Visible Scars Research Articles

Quantitative analysis of facial symmetry and animation following intraoral orthodromic temporalis transfer in facial paralysis

This study aimed to quantitatively analyze the degree and vector of commissure excursion following intraoral orthodromic temporalis transfer. Patients with unilateral facial paralysis who underwent intraoral temporalis transfer were included. Intra-oral coronoidectomy was followed by submucosa tunneling through two vertical intraoral incisions to fixate the temporalis tendon to the perioral location. Oral commissure excursion, upper lip and commissure height differences, and smile angle were measured.Postoperatively, the symmetry of commissure excursion improved in repose (affected side: 114.6 ± 7.0 mm, non-affected side: 115.2 ± 4.9 mm, p = 0.134), while asymmetry arose in smiling (affected side: 30.7 ± 3.4 mm, non-affected side: 34.5 ± 4.4 mm, p = 0.001). Furthermore, the postoperative smile angle demonstrated insufficient vertical movement on the affected side during smiling (affected side: 115.6 ± 5.8°, non-affected side: 118.4 ± 4.9°, p = 0.002) but no significant difference in repose (p = 0.134). Within the limitations of the study it seems that intraoral orthodromic temporalis transfer yields excellent resting symmetry, but smile asymmetry may occur owing to insufficient oral commissure excursion. Nevertheless, as a minimally invasive surgery, this technique can obviate visible scars and benefit patients wishing for the same and can have excellent resting symmetry.

After the pain: A sermon on John 20:19–20

In the Gospel of John, readers encounter a community of believers who gather behind locked doors even after they have heard Jesus is alive. What can one make of their actions? Why are they not rejoicing, spreading the good news? Something is amiss. Jesus is alive, but the disciples are terrified and appear uncertain about what to do next. Using a trauma-informed hermeneutic, I interpret the actions, words, and apparent mood of the disciples in John 20: 19–20 as symptoms of post-traumatic stress disorder (PTSD). Jesus’s visible scars testify to his pain and prove that the person in the room is the same person who hung on the cross. In a similar vein, the scars, visible and invisible, of trauma survivors tell stories of unimaginable horror. Many people who survive traumatic events manage to integrate their experiences without prolonged injury to their mental health. For others, however, this is not the case. Fragmentation, not integration, characterizes their post-trauma narratives. Is there any escape for those who live in this prison? For John, the answer, the healing, is in the Risen One. Ultimately, Jesus’s scars speak life and bring hope to a community haunted by loss.

Evaluation of Flexibility and Thickness of Cleft Lip Scars After Treatment with Microneedling Technique: a Cohort Trial.

The early surgical treatment of the cleft lip led to a postoperative scar formation which may affect the physiological and psychological aspects of the patient. Evaluating the improvement rate of thescar flexibility and thickness of the cleft lip scar after treatment with the micro-needling. Sixteen patients (12 females and 4 males), aged 16-30 years who had a cleft lip scare were included in the current study. All patients suffered from a visible defective scar in the upper cleft lip. All patients were treated with a microneedling pen device combined with topical application of oil-based hyaluronic acid. The procedure was performed in 4 sessions with 3-week intervals between sessions. The scars were assessed by the patient and an external observer using the Patient and Observer Scar Assessment Scale. Thickness of the scar was improved according to the patient and observer opinions (67.28% and 61.55% respectively). Flexibility was improved according to the patient observer opinion (65.57% and 60.25% respectively). Microneedling treatment can be considered as an effective method for the treatment of the defective scars resulting from the cleft lip plastic surgery. The microneedling technique is a simple, easy, safe, non-invasive, and low-cost procedure.

40. Lateral Canthotomy Revisited: A Refined Surgical Approach for Orbital Access

PURPOSE: Lateral canthotomy is a surgical technique which may broaden access to the lateral orbit and orbital floor. Despite the benefits of this maneuver, it has also been reported to lead to unpredictable healing and possible negative sequelae, such as rounding of the lateral canthal angle, entropion, and visible scar. We evaluate a less common modification to lateral canthotomy that aims to minimize complications while improving surgical access. METHODS: Lateral canthotomy was performed through a vertically-oriented incision made 2-3 mm medial to the lateral canthal angle along the lower lid. By this approach, only the inferior crus of the lateral canthal tendon was divided. A retrospective chart review was performed of patients with orbital floor fractures who underwent reconstruction using a transconjunctival incision and lateral canthotomy as described. Postoperative clinical documentation was evaluated on serial outpatient follow-up to assess for aesthetic and functional complications. RESULTS: The senior author performed 47 orbital floor repairs using a transconjunctival approach with lateral canthotomy. The average patient was 35.2 years of age (range, 4 - 75), and followed for 20.7 weeks (range, 0.4 - 132.1). The overall complication rate was 10.6%, consisting of residual enophthalmos 3 (6.4%), blurry vision 1 (2.1%), and infection 1 (2.1%). No patients demonstrated rounding of the lateral canthal angle, ectropion, entropion, or other aesthetic concerns. CONCLUSION: Our retrospective study highlights an uncommon approach for lateral canthotomy which minimizes risks traditionally associated with this surgical maneuver, while still affording the same degree of surgical exposure as the classical method.

Comparing outcomes of ovarian cystectomy by vaginal natural orifice transluminal endoscopic surgery versus laparoendoscopic single-site surgery: A retrospective cohort study.

We aimed to compare the outcomes of ovarian cystectomy (OC) performed by vaginal natural orifice transluminal endoscopic surgery (vNOTES) vs transumbilical laparoendoscopic single-site surgery (LESS). We retrospectively analyzed the data of patients in our hospital who underwent OC either by vNOTES or LESS between January 2015 and September 2021. Demographic data were collected. The primary outcome was the conversion rate. The secondary outcomes were the duration of surgery, length of hospital stay, estimated blood loss, maximum body temperature within 48 hours after operation, and duration of maximum body temperature (hours), among others. Statistical analysis was done using the SPSS software. Exactly 284 patients were screened. The vNOTES and LESS groups consisted of 21 and 47 patients, respectively. There was no significant difference in the conversion rates between the two groups (0 vs 8.5% in vNOTES and LESS, respectively; p = 0.303). Compared with the vNOTES group, the LESS group had a larger cyst diameter (6.00 ± 2.32 vs 4.69 ± 1.29 cm; p = 0.004), more endometriotic cysts (42.6% vs 9.5%; p < 0.001), and more pelvic adhesions requiring adhesiolysis (57.4% vs 19.0%; p = 0.003). At baseline, there were no other differences between the groups. The secondary outcomes included a shorter duration of surgery (70.14 ± 27.30 vs 99.57 ± 36.26 minutes; p = 0.001) and lower estimated blood loss (64.29 ± 39.19 vs 163.43 ± 251.20 mL; p = 0.011) in the vNOTES group. Regression analysis showed the diameter of the ovarian cyst correlated with surgical time. The complication was comparable between the two groups. Above all, the advantages of vNOTES include an absence of visible scars, shorter surgical duration, and less blood loss when compared with LESS. Further large-scale prospective trials should confirm the results of our study.

Natural Umbilicoplasty Without Visible Scarring: An Easily Taught and Reproducible Technique

Abstract Goals/Purpose The umbilicus is a focal point in an abdominoplasty, but the variety of published techniques can create confusion when deciding which incision is optimal for inset. Recently, an excellent technique was described that results in a scarless caudal umbilicus with superior hooding (2022 Samargandi). A similar technique has been used by this abstract’s senior author (J.G.) for over 20 years and has subsequently been implemented in our residency training. The inset is accomplished through an inverted-V incision in the abdominoplasty flap. The technique avoids excessive vertical tension on the abdominoplasty closure, a complicating factor of aggressive abdominoplasty advancement that can lead to vascular compromise in the inferomedial aspect of the flap. Insetting the umbilicus prior to resection of this inferior excess can allow for greater advancement of the abdominoplasty and decreased risk of flap over-resection. Methods/Technique The umbilical inset through an inverted-V incision in the abdominoplasty flap has been performed in all the senior author’s (J.G.) patients over the past 20 years. Following inferior wedge resection of the native umbilical stalk, the apex of the inferiorly based (inverted-V) flap is sutured to the dermis of the umbilical stalk and to the rectus fascia. The superolateral margins of the native umbilicus are approximated to the abdominoplasty skin. The sole deep suture inferomedially tethers the most visible aspect of the umbilicoplasty to the abdominal wall. The inverted-V incision in the abdominoplasty flap prior to low transverse closure increases the vertical tension on the flap and enables a safe resection of the inferior excess tissue. This technique has been taught to all residents in our training program and quickly incorporated in our abdominoplasty closures. Results/Complications Incising the inverted-V in the abdominoplasty flap eases tension on the low transverse wound closure. All residents have been able to independently perform this technique. Among the patients who have undergone this technique, none have experienced necrosis of the inferior aspect of the abdominoplasty flap or of the umbilical stalk base. As gravity encourages relaxation of the abdominoplasty skin, the superior aspects of the umbilicoplasty are overshadowed by the resulting superior hooding. This technique yields a natural-appearing umbilicus with adequate depth and a camouflaged inferior inset. Our patients frequently comment on the “untouched” appearance of their umbilici. No patients have required revisions of the umbilical inset, and none have experienced necrosis of the inferomedial aspect of the abdominoplasty flap. Residents have reported quick integration and predictable umbilical positioning with this technique. Conclusion The technique is easy to teach and can be rapidly incorporated by surgeons in practice, as well as in training. We are excited to see this technique having recently been described and feel strongly that its widespread adoption should be entertained. The inset during abdominoplasty flap advancement, prior to final resection of the inferior excess skin, can simplify decision-making for where to position the umbilicus and how much inferior excess tissue to resect. In addition to realizing the aesthetic superiority of this umbilicoplasty technique, it is important to proclaim the benefit of insetting prior to final abdominoplasty closure and the intuitive sense with which the new position of the umbilicus can be determined.

The Spiral Lift: A Novel Twist on Body Contouring

Abstract Goals/Purpose Thigh lifts historically have been performed using a vertical excision to correct the horizontal laxity.1However, this leaves an unsightly scar when wearing shorts or a bikini bottom. More recently the horizontal scar saving thighplasty has been described, but this only addresses a limited medial portion of the thigh laxity.2While plastic surgeons perform abdominoplasty concurrently with medial thigh lifts,3 there is no described technique of this type of spiral lift in the literature. The spiral lift does not use liposuction of the medial thighplasty portion of the procedure as is used in many of the published techniques.4 Moreover, compared to other described horizontal thigh lift techniques, which use a much smaller horizontal incision,5 the spiral lift extends this incision in the groin crease and into the inferior gluteal crease, resulting in a longer but very well hidden incision. This provides maximal lift of the entire thigh while avoiding a vertical scar. Our goal was to develop a technique to lift the medial and lateral aspect of the leg and the buttock skin while also minimizing visible scarring. Methods/Technique The lower abdominoplasty/belt lipectomy incision is designed in the pre-operative area such that the post-operative incision will be hidden in a pair of underwear of choice. The thighplasty incisions are designed in the groin crease, continuing into the lower abdominoplasty incision, and extend posteromedially around into the inferior gluteal crease. A pinch test is used to determine the appropriate amount of tissue that can be excised. The patient is intubated on the stretcher, then flipped into the prone position on an OR bed. Excision is performed to the level of the thoracolumbar fascia on the back and Scarpa’s fascia for the thighs to avoid the posterior cutaneous nerve. Two drains are left in the back. Following closure, the patient is flipped supine onto a second OR bed. A standard abdominoplasty is then performed in continuation with the back incision to complete the belt lipectomy. The anterior medial thigh excision is again performed at the level of Scarpa’s fascia, staying superficial in the region of the femoral vessels and lymphatics. Two drains are placed anterior in the abdomen. Results/Complications A total of 12 pts have undergone a full belt lipectomy with the spiral lift thighplasty since it first was performed in July 2019. This technique has shown good cosmetic results (Figures 1&amp;2), providing a circumferential vertical lift of the buttock and entire thigh while also addressing the abdomen and back. We have had good success in both men and women. This procedure is especially beneficial for massive weight loss patients, but we have also done the spiral thigh lift with abdominoplasties not requiring circumferential body lift. Five patients also underwent additional concurrent procedures involving the breast (mastopexy, augmentation, etc). Some patients had same day surgery (7), while five were observed overnight. The patients do tend to get some mild swelling of the mons. Scrotal swelling can be minimized with scrotal elevation and compression. Three patients had dehiscence of the thigh wounds, two of which were minor and were managed with dressing changes. One was caused by a fall at home and required return to the operating room for repair, but also had subsequent dehiscence requiring dressing changes. This was one of two patients that were re-admitted following the procedure, the other being a patient admitted for UTI sepsis 10 days after surgery. Forty-two percent of patients have had minor revisions following the procedure, 80% of which are performed concurrently with another primary surgery (eg. brachioplasty, cervicoplasty). One patient experienced transient lymphedema of the bilateral thighs. We have experienced no major infections. Some patients have experienced descent of the anterior medial thigh incision, visible in bikini bottoms. Conclusion The spiral lift is a technique that can successfully achieve a full body lift and address the thigh laxity circumferentially while completely hiding the scars in the underwear lines or natural skin creases.

The Buried Guide Suture Method: A Novel Technique to Correct Traumatic Facial Dimples.

Facial dimpling, frequently occurring after blunt trauma, presents as soft-tissue depression, which is particularly apparent during facial expression. The displacement of subcutaneous tissue can be detected and measured by high-frequency ultrasound. Limited surgical methods have been applied in these closed-injury cases. Repositioning the subcutaneous tissue without incisions on unscarred skin is challenging. The authors propose a novel three-dimensional technique to suture and fix the subcutaneous tissue at a distance through a concealed incision. The buried guide suture method was used in the treatment of 22 patients with traumatic facial dimples on the cheek. All patients showed great improvement in their depressed deformity with minor complications. This technique provides an option to correct soft-tissue depression without leaving a visible scar, especially for mimetic rupture caused by blunt trauma.

Mandible Angle Resection with the Retroauricular Approach

Square-shaped and large moon-shaped faces are commonly observed in Asians, and the contour of the mandible is associated with the shape of the lower part of the face. Mandible contouring surgery is performed to create a softer impression for East Asians. Currently, most surgeries are performed using an intraoral approach. External approaches have not been cosmetically attempted because of possible damage to the facial nerve and visible scarring and have been limited to mandible bone fracture reduction. This study included 42 patients who underwent mandibular angle reduction via classical intraoral incision and retroauricular incision between April 2019 and October 2021. Clinical outcomes were assessed using the Global Aesthetic Improvement Scale and Visual Analog Scale. Surgery was successful in all cases, with no significant complications. An appropriate mandibular contour was achieved postoperatively. All patients were satisfied with the outcome. Some patients experienced short-term complications, such as hematoma and wound disruption of the skin above the incision line. However, these improved within 3 weeks, and no serious long-term complications were observed. Mandible angle resection with the retroauricular approach is a promising alternative for patients, allowing speedy recovery and the resumption of routine daily life.

Treatment of Striae Distensae with Filler Injection: A Systematic Review.

Stretch marks, also known as striae cutis distensae (SD), are visible linear scars that occur in regions of dermal damage due to skin stretching. Stretch marks are not serious health issues, but they may have a major psychological effect on patients. Due to poor skin color improvement or prolonged skin atrophy, there is no standard treatment for SD. Fillers have been studied for their effectiveness in the treatment of SD. This systematic review aims to determine the efficacy of fillers onSD. This systematic review is reported following PRISMA guidance. We included all relevant articles published up to November 2022 in the following electronic databases: Science Direct, Midline, the Web of Science, CINAHL, and Google Scholar. The initial search yielded 119, of which seven were included after applying inclusion and exclusion criteria. The systematic review included a total of 184 female participants who were over the age of 18 years old. Three studies used jet volumetric remodeling (JVR) to inject HA pneumatically. One study injected polycaprolactone filler. One study used calcium hydroxylapatite, micro-needling, and ascorbic acid. MFU-V and CaHA were given in one study. One study delivered MFU-V using micro-focused ultrasound. All studies showed that it reduces SD with only mild, temporary side effects. More favor was given to combining CaHA and MFU-V, which had the fewest side effects compared to other dermal fillers. As monotherapy or combination therapy, injectable dermal fillers may treat SD with minimal adverse effects. We suggest that more RCTs look into injectable dermal filler to find out what is best for patients with SD and compare it to other treatment methods in terms of results, costs, and side effects to provide satisfactory practice and basic guideline interventions for these cases.

250 years of flood frequency and discharge in an ungauged Corsican mountain catchment: A dendrogeomorphic reconstruction

The primary goal of paleoflood hydrology is to estimate the frequency and magnitude of past floods. Botanical evidence, and particularly scars on trees, has been used repeatedly as paleostage indicators to reconstruct peak discharges and flood height. Yet, these reconstructions depend on the presence of visible scars on tree stems which tend to be masked as trees grow older. Here, we estimated flood magnitude using an alternative approach based on growth disturbances in tree-ring series, tree positions and the minimal discharge necessary to submerge the root collar of a tree as estimated by hydraulic modeling. We tested the reliability of this newly developed approach by using the traditional scar-based reconstruction as a benchmark. To this end, we sampled 60 trees showing evidence of flood damage on their stems along a 787-m long segment of the Asco river (Corsica, France). Based on 440 growth disturbances dated in tree-ring series, we reconstructed 28 floods between 1759 and 2020 and 18 during the 20th century. Using the two-dimensional Iber hydraulic model and detailed topographic data of the study site obtained from UAV imagery, we estimated that peak discharges of the 28 reconstructed events ranged between 10 and 210 m3s−1, with 200 m3s−1 being considered as the threshold for extreme floods. Not only do the scar-based and root collar submersion approaches yield similar results, findings are also clearly in line with the sparse information available from historical archives and short gauge station records on past floods. The unprecedented length and depth of the record presented here opens new avenues for climate change and flood impact research.

Compound 13 Promotes Epidermal Healing in Mouse Fetuses via Activation of AMPK

Unlike adults, early developing fetuses can completely regenerate tissue, and replicating this could lead to the development of treatments to reduce scarring. Mice epidermal structures, including wound healing patterns, are regenerated until embryonic day (E) 13, leaving visible scars thereafter. These patterns require actin cable formation at the epithelial wound margin through AMP-activated protein kinase (AMPK) activation. We aimed to investigate whether the administration of compound 13 (C13), a recently discovered AMPK activator, to the wound could reproduce this actin remodeling and skin regeneration pattern through its AMPK activating effect. The C13 administration resulted in partial formations of actin cables, which would normally result in scarring, and scar reduction during the healing of full-layer skin defects that occurred in E14 and E15 fetuses. Furthermore, C13 was found to cause AMPK activation in these embryonic mouse epidermal cells. Along with AMPK activation, Rac1 signaling, which is involved in leaflet pseudopodia formation and cell migration, was suppressed in C13-treated wounds, indicating that C13 inhibits epidermal cell migration. This suggests that actin may be mobilized by C13 for cable formation. Administration of C13 to wounds may achieve wound healing similar to regenerative wound healing patterns and may be a potential candidate for new treatments to heal scars.

Yellow Subthreshold Micropulse Laser in Retinal Diseases: An In-Depth Analysis and Review of the Literature.

Yellow subthreshold micropulse laser (YSML) is a retinal laser capable of inducing a biologic response without causing thermal damage to the targeted tissue. The 577-nm YSML is delivered to the retina abiding by different protocols in which wavelength, power, duration, spot size and number of spots can be properly set to achieve the most effective and safe treatment response in various chorioretinal disorders. The ultrashort trains of power modulate the activation of the retinal pigment epithelium cells and intraretinal cells, such as Müller cells, causing no visible retinal scars. Subthreshold energy delivered by YSML stimulates the production of the heat-shock proteins, highly conserved molecules that protect cells against any sort of stress by blocking apoptotic and inflammatory pathways that cause cell damage. YSML treatment allows resorption of the subretinal fluid in central serous chorioretinopathy and intraretinal fluid in various conditions including diabetic macular edema, postoperative cystoid macular edema and other miscellaneous conditions. YSML also seems to modulate the development and progression of reticular pseudodrusen in dry age-related macular degeneration. The aim of this review is to discuss and summarize the safety and efficacy of YSML treatment in retinal diseases.

Microsurgical Reconstruction of the Columella.

Traditionally, the columella can be difficult to reconstruct because of its unique contours, paucity of adjacent soft tissues, and tenuous vascularity. When local or regional tissues are unavailable, microsurgical transfer can provide a means for reconstruction. In this retrospective review, the authors report their experience with microsurgical reconstruction of the columella. Seventeen patients were enrolled in this study and divided into two groups: group 1, isolated columella defects; and group 2, defects of the columella and portions of adjacent soft tissues. There were 10 patients in group 1. Their average age was 41.2 years. Average follow-up was 10.1 years. Causes of the columellar defects included trauma, complication of nasal reconstruction, and complication of rhinoplasty. The first dorsal metacarpal artery flap was used in seven cases, and the radial forearm flap was used in five. Two flap losses were salvaged with a second free flap. The average number of surgical revisions was 1.5. In group 2, there were seven patients with an average follow-up of 10.1 years. Causes of the columella defects included cocaine injury, carcinoma, and complication of rhinoplasty. The average number of surgical revisions was 3.3. The radial forearm flap was used in all cases. There were no flap losses. All 17 cases in this series were brought to a successful conclusion. The authors' experience shows that microsurgical reconstruction of the columella provides a reliable and aesthetic means for reconstruction. This technique avoids the facial disfigurement and visible scarring that often accompany use of local flaps. In addition, microsurgical flaps can be preformed "off site," which may provide certain advantages in selected cases. Therapeutic, IV.

Minimally invasive retroauricular approach parotidectomy: A pictorial essay.

The surgical approach to a parotid neoplasm has traditionally been taught through a modified-Blair incision. This approach results in a visible scar in the preauricular, retromandibular, and upper neck skin. Various modifications have been undertaken which aim to improve cosmesis either by decreasing overall incision length and/or relocation of the incision to the hairline via what is commonly described as a "facelift approach". We describe a novel minimally invasive parotidectomy approach which utilizes a single retroauricular incision. This approach eliminates both the preauricular scar as well as the extended incision in the hairline and additional skin flap elevation which accompanies it. Sixteen patients underwent parotidectomy using this minimally invasive incision and the excellent clinical outcomes are reviewed. The minimally invasive retroauricular approach to parotidectomy provides excellent exposure with no visible incision/scar in appropriately selected patients.

Scarless Neck Feminization by Transoral Endoscopic Vestibular Approach Chondrolaryngoplasty: A Prospective Cohort.

Chondrolaryngoplasty (laryngeal-prominence reduction) is a gender affirmation surgery for transgender women, or for cisgender people desiring an esthetic correction. Up until recently, chondrolaryngoplasty required a visible neck scar. The transoral endoscopic vestibular approach (TOEVA) is gaining widespread use as a scarless alternative for thyroid/parathyroid surgeries. This study aims to describe the feasibility, safety, and outcomes of TOEVA-chondrolaryngoplasty, based on the first-ever performed cases. A prospective cohort. An academic referral center. Adult patients interested in chondrolaryngoplasty underwent scarless TOEVA-chondrolaryngoplasty between 2019 and 2022, according to the described protocol. Video stroboscopy was recorded pre-and postoperatively. Surgical data, adverse events, and complications were recorded. Patients' satisfaction was measured using an outcome instrument for esthetic chondrolaryngoplasty. Twelve patients (10 transgender women, a cisgender man, and a woman) were included. The mean age was 26.7 ± 6.5 years, ranging from 19 to 37. The average operative time was 3:01 ± 0:51hours. The thyroid cartilage and laryngeal prominence were easily and safely approached and reduced, with no adverse events or major complications. All patients were discharged on postoperative day 1. A single patient had a temporary mental nerve hypoesthesia that resolved spontaneously. Otherwise, no other complications were encountered. Vocal folds' function remained unchanged in all patients. Patients were very much to completely satisfied with the surgical results as measured by the outcome instrument; median (interquartile range), 25 (21-27.75). In this first reported cohort of scarless TOEVA-chondrolaryngoplasty, this approach was proven to be safe and feasible, with no adverse events or major complications, and with high patient satisfaction.

Single axillary incision endoscopic surgery and liposuction for gynecomastia.

Gynecomastia is a common type of breast tissue hypertrophy in men. Surgical excision is the most effective treatment for this condition. Minimally invasive surgical techniques can be used to avoid visible chest scarring. In this study, we evaluated the efficacy and safety of single-axillary-incision endoscopic mastectomy and liposuction for the treatment of gynecomastia. Nipple-sparing mastectomy via a single-port axillary incision was successfully performed in all patients. Twenty-four bilateral procedures were performed in total. Twenty patients underwent liposuction concomitantly. The median weight of the mastectomy pieces was 88.5 g (range: 42.5-440 g), and the median amount of liposuction was 262.5 cc (range: 25-350 cc). The median duration of surgery was 120 minutes (range, 73-195 minutes). Two patients developed a seroma, and 1 patient developed a hematoma in the early postoperative period. The mean satisfaction levels related to physical appearance, mental status, and social environment were 8.75 (standard deviation [SD]: 1.19), 9.17 (SD: 1.44), and 9.33 (SD: 0.76) points, respectively, on a 10-point visual analog scale. Endoscopic single-port nipple-sparing mastectomy combined with liposuction is a technically feasible method to avoid anterior chest wall scarring with good cosmetic results. Between June 2021 and June 2022, 30 patients underwent endoscopic single-port nipple-sparing mastectomy through a small axillary incision, while 20 underwent concomitant liposuction. The demographic information of the patients, duration of surgery, amount of tissue removed, and complications were recorded. Patients' levels of satisfaction with their physical appearance, mental status, and social environment were measured.

The impact of visible scars on well-being and quality of life: An international epidemiological survey in adults.

Scars are visible marks from various causes, including surgery, skin injury, burning or dermatological disease, and may impact the quality of life. To assess the impact of scars on quality of life (QoL). Data about sociodemography, presence, origin, and symptoms of scars were collected using an Internet survey between April and May 2020. Overall, 11,100 individuals answered the survey. In total, 48.5% of the responders had at least one scar of less than 1 year of age. Scars were mainly reported on the abdomen and face. Globally, 28.9% of subjects with recent scars reported pain, 23.7% reported burning, 35.0% reported itching, and 44.1% reported redness. Subjects were most frequently bothered by the visibility of their scars and the presence of marks. Incidences were significantly higher than for those with older scars. The average DLQI score was 7.44; it decreased to 2.90 after 1 year. Subjects with scars aged less than 3months had their QoL more frequently impacted (33.9%) than those with scars aged 12 months or more (10.2%). In subjects reporting skin discomfort, clinical symptoms significantly impacted body movement, choice of clothes, leisure activities, and sexual life more than in those reporting no skin discomfort. Moreover, subjects felt significantly more impacted in their daily lives due to their skin discomfort. When feeling bothered by the visibility of their scars, significantly more subjects were also impacted in their body movement, choice of clothes, leisure activities, and sexual life than those subjects who did not feel bothered. Moreover, significantly more subjects felt embarrassed. Scars significantly impact the subjects' quality of life. This impact is even more important when caused by recent and visible scars, with a lower DLQI score in subjects with more aged than in those with recent scars.

Development of Adapalene Loaded Liposome Based Gel for Acne

Retinoids are considered the mainstay treatment for moderate to severe acne. Adapalene, a third-generation retinoid, has physiochemical properties which hinder the effective delivery of the drug to the skin. Therefore, the current study aimed to develop and evaluate adapalene liposomal loaded gel (ADA-LP gel) for the effective management of acne to improve tolerability and delivery to targeted sites as compared to the conventional dosage form of the drug. A novel spontaneous phase transition method (SPT) was used to formulate liposomes. Liposomal formulation (ADA-LP) was prepared and optimized based on particle size, zeta potential, and PDI. Optimized formulation was further characterized by different techniques and loaded into Carbopol gel. In vitro drug release, ex vivo permeation, and in vivo studies were performed using the prepared adapalene-loaded liposomal-based gel. The in vivo study was done employing the testosterone-induced acne model in mice. The optimized formulation had a size of 181 nm, PDI 0.145, and a zeta potential of -35 mV, indicating that the formulation was stable. Encapsulation efficiency was 89.69 ± 0.5%. ADA-LPs were loaded into the gel. Prepared ADA-LP showed a 79 ± 0.02% release of drug in a sustained manner, within 24 h. The ex vivo permeability study showed a total of 43 ± 0.06 µg/cm2 of drug able to permeate through the skin within 24 h. Moreover, only 28.27 ± 0.04% was retained on the epidermis. The developed ADA-LP gel showed significant improvement in the acne lesions in mice with no visible scars and inflammation on the skin. Therefore, ADA-LP-based gel could be a promising carrier system for the safe and effective delivery of Adapalene.

Surgical treatment of tracheocutaneous fistula and tracheostomy scars using a hinged flap and local myocutaneous flap.

Tracheocutaneous fistula and tracheostomy scar are complications associated with the prolonged use of tracheostomy tubes. They have functional and cosmetic problems owing to tracheal tugging during swallowing and easily visible scars. Although many procedures exist to correct this issue, there is no consensus on the optimal surgical technique. Therefore, an ideal surgical procedure was devised. The study was performed on 12 patients between September 2016 and May 2021. All patients had persistent tracheocutaneous fistulas or hypertrophic scars on the neck after tracheostomy. All procedures were performed using a hinged flap and two myocutaneous local flaps. All patients had no complications, and their aesthetics were excellent in postoperative photographs. The scar was better on the straight scar when the flap's skin is denuded than on the VY advancement flap. It should be noted, however, that this procedure can cause the flap to become congested in a short period after head and neck surgery. This procedure is safe, reliable and simple for surgical closure. This was found to produce excellent cosmetic results with no major complications.