Unnatural Appearance Research Articles

The Extended Corset with Bra Strap: Refinements in the Corset Trunkplasty Technique.

The corset trunkplasty was introduced by Moya et al. in 2009 (Moya and Sharma inJPRAS 62:56-64, 2009). It is a modified abdominoplasty technique that combines vertical and high lateral incisions to achieve an hourglass shape in post-massive weight loss patients. Like the traditional fleur-de-lis abdominoplasty (Dellon in Aesth Plast Surg 9:27-32, 1985) it results in a midline scar, as well as additional transverse breast fold scars, however the lack of tissue undermining reduces the risk of skin necrosis and wound-healing problems. Since its original description, it has been promoted as a practical, cost- and time-efficient procedure in the massive weight loss patient population (Loh et al. in J Plast Reconstr Aesthet Surg 74:2303-2310, 2021). The senior author (PM), has performed 43 extended corset trunkplasties since 2018. Drawbacks of the original technique include migration of the midline scar over time, stretch and enlargement of the umbilicus giving an unnatural appearance, high, unsightly lateral scars, upper back skin redundancy relative to the anterior skin tightening, and persistence of tissue excess in the flanks and lower back. Over time, the senior author has refined his technique to overcome these post-operative complications and thus improve overall aesthetic appearance and patient satisfaction.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optimized multi-scale framework for image enhancement using spatial information-based histogram equalization

ABSTRACT The histogram equalization method, used to improve images, minimizes the amount of pixel intensities, which results in the loss of detail and an unnatural appearance. This study presents an approach for enhancing low contrast images based on their inherent characteristics. The statistical parameter skewness is derived from the photographs to facilitate the classification process into dark and bright images. Based on the classification, appropriate dark and bright pass filters are applied on the multi-level decomposed images to extract the significant edge details. The level of decomposition is optimized using particle swarm optimization. The extracted edge details are utilized by the two-dimensional histogram equalization technique. It leverages the combined presence of edge information and pixel intensities in the low contrast image. The algorithm's efficacy is assessed on three databases, namely CCID, LOL, and DRESDEN, through the utilization of standard deviation (SD), contrast improvement index (CII), discrete entropy (DE), the natural image quality evaluator (NIQE), and Kullback–Leibler distance (KL). Based on the empirical findings, it can be observed that the suggested methodology exhibits better performance compared to alternative methods, including deep learning architectures, in terms of high CII, SD, DE, and low NIQE, KL values.

On the coupling of Hamilton's principle and thermodynamic extremal principles

Extremal principles can generally be divided into two rather distinct classes. There are, on the one hand side, formulations based on the Lagrangian or Hamiltonian mechanics, respectively, dealing with time dependent problems, but essentially resting on conservation of energy and thus being not applicable to dissipative systems in a consistent way. On the other hand, there are formulations based essentially on maximizing the dissipation, working efficiently for the description of dissipative systems, but being not suitable for including inertia effects. Many attempts can be found in the literature to overcome this split into incompatible principles. However, essentially all of them possess an unnatural appearance. In this work, we suggest a solution to this dilemma resting on an additional assumption based on the thermodynamic driving forces involved. Applications to a simple dissipative structure and a material with varying mass demonstrate the capability of the proposed approach.

Hierarchical Perceptual Noise Injection for Social Media Fingerprint Privacy Protection.

Billions of people share images from their daily lives on social media every day. However, their biometric information (e.g., fingerprints) could be easily stolen from these images. The threat of fingerprint leakage from social media has created a strong desire to anonymize shared images while maintaining image quality, since fingerprints act as a lifelong individual biometric password. To guard the fingerprint leakage, adversarial attack that involves adding imperceptible perturbations to fingerprint images have emerged as a feasible solution. However, existing works of this kind are either weak in black-box transferability or cause the images to have an unnatural appearance. Motivated by the visual perception hierarchy (i.e., high-level perception exploits model-shared semantics that transfer well across models while low-level perception extracts primitive stimuli that result in high visual sensitivity when a suspicious stimulus is provided), we propose FingerSafe, a hierarchical perceptual protective noise injection framework to address the above mentioned problems. For black-box transferability, we inject protective noises into the fingerprint orientation field to perturb the model-shared high-level semantics (i.e., fingerprint ridges). Considering visual naturalness, we suppress the low-level local contrast stimulus by regularizing the response of the Lateral Geniculate Nucleus. Our proposed FingerSafe is the first to provide feasible fingerprint protection in both digital (up to 94.12%) and realistic scenarios (Twitter and Facebook, up to 68.75%). Our code can be found at https://github.com/nlsde-safety-team/FingerSafe.

Autologous Lipo-Dermal Advancement Flap for Inframammary Fold Reconstruction: A Technical Note for Prevention and Management of Caudal Breast Implant Migration

Inferior breast implant displacement, also known as caudal migration, or bottoming-out, is a known complication of breast augmentation. This leads to a loss of upper pole fullness, a more superiorly located nipple-areolar complex, and an unnatural appearance. Avoiding these complaints has been a longstanding challenge in the field of aesthetics and this technical note suggests a novel solution. This technical note describes the process of preoperative assessment, careful markings, and the use of an autologous lipo-dermal advancement flap that has been designed, mobilized, and rotated to be internally fixated to costal margins and the relevant deep fascial structures at the proposed inframammary fold level. This technique creates a robust partitioning hammock-like structure that stabilizes the breast implant and prevents future caudal displacement. The described technique may be implemented as an independent solution, or as an adjunct to other modalities like biological meshes in revision breast surgery.

Lip Lifting: The Missing Link in Central Facial Rejuvenation.

The lip lift is a powerful yet finesse operation in the realm of facial rejuvenation. In an era of increased popularity of nonsurgical lip augmentation, the astute plastic surgeon must identify which patients will end up with an unnatural appearance should they receive volume enhancement alone in pursuit of central facial and perioral rejuvenation. In this article, the authors review the ideal youthful lip appearance, characteristics of the aged lip appearance, and indications for lifting. The authors present their preferred surgical technique, the underlying principles that it respects, and adjunct procedures to optimize results in central facial rejuvenation.

Optimization of Modified Atmosphere Packaging for Sheep’s Milk Semi-Hard Cheese Wedges during Refrigerated Storage: Physicochemical and Sensory Properties

Modified atmosphere packaging (MAP) has become a good potential strategy to retain quality throughout the shelf life of perishable foods. The aim of this work was to evaluate different packaging atmospheres on semi-hard protected designation of origin Idiazabal cheese wedges. Six different packaging treatments (air, vacuum, and CO2/N2 gas mixtures in the ratio of 20/80, 50/50, 80/20, and 100/0% v/v, respectively) were studied. Changes in gas headspace composition, cheese gross composition, weight loss, pH, acidity, colour, and textural and sensory properties were investigated during 56 days of refrigerated storage at 5 ± 1 °C. MAP was the most effective preserving technique compared to air- and vacuum-packaging treatments. The cheese characteristics with the greatest discriminating weight in the preservation techniques were paste appearance, holes, flavour, a* (redness) and b* (yellowness) colour parameters, and slope to hardness. Air-packaged cheeses, on 35 day, presented a mouldy flavour. Vacuum packaging affected paste appearance (greasy, plastic marks, and non-homogeneous colour) and holes (occluded and unnatural appearance) starting after 14 packaging days. MAP mixtures with CO2 concentration between 50/50 and 80/20% CO2/N2 (v/v) are recommended to ensure sensory quality and stability in the distribution of these raw sheep-milk cheese wedges.

Sunken Upper Eyelid Deformity Correction by Orbital Fat Pad Repositioning and Orbicularis Oculi Muscle Folding in Blepharoplasty.

Sunken upper eyelid deformity results in an aged and unnatural appearance and is common among Asians along with the single eyelid. The upper eyelid volume restoration is as important as the creation of a supratarsal fold for patients with sunken eyelids. In the present study, the combination of orbital fat pad repositioning and orbicularis oculi muscle flap folding was established to correct the upper eyelid depression during blepharoplasty. A retrospective study was conducted on patients who underwent the orbital fat pad repositioning and orbicularis oculi muscle flap folding to correct the upper eyelid depression between July 2020 and October 2021. The preoperative and postoperative sunken depths were calculated and compared, and overall patient satisfaction was performed to evaluate the operation efficiency. There were 40 patients, including 39 females and 1 male, who underwent surgery with an average age of 25.4 years. During the mean follow-up period of 12.7 months, the sunken depth improved from 3.2mm preoperatively to 1.5mm postoperatively with a statistical significance. Satisfactory results were achieved without major complication. For patients with mild to moderate sunken upper eyelids, the combination of orbital fat pad repositioning and orbicularis oculi muscle folding has been proved efficient and consistent to restore the upper eyelid volume and helpful to build esthetic double eyelids.

Semantic-Aware Dehazing Network With Adaptive Feature Fusion.

Despite that convolutional neural networks (CNNs) have shown high-quality reconstruction for single image dehazing, recovering natural and realistic dehazed results remains a challenging problem due to semantic confusion in the hazy scene. In this article, we show that it is possible to recover textures faithfully by incorporating semantic prior into dehazing network since objects in haze-free images tend to show certain shapes, textures, and colors. We propose a semantic-aware dehazing network (SDNet) in which the semantic prior is taken as a color constraint for dehazing, benefiting the acquisition of a reasonable scene configuration. In addition, we design a densely connected block to capture global and local information for dehazing and semantic prior estimation. To eliminate the unnatural appearance of some objects, we propose to fuse the features from shallow and deep layers adaptively. Experimental results demonstrate that our proposed model performs favorably against the state-of-the-art single image dehazing approaches.

MODIFIED COMPOSITE PLANE FACELIFT WITH EXTENDED NECK DISSECTION.

The attenuation of retaining ligaments with aging leads to downward displacement of facial fat compartments, and is responsible for many of the stigmata that occur with aging. The zygomatic cutaneous and masseteric cutaneous ligaments prevent the transmission of adequate traction to the malar portion of the dissection during traditional low SMAS facelift techniques which involve plication or imbrication of the exposed surface of the SMAS because they do not include surgical release of these ligaments. Inadequate release of these ligaments, especially the zygomatic cutaneous ligament may lead to an unbalanced, unnatural appearance with unopposed nasolabial folds. In contrast, extended facelift techniques (extended SMAS, High SMAS, deep plane facelift, composite plane facelift) involving the release of these ligaments and can reposition the ptotic malar fat, and diminish the nasolabial folds. Additionally, the composite and modified composite plane facelifts include orbicularis oculi muscle elevation and can achieve a more harmonious rejuvenation. However, due to facial nerve injury risk, many facelift surgeons either inadequately release these ligamentous attachments or prefer less invasive techniques. Modified composite plane facelift allows safe release of the zygomatic cutaneous ligament, and safe entry into the right plane leaving all malar fat pad attached to the skin. Modified composite plane facelift technique also produces combined, balanced, and harmonious rejuvenation of the midface, cheek, lower face, and neck without requiring a separate midface lift procedure or a transblepharoplasty approach. Extending the subSMAS/subplatysmal dissection inferior to the angle of mandible, releasing of the cervical retaining ligaments, and adding a horizontal platysma myotomy below the angle of the mandible significantly improves the cervical contouring and enhances the jawline rejuvenation. This paper explains modified composite-flap facelift with extended neck dissection in a step by step manner, and highlights anatomical details to perform a safe, effective and successful extended face and neck lift surgery.

The Five Ds for Safe and Effective Buccal Fat Removal.

An aesthetically sculpted malar, cheek, and jawline contour is a desirable feature sought out by many adults with central facial adiposity. This fullness, anterior to the masseter, can be attributed to underlying buccal lipodystrophy. An attractive central facial concavity can be delivered by performing buccal fat pad excision in conjunction with malar fat pad augmentation and mandibular contouring if indicated. Appropriate patient selection is critical for preventing an aged or unnatural appearance. The authors present a safe and reliable five-step technique for buccal fat pad excision: the Five Ds.

Online Patient Reviews of Breast Reconstruction: RealSelf Analysis.

The breast reconstruction category from RealSelf.com was analyzed using a web crawler-based application built from Python and Selenium. Reviews were collected from May 2009 to November 2021. Information including RealSelf's inherent "worth it" ranking system, review text, the number of submitted photographs, and the number of readers who found the review helpful was captured. The content of the review was then independently reviewed by the authors and was categorized with key factors that determined positive or negative reviews. A total of 3451 breast reconstruction reviews were collected. After the authors analyzed each review, 3225 (94.33%) were identified as positive reviews. The most common factors associated with positive reviews were physician demeanor (n = 2600, 31.7%), aesthetic outcome (n = 1955, 23.8%), or staff (n = 1543, 18.8%), while negative reviews were associated with unfavorable aesthetic outcome (n = 94, 28.9%), physician demeanor (n = 82, 25.2%), or postoperative complications (n = 75, 23.1%). Although there are surveys that analyze patient satisfaction for breast reconstruction, there has not been a study that analyzed a large online review database. Predominating factors in both positive and negative reviews were physician demeanor and aesthetic outcome.

Adapted Generalized Unsharp Masking Algorithm for Sharpness Improvement of Scanning Electron Microscopy Images

Scanning electron microscope (SEM) images are highly valuable in different scientific applications because they can depict extremely small entities. SEM images are sometimes obtained blurry, in that such an issue reduces the clarity and hampers the detection of important features in the image. One way of processing the unwanted blurring effect is to use image sharpening, which aims at emphasizing the edges so that the output appears more significant to the observer with better-highlighted details. Many image sharpening methods exist, but not all are efficient as they may introduce artifacts, unnatural appearance, contrast/brightness modifications, or can be complicated and require a high computational cost. One algorithm of interest is the generalized unsharp mask (GUSM), which avoids the generation of artifacts that many sharpening methods own and have a somewhat simple structure. Still, when the GUSM algorithm is applied to different SEM images, it provides an unnatural sharpness and modifies the contrast and brightness as well. This is undesirable because proper sharpening is required for SEM images as they depict important information. Hence, an adapted GUSM algorithm is introduced in this article in that it provides a more natural sharpening without modifying the brightness or contrast of the filtered images. The main contribution of this study is to remove the contrast enhancement procedure and replace the smoothing process to deliver more natural sharpness. The developed AGUSM algorithm is verified with different real-unclear SEM images, its performance is appraised against different image sharpening methods, and the outcomes of comparisons are evaluated by utilizing advanced metrics. For the performed experiments, the AGUSM provided satisfying performances as the outcomes appear to have more acutance and look more natural when compared to the original counterparts and the outcomes of the comparison methods.

Other mental disorders YDT due to brain damage and dysfunction and physical disease in patients with anti-NMDA encephalitis

Autoimmune encephalitis (AIE) is considered one of the most common causes of acute noninfectious encephalitis. Autoimmune encephalitis is usually of acute or subacute onset and may become chronic later. Suggested mechanisms that may trigger AIE include tumor (paraneoplastic), infection (parainfection) or may be cryptogenic. Autoimmune encephalitis has a wide range of clinical manifestations including behavioral and psychiatric symptoms, autonomic disorders, movement disorders and seizures. In this Case Report 13 year old boy, Hindu, Balinese, currently attending junior high school, unmarried, student. The patient was consulted to the psychiatry department while in the Cempaka room because he looked restless and confused. The patient experienced mood swings in the form of an unstable mood, accompanied by irritability, difficulty calming down, feeling uncomfortable, disturbed sleep, and decreased appetite after the patient underwent treatment at the hospital since last February. On physical examination, physical status was found within normal limits, nutritional status was good, and general status was within normal limits. Examination of psychiatric status found an unnatural appearance that looked confused and uncomfortable, verbal and visual contact was lacking, clear consciousness, mood and affect were labile, in thought processes there was preoccupation with the disease, in perception there were visual hallucinations.

A low-light image enhancement method with brightness balance and detail preservation.

This paper proposes a new method for low-light image enhancement with balancing image brightness and preserving image details, this method can improve the brightness and contrast of low-light images while maintaining image details. Traditional histogram equalization methods often lead to excessive enhancement and loss of details, thereby resulting in an unclear and unnatural appearance. In this method, the image is processed bidirectionally. On the one hand, the image is processed by double histogram equalization with double automatic platform method based on improved cuckoo search (CS) algorithm, where the image histogram is segmented firstly, and the platform limit is selected according to the histogram statistics and improved CS technology. Then, the sub-histograms are clipped by two platforms and carried out the histogram equalization respectively. Finally, an image with balanced brightness and good contrast can be obtained. On the other hand, the main structure of the image is extracted based on the total variation model, and the image mask with all the texture details is made by removing the main structure of the image. Eventually, the final enhanced image is obtained by adding the mask with texture details to the image with balanced brightness and good contrast. Compared with the existing methods, the proposed algorithm significantly enhances the visual effect of the low-light images, based on human subjective evaluation and objective evaluation indices. Experimental results show that the proposed method in this paper is better than the existing methods.

Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients

BackgroundImplant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery.Methods A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction.Results The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases.Conclusions The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.

Organic Hallucinosis in Non-Hemorrhagic Stroke Caused by Thrombosis Process: A Case Report

Background/aim: Hallucinations are the special ability to experience phenomena that are not visible to normal individuals. Hallucinations, delusions, and confabulations are common symptoms between neurology and psychiatry. Nervous disease that manifests with hallucinatory symptoms like this is one of them due to right hemispheric stroke. The authors report cases of new-onset organic hallucinosis. and stroke in brain regions similar to the salience network (insular cortex, parietal cortex, and striatum). Case: A 43-year-old man comes to the ER Sanglah Hospital Denpasar, Bali Indonesia with complaints of slurred speech using an incomprehensible language, and repeating the same words. Talking about seeing a shadow following him but actually not there. Patients often experience sleep disorders, from the results of neurological physical examination found right eye ptosis, pupil anisokor, nerve III dextra complete lesion, supranuclear left NVII paresis, supranuclear left NXII paresis, left flaccid hemiparesis. Psychiatric status obtained unnatural appearance, looks confused, verbal and visual contact is sufficient, mood dysphoric, confused affect and there is no harmony. The thought process obtained realistic, coherent, preoccupation with pain. Perceptual disturbances in the form of visual and auditory hallucinations. Insomnia mixed type and there is hypobulia. Psychomotor calm on examination, history increases. Narcissistic personality traits and defense mechanisms of ego repression. Grade 4 view. CT scan of the head with and without contrast shows subacute ischemic cerebral infarction in the right internal capsule to the right thalamus and midbrain. Conclusion: Organic hallucinosis occur in non-hemorrhagic stroke caused by thrombosis process if an infarction is found in the right hemisphere. Keywords: organic hallucinations, ischemic cerebral infarction, non-hemorrhagic stroke, right hemisphere.

Oral Commissure Lift: A Retrospective Analysis of Complication Rates and Overall Outcomes.

Downward-turning oral commissures and sagging mouth corners can present an unfavorable impression. We introduced a new oral commissure lift procedure and investigated its effectiveness and complication rates. Patients who underwent oral commissure lift in the plastic surgery clinic between January 2010 and December 2017 were enrolled retrospectively. Pre-and postoperative photographs were evaluated to measure oral commissure angles and analyze surgical complications, including visible scarring, unnatural appearance, and asymmetry. Many patients underwent a oral commissure lift with a simultaneous facelift. To exclude potential bias, we compared angular changes between patients receiving both oral commissure lift and facelift, with those receiving only oral commissure lift. Moreover, oral commissure angles of patients only receiving facelift were also measured. Statistical significance was set at p < 0.05. Oral commissure lift was performed in 51 patients. The mean ages and follow-up periods were 46.7 ± 11.9 years, and 25.2 ± 22.9 months, respectively. The preoperative mean angles of the right and left oral commissures measured - 3.1 ± 4.0° and - 3.4 ± 3.7°, respectively, and postoperative mean angles measured 3.6 ± 3.2° and 3.3 ± 3.5°, respectively. Postoperative changes in oral commissure angles were statistically significant (p < 0.05). The low complication rate included undercorrection in one patient, asymmetry in one patient, and visible scarring in three patients. We found no statistically significant differences in the studies excluding bias. The new oral commissure lift procedure for correcting sagging oral commissures was simple, safe, and effective with a low complication rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Colored, Covert Infrared Display through Hybrid Planar‐Plasmonic Cavities

AbstractArtificial covert infrared (IR) displays have recently emerged as an anti‐counterfeiting method for spontaneous thermal emissive surfaces and optically encoded information. However, the unnatural appearance of a conventional thermal emissive label in the visible region limits the widespread application of an artificial covert IR display. This paper presents a colored, covert IR display exhibiting visible color patterns and thermally encoded data simultaneously based on a hybrid planar‐plasmonic cavity (HPPC). The HPPC is composed of two spectrally distinguished resonant structures: 1) an ultrathin planar cavity with an amorphous silicon (a‐Si) layer on gold (Au) for visible coloration and 2) an IR plasmonic cavity with hole‐patterned Au on a polymer substrate with a back mirror for thermal data encoding. Such hybridization of multi‐band resonance can not only enhance the vivid coloration but also enhance the data storage capacity per unit. Camouflage labels with encrypted thermal data are successfully demonstrated for practical applications using a flexible HPPC. Collectively, the proposed HPPC enables a new type of anti‐counterfeiting method that achieves both esthetic, visibly encoded data, and covert, thermally encoded data.

Perioral volumization using a temperature controlled fractionated radiofrequency device

Cosmetic rejuvenation of the perioral area can be challenging due to a mix of skin laxity and volumetric loss. Current techniques including fillers, neurotoxins, and non-ablative and ablative resurfacing have several drawbacks and can create a stiff, box-shaped, unnatural appearance. Aside from filler, these techniques do not address deeper volume deficiency. Temperature controlled fractionated radiofrequency (FRF) provides consistent formation of new collagen, elastin, and hyaluronic acid. This has been reported to provide long-lasting results for the treatment of skin laxity and volume loss of the face and neck with a single treatment, but it has not been previously reported for perioral rejuvenation. We present a series of seven patients who were treated with perioral FRF, and we assessed their results objectively using a published, validated scale for lower face laxity. All of the patients in this case series showed improvement on the Facial Laxity Rating (FLR) scale after FRF treatment. This case series represents the first reported use of temperature controlled FRF for perioral rejuvenation. FRF is a promising option for low-risk, natural perioral rejuvenation with long-lasting results and few risks.