Na Hyun Hwang

Adipose-derived stem cells inhibit epidermal melanocytes through an interleukin-6-mediated mechanism.

Background: Several investigators have postulated that human adipose-derived stem cells can be used for skin rejuvenation, but there have been few reports about their direct effects on human epidermal melanocytes. The authors studied the effects on melanocytes, and the causative agent of those effects was further investigated in this study. Methods: Human epidermal melanocytes were divided into three groups and cultured in adipose-derived stem cell–conditioned medium, human dermal fibroblast–conditioned medium, or control medium. Concentrations of melanogenic cytokines in these media were measured using enzyme-linked immunosorbent assay kits. After 3 and 7 days of incubation, cell proliferation, melanin content, tyrosinase activity, and melanogenic gene expression were measured. Interleukin-6–neutralizing antibodies were mixed with adipose-derived stem cell–conditioned medium in which human epidermal melanocytes were cultured, and melanocyte growth and melanogenesis were measured again. Results: Interleukin-6 concentrations in adipose-derived stem cell– and human epidermal melanocyte–conditioned media were 1373 and 495 pg/ml, respectively. Both types of medium suppressed melanocyte proliferation and melanin synthesis (p < 0.05), but adipose-derived stem cell–conditioned medium was more effective than human dermal fibroblast–conditioned medium in inhibition of human epidermal melanocyte proliferation, melanin synthesis, and tyrosinase activity (p < 0.05). Interleukin-6–neutralizing antibody sufficiently reversed the antimelanogenic effects of adipose-derived stem cell–conditioned medium such that human epidermal melanocyte proliferation, melanin content, tyrosinase activity, and tyrosinase mRNA levels were restored (p < 0.05). Conclusions: Adipose-derived stem cell–conditioned medium inhibited melanocyte proliferation and melanin synthesis by down-regulating melanogenic enzymes. Interleukin-6 plays a pivotal role in inhibition of melanocytes.

Outcomes of ablative fractional laser scar treatment.

Abstract Ablative fractional laser (AFL) systems are commonly used to treat various scars, and recent reports have indicated that early scar treatment with fractional lasers has good aesthetic results. Some scars respond dramatically to AFL treatment, incurring high levels of patient satisfaction; however, other scars respond poorly or became worse after treatment. This study was designed to clarify prognostic factors that predict AFL scar treatment outcomes. A total of 108 patients were included in this study. The fractional laser treatments were repeated every 4 weeks until the scar site was acceptable and no additional improvement was expected or the patient discontinued the treatment. The scar improvements were defined as changes in the Manchester scar scale (MSS) from before to after laser treatment. A digital camera was used to acquire digital photographs of the scars under the same light source, the same background, exposure, and white balance. This study developed a modification of the MSS for image analysis in which colour assessment was based on L*a*b* colour co-ordinates of the digital images. The mean MSS values prior to and after laser treatments were 11.6 ± 3.6 and 9.5 ± 2.9, respectively (p < 0.01). AFL treatment improved the qualities of each scar, and the improvements were evident in colour and contour. Scar elevation, pigmentation, high vascularity, early onset of treatment, and the number of treatment sessions were directly related to scar improvement after AFL therapy (p < 0.05). AFL treatments were effective methods for scar treatment. Clinicians can use these prognostic factors to determine treatment plans and to estimate scar improvement after AFL treatment.

Morphologic Changes in Photodamaged Organotypic Human Skin Culture After Treatment of Autologous Adipose-derived Stromal Cells

Background Recent clinical trials indicate that human adipose-derived stromal cells (hASCs) have beneficial effects on antiaging and wound healing. This study examined the morphologic changes in photodamaged human organotypic skin culture after treatment of autologous hASCs. Methods Abdominal skin flaps were obtained from 8 white females who underwent abdominoplasties with liposuction. The adipose layer was removed and used for hASC isolation. Sections of skin were removed and cultured in serum-free medium. To induce photodamage, some of the skin pieces were irradiated with maximum subcytotoxic doses of UVB (1600 J/m2) and UVA (250 J/m2). The effects of hASC on skin segments were evaluated by coculture as a feeder layer or by injecting intradermally. Portions of the skin samples were removed for analysis on days 3, 5, 7, and 9 of culture and analyzed histologically for morphology, viability, and proliferation status. Results Epidermal necrosis of irradiated skin was significantly reduced by the presence of hASCs. Increased parakeratosis was observed at early time points, and apoptosis in epidermis was markedly decreased by hASCs. Differences were observed in epidermal differentiation but not basal cell proliferation. Similar results were obtained by both methods of hASC treatment to the skin. Conclusions Exposure of UV-irradiated skin to hASC attenuated cell senescence and promoted repair from photodamage in an organotypic skin culture. These results suggest that hASC treatment may have a useful therapeutic effect for salvaging photodamaged skin.

Endoscope-assisted transoral fixation of mandibular condyle fractures: Submandibular versus transoral endoscopic approach

AbstractIn recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver.

Empirical Treatment of Highly Suspected Nontuberculous Mycobacteria Infections Following Aesthetic Procedures

Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.

Protective effects of adipose-derived stem cells against UVB-induced skin pigmentation

Abstract Background: Hyperpigmentation, mainly following UV-irradiation, can cause major cosmetic concerns. Human adipose tissue-derived stem cells (ASCs) have been reported to serve as whitening agents through a paracrine effect. However, there have been few reports on the direct effects of ASCs on skin pigmentation following UVB-irradiation. Methods: To evaluate the effect of ASCs on UVB-irradiated mouse skin, UVB-irradiation alone was applied to one side of the backs of mice (melanin-processing hairless mouse, HRM-2) as a control, and UVB-irradiation plus injection of ASCs was applied to the contralateral side. Skin pigmentation and histology were evaluated and the number of DOPA-positive melanocytes in the mouse skin was counted. The absolute value of ΔL* via a colorimeter was measured to evaluate the degree of skin pigmentation. The effects of ASCs on the melanogenic activities of mouse skin were examined by measuring the tyrosinase activity and the melanin contents in the epidermis of the mouse skin. Results: Skin pigmentation was suppressed in the ASC-injected side. Moreover, the change in skin thickness following UVB irradiation was reduced in the ASC-injected side. The number of DOPA-positive melanocytes in the ASC-injected side (139 ± 18 cells/mm2) was significantly lower than that in the control side (239 ± 48 cells/mm2). The tyrosinase activity (67.4 ± 9.8% of that of the control side) and melanin content (63.4 ± 5.7% of that of the control side) of the ASC-injected side were also significantly reduced. Conclusions: Collectively, these results suggest that ASCs injected subcutaneously into the backs of mice can attenuate tanning following UVB-irradiation, through suppression of tyrosinase activity.

Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair

Background The global prevalence of myelomeningocele has been reported to be 0.8–1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution. Methods Patients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed. Results A total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely. Conclusions Most myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

Septal Extension Graft in Asian Rhinoplasty

A septal extension graft (SEG) can control nasal tip projection, shape, and rotation. SEG and dorsal alloplastic implants have predominated in Asian rhinoplasty, leading to iatrogenic complications such as a foreshortened nose and destruction of remaining septum. The lower nasal two-thirds can be enhanced anteriorly and caudally using the septal L-strut extension graft in Asians with relatively small noses. The septal L-strut extension graft is indicated in primary cases in which the bony dorsum is acceptable but the cartilaginous dorsum is relatively hypoplastic, and in secondary cases with an iatrogenic short-nose deformity due to alloplastic implants.

Soft Tissue Reconstruction for Basaloid Squamous Cell Carcinoma on the Hemiface

Basaloid squamous cell carcinoma (BSCC), a rare variant of squamous cell carcinoma, has rarely been reported and is poorly understood. It was first described as a distinct form of carcinoma in 1986 by Wain et al. [1] BSCC is believed to arise from a totipotent primitive cell in the basal layer of the surface epithelium or from the salivary duct lining epithelium. This uncommon malignancy usually appears in the head and neck region, especially in the supraglottic larynx, tongue base, and piriform sinus. However, extensive BSCC involving the whole hemiface is extremely rare.

Modified Transconjunctival Lower Lid Approach for Orbital Fractures in East Asian Patients: The Lateral Paracanthal Incision Revisited.

117e Modified Transconjunctival Lower Lid Approach for Orbital Fractures in East Asian Patients: The Lateral Paracanthal Incision Revisited Sir: W have read the article “Modified Transconjunctival Lower Lid Approach for Orbital Fractures in East Asian Patients: The Lateral Paracanthal Incision Revisited” by Song et al.1 Because we have published similar results of our own,2 we read the article with great interest and congratulate the authors on their efforts. We share views similar to those of Song et al. but would like to address our method of “modified lateral canthal incision” published in 2009. This modified method provides less conspicuous scars and canthal distortion compared with the classic lateral canthotomy.3,4 Our modified canthal incision starts 2 to 3 mm medial to the canthal angle (Fig. 1). The full-thickness lower eyelid, involving the tarsal plate, is incised with scissors vertically at a right angle to the lateral canthus. Fig. 1. Modified lateral canthal incision design. Correspondence to Dr. Persing Yale Plastic Surgery Yale University School of Medicine 330 Cedar Street, 3rd Floor New Haven, Conn. 06520 john.persing@yale.edu