Excess Skin Research Articles

Assessment of outcomes of upper blepharoplasty in middle-aged women

Objective: To do statistics on some factors which lead to morphological changes of upper eyelid and surgical methods used to improve upper eyelid status in women over 40 years old. Subject and method: A prospective, descriptive study was conducted on 155 patients who were treated surgically at 108 Military Central Hospital from June 2022 to June 2023. Result: Patients had 89% of excess skin, 52.2% of muscle prolapse, 19.4% of fat hernia and fat atrophy. Patients were divided into 5 groups based on their characteristics of upper eyelid changes and skin properties (thick or thin) to apply surgical methods. Group 1 included patients who had excess skin, thin skin and multiple eyelid folds; and received surgical removal of excess skin along the eyelid folds and eyelid fold reconstruction. Group 2 included patients who had excess skin, thin skin and 1 clear eyelid fold; and received surgical removal of excess skin along the eyebrow curve. Group 3 included patients who had excess skin, thick skin, muscle prolapse and eyelid folds; and received surgical removal of excess skin along the eyebrow curve and browplasty. Group 4 included patients who had excess skin, thick skin, muscle prolapse, no eyelid folds or uneven eyelid folds; and received surgical removal of excess skin along the eyebrow curve, browplasty and correction of eyelid folds. Group 5 included patients who had thick skin, fat hernia and not much excess skin; and received surgical removal of fat and correction of eyelid folds. Conclusion: Through study, assessment and analysis of the outcomes of upper blepharoplasty for 155 female patients who are 40 years old or older, we conclude that if we identify correctly prolapse and deformity for each case, we can choose suitable solutions which have short postoperative recovery, good reconstructive outcomes and high patient satisfaction.

Técnica de ressecção lateral do conduto auditivo modificada para o tratamento de estenose auricular em seis equinos

The external ear extends from the pinna to the tympanic membrane, where it is supported and shaped by an arrangement of cartilages including the conchal, annular, scutiform, and external acoustic meatus. Environmental exposure can often lead to diseases of the external ear canal in animals. In horses, otitis primarily occurs due to infestation by ectoparasites, promoting local inflammation and infection. Chronic conditions can result in ear deformation, including auricular canal stenosis. While operative techniques for treating auricular stenosis are known, they are limited to companion animals, with few reports on horses. This study aimed to describe the modified lateral resection technique of the ear canal, which is commonly performed in small animals, for treating auricular canal stenosis in six horses. As a methodology, the intertragic notch was used as a reference for the incision due to species disparity. The ear canal cartilage was dissected, followed by resection of the lateral wall and the cartilaginous flap adhered to the skin. Excess skin was removed, and the ear canal was sutured to the skin with nylon thread. Our results indicated a significant improvement in the treatment of otitis in the treated horses, demonstrating a favorable evolution in the healing process and resolution of bacterial infections in all cases. In conclusion, the use of the modified lateral resection technique of the ear canal was successful in all six treated horses, providing access to clinical treatment of the canal without any occurrences of recurrence or postoperative complications.

THU667 Severe Hypothyroidism With Paradoxically Elevated Direct Free T4 Due To Anti-thyroxine Antibodies

Abstract Disclosure: O. Magvanjav: None. M.J. McPhaul: None. I. Choucair: None. E. Holt: None. Introduction Laboratory interference may cause abnormal thyroid function test (TFT) results, leading to misdiagnosis and inappropriate patient care. There are several major types of interference. Here, we describe a hypothyroid patient with an elevated thyroid stimulating hormone (TSH) level with a paradoxically elevated direct free thyroxine (FT4) level caused by interference from anti-thyroxine autoantibodies (THAAB). Clinical Case Our patient is a 38-year-old man who was found to have markedly elevated TSH and FT4 levels during an outpatient workup for Lyme disease. The patient was overall well-appearing but reported some symptoms suggestive of hypothyroidism including excessive fatigue, non-pitting edema, and dry skin. Physical exam was notable elevated blood pressure (systolic blood pressure of 150 mmHg and diastolic blood pressure of 95 mmHg), normal temperature, normal heart rate (72 bpm), regular heart rhythm, and normal body mass index. He had non-tender thyromegaly without nodules, non-pitting edema of bilateral hands and legs, decreased leg hair over bilateral shins, and coarse, dry skin of his hands. Initial TSH level was >150 mIU/ml, with a paradoxically elevated direct FT4 of 10 ng/dl (normal range 0.80-1.70 ng/dL). The FT4 level by equilibrium dialysis was <0.2 ng/dl. Outside laboratory testing to eliminate the effect of heterophile antibodies using two different assays again returned with elevated FT4 levels. Screening for macro TSH confirmed the markedly elevated TSH level. Further investigations at a second outside laboratory revealed that he had THAAB. A repeat FT4 level by dialysis confirmed the markedly low FT4 levels. He was empirically started on low dose levothyroxine and after increasing the levothyroxine dose, he showed improvement in clinical symptoms and the expected decline in TSH. Conclusions Here we present a rare case of THAAB that caused laboratory interference during thyroid function testing, leading to falsely elevated thyroid hormone levels on immunoassays. This case shows the importance of suspecting interference when there is a discrepancy between clinical symptoms and laboratory results or between results obtained from different testing methods. Our patient likely had a genetic predilection for autoimmunity, and Lyme disease is a known trigger for various autoimmune conditions. Our case also emphasizes the importance of taking a systematic approach to investigate the cause of the laboratory interference. This will help prevent misdiagnosis of thyroid disorders that may lead to additional unnecessary testing and treatment. Presentation: Thursday, June 15, 2023

Mid-to-long-term outcomes with image-guided placement of de novo low-profile gastrojejunostomy tubes in pediatric patients

ObjectiveDe novo low-profile gastrojejunostomy (GJ) tubes are advantageous in children that require prolonged supplemental nutrition. However, few institutions place these devices at the time of initial feeding tube placement. We aim to build upon our previously published initial experience with this procedure to study mid-to-long-term outcomes of pediatric patients who have had de novo, image-guided, percutaneous low-profile GJ tube placement. MethodsAll de novo, image-guided, percutaneous, low-profile GJ tube placements at a single children's hospital were retrospectively reviewed between May 2014 and March 2021. Technical parameters, including fluoroscopy time, tube size, technical success, and complications were recorded. Clinical data, including age, indication, weight gain and transition to gastric/oral feeds were analyzed. Results64 de novo low-profile GJ tubes were successfully placed in 65 patients (mean age: 4.6 years, median: 1, range: 0.2–19; mean pre-procedural weight: 16.8 kg, median: 8.2, range: 4.4–66.7). Average clinical follow-up 23.4 months (range: 0.1–75, median 10.4). Average weight gain was 6.1 kg. Average increase in weight percentile was 7.3%. 19 (19/64; 29.7%) patients had conversion from GJ to G tube. 11 (11/64; 17.2%) patients had their enteric tube removed completely. There were 7 minor complications (7/65; 10.7%), most common being excessive skin irritation (6/7) and 9 major complications (9/65; 13.8%), most common being tube dislodgment within the first 30 days (6/9). ConclusionsThese results further support that de novo, image-guided, percutaneous, low-profile GJ tube placement is technically feasible and efficacious in children requiring post-pyloric nutritional supplementation with a favorable safety profile.

Ehlers-Danlos Syndrome - living with chronic pain. Current knowledge of the disease

Ehlers Danlos Syndrome (EDS) is a group of the most common inherited connective tissue disorders. The main symptoms of this syndrome are excessive skin flexibility, joint hypermobility and blood vessels fragility. The diagnosis is based on clinical symptoms, but to confirm the type of EDS, it is necessary to identify the collagen-encoding gene or protein interacting with it. The group of Ehlers and Danlos diseases include fourteen types, the most common are classic, vascular, hypermobile, arthrochalasis, kyphoscoliotic and dermatosparaxis. [15] Connective tissue plays a key role in the process of movement, constituting the main component of bones, joint cartilage, tendons, ligaments and intervertebral discs. In addition, connective tissue is a part of every internal organ including the intestines and parenchymal organs and the cardiovascular system.[19] For this reason, patients with EDS show symptoms of many diseases, including respiratory, muscular, skeletal and vascular. Women suffering from EDS often struggle with complications during their pregnancies. Psychological and emotional issues are also common.[6] However, the most noticeable and debilitating symptom of EDS is pain, which is often severe and chronic. The pain occurs in approximately 90% or more of EDS patients.[8] Successful pain management in patients with EDS is a major challenge for specialists. The treatment involves non-steroidal anti-inflammatory drugs, acetaminophen, opioids and physiotherapy. Also marijuana, traditional chinese treatments, herbal remedies are considered to reduce the severity of the symptoms. [9] During the creation of this article, the authors analyzed the clinically relevant knowledge of EDS treatment and management based on research published on Pubmed.

Physiotherapy resources applied in patients submitted to abdominoplasty: a systematic review

Background: Abdominoplasty surgery is characterized by the removal of excess skin in the abdominal region, providing a desirable visual effect to the body. However, complications from the postoperative period can cause patient dissatisfaction and even risk to health, due to the inflammatory and scarring reaction due to the trauma caused by the surgical procedure. For the control and prevention of these effects, treatment with a physiotherapy professional is recommended, working with several resources. Objectives: To investigate the post-surgical interventions most used by physiotherapists in patients in the postoperative period of abdominoplasty, together with the resources used. Methods: This is a systematic literature review carried out using a comprehensive strategy in the PubMed, Embase, Cochrane, SCOPUS, Scielo, Web of Science and Google Scholar databases. Results: : Five studies, 3 clinical trials and 2 observational trials were carried out. included in the review. Of a total of 456 patients, 447 were female and 9 were male. The average age range was 18 to 67 years. The results showed that the most used resources with physiotherapeutic treatment include US, DML, Lymphotaping. Conclusion: It is concluded that the intervention of the physiotherapist is effective for the prevention of adverse symptoms such as hematomas, fibrosis, edema, swelling and inflammation, since the professional acts according to the scarring phases of the postoperative period.

Nipple-Preserving Inferior-Ellipse Mastectomy: A New Technique for Gender-Affirming Top Surgery.

The 2 most common techniques for gender-affirming mastectomy are the double-incision free nipple graft and periareolar techniques. However, some patients are not well suited for either technique. When the nipples are high and on the pectoralis muscle, but there is marked breast tissue and skin redundancy, a double-incision free nipple graft would land the incision above the pectoral shadow, but a periareolar approach would not adequately remove the excess skin. In these patients, a nipple-preserving inferior-ellipse incision allows for appropriate chest contouring, leaving the nipple position unchanged and placing the incision in the pectoralis muscle shadow. A retrospective review identified all consecutive patients undergoing nipple-preserving inferior-ellipse mastectomy by the senior author (R.B.-L.). Indications were patients with moderate glandular tissue, skin excess, and a high nipple-areola complex (NAC) above the inferior border of the pectoralis major. Sixteen patients underwent inferior-ellipse mastectomy and were included. Mean follow-up was 203 days. Two patients (14%) required revision of the NAC. There was no partial or complete NAC loss. One patient (7%) developed postoperative seroma, which resolved with aspiration. For patients with moderate glandular tissue, excess skin in the inferior pole, and NAC position above the inferior border of the pectoralis major, the nipple-preserving inferior-ellipse mastectomy technique achieves excellent chest contour.

The deep cervical fascia neck lift

The main and more frequent problem in face lift is recurrence of neck bands. To improve face lift stability, a new aging analysis is proposed. The visible sign of face aging is skin excess. Superficial musculo aponeurotic system (SMAS) retraction is a much less visible sign. Nevertheless, botulinum toxin injections elongate muscles of the SMAS and rejuvenate the face. In the Face Recurve Concept, MRI studies prove the mimic muscles retraction that comes with aging. Face lift techniques include SMAS plication, traction or excision, which increases discrepancy between the envelope, the skin and the core, the SMAS. As skin excision is poorly efficient because performed posteriorly, far from the anterior skin excess located at the medial neck, the association to SMAS retraction exacerbates the gradient difference between envelop and core. This analysis shows that it is paramount to preserve the SMAS. (1) The sub-skin dissection has to be executed moving beyond the marionette fold and the paramedian neck bands; (2) no action is performed on the SMAS, only an horizontal section of the platysma at the hyoid height that will avoid platysma band recurrence. A botulinum toxin injection performed herein just after, blocks muscle regeneration; (3) the skin is pulled backward with a clear posterior transposition to the platysma. The skin at the cervico-mental angle and all along the cervico-mental crease is fixed to the deep cervical fascia, in the gap between the edges of the sectioned platysma, blocking muscle recreation. A resorbable barbed thread is used, with a first bite made at the cervico-mental angle through the deep cervical fascia then in the direction of the mastoid, with long bites through the deep cervical fascia versus short subcutaneous bites. Thanks to this strong shift, the cervico-mental crease is definitely recreated with no need of pre-auricular skin tension. Thirty-two patients have been operated with this technique on a one-year period. The results are a lot more stable and swelling is lowered down to the minimum.

Panniculus Morbidus: A New Global Health Crisis Due to Extreme Obesity

At present panniculus morbidus becomes a cause of various physical complications, such as chronic cellulitis, skin rashes, intertriginous dermatitis, subcutaneous abscesses, folliculitis, skin ulcerations, fistulas, and ischemic panniculitis. Panniculus is seemed as an apron of an extremely large fold of excess skin, tissue, and fat hanging from the abdomen below the waistline and even down to the groin. It is extremely unsightly, painful, and susceptible to various infections. It is found in people who are severely obese, after extreme weight loss (usually 100 pounds or more) through the diet, fasting, and exercise or following gastric restrictive surgery. Medicine, exercise, diet or any other mechanism cannot cure panniculus morbidus; and in this stage, bariatric surgery is needed for the welfare of the panniculus patients.

Preliminary studies on the role of mast cells in the phenotype and immune activation of type 2 inflammatory cytokine release of atopic dermatitis

Objective: To investigate the role of mast cells in atopic dermatitis (AD) phenotype and the immune activation of type 2 inflammatory cytokine release. Methods: Nine AD skin samples were obtained from the Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, and nine healthy skin control samples were obtained from the surgical excision of excess normal skin by orthopedic surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, which were subjected to toluidine blue staining and fluorescence staining to clarify the mast cell degranulation activation status of the AD skin lesions. We investigated whether MC903 could directly activate mast cells in vivo through the toe swelling and exudation assay in wild-type mice; we constructed the MC903-AD model using wild-type and KitW-sh/W-sh mast cell-deficient mice in order to investigate whether mast cells affected the phenotype, histopathology, and the level of type 2 inflammatory factors in AD mice; we extracted mouse peritoneal mast cells and the ability of MC903 to activate mast cells to release inflammatory mediators in vitro was explored by calcium imaging, tryptase and β-aminohexokinase release assays, and MCP-1 and CXCL-2 release assays. Results: The number of degranulated mast cells in an activated state was increased in skin lesions of AD patients compared to healthy controls, with (5.40±1.14) and (2.20±0.84), respectively (P<0.001). KitW-sh/W-sh mast cell-deficient AD mice had an attenuated phenotype with ADI scores of (5.50±1.05), compared to wild-type AD mice with (10.00±0.89) (P<0.001). The release of type 2 inflammatory factors in wild-type AD mice was higher than those in KitW-sh/W-sh mast cell-deficient AD mice, with IL-4 levels of (29.50±1.87) and (15.33±1.86) pg/mg (P<0.001), IL-13 levels were (6.32±0.25) and (3.93±0.22) pg/mg (P<0.001), IL-31 levels were (9.73±0.38) and (6.89±0.27) pg/mg (P<0.001), and TSLP levels were (206.00±4.43) and (99.00±4.86) pg/mg (P<0.001), respectively. MC903 could cause mast cell activation in wild-type mice, leading to increased swelling and exudation in the toes of mice, and MC903 could activate mast cells in vitro, leading to increased degranulation and release of inflammatory factors such as MCP-1 and CXCL-2. Conclusions: The number of activated mast cells was increased in skin lesions of AD patients than in healthy controls. KitW-sh/W-sh mast cell-deficient AD mice showed significantly reduced phenotype, histopathology, and type 2 inflammatory factor levels compared with wild-type AD mice. MC903 activates mast cells in vivo and in vitro. Mast cells play a key role in AD phenotype and immune activation.

Implications of Ozempic and Other Semaglutide Medications for Facial Plastic Surgeons.

Obesity is a growing global health concern, leading to various health issues, including diabetes. Semaglutide-based medications, such as Ozempic, Wegovy, and Rybelsus, have emerged as potential treatments. These medications, belonging to the glucagon-like peptide-1 (GLP-1) receptor agonist class, mimic the action of GLP-1, regulating appetite and promoting weight loss. Clinical trials have shown their effectiveness in reducing body weight and improving metabolic parameters. Ozempic, though Food and Drug Administration-approved for diabetes, is also used off-label for weight loss alone. Rapid weight and fat loss with Ozempic can lead to the characteristic "Ozempic face," where facial volume and fat are depleted, resulting in wrinkles and sagging skin. Providers prescribing Ozempic seldom counsel patients about the potential impact on the face. As a result, the plastic surgery community faces a challenge in managing facial changes associated with rapid weight loss. Dermal fillers, skin tightening techniques, and surgical interventions are useful for both restoration of facial volume and to manage excess skin. Discontinuation of Ozempic should be considered prior to general anesthesia due to gastrointestinal side effects including delayed gastric emptying. As the popularity of Ozempic grows, facial plastic surgeons must be aware of both the impact on facial appearance and perioperative considerations.

Surgical correction of omphalocele in local goat breed (Beetal) of Jhang, Punjab: A case study

Omphalocele is a rare congenital condition where closure defects in the abdominal wall at the umbilical ring lead to the protrusion of intestinal or other visceral organs, covered by a thin epithelial layer. The developmental mechanism of this condition is not fully understood, and various theories have been proposed to explain it. This study presents a case of omphalocele in a newborn female black goat kid, detailing its clinical presentation, surgical management, and postoperative care. The surgical procedure involved meticulous preparation of the surgical site, administration of local anesthesia, and careful repositioning of the intestines, liver, and a portion of the spleen. Excess skin and the amnion membrane were removed to facilitate safe repositioning, and the umbilical ring was excised to widen the opening. The abdominal wall layers were meticulously closed using appropriate suture materials. The kid’s postoperative recovery was uneventful, with normal vital signs, fecal passage, and feeding behavior observed. The study discusses omphalocele in comparison to other abdominal abnormalities and explores potential developmental mechanisms. The authors emphasize the importance of immediate surgical intervention despite varying prognoses associated with this condition. The study underscores the significance of surgical treatment for omphalocele cases in newborn goat kids, providing hope for affected animals and valuable insights for veterinary professionals. Although the exact prevalence of omphalocele remains uncertain due to unreported cases, this report demonstrates successful surgical correction and the potential for curing the condition if diagnosed and treated promptly. Further research is needed to fully understand the genetic and environmental factors contributing to omphalocele and its impact on livestock.

Implant retained prosthesis on a free fibula flap: A challenging procedure for prosthetic and soft tissue management

A 39-year-old woman who had undergone fibular flap reconstruction and simultaneous implant placement after the surgical removal of a cemento-ossifying fibroma was experiencing mild discomfort 3 years later and requested an implant-supported prosthesis to restore her edentulous left maxillary quadrant. Initially, an interim removable partial denture was provided and later duplicated with clear resin. The interim prosthesis identified the excessive thickness of the grafted cutaneous soft tissue and the inadequate emergence angle of the nonfunctioning implants. By using the interim prosthesis as a surgical guide, vestibuloplasty was performed to thin the peri-implant soft tissue and the excessive skin graft from the initial maxillofacial surgery. Concurrently, the emergence angle of the implant was corrected with angled multi-unit abutments. A tissue compression stent was then made and attached to the abutments to guide the soft tissue healing process. When the peri-implant soft tissue had stabilized, a definitive implant-supported prosthesis was provided.

Factors Associated with Satisfaction with Male Genital Self-Image in Brazil.

Male genital self-image (GSI) refers to how men feel about their genitals. Studies suggest that GSI is influenced by several psychosocial and physical factors, such as frequency of sexual activities, anxiety, and sexual dysfunctions. In Brazil, no studies have investigated the factors associated with satisfaction with male GSI. This is a cross-sectional and online study conducted with Brazilian men over 18years of age. The Male Genital Self-Image Scale (MGSIS), Body Appreciation Scale-2 (BAS-2), and International Index of Erectile Function (IIEF) were used. Body appreciation and frequency of sexual activity were included as confirmatory variables and other variables were explored as factors associated with GSI. Data were analyzed by binary logistic and multiple linear regression, according to the MGSIS cut-off point for satisfaction with male GSI and total score of MGSIS, respectively. A total of 1,235 men (M = 26.14, SD = 7.28years) participated in the study. The mean of the total MGSIS score was 23.02 (SD = 4.45; absolute range, 7-28) points, with 62.11% of men being classified as satisfied with GSI. Men satisfied with GSI were more likely to have a partner, higher body appreciation, lower body mass index (BMI), and not have phimosis (excess skin covering the penis, making it difficult to expose the glans). Satisfaction with GSI of Brazilian men was associated with relationship status, body appreciation, BMI, and phimosis.

The application of chest wall perforator flaps in total breast reconstruction after mastectomy for breast cancer: A case report

Abstract Chest wall perforator flaps (CWPFs) have become a useful tool in oncoplastic surgery in recent years, and they can facilitate breast-conserving surgery for women who would otherwise be candidates for mastectomy. Patients with excess skin and fat in the lateral chest wall can be suitable for this technique. So far, it was believed that these local flaps cannot provide adequate volume for total breast reconstruction. Thus, there is a paucity of data on the subject, except for very few small case series worldwide. Here, we present a case report of a female breast cancer patient who underwent immediate total breast reconstruction after mastectomy, using two stacked perforator flaps from the lateral chest wall and the upper abdomen. This case report shows that CWPF can be a new alternative to other methods of breast reconstruction, such as implants and free or pedicled musculocutaneous flaps.

Surgical Tips for Aesthetic Lower Lid Blepharoplasty: Prevention of Round Eye

Purpose: In the present study, we highlight surgical tips based on our experience in lower eyelid blepharoplasty. These have been shown to be crucial in the prevention of several complications, specifically lateral lower-lid displacement. Methods: A series of bilateral lower-lid blepharoplasties were performed on 280 patients at Humanitas-Research-Hospital (Milan, Italy) between January 2016 and January 2020. Patients with a history of lower-lid blepharoplasty and patients requiring canthopexy/canthoplasty were excluded. Needing to singularly evaluate and correct several lower-eyelid structures to obtain a harmonic result, we preoperatively assessed the amount of skin excess, the eyelid margin malposition relative to the globe, and the presence/absence of herniated fat-pads. Pre- and postoperative standard photographs were collected. Patients were evaluated by measuring scleral show, snap-back test, and distraction test. Blinded-fashioned photograph analysis was performed by independent plastic and oculoplastic surgeons who did not execute the procedures. A visual analogue scale was administered to all patients to assess satisfaction. Results: In total, 280 patients underwent successful lower blepharoplasty, with satisfactory results of scleral show, snap-back test, and distraction test. Of the 280 patients, four presented postoperative complications. At 10-month follow-up visit, we achieved a mean patient visual analogue scale satisfaction score of 8.4. Postoperative surgeon’s photographs mean score was 4.5. Conclusions: Without the use of muscle flaps, our technique averts tarsal ligament misposition, preserves orbicularis-muscle innervation, and limits thermal spread, assuring excellent stability of results and high patient and surgeon satisfaction. Cosmetic outcome in terms of symmetry, appearance, and lower lid line definition revealed high satisfaction with the result over time, with a remarkably low complication rate.

Factors Associated with Excess Skin After Bariatric Surgery: a Mixed-Method Study.

After metabolic and bariatric surgery (MBS), many patients have excess skin (ES), which can cause inconveniences. Identifying factors related to ES quantity and inconveniences is crucial to inform interventions. The aim of this study was to identify sociodemographic, physical, psychosocial, and behavioral factors associated with ES quantity and inconveniences. A mixed-method study with a sequential explanatory design was conducted with 124 adults (92% women, Mage 46.5 ± 9.9years, Mtime post-MBS 34.2 ± 27.6months). During phase I, ES quantity (arms, abdomen, thighs) and inconveniences and sociodemographic, anthropometric, clinical, and behavioral outcomes were assessed. In phase II, 7 focus groups were performed with 37 participants from phase I. A triangulation protocol was completed to identify convergences, complementarities, and dissonances from quantitative and qualitative data. Quantitative data indicate only ES quantity on arms was associated with ES inconveniences on arms (r = .36, p < .01). Total ES quantity was associated with maximal body mass index (BMI) reached pre-MBS (r = .48, p < .05) and current BMI (r = .35, p < .05). Greater ES inconvenience was associated with higher social physique anxiety and age (R2 = .50, p < .01). Qualitative data were summarized into 4 themes: psychosocial experiences living with ES, physical ailments due to ES, essential support and unmet needs, and beliefs of ES quantity causes. Measured ES quantity is related to higher BMI, but not reported inconveniences. Greater self-reported ES quantity and inconveniences were associated with body image concerns.

A National Analysis of Socioeconomic Variables of Access to Inpatient Body Contouring Procedures After Bariatric Surgery.

Weight loss following bariatric surgery often results in excess skin, which has led to a population of patients seeking body contouring surgery (BCS). This study aimed to investigate the prevalence of patients who underwent BCS following bariatric surgery using the national inpatient sample (NIS) database and to assess the demographic and socioeconomic variables of this cohort. NIS database was queried from 2016 to 2019 using ICD-10 codes to identify patients that underwent bariatric surgery procedures. Patients who subsequently underwent BCS were compared to those who did not. Multivariate logistic regression was used to identify factors associated with receipt of BCS. A total of 263,481 patients that underwent bariatric surgery were identified. Of those, 1777 (0.76%) patients underwent subsequent inpatient BCS. Being female was associated with greater odds of undergoing body contouring (OR 1.28 95% CI 1.13-1.46, p = 0.0001). Patients who underwent BCS were more likely to have their procedure performed in large and government-controlled hospitals than bariatric surgery-only patients (55% vs. 50%, p < 0.0001, and 11% vs. 9.4%, respectively). Higher-income did not impose higher odds of receiving BCS compared to lowest income quartile (OR 0.99, 95% CI 0.86-1.16, p = 0.99066). Lastly, compared to Medicare holders, self-payers (OR 3.5, 95% CI 2.83-4.30, p < 0.0001) or private insurance (OR 1.23, 95% CI 1.09-1.40, p = 0.001) had greater odds of undergoing BCS. There is a gap in access to BCS procedures, with cost and insurance coverage being the principal barriers. Developing policies that allow for holistic evaluation of patients is crucial to improve access to these procedures.

Rare Congenital Frontal Hairline Deformity with Temporo-Parieto-Occipital Multiple Folds of Scalp.

Two cases of congenital hairline deformity are reported. Both cases exhibited multiple wrinkled areas in the lower occipital region, with hair that punctured and irritated the adjacent skin as it grew, creating ulcerated lesions. Both patients had a unilateral folded and raised wrinkled and twisted region stretching from the temporal area to the parietal and occipital areas. There was also a defect in the frontotemporal hairline of the affected side that was not present on the contralateral side. The skin of the forehead was also thinner on the affected side. Both patients were in good physical health and had no other congenital abnormalities or pertinent family history. There were no other skin, neurological, or physical abnormalities. In each case, the excessive skin was excised from the temporo-occipital region and microscopically dissected into follicular units, which were transplanted into the temporal area and the frontal hairline. Histologic examination did not reveal any specific abnormal findings. The transplanted hairs were well engrafted and showed natural results. Congenital anomalies of the hairline or hair-bearing scalp tissue are rare. Cutis verticis gyrata is a rare disease that causes multiple furrows and folds of the scalp. However, the cases reported here exhibited a somewhat different appearance from that of cutis verticis gyrata, as multiple folds were present in the scalp in each case, along with an alopecic lesion. This author has successfully treated 2 cases of this rare form of congenital hair loss that has not yet been reported to our knowledge.

Hyperglycemia-activated 11β-hydroxysteroid dehydrogenase type 1 increases endoplasmic reticulum stress and skin barrier dysfunction

The diabetes mellitus (DM) skin shows skin barrier dysfunction and skin lipid abnormality, similar to conditions induced by systemic or local glucocorticoid excess and aged skin. Inactive glucocorticoid (GC) is converted into active glucocorticoid by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). Hyperglycemia in DM and excessive GC are known to increase endoplasmic reticulum (ER) stress. We hypothesized that hyperglycemia affects systemic GC homeostasis and that the action of skin 11β-HSD1 and GC contributes to increased ER stress and barrier defects in DM. We compared 11β-HSD1, active GC, and ER stress between hyperglycemic and normoglycemic conditions in normal human keratinocytes and db/db mice. 11β-HSD1 and cortisol increased with time in keratinocyte culture under hyperglycemic conditions. 11β-HSD1 siRNA-transfected cells did not induce cortisol elevation in hyperglycemic condition. The production of 11β-HSD1 and cortisol was suppressed in cell culture treated with an ER stress-inhibitor. The 14-week-old db/db mice showed higher stratum corneum (SC) corticosterone, and skin 11β-HSD1 levels than 8-week-old db/db mice. Topical 11β-HSD1 inhibitor application in db/db mice decreased SC corticosterone levels and improved skin barrier function. Hyperglycemia in DM may affect systemic GC homeostasis, activate skin 11β-HSD1, and induce local GC excess, which increases ER stress and adversely affects skin barrier function.