Theoretical Health Risk Assessment Based on Potentially Toxic Element Profiling of Cosmetic Products in Istanbul Street Bazaars

Toxic elements that pose a potential threat to human health are found as impurities in various cosmetic products. In this study, the inorganic profile of 19 elements (Li, B, Mg, Al, Cr, Mn, Co, Ni, Cu, Zn, As, Se, Sr, Mo, Cd, Sb, Ba, Hg, and Pb) in 90 cosmetic products (lipsticks, lip glosses, lip pencils and eye shadows) were detected by inductively coupled plasma-mass spectrometry after microwave acid digestion method and hazard indices (HI) of 9 toxic elements (Pb, Cd, Cr, Ni, Co, As, Hg, Sb, and Al) were calculated for the assessment of theoretical health risk. Satisfactory method performance parameters were found for each analyte. The results were compared with the maximum permissible limits set by regulatory agencies; 38 of 41 lip products (92.68%) and all eye shadows (n = 49) exceeded the established limits. The HI was found to be ≥ 1 in 82.76% of lip products for oral exposure, whereas HI was ≤ 1 for dermal exposure in all lip products (n = 41) and only one eye shadow sample was ≥ 1 (2.04%). Remarkable results were also detected for 19 elements in this study, which conducted a comprehensive inorganic profiling for the first time. Wide-range concentrations of Mg, Al, Ba, Mn, Cu, Zn, and Sr elements were remarkable. HI values were firstly brought out in this study, although Al, as a well-known toxic element, has not been listed in regulations yet. In conclusion, it is obviously seen that continuous monitoring of cosmetics is crucial not only for toxic elements but also for other essential or non-toxic elements to prevent consumers from long-term exposure.

Successful treatment of Bowen's Disease in the nipple-areola complex with a combination of photodynamic therapy and cryotherapy-A case report

Photodynamic therapy (PDT) is a non-invasive, effective treatment for superficial skin conditions, offering superior cosmetic outcomes compared with traditional therapies. Bowen's disease (BD) of the nipple-areola complex (NAC) is rare and thus, lacks a standardized treatment approach. This report details the case of a 48-year-old woman who was successfully treated for BD of the NAC using PDT. Over a follow-up period of 30 months, there was no evidence of disease recurrence, underscoring the potential of PDT as a viable treatment option for this rare manifestation of BD.

Why different types of patients seek cosmetic treatments

The extent to which demographics drive patients to pursue minimally invasive cosmetic procedures is not well-understood. The aim of this project was to better understand how patient demographics impact motivations for cosmetic procedures, irrespective of the procedure desired. Patient-level information from the Cosmetic Motivation Database was evaluated using linear regression analyses to determine whether geographic region, age, gender, race, and education independently influence patients to pursue any cosmetic treatment or consultation. Patients in the Midwest reported fewer motivations related to cosmetic appearance, mental/emotional health, physical health, social life, and school/work success than those in the South. Patients younger than 45 years reported more mental/emotional health and cost/convenience motives compared to older patients. Men noted fewer motives related to cosmetic appearance, mental/emotional health, and cost/convenience but more related to school/work success. Non-White patients reported more cost/convenience motives. Participants with up to a high school diploma cited more mental/emotional health, physical health, social life, and school/work success motivations than those with post-bachelor's education. College graduates cited more school/work success motives than those with graduate-level education. In summary, patient's gender, education, age, location, and race affect why they seek cosmetic treatments. Future research may study younger and less educated patients to improve their access to treatment.

Postoperative Scar Management Protocol for Asian Patients

BACKGROUND

Postoperative scar formation remains a morbidity for patients even with the advent of minimally invasive techniques. Furthermore, the significant difference between the Asian and Caucasian skin results in poorer postoperative scar outcomes in Asians, supporting the need for an evidence-based scar management protocol.

METHODS

Following a literature review of the PubMed and the Cochrane databases over the past 10 years, we constructed a novel postoperative scar management protocol for the Asian skin, utilized in a Singaporean tertiary healthcare institution.

RESULTS

We describe a timeline-based scar protocol from the point of skin closure to a minimum of 1 year of follow-up. We support the use of intraoperative botulinum toxin for selected high-risk individuals upon skin closure with a follow-up regimen in the postoperative setting. For recalcitrant keloids, we have described a multimodal therapy comprising elements of intralesional steroids, botulinum toxin, lasers, surgery, and radiotherapy.

CONCLUSIONS

A consolidated postoperative scar management protocol provides the necessary guidance for improved scar outcomes in the Asian skin. There is inherent potential in expanding the protocol to include post-traumatic and burn wounds or support other skin types including the Caucasian skin.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Extracapsular dissection versus total excision for benign submandibular gland tumors

INTRODUCTION

Benign submandibular gland tumors pose challenges in balancing treatment effectiveness and preserving gland function. This study aimed to compare gland-preserving surgery, extracapsular dissection (ECD), with total excision in managing these tumors, focusing on function preservation and recurrence rate.

METHODS

Fifty consecutive patients with treatment-naïve benign submandibular gland tumors were alternatively allocated to receive ECD (n = 25) or total excision (n = 25) without randomization procedures. Intraoperative findings, postsurgical complications, subjective satisfaction, and gland function were assessed. Follow-up data were collected for a median duration of 55 months (24-80 months) to monitor recurrences.

RESULTS

ECD demonstrated significant advantages, including shorter operation time, reduced bleeding, and preservation of the facial artery and vein (P < 0.05). Both groups exhibited acceptable postsurgical pain and taste sensations. Complications were minimal and similar between the two groups. ECD resulted in superior facial contour satisfaction (P = 0.030) and preserved gland function, as evidenced by salivary scintigraphy. No recurrences were observed in either group during the follow-up period.

CONCLUSIONS

ECD is a practical approach for benign submandibular gland tumors, offering favorable functional outcomes, reduced surgical morbidity, shorter operation times, and improved cosmetic results.

Multi-class analysis of 100 drug residues in cosmetics using high-performance liquid chromatography-quadrupole time-of-flight high-resolution mass spectrometry

Cosmetics are an important aspect of the lives of many people. With an increasing demand for cosmetics, consumers pay more attention to their efficacy and composition. To improve their efficacy, prohibited substances, such as hormones, glucocorticoids, antibiotics, antifungals and antihistamines, may be added to cosmetics. We developed a rapid method for the multi-class analysis of drug residues in toner and lotion cosmetic samples using high-performance liquid chromatography coupled with quadrupole time-of-flight high-resolution mass spectrometry (HPLC-Q-TOF-HRMS). The primary variables in the extraction and purification steps were studied to minimize the interference of the sample matrix. The non-information-dependent sequential window acquisition of all theoretical fragment ion spectra (SWATH®) mode was used to improve the data acquisition efficiency. The secondary product ion peak areas were used for quantification to obtain a satisfactory matrix effects. The validation experiments confirmed that the developed method exhibited good linearity (5-200 ng/L) with correlation coefficients (R) ≥ 0.9902. Our developed method was then successfully applied to 92 real cosmetic samples. The calibration curve established by this method can be used for retrospective quantitative analysis over long durations without re-calibration. This method is efficient and suitable for screening and controlling multi-class prohibited substances in the cosmetics industry to reduce potential risks.

Subclinical Upper Eyelid Ptosis in Asian Patients: The Role of Levator Advancement in Optimizing Outcomes in "Cosmetic" Upper Blepharoplasty

BACKGROUND

Subclinical ptosis is prevalent in Asian patients presenting for aesthetic upper blepharoplasty. To achieve predictable and satisfactory results in these patients, addressing the ptosis component is critical. In this paper, we present a precision levator advancement technique that enabled us to predictably incorporate the levator advancement into our upper blepharoplasty to deliver more predictable results in these patients.

MATERIALS AND METHODS

Asian patients with normal or near normal margin to reflex distance 1 (MRD 1 of ≥ 3.5 mm) and symptoms and signs of straining of the frontalis with eyelid opening were diagnosed with subclinical upper eyelid ptosis and included in this prospective study. The advancement required was estimated pre-operatively using a formula that we developed. Our surgical technique is presented in detail here, and our long-term results were analysed.

RESULTS

From December 2019 to August 2022, 97 patients were included in this study. Sixty-five patients were primary cases and 32 were revision cases. The mean follow-up was 15 months. Of the 192 eyelids analysed, our formula was able to correctly identify the required fixation location in 69% of eyelids. In majority of the eyelids (94%), the correct location of fixation location within +/- 1 mm of the estimated location. All patients (100%) were satisfied with their long-term results. Our revision rate was 3%.

CONCLUSIONS

Incorporating a precisely done levator advancement into the upper blepharoplasty in patients with subclinical ptosis is critical for optimizing the aesthetic and functional outcomes. This approach has enabled us to perform this procedure greater predictably in this group of patients.

LEVEL OF EVIDENCE III

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 .

Frontotemporal craniotomy with skin incision along the superior temporal line outside the hairline in bald male patients with temporal gliomas

A head skin incision is inevitable in neurosurgical procedures and is usually concealed within the hairline. Androgenetic alopecia (AGA) is a progressive hair loss disorder or baldness highly prevalent in men. Therefore, if bald male patients require neurosurgical procedures, skin incisions cannot be concealed, but this subject is yet to be discussed in the literature. This study presents a frontotemporal craniotomy using a skin incision along the superior temporal line, ignoring the hairline in bald male patients. Thirty-three patients with temporal gliomas underwent surgical removal between 2015 and 2022. They were divided into three groups: bald male patients with skin incisions not concealed in the hairline (minimum group, n = 13), bald and non-bald male patients with skin incisions concealed in the hairline (male group, n = 11), and female patients with skin incisions concealed in the hairline (female group, n = 9). In the minimum group, patients had no complaints regarding the incision scar. Cosmetic outcome was excellent, and no cases showed surgical site infection or peripheral facial nerve palsy. Compared with the male and female groups, the minimum group had the shortest skin incision length; however, the craniotomy size and extent of resection were similar. Skin incision for frontotemporal craniotomy cannot be hidden in bald male patients, and the preferred location for the incision is unknown. The skin incision along the superior temporal line is a cosmetically favorable, feasible, and safe procedure.

Inorganic nanoparticles in dermopharmaceutical and cosmetic products: Properties, formulation development, toxicity, and regulatory issues

The use of nanotechnology strategies is a current hot topic, and research in this field has been growing significantly in the cosmetics industry. Inorganic nanoparticles stand out in this context for their distinctive physicochemical properties, leading in particular to an increased refractive index and absorption capacity giving them a broad potential for cutaneous applications and making them of special interest in research for dermopharmaceutical and cosmetic purposes. This performance is responsible for its heavy inclusion in the manufacture of skin health products such as sunscreens, lotions, beauty creams, skin ointments, makeup, and others. In particular, their suitable bandgap energy characteristics allow them to be used as photocatalytic semiconductors. They provide excellent UV absorption, commonly known as UV filters, and are responsible for their wide worldwide use in sunscreen formulations without the undesirable white residue after consumer application. In addition, cosmetics based on inorganic nanoparticles have several additional characteristics relevant to formulation development, such as being less expensive compared to other nanomaterials, having greater stability, and ensuring less irritation, itching, and propensity for skin allergies. This review will address in detail the main inorganic nanoparticles used in dermopharmaceutical and cosmetic products, such as titanium dioxide, zinc oxide, silicon dioxide, silver, gold, copper, and aluminum nanoparticles, nanocrystals, and quantum dots, reporting their physicochemical characteristics, but also their additional intrinsic properties that contribute to their use in this type of formulations. Safety issues regarding inorganic nanoparticles, based on toxicity studies, both to humans and the environment, as well as regulatory affairs associated with their use in dermopharmaceuticals and cosmetics, will be addressed.

Inline phase transition trapping-selective supercritical fluid extraction-supercritical fluid chromatography: A green and efficient integrated method for determining prohibited substances in cosmetics

BACKGROUND

Developing an environmentally friendly and efficient integrated analytical approach is a cutting-edge topic in current analytical science. Due to the unique properties of supercritical carbon dioxide (sc-CO2), online supercritical fluid extraction-supercritical fluid chromatography (SFE-SFC) is developing rapidly and has been widely applied in many fields. However, it still faces several challenges such as peak broadening and matrix interference. In order to solve the problems, we developed an inline phase transition trapping-selective supercritical fluid extraction-supercritical fluid chromatography (PTT-SSFE-SFC)-tandem mass spectrometry (MS/MS) method in this study.

RESULTS

This method integrated extraction, purification, separation, and detection, which was applied to determine 114 prohibited substances in cosmetics within 33 min, covering ten categories. The PTT strategy trapped the extracts on the head of the column by transforming CO2 from a supercritical state to a gaseous state, preventing peak spreading and improving sensitivity. Several adsorbents were tested when analyzing aqueous samples to reduce matrix interference and absorb water. Compared with conventional online SFE-SFC, this method improved the matrix effects of 93 and 87 target substances in the toner and mask matrix, respectively. Because the integrated method reduced sample loss, it achieved high sensitivity with LODs ranging from 0.00104 μg L-1 to 3.09 μg L-1. Furthermore, compared with other reported green methods, the inline method showed advantages in automation, efficiency, sample amount, and waste volume.

SIGNIFICANCE AND NOVELTY

With the introduction of the PTT strategy and the adsorbent, the system obtained good peak shapes, high sensitivity, low matrix effect, and good recovery. Based on the results, inline PTT-SSFE-SFC-MS/MS as a green and efficient integrated method has great potential for analyzing low abundance and multiple categories of targets in complex samples.

Gasless endoscopic thyroidectomy via the anterior chest approach: the experience with 1500 cases

BACKGROUND

Conventional thyroidectomy leaves an eye-catching scar in the anterior neck region. Endoscopic thyroidectomy may achieve a better esthetic effect and improve quality of life postoperatively. The aim of this study was to undertake a complete review of a large cohort of the patients undergoing gasless endoscopic thyroidectomy (GET) via anterior chest approach (ACA) with a long-term follow-up period, and evaluate the results and limits of this procedure.

METHODS

Between 2003 and 2022, 1413 patients undergoing GET via ACA in our department were included. The demographic, clinicopathological characteristics, oncologic and esthetic outcomes were summarized and analyzed.

RESULTS

The indication for surgery was papillary thyroid carcinoma in 686 (48.5%) patients and benign thyroid diseases in 727 (51.5%) patients. Among them, 802 (56.8%) patients took hemithyroidectomy, and 611 (43.2%) patients did sub-total/total thyroidectomy. Meanwhile, 598 (42.3%) ones had central neck dissection, while 88 (6.2%) lateral neck dissection. The most common complication was transient hypoparathyroidism with an incidence of 2.9%. During the follow-up period of 2 to 232 months, three patients were confirmed locoregional recurrence. Most of the patients were satisfied with the cosmetic results.

CONCLUSION

Gasless endoscopic thyroidectomy via anterior chest approach is a safe and feasible procedure, which could achieve excellent oncologic and esthetic outcomes.

Obesity as a Risk Factor in Cosmetic Abdominal Body Contouring: A Systematic Review and Meta-Analysis

BACKGROUND

The incidence of obesity is on the rise around the globe. Outside of the massive weight loss (MWL) patient population, knowledge of risk factors associated with abdominal body contouring (BC) is limited. This systematic review and meta-analysis assesses the impact of obesity has on cosmetic abdominal BC outcomes.

METHODS

A systematic review conducted in accordance with PRISMA 2020 was done. PubMed, Embase, Scopus, and COCHRANE databases were reviewed under search syntax "obesity," "abdominoplasty," "panniculectomy," and "body contouring" for articles. Cosmetic was defined as abdominoplasty or panniculectomy outside the context of MWL. Obesity was defined as BMI ≥ 30 kg/m2. Studies reporting postoperative outcomes with less than 50% of their population involving MWL patients were included. Postoperative outcomes were assessed by pooled analysis and meta-analysis.

RESULTS

Of 3088 initial studies, 16 met inclusion criteria, and nine were used for pooled and meta-analysis. Meta-analysis demonstrated that obesity was associated with more seromas (OR 1.45, 1.06-1.98, p = 0.02), hematomas (OR 2.21, 1.07-4.57, p = 0.03), and total surgical site occurrences (OR 1.99, 1.30-3.04, p = 0.0016). There was no significant difference in odds of any other complications. Analysis by obesity class showed no significant increase in odds in seromas or wound dehiscence.

CONCLUSIONS

This review demonstrates obesity increased odds of postoperative complications following cosmetic abdominal BC. However, risk of complications does not continue to increase with higher obesity class. A BMI ≥ 30 kg/m2 should not be a strict contraindication to cosmetic abdominal BC. Instead, plastic surgeons should evaluate patients on a case-by-case basis.

LEVEL OF EVIDENCE III

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 .

Keeping up appearances: Don't frown upon the effects of botulinum toxin injections in facial muscles

Aesthetic use of low doses of Botulinum toxin (BoNT) injections into the facial muscles has become a leading non-surgical aesthetic treatment worldwide to reduce facial wrinkles, including glabellar lines, forehead lines, and periorbital wrinkles. Within these aesthetic applications, BoNT injections intend to reduce and prevent wrinkles, and the recommended usage of 2 years is often exceeded, which may result in atrophy of the injected muscles. The long-term effects of BoNT injections in the facial muscles and the evidence of diffusion of BoNT to surrounding muscles are obvious pitfalls and challenges for clinical neurophysiologists in differential diagnosing neuromuscular transmission failures. Also, this is further complicated by the risk of developing side effects upon permanent chemical denervation of facial muscles, with less possibility for reinnervation. This review summarizes the known long-term effects of BoNT over time in different facial muscles and the use of objective electrophysiological measures to evaluate these. A better understanding of the long-term effects of BoNT is essential to avoid misdiagnosing other neuromuscular disorders.

Rosacea Topical Treatment and Care: From Traditional to New Drug Delivery Systems

Rosacea is a multifactorial chronic inflammatory dermatosis characterized by flushing, nontransient erythema, papules and pustules, telangiectasia, and phymatous alterations accompanied by itching, burning, or stinging, the pathophysiology of which is not yet fully understood. Conventional topical treatments usually show limited efficacy due to the physical barrier property of the skin that hinders skin penetration of the active ingredients, thereby hampering proper drug skin delivery and the respective therapeutic or cosmetic effects. New advances regarding the physiopathological understanding of the disease and the underlying mechanisms suggest the potential of new active ingredients as promising therapeutic and cosmetic approaches to this dermatosis. Additionally, the development of new drug delivery systems for skin delivery, particularly the potential of nanoparticles for the topical treatment and care of rosacea, has been described. Emphasis has been placed on their reduced nanometric size, which contributes to a significant improvement in the attainment of targeted skin drug delivery. In addition to the exposition of the known pathophysiology, epidemiology, diagnosis, and preventive measures, this Review covers the topical approaches used in the control of rosacea, including skin care, cosmetics, and topical therapies, as well as the future perspectives on these strategies.

Needs and Gaps in Resident Trainee Education, Clinical Patient Care, and Clinical Research in Cosmetic Dermatology: Position Statement of the Association of Academic Cosmetic Dermatology

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

Nanocrystals in cosmetics and cosmeceuticals by topical delivery

The main issues with local delivery of cosmetics are their high sensitivity and limited drug loading of active pharmaceutical ingredient. Nanocrystal technology offers consumers cutting-edge and effective products and exhibits enormous development potential in the beauty business as a new delivery method to address the issue of low solubility and low permeability of sensitive chemicals. In this review, we described the processes for making NCs, along with the impacts of loading and the uses of different carriers. Among them, nanocrystalline loaded gel and emulsion are widely used and may further improve the stability of the system. Then, we introduced the beauty efficacy of drug NCs from five aspects: anti-inflammation and acne, anti-bacterial, lightening and freckle removal, anti-aging as well as UV protection. Following that, we presented the current scenario about stability and safety. Finally, the challenges and vacancy were discussed along with the potential uses of NCs in the cosmetics industry. This review serves as a resource for the advancement of nanocrystal technology in the cosmetics sector.

Influence of social media on the esthetic perception of the lip profile of orthodontic patients

Objective

To identify the use of social media as an influencing factor of the orthodontic patient's preferences regarding the lip profile protrusion.

Methods

A two-part cross-sectional questionnaire was distributed to orthodontic patients in Spain and The Netherlands. The first part collected general data and frequency of use of different social media. The second part consisted of a series of modified female and male silhouettes presenting different lip profile positions. Each participant was required to choose both the (male and female) most attractive silhouette and the least attractive one.Student t-test, one-way ANOVA and Chi-square test were performed. Effect sizes were calculated to express the magnitude of differences between samples.

Results

The Spanish sample resulted in a moderate higher tendency (R² = 0.060) to choose protrusive lips as the most attractive lip profile for females, on subjects with more frequent use of social media. A medium tendency (R²⁼0,26) was observed as result of low users of social media choosing and ideal lip profile for men.The Dutch sample showed that high users of social media tended to choose as attractive a more protrusive female lip profile versus low users (p < .01). This was also observed (p < .05) on male attractive lip profiles.

Conclusions

Results suggest that frequent users of social media platforms tend to prefer more protruded lips than their less frequent counterparts. This information is valuable to be considered when formulating a treatment plan to satisfy the patient's expectations.

Clinical and patient-reported outcome after patient-specific 3D printer-assisted cranioplasty

Various cranioplasty techniques exist for the reconstruction of cranial bone defects. Patient-specific implants can be produced in-house using a recently developed 3D printer-assisted cranioplasty technique. However, the resulting cosmetic outcomes from the patient's perspective are underreported. With our case series, we aim to present the clinical outcome, morbidity rate, patient-reported cosmetic results, and cost-effectiveness of patient-specific3D printer-assisted cranioplasty technique. This is a consecutive retrospective case series of adult patients undergoing cranioplasty using the patient-specific 3D printer-assisted technique. As primary endpoint, the functional outcome based on modified Rankin scale (mRS) at discharge and follow-up was assessed. A prospective telephone survey was conducted to collect and provide patient-reported outcomes. Thirty-one patients underwent patient-specific 3D printer-assisted cranioplasty, mostly to reconstruct frontotemporoparietal (61.3%) and frontotemporal defects with orbital involvement (19.4%). Good functional outcome (mRS ≤ 2) at discharge and during the last follow-up was achieved in 54.8% (n = 17) and 58.1% (n = 18) patients. Overall, the rate of clinically relevant surgery-related complications was 35.5% (n = 11). Postoperative epidural hematoma/collection (16.1%) and infections (12.9%) were the most frequent complications. Permanent morbidity occurred in one patient (3.2%) with postoperative acute ipsilateral vision loss after frontotemporal cranioplasty with orbital involvement. No surgery-related mortality occurred. The mean patient-reported cosmetic satisfaction score was 7.8 ± 1.5, with 80% of patients reporting satisfying or very satisfying cosmetic results. No significant differences were seen between the different defect localization regarding the cosmetic outcome. The mean manufacturing costs of a patient-specific 3D printer-assisted implant ranged from 748 to 1129 USD. Based on our case series, patient-specific 3D printer-assisted cranioplasty is cost-effective and leads to satisfying cosmetic results, especially in large defects and/or defects with complex geometry.

Acute unilateral vision loss and bilateral cerebral infarction following cosmetic filler injection

The current case report describes acute unilateral vision loss and bilateral cerebral infarction as devastating complications following cosmetic injection of hyaluronic acid to the nasal bridge in a 34-year-old female. The patient reported the onset of sudden eye pain, headache, and vision loss in her right eye. At the initial visit to the hospital, the patient had no light perception in the right eye. Examinations revealed marked ptosis and complete ophthalmoplegia with no proptosis. At the time of the patient's hospital evaluation, computed tomography, and magnetic resonance imaging were ordered. Few mottled materials (denser than blood) were observed in the cavernous sinus with a density of 106 Hounsfield units (HU), yet no air was depicted in the cavernous sinus. MRI scan revealed multiple areas of bilateral intracranial infarcts. Although cosmetic injection of hyaluronic acid has been documented as a safe procedure, vision loss remains one of the most feared complications.

Filtration of biopolymer PHB particles loaded with synthetic musks does not cause significant bioaccumulation in marine mussels

The role of the biopolymer polyhydroxybutyrate (PHB, <250 µm) as a vehicle of a synthetic musks mixture (celestolide, galaxolide, tonalide, musk xylene, musk moskene and musk ketone) to Mytilus galloprovincialis was investigated. For 30 days, virgin PHB, virgin PHB+musks (6.82 µg g-1) and weathered PHB+musks, were daily spiked into tanks containing mussels, followed by a 10-day depuration period. Water and tissues samples were collected to measure exposure concentrations and accumulation in tissues. Mussels were able to actively filter microplastics in suspension but the concentration of the musks found in tissues (celestolide, galaxolide, tonalide) were markedly lower than the spiked concentration. Estimated Trophic Transfer Factors suggest that PHB will only play a minor role on musks accumulation in marine mussels, even if our results suggest a slightly extended persistence in tissues of musks loaded to weathered PHB.

A novel modified Winograd surgical tricks and tips with a "bird flap" for the treatment of ingrown toenails

BACKGROUND

The Winograd technique is the most commonly used surgical treatment for ingrown toenails. We describe a novel modified approach, more effective and simpler to perform with a better cosmetic outcome.

METHODS

We retrospectively included 45 and 39 patients with 67 and 58 ingrown toenails who underwent our modified Winograd technique and the Winograd technique, respectively, from July 2017 to June 2020, and obtained data after 3, 6, and 12 months of follow-up.

RESULTS

No significant differences in the postoperative time taken to return to regular activities in the modified Winograd and traditional Winograd groups (p = 0.103) and regarding the recurrence in both groups (p = 0.055) were found. The extent of proximal germinal matrix exposure with the modified Winograd technique was significantly more clearly revealed than in the traditional Winograd method contextually (p < 0.05). The postoperative appearance satisfaction rate was significantly higher in the modified Winograd group than in the traditional Winograd group (p = 0.029).

CONCLUSION

The modified Winograd technique is effective in treating ingrown toenails.

Endoscopic hemithyroidectomy plus prophylactic central neck dissection via breast approach versus gasless transaxillary approach in treating low-risk papillary thyroid cancer: a retrospective series

Hemithyroidectomy plus prophylactic central neck dissection (pCND) has been adopted as a de-escalating surgical strategy for low-risk papillary thyroid cancer (PTC). This study aimed to evaluate and compare the outcomes of these two different endoscopic approaches in the treatment of PTC with hemithyroidectomy plus pCND. This retrospective study reviewed medical records of 545 patients receiving breast approach (ETBA) (n = 263) or gasless transaxillary approach (ETGTA) (n = 282) in treating PTC. Demographics and outcomes were compared between the two groups. Preoperatively, the two groups were similar in demographics. Regarding surgical outcomes, no differences were found in terms of intraoperative bleeding, total amount of drainage, duration of drainage, postoperative pain, hospital stay, vocal cord palsy, hypoparathyroidism, hemorrhage, wound infection, chyle leakage, or subcutaneous ecchymosis. Conversely, ETBA recorded fewer skin paresthesia (1.5% vs. 5.0%, respectively) but longer operative times (138.1 ± 27.0 vs. 130.9 ± 30.8 min,) and more swallowing disturbances (3.4% vs. 0.7%) compared to ETGTA (p < 0.05). No difference in scar cosmetic results, but ETBA had lower neck assessment score than ETGTA (2.6 ± 1.2 vs. 3.2 ± 2.0, p < 0.05). For low-risk PTC, endoscopic hemithyroidectomy plus pCND using either ETBA or ETGTA is both feasible and safe. Although the two approaches are comparable in terms of most surgical and oncological outcomes, ETBA is superior to ETGTA in terms of neck cosmetic results and skin paresthesia but is associated with more swallowing disturbances and requires a longer operative time.

An accurate and reliable analytical strategy for simultaneous determination of target furanocoumarins and flavonoids in cosmetic and pharmaceutical samples by ultra-high performance supercritical fluid chromatography

Furanocoumarins and flavonoids have various important biological activities and wide application. In the present study, a rapid and reliable supercritical fluid chromatography method was proposed for the separation of 10 target components including 8 furanocoumarins and 2 flavonoids. After detailed condition optimization, the 10 target compounds can be baseline separated on a Trefoil CEL1 (3.0 mm × 150 mm, 2.5 µm) column using gradient elution. A 0.07% (v/v) trifluoroacetic acid in ethanol was determined to be the most proper mobile phase for the separation of target compounds. The column temperature, back pressure, flow rate were set at 36 ℃, 2000 psi, 1.0 mL min^-1 to 1.4 mL min^-1, respectively. The ten target compounds were analyzed within 24 min using the optimized conditions. Under the optimized conditions, all the target compounds showed good linearity with linear correlation coefficients higher than 0.995, and satisfactory recovery in the range of 83.52-112.92%. All these results showed that the developed ultra-high performance supercritical fluid chromatography method was reliable and effective. Finally, the application of the developed method to cosmetic, Psoraleae fructus and Angelicae dahuricae radix samples were presented. The results highlight the applicability of the ultra-high performance supercritical fluid chromatography method to the analysis of interested compounds in pharmaceutical and cosmetic samples.

Recent Patents on the Industrial Application of Biosurfactants

BACKGROUND

Biosurfactants are natural bioactive compounds produced from fungi, bacteria and plants. These molecules have several properties that enable them to be involved in various industrial applications. The surface-active properties of biosurfactants allow their use in various sectors, such as agriculture, health, cosmetics, bioremediation/petroleum, mining, and bioprocess.

OBJECTIVE

The objective of this study was to analyze the patents deposited in intellectual property databases for applications of biosurfactants in the areas of agriculture, health, cosmetics, bioremediation/petroleum, mining, and bioprocesses, with the research period consisting of the last six years.

METHOD

This study targeted the use of biosurfactants in various industrial sectors. The patent search was carried out using the Google Patents platform, a platform that is commonly used for this purpose and freely accessible.

RESULTS

During the search for patents related to applications of biosurfactants in industry filed in the last 6 years, results were found to be distributed in the following areas: agriculture (70), cosmetics (2311), bioremediation/petroleum (179), health (1794), mining (5), and bioprocess (133). Six patents were selected from each area, except for health and mining, for which the search resulted in only 5 and 4 patents, respectively, to be discussed and provide information on the biotechnological applications of biosurfactants in the industry.

CONCLUSION

The present study showed a wide area of application of biosurfactants in industry. The interest in the inclusion of biosurfactants in the industry is directly related to the need for more sustainable solutions to solve real market problems. The cosmetics sector presented the most patents that employ the use of biosurfactants.

Separation of the seventh costal-sternal junction-A new technique to improve outcomes for the Nuss procedure for pectus excavatum

BACKGROUND

In the standard Nuss procedure for pectus excavatum, the costal arch is often elevated together with the sternum, resulting in unevenness of the lower part of the thorax. This complication is commonly called rib flaring. This paper presents a technique to avoid rib flaring and evaluates its effectiveness.

MATERIALS AND METHODS

In our technique, a part of the seventh costal cartilage is removed, disconnecting the costal arch from the sternum. The effectiveness of this technique was evaluated in a retrospective clinical study of 63 pectus excavatum patients who were randomly collected and were divided into two groups. One group-defined as the Standard Group-includes 27 patients (29.8 ± 6.5SD y/o) on whom standard Nuss procedure was conducted; the other group-defined as the Separation Group-includes 36 patients (31.8 ± 6.1SD y/o) on whom the cartilage removal was conducted in addition to the standard Nuss procedure. The degree of postoperative costal-arch elevation was defined as ECA (Elevation of Costal Arch) and was compared between the two groups.

RESULTS

ECA was significantly greater for the Standard Group (10.2 ± 3.3SD mm) than for the Separation Group (-1.1 ± 3.42SDmm).

CONCLUSION

Postoperative protrusion of the costal arch is prevented by the separation of the seventh costal cartilage from the sternum. Our original technique is a useful option for the treatment of pectus excavatum.

An insight into photodynamic therapy towards treating major dermatological conditions

Photodynamic therapy (PDT), as the name suggests is a light-based, non-invasive therapeutic treatment method that has garnered immense interest in the recent past for its efficacy in treating several pathological conditions. PDT has prominent use in the treatment of several dermatological conditions, which consequently have cosmetic benefits associated with it as PDT improves the overall appearance of the affected area. PDT is commonly used for repairing sun-damaged skin, providing skin rejuvenation, curbing pre-cancerous cells, treating conditions like acne, keratosis, skin-microbial infections, and cutaneous warts, etc. PDT mediates its action by generating oxygen species that are involved in bringing about immunomodulation, suppression of microbial load, wound-healing, lightening of scarring, etc. Although there are several challenges associated with PDT, the prominent ones being pain, erythema, insufficient delivery of the photosensitizing agent, and poor clinical outcomes, still PDT stands to be a promising approach with continuous efforts towards maximizing clinical efficacy while being cautious of the side effects and working towards lessening them. This article discusses the major skin-related conditions which can be treated or managed by employing PDT as a better or comparable alternative to conventional treatment approaches such that it also brings about aesthetic improvements thereof.

A systematic review and meta-analysis

Several studies have showed good/excellent results of thermal-ablation (TA) to reduce volume of benign thyroid nodule (TN). Nevertheless, no systematic review has reported information about clinical achievements with TA. Being the latter of high interest, this systematic review was undertaken to achieve high evidence about the efficacy of TA in reducing TN-related symptoms and cosmetic concerns. Radiofrequency (RFA) and laser (LA) therapies were considered. A comprehensive literature search of online databases was performed on January 2022 looking for studies reporting clinical results obtained by RFA or LA in terms of VAS (namely, Visual Analogic Scale) and cosmetic concerns. Initially, 318 records were found and 14 were finally included in the meta-analysis. VAS data were available in all RFA studies and the pooled mean reduction was of 3.09 points with significant heterogeneity. Cosmetic score data were available in 11 RFA studies and the pooled mean reduction was of 1.45 with significant heterogeneity. Regarding LA studies, 4 series reported VAS data and the pooled mean reduction was of 2.61 points with significant heterogeneity. The analysis of LA data about cosmetic concerns was not performed due to data paucity. Importantly, heterogeneities were not explained by meta-regression analyses using several covariates (i.e., baseline TN volume, follow-up duration, volume reduction rate). This systematic review showed that clinical data about TN TA efficacy are sparse and affected by high unexplained inconsistency. International societies should give indication about how we should clinically select and evaluate patients undergoing TN TA.

Impact of COVID-19 on the patient referral pattern and conversion rate in the university versus private facial plastic surgery centers

Purpose

To compare the number of referrals and conversion rate between the pandemic and pre-pandemic period.

Methods

The number of referrals and conversion rate between the 10-month pandemic (March–December 2020) and pre-pandemic (March–December 2019) were evaluated in the two university (mainly non-cosmetic) and private (mainly cosmetic) facial plastic surgery centers. Demographics and monthly number and type (cosmetic and non-cosmetic) of the referrals and surgeries were recorded from the both and cosmetic facial injections (botulinum toxin and filler) and the source of referrals (web- and non-web-based) from the private center. The conversion rate was a ratio of the number of the surgeries to the number of referrals.

Results

The number of referrals declined by 7.7% in the private center which was significantly higher for the non-cosmetic (26%) than the cosmetic (0.5%) referrals. It was 32% in the university center. The private center conversion rate significantly (P < 0.001) decreased for both the cosmetic (60%) and non-cosmetic (82%) procedures. It was not significantly different between the cosmetic (65%) and non-cosmetic (58%) procedures in the university center. However, the number of cosmetic facial injections (11%) and the web-based referral source (4%) increased. The recovery was better for the number of referrals (better in the private center) than the conversion rate.

Conclusion

The fall in the conversion rate was statistically significant in the private center. While the number of referrals recovered to almost the pre-pandemic level, the conversion rates, despite recovery, remained at a lower level at the end.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10792-022-02469-1.

Fibrous Clays in Dermopharmaceutical and Cosmetic Applications: Traditional and Emerging Perspectives

Functionalization of natural clay minerals for high value-added pharmaceutical and cosmetic applications receives significant research attention worldwide attributable to a rising demand and ongoing search for green, efficient, economically sustainable and ecofriendly geomaterials. Fibrous clays, i.e. palygorskite and sepiolite, are naturally-occurring hydrated magnesium aluminum silicate clay minerals with 2:1 layer-chain microstructure and one-dimensional nanofibrous morphology. Due to their unique structural, textural and compatibility features, over the past decade, fibrous clays and their organic modified derivatives are increasingly used in the dermopharmaceutical and cosmetic fields as excipients, active agents or nanocarriers to develop novel skin delivery systems or to modify drug release profile for enhanced health effects. This comprehensive review presents the up-to-date information on fibrous clays used in topically-applied products for therapeutic and cosmetic purposes with the focus on their performance-related structural characteristics and the underlying mechanisms. The recent advancement of fibrous clay-based skin delivery systems was summarized in wide range of applications including pelotherapy, wound healing, antimicrobial action, coloration and UV protection. An overview of the commonly used topically-applied dosage forms (powders, hydrogels, films, peloids and Pickering emulsion) as well as the toxicological aspects was also included, which might provide guidance to the design and development of fibrous clay-based skin delivery systems.

Nanoencapsulation of Tea Catechins for Enhancing Skin Absorption and Therapeutic Efficacy

Tea catechins are a group of flavonoids that show many bioactivities. Catechins have been extensively reported as a potential treatment for skin disorders, including skin cancers, acne, photoaging, cutaneous wounds, scars, alopecia, psoriasis, atopic dermatitis, and microbial infection. In particular, there has been an increasing interest in the discovery of cosmetic applications using catechins as the active ingredient because of their antioxidant and anti-aging activities. However, active molecules with limited lipophilicity have difficulty penetrating the skin barrier, resulting in low bioavailability. Nevertheless, topical application is a convenient method for delivering catechins into the skin. Nanomedicine offers an opportunity to improve the delivery efficiency of tea catechins and related compounds. The advantages of catechin-loaded nanocarriers for topical application include high catechin loading efficiency, sustained or prolonged release, increased catechin stability, improved bioavailability, and enhanced accumulation or targeting to the nidus. Further, various types of nanoparticles, including liposomes, niosomes, micelles, lipid-based nanoparticles, polymeric nanoparticles, liquid crystalline nanoparticles, and nanocrystals, have been employed for topical catechin delivery. These nanoparticles can improve catechin permeation via close skin contact, increased skin hydration, skin structure disorganization, and follicular uptake. In this review, we describe the catechin skin delivery approaches based on nanomedicine for treating skin disorders. We also provide an in-depth description of how nanoparticles effectively improve the skin absorption of tea catechins and related compounds, such as caffeine. Furthermore, we summarize the possible future applications and the limitations of nanocarriers for topical delivery at the end of this review article.

Near-infrared spectroscopy combined with chemometrics to classify cosmetic foundations from a crime scene

Cosmetic smears are a form of trace evidence that can link the crime scene, suspects, and victims. Foundation and lipstick are the most common sources of cosmetics that can easily smear, with most current research focused on the evidential analysis of lipsticks. This research aims to create a database of cosmetic foundations on different materials and to access the robustness of using Near-infrared with chemometrics as a non-destructive technique to identify unknown samples collected from a crime scene. Small amounts of six shades of three brands of foundations were smeared on clothing materials, which were then analysed with a combination of Near-infrared with chemometric analysis. Principle component analysis (PCA) was used to reduce data dimensionality and explore potential patterns in sample separation and Linear Discriminant Analysis (LDA) was utilised to assign unknown samples to one of the established classes. The selected techniques proved to be promising for database construction and as a preliminary method of analysis, with 93% of the spectra being correctly classified. Notably, darker foundation shades were less likely to be correctly classified (90% classified correctly) compared to lighter ones (96.7% classified correctly). This could not be improved with Standard Normal Variate (SNV) data pre-treatment or selecting specific NIR regions. This finding is of particular importance; according to the Crime Survey for England and Wales (year ending March 2020) police recorded sexual offences demonstrated that those in Mixed and Black or Black British ethnic groups were significantly more likely to be a victim of sexual assault compared to White, Asian or Other ethnic groups. It is, therefore, crucial to add a wide range of foundation shades, particularly of darker tones, to the future database.

Supraorbital Keyhole Craniotomy in Pediatric Neurosurgery: A Systematic Review of Clinical Outcomes and Cosmetic Outcomes

BACKGROUND

Supraorbital keyhole craniotomy is a minimally invasive approach used to access the parasellar region with advantages of decreased cortical exposure, simple closure, and decreased risk of postoperative cerebrospinal fluid leak. The incision of this approach, however, has raised cosmetic concerns, especially for pediatric patients. The aim of this study is to assess postoperative complications and cosmeses of the supraorbital keyhole approach for resection of intracranial lesions in pediatric patients.

METHODS

A literature search of PubMed, Scopus, and Web of Science databases was performed on June 1, 2021, searching for all studies of pediatric patients undergoing supraorbital keyhole craniotomy for surgical resection of lesions in the anterior fossa/sellar region.

RESULTS

Of 729 unique hits, 15 supraorbital keyhole studies reporting on 177 pediatric cases were included in the final review. Quality of all included studies was moderate. Overall, the surgery was well tolerated with a low number of severe adverse events. A wide variety of pathologies were treated with this approach. Complications of surgery included changes in vision, epidural hematoma, subdural hematoma, cerebrospinal fluid leak, and wound infection. At 6 weeks of follow-up, surgical scars in most patients were noted to be minimally detectable. At 3-6 months of follow-up, scars were no longer visible. Cosmetic complications included 5 bone defects, 1 split eyebrow, and 1 case of ptosis.

CONCLUSIONS

This study suggests that supraorbital keyhole craniotomy is a safe and effective approach to access the parasellar region in pediatric patients with excellent cosmetic outcomes reported across multiple institutions.

Functional panniculectomy vs cosmetic abdominoplasty: Multicenter analysis of risk factors and complications

BACKGROUND

Amidst the rising trend of bariatric surgical procedures being performed across the country and around the world, patients seeking functional panniculectomy after massive weight loss represent a different population than those seeking cosmetic abdominoplasty. The purpose of this study was to determine whether certain complications are more likely to occur in patients undergoing functional panniculectomy, as well as identify risk factors that are implicated in the occurrence of adverse events.

METHODS

Retrospective cohort study was conducted of patients undergoing cosmetic abdominoplasty and functional panniculectomy in North America between 2015 and 2019 using the National Surgical Quality Improvement Program database sponsored by the American College of Surgeons. Comorbidities and postoperative complications between these two cohorts were analyzed with appropriate statistics.

RESULTS

During the study interval, 11,137 patients underwent excision of excessive infraumbilical abdominal skin, including 57.4% (n = 6397) patients undergoing functional panniculectomy and 42.6% (n = 4740) patients undergoing cosmetic abdominoplasty. Patients undergoing functional panniculectomy were significantly more likely to have comorbidities than those undergoing cosmetic abdominoplasty (p < .001). Overall adverse events (p < .001), medical complications (p = .047), surgical complications (p < .001), related readmission (p < .001), and related reoperation (p < .001) were significantly higher in patients undergoing functional panniculectomy. Surgical complications significantly higher in functional panniculectomy included superficial incisional infection (p < .001), deep incisional infection (p < .001), organ/space infection (p < .001), dehiscence (p = .003), and bleeding requiring transfusion (p = .003).

CONCLUSIONS

Patients undergoing functional panniculectomy are significantly more likely to have comorbidities and experience postoperative wound infection, dehiscence, sepsis, bleeding, related readmission, and related reoperation.

Gland-preserving surgery of benign parotid tumours via postauricular sulcus incision: Is it safe and effective with the scarless incision?

Gland-preserving surgery has been introduced to reduce the complications of conventional parotidectomy that requires removal of total superficial or entire parotid gland along with the tumour. Several cosmetic incisions have also been developed along with conservative parotid surgery involving partial dissection of the facial nerve and gland. The incision length in the cosmetic approaches is gradually shortened from facelift to periauricular incision, and endoscopic parotidectomy techniques emerged. A more functional approach via postauricular sulcus incision was also introduced to remove benign parotid tumours with high cosmetic satisfaction and oncological safety. Therefore, this article presents the surgical procedures, potential indications, pros and cons of the postauricular sulcus approach.

Asian Upper Blepharoplasty with the Hinge Technique

Asian upper blepharoplasty is one of the most commonly requested procedures in Asian patients. Many incisional and suture methods have been described in the literature. While the suture method is advantageous for its simplicity and quick recovery, the incision method is more versatile and able to deliver predictable and reproducible results for Asian patients presenting with a diverse range of anatomy and requests. Accordingly, the incision method remains the preferred approach for many surgeons performing Asian upper blepharoplasty. In this paper, we detail our open incision hinge upper blepharoplasty technique to create dynamic upper eyelid creases in Asian patients. The surgical videos associated with this paper present our surgical technique in detail, highlighting technical refinements and surgical nuances to perform the surgery precisely and predictably. The conceptual core of our approach is the use of a vascularized orbital septum as a flap to create a fibrous extension from the levator aponeurosis to the dermis at the location of eyelid crease. This vascularized flap securely connects the posterior lamella with the anterior lamella to securely form the eyelid crease with eye opening. This most accurately recreates the anatomy that is present in attractive Asian patients with naturally occurring double eyelid and predictably creates a dynamic and crisp upper eyelid crease. LEVEL OF EVIDENCE V: 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 .

Determination of Heavy Metals in Hair Dye Sale in Iranian Market: Dermal Sensitivity and Carcinogenicity Assessment

Despite the high consumption of cosmetics especially hair dyes in Iran, limited studies have measured human exposure to heavy metals in these products. Therefore, due to the sensitivity of the issue from a health perspective, this study was performed for the purpose of dermal risk assessment of heavy metals in different brands of hair dyes in Kashan region. The present study is an analytical-observational study. In this study, 36 samples of hair dyes from four best-selling brands in Kashan market (Iran) were selected; then the concentration of lead, cadmium, nickel, chrome, and cobalt was measured by inductively coupled plasma optical emission spectrometry (ICP-OES) and reported as μg g^-1 of dry weight; and finally, a health risk assessment was performed. The heavy metal concentrations in the hair dye samples were 1.825, 0.525, 48.15, 2.975, and 0.575 μg g^-1 for Pb, Cd, Cr, Ni, and Co respectively that were lower than the permissible limit. Both of HI and LCR were below of 1 and 10^-6 that indicated heavy metal in this study had not probable non-carcinogenic and carcinogenic risks for the consumers of these products. An exposure-based sensitization Quantitative Risk Assessment determined an absence of skin-sensitizing potential. However, Cr, Ni, and Co were found at concentrations above the allergenic limit of 5 μg g^-1. According to the results, although due to low concentrations of toxic metals, there is a low level of exposure to heavy metals in hair dye users, but can cause potential health damage to users.

Effect of Modified Allgöwer-Donati Suture Technique on Wound Cosmetics in Spinal Surgery

Objective

To analyze the efficacy of modified Allgöwer–Donati suture (MADS) technique on cosmetic outcomes compared with vertical mattress suture (VMS) technique in spinal surgery wounds.

Methods

This randomized controlled trial was conducted at the First Hospital of Lanzhou University (Gansu, China) from September 2019 to August 2020. The patients were randomly divided into two groups, a VMS group and a MADS group, by staff not involved in the treatment using a computer‐based random number table program (no restrictions on age or sex). Both procedures were performed by the same group of physicians as well as assistants. All suture wounds were completed by the same person. The primary endpoint was the scar area, and the postoperative scar area was scored by the Patient and Observer Scar Scale Assessment (POSAS). The scar area was calculated by ImageJ software. The second outcome measure was wound complications, including poor wound healing, wound edge necrosis, and infection. The trial was recorded in the Chinese Clinical Trial Register on 18 August 2019 (ChiCTR1900024548).

Results

A total of 143 patients were included: 72 in the VMS group and 71 in the MADS group. There was no significant difference in their demographics in terms of age (49.71 ± 8.91 vs 50.15 ± 6.79 years, P = 0.737), sex (M/F, 30/41 vs 31/41, P = 0.923), suture time (3.39 ± 0.22 vs 3.47 ± 0.25 s/mm, P = 0.057), or body mass index (BMI, 23.88 ± 3.50 vs 24.05 ± 3.50, P = 0.765) for MADS to VMS. The postoperative scar area was compared between the two groups transversely on day 12, the MADS wound scars decreased by 58.95% (75,133.24/127,452.58). In the POSAS evaluation, after MADS treatment, surface area score decreased from 5 (4, 5) to 2 (2, 3) (P < 0.0001), observer's overall opinion from 5 (4, 5) to 3 (2, 3) (P < 0.0001), itching from 3 (3, 4) to 3 (2, 3) (P = 0.001), color from 4 (4, 5) to 3 (2–4) (P < 0.0001), stiffness 4 (3–4.75) to 3 (3, 4) (P < 0.0001), or thickness from 4 (3–5) to 4 (3, 4) (P = 0.004). In terms of overall opinion evaluation, the MADS showed a significant difference in observer's overall opinion to the VMS (5 (4, 5) vs 3 (2, 3), P < 0.0001) and in patient's overall opinion 5 (5, 6) to 3 (3, 4), (P < 0.0001). There was no significant statistical difference in poor wound healing (3 vs 0, P = 0.245), wound edge necrosis (3 vs 0, P = 0.245), and infection (1 vs 0, P = 1.000) with the MADS to the VMS.

Conclusion

The results of this study show that the MADS effectively reduced the surgical scar area to 58.95% with no additional adverse events compared with that of the VMS in spine surgery.

Polyacrylate crosspolymer-11 enhances soil clay dispersibility: An indication for inadvertent environmental impacts from personal care and cosmetic ingredients

Polymer ingredients are commonly found in personal care and cosmetic industry and their "leakages" into the environment have recently been warned as an emerging environmental risk. Daily use of personal care and cosmetic products can inadvertently release large amounts of polymer ingredients into water courses. However, their fate and interaction with other constituents, especially colloids (e.g., clays), have not been fully understood. This study primarily evaluates the colloidal dynamics of soil clays under the presence of polyacrylate crosspolymer-11 (PC11) (a common ingredient of cosmetic and personal care products) with the aim of identifying possible induced changes in the clay-accumulated environments, e.g., soil and sediment. The test-tube experiments were coupled with a particle charge detector to mutually evaluate the colloidal dynamics and surface charge properties of the soil clays. It was revealed that adsorption of PC11 onto the clays shifted clay surface to more negative, thereby intensifying repulsive force and favouring the dispersion state of the soil clays. This implies that various polymer ingredients can act in the same way in stabilizing clay dispersion or even altering the fate of the soil clays. As the growing consumption of personal care and cosmetic products will likely continue, it requires a tighter consideration of the possible impacts of polymer ingredient residues, not limited to dispersion-induced effects, in various clay-accumulated environments such as paddy fields, river mouths or mangroves.

Regulation of Molecular Farming Products

The regulation of molecular farming is a complex topic because plants and plant-based systems are relative newcomers among the many production platforms available for recombinant proteins. The regulations specific for different types of product (human/veterinary pharmaceuticals and medical devices, cosmetics, diagnostics, and research reagents) must therefore be overlaid with the regulations governing hitherto unfamiliar production platforms, and this must be achieved in different jurisdictions that handle genetically modified organisms (and genetically modified plants in particular) in very different ways. This chapter uses examples of different product types and production methods in three different jurisdictions (the USA, the EU, and Canada) to demonstrate some of the challenges facing the regulatory authorities.

An in vitro assessment for human skin exposure to parabens using magnetic solid phase extraction coupled with HPLC

Skin contact was a significant source of human exposure to parabens during the use of personal care products. In this study, a novel and simple in vitro evaluation method for human skin exposure to parabens was established for the first time. Firstly, magnetic porous carbon (MPC) derived from discarded cigarette butts was prepared as an adsorbent of magnetic solid-phase extraction (MSPE), which provided a fast and efficient sample preparation method with satisfactory extraction performance for parabens in cosmetics and was easy to couple with high performance liquid chromatography. Secondly, the extraction conditions were optimized including the etching ratio of KOH, amount of MPC, extraction time, pH, salt concentration, desorption solvent volume and desorption time. Under the optimized conditions, the limits of detection were between 0.25 and 0.34 ng mL^-1 and the spiked recoveries were in the range of 85.8-112.6%. Thirdly, the developed method was successfully employed to determine five typical parabens in real unspiked cosmetic samples, and two parabens were detected at a relatively high level. Then, the developed method was applied to in vitro assays. The absorbable dose of parabens in cream was investigated and in vitro experiments were further designed with agarose-simulated skin to demonstrate the penetration ability of parabens. In conclusion, these results indicated that parabens did have the risk of entering the body through the skin and the exposure was preferably no more than 3 h with skin contact.

A Review on Cosmetics Causing Conatct Urticaria

Physical appearance is more strongly pursued than ever in today's world and is considered to provide confidence, success and self-esteem. Cosmetics are the important product in beauty market and their growth is unstoppable. It is estimated that about 95% of women and 75% of men were daily using cosmetics. Despite the considerable use of cosmetics, most people are unaware of its adverse reactions. Urticaria is severe as well as the most common adverse reaction caused by cosmetics. Major cosmetics that cause urticaria include fragrance, preservatives, hair care products, lip plumbers, plant- and animal-derived products, bindi or kumkum, nail cosmetics, glycol peel, permanent makeup and tattoos, etc. This review provides a brief explanation of the cosmetic components that cause urticaria.

Bacterial cellulose-based composites for biomedical and cosmetic applications: Research progress and existing products

Bacterial cellulose (BC) is a promising unique material for various biomedical and cosmetic applications due to its morphology, mechanical strength, high purity, high water uptake, non-toxicity, chemical controllability, and biocompatibility. Today, extensive investigation is into the manufacturing of BC-based composites with other components such as nanoparticles, synthetic polymers, natural polymers, carbon materials, and biomolecules, which will allow the development of a wide range of biomedical and cosmetic products. Moreover, the addition of different reinforcement substances into BC and the organized arrangement of BC nano-fibers have proven a promising improvement in their properties for biomedical applications. This review paper highlights the progress in synthesizing BC-based composites and their applications in biomedical fields, such as wound healing, drug delivery, tissue engineering, and cancer treatment. It emphasizes high-performance BC-based materials and cosmetic applications. Furthermore, it presents challenges yet to be defeated and future possibilities for BC-based composites for biomedical and cosmetic applications.

The impact of social media accounts on periocular cosmetic surgeries

PURPOSE

The study aims to assess the impact of social media on patients who underwent periocular cosmetic surgeries during 2019 and to determine the appropriate platforms to enrich the knowledge and awareness of the general Saudi population regarding periocular cosmetic surgeries.

METHODS

A cross-sectional study was conducted at Ibn Rushd Hospital, Riyadh, Saudi Arabia. Three hundred and ninety-five participants with periocular cosmetic surgeries in 2019 were recruited for the study. The questionnaire included 43 questions distributed under four domains: demographics, personal and family history of periocular eye surgeries, influence of social media on cosmetic eye procedures, and psychological effects of social media.

RESULTS

Periocular cosmetic surgeries were more common among women, with eyelid surgery being the most popular type. About 48.9% of the participants knew their oculoplastic surgeons from social media platforms, and over 57% who used accounts on social media were interested in cosmetology managed by nonphysicians. The majority of the participants (64.1%) chose Instagram as a social media platform to find an oculoplastic surgeon. Consequently, 91.6% stated that seeing before and after photos on social media platforms affected their decision in selecting their oculoplastic surgeon. Besides, 82.8% revealed that visiting surgeons' clinic came as a step next to their search for their accounts on social media.

CONCLUSION

The majority of the participants were, somewhat or another, affected by social media and this is due to people's belief regarding social media as a beneficial source of medical information that can provide reviews and expert opinion. The accuracy of the information presented in social media accounts managed by both physicians and nonphysicians is essential in making the appropriate decision for undergoing this kind of surgeries or not.

Refractory iatrogenic pigmentary glaucoma secondary to cosmetic laser treatment: A case report

PURPOSE

To report a case of bilateral iatrogenic pigmentary glaucoma secondary to cosmetic iris-lightening laser treatment.

CASE REPORT

A 39-year-old patient presented with bilateral iatrogenic pigmentary glaucoma. She had elevated intraocular pressures (IOPs), scattered iris pitting, and intense angle pigmentation secondary to the cosmetic laser treatment she underwent 4 weeks prior to presentation. Her IOPs were refractory to maximal medical treatment and she subsequently underwent trabeculectomy.

CONCLUSION

The true scale of complications related to cosmetic laser treatments is as yet unknown. Robust clinical investigations into its safety profile, including long-term data, are required. Prospective patients should consider this with great care. Clinicians should be aware of the potential risks of this procedure, as early recognition of cosmetic laser-induced pigmentary glaucoma may avert further sequelae.

The effect of prolonged exposure on sodium dodecyl sulfate penetration into human skin

The purpose of this study was to examine the effect of prolonged surfactant exposure on mechanisms of anionic surfactant penetration into human skin. A radiolabeled probe (14-carbon sodium dodecyl sulfate (¹⁴C-SDS)) was used to trace the penetration of a model anionic surfactant, sodium dodecyl sulfate (SDS), into excised human skin and into an inert membrane composite in vitro. SDS dose varied from 0.03 to 15 mg/cm², mimicking the exposure of a rinse-off cleanser on skin. Two surfactant exposure lengths were tested, 2 min and 5 h. SDS penetration into excised human skin was constant from 50 to 600 mM for skin samples exposed to SDS for 2 min. For skin samples exposed to SDS for 5 h, SDS penetration into skin increased log-linearly with increasing SDS concentration. SDS penetration into the inert membrane composite was constant from 50 to 600 mM SDS regardless of length of surfactant exposure. Penetration of the radiolabeled probe into skin and into the inert membrane correlated well with the monomeric concentration of the radiolabeled probe in the applied surfactant solution. These results support that monomer concentration is the driving force for initial SDS penetration into upper layers of the stratum corneum over a wide range of concentrations. With prolonged exposure, SDS penetrates the skin in a dose-dependent manner due to surfactant-induced damage to the skin.

Determination and risk assessment of toxic metals in lipsticks from Europe and China

BACKGROUND

The presence of toxic toxic metals in lipstick can pose a health risk to many consumers of this type of cosmetics, especially for women. Thus, the aim of this study was to assess consequences attributed to dermal and oral exposure to toxic metals in lipsticks manufactured in China and Europe as determined by non-cancer and cancer risks assessment models from SCCS and USEPA, respectively.

METHOD

The treatment of the samples was carried out by calcination using muffle furnaces and the determination of Al, Cd and Pb were determined by inductively coupled plasma optical emission spectrometry (ICP-OES).

CONCENTRATIONS

The concentration of Cd and Pb in the study samples does not exceed the limits stablished for the FDA (00,228 mg kg^-1·day^-1 for Cd and 000,343 mg kg^-1·day^-1 for Pb, respectively) but they do not comply with the Regulation of the European Parliament, which prohibits the presence of these two metals in cosmetics. Neither European Union nor United States have established maximum levels for Al in cosmetics.

CONCLUSIONS

The cancer risk assessment of Cd and Pb metals resulted in a total cancer risk less than 1. The results of non-cancer oral risk assessment for Pb had a MoS result of 88 for China and 62 for Europe, suggesting that Pb poses a risk for the human health, especially in samples manufactured in Europe.

Enhanced digestion of complex cosmetic matrices for analysis of As, Hg, Cd, Cr, Ni, and Pb using triton X-100

A suitable optimized digestion method for lipsticks and powders for the analysis of As, Hg, Cd, Cr, Ni and Pb by Hydride Generation Atomic Absorption Spectrophotometry (HG-AAS), Cold Vapor Atomic Absorption Spectrophotometry (CV-AAS) and Flame Atomic Absorption Spectrophotometry (FAAS) was developed using common acid digestion methods enhanced by the use of Triton X-100. The three acid digestion methods used in this study were Method A (nitric acid and hydrogen peroxide), Method B (nitric acid and hydrochloric acid) and Method C (nitric acid, hydrochloric acid and hydrogen peroxide). Triton X-100 was added to each of these and the effects were studied. The acid digestion method that was determined to be the most suitable and efficient for lipsticks and powders was Method A-1 (nitric acid and hydrogen peroxide with 5% Triton X-100 at 95 °C for 3 h). The range of percentage recoveries obtained were; powders (98.50% to 92. 61%) and lipsticks (100.96% to 99.41%) for As, Cd, Cr, Pb, Hg and Ni. The addition of Triton X-100 significantly improved the efficiency of the method.•

Triton X-100 improves the efficiency of acid digestion of fatty hydrophobic samples by dispersing the sample throughout the acid digestant.

Effect of mind and body education on quality of life among young breast cancer patients: a randomized controlled trial

PURPOSE

This study aim was to evaluate efficacy of the combination with cosmetic and psychosocial education program on body image, sexual function, and emotional function among young-onset breast cancer (YBC).

METHODS

An unblended, randomized, controlled trial design was conducted in patients newly diagnosed with stage I-III breast cancer from 2014 to 2015. The intervention group received a structured education program including appearance management and mind control for 4 weeks. The outcome of this study shows effect on body image and sexual functioning and a distress due to altered appearance and anxiety after the intervention and 6 months after intervention.

RESULTS

Among 228 eligible patients, 109 (47.8%) agreed to participate in the present study and were randomized to intervention (n = 54) or control (n = 55) groups. After intervention, the intervention group reported significantly better body image compared to the control group (mean score of 75.0 vs. 59.3, respectively; P < 0.01). The intervention group also reported significantly lower levels of distress due to altered appearance and higher levels of sexual functioning compared to the control group after the intervention. The effects were maintained even 6 months after intervention.

CONCLUSION(S)

Body image intervention for YBC had effect on improving body image and sexual functioning and a reduction in distress due to altered appearance and anxiety. Trial registration number and date of registration: The study was registered at the Clinical Research Information Service (no. KCT0001191, https://cris.nih.go.kr/cris ) on 23 July 2014.

Q-switch nanosecond laser as innovative and instant management for bruises discoloration, a case report

Bruises is one of the most common side effects of injectable cosmetic procedures, which leads to stress to clients and health care providers. Conventional treatments such as vitamin K preparation, cold compresses, and Arnica cream have been used to treat bruises, yet these treatments do not provide instant results. The purpose of this report is to present a case in which different wavelengths of Q-switch nanosecond laser was used to treat cosmetic injection-related bruises.Four different laser wavelengths were used to treat injection-related bruises. Pictures were taken before and after the treatment and analyzed using the RGB color histogram and the Image color analyzer from http://mkweb.bcgsc.ca/. Pictures showed a close to complete resolution of the bruises and discoloration. The results of this report suggest that using multiple selective wavelengths, in shorter pulse width but higher fluence would be more effective in resolving bruise-related discoloration compared to using one wavelength with longer pulse width.