Objective To guide the botulinum toxin injections,the types of glabellar wrinkles and the corresponding muscle contraction patterns of aesthetic seeking patients were classified.Methods Sixty aesthetic seeking patients between 20 to 65 ages were selected randomly,whose glabellar wrinkles and muscle contraction patterns were classified and analyzed.Targeted injections of botulinum toxin were taken only within the muscles related to the wrinkles.Results Type‖accounts for 58.3％ (35/60),type ∪ accounts for 26.7％ (16/60),type ∩ accounts for 11.7％ (7/60),and type口accounts for 3.3％ (2/60).Muscle contraction receded 2 or 3 days after injection,reached optimum about 2 weeks,and then maintained 3 to 6 months.Higher satisfaction was obtained using classified injection methods.All objects achieved excellent results.Targeted injections of botulinum toxin on these muscles were able to achieve better clinical effects.Conclusions Using classified injection methods according to 4 types of aesthetic seeking patients’ glabellar wrinkles can achieve higher satisfaction.

Objective To analyze and summarize the features of children's facial wound and to share the emergency treatment experiences.Methods An retrospective study was conducted on the pathogenesis,age distribution,emergency treatment methods and complications in 1407 children (under 15 years of age) during recent 8 years (from January 2004 to December 2011).Results In this study the major facial wound type was simply lacerations (1196/1407,85.0 ％),and the most common wound cause was trumbling injury (1154/1407,82.0 ％).The T area was the easiest injured,successively,forehead (562/1407,39.9％),chin (211/1407,15.0％),lips (196/1407,13.9％) and nose (95/1407,6.8％).Here were 2 peaks in age distribution which were 2 and 5 years of age,respectively.Pleased outcome would be found while normalized plastic means were taken.After 3 to 6 months following up,there were 5 infection cases,27 cases healed with hypertrophic scars,and 7 cases with traumatic tattoos in wound location.Conclusions The most common wound type is simply laceration.2 and 5 years of age are two of the highest risk stages.It is necessary to act up to plastic surgery principles and take children's particularity into account when emergency treatment,and to do our best to minimize the scar in the first operation time.

Objective To search for a good solution for aesthetic beard reconstruction and to explore the effect of the single-hair grafting in beard reconstruction. Methods Under the local anesthesia, a scalp strip (length range from 5～7 cm, width range from 1.0～1.5 cm) was harvested from the back of the head and then was divided into a series of single-hair micrografts. After the slits were made, the grafts were implanted into the holes, parallel to the original beard directions. The donor sites were directly closed. With this method, 18 sparse beard patients and 3 patients with upper lip scars were treated. Results The grafted hairs grew nearly in the direction of normal beard, which achieved 90 %～95 % survival in recipient areas. The patients were satisfied with the results, in which 19 cases received only 1 operation and 2 cases received another repeated operation. Conclusion Beard reconstruction by single-hair grafting technique is a good, safe and effective method.

Objective To study the process of hyaluronidase enzymolysis under different condi tions and to provide the basis for clinical application.Methods The experiment of 15 hyaluronic acid products from 10 brands was conducted in vitro with 15 concentrations and 4 dosages of hyaluronidase at 37 ℃ and 24 C.The results of experiment were compared with the clinical observations.Results The duration of enzymolysis was inversely correlated with hyaluronidase concentration.The duration of enzymolysis process reduced 60％ when equal hyaluronidase was used as compared with that when half hyaluronidase was used.The enzymolysis duration could be 24 folds in different products.The enzymolysis time was 2.9 folds at 24 C [24 ℃ was (77.67±35.33) min],compared with that at 37 ℃[37 ℃ was (27.13±11.05) min].It took much more time of enzymolysis in vivo than in vitro for the same product.Conclusions Enzymolysis efficiency is positively correlated with the concentration and dosage of enzyme and inversely associated with the particle size and viscosity.

Objective To illustrate and analyze the clinical feature and treatment of botulism introduced by illegal injection of botulinum neurotoxins (BoNT),in order to provide some evidence for early diagnosis and treatment strategy.Methods Retrospective analysis of 13 botulism patients was performed in this article.All of the patients were suffered from illegal injection of botulinum neurotox in products.Support treatments were carried out according to their severe grade,and the courses of disease and the curative effects were observed.Results A new category was first identified as injection induced botulism to describe such a situation of cosmetic injection out of the hospital with neither the prescribed botulinum toxin product nor a doctor.One in 13 patients graded mild botulism,the other 12 patients graded middle level.The processes of the new botulism had 4 stages:preclinical stage (4 days),progressive stage (9.8 days),apical stage (9.1 days) and restoration stage (5.2 months).The relationships of a positive correlation in injection dose and the length of progressive stage were identified,while a negative correlation with the length of preclinical stage was revealed.Conclusions The earlier2-3 weeks after illegal injection are crucial for intense care because of the acceleration in this period.Absolute rest and active treatments as well as antitoxinum are benefit for the recovery of patients.

Objective Lab color mode can be used to digitize the color.This study explores the possibility of using Lab model to measure facial pigmentations.Methods Lab color model was used to measure the normal skin and three common clinical pigmentations (Ota nevus,freckles and melasma).We also analyzed the characteristics and assessed the data changes after the treatment.Results Average L,a and b values were 54.4,13.8 and 19.0 in normal skin,34.6,5.17 and 6.9 in Ota nevus,43.25,16.15 and 23.05 in freckles and 40.5,16.8 and 23.35 in melasma,respectively.The Lab values of freckles and melasma were close.The order of L value was:normal skin ＞ freckle ＞ melasma ＞Ota nevus;the order of value of a and b was:melasma ＞ freckle ＞ normal skin ＞ Ota nevus.After treatment,the Lab values gradually tended to be the values of normal skin.Conclusions The Lab color mode can be used as a digital description method for skin color and facial pigmentation,which provides an objective measure for clinical research.

Objective The mechanism of traditional double-eyelid blepharoplasty is adhering skin to tarsus,by which the skin below the incision could be elevated along with the tarsus and produce the crease.But the anatomic basis of native double-eyelids is not the same,which depends on the connection of levator aponeuroses with muscle and skin.That is,the elevations of tarsus and skin is based on the different branches of levator aponeuroses to skin.According to this,the authors have developed a modified blepharoplasty suturing levator aponeuroses to the obicularis occuli muscle to mimic the native double eyelid.Methods The surgical procedures were modified from traditional surgery.The major improvements were:keeping obicularis occuli muscles intact,dissecting the levator aponeuroses and suturing them together.Since the suturing was performed between mobilized tissues of muscle and aponeurosis,the method was named as "flexible suspension technique".Five-hundred patients were performed with this method.Forty cases randomly selected from them were compared with 40 cases performed with traditional method,and the results were investigated using questionnaire survey.Results The results of the modified surgery were more natural than traditional technique.Majority of patients were satisfactory,whereas 15 cases (3％) had asymmetry,narrowing and even fold loss.All these 15 cases were puffy eyelids.Statistical results indicated that the satisfaction rate was significantly high (P =0.003),and the adverse effects (edema,bruise and scar) were significantly lighter than traditional technique;whereas the asymmetry and fold loss were higher than traditional technique.Conclusions The flexible suspension technique of blepharoplasty can obtain more natural double eyelid appearance,and is suitable for primary blepharoplasty but not applicable for severe puffy eyelids.

Objective The recommended concentration of botulinum toxin type A is 40 100 U/ml.This study observed diffusion areas of two different concentration (40 U/ml and 100 U/ml) of botulinum toxin type A with intradermal injection to provide data for clinical application.Methods Intradermal injections with two different concentrations of botulinum toxin type A were conducted in subjects' forearm,with each level 4 points,and 4U per point (40 U/ml as 0.1 ml,100 U/ml as 0.04 ml).Minor's tests were conducted in 2nd day,5th day,2nd week and every month between 1st to 9th month respectively.The anhidrosis areas were measured and then effects of both concentrations were compared.Results The round anhidrosis areas were found in 2nd day,reaching the maximum range nearly at 2nd week,and then gradually dimming from 6th month,and completely vanishing at 9th month.In different measured points,the definite anhidrosis areas of high concentration (100 u/ml) were 113,345,530,380,330,255,285,295 and 295 mm2 respectively,while the low concentration (40 u/ml) were 113,345,450,345,285,255,255,255 and 255 mm2 respectively.The results did not show significant difference.Conclusions Concentration and volume do not show significant influence on areas of sweat gland when botulinum toxin type A is injected intradermally in a certain dose.

Objective To investigate the safety and effect of bloodletting after hyaluronic acid embolization.Methods Rabbit ear auricle artery was chosen as a vascular model.After injection of hyaluronic acid,artery embolization was made.Rabbit ears were randomly divided into three groups,including bloodletting,hyaluronidase injection and untreated groups.We evaluated the effect through appearance observation and histological examination of the rabbit ears.Results During bloodletting,some points in acupuncture needles after extrusion appeared hyaluronic acid,some points even appeared massive hemorrhage and hematoma,but most points did not present any change.The histological examination showed the auricle artery was still full of hyaluronic acid,and the surrounding tissues showed necrosis after bloodletting.Long-term observation showed,after 12 days,all rabbits were alive,all of three groups presented scabby necrosis on the edge of ear.Scabby necrosis area ranked from large to small in untreated group (33.6 ％),bloodletting group (22.0％) and hyaluronidase injection group (12.6％) (t=0.013,P＜0.05);there was a statistical difference between the later two groups.At the same time,80％ of rabbit ears after bloodletting showed obvious color sink,infection or congestion.Conclusions After embolization of the hyaluronic acid artery,bloodletting is not as effective as hyaluronidase,and it would cause the adverse changes of local tissues.

Objective:To figure out the structure and relevant data measurements of zygomatic ligament by cadaver anatomy and review of previous studies.Methods:From July 2018 to January 2020, the zygomatic areas of 20 Chinese frozen fresh cadaver hemifaces were dissected in the Department of Anatomy, Health Science Center of Hangzhou Normal University. Then the structures of zygomatic ligaments were shown. The characters of the ligament and the relationship with adjacent tissue were described and measured. And 16 previous studies were reviewed to get a comprehensive description about the characters of zygomatic ligaments.Results:Zygomatic ligaments were even and dense fibrous tissue structures distributed vertically between the skin and the subcutaneous tissue. Under the SMAS plane, the ligaments divided into two bundles. The origin of major bundle located beyond the origin of the zygomatic major muscle on the periosteum, and the origin of minor bundle located between the origin of the zygomatic minor and major muscle.Conclusions:The anatomy of the zygomatic ligament has a regular pattern, and its anatomical data has certain directive significance for clinical application.