Normal Facial Skin Research Articles

Facial appearance associates with longitudinal multi-organ failure: an ICU cohort study

BackgroundFacial appearance, whether consciously or subconsciously assessed, may affect clinical assessment and treatment strategies in the Intensive Care Unit (ICU). Nevertheless, the association between objective clinical measurement of facial appearance and multi-organ failure is currently unknown. The objective of this study was to examine whether facial appearance at admission is associated with longitudinal evaluation of multi-organ failure.MethodsThis was a sub-study of the Simple Intensive Care Studies-II, a prospective observational cohort study. All adult patients acutely admitted to the ICU between March 26, 2019, and July 10, 2019, were included. Facial appearance was assessed within three hours of ICU admission using predefined pictograms. The SOFA score was serially measured each day for the first seven days after ICU admission. The association between the extent of eye-opening and facial skin colour with longitudinal Sequential Organ Failure Assessment (SOFA) scores was investigated using generalized estimation equations.ResultsSOFA scores were measured in 228 patients. Facial appearance scored by the extent of eye-opening was associated with a higher SOFA score at admission and follow-up (unadjusted 0.7 points per step (95%CI 0.5 to 0.9)). There was no association between facial skin colour and a worse SOFA score over time. However, patients with half-open or closed eyes along with flushed skin had a lower SOFA score than patients with a pale or normal facial skin colour (P-interaction < 0.1).ConclusionsThe scoring of patients’ facial cues, primarily the extent of eye-opening and facial colour, provided valuable insights into the disease state and progression of the disease of critically ill patients. The utilization of advanced monitoring techniques that incorporate facial appearance holds promise for enhancing future intensive care support.

Keratinocyte-Immune Cell Crosstalk in a STAT1-Mediated Pathway: Novel Insights Into Rosacea Pathogenesis.

Rosacea is a common chronic inflammatory condition that mainly affects the central face. However, the molecular background of the normal central face and the transcriptional profiling and immune cell composition of rosacea lesions remain largely unknown. Here, we performed whole-skin and epidermal RNA-seq of central facial skin from healthy individuals, lesions and matched normal skin from rosacea patients. From whole-skin RNA-seq, the site-specific gene signatures for central facial skin were mainly enriched in epithelial cell differentiation, with upregulation of the activator protein-1 (AP1) transcription factor (TF). We identified the common upregulated inflammatory signatures and diminished keratinization signature for rosacea lesions. Gene ontology, pathway, TF enrichment and immunohistochemistry results suggested that STAT1 was the potential core of the critical TF networks connecting the epithelial–immune crosstalk in rosacea lesions. Epidermal RNA-seq and immunohistochemistry analysis further validated the epithelial-derived STAT1 signature in rosacea lesions. The epidermal STAT1/IRF1 signature was observed across ETR, PPR, and PhR subtypes. Immune cell composition revealed that macrophages were common in all 3 subtypes. Finally, we described subtype-specific gene signatures and immune cell composition correlated with phenotypes. These findings reveal the specific epithelial differentiation in normal central facial skin, and epithelial–immune crosstalk in lesions providing insight into an initial keratinocyte pattern in the pathogenesis of rosacea.

Research value of 50 MHz high-frequency ultrasound on sonography of normal facial skin in adult

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.

Concentrated growth factor inhibits UVA-induced photoaging in human dermal fibroblasts via the MAPK/AP-1 pathway.

Ultraviolet (UV) radiation-induced photoaging is one of the contributors to skin aging. UV light triggers oxidative stress, producing a large number of matrix metalloproteinases (MMPs) and degrading the extracellular matrix in skin cells, thereby causing a series of photoaging symptoms. Concentrated growth factor (CGF) is a leukocyte- and platelet-rich fibrin biomaterial that plays a protective role in the occurrence and development of skin photoaging. In the present study, we investigated the underlying mechanism of CGF in the UVA-induced photoaging of human dermal fibroblasts (HDFs). A primary culture of HDFs was isolated from normal human facial skin. The cells were treated with CGF following UVA radiation. Proliferation of cells was detected using MTT assay, followed by measurement of reactive oxygen species (ROS) using immunofluorescence assay and flow cytometry. The mRNA and protein expression levels of P38, c-Jun, and MMP-1 were detected using real-time polymerase chain reaction and Western blot, respectively. CGF was found to improve cell viability by inhibiting the production of ROS and reducing oxidative damage. In addition, there was lower expression of p38 and c-Jun at the mRNA and protein levels following CGF treatment, thus resulting in the inhibition of MMP-1 expression. Our results suggest that CGF could protect HDFs against UVA-induced photoaging by blocking the P38 mitogen-activated protein kinase/activated protein-1 (P38MAPK/AP-1) signaling pathway. These findings provide a new clinical strategy for the prevention of skin photoaging.

Structural validation of facial skin using optical coherence tomography: A descriptive study.

In this immediate ex vivo study, we aimed to identify the structures of normal and pathological facial skin using optical coherence tomography (OCT) and compared them to the gold standard histopathology. A total of 53 patients, with 57 suspicious facial lesions, participated in this study. A set of variables have been highlighted by the pathologist to represent the minimum unique features that could be used to diagnose a skin pathology have been included in a checklist. One pathologist used this checklist while examining the histopathology slides and one clinician while examining the OCT images. The data from both checklists have been reviewed and compared. Optical coherence tomography's overall accuracy in diagnosing AK was 83%. Best accuracy was achieved in diagnosing BCC and was 97%, while it was 85% for cutaneous SCC. OCT failed to diagnose LM with an accuracy of 33.3% based on the two parameters of the pathology checklist, while it was 81% for malignant melanoma. This study proved the success of OCT in identifying structural changes in normal and pathological facial skin. Further studies to prove its usefulness in vivo are recommended.

565 The role of photo-induced collagen degeneration in the development of telangiectasias in rosacea

Disruption of the dermal matrix secondary to photoaging is one of the proposed etiologies for rosacea. Matrix metalloproteinase-1-mediated collagen degeneration has been shown to impact endothelial cells, leading to the formation of vascular tubes resembling telangiectatic lumina. We performed a case-control study to examine the relationship between clinical presentation, collagen degeneration, and microvascular changes between 5 patients with erythematotelangiectatic rosacea ages 47-83 and 5 controls matched by age ±5 years and race. Biopsies were taken of telangiectasias from rosacea patients and of normal facial skin from controls. Samples were stained with Picrosirius red for collagen visualization and CD31 for vessels. Image J and SPSS-25 were used for image analysis. When examining the papillary and reticular dermis of Picrosirius red-stained slides, samples from controls displayed significantly greater mean collagen content (19.603% ±8.821%) compared to rosacea patients (16.812% ±7.787%, p=0.030). Examination of the CD31-stained sections demonstrated a significantly higher mean microvessel density in rosacea patients (4.775 E-5 ±1.493 E-5 μm-3) compared to controls (2.559 E-5 ±8.732 E-6 μm-3, p=0.004) and significantly higher mean vessel lumen area in rosacea (491.710 ±610.188 μm2) compared to controls (347.879 ±539.624 μm2, p=0.003). By individual patient-control pair, 5/5 pairs had increased microvessel density and decreased collagen content in rosacea patients compared to controls. 3/5 pairs demonstrated significantly increased mean lumen area in rosacea individuals. No significant correlations were identified between the histologic findings and clinical severity grading of rosacea or photoaging. However, we identified a direct relationship between decreased collagen and increased microvessel size and density in rosacea patients. These structural changes may represent early aberrations that develop in this condition and provide a link between photodamage and rosacea.

Effects of free anterolateral femoral or medial calf flaps in the repair of severe facial burns

Objective: To explore the effects of free anterolateral femoral or medial calf flaps in the repair of severe facial burns. Methods: From January 2014 to October 2017, 18 patients with severe facial burns were admitted to Zhengzhou First People's Hospital, including 12 males and 6 females, aged 15-78 years. Autologous intermediate split-thickness skin grafts were transplanted to replace oral mucosa in 4 patients with perforating cheek defects, and 8 patients underwent early vacuum sealing drainage and autologous intermediate split-thickness skin grafting to reduce the wound area to 14 cm×6 cm-22 cm×14 cm before flap transplantation. The wounds of 15 patients were repaired with free anterolateral femoral flaps, and the wounds of the other 3 patients were repaired with free medial calf flaps. The area of flaps ranged from 16 cm×7 cm to 24 cm×17 cm. The facial artery or superficial temporal artery was anastomosed end-to-end with lateral femoral circumflex artery or posterior tibial artery under microscope routinely and manually, and the two accompanying veins were anastomosed end-to-end by Coupler microvascular anastomat. The donor site was sutured or transplanted with autologous intermediate split-thickness skin graft. The anastomosis time of veins was recorded. The patency rate of vascular was calculated. The survival status of flaps were observed. The recovery of recipient area was observed during follow-up. Results: The anastomosis time of two veins in this group was 6-10 minutes, with an average of 8.5 minutes. The patency rates of veins and arteries were 100%. There was no vascular crisis due to the anastomosis problem. The free flaps survived well in 16 patients; one patient had hemorrhage under the flap 6 hours after operation, and the blood circulation of flaps turned well after hemostasis by surgical exploration; the other patient had 3 cm necrosis at the distal end of flap after operation, and the wound was closed after dressing change and autologous intermediate split-thickness skin grafting. The patients were followed up for 2 to 24 months after discharge. Most of the five senses function recovered. The color and texture of the flaps were not consistent with those of the normal facial skin. Some flaps were slightly swollen. Oral integrity was restored in 4 patients with perforating cheek defect with mouth opening of 2.2-3.5 cm. Conclusions: Free anterolateral thigh flaps or medial calf flaps can repair severe facial burn wounds. It takes less time to anastomose venous vessels by microvascular anastomat during operation and can ensure the quality of venous anastomosis.

Androgens modulate keratinocyte differentiation indirectly through enhancing growth factor production from dermal fibroblasts

BackgroundThe main pathogenesis of acne vulgaris is increase in sebum production and abnormal keratinization of the hair infundibulum. The androgens are involved in acne pathogenesis by modulating sebaceous glands to enhance sebum production. However, the molecular mechanisms of abnormal keratinization of the hair infundibulum are not fully elucidated. ObjectiveWe hypothesized that the androgens affect the dermal fibroblasts, another androgen receptor-positive cells in the skin, resulting in abnormal keratinization through keratinocyte-fibroblast interaction. MethodsWe investigated effects of androgens and estrogens on growth factors expressions by RT-PCR and western blot analysis in human fibroblast (hFB), human keratinocyte (hKC), and fibroblast-keratinocyte co-culture. In vivo, we examined the growth factor expression in acne lesions compared to normal hair follicles by laser-assisted confocal microscope. ResultsIn vitro, androgens but not estrogens significantly increased amphiregulin (AREG), epiregulin (EREG), fibroblast growth factor (FGF) 10, and insulin-like growth factor binding protein (IGFBP) 5 mRNA and protein expressions in human fibroblasts but not in keratinocytes. In vivo, AREG, EREG, FGF10, and IGFBP5 were more abundant in acne lesion compared to normal facial skin. FGF10 suppressed cytokeratin 1 and cytokeratin 10 expression in hKC, which was along with the decreased ratio of cytokeratin 10 against cytokeratin 14 in acne lesions compared to normal facial skin. Also, DHT suppressed cytokeratin 1 and cytokeratin 10, in fibroblast-keratinocyte co-culture similarly to the effect of FGF10 to hKC. ConclusionThese observations suggested that androgens enhance growth factors production from dermal fibroblasts, and growth factors from fibroblasts alter keratinocyte differentiation in acne lesion.

Elastography reference values of facial skin elasticity.

IntroductionWith an introduction of new ultrasonographic transducers, skin elastography may find an application in dermatology and aesthetic medicine enabling direct evaluation of various pathological or natural processes.AimTo verify which elastographic technique, strain elastography (SE) or shear wave elastography (SWE), is a better candidate for the reference method of facial skin elasticity examination and to determine normal ranges for elastographic parameters in various facial regions.Material and methodsThe study included 71 female volunteers (age: 40–67 years, mean: 52 ±7.5 years). All participants were subjected to SE and SWE of the skin in five anatomical regions: the forehead, suborbital regions, cheeks, nasolabial folds and chin. Reference ranges for elastographic parameters were defined as 95% confidence intervals and ±2 standard deviations and estimated by means of ROC analysis.ResultsShear wave elastography parameters, but not SE indices, showed strong inverse correlations with the patient age. No significant correlations were found between SE and SWE parameters of the facial skin. In contrast to SWE, no significant correlations were observed between bilateral SE parameters. Based on these findings, SWE was chosen as the reference method to determine age-specific normative values for the elasticity of the facial skin. Reference and cut-off values of SWE parameters were defined for three age groups.ConclusionsShear wave elastography is suitable for the determination of elastographic parameters of normal facial skin, and can be used to determine reference ranges thereof. Elasticity of the facial skin decreases considerably with age, and this factor should be considered during determination of reference values for the elastographic parameters.

Demodex mites modulate sebocyte immune reaction: possible role in the pathogenesis of rosacea

Rosacea is a common facial skin disorder mainly affecting middle-aged adults. Its aetiology is unknown and pathogenesis uncertain. Activation of the host innate immune response has been identified as an important factor. The Demodex mite population in the skin of rosacea patients is significantly higher than in patients with normal skin, suggesting that they may be of aetiological importance in this disorder. To determine the potential of Demodex mites to interact with the host immune system. Live Demodex mites were extracted from normal facial skin of control subjects and used in cell stimulation experiments with the immortalized SZ95 sebocyte line. Time- and mite-dose-dependent experiments were performed. Direct effects of Demodex and effects of the medium in which Demodex had been cultured were evaluated on the Toll-like receptor (TLR) signalling pathway on both a gene and protein expression level. Mites modulated TLR signalling events on both mRNA and protein levels in SZ95 sebocytes. An initial trend towards downmodulation of genes in this pathway was observed. A subsequent switch to positive gene upregulation was recorded after 48 h of coculture. Demodex secreted bioactive molecules that affected TLR2 receptor expression by sebocytes. High numbers of Demodex induced proinflammatory cytokine secretion, whereas lower numbers did not. Demodex mites have the capacity to modulate the TLR signalling pathway of an immortalized human sebocyte line. Mites have the capacity to secrete bioactive molecules that affect the immune reactivity of sebocytes. Increasing mite numbers influenced interleukin-8 secretion by these cells.

The Use of a Combined Local Flap for Reconstructing a Complex Nasal Defect.

The main goals of reconstruction of nasal defects are to restore the topographic subunit outline, thereby maintaining the aesthetic three-dimensional facial contours and more importantly ensuring a patent airway. Wide excision of tumours of the external nose can at times result in complex defects causing significant facial disfigurement and this poses a significant reconstructive challenge. Nasal reconstruction with only micro-vascular free flaps can at times produce poor aesthetic outcomes as distant skin often appears as a mismatched patch within the surrounding normal facial skin. We describe a novel technique for external nose reconstruction using a combination two well described local flaps, superiorly based nasolabial flap alongside a paramedian forehead flap.

Investigation on Demodex infection status and influencing factors in medical students in Wuhu City

To investigate the Demodex infection status and influencing factors in medical students in Wuhu City. The mite specimens were collected by the cellophane tape method, and the influencing factors were investigated through the questionnaires. A total of 316 medical students were surveyed, 117 students were infected with Demodex mite, and the total infection rate was 37.03%. There was no significant difference between the male and female in the infection rate (χ2 = 0.00, P > 0.05). Of the 117 infected cases, the infection rate of simple Demodex folliculorum was 51.28%, the infection rate of simple Demodex brevis was 24.79%, and the rate of mixed infections was 23.93%. The rate of the mild infection (83.76%) was significantly higher than that of the moderate infection (12.82%) and that of the severe infection (3.42%). The infection rate in the forehead was the highest (29.41%). Among the students with the oily skin, the infection rate of Demodex mite was related to sex. The infection rate of simple Demodex brevis in the male (3.70%) was lower than that in the female (16.42%) (χ2 = 6.92, P < 0.05), while the rate of the mixed infections in the male (17.28%) was higher than that in the female (4.48%) (χ2 = 5.91, P < 0.05). The infection rate of facial skin with symptoms (51.80%) was higher than that of normal facial skin (33.05%) (χ2 = 9.14, P < 0.01). There was no significant difference between the infection rate of Demodex mite and the living habits and other factors. There is some infection of Demodex in the medical students. The infection rate of facial skin with symptoms is higher than that of the normal facial skin. So we should strengthen the prevention and treatment of Demodex infection in medical students.

Low doses of nanodiamonds and silica nanoparticles have beneficial hormetic effects in normal human skin fibroblasts in culture

Nanodiamonds (ND) and silica nanoparticles (SiO2-NP) have been much investigated for their toxicity at high doses, little is known about their biological activity at low concentrations. Here we report the biphasic dose response of ND and SiO2-NP in modulating normal human facial skin fibroblasts (FSF1) in culture. ND and SiO2-NP at low concentration (up to 0.5 μg/ml) had beneficial effects on FSF1 in terms of increasing their proliferation and metabolic activity. Exposure of FSF1 cells to low levels of NP enhanced their wound healing ability in vitro and slowed down aging during serial passaging as measured by maintenance of youthful morphology, reduction in the rate of loss of telomeres, and the over all proliferative characteristics. Furthermore, NP treatment induced the activation of Nrf2- and FOXO3A-mediated cellular stress responses, including an increased expression of heme oxygenease (HO-1), sirtuin (SIRT1), and DNA methyltransferase II (DNMT2). These results imply that ND and SiO2-NP at low doses are potential hormetins, which exert mild stress-induced beneficial hormetic effects through improved survival, longevity, maintenance, repair and function of human cells.

Evaluation of unique elastic aggregates (elastic globes) in normal facial skin by multiphoton laser scanning tomography.

There is no reliable marker to estimate the degree of skin aging in vivo. It now has become possible to quantitatively determine the dermal characteristics of the extracellular matrix (ECM) in vivo using multiphoton laser tomography (MLT). Fifty-seven healthy Japanese female volunteers, aged from 20 to 60 years old, were examined using multiphoton depth-resolved measurements of autofluorescence (AF) and second harmonic generation (SHG) at three sites on their right cheek. Paraffin-embedded skin specimens obtained from the faces of 12 normal individuals aged 38-68 years old were stained with Elastica van Gieson (EVG). We found unique elastic aggregates at a 20 μm depth from the dermo-epidermal junction (DEJ) in vivo which increased in size with aging of subjects from 20 to 60 years old. SHG fibers seemed to surround those elastic aggregates. Histological examination of specimens from normal individuals stained with EVG confirmed the occurrence of elastic aggregates with varied sizes just beneath the epidermis or hair follicles. The elastic aggregates are morphologically similar to previously described 'elastic globes' and can serve as a marker of the early stage of photoaging. MLT will contribute to determine age-related dermal changes using a non-invasive technique.

Epidermal hydration levels in patients with rosacea improve after minocycline therapy

Patients with rosacea frequently report increased skin sensitivity, with features suggestive of an abnormal stratum corneum (SC) permeability barrier. Sebum, pH and hydration levels influence epidermal homeostasis. The correlation of changes in these parameters with clinically effective treatment has not been previously analysed. To analyse sebum, pH and epidermal hydration levels of patients with papulopustular rosacea (PPR) before and after treatment with systemic minocycline. We analysed sebum casual levels, pH and hydration along with erythema levels (as a marker of disease activity and response to treatment) on seven designated facial sites of 35 patients with active PPR and compared the results with values on the same sites of 34 control subjects with normal facial skin. To determine the effect of minocycline on these parameters, we re-examined the patients with PPR at the same sites after a 6-week course of treatment. Patients with untreated PPR had significantly increased erythema indices, normal sebum casual levels, a more alkaline centrofacial region and reduced epidermal hydration levels compared with controls. Treatment with minocycline resulted in reduced erythema and increased hydration levels, with the most marked changes evident in the cheeks (13·3% reduction in erythema indices, P<0·001; 12·4% increase in hydration levels, P=0·012). There was no change in skin pH or sebum casual levels following treatment. Patients with PPR have increased erythema indices, normal sebum casual levels, a more alkaline centrofacial region and reduced epidermal hydration levels compared with control subjects. Treatment with systemic minocycline reduces erythema and increases hydration, in the absence of any change in skin pH or sebum casual levels.

Lipid peroxidation-derived 4-hydroxynonenal-modified proteins accumulate in human facial skin fibroblasts during ageing in vitro

The reactive aldehyde, 4-hydroxynonenal (HNE), is recognized as a product of lipid peroxidation, which binds to macromolecules, in particular proteins. HNE-modified proteins (HNE-MP) have been shown to accumulate during ageing, generally by using polyclonal antibodies, which increase the possibility of detecting false positives. Therefore, we have used a genuine monoclonal antibody specific for HNE-His adducts of proteins/peptides, which were revealed by immunoblotting method for whole-cell HNE-MP measurements in serially passaged human facial skin fibroblasts undergoing ageing in vitro. There was a significant increase in the levels of HNE-MP in serially passaged cells approaching a near senescent state at high passage level (P-61), as compared with low passage level (P-11) young and middle-aged (P-27) cells. However, if the cells were analyzed soon after re-initiation from the frozen samples with little further passaging, the amount of HNE-MP was low even in relatively high passage level (P-37) cells, which is an indication of selective elimination of cells with high molecular damage during the process of thawing and re-initiation in culture. This pilot study on normal human facial skin fibroblasts shows that HNE-MP detection by monoclonal antibody-based dot blot method can be used as a marker for age-related accumulation of lipid peroxidative molecular damage, and could be useful for testing and monitoring the effects of potential skin care products on ageing parameters.

Are dark-skinned people really protected from ultraviolet radiation?

Premature ageing of the skin (photoageing) results from the action of ultraviolet radiation (UVR) on skin. One of the histopathological findings of photoageing is the presence of solar elastosis in the dermis. Skin pigmentation is protective against UVR. To evaluate the presence of solar elastosis in dark-skinned people. Normal facial skin biopsies of 147 dark-skinned and 140 light-skinned people were examined histopathologically for solar elastosis. The degree of solar elastosis was graded on a five-point scale by a panel of dermatopathologists blinded to patient demographics. There were 112 of 140 (80%) light-skinned and 50 of 147 (34%) dark-skinned patients with high-grade solar elastosis. In the dark-skinned patient group, high-grade solar elastosis was seen in 29 of 61 (47.5%) Hispanic and 5 of 49 (10.2%) African American subjects. Dark-skinned people are not completely protected from the effects of UVR.

Reconstruction esthétique totale du nez et des unités faciales adjacentes par combinaison optimisée lambeaux libres, greffes cartilagineuses et lambeau pédiculé frontal paramédian

Facial reconstruction with only free microvascular flaps has rarely produced an aesthetic result. Menick : "Distant skin always appears as a mismatched patch within residual normal facial skin." In addition, earlier techniques using a single large nasal lining flap or bilateral nasal lining vaults incurred a high incidence of airway obstruction. The authors describe 10 consecutive patients requiring reconstruction of the nasal vestibule and columella lining from October of 1997 through May of 2005. Most of them also required reconstruction of the floor of the nose, the platform on which the alar bases and columella rest, and of the facial units adjacent to the nose. Aesthetic nasal reconstruction used two separate skin paddles to reconstruct the lining for the nasal vestibule and columella, an artistically constructed nasal framework made of cartilage, a forehead flap for cover, and other flaps and grafts to reconstruct adjacent facial unit defects. The average patient age was 41.8 years (range, 10.4 to 65.3 years). Follow-up (from the time of the first operative stage) averaged 26.4 months (range, 4 to 49 months). Nine patients had functional airways and one required nasal airway support with internal silicone tubes. At the time of publication, eight patients had normal-appearing noses and two were awaiting secondary surgery to correct persistent deformity. Microvascular free flaps have proved to be highly reliable and efficacious for restoration of missing elements of the nasal lining and adjacent facial soft-tissue defects in total and subtotal nasal reconstruction. Combined with a forehead flap, this aesthetic approach allows for reconstruction of the center of the face layer-by-layer and facial unit by facial unit. Specific attention is paid to the artistic creation of normal nasal dimensions, proportion, and form using carved and assembled cartilage grafts and by secondary subcutaneous contouring. In addition, this technique produces a patent airway.

Application of expanded skin flap in facial aesthetic and plastic surgery

Objective To explore the aesthetic effect of the applying the expanded skin flap to re-pair facial defects produced by removal of nevus, hemangioma, scars and so on. Methods The experience of the treating 67 patients with facial lesions using the expanded flaps were reviewed. The proper expand-ers were chosen according to the scope of the facial lesion. The incision was located at the scar region and the dissection was executed in the superficial layer of the SMAS. The interspace was larger than the ex-pander by 1.0～1.5 cm. After exact hemostasis, the expanders and negative pressure drainage tubes were placed into the interspace. The design of the facial expanded skin flap included the advance, rotation, and transposition of skin flap and so on. The advance of skin flap took fully use of the expanded skin flap without the donor site defect. The transposition of skin flap also took fully use of the expanded skin flap, furthermore, it overcame the displacement and the disfiguration caused by the applying of the advance skin flap and rotation skin flap. The incisions in face were designed to a minimal extent and parallel to the Lan-ger line. Results All of the 67 cases got aesthetic satisfied results with all the flaps surviving. Conclusion The application of expanded skin flaps is proved to be an effective way of repairing facial wound when there is enough normal facial skin for expansion. Key words: Flap; Expansion; Face; Reparation

Epidermal Overgrafting Improves Coloration in Remote Flaps and Grafts Applied to the Face for Reconstruction

Flaps and grafts applied to the face from sites below the clavicles are mismatched with regard to their coloration compared with normal facial skin. The color can be improved by removing the epidermis and overgrafting with a thin, split-thickness skin graft of scalp epidermis. This report reviews the authors' clinical experience using this technique. A retrospective review of 15 consecutive patients who underwent scalp epidermal overgrafting of flaps and grafts to the face from July 1, 1995, through January 1, 2006, was performed. The resulting color was compared with the adjacent facial skin using a digital scale color analysis. Results were subjected to a Wilcoxon signed rank test. Scalp donor sites were evaluated for hair growth and density. Postoperative graft color analysis revealed significant improvement in graft/flap coloration compared with preoperative values. Evaluation of the scalp donor sites revealed no evidence of scarring, hair thinning, or hair loss. There have been no complications to date. This study is the first to demonstrate the feasibility of altering the coloration of flaps and grafts applied from remote body sites to the face using epidermal overgrafting from the scalp in Caucasian patients. Significant improvement in coloration in the treated areas compared with the adjacent facial skin has been demonstrated by this technique. The authors believe that epidermal overgrafting is a useful adjunct for enhancing color aesthetics in facial reconstruction and may well lower the threshold for use of remote flaps and grafts previously ignored because of poor color match.