OBJECTIVETo investigate the trans-areola approach for costicartilage harvesting in order to avoid the obvious scar resulted by traditional approach through chest incision.

METHODSFrom 2013, 7 cases who underwent rhinoplasty received costicartilage harvesting through trans-areola approach. The incision was designed along the lower interior edge of right areola. Then the dissection was performed to expose the 5th costicartilage. Then a costicartilage, 2 - 5 cm in length, was harvested. The incision was closed delicately. The suture was removed 7 days after operation.

RESULTSThe patients were followed up for 3 months to 2 years without hypertrophic scar and breast deformity. The scar was located in conceal location. The satisfactory rate was higher than that in patients with chest incision.

CONCLUSIONSThe scar resulted from trans-areola approach is comparatively conceal, compared with that at chest.

Breast ; surgery ; Cicatrix ; pathology ; Costal Cartilage ; Dissection ; methods ; Female ; Follow-Up Studies ; Humans ; Nipples ; surgery ; Rhinoplasty ; methods ; Time Factors ; Tissue and Organ Harvesting ; methods ; Transplant Donor Site

Objective To illustrate a method of lifting the upper-lip to alleviate the aging face,and to evaluate its effects and risks.Methods In the past two years,53 cases of overlong upper-lip were performed with this procedure.The recovery periods,lifted effects,side effects and the total satisfactions were evaluated.Results As for recovery periods,edema roughly reduced in 6-20 months,reddish scar faded in 1-11 months,expression restored in 2-8 months,and numbness disap peared from 4 to over 18 months.The lifted effects showed that 37 cases (78.7％) were satisfactory,7 cases (14.9％) of the lifting was not enough and still complained a long upper-lip,2 cases (4.2％) was ineffective,and 1 case (2.1 ％) considered an excessive lifting.The long term follow-up showed that 3 cases (6.4％) had obvious scar (visible at a distance of more than 1 m),14 cases (29.8％) had depression of columella/base of nostril alar or with increased exposure of nostril,3 cases (6.4 ％) had expansion or morphological changes of alar,6 cases (12.8％) had increased thickness of the upper lip and prominent vermilion tubercle,1 case (2.1％) had changes of expression,1 case (2.1％) had asymmetry,1 case (2.1％) had arching sagging,and 35 cases (74.5％) had numbness or insensitivity of upper-lip.Overall results showed very satisfied in 29 cases (61.7％),satisfied in 15 cases (31.9 ％) and dissatisfied in 3 cases (6.4 ％).Conclusions The technique for upper-lip lifting displays a significant effect with few complication.It is recommended for further clinical application.

Objective:To explore the technique procedure for comprehensive facial rhytidectomy, and to evaluate the surgical outcome.Methods:A total of 126 patient received comprehensive facial rhytidectomy were involved in this study and the outcomes were evaluated by using 14 FACE-Q scales.Results:Totally 44 patients completed the FACE-Q scales, with the follow-up of 6 to 86 months, with an average of 27.9 months. The overall satisfaction was 87.30±10.79 (mean±standard deviation), satisfaction with forehead and brow was 92.16±10.12, satisfaction with cheekbones was 93.30±6.95, satisfaction with cheek was 91.20±10.17, and satisfaction with neck was 87.16±9.65; appraisal of overall lines was 87.57±9.71, appraisal of forehead lines was 91.80±10.23, appraisal of glabella lines was 90.43±10.76, appraisal of nasolabial fold was 88.25±12.10, and appraisal of crow＇s feet was 91.52±13.66; social function scores were 88.70±9.40, psychological function scores 88.77±10.49, surgical decision satisfaction scores 90.86±9.06, and surgical outcome satisfaction scores 90.03±10.61. Self-evaluation was 8.33±3.15 years younger. There was no statistically significant difference in the scale results between the age groups of <40 years, 40-50 years, and >50 years.Conclusions:Comprehensive facial rhytidectomy is a systematic and thorough surgical solution for rejuvenation. This procedure is proved to be of high satisfactory degree in short and long-term follow-up by FACE-Q scales.

Objective To establish a cosmetic medicine bio-psycho-social model and its theory frame and a new clinical work system. Methods The clinical observation and clustering analysis were used in this study, which based on the modern medicine patterns to carry on the logical proof, theory derivation and systematic design. Results The bio-psycho-social model of cosmetic me dicine with combination of the theory and practice was established, including its concept, theory constitution and clinical work system. Conclusion The bio-psycho-social model of cosmetic medicine can most scientifically and comprehensively explain this discipline rule and clinical work, and it will bring the profound influence on the development of the theory and practice in cosmetic medicine.

Klinefelter syndrome is a congenital disease of chromosomal aberrations with a prevalence of 0.8%-2.0% in men, which mainly represented as absence of sexual characteristics such as postpubescent undeveloped or less developed testicular, feminine breast development. This article reports two Klinefelter syndrome patients with chromosome karyotype of 47, XXY from 2006 to 2016. Each has successively received series of sex reassignment surgery to improve their genital and secondary sexual characteristics based on their own preferences, satisfactory outcome is therefore achieved.

Objective:To explore the interleukin-31 protein expression in the hypertrophic scar of incision tissue after surgery and its underlying pathological impact.Methods:From February 2022 to February 2023, three HS patients scar tissue (HS) and their normal skin tissue (Control, NS) were obtained. Two patients were female and one patient was male. The tissues were fixed in 4% formalin and embedded in paraffin. Haematoxylin-eosin (HE) stain and immunohistochemical stain were used to evaluate the epidermal thickness, myofibroblasts of dermis and the expression level of IL-31 between HS and NS.Results:The epidermis thickness was (303.88±46.03) μm in HS group, while (133.02±17.40) μm in NS group ( t=12.60, P<0.001). The expression level of IL-31 protein was measured by IRS score and positive cell density. The IRS score was 9.89±2.03 of the basal layer in HS group and was 4.33±1.66 of the basal layer in NS group. The positive cell density was 786 343.83±159 627.97 of the basal layer in HS group ( P<0.001) and was 555 457.61±128 097.21 of the basal layer in NS group ( P=0.014). In the dermis layer, the IRS score was 7.11±1.05 in HS group and was 4.33±0.71 in NS group, the positive cell density was 156 760.97±26 046.10 in HS group ( P<0.001) and was 49 576.01±52 369.33 in NS group ( P<0.001). In the dermis layer, the count of myofibroblasts was 120.44±15.75 in HS group while was 27.39±14.89 in NS group ( t=23.79, P<0.001). Conclusions:Our study demonstrates that both myofibroblast count and IL-31 protein expression level are notably increased in HS patients. The expression of IL-31 protein is prominent in the cytoplasm of myofibroblasts, basal cells, macrophages and mast cells which could implicate that IL-31 may be a potential therapeutic target to enhance the resolution of HS.

Objective:To compare the anti-androgenic effect of cyproterone acetate (CPA) and spironolactone (SPL) on male-to-female transsexuals.Methods:From January 2012 to September 2021, 185 male-to-female transsexuals (95 using CPA and 90 using SPL) who visited the Peking University Third Hospital and under stable medication for ≥3 months were enrolled, aged 16 to 40 (23±5) years. General information and laboratory indicators of the last visit were collected for a cross-sectional study.Results:The median doses of antiandrogens in the CPA group and SPL group were 25 mg/d and 80 mg/d, respectively. And the median dose of oral estradiol valerate in both groups was 2 mg/d. Testosterone level in the CPA group was significantly lower than the SPL group [0.7 (0.7-1.5) nmol/L vs. 13.2(6.7-18.4) nmol/L, U= 6 970.500, P<0.001]. The CPA group also had better subjective effects on testicular atrophy, erection decrease, body hair decrease, skin softening and figure feminization (all P<0.05). The prolactin level of CPA group was significantly higher than that of SPL group [21.5 (12.6-30.1) ng/ml vs. 11.9 (7.7-20.0) ng/ml, U= 2 053.500, P<0.001]. Conclusions:CPA has a more significant effect on lowering testosterone levels than SPL, and is better than SPL in terms of testicular atrophy, erection decrease, body hair decrease, skin softening and figure feminization, albeit with a potentially higher risk of hyperprolactinemia.

Objective:To investigate the application value and clinical effect of tissue expansion in post-mastectomy breast reconstruction.Methods:From January 2013 to May 2019, 173 patients (38.2±8.0 years old) with body mass index (BMI) of (21.5±2.1) kg/m 2 were treated in Peking University Third Hospital. There were 76 cases on the right side and 97 cases on the left side; 8 cases underwent nipple sparing mastectomy, and 165 cases underwent modified radical mastectomy; 150 cases received chemotherapy and 9 cases received radiotherapy. In the first stage, immediate or delayed chest wall soft tissue expansion was performed. In the second stage, implant replacement, autologous tissue transplantation, or the combination of these two methods was performed to complete the breast reconstruction. All patients were followed up and the clinical effect was evaluated by Harris evaluation method. Results:Among 173 cases, 95 cases were provided immediate reconstruction, and 78 cases were applied delayed reconstruction. The period of tissue expansion was (7.7±3.2) months. During the second stage of reconstruction, implant exchange was conducted in 105 cases, 48 cases received implant exchange with autologous fat injection, 17 cases were performed implant exchange with endoscopy-assisted latissimus dorsi muscle transfer, and 3 cases were applied deep inferior epigastric perforator flap (DIEP) transplantation. The average follow-up time was 12.6 months (3.5-41.0 months). One patient had local tumor recurrence, and the implant was finally removed. The reconstruction effects were evaluated by Harris method, which showed that 23 cases had excellent appearance, 129 cases were good, 13 cases were fair, 7 cases were poor, and 88.4% (152/172) patients were good or above.Conclusions:Tissue expansion plays an important role as a transfer station in post-mastectomy breast reconstruction. In the second stage, the breast reconstruction method can be flexibly selected. Tissue expansion has a wide range of indications, and is especially suitable for immediate post-mastectomy breast reconstruction. Good result can be obtained by using this technique.

Objective:To investigate the similarities and differences of chondrolaryngoplasty between female and male-to-female transgender patients.Methods:A retrospective analysis focused on the case with chondrolaryngoplasty in Peking University Third Hospital from March 2016 to September 2019.Patients were followed up an average 14mths with an eleven-point Likert scale. We assigned patients into a female ( n=11) and transgender women( n=12) groups, using SPSS 22.0 tool to process and analyze data. The paired sample t test is conducted to compare pre-and postoperative differences, while independent sample t test is to compare between groups; a P-value less than 0.05 is considered to have statistical significance. Results:A total of 23 patients were enrolled, including 11 female patients and 12 transgender patients, aged 18 to 37 years old (mean 26.87±5.54 years old). Satisfaction with surgery is 95.65% (22/23 patients), satisfaction with the appearance of laryngeal prominence is 82.61% (19/23 patients). After the operation, the Self-Estimate Laryngeal Prominence Score improves from 6.57±2.45 to 2.22±2.09, the Social Ability Restriction Score improves from 6.30±3.02 to 1.52±2.54, the Phycological Burden Score decrease from 7.70±2.44 to 1.83±2.62, all data have statistical significances ( P<0.01). The improvement value of the previous two scores is greater than the transgender women group with statistical significances ( P<0.05). Conclusions:Chondrolaryngoplasty can remarkably improve the appearance of laryngeal prominence of patients. Transgenders women can obtain better social and phycological improvement than female patients after chondrolaryngoplasty.