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Sethupathi SK, Poole M, Darji K, Fehlman J. Cosmetic Dermatology Concerns in Older Adults. Clin Geriatr Med 2024; 40:197-210. [PMID: 38000860 DOI: 10.1016/j.cger.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
It is important to understand that each layer of facial tissue, from the underlying facial skeleton to the overlying skin, undergoes significant changes during the aging process. Bony support is lost along the mandible and maxilla and the orbital aperture widens. Superficial and deep fat pads undergo volume loss and migration and the overlying skin begins to reveal signs of both intrinsic aging with skin laxity and fine rhytids as well as extrinsic aging in the form of coarse, deeper rhytids and dyspigmentation.
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Affiliation(s)
- Sheetal K Sethupathi
- Department of Dermatology, Saint Louis University, 1008 S Spring Avenue, Saint Louis, MO 63110, USA
| | - Mackenzie Poole
- Saint Louis University School of Medicine, 1008 S Spring Avenue, Saint Louis, MO 63110, USA
| | - Kavita Darji
- Department of Dermatology, Saint Louis University, 1008 S Spring Avenue, Saint Louis, MO 63110, USA
| | - Jennifer Fehlman
- Saint Louis University SLU Care Physician Group -SSM Health, 2315 Dougherty Ferry Road, Suite 200C, Saint Louis, MO 63122, USA.
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Zhang L, Zhao Y, Gu Q, Feng X, Li J, Lai F, Pan L, Sun Y, Wu S. A roadmap for safety during facial filler injections: A fresh frozen cadaver study. J Plast Reconstr Aesthet Surg 2023; 86:155-164. [PMID: 37717300 DOI: 10.1016/j.bjps.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Filler injections are commonly applied to reshape facial contouring. However, cadaveric injections of filler for facial contouring on the whole face, followed by anatomic analysis and measurement, have rarely been reported. This study aimed to provide comprehensive anatomical information, including topographies and roadmap of injection point entry, penetration depth, filler location, the hierarchy of facial structure, and vital vascular course. METHODS Thirty faces on fresh frozen cadaver heads were used for this anatomic study. The whole face was divided into seven facial zones and 14 injection points for penetration depth measurement and cadaveric injection. Static periosteum injections with a sharp-needle technique were performed. Specimens were then dissected to observe the precise locations of fillers and their relationships with surrounding anatomic structures. RESULTS The topography of penetration depth gradually increased from the upper face to the middle face, lower face, and temporal region. Most of the injected hyaluronic acid filler flowed backward to the loose areolar tissue layer between the superficial musculoaponeurotic system and periosteum or deep fascia. Multilevel layer distributions and anastomosis of the vessels were found in the face, especially in the glabella, dorsum nasi, and temporal regions. CONCLUSIONS This study can provide clinicians with a comprehensive reference for facial contouring injections: topographies of the injection point and penetration depth and the vascular anatomical structure in high-risk facial zones. The static periosteum injection with effective aspiration is recommended as a relatively safe technique. Clinicians are supposed to grasp the anatomy and injection technique to achieve maximum safety during filler injections.
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Affiliation(s)
- Lei Zhang
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Ye Zhao
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Qinghao Gu
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Xiao Feng
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Jingyu Li
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Fangyuan Lai
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Lei Pan
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Yi Sun
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China
| | - Sufan Wu
- Department of Plastic and Reconstructive Surgery, Center of Plastic and Reconstructive Surgery; Zhejiang Plastic Surgery Hospital, Zhejiang Provincial People's Hospital, Affiliated of Hangzhou Medical College, Hangzhou, China.
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Alloplastic malar implants in aesthetic facial surgery. Curr Opin Otolaryngol Head Neck Surg 2022; 30:286-289. [PMID: 35906984 DOI: 10.1097/moo.0000000000000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To examine the recent literature on aesthetic alloplastic malar implants. RECENT FINDINGS Alloplastic implantation is heavily favored in the oromaxillofacial literature. Recent articles have examined porous polyethylene and silicone implantation. Overall patient satisfaction is high and complications are low. Outcomes are likely comparable with alternative modalities to rejuvenate the face in the appropriate hands. SUMMARY Alloplastic implantation continues to be a reliable tool for malar augmentation.
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Pavicic T, Sattler G, Prager W, Fischer T, Gauglitz G, Hofmann M, Dersch H, Riaz S, Kerscher M. Safety of Cohesive Polydensified Matrix Cross-Linked Hyaluronic Acid Volumizing Gel in Temporal Hollows and Cheeks: A Prospective, Open-Label, Postmarket Study. Dermatol Surg 2021; 47:1359-1364. [PMID: 34417392 DOI: 10.1097/dss.0000000000003176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Facial aging is characterized by volume loss and progressive hollowing of temples and cheeks. Biodegradable filler materials are preferred over nonabsorbable materials; of these, hyaluronic acid (HA) fillers are the most often used because of their favorable effectiveness and safety profile. OBJECTIVE To confirm the safety and effectiveness of Cohesive Polydensified Matrix (CPM)-HA26 gel in the treatment of volume deficiency. METHODS Subjects received up to 2 treatments in the temples and/or cheeks. A blinded investigator assessed improvement according to the Merz Temple Volume Scale (MTVS) and Merz Cheek Fullness Assessment Scale (MCFAS). Subjects were followed for 48 weeks after the last treatment. RESULTS In total, 87 healthy subjects were enrolled. The proportion of subjects achieving at least a 1-grade improvement on MTVS and/or MCFAS was above 70% for each (MTVS: Weeks 4, 24, and 48 = 95.4%, 94.2%, and 77.0%; MCFAS: Weeks 4, 24, and 48 = 92.3%, 83.1%, and 71.8%). Based on MTVS and MCFAS scores at Visit 5, improvement remained visible at up to 48 weeks. No treatment-related serious AEs occurred. CONCLUSION CPM-HA26 demonstrated both a favorable safety and effectiveness profile, with improvement in facial volume evident for up to 48 weeks. It was well tolerated and had a positive, long-lasting effect.
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Affiliation(s)
- Tatjana Pavicic
- Privatpraxis für Dermatologie und Ästhetik Maximilianstr, Munich, Germany
| | | | - Welf Prager
- Prager & Partner Dermatologische Praxis, Hamburg, Germany
| | - Tanja Fischer
- Haut-und Lasercentrum Berlin-Potsdam, Praxis Potsdam, Potsdam, Germany
| | - Gerd Gauglitz
- Dermatologie München-Neuhausen, Leonrodstraße, Munich, Germany
| | | | - Hanna Dersch
- Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany
| | - Shahbaz Riaz
- Merz North America, Inc., Raleigh, North Carolina
| | - Martina Kerscher
- Division of Biochemistry and Molecular Biology, Cosmetic Science, University of Hamburg, Hamburg, Germany
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Diab HM, Elhosseiny R, Bedair NI, Khorkhed AH. Efficacy and safety of plasma gel versus platelet-rich plasma in periorbital rejuvenation: a comparative split-face clinical and Antera 3D camera study. Arch Dermatol Res 2021; 314:661-671. [PMID: 34231136 DOI: 10.1007/s00403-021-02270-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Periorbital skin is the thinnest. That is why, it is the easiest to wrinkle and the most challenging to rejuvenate. Platelet-rich plasma (PRP) as well as plasma gel have been used for skin rejuvenation and considered relatively safe and effective. METHODS This split-face study was conducted on forty female patients seeking periorbital rejuvenation where PRP was injected in the right (Rt) side and plasma gel in the left (Lt) side, two treatment sessions 4 weeks apart (week 0 and week 4). Patients were followed up 2 weeks after each treatment session (week 2 and week 6) as well as 12 weeks after the last session (week 16) using both subjective [physician assessment through Global Aesthetic Improvement score (GAIS) and patient's satisfaction (Likert scale)] and objective [Antera 3D camera] assessment methods. RESULTS Both modalities yielded a significant improvement of periorbital wrinkles after the 2nd session, with significantly better results on the plasma gel injected side; however, the improvement achieved through both modalities could not be maintained for the following 3 months. Besides, objective assessment could not prove any improvement in periorbital hyperpigmentation. CONCLUSION Two sessions of both PRP and plasma gel are effective for periorbital rejuvenation, with plasma gel showing significantly better results. However, improvement was not maintained for 3 months.
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Affiliation(s)
- Heba M Diab
- Department of Dermatology, Veneriology and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rania Elhosseiny
- Department of Dermatology, Veneriology and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nermeen Ibrahim Bedair
- Department of Dermatology, Veneriology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt.
| | - Ahmad Hamid Khorkhed
- Department of Dermatology, Veneriology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
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Trinh LN, Gupta A. Hyaluronic Acid Fillers for Midface Augmentation: A Systematic Review. Facial Plast Surg 2021; 37:576-584. [PMID: 33634456 DOI: 10.1055/s-0041-1724122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Injectable fillers represent one of the most requested minimally invasive treatments to rejuvenate the aging face, and its popularity is steadily rising. A vast majority of filler treatments are with hyaluronic acid (HA). The aim of this systematic review is to evaluate patient outcomes, safety profile, and administration techniques of various HA fillers for malar augmentation. A systematic review of the published literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included PubMed, Embase, and Science Direct databases. Medical Subject Headings (MeSH) terms used were "cheek" OR "midface" OR "malar" and "filler" OR "hyaluronic acid" OR "Juvederm" OR "Restylane" OR "Perlane" OR "Belotero." The initial search identified 699 articles; 256 duplicates were removed. Additional 12 studies were identified from reference lists. A total of 455 were screened by title and abstract and 387 studies were eliminated based on criteria. Also, 68 articles underwent full-text review, and 18 articles were included in the final review and involved seven different HA formulations. Men and women from many age groups were highly satisfied with their results following HA treatment for midface augmentation up to 24 months. The most common adverse events included bruising, swelling, and tenderness, and typically lasted no more than 2 weeks. Upper cheek filler injections near the zygoma should be placed in the submuscular plane while lower cheek injections should be placed in the subcutaneous tissue. HA is an attractive choice for midface augmentation due to its high patient satisfaction, long-lasting effects, and low side-effect profile. Due to the variability in technique, level of expertise, and subjective measurements across studies, one optimal regimen could not be concluded. However, midface augmentation treatment should be personalized to each patient. Additional clinical trials are required to more conclusively determine the most appropriate approach for this procedure.
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Affiliation(s)
- Lily N Trinh
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Tulane University, New Orleans, Louisiana
| | - Amar Gupta
- Department of Otolaryngology - Head and Surgery, St. Elizabeth's Medical Center, Brighton, Massachusetts
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Matecka M, Lelonkiewicz M, Pieczyńska A, Pawlaczyk M. Subjective Evaluation of the Results of Injectable Hyaluronic Acid Fillers for the Face. Clin Interv Aging 2020; 15:39-45. [PMID: 32021131 PMCID: PMC6968800 DOI: 10.2147/cia.s233405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background Skin ageing is a physiological process, progressive and irreversible. Hyaluronic acid injection treatments are used to correct the signs of skin ageing. Material and Methods Hyaluronic acid was implanted in the area of the cheek and the forehead aesthetic units in 57 women, aged 35-55 years. Apart from the clinical observation, self-assessment of the therapeutic results was conducted. The "My skin" questionnaire was used for subjective evaluation of the treatment results. Results Mean wrinkle score in the pre-menopausal group changed after the treatment, from 3.2±0.6 to 1.1±0.3 and from 3.2±0.6 to 0.8±0.6 for the forehead and the cheek esthetic units, respectively. In the post-menopausal group, the score decreased from 3.8±0.4 to 1.7± 0.7 and from 3.2±0.617 to 0.8± 0.6 for the forehead and the cheek esthetic units, respectively. The changes were age-dependent. Improved appearance of the facial skin - higher satisfaction with skin tone and scent - was reported after hyaluronic acid injections. Higher subjective perception of improvement corresponded to older age, irrespectively of the menopausal status. Correlations between age and the effect of the treatment on maintaining proper skin hydration as well as between improved appearance of the forehead area and feelings of autonomy and well-being were found. Conclusion Hyaluronic acid injections significantly improved the subjective perception and overall assessment of the scent and appearance of the facial skin.
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Affiliation(s)
- Monika Matecka
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Anna Pieczyńska
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariola Pawlaczyk
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland
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The Role of Hyaluronidase for the Skin Necrosis Caused by Hyaluronic Acid Injection-Induced Embolism: A Rabbit Auricular Model Study. Aesthetic Plast Surg 2019; 43:1362-1370. [PMID: 31139914 DOI: 10.1007/s00266-019-01398-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Skin necrosis is considered the most serious complication of hyaluronic acid dermal filler injection procedures. To effectively treat skin necrosis, hyaluronidase injection is one of the essential preventative treatments, and yet optimal complication management remains an unmet need. Therefore, this paper investigates the effects of hyaluronidase injection timing on the treatment of skin necrosis. METHODS In an in vitro experiment, the carbazole method was used to determine the degradation time of hyaluronic acid gels in a large volume of hyaluronidase. In vivo experimental rabbit ear models were developed to simulate the skin necrosis caused by hyaluronic acid and the test animals distributed into five groups. Except one control group, the other four groups were injected with a large volume of hyaluronidase as treatment at 2 h, 4 h, 8 h and 16 h, respectively, after models were built. The necrosis degree of models was analyzed with necrotic area and histologic examination on the postoperative 7th day. Besides, temperatures of rabbit ears were observed to demonstrate the healing process of flap models. RESULTS The average necrotic area of flaps in the 2-h and 4-h injection groups showed a significant difference compared with that of the control group (p < 0.05; p < 0.05). The histologic examination showed that there were HA embolisms, vascular thrombolytic recanalization and arteriovenous thromboses in the survival area. In addition, the mean temperatures of the rabbit ear flaps fluctuated over time and showed clear differences between distal and proximal parts. CONCLUSIONS The area of flap necrosis positively correlates with injection timing of the large volume of hyaluronidase. More importantly, when injection timing is within 4 h, treatment effectiveness will be significantly improved. NO LEVEL ASSIGNED 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 .
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Moon KC, Kim KB, Han SK, Jeong SH, Dhong ES. Assessment of Long-term Outcomes of Soft-Tissue Augmentation by Injecting Fibroblasts Suspended in Hyaluronic Acid Filler. JAMA FACIAL PLAST SU 2019; 21:312-318. [PMID: 30920578 DOI: 10.1001/jamafacial.2018.2127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In previous studies, this group has reported that cultured human fibroblasts suspended in hyaluronic acid (HA) filler might have potential use as a long-lasting injectable soft-tissue filler. However, the data were insufficient to determine the long-term outcomes. Objective To evaluate the long-term outcomes of cultured human fibroblasts suspended in HA filler used for soft-tissue augmentation. Design, Setting, and Participants A long-term case series study was performed. Between January 2010 and December 2013, a total of 38 patients were treated with fibroblast-HA filler mixture to augment nasal dorsa, nasolabial folds, and cheek depressions. Of these 38 patients, patients with follow-up period of greater than 3 years were included in this study. A total of 22 patients met the inclusion criteria. Main Outcomes and Measures Subjective assessment was performed to evaluate degree and time of resorption, improvement, satisfaction, softness of injection sites, and willingness to recommend this treatment to others. Objective assessment was carried out with patients' photographs. Safety and tolerability were also evaluated for this treatment. Results Of the 22 patients included in this study, 19 were women; mean (SD) patient age was 43 (15) years. All 22 patients experienced improvement following the treatment. Twenty (91%) patients were satisfied with the treatment. Nineteen patients (86%) considered that the injection site was as soft as it was before treatment. Patients' mean (SD) grading of improvement, satisfaction, and softness were 4.50 (0.51) (95% CI, 4.27-4.73), 4.14 (0.71) (95% CI, 3.82-4.45), and 4.82 (0.50) (95% CI, 4.59-5.00) at the last visit, respectively. Objective assessment demonstrated postoperative improvement in all patients: a rating of "much improved" was given to 7 patients (32%) by investigator 1; 8 patients (36%) by investigator 2; and 12 patients (55%) the injecting physician. This treatment was well tolerated; no adverse event was recorded for any patient. Conclusions and Relevance Injection of cultured human fibroblasts suspended in HA filler might be successful for long-term soft-tissue augmentation. To our knowledge, this study represents the longest follow-up study of soft-tissue augmentation with a fibroblast-HA filler mixture to date. Level of Evidence 4.
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Affiliation(s)
- Kyung-Chul Moon
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Ki-Bum Kim
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University Guro Hospital, Seoul, South Korea
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Dayan SH. Translating Pivotal Trial Findings to Clinical Practice. JAMA FACIAL PLAST SU 2017; 19:93-94. [PMID: 27768173 DOI: 10.1001/jamafacial.2016.1283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Steven H Dayan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, University of Illinois, Chicago
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