Left Forehead Research Articles

Intracranial penetrating injury by clothes fork in an infant: case report and review of the literature.

Nonmissile intracranial penetrating injury (IPI) in pediatric population is rare. Here, we report the exceedingly rare case of a 5-month-old infant sustained by a metallic clothes fork penetrating into his left forehead. The little baby was identified to carry a traumatichemorrhagic shock, and a multidisciplinary team (MDT) was immediately established response for whole-course evaluation and decision-making. Computed tomography revealed that the clothes fork had impaled into the left frontal bone and brain parenchyma with about 3.2cm inside the cranial vault. The infant underwent emergency surgery, and the clothes fork was removed jointly by MDT members under general anesthesia in the retrograde direction. His recovery was uneventful and was followed up 2years without growth and developmental abnormality. As an extremely rare entity with distinct age-related characteristics, a MDT approach is a best choice and effective strategy to manage infant nonmissile IPI, including preoperative management, surgical treatment, and even following rehabilitation.

Correlation and agreement of regional cerebral oxygen saturation measured from sensor sites at frontal and temporal areas in adult patients undergoing cardiovascular anesthesia.

BackgroundThe function and viability of the brain depend on adequate oxygen supply. A decrease in cerebral blood supply causing cerebral desaturation may lead to many neurological complications. Direct measurement of regional cerebral oxygen saturation (rScO2) assists in early detection and management. Near-infrared spectroscopy (NIRS) has been introduced for measuring rScO2. A pair of sensors are attached to the right and left forehead. However, there are some situations where the forehead of the patient is not accessible for sensor attachment (e.g., neurosurgery involving the frontal area; a bispectral index (BIS) sensor already attached, or a wound to the forehead); therefore, alternate sites for sensor attachment are required. The temporal area was proposed as an alternate site. The objective of this study was to assess the correlation and agreement of rScO2 measured at the forehead vs. the temporal area.MethodsAdult patients undergoing cardiothoracic or vascular surgery were monitored for rScO2 using two pairs of ForeSight sensors. The first pair (A1 and A2) were attached to the right and left forehead, while the second pair (B1 and B2) were attached to the right and left temporal area. The rScO2 values measured from A1 vs. B1 and A2 vs. B2 were assessed for correlation and agreement using the Bland-Altman analysis.ResultsData from 19 patients with 14,364 sets of data were analyzed. The data from A1 vs. B1 and A2 vs. B2 showed moderate positive correlation (r = 0.627; P < 0.0001 and r = 0.548; P < 0.0001). The biases of A1 vs. B1 and A2 vs. B2 were −2.3% (95% CI [−2.5 to −2.2]; P < 0.0001) and 0.7% (95% CI [0.6–0.8]; P < 0.0001). The lower and upper limits of agreement of A1 vs. B1 were −17.5% (95% CI [−17.7 to −17.3]) and 12.8% (95% CI [12.6–13.0]). The lower and upper limits of agreement of A2 vs. B2 were −14.6% (95% CI [−14.8 to −14.4]) and 16.0% (95% [CI 15.8–16.3]).ConclusionsThe rScO2 values measured from sensors at the frontal and temporal areas show a moderate correlation with sufficiently good agreement. The temporal area may be an alternative to the frontal area for cerebral oximetry monitoring.

A rare presentation of neurosarcoidosis as the superior orbital fissure syndrome

We are reporting a rare case of neurosarcoidosis that presented with superior orbital fissure syndrome. A 51-year-old Indian woman who suffered from 2 weeks duration, insidious onset gradually progressive left sided headache limited to forehead, left periorbital pain, diplopia on looking toward left, and numbness on the left forehead was referred to our hospital. Ophthalmic findings included left oculomotor nerve, trochlear nerve and abducens nerve palsies, absent corneal reflex, and loss of touch, pain and temperature sensation in V1 distribution. Brain and orbit magnetic resonance imaging (MRI) showed contrast enhancing area at the left orbital apex with normal optic nerve. Normal CSF analysis. High ESR, and chest x-ray showing non-homogenous patchy opacities in bilateral lung fields leaded us for neoplastic screening. Chest computed tomography (CT) revealed multiple ill-defined irregular lung parenchymal nodular opacities of varying sizes involving bilateral lungs with enlarged mediastinal and bilateral axillary lymph nodes. Elevated angiotensin converting enzyme level was found. Biopsy of the axillary lymph node showed non-caseating granulomatous lymphadenitis with giant cells containing schaumann bodies and asteroid bodies in the cytoplasm. These findings indicating an inflammatory response induced by sarcoidosis. After the initiation of steroid treatment, the patient experienced complete remission without any recurrence. When examining a case presenting with superior orbital fissure syndrome with contrast enhancing MRI lesion at the orbital apex, the additional chest CT to exclude neoplastic lesions can detect pulmonary sarcoidosis and extraneural lesions. These may avoid delays in the diagnosis and management of neurosarcoidosis.

Cutaneous eruption in neonate with congenital heart defect

A 10-day-old infant born with hypoplastic left heart syndrome developed an urticarial eruption. He was started on prostaglandin E1 (PGE1) at birth and failed attempts to wean treatment secondary to cardiogenic shock. He also required extracorporeal membrane oxygenation (ECMO) and a dose increase of PGE1 via a peripheral intravenous line infusion. The eruption developed shortly after the PGE1 dose increase. Physical examination revealed ill-defined, bright pink, blanchable patches on the left forehead and periocular skin and polycyclic, bright red, edematous plaques without overlying scale on the left chest and upper arm (Fig 1).

Cross-Modal Somatosensory Repetition Priming and Speech Processing

Motor speech treatment approaches have been applied in both adults with aphasia and apraxia of speech and children with speech-sound disorders. Identifying links between motor speech intervention techniques and the modes of action (MoA) targeted would improve our understanding of how and why motor speech interventions achieve their effects, along with identifying its effective components. The current study focuses on identifying potential MoAs for a specific motor speech intervention technique. We aim to demonstrate that somatosensory inputs can influence lexical processing, thus providing further evidence that linguistic information stored in the brain and accessed as part of speech perception processes encodes information related to speech production. In a cross-modal repetition priming paradigm, we examined whether the processing of external somatosensory priming cues was modulated by both word-level (lexical frequency, low- or high-frequency) and speech sound articulatory features. The study participants were divided into two groups. The first group consisted of twenty-three native English speakers who received somatosensory priming stimulation to their oro-facial structures (either to labial corners or under the jaw). The second group consisted of ten native English speakers who participated in a control study where somatosensory priming stimulation was applied to their right or left forehead as a control condition. The results showed significant somatosensory priming effects for the low-frequency words, where the congruent somatosensory condition yielded significantly shorter reaction times and numerically higher phoneme accuracy scores when compared to the incongruent somatosensory condition. Data from the control study did not reveal any systematic priming effects from forehead stimulation (non-speech related site), other than a general (and expected) tendency for longer reaction times with low-frequency words. These findings provide further support for the notion that speech production information is represented in the mental lexicon and can be accessed through exogenous Speech-Language Pathologist driven somatosensory inputs related to place of articulation.

The presence of adjacent others facilitates interpersonal neural synchronization in the left prefrontal cortex during a simple addition task

The hyperscanning technique, that is, simultaneous measurement of neural signals in more than one person, is a powerful research tool for understanding humans’ social interactions. In recent years, many studies have investigated interpersonal neural synchronization during various types of communication processes. However, there has been little focus on the impact of the presence of others without explicit social interaction, despite the mere presence of others having been suggested as influencing behavior. In this study, we clarify whether neural signals during a self-paced, repeated, addition task are synchronized when another individual is adjacent without direct interaction. Twenty pairs of participants were measured using a hyperscanning approach with near-infrared spectroscopy. The results show that interpersonal neural synchronization of the task-related signal in the left forehead region was enhanced under the condition of being adjacent to another participant. By contrast, a significant decrease in neural synchronization in the center of the forehead region, where increased neural synchronization is often reported in explicit communication, was observed. Thus, the results indicate that the adjacency of others modulates interpersonal neural synchronization in the task-related signal, and the effect on cognitive processing is different from that of explicit social interaction.

Herpes zoster masquerading viral endophthalmitis after ozurdex intravitreal implant

A 64-year-old gentleman presented with decreased vision, raised intraocular pressure, and anterior chamber reaction of 1+ with grade 3 vitreous exudates on day 5 after intravitreal Ozurdex® implant. Microbiological culture showed no bacterial or fungal growth. On suspicion of viral endophthalmitis, the patient was started on topical prednisolone, moxifloxacin, atropine, dorzolamide, and timolol eye drops and oral valacyclovir 1 g twice a day for 10 days. On day 9, a vesicular eruption was noted on the left forehead, confirming the diagnosis of herpes zoster-related shingles infection. Complete resolution of inflammation was noted on day 30. This is the first case report highlighting the occurrence of ocular zoster infection after an intravitreal Ozurdex® implant.

Superficial Temporal Artery Aneurysm

The superficial temporal artery aneurysm is a rare pathology. We report the case of a 7-year-old child who consulted for a beating mass on the left forehead. The doppler ultrasound and The CT angiography confirmed the diagnosis of a superficial temporal artery aneurysm. The treatment was surgical and the postoperative course was simple.

Comparison of Temperature and Pain Changes between the Drip and Topical Methods of Administering the Transnasal Sphenopalatine Ganglion Block.

The objective of this study was to compare facial temperatures and the visual analogue scale (VAS) between the drip method and the topical method of transnasal sphenopalatine ganglion block (SPGB). The transnasal SPGB is administered to patients with facial or head and neck pain. In the transnasal approach, the drip and topical methods are frequently used. We compared facial temperatures and VAS after transnasal SPGB. Medical records of 74 patients who visited the pain clinic and underwent transnasal SPGB were retrospectively reviewed. A total of 156 transnasal SPGB were performed. The patients were divided into the drip-method and topical-method groups. Facial temperatures were measured in six areas of the right and left forehead, maxilla, and mandible before and 30 min after completion of the transnasal SPGB. Temperatures were compared before and 30 min after SPGB in each group and between the two groups. VAS scores were compared at the same times of SPGB in each group and between the two groups. In the drip-method group, there were significant increases at four areas of the face in temperature changes at 30 min after SPGB. In the topical-method group, there was no significant difference in the temperature changes at 30 min after SPGB. There were statistically significant differences in the facial temperature changes between the two groups in the right forehead (p = 0.001), left forehead (p = 0.015), and right maxillary area (p = 0.046). In herpes zoster, there were statistically significant differences in the VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.008) and between two groups (p < 0.001). In migraine, there were statistically significant differences in VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.004) and between two groups (p = 0.014). Transnasal SPGB using two methods showed different temperature changes and VAS scores.

Preseptal cellulitis and cerebral venous sinus thrombosis complication in a patient with diabetes mellitus

This was a rare case of preseptal cellulitis with an unexpected complication by cerebral venous sinus thrombosis. A 73-year-old woman with poorly controlled diabetes mellitus presented with a week history of swelling and redness on the left upper eyelid and right forehead, associated with poor oral intake, lethargy, and fever. She was generally lethargic with poor verbal response. She had cellulitis of the left upper eyelid and right forehead with the left upper eyelid necrosis. Computed tomography venography of the brain revealed thrombosis of the right transverse sinus, right sigmoid sinus, and right internal jugular vein. She later developed left upper eyelid and right forehead abscesses. Incision, drainage, and wound debridement were performed. She was treated with intravenous antibiotics and anticoagulant. After 1 week of treatment, the preseptal and forehead cellulitis had resolved. However, she passed away due to aspiration pneumonia with respiratory failure on day-13 of hospitalization.

Multi-ROI Spectral Approach for the Continuous Remote Cardio-Respiratory Monitoring from Mobile Device Built-In Cameras.

Heart rate (HR) and respiratory rate (fR) can be estimated by processing videos framing the upper body and face regions without any physical contact with the subject. This paper proposed a technique for continuously monitoring HR and fR via a multi-ROI approach based on the spectral analysis of RGB video frames recorded with a mobile device (i.e., a smartphone’s camera). The respiratory signal was estimated by the motion of the chest, whereas the cardiac signal was retrieved from the pulsatile activity at the level of right and left cheeks and forehead. Videos were recorded from 18 healthy volunteers in four sessions with different user-camera distances (i.e., 0.5 m and 1.0 m) and illumination conditions (i.e., natural and artificial light). For HR estimation, three approaches were investigated based on single or multi-ROI approaches. A commercially available multiparametric device was used to record reference respiratory signals and electrocardiogram (ECG). The results demonstrated that the multi-ROI approach outperforms the single-ROI approach providing temporal trends of both the vital parameters comparable to those provided by the reference, with a mean absolute error (MAE) consistently below 1 breaths·min−1 for fR in all the scenarios, and a MAE between 0.7 bpm and 6 bpm for HR estimation, whose values increase at higher distances.

A One-Dollar, Disposable, Paper-Based Microfluidic Chip for Real-Time Monitoring of Sweat Rate.

Collecting sweat and monitoring its rate is important for determining body condition and further sweat analyses, as this provides vital information about physiologic status and fitness level and could become an alternative to invasive blood tests in the future. Presented here is a one-dollar, disposable, paper-based microfluidic chip for real-time monitoring of sweat rate. The chip, pasted on any part of the skin surface, consists of a skin adhesive layer, sweat-proof layer, sweat-sensing layer, and scale layer with a disk-shape from bottom to top. The sweat-sensing layer has an impressed wax micro-channel containing pre-added chromogenic agent to show displacement by sweat, and the sweat volume can be read directly by scale lines without any electronic elements. The diameter and thickness of the complete chip are 25 mm and 0.3 mm, respectively, permitting good flexibility and compactness with the skin surface. Tests of sweat flow rate monitoring on the left forearm, forehead, and nape of the neck of volunteers doing running exercise were conducted. Average sweat rate on left forearm (1156 g·m−2·h−1) was much lower than that on the forehead (1710 g·m−2·h−1) and greater than that on the nape of the neck (998 g·m−2·h−1), in good agreement with rates measured using existing common commercial sweat collectors. The chip, as a very low-cost and convenient wearable device, has wide application prospects in real-time monitoring of sweat loss by body builders, athletes, firefighters, etc., or for further sweat analyses.

Can Cerebral Regional Oxygen Saturation (rSO2) Be Used as an Indicator of the Quality of Chest Compressions in Patients With Cardiopulmonary Arrest? A Study Evaluating the Association Between rSO2 and Mean Arterial Pressure: The PRESS Study.

IntroductionSudden cardiac arrest causes numerous deaths worldwide. High-quality chest compressions are important for good neurological recovery. Arterial pressure is considered useful to monitor the quality of chest compressions by the American Heart Association. However, arterial pressure catheter might be inconvenient during resuscitation. Conversely, cerebral regional oxygen saturation (rSO2) during resuscitation may be associated with a good neurological prognosis. Therefore, we aimed to evaluate the correlation between mean arterial pressure and rSO2 during resuscitation to evaluate rSO2 as an indicator of the quality of chest compressions.Materials and MethodsThis study was a single-center, prospective, observational study. Patients with out-of-hospital cardiac arrest who were transported to a tertiary care emergency center in Japan between October 2014 and March 2015 were included. The primary outcome was the regression coefficient between mean arterial pressure (MAP) and rSO2. MAP and rSO2 were measured during resuscitation (at hospital arrival [0 min], 3, 6, 9, 12, and 15 min), and MAP was measured by using an arterial catheter inserted into the femoral artery. For analysis, we used the higher value of rSO2 obtained from the left and right forehead of the patient measured using a near-infrared spectrometer. Regression coefficients were calculated using the generalized estimating equation with MAP and systolic arterial pressure as response variables and rSO2 as an explanatory variable since MAP and rSO2 were repeatedly measured in the same patient. Since the confounding factors between MAP or systolic arterial pressure and rSO2 were not clear clinically or from previous studies, the generalized estimating equation was analyzed using a univariate analysis.ResultsIn this study, 37 patients were analyzed. The rSO2 and MAP during resuscitation from hospital arrival to 15 min later were expressed as follows: (median [interquartile range, IQR]): rSO2, 29.5 (24.3–38.8)%, and MAP, 36.5 (26–46) mmHg. The regression coefficient (95% CI) of log-rSO2 and log-MAP was 0.42 (0.03–0.81) (p = 0.035).ConclusionThe values of rSO2 and MAP showed a mild but statistically significant association. rSO2 could be used to assess the quality of chest compressions during resuscitation as a non-invasive and simple method.

A novel technique for forehead and eyebrow reconstruction using a temporal hairline flap combined with a free forearm flap: a report of two cases.

We herein report a novel technique for managing large forehead skin defects that include the eyebrows and upper eyelid. Case 1 was of a 55-year-old woman with an eccrine carcinoma (T2N0M0) at the right forehead, resulting in a skin defect 15 cm in diameter. Case 2 was of an 81-year-old man with a malignant peripheral nerve sheath tumor (T1a N0M0) at the left forehead, resulting in a skin defect 18 cm in diameter. A pedicled temporal hairline flap and free forearm flap were combined and placed on the defect, and good eyebrows and forehead morphology was ultimately achieved.

Topography and lateralization of long-latency trigeminal somatosensory evoked potentials

ObjectiveLong-latency trigeminal somatosensory evoked potentials (SSEPs) have not been sufficiently studied regarding their topography and lateralization. SSEPs are hypothesized to contribute to the evoked potentials after transcranial magnetic stimulation (TMS). This study focused on trigeminal SSEPs with latencies > 100 ms, potentially overlapping with TMS-evoked N100. MethodsIn 14 healthy subjects, the trigeminus was electrically stimulated on the left and right forehead, and time-course, topography, and lateralization of trigeminal SSEPs were examined in 64-channel electroencephalogram (EEG). SSEPs were then compared to TMS-evoked potentials when TMS was applied to the left and right dorsolateral prefrontal cortex. ResultsTrigeminal stimulation produced a somatosensory N140 with topographic maximum over centroparietal electrodes with larger amplitudes contra- than ipsilaterally to the stimulation. Contralateral potentials after TMS were partly comparable in their topography but differed in latencies. ConclusionsSSEPs generated by electrical stimulation of the trigeminus occurred over somatosensory areas with a contralateral lateralization. Therefore, contralateral potentials after TMS should be interpreted with caution, as they may include somatosensory components. SignificanceThe topography and lateralization of long-latency trigeminal SSEPs should be considered in future TMS-EEG designs.

Ocular and Facial Herpes Zoster and Meningitis in an Adult after Zoster Vaccination

Purpose: To report a case of ocular and facial herpes zoster and meningitis after herpes zoster vaccination.Case summary: A 60-year-old man was administered Zostavax® on his left arm; he developed a vesicular rash over his left eye and forehead 4 days afterwards. He started antiviral drugs for the rash, and visited the hospital for severe headache and spread of the rash to involve the tip of his nose, face, and palate by day 7. He was taking Synthyroid® (Bukwang Pharmaceuticals, Seoul, Korea) since his thyroidectomy for thyroid cancer 6 years ago. He had never been diagnosed with chickenpox, but had an episode of red facial rash in childhood. Slit-lamp examination revealed conjunctival chemosis, hyperemia, and a pseudodendrite in the peripheral cornea. The anterior chamber was quiet, and there were no significant findings on his brain magnetic resonance imaging. Varicella zoster virus was detected in the cerebrospinal fluid by polymerase chain reaction. The patient was treated with oral acyclovir drugs and topical ganciclovir, levofloxacin, and bromfenac. One week later, the pseudodendrite disappeared and conjunctival chemosis improved. There was no recurrence during 6 months follow-up.Conclusions: Reactivation of ocular or facial herpes zoster or meningitis after zoster vaccination may occur, rarely. Immediate antiviral treatment is required in these cases.

Predictors of changes in cerebral perfusion and oxygenation during obstructive sleep apnea

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder. Severe OSAS defined as apnea–hypopnea index (AHI) ≥ 30/h is a risk factor for developing cerebro-cardiovascular diseases. The mechanisms of how repetitive sleep apneas/hypopneas damage cerebral hemodynamics are still not well understood. In this study, changes in blood volume (BV) and oxygen saturation (StO2) in the left forehead of 29 newly diagnosed severe OSAS patients were measured by frequency-domain near-infrared spectroscopy during an incremental continuous positive airway pressure (CPAP) titration protocol together with polysomnography. The coefficients of variation of BV (CV-BV) and the decreases of StO2 (de-StO2) of more than 2000 respiratory events were predicted using linear mixed-effect models, respectively. We found that longer events and apneas rather than hypopneas induce larger changes in CV-BV and stronger cerebral desaturation. Respiratory events occurring during higher baseline StO2 before their onsets, during rapid-eye-movement sleep and those associated with higher heart rate induce smaller changes in CV-BV and de-StO2. The stepwise increased CPAP pressures can attenuate these changes. These results suggest that in severe OSAS the length and the type of respiratory event rather than widely used AHI may be better parameters to indicate the severity of cerebral hemodynamic changes.

Microsurgical Resection of Hybrid Nerve Sheath Tumor Involving the Orbit and Lateral Wall of the Cavernous Sinus: 2-Dimensional Operative Video.

Surgical removal of the tumor involving both the orbital and cavernous sinus remains challenging. Hybrid nerve sheath tumors (HNSTs) are defined as benign peripheral nerve sheath tumors with combined features of more than one type of benign peripheral nerve sheath tumors, including schwannoma, neurofibroma, and perineurinoma.1 They rarely arise from the orbit.1-3 This video shows the microsurgical resection of HNST involving both the orbit and lateral wall of the cavernous sinus. A 43-yr-old woman presented with 1-yr history of a slowly growing painless mass in her left medial eyelid. Neuroimaging examinations demonstrated a multilobulated and well-demarcated mass with a heterogeneous enhancement located in the extraconal region, just above the levator muscle, and extending from the eyelid to the middle fossa through the superior orbital fissure. Based on the neuroimaging features, we diagnosed it as trigeminal schwannoma involving the orbit and lateral wall of the cavernous sinus preoperatively. We performed left frontotemporal craniotomy with superolateral orbitotomy to gain access to the tumor. The tumor was grayish yellow and relatively firm. No intact nerve fibers of the frontal and ophthalmic nerves could be identified, making the diagnosis of the tumor originating from both nerves. Finally, we completely resected the tumor, which was confirmed by postoperative magnetic resonance images. Her postoperative course was uneventful, except for transient diplopia and expected left forehead hypesthesia. The pathology returned to HNST containing schwannoma and neurofibroma with no malignancy. The patient consented to the procedure prior to the surgery. And, the patient consented to the publication of their image.

Ayurvedic Approach for Shwitra- A Case Study

Skin is one of the most important and visible organ of our body. Skin anomalies create physical as well as psychological problems in an individual. Among different variety of Kustha, Shwitra is considered as one of them in the Ayurvedic classics which occur due to vitiation of Tridoshas and Dhatus like Rakta, Mamsa and Meda. Shwitra can be correlated with vitiligo or leucoderma, where it manifest as white patch on the skin due to partial or complete loss of skin pigmentation and causes cosmetic imbalance of the body. Vitiligo is an autoimmune disease and it may be associated with other autoimmune diseases such as pernicious anaemia, addison disease and diabetes mellitus results in destruction of melanocytes thus causing depigmentation. A female patient, aged 36 years suffering from white patches in left forehead region for last 2 years and she was treated with both Sodhan and Shaman Chikitsa for a period of 3 months. Result was assessed from the changes in the size of patch and photographs. Proper written consent was taken from the patient prior to the study. Follow up was done at 1 month interval and after 3 months there was marked improvement seen in patch and colour. The present study indicates different prospective of treatment for Shwitra kustha and it provides cost effective as well as safe treatment of the disease. This study shows a new dimension in the treatment for Shwitra and could be carried out for statistical significant study.

Split Face Comparative Study of Plasma Gel versus Non Cross Linked Hyaluronic Acid for Treatment of Static Forehead Wrinkles

Abstract Background The entire human body is subject to changes associated with aging. Those occurring in the skin are visible, facial aging can be particularly negative since it represents the main image. Among the factors playing an important role in facial aging are exposure to ultraviolet (UV) light, smoking habits and alcohol consumption, which, together with genetic factors, can alter the rate of skin aging. Objectives The presented study aimed to compare the efficacy of the plasma filler and the non-cross linked hyaluronic acid in treating static forehead wrinkles. Patients and Methods The present study is a prospective study which included 20 adult male and female with different grades of static forhead wrinkles. Our participants range between 40 to 55 years old. This study was done in a period of 6 months starting from February 2019 to September 2019. All participant signed informed consent after explaining to them the objective of the study. An official research approval was granted from research ethical committee, faculty of medicine in Ain Shams University and fulfilled all the ethical aspects required in human research. Results So the plasma gel is as safe and efficient as non cross linked hyaluronic acid in treating static forehead wrinkles as there is no significant difference between the right and left forehead after treatment. Conclusion Plasma gel is as safe and effective as non cross-linked HA, plasma gel is cheap, available, easy promising tool to treat wrinkles.