The Combined Effect of Botulinum Toxin Type A with a Biorevitalizing Treatment on Forehead Rejuvenation: A Case Series

Background: The forehead is particularly prone to repetitive facial expressions and hyperdynamic activity, resulting in deep wrinkles and a loss of elasticity and hydration. Although botulinum toxin type A (BoNTA) has been shown to reduce the appearance of wrinkles and allow patients to have a smoother and hence younger upper face, it cannot help to improve the other aspects that determine overall skin quality. Objective: This case series aims to evaluate the clinical efficacy of combining BoNTA injections with a biorevitalizing treatment (NCTF®135HA) on skin aging signs and quality using a split face approach. Patients and Methods: A total of eight patients from 30 to 55 years old were treated with botulinum toxin type A combined with NCTF®-135HA or alone. Results: At D60, clinical skin quality scoring showed that NCTF®135HA injection significantly reduced wrinkles and enhanced skin homogeneity, hydration, firmness, and radiance. The Global Aesthetic Improvement Scale (GAIS) by the evaluator at D60 reported mean scores of 2375 (much improved) on the side of the face treated with BoNTA + NCTF®-135HA compared to the side of the face without NCTF®135HA. According to patients, the NCTF®135HA injections resulted in a significantly better aesthetic improvement score on D60 (mean score of 2.5 compared to 0.125 without NCTF®135HA, p 0.001). Conclusions: Our findings show that combining a biorevitalizing treatment with a BoNTA injection can significantly improve the skin’s overall appearance and decrease the wrinkle score when compared to the BoNTA injections alone. The results suggest that the combinatory strategy is effective, safe, and associated with a high level of patient satisfaction.

Forehead Flap in Coverage of Nasal Defects: Our Experience

Background: Coverage of post-traumatic or post-oncosurgical nasal defects is a very challenging procedure. Small nasal defects may be covered by skin grafts or small local flaps while larger nasal defects require more complex flap coverage techniques as using tissue expanders, prefabricated flaps or free flaps. The forehead flap has been used for centuries and remains a workhorse flap for reconstruction of large and complex nasal defects. Aim: evaluate the feasibility and versatility of forehead flap for resurfacing nasal defects. Materials and Methods: 12 patients underwent coverage of nasal defects after trauma or tumor excision using forehead flaps. All flaps needed a second stage for flap separation 3 weeks after the time of operation. The size of the harvested flap, the harvesting time, results of transferred flaps, patient satisfaction and flap-related complications were analyzed. Results: 12 patients (10 males and 2 females) underwent reconstruction of different nasal defects using 12 forehead flaps. The overall complications occurred in 2 patients. The remaining 10 patients showed no complications and passed an uneventful follow-up period. 7 Patients were very satisfied, 4 were satisfied and only one patient was not satisfied as she was 23 years old young female and was subjected to human bite. Follow-up periods ranged from 6 to 12 months. Conclusion: Nasal defects can successfully be managed with the forehead flap. Probably, the flap provides the best result due to the good matching of the skin in terms of color, texture, and thickness. Also, despite the increasing use of free flaps, the forehead flap is still a valid and safe option for nasal defects coverage that allows good aesthetics and functional outcomes.

Double Forehead Expanded Flaps for Reconstruction of Total Nasal Defect: A Case Report

Objective To introduce a method for total nasal defect reconstruction with a double forehead expanded flap.Case presentation A 55-year-old man underwent three-stage total nasal reconstruction for a complete nasal defect due to electrical injury.The skin expander was implanted during the 1st stage.Total nasal reconstruction was performed with double expanded forehead flap transfer during the 2nd stage.The unilateral forehead flap was used for lining and the contralateral forehead flap,together with the autologous cartilage and titanium mesh framework,were used for skin replacement.The forehead donor defect was covered with a skin graft.Pedicle division and inset were performed in the 3rd stage.Results There was no flap loss,infection,hematoma,rhinostenosis,or implant exposure over the 2-year follow-up,and satisfactory aesthetic results were achieved.Conclusion The double forehead expanded flap method is useful for the reconstruction of large composite nasal defects in patients who are not suitable for nasolabial flaps and those who may not tolerate free tissue transfer.The operation has fewer complications and is uncomplicated.

CHAP-Hyaluronic Acid (CHAP-HA) Filler as an Optimal Candidate for Forehead Filler Augmentation Using a 3-Point Injection Technique

Minimally invasive forehead augmentation is becoming increasingly popular in Asia. However, treatment of the glabella is associated with injection-related complications. The safety of injections can be increased through a thorough understanding of the anatomy and precise injection planes. The authors propose a 3-point injection technique for forehead augmentation in Asian patients that uses CHAP-hyaluronic acid (CHAP-HA) filler. The longevity of the filler was assessed using high-resolution ultrasound (HRU) imaging. Fifteen patients were examined using HRU before and immediately after treatment and at 1 month, 3 months, 6 months, and 12 months. As evident in HRU imaging, CHAP-HA remained visible within surrounding tissue for 6.4 ± 3.7 months. The mean Global Aesthetic Improvement Scale rating was 2.4 ± 0.5 immediately after treatment, 2.8 ± 0.3 at 1 month, 2.7 ± 0.5 at 3 months, 2.1 ± 0.6 at 6 months, and 1.5 ± 0.6 at 12 months. Minimal side effects were reported. The authors demonstrated that CHAP-HA filler may be an optimal candidate for forehead filler augmentation using a 3-point injection technique.

Investigation on the Application Value of Infrared Forehead Temperature Gun in Body Temperature Screening of New Crown Epidemic

The outbreak of the novel coronavirus pneumonia has had a great impact on the life safety of our people and social production activities.Therefore,it is very important and meaningful to analyze the application value of infrared forehead thermometers in body temperature screening under the new crown pneumonia epidemic and propose improved measures for body temperature detection.This paper summarizes the questionnaire on the application value of infrared forehead thermometer in body temperature screening and the results of staff interviews,and analyzes the principle of infrared forehead thermometer temperature measurement to explain the factors that affect the accuracy of temperature measurement results.Finally,it is concluded that the reflected radiation of the environment and the temperature measurement distance affect the accuracy of the temperature measurement results of the infrared forehead gun.

Aesthetic Considerations in Forehead Reconstruction in Skin Carcinoma

Reconstruction of the forehead has been a challenge for many surgeons. Some use skin grafts, other microvascular flaps, but local flaps for coverage of forehead skin are still the cornerstone principle in providing the ideal skin color and texture. In this article, the forehead is classified into surgical reconstructive subunits. These subunits are set according to the surrounding structures. Flaps are rectangular in shape in mobility in order to follow the natural lines of the forehead.

Expanded Forehead Stepped Flaps for Delayed Three-Stage Repair of Midface Skin Lesions

Background The forehead flap is the best flap for nasal defect repair and nasal reconstruction.It is also an ideal option for repairing skin lesions in the midface(including the nasal area,inner area of the cheek,and upper lip of the perioral area).However,the traditional frontal myocutaneous flap is relatively bulky for repairing pure skin lesions.In addition,the original forehead flap is generally not sufficient to cover a large wound area.If a large forehead flap is removed,the donor site cannot be sutured in one stage.In this study,an expanded forehead stepped flap was used to overcome the shortcomings of the traditional frontal myocutaneous flap.Methods In stage one surgery,a rectangular expander(80–100 mL)was implanted on the side of the forehead.The expansion pot was built-in,and the excess expansion amount was 160–200 mL.After 4 weeks of rest,stage two operation was performed to remove the skin lesions in the midface.The pulsation point of the supratrochlear artery on one side was used as the pedicle,and the flap was designed diagonally to the upper region of the opposite side.The flap was designed according to the size and shape of the wound.The distal portion of the flap was separated in the superficial layer of the frontalis muscle,approximately 1.7 cm above the superior orbital edge,and cut into the submuscle.The flap pedicle was cut from the superficial layer of the periosteum to form a stepped flap.Then,the flap was rotated downward to repair the wound in the midface.Five weeks later,stage three of the operation which involved flap pedicle division,was performed.Results Expanded forehead stepped flaps were used in 12 cases with 6–36 months of follow-up.In all cases,the blood supply to the flaps was good,and their color,texture,and thickness matched well with those of the surrounding skin.All patients were satisfied with the outcome of the repair.Conclusion Expanded forehead stepped flaps present an ideal option for repairing wounds after large skin lesion resections in the midface since they have multiple edges from a reliable blood supply,easiness to transfer,and well-matched color,texture,and thickness to those of the surrounding skin of the face to no need for many auxiliary incisions.

提上睑肌腱膜前徙术矫正双眼轻度先天性上睑下垂的临床特征分析

目的探讨提上睑肌腱膜前徙术矫正双眼轻度先天性上睑下垂的临床特征。方法选取双眼轻度先天性上睑下垂患者为实验组,共23例(46只眼),采用提上睑肌腱膜前徙手术,分析其术后额纹及上睑倒睫改善情况。并与既往同年龄段的23例(46只眼)双眼重度上睑下垂患者(对照组)屈光状态进行比较。分析未经手术治疗的轻度及重度上睑下垂与近视及散光的关系、与远视及弱视的关系。结果23例实验组患者中,12名患者行准分子激光术前检查时发现倒睫,要求行倒睫矫正手术时发现上睑下垂。6例患者因高度散光,发现上睑下垂。3例患者自觉眼睛小而无神,要求行重睑手术时发现上睑下垂。仅有2例患者考虑上睑下垂以上睑下垂首诊。有43只眼合并近视,29只眼合并散光,3只眼合并弱视。20例患者存在明显额纹,占比为86.9%;上睑倒睫14人,占比为60.9%。术后所有患者额纹明显缓解,上睑倒睫均矫正。对照组患者弱视发生明显高于实验组,差异有统计学意义(P<0.05);2组患者近视、远视、散光的发生率比较差异无统计学意义(P>0.05)。结论提上睑肌腱膜前徙手术,能很好地纠正轻度上睑下垂,明显改善额纹和上睑倒睫,术后患者满意度高。轻度上睑下垂与近视和散光的关系还需进一步研究。

A型肉毒毒素防治额部外伤瘢痕的美学效果及对血清TGF-β_(1)、BMP-7水平的影响

目的:探讨A型肉毒毒素防治额部外伤瘢痕的美学效果及对血清TGF-β_(1)、BMP-7水平的影响。方法:选取2020年7月-2022年10月笔者医院收治的84例额部外伤患者为研究对象,按随机数字表法分为观察组和对照组,各42例。对照组采用清创美容缝合联合外用硅凝胶制剂防治瘢痕;观察组采用美容缝合拆线后伤口两侧注射A型肉毒毒素防治瘢痕。拆线后3个月,统计比较两组瘢痕临床防治有效率、瘢痕评分[温哥华瘢痕量表(Vancouver scar scale,VSS)]、瘢痕疼痛或瘙痒程度评分[视觉模拟评分法(Visual analogue scale,VAS)]、患者满意度、血清转化生长因子β_(1)(Transforming growth factor-β_(1),TGF-β_(1))和骨成型蛋白7(Recombinant bone morphogenetic protein 7,BMP-7)水平及不良反应。结果:观察组VSS评分、瘢痕疼痛或瘙痒程度VAS评分低于对照组(P<0.05);观察组瘢痕临床防治有效率为90.47%,高于对照组的69.04%(P<0.05);观察组患者满意度高于对照组(P<0.05);观察组TGF-β_(1)水平低于对照组,BMP-7水平高于对照组(P<0.05);两组均未发生严重不良反应。结论:额部软组织外伤患者美容缝合拆线后伤口两侧注射A型肉毒毒素可抑制瘢痕形成,有效提升瘢痕防治有效率及患者满意度,其临床效果可能与调控血清TGF-β_(1)和BMP-7水平有关,且安全性较高,具有一定的临床应用价值。

夏季温度漂移环境下的人体热舒适研究

长期处于稳态热环境会削弱人体的热适应能力,影响人体热舒适,并且空调系统的长期运行也会造成能源过度消耗。研究显示,允许室内环境温度适当地变化可以改善上述问题。通过控制空调的间歇启停,结合主观热评价、额头温度、耳温以及平均皮肤温度的变化,探究了短暂温度漂移下的人体热反应,并且分析了额头温度与热舒适投票之间的相关关系。结论如下:存在温度漂移的夏季空调环境,可以提高人体对偏热环境的接受度;适当范围内的温度漂移可以提高人体热舒适,为室内空调系统的动态调节提供了新的研究思路;温度漂移热环境中,人体额头温度与热舒适显著相关,其可以作为表征动态环境热舒适的重要指标之一。

额部年轻化应用进展

面部皮肤衰老受到内外环境变化和多种生理变化等因素的影响,在额部表现尤为明显,越来越多求美者选择行额部年轻化治疗。额部年轻化已经历近百年的发展,从传统的皮肤切除到现在的光电声技术除皱,方案已日益成熟,与既往传统年轻化方法已有较大区别。本文将从额部软组织解剖、动态皱纹、静态皱纹及额部凹陷四个方面阐述目前额部年轻化方案的应用进展,旨在为整形外科医生提供参考。

额部冷敷联合同理心责任护理对耳鼻喉患者自我效能的影响研究

目的:探讨额部冷敷联合同理心责任护理对耳鼻喉患者自我效能的影响。方法:选取医院耳鼻喉头颈外科收治的66例耳鼻喉患者,通过随机数表法分为对照组(33例)和观察组(33例)。对照组患者予以常规护理,观察组患者采用额部冷敷联合同理心责任护理。比较两组患者护理效果。结果:观察组患者治疗依从性高于对照组(P<0.05)。较护理前,两组患者护理后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均降低(P<0.05),观察组更低(P<0.05);两组患者护理后一般效能感量表(GSES)、自我护理能力测定量表(ESCA)评分均升高(P<0.05),观察组更高(P<0.05)。结论:额部冷敷联合同理心责任护理可改善耳鼻喉患者的不良情绪,提升患者治疗依从性、自我效能及自我护理能力,值得推广。

罗陆一望前额辨治肺系疾病经验介绍

介绍罗陆一教授望前额辨治肺系疾病的临床经验。罗陆一教授认为,前额可反映肺脏气血充盈与否,甚至可反映全身气血阴阳之变化。正常前额表现为饱满红润。望前额可大体分为望前额之形态、望前额之色,临证将前额形态与色二者相结合进行综合判断,若连续多次比较,还可预知疾病的发展趋势。

美容缝合联合A型肉毒毒素治疗额部外伤的美学效果

目的:探究美容缝合联合A型肉毒毒素治疗额部外伤的美学效果。方法:选取2020年1月-2022年1月笔者医院收治的90例额部外伤患者为研究对象,按照随机数字表法分为观察组和对照组,各45例。对照组采用美容缝合治疗,观察组采用美容缝合联合A型肉毒毒素治疗。统计比较两组术后的临床疗效、瘢痕评分及美学效果满意度。结果:术后1个月,观察组总有效率高于对照组(P<0.05);术后1、6个月,观察组瘢痕评分低于对照组(P<0.05);术后6个月,观察组美学效果满意度高于对照组(P<0.05)。结论:美容缝合联合A型肉毒毒素治疗额部外伤能够提高临床疗效,改善患者瘢痕状况,提高患者美学效果满意度,值得临床推广。

Dural arteriovenous fistulae after forehead knife-cut injury

Dural arteriovenous fistulae (DAVF) is a rare intracranial vascular disease. It is pathologically characterized by direct shunting of the intracranial artery and vein, which results in cerebral ischemia, intracranial hemorrhage, neural deficit and intracranial murmur. The etiological mechanism of DAVF is not well known, but most researchers think it is associated with congenital abnormal development, especially abnormal development of dural blood vessels at the stage of embryogenesis. Recently, some researchers have found that DAVF is also associated with some acquired factors. This article reports a case who developed DAVF within 2 years after debridement of frontal bone fragmentation, depressed fracture, left frontal lobe contusion and superior sagittal sinus injury due to forehead knife-cut injury. The pathogenic mechanism was explored through a review of the related literatures.

The forehead flap:a valuable option in resource depleted environment

Aim:Reconstruction of orofacial soft tissue defect is often challenging and this is more difficult in resource challenged environment.This retrospective study highlights our experience with the use of forehead flap to overcome some of the challenges of orofacial reconstruction in a resource depleted environment.Methods:A 23-year retrospective analysis of all patients who had orofacial defect reconstruction using forehead flap in our department was undertaken.Information was sourced from patient’s case notes and operating theatre records.Data was analyzed using Statistical Package for Social Sciences(SPSS)version 16(SPSS Inc.,Chicago,IL,USA)and Microsoft Excel 2007(Microsoft,Redmond,WA,USA).Results:A total of 43 patients were managed within the period reviewed and consisted of 31(72.1%)males and 12(27.9%)females.Trauma 24(55.8%)accounted for most defect and the lip was the commonest site of defect.Complete forehead flap was used in 31(72.1%)of cases and when timing of defect repair is considered,delayed reconstruction was the preferred method.Postoperative complications was observed in 8(18.6%)patients and consisted of failed flap in 2(25.0%)patients,tumor recurrence in reconstructed site in 2(25.0%)patients and tumor occurrence in forehead flap donor site in 1(12.5%)patient.Conclusion:The forehead flap remains a reliable option in orofacial soft tissue defect reconstruction.It is easy to raise and can provide coverage for wide defects as far as the paramandibular and submandibular regions.Moreover,it does not require patient repositioning.

Preliminary stages before nasal reconstruction using forehead flap:restoring perinasal subunits and nostril patency

Due to the complex three-dimensional structure of the nose,the repair of the nasal defect requires reconstruction of three different layers:skin envelope,osteocartilaginous framework and nasal lining.Before nasal reconstruction can be accomplished,the nose must rest on a stable platform to avoid late nasal obstructions,and septal deviations resulting from scar contraction.We present three cases of nasal reconstruction using a forehead flap in which we performed a preliminary stage to increase reliability of outcomes.

Get Ahead in Advertising-Get a Forehead

选注者言:也许是从世界杯足球赛期间球迷们彩绘脸庞得到的启发,英国人开始在大学生的脸上动脑筋了。文章中的一句话,让我们得知英国学生的日子不好过:The idea came when we realized how much coverage students gained in thenewspapers during recent demonstrations over debt.

射频技术结合内窥镜在额部除皱术中的应用

目的:探索射频结合内窥镜在额部除皱术中应用的临床疗效及安全性。方法:从2018年7月-2019年3月,对16例因额部皱纹就诊的就医者(年龄17~55岁)采用射频刀结合内窥镜的方法进行治疗,观察疗效及并发症。结果:治疗后,16例就医者额部皱纹均有明显改善,术后无明显并发症,轻微疼痛、肿胀等均可自行消退。术后就医者满意度高,满意率达93.75%。结论:射频结合内窥镜进行额部除皱术具有创伤小、恢复周期短、就医者满意度高、安全性高等优点,值得临床进一步推广。

额部纤维肉瘤型隆突性皮肤纤维肉瘤1例

目的探讨纤维肉瘤型隆突性皮肤纤维肉瘤(fibrosarcomatous dermatofibrosarcoma protuberans,FS-DFSP)临床特点,以期提高对该病的认识,减少临床误诊。方法回顾性分析2020年7月兰州大学第二医院收治的1例FS-DFSP病人临床资料。结果病人因“额部肿块切除术后10年,再发1年”入院。皮损组织病理:短梭形细胞呈席纹状排列,部分区域呈束状、鱼骨样排列。免疫组化:CD34(+)、波形蛋白(Vimentin)(+)、Ki-67增生活跃区60%(+)。诊断为FS-DFSP,予以扩大范围皮肤病损根治性切除术,术后随访至今未见复发。结论FS-DFSP发病率低,易误诊,提高对该病的认识及警惕性有助于确诊及降低临床误诊率。