Follow-up Photographs Research Articles

Nursing process for patients with chronic wounds: A series of successful cases

The care of patients with chronic wounds represents a significant challenge for nursing. Recently, healing protocols have been developed that employ extracellular matrices (ECM), achieving complete wound regeneration. These protocols require an individualized care plan led by nurses, who work in multidisciplinary teams and provide a holistic view of the patient, thus improving care management processes. The nursing process, which includes research, logical analysis and interpersonal techniques, has been shown to improve the quality of care. In this study, evidence was presented on the successful management of chronic wounds through a comprehensive protocol in a first level hospital in Girón, Colombia. Three patients with venous insufficiency who had received conventional management without success were selected. The assessment was performed using the NANDA domains, with a diagnosis of impaired skin integrity. The protocol included disinfection, application of Regenesis® matrix and appropriate dressings, with daily photographic follow-up. The first patient, a 74-year-old woman with a 22-year-old venous ulcer, showed complete wound closure in six weeks. The second patient, a 53-year-old woman with a five-year-old venous ulcer, achieved closure in five weeks. The third patient, a 47-year-old man with a three-year-old venous ulcer, experienced complete closure in eight weeks. All patients showed significant improvements in their wound characteristics and had no adverse events. The study concluded that the healing protocol, which integrates the nursing process, is effective in closing chronic wounds in a short period, even in patients who have not responded to conventional treatments. These results underscore the importance of strict adherence to standardized protocols and nurse-patient interaction for successful treatment

Crystalline keratopathy secondary to the use of ciprofloxacin after cataract surgery with confirmation by histopathological study: A case report and review of the literature

ObjectiveTo report the case of a 75-year-old patient who presented crystalline keratopathy secondary to the use of topical ciprofloxacin with histopathological verification, after cataract surgery without complications. MethodCase report with clinical and photographic follow-up, as well as slides with samples of epithelium and crystalline deposits. ResultsCorneal deposits resolved after drug suspension, topical lubricant change, and subsequent surgical debridement. The histopathological examination reported epithelial cells and basophilic particles compatible with drug precipitates. ConclusionsCrystalline keratopathy is a condition in which crystals of various kinds are deposited in the corneal epithelium and/or in the anterior stroma. It may have an infectious, pharmacological cause or, in rarer cases, corneal dystrophies. Certain factors such as a previous epithelial defect, systemic pathology with diabetes mellitus, ocular surgery and previous dry eye can favor the deposition of ciprofloxacin leading to the formation of a keratopathy.

Neck and chest rejuvenation with fractional 1440and 1927-nm low-powered diode laser.

Ultraviolet light and infrared radiation exposure to the chest and neck can result in photoaging changes, such as rhytids, skin roughness, and dyschromia, which can be treated with nonablative fractionated lasers. The low-powered fractionated 1440and 1927-nm diode lasers have been shown to safely reduce facial photodamage. This study was conducted to investigate the safety and efficacy of a low-powered 1440and 1927-nm nonablative fractionated diode laser in addressing photoaging symptoms, such as rhytids, skin roughness, and dyschromia, of the neck and chest. In a prospective, single-arm, nonrandomized study, a cohort of 24 adult female patients with photodamage to their neck and chest received four treatments to these areas, administered at 4-week intervals. Treatments consisted of four passes on high settings with the 1440 nm handpiece followed by four passes with the 1927 nm handpiece. Photographs were taken at each study visit. Study investigators graded wrinkle severity, texture, and mottled pigmentation of the treated area at baseline and follow-up visit, 3 months after the fourth treatment. Subjects also rated clinical improvement of their neck and chest, along with overall appearance. Blinded evaluators used baseline and follow-up photographs to quantify improvements of rhytids and hyperpigmentation of the neck and chest using a 6-point improvement scale. Of the original cohort, 20 subjects completed all four treatments and 3-month follow-ups. The mean rhytid scores improved by 0.7 ± 1.0 for both neck and chest. Meanwhile, texture scores improved by 1.2 ± 0.4 for the neck and 1.4 ± 0.7 for the chest, with pigment scores improving by 0.5 ± 0.6 for the neck and 0.67 ± 0.7 for the chest. Statistical analysis using paired t-tests, performed on all pre- and posttreatment scores, revealed significant differences (p < 0.05) in wrinkle severity, skin texture, and pigmentation of the neck and chest posttreatment. The degree of improvement was consistent for both the neck and chest areas. Blinded evaluators graded clinical improvements in rhytids and pigmentation at 0.6 ± 1.0 and 0.8 ± 1.2 respectively, corresponding to mild improvement of both neck and chest. A series of treatments with the nonablative low-energy fractional 1440and 1927-nm diode laser appears to be safe and effective for improving rhytids, skin texture, and hyperpigmentation of the neck and chest.

Evaluation of Long-Term Outcomes of Transverse Facial Cleft Repair.

To evaluate the long-term outcomes of linear commissuroplasty and linear skin closure with a focus on commissural migration. Retrospective study. Individuals who underwent transverse facial cleft repair at a single institution between 2004 and 2021. The disrupted orbicularis oris muscle was reoriented and sutured. A simple linear commissuroplasty technique was used, and the cheek skin was closed linearly without Z-plasty. The distances from Cupid's bow peak to the oral commissure were measured bilaterally, and the difference between the normal and cleft sides was obtained. Finally, its proportional value as a percentage of the total lip length was calculated from short- and long-term follow-up photographs. Cheek scarring and its effects on melolabial fold breakage were evaluated. Of the 18 patients who underwent transverse facial cleft repair, 12 were included in this study. The mean follow-up period based on medical photographs was 1773.5 days. The average proportional difference was 4.6%, demonstrating no observable commissural migration. There were no consistent trends in the direction of migration, either on the cleft or normal side. In patients with a transverse cleft crossing the melolabial fold, the folds appeared broken before and after the cleft repair surgery. No significant long-term commissural migration was observed after transverse facial cleft repair with simple linear commissuroplasty and linear skin closure. Deliberate positioning of the new oral commissure, proper myoplasty, and meticulous skin closure with minimal scar burden can be considered key procedures for successful transverse cleft repair.

Dehydrated human amnion/chorion membrane allograft with spongy layer to significantly improve the outcome of chronic non-healing wounds.

We investigated the healing effect of a new dehydrated amnion/chorion membrane with a spongy layer over a 30-month period in 32 patients with 53 chronic non-healing wounds of different aetiologies. Wounds with <40% surface reduction after 4 weeks of best wound treatment underwent weekly allograft application by a certified wound specialist based on national guidelines and a standardised protocol until complete healing or definite treatment interruption. The main outcome measure was the percentage of wound surface reduction from baseline calculated using digital planimetry follow-up photographs. Overall, 38 (71.7%) wounds presented a favourable outcome (70%-100% area reduction), with 35 (66%) completely healing over a median time of 77 days (range 29-350 days). Favourable outcomes were observed in 75% of traumatic wounds, surgical wounds, venous leg ulcers and pressure injuries, as well as in 50% of ischaemic wounds. Wounds being present <12 months were significantly more likely to have a favourable outcome than more long-standing wounds (χ2 = 7.799; p = 0.005; OR = 3.378; 95% CI, 1.410-8.092). Thus, treatment with dehydrated amnion/chorion membrane with a spongy layer improves the outcome of non-healing wounds of different aetiologies and, therefore, has to be considered early in the management of refractory wounds.

Periosteal flaps allow for single stage reconstruction of larger full thickness eyelid defects: a retrospective study.

Full-thickness lower eyelid defects after Mohs micrographic surgery are frequently referred out to oculoplastic surgery for reconstruction. Reconstructive options include wedge closure with or without canthotomy/cantholysis and tarsoconjunctival sliding flaps. Defects > 50% of the eyelid margin have traditionally required the two-stage Hughes flap, leaving the patient with monocular vision for 3-6weeks until pedicle division. To demonstrate single-stage periosteal flaps performed by dermatologic surgeons can result in safe, functional, and cosmetically acceptable repairs for large full thickness eyelid defects, an institutional review board-approved retrospective study of repairs performed by two dermatologic surgeons between January 2017 and July 2021 at the University of Minnesota. Patient demographics, operative notes, and follow-up notes were reviewed. Defect and follow-up photographs were scored using a visual analogue scale to assess aesthetic results. Ten cases were included in the analysis. Six patients were male and the average age was 62years old. 8/10 were basal cell carcinoma and 2/10 were melanoma. The mean defect was 9.5cm2, with a range of 1-24cm2. The median cosmetic score was 85.8 ± 10.7. There were no serious complications reported. Mohs micrographic surgeons can safely and successfully reconstruct large, full thickness eyelid defects by periosteal flap.

Effect of pdo facelift threads on facial skin tissues: An ultrasonographic analysis.

Recent studies demonstrate that PDO threads, after being introduced into the facial skin, provide benefits due to collagen formation around the thread and improved vascularization. This work aims to report the ultrasound and photographic follow-up after the execution of the facelift thread technique, thus evaluating the anti-aging treatment that PDO threads will provide for human facial skin. The facelift will be performed using PDO thread 18G cannulated Sculpt i- Thread FML 100 × 185 mm, and 29G PDO thread Needled Flat i-Thread 38 × 50 mm. A total of 10 patients were selected for the study; all of them had medium-grade facial ptosis and aged 40-50 years old. In order to control tissue changes after thread, insertion ultrasound measurements will be made with Philips ultrasound 12 MHz linear probe at maximum resolution, initial evaluations and control of 30, 60, 90, and 120 days, measuring the skin layers: epidermis\dermis and hypodermis. Photographic control was performed before and after 120 days of intrusion of the PDO threads. The formation of collagen around the PDO thread was evidenced through ultrasound images in all patients in this study, as well as improvement in the appearance of the skin and sagging, evaluated by photographic control. We can define that the PDO threads used for the facelift are effective in the formation of collagen around the thread (observed through the increase in the dermal layer), and improvement of the condition of the anti-aging factor through sagging skin, vascularization and thinning of the superficial fat layer (observed through the reduction of the subcutaneous or hypodermis layer).

AN IN VITRO COMPARISON OF ULTRAVIOLET VERSUS WHITE LIGHT IN THE DETECTION OF ADHESIVE REMNANTS DURING ORTHODONTIC DEBONDING

Objectives: The purpose of this study is to compare ultraviolet (UV) illumination with traditional white light for locating fluorescent-tagged adhesive residues during orthodontic debonding, and to draw conclusions about whether kind of lighting is more successful and efficient.&#x0D; Materials and Methods: The extracted human premolars were bonded to orthodontic brackets using one of two fluorescent bonding resins (Pad Lock, Reliance Orthodontics, Itasca, Ill.;). Opal Bond MV, Opal Orthodontics, South Jordan, Utah; $40 a pop).” After debonding, the operatory light was used to illuminate most of the teeth in each paste bundle (n = 20), while an ultraviolet (395 nm) light release diode (Drove) spotlight illuminated the remaining teeth. Cleaning one's teeth took a certain amount of time, which was recorded. The surface area of adhesive remains was determined by taking follow-up photographs with a dissecting microscope under UV light. The effectiveness of cement removal was also investigated using scanning electron microscopy. We used an ANOVA and a Kruskal-Wallis test to compare the two variables, time and adhesive residue.&#x0D; Results: Using a dissecting microscope, researchers determined that there were considerably less adhesive remains in the UV light group compared to the white light group (P .01). Opal Bond MV glue removed in much less time (P .01) when exposed to UV light as opposed to white light. Scanning electron microscopy analysis revealed invisible to UV light, minute adhesive residues (2 m).&#x0D; Conclusions: When it comes to spotting fluorescent adhesive during orthodontic debonding, ultraviolet light is both more effective and more efficient than white light. UV LED illumination is a useful tool for finding adhesives, despite its drawbacks.

Skin wound healing improvement in diabetic mice through FTIR microspectroscopy after implanting pluripotent stem cells.

Diabetes is a chronic degenerative disease that carries multiple complications. One of the most important complications is the diabetic cutaneous complications, such as skin lesions, ulcerations, and diabetic foot, which are present in 30%-70% of the patients. Currently, the treatments for wound healing include growth factors and cytokines, skin substitutes, hyperbaric oxygen therapy, and skin grafts. However, these treatments are ineffective due to the complex mechanisms involved in developing unhealed wounds. Considering the aforementioned complications, regenerative medicine has focused on this pathology using stem cells to improve these complications. However, it is essential to mention that there is a poor biomolecular understanding of diabetic skin and the effects of treating it with stem cells. For this reason, herein, we investigated the employment of pluripotent stem cells (PSC) in the wound healing process by carrying out morphometric, histological, and Fourier-transform infrared microspectroscopy (FTIRM) analysis. The morphometric analysis was done through a photographic follow-up, measuring the lesion areas. For the histological analysis, hematoxylin & eosin and picrosirius red stains were used to examine the thickness of the epidermis and the cellularity index in the dermis as well as the content and arrangement of collagen type I and III fibers. Finally, for the FTIRM analysis, skin cryosections were obtained and analyzed by employing a Cassegrain objective of 16× of an FTIR microscope coupled to an FTIR spectrometer. For this purpose, 20 mice were divided into two groups according to the treatment they received: the Isotonic Salt Solution (ISS) group and the PSCs group (n = 10). Both groups were induced to diabetes, and six days after diabetes induction, an excisional lesion was made in the dorsal area. Furthermore, using microscopy and FTIRM analysis, the skin healing process on days 7 and 15 post-skin lesion excision was examined. The results showed that the wound healing process over time, considering the lesion size, was similar in both groups; however, the PSCs group evidenced hair follicles in the wound. Moreover, the histological analysis evidenced that the PSCs group exhibited granulation tissue, new vessels, and better polarity of the keratinocytes. In addition, the amount of collagen increased with a good deposition and orientation, highlighting that type III collagen fibers were more abundant in the PSCs. Finally, the FTIR analysis evidenced that the PSCs group exhibited a faster wound healing process. In conclusion, the wounds treated with PSCs showed a more rapid wound healing process, less inflammatory cellular infiltration, and more ordered structures than the ISS group.

Does Oral Propranolol Improve the Final Outcome of All Involuted Infantile Hemangiomas? A Matched Retrospective Comparative Study.

Oral propranolol can effectively activate and accelerate infantile hemangioma (IH) involution; however, could the final outcome of oral propranolol treatment for IHs commensurate that of spontaneous involution? This study aimed to investigate the long-term therapeutic effect of oral propranolol for IHs. We present an individual matching comparative study with (1) oral propranolol therapy for mixed and deep IHs on the lips, nose, and parotid and (2) lesion type- and lesion location-matched untreated IHs as controls. Patients' follow-up photographs were assessed by 3 surgeons blinded of their treatment. Outcome measures were the quantification of the degree of sequelae ranging from 1 to 4 and the age at which IH achieved involution arrest. Ten groups of oral propranolol and untreated patients with matched lesions were assessed. Average age at which lesions stabilized and reached no change in appearance was 1.7 years old and 6.3 years old for propranolol group and untreated group ( t = 5.663, P < 0.001). There was no significant difference in the quantified degree of sequelae for oral propranolol group and untreated group upon follow-up (1.60 vs 1.40, respectively; t = 1.259, P = 0.240). Oral propranolol therapy accelerates IH involution but does not have a superior effect than spontaneous involution on the overall outcome of problematic IHs.

Comparative study of treatment methods for benign lichenoid keratosis of the face.

Benign lichenoid keratosis is one of the most common skin lesions that develop on the faces of middle-aged women. This study aimed to find an effective treatment method for benign lichenoid keratosis. A total of 49 patients, who had a positive diagnosis during 2010-2018, were enrolled in the study. An Investigator's Global Assessment of the lesion was done using the 5-point visual analog scale to evaluate treatment efficacy. After excluding subjects who did not have a follow-up photograph, 38 subjects were given an Investigator's Global Assessment score. Combination therapy using laser and a topical agent was useful in the management of benign lichenoid keratosis on the face. Ablative laser was effective for immediate improvement of the lesion, whereas non-ablative laser was also useful and showed several benefits over ablative laser. Optimal treatment should be decided after considering the patient's preference, compliance with treatment regimen, and skin type.

Factors affecting outcomes of second intent healing of nasal defects after Mohs micrographic surgery.

Reconstruction of nasal defects secondary to Mohs micrographic surgery (MMS) presents particular challenges related to the complex topography, skin quality, tissue laxity, and functional and aesthetic concerns of the region. Factors affecting outcomes resulting from second intent healing (SIH) on the nose have not been well described. The purpose of the study was to identify factors impacting outcomes of SIH for nasal tumors following MMS. Retrospective analysis was performed of all nasal lesions treated with MMS followed by SIH from a single surgical center over a 1.5-year period. Ninety-six cases were included. Chart review was performed, and data were collected including age, gender, nasal site, tumor type, defect size, depth, and number of MMS stages. Pre- and post-operative follow-up photographs were available for all cases. All five authors evaluated the photographs using the modified Manchester scar scale. Analysis was then conducted to identify features associated with good outcomes. Of the 96 tumors, 39 lesions (40.6%) were located on the nasal tip (including supratip), 32 (33.3%) on the ala/alar groove, 17 (17.7%) on the sidewall, and 8 (8.3%) on the dorsum. The average defect size was 0.83 cm2 (diameter of 1.06cm ± 0.4). Defect diameter and defect depth were the factors that significantly impacted scar outcome (p < 0.001) in multivariate analysis. No significant functional deficits were reported. This retrospective study suggests that nasal defects with area less than 0.83 cm2 (or 1.06cm diameter) and depth of defect not extending beyond the superficial fat healed well by SIH regardless of location on the nose.

Evaluation of white spot lesions around orthodontic brackets using different bonding agents – An in vivo study

Objectives: The objectives of the study were to assess the white spot lesions around orthodontic bracket macroscopically using two different bonding agents – one with amorphous calcium phosphate (ACP) (Aegis Ortho) and one without ACP (Transbond XT). Materials and Methods: The study comprises 10 patients from 14 to 23 years of age. Patients were divided into control and study groups. Forty premolar teeth were then observed (20 teeth in each group). Bonding procedure was done and brackets were positioned on all four 1st pre-molars teeth and pre-treatment photographs were taken. The experimental material used was Aegis Ortho composite (study group) and Transbond XT (control group). Debonding procedure (by Wing deformation technique) was performed after 16 weeks which led to adhesive fracture at composite resin adhesive bracket interface leaving essentially all adhesive on the enamel. Then, follow-up photographs were taken to evaluate each. Results: Aegis Ortho containing ACP used for bonding purpose, provided lesser enamel demineralization than Transbond XT. Conclusion: Aegis Ortho for orthodontic bonding is significantly more beneficial and reliable, however, further investigations are also required to understand its clinical performance better.

Odontogenic Cutaneous Fistula and Abscess of the Superficial Peri-Zygomatic Area

Purulent processes of the zygomatic and peri-zygomatic area are not common. Among etiologies are: otitis media, complication of zygomatic implantation, osteomyelitis, medication-related osteonecrosis of the jaw, drug-related osteonecrosis, and odontogenic infection. This article highlights the first literature reported case of clinical presentation of odontogenic abscess and cutaneous fistula of the superficial peri-zygomatic area from the upper third molar. The preoperative and follow-up photographs of a 76-year-old Caucasian male patient are demonstrated. The uniqueness of this case is that until now the upper third molars never been published as a source of abscesses of the peri-zygomatic area.

Hyaluronic Acid Embolism Treated with Subcutaneous High and Low Hyaluronidase Doses: Efficacy and Surrounding Tissue Effect.

The use of hyaluronidase in hyaluronic acid vascular occlusion has been evaluated; however, the models used do not accurately assimilate the facial morphologic characteristics or study the effects on adjacent tissues. The purpose of this study was to determine an effective concentration of subcutaneous hyaluronidase to dissolve a hyaluronic acid embolism and its effect on surrounding tissue. Fifteen rabbits were divided into six groups. An inguinal incision was performed on the femoral artery to create a hyaluronic acid embolism in the control and treatment groups (low-, medium-, and high-hyaluronidase groups). Hyaluronidase was injected subcutaneously. Photographic follow-up, histologic analysis, and quantification of hyaluronic acid were performed. Kruskal-Wallis test and post hoc with Bonferroni correction (p < 0.05) was used to compare the presence of hyaluronic acid in the arterial lumen between groups. Despite the persistence of intravascular hyaluronic acid, macroscopic and microscopic differences were found between the embolism control group and embolism hyaluronidase high-dose group. Histologic analysis demonstrated thrombosis throughout groups. Skeletal muscle was least affected in the embolism hyaluronidase 500 IU group with less lysis and inflammatory infiltrate. A 500 IU hyaluronidase dose partially prevents the damage caused by the embolism, and does not affect the surrounding tissue. The use of thrombolytic therapy combined with higher doses of hyaluronidase subcutaneously in this model is proposed.

Bipolar fractionated radiofrequency midface lift: A retrospective review.

Midface rejuvenation is an important component of overall facial rejuvenation. Traditionally, midfacial skin laxity and volume loss have been addressed with surgical midfacial lifting and soft tissue augmentation with dermal fillers. We present a novel noninvasive approach to midface rejuvenation with a bipolar fractionated radiofrequency (FRF) device that addresses both volume loss and improves skin laxity. An institutional review board-approved retrospective review was performed and included subjects who received midfacial treatment with a bipolar FRF device. Follow-up photographs were objectively assessed by a blinded evaluator using a validated scale, the Facial Laxity Rating Scale. Paired t tests were used to evaluate the results for statistical significance. A total of 15subjects were included in the study. The average age was 64 and ranged from 48 to 73. The average midface laxity score prior to treatment was 5.6 and post-treatment was 6.3 (p<0.01). Bipolar FRF is a promising noninvasive intervention for midface rejuvenation.

Superficial X-ray-induced hyperpigmentation in postoperative keloid radiotherapy: A study of 70 keloids to identify clinical features and risk factors.

Postoperative radiation is one of the most effective treatments for keloid. Radiation-induced hyperpigmentation is, however, a concern for both patients and dermatologists. To identify clinical features and risk factors of superficial X-ray-induced hyperpigmentation in postoperative keloid radiotherapy. From November 2019 to November 2020, 70keloids in 55 patients were treated with superficial X-ray after surgery. Patient data and treatment-related parameters were collected. Follow-up photographs were taken one month after radiotherapy. Three independent dermatologists assessed photographs for pigmentation.The clinical characteristics and severity of pigmentation were summarized. Logistic regression was used to analyze the risk factors associated with occurrence and severity of hyperpigmentation. The pigmentation was a well-defined rectangular brown macule consistent with the unprotected area that involves normal skin, and 82.9% of keloids displayed pigmentation induced by superficial X-ray at one month after treatment. All keloids of trunk appeared to be mild-to-moderately hyperpigmented (100%); 92.89% of limb keloids displayed mainly severe pigmentation. Keloid location was an independent risk factor for the incidence and severity of pigmentation. Longer incision length was also predictive of increased hyperpigmentation severity. Superficial X-ray-induced hyperpigmentation was common and severe in postoperative keloid radiotherapy. The incidence and severity of pigmentation can be predicted by the location and incision length of the keloid.

Efficacy of Platelet Rich Plasma in Treatment of Acne Scars

History: Scarring is a typical consequence of acne vulgaris; acne scarring frequently takes place on the face leading to psychological trauma and social impairment, particularly nowadays when a self-confident appearance is very necessary with all those cosmetic methods. The aim of the work is to estimate the effectiveness of plasma-rich platelet injection in atrophic scar patients. Methods: PRP injection was compared to the left side of the same patient's face for the therapy of acne scars by 2 sessions – one month apart. The research includes 20 participants, and follow-up photographs (pre- and post-treatment) before 1 month after the last session. The evaluation was carried out with the use of the qualitative and quantitative scar method. Results & Conclusion: major improvements have been made on the right side (PRP side).

The Utility of the Subalar Graft in Nostril Symmetry in Rhinoplasty.

A deviated nose can be attributable to multiple anatomical factors, including asymmetric maxilla. A subalar graft helps to correct maxillary hypoplasia and may be a useful tool for correcting a deviated nose. The authors' objective is to show the effects of the subalar graft in improving nostril symmetry and to propose an algorithm for using this graft in open and endonasal rhinoplasty. A retrospective case series was performed on patients who had undergone rhinoplasty performed by the senior author (R.W.) from September of 2008 to July of 2015. Patients with at least 3 months of follow-up and adequate photographs were included. The mean follow-up period was 11.0 months (range, 3 to 72 months). A total of 68 patients were included. Preoperative and postoperative photographs were analyzed to measure changes in nasal axis deviation, alar facial angle on base view, alar facial angle on frontal view, and nostril show bilaterally. Of the 68 patients, statistically significant improvement of nasal axis deviation of 4.32 degrees toward the midline was observed. Alar facial angle on base view was improved 1.01 degrees toward the horizontal. Nostril symmetry also improved based on the ratio between the shorter side and the longer side. The mean change in nostril show ratio was 0.19 toward a 1:1 ratio. Previous studies have shown that the subalar grafting technique is an important adjunctive technique in rhinoplasty for patients with midfacial asymmetries. This case series demonstrates that this technique can provide sustained results in the correction of the nasal foundation. Therapeutic, IV.

Carboxytherapy, subcutaneous injections of carbon dioxide in the management of infraorbital dark circles: A reliable and effective procedure

The aim of this study is to assess the efficacy and tolerability of carboxytherapy in the cosmetic correction of dark circles. Carboxytherapy is a cosmetic technique based on the subcutaneous injection of carbon dioxide that improves the quality and elasticity of the dermis by increasing the oxygen release to the tissue through an enhancement of the Bohr effect. A prospective clinical trial was conducted on 35 patients requesting the correction of dark cicles. Our protocol was based on weekly treatment sessions and lasted 3 weeks. Each treatment session was based on the bilateral injections of the tear-through defect. Pre- ∖treatment photographs and 6-month post-procedural follow-up photographs were examined and analysed through a face objective assessment scale. All 35 patients were treated. The average scores showed a significant reduction of the skin discoloration without major side effects (p < 0.00001). This study proves that it is possible to carry out multiple injections during the same session to increase the application time of the carbon dioxide and to decrease the number of sessions. These results allowed us to validate a 3-sessions injection protocol to increase the patient compliance.