Aesthetic Surgery Center

Drainage is used to prevent complications such as hematoma and seroma formation during liposuction. This study aims to place the drain into the desired area in patients undergoing liposuction with the liposuction canulae. This technique enables the procedure to be completed without the need for instruments or additional incisions. In this technique, we used a thick, long liposuction cannula with a wide hole at its tip. The cannula was advanced along the desired tract through the liposuction trocar incision. Once the cannula reached the most distal point where the drain was intended to be placed, a 2/0 Vicryl suture was sequentially passed through the skin, between the holes of the cannula, and then through the skin again, exiting externally. The end of the suture emerging from the trocar site was tied to the distal end of the drain that was intended to remain within the tissue. Then, by gently pulling the externalized end of the suture at the skin, the drain was advanced through the tissue. No additional scars were created during the drain placement in any of the patients. Furthermore, no complications, such as hematoma or seroma, were observed in the liposuction area. No additional incisions are made, thereby preventing the formation of extra scars. The drainage tube can be placed precisely within the desired area or tract. Only instruments already utilized during the surgical procedure are employed, resulting in reduced overall cost. 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 .

Cutaneous squamous cell carcinoma (cSCC) is a malignant skin cancer which is derived from epidermal keratinocytes, and long-term exposure to ultraviolet rays is its main risk factor. Procollagen-lysine, 2-oxoglutarate 5-dioxygenase 2 (PLOD2) is a crucial gene for the formation and stability of collagen intermolecular cross-links, being vital in the development of cancer. Nevertheless, the interaction between cSCC and PLOD2 has not been elucidated. Here, we found PLOD2 upregulated in human cSCC. Its knockdown in cSCC cells suppressed proliferation, migration, invasion, and angiogenesis while inducing apoptosis and cell cycle arrest; overexpression promoted these malignant phenotypes. In mouse xenografts, PLOD2 knockdown inhibited tumor growth and collagen deposition. Furthermore, in a DMBA/TPA-induced carcinogenesis model, topical PLOD2 inhibition by minoxidil suppressed tumor development as well. Mechanistically, our studies revealed that PLOD2 acts as a key downstream effector of STAT3 to activate ERK and AKT signaling evidenced by rescue experiments. As a result, our study not only establishes the STAT3/PLOD2/ERK-AKT axis as a key driver of cSCC but also identifies the clinically approved drug minoxidil as a potent PLOD2 inhibitor, demonstrating immediate promise as a repurposed therapeutic agent.

Melatonin has long been known for its function in circadian rhythm regulation, but new dermatological studies emphasize its significance as a multifunctional molecule in skin protection and hair biology. Melatonin protects the skin from UV radiation, oxidative stress, and inflammation by acting as a potent antioxidant, radioprotective agent, and mitochondrial stabilizer, according to scientific research. As a component of a "melatoninergic antioxidant system", topical melatonin improves DNA repair, lowers oxidative damage, and regulates inflammatory reactions. Melatonin also affects the cycling of hair follicles and may encourage the prolonging of the anagen phase, which supports hair renewal. In addition to highlighting melatonin's potential therapeutic uses in dermatology and cosmetology, this research examines the biological roles of melatonin in skin defense and hair repair.

Correction of prominent upper pole of ear is challenging, with high recurrence rates. Conventional otoplasty often fails to address the inferior crus, a key anatomical determinant of prominence. This study introduces a surgical technique targeting the inferior crus, a novel Inferior Crus Morphological Grading System (ICMGS) for diagnosis, and a new "upper pole declination angle" for objective assessment. In this retrospective comparative study, 120 ears treated with a new technique were compared to 120 ears in a historical control group (traditional method). The new technique combines superior auricular muscle release, multi-loop inferior crus suturing, conchal reduction, and cartilage graft reinforcement. Outcomes were assessed via objective photogrammetry (including the upper pole declination angle) and blinded subjective scoring. The new technique demonstrated statistically superior results, with significantly greater reductions in upper pole declination angle, L1, and L2 distances (p<0.001). Blinded aesthetic scores were also significantly higher (p<0.001). The technique's efficacy correlated directly with the preoperative ICMGS grade (p<0.001). The revision rate was lower in the new technique group (3.3% vs. 8.3%). Anatomical correction of the inferior crus is a critical and effective strategy for prominent upper pole. The proposed technique, along with the ICMGS and upper pole declination angle, provides a reliable and durable solution with superior objective and subjective outcomes and a lower revision rate compared to traditional methods.

ABSTRACTExosome therapy has emerged in recent years as a promising acellular approach for the treatment of tissue regeneration and wound healing. Initial preclinical investigations have demonstrated accelerated fibroblast proliferation, improved angiogenesis and reduced scar formation. It is evident that patients are more likely to gain an understanding of these treatments and acquire information from digital platforms as opposed to from peer‐reviewed scientific publications. This study assessed the credibility and instructional merit of exosome therapy content on YouTube, a prominent source of online health information. A cross‐sectional study was performed on the initial 50 videos in English obtained using the keyword ‘exosome therapy’ (15 July 2025). The videos were independently assessed by two plastic surgeons and a dermatologist using three validated scoring systems. The scoring system was based on the Journal of the American Medical Association (JAMA) reference criteria for transparency and reliability, the Global Quality Score (GQS) for overall educational quality and the modified DISCERN tool for content reliability and balance. The median scores obtained were consistently low (DISCERN: 2.67; GQS: 2.67; JAMA: 2.00). However, videos created by doctors exhibited a statistically significant higher average score compared to videos published by patients, companies and YouTubers (p < 0.05). A robust positive correlation was identified between DISCERN and GQS (ρ = 0.95, p < 0.001). Despite the substantial experimental evidence that confirms the efficacy of exosome therapy for acute and chronic wounds, none of the videos addressed the recognised wound healing applications of exosome therapy. In contrast, the contents primarily focus on cosmetic enhancement, anti‐ageing interventions and beauty‐related applications. The discrepancy between the scientific advancements in the fields of regenerative medicine, dermatology and plastic surgery and the accessibility of online educational resources, highlights the necessity for professional health organisations to furnish accessible, evidence‐based materials that accurately demonstrate the therapeutic potential of exosomes in wound healing.

Fungi play a dual role as indispensable ecological engineers and as major agents of disease in humans, animals, and plants. Recent estimates highlight their substantial impact, with millions of invasive infections annually and severe agricultural losses threatening food security. At the same time, fungi underpin ecosystem services such as decomposition, soil aggregation, and carbon sequestration, while also serving as prolific sources of enzymes, metabolites, and sustainable biomaterials. Advances in single-cell and spatial omics, cryo-electron microscopy, AlphaFold-based structural predictions, and machine learning applied to biosynthetic gene clusters are transforming the study of fungal pathogenicity, symbiosis, and metabolism. These approaches are shifting fungal research from descriptive biology toward predictive, translational pipelines that connect mechanistic insights to drug discovery, resistance management, and biotechnological innovation. Nevertheless, challenges remain, including antifungal resistance, climate-driven emergence of new pathogens, limited therapeutic options, and bottlenecks in scaling fungal applications for sustainability. Addressing these requires integrated One Health strategies that bridge clinical, agricultural, and environmental perspectives. By uniting structural biology, omics, genome editing, and computational tools within a global framework, fungal biology can be harnessed not only to mitigate emerging risks but also to drive innovations in medicine, agriculture, and green technologies.

Lymphovenous anastomosis (LVA) is a microsurgical procedure that redirects stagnant lymph flow into the venous circulation, reducing fluid stasis in patients with secondary limb lymphedema. Although previous studies have reported that complex decongestive therapy redistributes fluid from the affected leg to other body segments, whether fluid reduction after LVA results from systemic elimination or intersegmental redistribution remains unclear. This study aimed to clarify the mechanism by analyzing the changes in segmental body water (SBW) volume using bioelectrical impedance analysis (BIA).We retrospectively analyzed the data of 40 Japanese women with unilateral stage II secondary leg lymphedema who underwent LVA from 2013 to 2021. Multifrequency segmental BIA was used to assess extracellular water, intracellular water, and SBW in the legs, trunk, and arms. Measurements were performed preoperatively and at least 12 months postoperatively. Changes in segmental and total body water (TBW) were statistically evaluated.Significant reductions were observed in SBW in the affected leg, and in the TBW (affected leg: 5.80-5.20 L, p < 0.001; TBW: 25.6-25.0 L, p = 0.002), with no significant changes in the unaffected leg, trunk, or arms. Extracellular and intracellular water in the affected leg decreased significantly (p = 0.001 and p < 0.001, respectively), whereas the percentage of extracellular water remained stable.LVA achieved sustained reductions in segmental and TBW volumes, localized to the affected leg, without compensatory increases in other body segments. These findings support the efficacy of leg LVA in achieving long-term fluid homeostasis through systemic elimination of excess lymphatic fluid rather than redistribution.

Senile purpura is characterized by the recurrent ecchymoses following minor trauma [1]. This condition arises due to the weakening of the structural integrity of dermal collagenous tissues and increased fragility of blood vessels. Therapeutic approaches that restore the structural support of the dermal extracellular matrix (ECM) in patients with senile purpura may lead to progressive improvements. Calcium hydroxylapatite (CaHA) has been used as a dermal filler and is known to improve skin quality by inducing mechanotransduction, a process in which mechanical stimuli are converted into biochemical signals [2]. The transcriptional regulator YAP has been highlighted as a key cellular mechanotransducer that exerts influence over collagen synthesis and skin regeneration [3]. A 65-year-old male and a 67-year-old male presented with recurrent bruises on the dorsum of hands (Figure 1a). Despite the regular use of moisturizers and physical protection, purpura continued to worsen. Consequently, 1.5 cc of CaHA (Radiesse; Merz, Raleigh, NC) was diluted in a 1:1 ratio with 0.1% lidocaine and injected subdermally into the dorsum of the hand using a proximal-to-distal fanning technique. The injection was performed on the left hand at baseline, while the right hand remained untreated to serve as a comparison control. After 3 months, gross examination revealed clinical improvements in senile purpura, skin texture, and volume, compared to the baseline (Figure 1a,b). Two punch biopsy specimens were obtained for histopathological examination. The treated side tended to have greater epidermal thickness compared to the control side. Additionally, special stains demonstrated more prominent collagen and elastic fibers in the treated area (Figure 1c–e). Immunohistochemistry analysis also revealed the number of cells exhibiting increased YAP expression after the treatment (Figure 1f,h). The expression of vascular endothelial growth factor is higher in the treated side compared to the control (Figure 1g,i). Given that YAP regulates collagen production in fibroblasts and mediates feedback mechanisms in cellular mechanotransduction, these findings suggest that ECM synthesis following CaHA treatment occurs via a mechanotransduction pathway involving YAP activation. In both patients, CaHA was also administered to the control hand at 3 months, with follow-up for another 3 months post-procedure. Both hands demonstrated sustained improvement in hand volume and skin quality, with favorable clinical results up to 6 months. To address whether CaHA modulates the YAP-mediated mechanotransduction pathway, we performed a 3-dimensional spheroid culture experiment using benign immortalized human dermal fibroblasts and retinal pigment epithelium-1 (RPE1) cells (Supplementary Text, available via Mendeley at https://doi.org/10.17632/b2j2rdxv5n.1), more relevant to the in vivo condition (Figure 2 and Supplementary Figure 1) [4]. Cells exhibiting high levels of nuclear YAP enrichment, indicative of YAP activation, were more frequent in the condition where CaHA was supplemented, compared to the control (Figure 2b,c). Fibroblasts adhering to CaHA microspheres exhibited actin cytoskeletal remodeling (Figure 2c), which is known to strongly influence YAP activity. Our study shows that injecting diluted CaHA into the dorsum of the hand improves senile purpura, accompanied by histological evidence of epidermal and dermal proliferation, increased collagen and elastic fiber density. This dermal ECM reinforcement likely stabilizes fragile vasculature [3]. Notably, we observed a significant increase in YAP-positive cells in the dermis post-CaHA injection, supported by in vitro spheroid culture. Since YAP regulates ECM homeostasis and is suppressed in aged fibroblasts due to reduced mechanical cues, CaHA may restore dermal stiffness and activate YAP-dependent mechanotransduction, promoting neocollagenesis and skin integrity [5]. Nevertheless, this study represents a preliminary and exploratory observation intended to stimulate further controlled trials. Moreover, the clinical inference of our findings is limited by the sample size, male sex homogeneity, and a short follow-up period. While further studies are required to determine whether CaHA can provide long-term improvement for senile purpura, its use may be considered a treatment option for patients unresponsive to conservative therapies. This study was supported by a research grant from Merz Asia Pacific Pte. Ltd. The patient provided written informed consent for the use of clinical images and related data for research and publication purposes. The authors declare no conflicts of interest. The data that supports the findings of this study are available in the supporting information of this article.

Background: Gynaecomastia is a common benign condition in males that may cause physical discomfort and significant psychological distress. Surgical management remains the definitive treatment for persistent disease, particularly in the presence of glandular tissue, skin excess, or ptosis. Scar quality is a key determinant of patient satisfaction, and refinement of closure techniques may influence long-term outcomes. Methods: A retrospective analysis was conducted of 265 male patients who underwent surgical correction of primary gynaecomastia between June 2005 and December 2023 in a single private centre. Outcomes were compared with a pre- 2005 cohort of 108 patients treated using braided non-absorbable sutures. Surgical management was guided by the Simon classification and included liposuction alone, liposuction with glandular excision, or combined approaches with peri-areolar round-block skin resection. From 2005 onwards, peri-areolar closure was performed using absorbable bidirectional barbed sutures. Primary outcomes were post-operative scar quality and patient-reported satisfaction at 12 months. Secondary outcomes included complication rates and the need for revision surgery. Results: Early post-operative complications were uncommon in both cohorts. Rates of seroma, haematoma, infection, and partial nipple–areolar complex necrosis were low and comparable between groups. Scar enlargement occurred significantly less frequently in the post-2005 cohort following the introduction of barbed suture closure. Hypertrophic scarring and wound dehiscence rates were similar between cohorts. At 12 months, most patients in the post-2005 group reported satisfaction with their aesthetic outcome and scar quality, with dissatisfaction being uncommon. Conclusions: The peri-areolar round-block approach with absorbable barbed suture closure is a safe and reproducible technique for the surgical management of primary gynaecomastia. Refinement of the closure technique was associated with improved scar-related outcomes without increased complication rates, contributing to high levels of patient satisfaction.