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A filler injection in the nose can be essential but is also dangerous, especially in the nasal cartilage region. To safely and accurately perform a filler injection, surgeons must have detailed knowledge of nasal anatomy.Associated the vessel branches and the characteristics of different nasal regions to provide suggestions for more suitable injection sites.Fifty specimens underwent computed tomography (CT) after contrast infusion. Qualified specimens were selected for 3D CT reconstruction. Dissection was performed to confirm the accuracy of the CT data.The branches of arteries with large diameters, the dorsal nasal artery (DNA) and the lateral nasal artery (LNA) were distributed within the superficial musculoaponeurotic system layer. The DNA was seen in only 58% of specimens. The artery crossed the midline over the upper lateral cartilage in 16% of specimens. The LNA was a constant branch that traversed the nasal tip. The LNA crossed the midline to the contralateral side in 18% of patients. We divided the nasal cartilage dorsum into two regions for easy handling: the supratip region (STR) and the nasal tip region (NTR). The branches distributed in the STR mostly originated from the DNA (81.6%, 40/49), while those in the NTR mostly originated from the LNA.The vasculature of the nasal cartilage region observed in this study is similar to that observed in previous studies. However, we found that the STR was an advantageous area for filler injection. At the same time, we provided suggestions for more suitable injection methods.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background The measured intraarterial volume of cadaveric ophthalmic arteries was utilized for safety recommendations during facial soft tissue filler injections. However, its clinical practicability and model applicability have become questionable. Objectives To measure the volume of the ophthalmic artery in living individuals by utilizing computed tomography (CT) imaging technology. Methods A total of 40 Chinese patients (23 males, 17 females) were included in this study with a mean age of 61.0 (14.2) years and a mean body mass index of 23.7 (3.3) kg/m2. Patients were investigated with CT imaging technology to evaluate the length, diameter, and volume of the bilateral ophthalmic arteries as well as the length of the bony orbits, resulting in a total of 80 investigated ophthalmic arteries and orbits. Results Independent of gender, the average length of the ophthalmic artery was 80.6 (18.7) mm, the calculated volume of the ophthalmic artery was 0.16 (0.05) mL and the minimal and maximal internal diameter of the ophthalmic artery were 0.50 (0.05) mm and 1.06 (0.1) mm, respectively. Conclusions Based on the results obtained from the investigation of 80 ophthalmic arteries it must be concluded that current safety recommendations should be reevaluated. The volume of the ophthalmic artery appears to be 0.2 mL rather than 0.1 mL as previously reported. In addition, it appears impractical to limit the volume of soft tissue filler bolus injections to 0.1 mL due to the aesthetic requirements of each individual patient and treatment plan.

Background Facial regions with a high risk for causing injection-related visual comprise are dual-supply vascular areas such as the nose, glabella, and forehead. These regions have in common that they receive arterial blood supply both by branches of the internal (ICA) and the external carotid artery (ECA). Objective The authors sought to investigate the anastomotic pathways between ICA and ECA branches in the upper face. Methods Postmortem computed tomographic angiographic scans of n = 38 Chinese non-embalmed hemifaces (25 males, 13 females; mean age, 37.79 [11.8] years; mean BMI, 21.90 [2.3] kg/m2) were conducted. Data analysis relied on the calculation of depth, distances, and pathways of forehead and temporal arteries to investigate the number of anastomotic connections, the connecting branches, and the layer of connection between ICA and ECA territories. Results Between ICA and ECA territories, only 1 connection in 57.9%, 2 connections in 31.6%, 3 connections in 5.3%, and 4 and 5 connections in 2.6% each were identified. A superficial connection was observed in 15.8% whereas in 84.2% the anastomotic connection was identified to be both superficial and deep. Conclusions Adverse events following facial minimally invasive soft-tissue filler injections for aesthetic purposes are not frequent but devastating if they occur. Anatomic knowledge as presented in this study can help to increase awareness of 3-dimensional vascular anastomotic pathways and identify safer injection zones and safer fascial planes. Evidence-based injection techniques should be followed, and safety aspects should be placed over the aesthetic outcome.

In patients with breast atrophy and ptosis, it is necessary to correct both problems simultaneously. This study aimed to analyze breast morphological changes with a three-dimensional (3D) scanning technique to demonstrate the improvement effect of dual-plane breast augmentation combined with internal suture mastopexy.3D breast surface scans were performed preoperatively and postoperatively in 24 patients (n = 35 breasts) undergoing internal suture mastopexy combined with prosthetic augmentation through the periareolar approach and 24 patients (48 breasts) undergoing simple dual-plane breast augmentation. Changes in linear distance, breast volume and volume distribution, breast projection, and nipple position were analyzed to assess the breast morphology.Compared with simple breast augmentation, augmentation combined with internal suture mastopexy was associated with a higher upper pole volume increase and greater medial and upward nipple displacement. After the surgery, the upper pole volume increased by an average of 10.6% in combined augmentation group and decreased by an average of 2.2% in the simple breast augmentation group. The measured breast projections were 24.8 ± 2.2% lower than expected in the combined group and 23.1 ± 4.1% lower than expected in the simple group, based on implant parameters recorded by the manufacturer. The nipple moved 0.2 ± 0.5 cm laterally, 1.6 ± 0.6 cm upward, and 2.8 ± 0.7 cm anteriorly in the combined group and 0.9 ± 0.5 cm laterally, 0.7 ± 0.6 cm upward, and 3.0 ± 0.6 cm anteriorly in the simple group.Dual-plane breast augmentation in addition to internal suture mastopexy appears to reposition breast tissue from the lower pole to fill in the deficient upper breast, pull the nipple medially and superiorly, and ultimately correct mild to moderate breast ptosis.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hyaluronic acid (HA) gel is a widely used dermal filler for the correction of facial volume loss. The relationship between the characteristics of HA and clinical efficacy remains unclear. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of monophasic and biphasic HA in the treatment of nasolabial folds (NLFs).Studies were identified by searching the electronic databases PubMed, Embase, and Web of Science from inception to May 2021. Randomized controlled trials (RCTs) were selected according to the inclusion criteria. Outcomes included the Wrinkle Severity Rating Scale (WSRS) score, Global Aesthetic Improvement Scale score, and incidence of adverse events.A total of 1190 patients from 14 RCTs were included in the meta-analysis. The mean WSRS score improvement in the biphasic HA group was much lower than that in the monophasic HA group (MD = 0.18, 95% CI: 0.16-0.20, p 0.00001). The subject satisfaction percentage was significantly higher for monophasic than biphasic HA (RR = 1.95, 95% CI: 1.09-3.48, p = 0.02). There was no significant difference in the adverse event rate between the monophasic and biphasic HA groups (RR = 0.96, 95% CI: 0.75-1.24, p = 0.77).Regardless of whether improvement in NLFs or patient satisfaction is considered, monophasic HA is better than biphasic HA. Regarding the adverse event rate, there is no difference between monophasic and biphasic HA.

The forehead has high risks associated with filler injection considering its highly complex vascular system. This study aims to thoroughly describe the anatomical variations and relationships between the supratrochlear artery (STA) and supraorbital artery (SOA).We studied 56 cadaveric heads by computed tomography after contrast-agent injection.The deep branch of the STA originated in the deep superior orbital arcade and the ophthalmic artery (OA), whereas that of the SOA originated at 3 locations: the deep superior orbital arcade, deep superior orbital artery, and OA. The superficial branch of the STA also had 3 origins: the superficial superior orbital arcade, OA, and angular artery, whereas the superficial branch of the SOA had 2 origins: the superficial superior orbital arcade and OA. Based on the relationship between the STA and SOA, 2 main arterial distribution patterns were observed in both superficial and deep layer arteries: STA/SOA connected pattern and STA/SOA disconnected pattern, of which the latter pattern has 3 subtypes.The forehead arteries have complex origins. The relationship of the supratrochlear and supraorbital arteries could be categorized into 2 main patterns. The study elucidated the complexity of the forehead vasculature.

Background Horizontal neck wrinkles develop during the aging process. Aims This study assessed the effectiveness of a comprehensive approach to treating horizontal neck wrinkles using non-cross-linked hyaluronic acid injection and smooth absorbable PPDO (Poly p-dioxanon) thread insertion. Methods Ten patients with horizontal neck wrinkles were treated with hyaluronic acid injection and thread-lifting. The clinical outcomes were evaluated six months after treatment. Results The median global aesthetic improvement scale scores evaluated by plastic surgeons and the patients were 4.3 ± 0.8 (3–5) and 4.1 ± 0.7 (3–5), respectively, at six months post-treatment. Five (50%) patients strongly agreed, and three subjects (30%) agreed that their horizontal neck wrinkles had improved following treatment. No serious adverse events, including infections, lumps, irregularities, or the Tyndall effect, occurred during treatment. Conclusion This study revealed that a comprehensive approach using hyaluronic acid and thread-lifting provided satisfactory and effective clinical outcomes in treating horizontal neck wrinkles. Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

This study analyzes multi-function land use and land use coordination to provide support for the sustainable use of regional land. Under the guidance of system theory, this study deduced the multi-functional mechanism of land use from the two dimensions of land use status classification and land use planning zoning and constructed the evaluation index system based on it. Using the entropy method, fuzzy comprehensive evaluation method, coupling coordination model, and grey correlation models, this study examined the comprehensive development level, coupling coordination degree, and temporal and spatial evolution characteristics of land use functions in Guangxi and its cities from 2008 to 2017. The results indicated the following:from 2008 to 2017, the comprehensive evaluation level index of all functions of land use in Guangxi increased from 0.270 9 to 0.781 2, and all functions had made considerable progress. The comprehensive level of land use in Guangxi was as follows:cultural > economic > social > ecological functions. However, there was much room for the improvement of ecological function in the process of land use. The coupling and coordination types of land use in Guangxi had experienced the evolution process of "moderate maladjustment-mild maladjustment-near maladjustment-reluctant coordination-primary coordination-intermediate coordination". Among the 14 prefecture level cities, Guilin, Liuzhou, and Nanning were the best. In general, the functions of land use in Guangxi were developing well. The coupling and coordination degree of ecological, economic, social, and cultural functions of land use in different cities were quite different, and the development is unbalanced. There was no stable and efficient coordinated development mechanism among the functions of land use in the region. To improve the multi-functional levels of land use, Guangxi should take Guilin, Liuzhou, and Nanning as the core nodes, point to area, cultural function as the guide, ecological function as the key, and coordinate the development of social and economic functions.

The serratus plane block is a regional anesthesia technique awaiting efficacy and safety evaluation in breast cancer surgery, but evidence is unclear. This meta-analysis evaluates the analgesic effectiveness of serratus plane block vis-à-vis general anesthesia and paravertebral block for breast cancer surgery. We searched for randomized controlled trials in PubMed, the Cochrane Library, and Web of Science with no language limitation, comparing the serratus plane block with multimodal analgesia or the thoracic paravertebral block in breast cancer surgery. The Hartung-Knapp-Sidik-Jonkman method in combination with a random-effects model was used to pool data. We included 12 randomized controlled trials (799 patients). Compared with multimodal analgesia, pooled outcomes favored the use of serratus plane block for effectively alleviating acute postoperative pain severity at multiple time points. The serratus plane block also resulted in decreased postoperative analgesic consumption of 28.81mg (95% confidence interval [CI]: -51.20, -6.43), decreased intraoperative fentanyl consumption of -56.46 mg (95% CI: -79.61, -33.30), increased duration of postoperative anesthesia of 243.85 min (95% CI: 104.38, 383.31), and reduced postoperative nausea and vomiting with a log relative risk of -1.07 (95% CI: -1.90, -0.24). Compared with the thoracic paravertebral block, the serratus plane block was not statically worse for all of the outcomes assessed. No adverse effects were reported. The serratus plane block effectively alleviates acute postoperative pain, reduces the rate of postoperative nausea and vomiting, and improves perioperative anesthesia outcomes in breast cancer surgery, and it may represent an alternative to thoracic paravertebral block.

Background Temple filler injection is one of the most common minimally invasive cosmetic procedures involving the face; however, vascular complications are not uncommon. Objectives This study aimed to investigate the anatomy of the temporal vessels and provide a more accurate protocol for temple filler injection. Methods Computed tomography (CT) scans of 56 cadaveric heads injected with lead oxide were obtained. We then used Mimics software to construct 3-dimensional (3D) images of the temporal vessels described by a coordinate system based on the bilateral tragus and right lateral canthus. Results In the XOY plane, the superficial temporal artery (STA), middle temporal artery (MTA), zygomatico-orbital artery (ZOA), posterior branch of the deep temporal artery (PDTA), and lateral margin of the orbital rim divide the temple into 4 parts (A, B, C, and D). The probabilities of the STA, MTA, ZOA, and PDTA appearing in parts A, B, C, and D were 30.73%, 37.06%, 39.48%, and 77.18%, respectively. In 3D images, these vessels together compose an arterial network that is anastomosed with other vessels, such as the external carotid, facial, and ocular arteries. Conclusions 3D CT images can digitally elucidate the exact positions of temporal vessels in a coordinate system, improving the safety of temple filler injections in a clinical setting.

Background Results regarding immediate prosthetic breast reconstruction after postmastectomy radiation therapy (PMRT) have been inconsistent. Objectives The authors aimed to assess the efficacy and safety of PMRT before immediate prosthetic breast reconstruction for patients with breast cancer. Methods Electronic databases (PubMed, EmBase, and the Cochrane Library) were systematically searched to identify eligible studies from their inception until March 2020. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was applied as an effect estimate and calculated using the random-effects model. Results Nineteen studies including a total of 6757 patients were selected for final meta-analysis. The pooled OR showed that PMRT was associated with a higher incidence of reconstruction failure (OR = 2.57; 95% CI =1.55–4.26; P Conclusions Although PMRT is the standard adjuvant therapy for mastectomy patients treated with immediate implant-based breast reconstruction, PMRT for patients undergoing immediate implant-based breast reconstruction has been associated with high risks of reconstruction failure, capsular contracture, and overall complications as well as low incidences of patient satisfaction and good aesthetic results. Level of Evidence: 4

To better understand the coupling coordination mechanism between urbanization and territorial spatial ecological restoration, a typical study was conducted in three provinces with "revolutionary-minority-border-montanic-poverty" characteristics. This study constructed a coupling coordination system by which the relationship between urbanization and territorial spatial ecological restoration could be determined after which the coupling coordination and grey correlation models, were used to explore the spatiotemporal differentiation characteristics and driving factors of urbanization and ecological restoration. The results showed the level of territorial spatial ecological restoration throughout the "revolutionary-minority-border-montanic-poverty" region was higher than the level of urbanization before 2015 and was lower than that after 2015. The gap between these two categories was widening. The overall difference in the degree of urbanization and territorial spatial ecological restoration systems showed an increasing trend, and the degree of internal difference of the latter was higher than that of the former. The coupling coordination relationship between urbanization and territorial spatial ecological restoration systems had changed from slightly irregular to primary coordination, and the overall coupling coordination level of the regions was higher than that of the each provinces. Although the coupling coordination level had improved, it was still relatively low and did not result in the formation of a favorable mutual relationship. There was strong correlation among the indexes of the two systems; therefore, ensuring good territorial spatial ecological governance was a strong driving force for promoting the development of urbanization. The development of the "revolutionary-minority-border-montanic-poverty" region should be planned in a holistic manner. According to the theory of marginal analysis, the degree of improvement in urbanization should be regarded as a marginal benefit, the degree of improvement in territorial spatial ecological restoration should be regarded as a marginal cost, and the degree of coupling coordination should be taken as constraint with which to form a benign mechanism driven by the former two factors in order to ensure sustainable development.

Breast ptosis is a deformity commonly found in patients seeking breast augmentation. Current mastopexy techniques rely on incisions on the breast to correct ptosis; nonetheless, they leave extensive scars. Having to opt for a visibly scarred breast over a ptotic breast can be a difficult choice.We sought an innovative internal suture mastopexy for hypomastia of mild breast ptosis.A procedure that left a tiny scar on the nipple-areolar complex was introduced. This method was safe and efficient when combining mastopexy with augmentation.Overall, 53 patients underwent this operation in the Plastic and Cosmetic Department of Guangdong Second Provincial General Hospital from January 1, 2013, to June 30, 2017, with a mean follow-up of 38 ± 16 months. The pre-operation and post-operation SN-N lines (the distance from the sternal notch to the nipple) were 21.8 ± 1.2 cm and 20.7 ± 1.0 cm, respectively; the difference was statistically significant (P0.05). The patients and surgeon expressed satisfaction with the procedure.Based on the results of the present study, which included more than 50 patients, we believe that internal suture mastopexy can be used as an effective alternative hypomastia in patients with mild breast ptosis.IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. .

Background Vascular complications from periorbital intravascular filler injection are major safety concerns. Objective To thoroughly describe the superior orbital vessels near the orbital rim and propose considerations for upper eyelid and forehead injections. Methods Fifty-one cadaver heads were infused with lead oxide contrast media through the external carotid artery, internal carotid artery, and facial and superficial temporal arteries. Computed tomography (CT) images were obtained after contrast agent injection, and 3-dimensional CT scans were reconstructed by using a validated algorithm. Results Eighty-six qualified hemifaces clearly showed the origin, depth, and anastomoses of the superior orbital vessels, which consistently deployed 2 distinctive layers: deep and superficial. Of all hemifaces, 59.3% had deep superior orbital vessels near the orbital rim, including 44.2% with deep superior orbital arcades and 15.1% with deep superior orbital arteries, which originated from the ophthalmic artery. Additionally, 97.7% of the hemifaces had superficial superior orbital arcades, for which 4 origins were identified: ophthalmic artery, superior medial palpebral artery, angular artery, and anastomosis between the angular and ophthalmic arteries. Limitations The arterial depth estimated from 3-dimensional CT needs to be confirmed by standard cadaver dissection. Conclusion This study elucidated novel arterial systems and proposed considerations for upper eyelid and forehead injections.

Background Large area androgenic alopecia patients seeking hair transplantation treatment has become common. FUE Megasession has become a choice for more and more people. Long-term in vitro preservation of hair follicles during FUE Megasession has become a new challenge. Objective To explore optimal in vitro preservation condition according to FUE Megasession long-period surgery time and to perform clinical practice to confirm the feasibility. Methods Human follicles were obtained from informed patients by FUE Megasession and preserved under different conditions. Live and dead staining with DAPI was used to assess the survival rate of cells. Hair follicles were preserved in vitro for 7 days under different conditions, and the extension of the hair shaft was observed. We also performed some clinical procedures to illustrate the effectiveness of these methods. Results Under the condition of 4℃ Ringer's solution, the death rate of hair follicle cells was lower than that of the rest. 4℃ Ringer's solution supported superior growth of the hair follicle unit according to organ culture. 8-h preservation in 4℃ Ringer's solution was kept as high survival rate as the traditional hair transplantation surgery（P > .05）. Clinical procedures confirmed the feasibility of FUE Megasession hair transplantation surgery. Conclusion 4℃ Ringer's solution in vitro preservation is optimal for clinical FUE Megasession surgery which ensures the hair follicle survival rate and postoperative results.