Objective:To investigate the outcome of epicanthoplasty combined with double eyelidplasty in different aesthetic forms of double eyelids (inner type and outer type) using Z-epicanthoplasty and inverted L method.Methods:The clinical data of patients with single eyelids and epicanthus were retrospectively analyzed from November 2021 to October 2022 in Gaoxin Hospital of the First Affiliated Hospital of Nanchang University. Patients were divided into inner type group and outer type group based on their aesthetic requirements for inner double eyelids. Both groups underwent Z-epicanthoplasty or inverted L method for epicanthus correction. Postoperative follow-up was conducted to observe the incision healing, complications, and postoperative effects of the two groups. The correction effects [ineffective, effective, and markedly effective, with the effective rate calculated as (the number of markedly effective cases + the number of effective cases)/total number of cases × 100%], scar scores, and patient satisfaction scores were collected for more than 12 months after surgery. Independent sample t-test was used for the scar scores and patient satisfaction scores, and chi-square test was used for the epicanthus correction effects. P<0.05 indicated a statistically significant difference. Results:A total of 76 patients were included. Among them, 41 patients in the inner type group (4 males and 37 females, with an average age of 22.3 years, ranging from 18 to 28 years) underwent 19 cases of Z-epicanthoplasty and 22 cases of inverted L method; 35 patients in the outer type group (3 males and 32 females, with an average age of 24.2 years, ranging from 19 to 30 years) underwent 20 cases of Z-epicanthoplasty and 15 cases of inverted L method. After 12 to 16 months of follow-up, with an average of 14 months, all incisions in both groups healed in the first stage, with no significant scar hyperplasia or other complications. Most of the double eyelid shapes are natural after the surgery, and the correction of epicanthus is obvious. Comparison of the treatment efficacy between Z-epicanthoplasty and inverted L method showed no significant difference [94.87% (37/39) vs. 94.59% (35/37), P>0.05]. In the inner type group, the postoperative scar score of the inverted L method was lower than that of the Z-epicanthoplasty [(6.81±0.66) vs. (7.31±0.88)], and the satisfaction score was better than that of the Z-epicanthoplasty [(0.86±0.63) vs. (1.73±0.65)], with statistically significant differences (both P<0.05). In the outer type group, the scar score of the inverted L method was higher than that of the Z-epicanthoplasty [(7.66±0.89) vs. (7.00±0.64)], and the satisfaction score was worse than that of the Z-epicanthoplasty [(1.80±0.86) vs. (1.00±0.56)], with statistically significant differences (both P<0.05). Conclusion:For patients requiring inner type aesthetic form of medial double eyelids, inverted L method can achieve less postoperative scars and higher postoperative satisfaction compared with Z-epicanthoplasty. For patients requiring "outer type" aesthetic form, Z-epicanthoplasty can achieve less postoperative scars and higher postoperative satisfaction compared with inverted L method.

Dark circles refer to a cosmetic issue characterized by relatively darker skin color between the brow arch and the cheekbones. It has a high incidence rate and significantly affects patients’ quality of life and mental health. This article provides an overview of the periocular anatomical structures and the clinical classification of dark circles. It delves into the pathogenesis and etiologies of structural, pigmented, and vascular dark circles, summarizing and differentiating the clinical manifestations of these three types. This article also discusses selection of the appropriate diagnostic and therapeutic approaches based on the etiology and types, offering valuable insights for clinical practice.

Objective:To investigate the effects and mechanism of baicalin on the wound healing of full-thickness skin defects in diabetic mice.Methods:This study was an experimental research. Mononuclear cells were isolated from five male C57BL/6J mice aged 8-12 weeks and induced to differentiate into macrophages for conducting the subsequent experiments. According to the random number table (the same grouping method below), macrophages in a high-glucose environment were divided into 0 μmol/L baicalin group (no baicalin was added), 5 μmol/L baicalin group, 15 μmol/L baicalin group, 25 μmol/L baicalin group, 50 μmol/L baicalin group, and 75 μmol/L baicalin group treated with the corresponding final molarity of baicalin and 1 μg/mL endotoxin/lipopolysaccharide (LPS). After treatment for 48 hours, the cell proliferation activity was detected using a microplate reader. Macrophages in a high-glucose environment were divided into LPS group treated with 1 μg/mL LPS and LPS+baicalin group treated with 50 μmol/L baicalin+1 μg/mL LPS. After treatment for 48 hours, the percentage of double-positive cells for inducible nitric oxide synthase (iNOS) and CD80, as well as that for arginase 1 (Arg1) and CD206 among the cells, were detected using immunofluorescence method, the secretion levels of interleukin 1β (IL-1β), IL-6, IL-23, IL-10, insulin-like growth factor (IGF), and transforming growth factor β 1 (TGF-β 1) by the cells were detected using enzyme-linked immunosorbent assay, the expression of reactive oxygen species in the cells was detected using a fluorescent probe method, the protein expression of nuclear factor κB in the cells were detected using Western blotting, and the expression of nuclear factor 2 in the cells was observed using immunofluorescence method. The number of cell experimental samples was 3. Twenty-four 8-week-old male db/db mice were selected. After preparing full-thickness skin defect wounds on their backs, they were divided into baicalin group and normal saline group (with 12 mice in each group). On the third day after injury, 50 μmol/L baicalin and normal saline were injected into the wounds of mice, respectively. The wound healing situation was observed and the percentage of the residual wound area was calculated on the 4 th, 8 th, and 12 th day after injury. The wound tissue was sampled on the 8 th day after injury, hematoxylin-eosin staining was performed to observe the epithelial regeneration and inflammatory cell infiltration, the protein expression of CD31 was detected by Western blotting, and the expression of reactive oxygen species was detected by a microplate reader. The number of animal experimental samples was 6. Results:After treatment for 48 hours, only the proliferation activity of macrophages in 50 μmol/L baicalin group was significantly higher than that in 0 μmol/L baicalin group ( P<0.05). After treatment for 48 hours, the percentage of double-positive cells for iNOS and CD80 among the macrophages in LPS+baicalin group was (21.0±2.4)%, which was significantly lower than (66.6±4.5)% in LPS group ( t=15.63, P<0.05); the percentage of double-positive cells for Arg1 and CD206 among the macrophages in LPS+baicalin group was (59.1±2.1)%, which was significantly higher than (18.6±1.7)% in LPS group ( t=25.38, P<0.05); compared with those in LPS group, the secretion levels of IL-1β, IL-6, and IL-23 by the macrophages in LPS+baicalin group were significantly decreased (with t values of 14.26, 15.95, and 12.23, respectively, P<0.05), while the secretion levels of IL-10, IGF, and TGF-β 1 were significantly increased (with t values of 8.49, 11.98, and 13.84, respectively, P<0.05); the expression of reactive oxygen species in the macrophages in LPS+baicalin group was significantly lower than that in LPS group ( t=5.54, P<0.05); compared with those in LPS group, the protein expression of nuclear factor κB in the nucleus of the macrophages in LPS+baicalin group was significantly decreased ( t=36.22, P<0.05), while that in the cytoplasm was significantly increased ( t=14.47, P<0.05), and the expression of nuclear factor 2 in the nucleus was increased. On the 4 th and 8 th day after injury, the wound area of mice in baicalin group was significantly smaller than that in normal saline group, and the wounds of mice in baicalin group completely healed on the 12 th day after injury. On the 4 th, 8 th, and 12 th day after injury, the residual wound area percentage of mice in baicalin group was significantly lower than that in normal saline group (with t values of 13.29, 10.08, and 11.72, respectively, P<0.05). On the 8 th day after injury, compared with those in normal saline group, the wound tissue of mice in baicalin group showed significant re-epithelization, the infiltration of inflammatory cells was reduced, the expression of CD31 protein was significantly increased ( t=17.23, P<0.05), and the expression of reactive oxygen species was significantly reduced ( t=5.78, P<0.05). Conclusions:Baicalin alleviates the inflammatory response of macrophages by lowering the level of reactive oxygen species in cells and promoting the polarization of macrophages to the M2 type, thereby facilitating the healing of full-thickness skin defect wounds in diabetic mice.

Objective:To investigate the outcome of epicanthoplasty combined with double eyelidplasty in different aesthetic forms of double eyelids (inner type and outer type) using Z-epicanthoplasty and inverted L method.Methods:The clinical data of patients with single eyelids and epicanthus were retrospectively analyzed from November 2021 to October 2022 in Gaoxin Hospital of the First Affiliated Hospital of Nanchang University. Patients were divided into inner type group and outer type group based on their aesthetic requirements for inner double eyelids. Both groups underwent Z-epicanthoplasty or inverted L method for epicanthus correction. Postoperative follow-up was conducted to observe the incision healing, complications, and postoperative effects of the two groups. The correction effects [ineffective, effective, and markedly effective, with the effective rate calculated as (the number of markedly effective cases + the number of effective cases)/total number of cases × 100%], scar scores, and patient satisfaction scores were collected for more than 12 months after surgery. Independent sample t-test was used for the scar scores and patient satisfaction scores, and chi-square test was used for the epicanthus correction effects. P<0.05 indicated a statistically significant difference. Results:A total of 76 patients were included. Among them, 41 patients in the inner type group (4 males and 37 females, with an average age of 22.3 years, ranging from 18 to 28 years) underwent 19 cases of Z-epicanthoplasty and 22 cases of inverted L method; 35 patients in the outer type group (3 males and 32 females, with an average age of 24.2 years, ranging from 19 to 30 years) underwent 20 cases of Z-epicanthoplasty and 15 cases of inverted L method. After 12 to 16 months of follow-up, with an average of 14 months, all incisions in both groups healed in the first stage, with no significant scar hyperplasia or other complications. Most of the double eyelid shapes are natural after the surgery, and the correction of epicanthus is obvious. Comparison of the treatment efficacy between Z-epicanthoplasty and inverted L method showed no significant difference [94.87% (37/39) vs. 94.59% (35/37), P>0.05]. In the inner type group, the postoperative scar score of the inverted L method was lower than that of the Z-epicanthoplasty [(6.81±0.66) vs. (7.31±0.88)], and the satisfaction score was better than that of the Z-epicanthoplasty [(0.86±0.63) vs. (1.73±0.65)], with statistically significant differences (both P<0.05). In the outer type group, the scar score of the inverted L method was higher than that of the Z-epicanthoplasty [(7.66±0.89) vs. (7.00±0.64)], and the satisfaction score was worse than that of the Z-epicanthoplasty [(1.80±0.86) vs. (1.00±0.56)], with statistically significant differences (both P<0.05). Conclusion:For patients requiring inner type aesthetic form of medial double eyelids, inverted L method can achieve less postoperative scars and higher postoperative satisfaction compared with Z-epicanthoplasty. For patients requiring "outer type" aesthetic form, Z-epicanthoplasty can achieve less postoperative scars and higher postoperative satisfaction compared with inverted L method.

Dark circles refer to a cosmetic issue characterized by relatively darker skin color between the brow arch and the cheekbones. It has a high incidence rate and significantly affects patients’ quality of life and mental health. This article provides an overview of the periocular anatomical structures and the clinical classification of dark circles. It delves into the pathogenesis and etiologies of structural, pigmented, and vascular dark circles, summarizing and differentiating the clinical manifestations of these three types. This article also discusses selection of the appropriate diagnostic and therapeutic approaches based on the etiology and types, offering valuable insights for clinical practice.

Objective:To evaluate the static symmetry in patients with early facial paralysis after masseteric-to-facial nerve transfer combined with fascia lata graft.Methods:Clinical data of paralyzed patients who treated with masseteric-to-facial nerve transfer combined with fascia lata graft in Shanghai Jiao Tong University School of Medicine Affiliated Ninth People’s Hospital from January 2016 to December 2018 were retrospectively analyzed. Patients were divided into two groups according to the degree of preoperative oral commissure dropping: slight asymmetry (Scale Ⅱ, Group A) and severe asymmetry (Scale Ⅲ, Group B). Facial muscle contraction was evaluated by Terzis Facial Grading System to evaluate smile function, which was divided into Score Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴ. The higher the score, the better the facial muscle contraction and the better the dynamic symmetry during preoperatively and one year postoperatively. The static symmetry of oral commissure was evaluated by Symmetry Scale of Oral Commissure to evaluate symmetry at rest, which was divided into Scale Ⅰ, Ⅱ, Ⅲ and Ⅳ, the higher the scale, the worse the static symmetry. Face-gram software was adopted to measure bilateral vertical differences(D 1) or horizontal differences(D 2) in the oral commissure position of the patients with facial paralysis for evaluating the postoperative static symmetry objectively. Statistical analyses were performed with SPSS version 26.0. Numeration data were analyzed by chi-square test. Intragroup quantitative data was analyzed by paired t-test and intergroup quantitative data was analyzed by two-sample t-test. The significance level was set at 0.05. Results:A total of 58 patients were included, including 30 patients in group A [male 12, female 18, age (43.5 ±8.1) years], and 28 patients in group B[male 12, female 16, age (40.6 ±9.6) years]. There was no significant difference in sex, age at surgery, paralyzed side and denervation time between groups ( P>0.05). The patients were scored Ⅰ on Terzis’ smile functional evaluation scale preoperatively. The score of smile function in postoperative percentage in all patients was improved to Score Ⅲ (Group A, 9/30, 30.0%; Group B, 10/28, 35.7%) or Score Ⅳ (Group A, 21/30, 70.0%; Group B, 18/28, 64.3%), according to the Terzis Facial Grading System. There was no significant difference in the improvement of smile function between groups ( P>0.05). In Group A, 73.3% patients had postoperative improvement in static symmetry (Scale Ⅱ to Scale Ⅰ, 22/30) and 26.7% patients were still Scale Ⅱ according to Symmetry Scale of Oral Commissure to evaluate symmetry at rest. In Group B, 39.3% of patients achieved static symmetry effect (Scale Ⅲ to Scale Ⅰ, 11/28), 42.9% patients had postoperative improvement (Scale Ⅲ to Scale Ⅱ, 12/28) and 17.8%(5/28) of them were still Scale Ⅲ. The proportion of achieving static symmetry effect (Scale Ⅰ) in Group A was higher than that in Group B ( P<0.01). D 1 values of one-year postoperation were smaller than that of preoperation [Group A: (5.27 ±0.74) mm vs. (2.24 ±0.57) mm; Group B: (8.22 ±1.37) mm vs. (4.42 ±0.95) mm, P<0.01]. Similarly, D 2 values of one-year postoperation were smaller than that of preoperation [Group A: (6.11 ±1.18) mm vs. (2.98±1.13) mm; Group B: (8.84 ±2.16) mm vs. (5.24 ±1.85) mm, P<0.01]. There were significant differences between groups in preoperative comparison and one-year postoperative comparison( P<0.01). Conclusions:Masseteric-to-facial nerve transfer combined with fascia lata graft achieved dynamic and static symmetry in patients with different levels of asymmetry. The postoperative static symmetry effect at rest may be influenced by the different levels of oral commissure asymmetry preoperatively.

Objective:To evaluate the static symmetry in patients with early facial paralysis after masseteric-to-facial nerve transfer combined with fascia lata graft.Methods:Clinical data of paralyzed patients who treated with masseteric-to-facial nerve transfer combined with fascia lata graft in Shanghai Jiao Tong University School of Medicine Affiliated Ninth People’s Hospital from January 2016 to December 2018 were retrospectively analyzed. Patients were divided into two groups according to the degree of preoperative oral commissure dropping: slight asymmetry (Scale Ⅱ, Group A) and severe asymmetry (Scale Ⅲ, Group B). Facial muscle contraction was evaluated by Terzis Facial Grading System to evaluate smile function, which was divided into Score Ⅰ, Ⅱ, Ⅲ, Ⅳ and Ⅴ. The higher the score, the better the facial muscle contraction and the better the dynamic symmetry during preoperatively and one year postoperatively. The static symmetry of oral commissure was evaluated by Symmetry Scale of Oral Commissure to evaluate symmetry at rest, which was divided into Scale Ⅰ, Ⅱ, Ⅲ and Ⅳ, the higher the scale, the worse the static symmetry. Face-gram software was adopted to measure bilateral vertical differences(D 1) or horizontal differences(D 2) in the oral commissure position of the patients with facial paralysis for evaluating the postoperative static symmetry objectively. Statistical analyses were performed with SPSS version 26.0. Numeration data were analyzed by chi-square test. Intragroup quantitative data was analyzed by paired t-test and intergroup quantitative data was analyzed by two-sample t-test. The significance level was set at 0.05. Results:A total of 58 patients were included, including 30 patients in group A [male 12, female 18, age (43.5 ±8.1) years], and 28 patients in group B[male 12, female 16, age (40.6 ±9.6) years]. There was no significant difference in sex, age at surgery, paralyzed side and denervation time between groups ( P>0.05). The patients were scored Ⅰ on Terzis’ smile functional evaluation scale preoperatively. The score of smile function in postoperative percentage in all patients was improved to Score Ⅲ (Group A, 9/30, 30.0%; Group B, 10/28, 35.7%) or Score Ⅳ (Group A, 21/30, 70.0%; Group B, 18/28, 64.3%), according to the Terzis Facial Grading System. There was no significant difference in the improvement of smile function between groups ( P>0.05). In Group A, 73.3% patients had postoperative improvement in static symmetry (Scale Ⅱ to Scale Ⅰ, 22/30) and 26.7% patients were still Scale Ⅱ according to Symmetry Scale of Oral Commissure to evaluate symmetry at rest. In Group B, 39.3% of patients achieved static symmetry effect (Scale Ⅲ to Scale Ⅰ, 11/28), 42.9% patients had postoperative improvement (Scale Ⅲ to Scale Ⅱ, 12/28) and 17.8%(5/28) of them were still Scale Ⅲ. The proportion of achieving static symmetry effect (Scale Ⅰ) in Group A was higher than that in Group B ( P<0.01). D 1 values of one-year postoperation were smaller than that of preoperation [Group A: (5.27 ±0.74) mm vs. (2.24 ±0.57) mm; Group B: (8.22 ±1.37) mm vs. (4.42 ±0.95) mm, P<0.01]. Similarly, D 2 values of one-year postoperation were smaller than that of preoperation [Group A: (6.11 ±1.18) mm vs. (2.98±1.13) mm; Group B: (8.84 ±2.16) mm vs. (5.24 ±1.85) mm, P<0.01]. There were significant differences between groups in preoperative comparison and one-year postoperative comparison( P<0.01). Conclusions:Masseteric-to-facial nerve transfer combined with fascia lata graft achieved dynamic and static symmetry in patients with different levels of asymmetry. The postoperative static symmetry effect at rest may be influenced by the different levels of oral commissure asymmetry preoperatively.

Objective:To compare the clinical efficacy of autologous fat injection and conjunctival pedicled orbital septal fat grafting for infraorbital margin depression in young people.Methods:Fourty young patients with lower eyelid pouch and infraorbital margin depression with age of 20 to 40 years and average age of 30.6 yaers in the First Affiliated Hospital of Nanchang University from September 2017 to September 2019 were enrolled. According to the surgical method, all patients were divided into 2 groups with 20 cases each. Group 1 underwent transconjunctival orbital septum fat reset. Group 2 underwent various autologous fat injection after proper amount of orbital septal fat being removed, including structural fat, fine-particle fat and nano-fat, performed in different parts and layers. The tear trough rating scale (TTRS) scores and patients＇ satisfaction at 1 year after operation between 2 groups were compared.Results:Compared with the preoperative TTRS scores, the differences in scores at 6 months and 1 year after surgery were statistically significant ( P<0.01). The scores between two groups were compared at 6 months and 1 year respectively after the operation, and the difference were both statistically significant ( P<0.01). 6 months after the operation, the TTRS scores including four items were carefully compared between the two groups. It showed that the reduction of tear groove depth ( P<0.05), pigmentation ( P<0.01) and wrinkle ( P<0.01) in group 2 were more obvious than those in group 1. The percentage of satisfaction in group 2 (95%) was higher than that in the group 1 (70%), and the difference was statistically significant ( P<0.01). Conclusions:For infraorbital margin depression of young people, after proper amount of orbital septal fat being removed, various free fats graft injection into different parts and layers could obtain better treatment results, reducing not only the depth of the tear groove, but also periorbital pigmentation and fine wrinkles.

The efficient management of wounds is the focus of current research. In addition to conventional wound management and necessary surgery, the role of pro-healing drugs in wound treatment has gradually been emphasized. Platelet-rich blood products that is rich in a variety of biologically active molecules are considered as a low-cost and safe therapy in promoting tissue healing, and have great development prospects in the field of regenerative medicine. However, due to the lack of standard preparation and management and the unstable activities of the biomolecules in them, the therapeutic effects of platelet-rich blood products are uneven. In order to solve these problems, researches related to the protection and delivery of biologically active molecules in platelet-rich blood products by biomaterials have gradually increased in recent years, which is also one of the latest trends in wound treatment research. This article first briefly introduces the types of platelet-rich blood products, then outlines the latest research progress achieved by their combination with biomaterials, and finally summarizes the research progress and future research directions of the combination approach in wound treatment.

Objective: To discuss a method, increasing the resistance and decreasing the power of the levator palpebrae superioris, to treat the upper eyelid retraction, after upper blepharoplasty, and summarize the feasibility and efficacy of this operation. Methods: A total of 33 female patients (42 eyes) with upper eyelid retraction after blepharoplasty were treated. According to preoperative evaluation, an adjusted method, levator tendon membrane and Muller′s muscle compound tissue turnover flap, was selected. Following the incision of past blepharoplasty, scar and adhesions were removed as much as possible. The space between orbital septum and levator palpebral tendon membrane was widely separated, as well as the space between levator palpebral tendon membrane and Muller′s muscle, and the conjunctiva. A composite tissue flap consisting of levator palpebral tendon membrane and Muller′s muscle was formed. At the spot above the end of the composite tissue flap, paralleling to the upper edge of upper tarsal plate, the tissue was stripped. The compound flap was divided into two layers, a deep and a shallow layer, to form the aponeurosis turnover flap with pedicle at the free end. The turnover flap was horizontally sutured to the upper edge of tarsal plate. The buccal fat pad was cut and covered, between the levator palpebral tendon membrane and the orbital septum fat. At the end, conventional blepharoplasty was performed to close the incision. Results: All the incisions were primary healed. Stitches were taken out 7 days after surgery. There was different scar proliferation. The recovery period last 3-6 months. Transplanted buccal fat was survived, without nodule, liquefaction, unevenness or other complications. All patients were followed for 3 to 12 months, with a mean follow-up of 6 months, for static and dynamic assessment. In static evaluation, the upper palpebral margin decreased by 2 mm. The upper palpebral margin decreased by 3 mm on average. Three cases (9%) had insufficiently corrected upper eyelid retraction, 2 cases (6%) recurred upper eyelid retraction in 3 months after operation, while the other 28 cases (85%) showed satisfactory results. Conclusions The upper eyelid tendon membrane and Muller′s muscle compound tissue turnover flap extension is helpful to correct the upper eyelid retraction, caused by blepharoplasty.