Sai Luo

Lipid droplet (LD) accumulation and impaired lipid mobilization induce lipotoxic stress and contribute to metabolic, cardiovascular, cancer, and neurodegenerative diseases (NDDs). Although LD-selective autophagy (lipophagy) is being increasingly studied, the mechanisms that confer LD specificity and enable tissue- and stage-specific therapeutic modulation remain unclear. Effective lipophagic flux requires coordinated LD coat remodeling, nutrient and energy sensing, and organelle contact. Coat remodeling governs substrate access and droplet recognition. The AMPK-mTORC1-TFEB axis links autophagy induction to lysosome biogenesis and capacity. Endoplasmic reticulum (ER)-LD, mitochondria-LD, and LD-lysosome contact sites facilitate lipid transfer by coupling lysosomal hydrolysis to mitochondrial β-oxidation. Lipophagy is a highly stage- and cell-type-dependent process: it removes excess lipids to protect cells, but its dysregulation can promote inflammation and fibrogenesis or supply substrates to tumors. This review synthesizes mechanistic and translational evidence on lipophagy initiation, regulation, and disease relevance, and identifies the following priorities: robust biomarkers, distinction of cargo-recognition defects from lysosomal dysfunction, and precision interventions tailored to the tissue and disease stage.

Autologous fat grafting is common for soft tissue repair, but often results in adipocyte necrosis due to ischaemia and hypoxia, causing inflammation and po

Background Nostril overexposure is a common aesthetic concern among Asian populations, which significantly affects facial harmony. Traditional surgical interventions carry risks such as substantial trauma and visible scarring. This study aims to evaluate the clinical efficacy of Botulinum Toxin Type A (BoNT-A) injections in treating nostril overexposure using three-dimensional (3D) scanning technology. Methods This study recruited 52 patients seeking improvement for nostril overexposure. BoNT-A was injected into the nasal dilator muscles. Changes in nostril cross-sectional area and alar mobility were quantified using 3D scanning technology before treatment and at 4, 12, and 24 weeks post-treatment. Subjective improvements were evaluated by patients and one independent plastic surgery experts using the Global Aesthetic Improvement Scale (GAIS). Results A total of 32 patients completed the entire 24-week follow-up period. Post-treatment 3D analysis showed a significant reduction in both nostril cross-sectional area and alar mobility. At 4 weeks post-injection, the nostril area decreased from 89.42 ± 13.21 to 72.50 ± 13.93 mm² (p < 0.05), and alar mobility decreased from 10.50 ± 3.92 to 4.64 ± 3.09% (p < 0.05). GAIS scores indicated that both patients and expert rated the improvement as significant at 4 weeks. Measurements at 24 weeks approached baseline levels. Conclusion BoNT-A injections effectively and safely improve nostril overexposure with high patient satisfaction. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

At present, fat transplantation is widely used in the plastic surgery industry, but the long-term preservation rate of transplanted fat decreases because of complications such as oil cysts due to the inability in macrophages to metabolize absorption. In cell-assisted lipotransfer technology, adipose-derived stem cells (ASCs) can influence the inflammatory response of grafts through the immunoregulation in macrophages, and the lipid metabolism in macrophages plays an important role in this process. Therefore, we hypothesized ASCs could improve the retention rate of fat grafts by regulating the progress of lipid metabolism in macrophages. We established fat transplantation and ASC-assisted fat transplantation model in C57BL/6 mice in vivo, and bone marrow-derived macrophages cocultured with apoptotic adipocytes were treated with or without ASCs in vitro. Graft retention, tissue structure, fibrosis, macrophage phenotype transformation, lipid deposition, mitochondrial morphology, oxygen consumption rate (OCR), fatty acid β-oxidation (FAO) level, and ATP production were assessed. Additionally, fat transplantation and ASC-assisted fat transplantation model was treated with etomoxir which inhibits mitochondrial FAO. Macrophages pretreated with etomoxir were co-cultured with apoptotic adipocytes and treated with or without ASCs. The method aboved was used for detection and verification. In vivo, ASC-assisted fat transplantation improved macrophage mitochondrial expression and FAO level, promoted the early transformation of M2 macrophages, reduced the long-term lipid deposition of macrophages, and improved the retention rate of fat grafts. In vitro, ASCs up-regulated the level of mitochondrial FAO, OCR and ATP production in macrophages, reduced lipid deposition of macrophages and promoted M2 macrophages polarization by paracine function. The ability of ASCs in group pretreated with etomoxir to reduce the foaming of macrophages, promote the transformation to M2 macrophages, and improve the retention rate of fat transplantation was weakened. ASCs increased the retention rate of transplanted fat by upregulating mitochondrial FAO to promote M2 polaration in macrophages. In addition, ASCs up-regulate mitochondrial FAO by paracrine effect to reduce foam cells formation and promote M2 transformation in macrophages in vitro.

Autologous fat grating is a widely-accepted method to correct soft tissue deficiency. Although fat transplantation shows excellent biocompatibility and simple applicability, the relatively low retention rate caused by fat necrosis is still a challenge. The vasculature is integral after fat grafting, serving multiple crucial functions. Rapid and effective angiogenesis within grafts is essential for supplying oxygen necessary for adipocytes’ survival. It facilitates the influx of inflammatory cells to remove necrotic adipocytes and aids in the delivery of regenerative cells for adipose tissue regeneration in fat grafts. The vasculature also provides a niche for interaction between adipose progenitor cells and vascular progenitor cells, enhancing angiogenesis and adipogenesis in grafts. Various methods, such as enriching grafts with diverse pro-angiogenic cells or utilizing cell-free approaches, have been employed to enhance angiogenesis. Beige and dedifferentiated adipocytes in grafts could increase vessel density. This review aims to outline the function of vasculature in fat grafting and discuss different cell or cell-free approaches that can enhance angiogenesis following fat grafting.

Botulinum toxin-A（BTX-A）is used in the treatment of nasolabial fold (NLF). However, light and clinician subjectivity play a big role in evaluating the efficacy of this treatment. With the application of three-dimensional (3D) technology, this study aimed to quantitatively evaluate the effects of muscular type (M) and muscle-fat pad mixed-type (MF) NLF with BTX-A injection. BTX-A was injected into the bilateral mark points of the NLF, where the levator labii alaeque nasi(A), zygomaticus minor(B), and zygomaticus major(C) pull the skin to form the NLF (2 U at each injection site). Pretreatment and posttreatment 3D facial images were captured with static and laughing expressions. The curvature, width, depth, and lateral fat volume of the NLF were measured to compare the therapeutic efficacy of patients with type M and MF NLF. Thirty-nine patients with type M and 37 with type MF completed the follow-up data. In these patients, the curvature, width, and depth of the NLF showed a significant reduction at 1 month and gradually recovered at three and six months after treatment, with more significant improvement when laughing than when static. Variations compared to the pretreatment values of type MF were greater than those of type M at each time point. The lateral fat volume of the type MF NLF was significantly reduced (P < 0.05). Three-dimensional technology can quantitatively evaluate the effects of type M and MF NLF treatments with BTX-A injection. BTX-A has a better effect on the NLF of type MF than that of type M.

As a derivative of adipose tissues, stromal vascular fraction gel has been widely used in facial soft tissue filling, but it still does not achieve the expected effect in forehead filling. The reason may be related to the corrugator muscles movements. The authors aimed to evaluate the effect of botulinum toxin-A (BTX-A) on the retention rate of stromal vascular fraction gel by limiting the corrugator muscles movements and provide a theoretical basis that short-term inhibition of movement in the affected area could improve the effects of the fat graft. From January 2019 to June 2021, patients with stromal vascular fraction gel facial filling (including frontal and temporal parts) were selected. According to whether or not BTX-A treatment was received, patients were divided into the injected and the non-injected groups. A questionnaire and the global aesthetic improvement scale (GAIs) were administered with two-dimensional (2D) photos. The retention rate and curvature were calculated with three-dimensional (3D) images using the Artec Studio 13 Professional (Artec Europe Sàrl, Senningerberg, Luxembourg) and MATLAB (Natick, MA) software. The graft retention, forehead curvature, and GAIs scores were all higher in the injected group than in the non-injected group (P < 0.01). In the questionnaire, the injected group also showed a more satisfactory attitude towards the treatment effect and were more willing to recommend the treatment to their friends. BTX-A injection can improve the retention rate of prefrontal stromal vascular fraction gel filling with higher satisfaction and better postoperative effects.

Background: The design lines for midfacial filling shift upward with a patient’s position changes from upright to supine during operation. This will cause the actual filled part to deviate from the target area. Objectives: This authors aimed to evaluate the effect of positional changes on midfacial landmarks and find the optimal body position for midface filling. Methods: The process involved the grading and evaluation stages. The midfacial laxity of each sample in the evaluation stage was graded into minimal, moderate, and severe by the system established in the grading stage. Measured through the 3-dimensional images in each grade, the vertical distances from landmarks C, D, and E (representing the region of the tear trough, infraorbital area, and nasolabial fat pad, respectively) to the horizontal line of the inner canthus and depth of nasolabial fold at an angle of 90° were separately compared with those from the other angles (60°, 45°, 30°, and 0°) of the operating table. Results: In the minimal midfacial laxity group, all 3 landmarks significantly moved upward when the angle decreased to 30°. However, landmark E of the moderate and severe and landmark D of the severe midfacial laxity groups both significantly moved upward when the angle decreased to 45°. The depth of the nasolabial fold at a 45° angle was significantly less than that at a 90° angle in the moderate and severe groups. Conclusions: In midface filling, a patient’s body position should be optimally selected according to the midfacial laxity and filling area.