inclusion criteria were recruited by the Affiliated Hospital of Southwest Medical University with simple random sampling method, and then were included in this cross-sectional investigation study. Then 50 MHz high-frequency ultrasound was used to obtain skin ultrasonogram of volunteers' forehead, canthus, eyelid, and cheek. According to the ages, 100 female volunteers were divided into 20-29 years old (30 females), 30-39 years old (25 females), 40-49 years old (20 females), and 50-70 years old (25 females) groups; 100 male volunteers were divided into 20-29 years old (30 males), 30-39 years old (25 males), 40-49 years old (20 males), and 50-70 years old (25 males) groups. The thickness of full-skin, the upper dermal echo density, and the lower dermal echo density of the female and male volunteers'forehead, canthus, eyelid, and cheek were recorded respectively. Data were statistically analyzed with one-way analysis of variance, analysis of variance for repeated measurement, least significant difference test, and Bonferroni correction. Results: (1) The thickness of full-thickness skin in forehead, canthus, eyelid, and cheek of female and male volunteers in 20-29 years old group were (1.86±0.26), (1.36±0.11), (1.24±0.25), and (1.90±0.21) mm, (2.45±0.37), (1.64±0.19), (1.44±0.16), and (2.53±0.26) mm, respectively, in 30-39 years old group were (1.98±0.24), (1.43±0.13), (1.15±0.15), and (2.12±0.13) mm, (2.34±0.27), (1.63±0.27), (1.50±0.38), and (2.43±0.40) mm, respectively, in 40-49 years old group were (1.90±0.21), (1.43±0.18), (1.24±0.27), and (1.98±0.12) mm, (2.14±0.24), (1.54±0.25), (1.28±0.14), and (2.39±0.36) mm, respectively, in 50-70 years old group were (1.64±0.25), (1.36±0.19), (1.16±0.12), and (1.89±0.29) mm, (2.28±0.27), (1.73±0.25), (1.58±0.18), and (2.38±0.32) mm, respectively. There were no statistically significant differences between female volunteers in the 4 groups and male volunteers in the 4 groups in thickness of full-thickness skin in canthus, eyelid, and cheek (F=0.677, 0.666, 0.136, 0.697, 0.294, 0.888, P>0.05). The thickness of full-thickness skin in forehead and cheek of the female volunteers in the 4 groups and male volunteers in the 4 groups was similar (P>0.05), and was significantly higher than that of canthus and eyelid (P 0.05), while thickness of full-thickness skin in canthus and eyelid of male volunteers in the 4 groups was similar (P>0.05). (2) The upper dermal echo density of forehead, canthus, eyelid, and cheek of female volunteers in 50-70 years old group was significantly lower than that in 20-29 years old and 30-39 years old groups (P 0.05). The upper dermal echo density of forehead and cheek of female volunteers in 20-29 years old, 40-49 years old, and 50-70 years old groups was significantly lower than that of canthus and eyelid (P 0.05), the upper dermal echo density of forehead and cheek was similar (P>0.05). (3) The lower dermal echo density of forehead, canthus, eyelid, and cheek of female volunteers in 50-70 years old group was significantly higher than that in 20-29 years old and 30-39 years old groups (P 0.05). The lower dermal echo density of forehead and cheek of female volunteers in the 4 groups was significantly lower than that of canthus and eyelid (P 0.05). Conclusions: The 50 MHz high-frequency ultrasonography shows that the thickness of full-thickness skin of canthus, eyelid, and cheek is similar in all age groups of female and male adult volunteers with normal facial skin. In the same age group, the thickness of full-thickness skin of forehead and cheek of male and female volunteers is significantly higher than that of canthus and eyelid. The upper dermal echo density of forehead, canthus, eyelid, and cheek of female and male volunteers shows a decreasing trend with age, while the lower dermal echo density shows an increasing trend with age. In addition, the echo density of upper and lower dermis of canthus and eyelid was significantly higher than that of cheek in all the four age groups.

Objective To explore the effect of swallowing function training on dysphagia patients after anterior cervical decompression and interbody fusion. Methods From January 2014 to January 2018, 119 patients with anterior cervical decompression and interbody fusion and difficulty in swallowing were divided into intervention group (59 cases) and control group (60 cases) by random digits table method. Patients in the control group were given routine hospital nursing and health education, while patients in the intervention group were given swallowing function training for 6 months, and swallowing function and quality of life were evaluated by Water Swallow Test and M.D.Anderson Dysphagia Inventory(MDADI) and compared between the two groups. Results There was no significant difference in swallowing function and quality of life between the two groups(P> 0.05). After intervention, Water Swallow Test score was 2.00 (1.00, 3.00) in the intervention group, and 3.00 (2.00, 4.00) in the control group, the difference was statistically significant (Z value was 3.205, P < 0.01). After intervention, the total score of MDADI and general, emotional, social and physiological functions dimensions was (69.91 ± 10.59), (3.37 ± 0.63), (21.37 ± 2.97), (17.91 ± 2.14), (27.26 ± 4.19) in the intervention group, and (64.61 ± 9.78), (2.96 ± 0.66), (19.69 ± 3.03), (16.48 ± 4.41) in the control group, the difference was statistically significant (t value was 2.257-3.714, all P < 0.05). Conclusions Swallowing function training can improve the range and strength of patients' oral, tongue, cheek, mandible and pharynx and larynx muscles, and help improve patients' dysphagia and quality of life. Key words: Nursing care; Dysphagia; Intervertebral fusion; Cervical vertebra

Background: This study aimed to evaluate the utility of bilateral axial, lateral nasal flaps sharing a single skin pedicle in the reconstruction of large midline nasal dorsum defects. Materials and Methods: Six patients with large midline nasal dorsum defects due to tumor ablation (four basal cell carcinomas and two squamous cell carcinomas) were included in this study. Nasal defects were reconstructed by bilateral axial, lateral nasal flaps that easily reached nasal dorsal defect bilaterally. After the two parts of the flap were sutured on the dorsum of the nose, the donor area defects on each side of the flap were easily closed by pulling the cheek skin toward the flap sides. Results: After an average of 10 months of follow-up, the color and texture matches were good, and all the scars were at the borders of the esthetic units and symmetrical. Share of single pedicle by the two lateral nasal flaps enabled larger defect closure, and the likelihood of lengthening of the flap through the nasolabial sulcus bilaterally to enable the closure of nasal tip defects. Preparation of relatively smaller size flaps enables the formation of smaller defects in the donor site which could easily and safely be repaired with minimal complication risk. There were no complications related with the flaps or donor sites, except for venous congestion in one patient, and neither a tumor relapse nor a metastasis was detected. Conclusion: In conclusion, our findings revealed feasibility and safety of using bilateral axial, lateral nasal flaps sharing a single skin pedicle in repair of large midline nasal dorsum defects due to tumor ablation, which enables maximal defect closure and minimal donor-site morbidity.

Shakespeare in the Theatre: Cheek by Jowl by Peter Kirwan

Les concepts et travaux récents de la recherche en psychologie de l’identité peuvent permettre de mieux comprendre la formation et la dynamique des préférences économiques. Dans cette perspective, nous proposons une traduction française du questionnaire Aspects of Identity IV (AIQ-IV) qui mesure l’orientation individuelle de l’identité subjective selon ses dimensions personnelle, relationnelle, publique et collective (Cheek et Briggs [1982], [2013]). Cette étude de validation psychométrique teste les validités interne et externe de l’échelle sur un échantillon représentatif de jeunes adultes français (N = 1 118). Les analyses factorielles exploratoires et confirmatoires révèlent une structure à quatre facteurs qui correspond bien aux aspects personnel, relationnel, public et collectif de l’identité. Les réponses individuelles sont stables dans le temps. De plus, tout en étant modérément corrélée à des construits psychologiques connexes (estime de soi, estime de soi sociale, conscience de soi), les dimensions de l’AIQ-IV prédisent, à des degrés variés, les préférences pour le risque et le temps ainsi que les préférences sociales, mesurées grâce à des échelles de Likert ou des choix hypothétiques.

Objective To explore the clinical outcomes of multiple-paddled anterolateral thigh flap in composite cheek through-and-through defect reconstruction. Methods From September, 2014 to Feburuary, 2016, 20 patients were performed complicated through-and-through defect reconstruction following oral cancer removal with free multiple-paddled anterolateral thigh flap including 12 cases of buccal mucosa carcinoma, 5 cases of basal cell carcinoma of buccal skin and 3 cases of gingiva carcinoma.The intraoral defects ranged from 6.0 cm×4.0 cm to 8.0 cm×5.0 cm. The cheek skin defects ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm and the flaps ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm in size.Multiple-paddled anterolateral thigh flap was divided into 3 types based on the anatomical variation, including: (1) lateral descending branch type; (2) descending branch + oblique branch type; (3) lateral and medial descending branch type; different methods were applied according to the different types. Results All the 20 flaps survived totally, including 13 cases of type 1, 5 cases of type 2, and 2 cases of type 3. In all of the 20 cases, the flaps survived well and the donor sites were closed directly.All wounds healed primarily. The follow-up period was 9 to 28 months (13.6 months on average). All patients were satisfied with their facial appearance. Mouth opening ranged from 3 to 5 cm. All patients had normal deglutition and normal oral competence and intelligible speech, although linear scar was left in the donor site. 6 patients received post-operative radiotherapy. 2 patients died of recurrence and all other patients were alive without disease. Conclusions The multiple-paddled anterolateral thigh flap is suitable for the through-and-through cheek defect reconstruction following oral cancer removal. Satisfying outcome can be achieved. This method is worthy of being popularized. Since the anatomical variation forms exist, flexible strategies for flap harvest and reconstruction are needed. Key words: Penetrating wound; Anterolateral thigh flap; Perforator flap; Flap transplantation

Objective To compare the efficacy and safety of two administration modes of autologous platelet-rich plasma (PRP), intradermal injection (ID) and microneedle technique in the treatment of facial post acne scars. Methods From March 2017 to March 2018, 32 patients (8 male, 14 female) with facial acne scars were included. They were randomly divided into two groups (group A and group B) and both underwent splitface therapy. Each group was randomly divided into two subgroups. Group A was administered by microneedle + PRP (A1) on one side and by microneedle + saline (A2) on the other. In group B, one cheek was treated with ID PRP (B1) and the other received ID saline (B2). Each patient received overall 3 treatments per session with 28 days intervals. Patients were followed-up six months after their last treatment and clinical evaluation was assessed by 2 independent plastic surgeons and patients themself. Results The results were obvious difference between each group. The score of evaluation by physicians and patients in A1 group (2.565±0.504) point showed significantly better results compared with other groups. B1 group (1.820±0.592) point was significantly higher than B2 group (1.345±0.483) point (P 0.05). The total effective rate in A1 group was 100%, which was higher than B1 group (43.75%), A2 group (81.25%) and B2 group (25%), with statistical significance (P<0.05). Conclusions The current study introduces the combination of autologous PRP and microneedle technique as an effective and safe modality in the treatment of facial post acne scars with short recovery time and easy operation. Any concerns of immunogenic reactions or disease transfer are eliminated because PRP is prepared from autologous blood. Therefore, the method is suitable to be widely used in clinic. Key words: Platelet-rich plasma; Acne vulgaris; Cicatrix; Atrophy; Microneedle acupuncture therapy

Dataset of the Cucchi et al. Manuscript including the 2D Procrustes coordinates for second and third maxillary Molars (M2max, M3max) and the third mandibular molar (M3Mand)

Objective To analyze the composition of bacteria and fungi on the facial skin of healthy women aged 20-25 years in Beijing by using high-throughput sequencing technology, and to compare the composition and diversity of microbes among 4 kinds of subjective skin types. Methods Totally, 31 female undergraduates were enrolled from Beijing Technology and Business University, and classified into 4 groups, including dry skin group (n=6) , neutral skin group (n=8) , mixed skin group (n=9) and oily skin group (n=8) , according to their subjective feeling of facial skin greasiness and dryness. On 24th December 2017, the facial skin water content, transepidermal water loss (TEWL) , sebum content and pH value were determined for these undergraduates, and these physiological parameters of the skin were compared among the 4 kinds of subjective skin types. Skin samples were collected with swabs from the cheeks of these subjects. After DNA extraction and PCR amplification, the bacterial 16S rRNA regions V1-V2 and fungal internal transcribed spacer regions 1 and 2 (ITS-1-ITS-2) were sequenced separately, and sequences were grouped by OUT cluster analysis at 97% sequence similarity followed by classification and annotation of species. One-way analysis of variance was used for intergroup comparison, and least significant difference (LSD) -t test for multiple comparison. Results The sebum content and bacterial diversity of the facial skin both significantly differed among the 4 kinds of subjective skin types. The skin sebum content in the dry skin group, neutral skin group, mixed skin group and oily skin was 5.50 ± 4.60 μg/cm2, 7.69 ± 5.26 μg/cm2, 10.56 ± 5.42 μg/cm2, 22.81 ± 8.53 μg/cm2 respectively (F=11.685, P 0.05) . The fungi on the facial skin of these subjects mainly consisted of Ascomycota and Basidiomycota, and no significant difference in their relative abundance was observed among the 4 groups (both P > 0.05) . Moreover, there was no significant difference in the composition of fungal genera at relative abundance > 1% among the 4 groups (all P > 0.05) . Conclusion The physiological parameters and bacterial diversity of the cheek skin differed among young women of different subjective skin types, while there was no difference in the fungal diversity or richness, suggesting that the colonization of skin bacteria is associated with subjective skin types. Key words: Skin; Microbial consortia; Bacteria; Fungi; Subjective skin types; High-throughput sequencing

Objective To measure the thickness and echo density of the skin at multiple sites of healthy adults by using high-frequency ultrasound. Methods A total of 50 healthy volunteers were enrolled from Department of Dermatology and Venereology, China-Japan Friendship Hospital between June and December in 2018, including 33 females and 17 males aged 22-69 years. The thickness and echo density of the epidermis, dermis and epidermis-dermis layer were detected by using high-frequency ultrasound at 12 sites, including the forehead, cheek, chest, abdomen, and the inner and outer sides of the upper arm, forearm, thigh and leg. The means of two groups were compared by using t test, and means of several groups were compared by using one-way analysis of variation. Results High-frequency skin ultrasound images differed among different anatomical sites. There were significant differences in the thickness and echo density of the epidermis, dermis and epidermis-dermis layer among the 12 sites (P < 0.05) . The epidermis was thickest at the inner side of the thigh (160.68 μm ± 25.71 μm) , the dermis was thickest at the cheek (1 828.78 μm ± 399.10 μm) , and the epidermis-dermis layer was thickest at the cheek (1 943.48 μm ± 402.4 μm) . The echo density of the epidermis, dermis and epidermis-dermis layer was highest at the inner side of the leg (152.27 ± 21.56) , forearm (52.71 ± 15.57) and forearm (62.56 ± 15.76) respectively. The thickness of the epidermis, dermis and epidermis-dermis layer at the forehead, cheek and the inner side of the forearm was significantly higher in male volunteers than in female volunteers (P ≤ 0.05 or < 0.01) , while the echo density of the dermis and epidermis-dermis layer at the forehead, cheek and the outer side of the leg was significantly lower in male volunteers than in female volunteers (P < 0.05 or 0.01) . Conclusion Differences exist in skin thickness and echo density among different anato mical sites and between male and female healthy adults. Key words: Ultrasonography; Epidermis; Dermis; Skin thickness; Skin echo density

Objective To observe the clinical effect of repairing the defect after extended resection of lower lip cancer by modified lip and cheek fan-shaped flap. Methods Six cases of lower lip cancer were treated. The defect of the lower lip was about 1/3-1/2 after 1 cm of enlarged resection outside the margin of the mass. The defect was repaired with modified lip and cheek fan-shaped flaps. The morphology and function were observed 3-36 months after operation. Results All patients healed in one stage, and the shape and function of lower lip recovered well without complications. Conclusions Lower lip defect about 1/3-1/2 of patients with modified lip and cheek fan-shaped flap is an ideal method of restoration and reconstruction, with satisfactory results after surgery. Key words: Lip; Carcinoma; Defect; Modified lip and cheek fan-shaped flap; Restoration and reconstruction

Objective To investigate the clinical outcome of expanded frontotemporal flap pedicled with bilateral superficial temporal vessels, in repairing facial and cervical scar contracture deformity. Methods From January 2012 to December 2017, 12 male patients with severe facial and cervical scar hyperplasia and contracture deformity, ranging from preauricular region, cheek, chin to neck, were treated in the Burn Department of the First People′s Hospital in Zhengzhou. The patients were aged at 15-58 years, with the mean age of 29.3 years. The frontotemporal scalp flaps were simultaneously expanded to prefabricate a flap pedicled with bilateral superficial temporal arteries and veins. The operations were carried out in 3 stages. Stage Ⅰ: A 400-600 ml cylindrical expander was placed in the frontal region, underneath of galea aponeurosis and frontal muscle, meanwhile, a 50-100 ml cylindrical expander was placed in the temporal region on each side, between the deep temporal fascia and temporal muscle. Stage Ⅱ: The expanded flap pedicled with bilateral superficial temporal vessels were received, to repair the secondary wound after scar resection and contracture release. The neck curve was reshaped. The donor area was directly sutured. Stage Ⅲ: The flap pedicle was repaired, and residual scar was removed. Laser hair removal was performed on the skin flaps about 3 weeks after operation. Results Seven patients underwent simultaneously cervical and thoracic tissue expansion. The expansion time was 5-6 months (average 5.2 months). The expanded flap was 40 cm×9 cm to 45 cm×15 cm in size. All flaps survived. The venous reflux disorder after the second stage operation occurred in 1 patient. The affected area was purple and swollen. It was recovered after acupuncture and compression bandage for 1 week. Laser hair removal was performed in 8 flaps. Flap thinning was performed in 5 flaps. All 12 patients were followed up for 4 to 24 months. The flaps have good appearance, without bloating. The transferred flaps have similar color and texture with adjacent the facial skin. The cervical mobility was significantly improved. The hairline of the head was normal, and the suture scar was slight and concealed. Conclusions The expanded frontal and temporal flaps provide considerable amount of tissue with thin skin and reliable blood supply. It is an alternative method to repair facial and cervical scar contracture. Key words: Soft tissue expansion; Surgical flap; Face; Neck; Burn; Scar; Superficial temporal vessel

Objective To investigate the demodex infection in students living on campus in one university. Methods Samples from different face parts of college students were obtained with transparent adhesive tape method from November 2016 to April 2017. Questionnaire on skin disease was performed simultaneously. Results Among the selected 948 students, 516 students (54.43%) were infected, of which 56.20% were males and 53.33% were females. There was no significant difference in infection rate between males and females (P>0.05). Demodex folliculorum and demodex brevis invaded the 516 infected students, accounting for 41.86% and 28.49% individually, 29.65% of them were with mixed infection. Infectiosity was classified as grade Ⅰ(84.30%), grade Ⅱ(9.88%), grade Ⅲ (4.07%) and grade Ⅳ(1.74%). Infection rates of nose (48.84%) and forehead (44.77%) were higher than that of cheek (36.05%) or genial region (29.65%). The infection rate of facial dermatosis group (59.84%) was higher than that of patients without facial disease (50.79%, P<0.01). Conclusions Demodex infection rate is high among college students living on campus. Demodex folliculorum infection was the main type demodex infection, which manifests mild symptoms with. Nevertheless, nose and forehead are more susceptible to be infected with demodex than cheek or genial region. Additionally, demodex infection is closely correlated with facial skin disease. Key words: Demodex; Infection rate; College students

Objective To evaluate the effect of double-leaf perforator free flap pedicled with posterolateral calf peroneal artery on repairing facial through-and-through defect after oral cancer oblation. Methods Nine patients with facial through-and-through defects after oblation of oral and maxillofacial malignancies, including 4 cases of buccal mucosa carcinoma, 2 cases of maxilla osteosarcoma, 1 case of carcinoma of the maxillary sinus and 2 cases of parotid duct carcinoma, were recruited from May, 2016 to May, 2018. The flap was used to repair the facial defect of recruited patients. The area of the bigger leaf of bilobed perforator flap was 7.0 cm×8.0 cm-6.0 cm×7.0 cm and the small leaf was 4.5 cm×4.5 cm-4.0 cm×4.0 cm, respectively. The intraoral and facial defects needed to be reconstructed contained the oral mucosal of the upper palate, the skin, subcutaneous tissue and mucosa of the cheek. The radiotherapy was performed 1.0-1.5 months after the operation. The prognosis including appearance, mouth opening, and the functions of deglutition, and language were assessed. Results Through 3-18 months outpatient followed-up, all 9 cases of transplanted flaps survived well and the incisions of the donor and recipient areas healed by first intention. The patients were satisfied with the facial appearance, mouth opening, and the functions of deglutition and language at the 6 months follow-up. The radiotherapy had no damage on the survival of the bilobed perforator flap. There was no recurrence or metastasis in follow-up. Conclusion The double-leaf perforator free flap pedicled with posterolateral calf peroneal artery is an ideal free tissue for repairing the facial perforating defect after oral cancer oblation because of its constant blood vessel, abundant tissues, flexible design and operating methods. Key words: Oral cancer; Through-and-through defect; Double-leaf perforator free flap; Peroneal artery; Repair

Objective To investigate the therapeutic outcome of expanded scalp flaps pedicled with superficial temporal vessel for the reconstruction of large facial defects. Method From Dec 2014 to Oct 2016, 10 cases with large facial skin defects were treated with expanded scalp flaps pedicled with superficial temporal vessel and delayed laser hair removal.Extra expanded scalp flaps were collected as experimental groups. Normal skin(forehead, temporal scalp, cheek, upper eyelid, lower eyelid and nasal dorsum)of 10 cases were collected for control, to compare skin thickness.All patients were followed at least 6 months. Results There was no significant difference of skin thickness between the expanded scalp flaps and cheek, forehead, nasal dorsum skin(P>0.05). But upper eyelid and lower eyelids skin was significantly thinner than other local skin tissuein controls, and expanded scalp flap (P<0.05). The expanded scalp flap matched well with surrounding tissues in color, texture and thickness. Conclusions It is a good option to repair large facial skin defects with expanded scalp flaps, pedicled with superficial temporal vessel, and laser hair removal, though its shortcoming in eyelid skin defect repairment. Key words: Soft tissue expanded scalp flaps; Skin thickness; Facial; Skin defects

Hydatid cyst or echinococcosis is a zoonotic parasitic disease caused by dog tapeworm and occurs in humans only when they are accidental intermediate hosts for dog tapeworms. The liver is the most common organ affected (60%), followed by the lung (20%), kidneys (3%), brain (1%) and bone (1%). Previous literature recorded its occurrence in a very few cases involving head and neck region with only three cases involving cheek so far. The present case report demonstrates extreme rare occurrence of hydatid cyst in orofacial region. It is a rarity and potential risk of anaphylactic shock in susceptible individuals poses diagnostic and surgical challenge. Surgical management demands to be prepared with appropriate precautions to be taken perioperatively. Rationale for perioperative management of anaphylactic shock from cystic echinococcus is emphasized.

Measure for Measure by Cheek by Jowl and the Pushkin Theatre, Moscow

Intradermal administration of formalin to the cheek induces itch as well as pain behaviors in rats

Objective This paper describes a technique of facelift that utilizes bidirectional barbed sutures for superficial musculoaponeurotic system (SMAS) double plication. It corrects the facial aging of middle and lower part. Methods An extensive skin flap was undermined subcutaneously, and the sagging tissue of SMAS was lifted latero-superiorly by a secured barbed suture in two oval-shaped areas, with double plication, and without the need for knots, in order to correct the nasolabial groove and descended jowls, repositioning the midfacial volumes. Results A very high patient satisfaction was obtained in 76 patients. One patient had a small hematoma, and one patient had a temporary contour irregularity in the cheek. All resolved without any treatment. Conclusions The double plication facelift utilizing barbed sutures, mainly affects the middle and lower third of the face. Its advantages are: quick procedure, pleasant results, low complication rate, and short recovery period. It also eliminates the possibility of knot visibility, palpability, or extrusion. Key words: Face lifting; Superficial musculoaponeurotic system; Aging face