Minliang Chen

To investigate the efficacy of micro-plasma radio-frequency (MPRF) in enhancing the healing of infected skin ulcers. This study involved ten patients diagnosed with infected skin ulcers between May and December 2023. Treatments were administered using MPRF every three days until the ulcers healed completely. We assessed microbial infection status, wound healing progression, healing duration, and changes in patient-reported symptoms such as pain and itching. We also monitored for adverse effects, including erythema and blisters, and evaluated scar formation post-healing. Cultures from the wounds of all ten patients became negative after 2-8 MPRF treatments. After 7-15 treatments, over 90% of the ulcers healed, indicating an effective therapeutic outcome. Patients reported no itching or discomfort during treatment, experiencing only transient, mild, and tolerable pain. No cases of erythema, edema, or other skin irritations were observed. Six-month follow-up showed mild scarring in the treated areas, primarily presenting as hyperpigmentation or hypopigmentation. Micro-plasma radio-frequency (MPRF) demonstrates significant potential in promoting the healing of infected skin ulcers. This is evidenced by the rapid bacterial clearance (cultures turning negative after 2-8 treatments) and a high healing rate (>90% after 7-15 treatments) observed in all 10 patients. Furthermore, its ease of operation, convenient application, and favorable safety profile-characterized by transient, mild, and tolerable pain, absence of local skin irritation (e.g., erythema, edema), and mild scar formation (primarily hyper- or hypopigmentation) upon 6-month follow-up-underscore its promise. While these preliminary findings are encouraging, further large-scale clinical studies are warranted to conclusively establish the efficacy and long-term safety of MPRF in wound healing. This study is classified as a case series, as it included only 10 patients and lacked a control group for comparison. Such a study design does not provide high-level evidence of causality; its findings primarily offer descriptive observations and preliminary evidence for future higher-quality research, such as randomized controlled trials.

Vulvovaginal rejuvenation procedures are increasingly popular. Hyaluronic acid (HA) filler injection, a significant representative of non-surgical method, can cause a rare but serious complication: vascular embolism. Mild cases may present as skin necrosis and ulceration, while severe cases can be life-threatening. The possible complications caused by vulvovaginal injection of hyaluronic acid were systematically reviewed. A 47-year-old Asian woman underwent a vulvovaginal rejuvenation procedure with HA fillers for labia majora, labia minora, and vaginal rejuvenation. She experienced a vascular occlusion event characterized by severe pain and necrotic skin ulceration. 7 days after the HA injection, she received superselective intra-arterial thrombolysis. Necrotic wounds were treated with CGF via topical application and local injection. Three cases of vascular complications have been reported previously. This paper describes the fourth. After immediate intra-arterial thrombolytic therapy (IATT), angiography showed improved blood supply in the right internal pudendal artery. The patient's severe pain was relieved, and the necrosis was under control. The patient achieved complete wound healing within 5 days following CGF treatment and was subsequently discharged from the hospital. Serious vascular embolic events can be caused by hyaluronic acid injection for vulvovaginal rejuvenation, which can be treated with superselective IATT. For wound repair resulting from compromised skin perfusion caused by HA injection, CGF therapy offers a viable alternative. 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.

The global prevalence of alopecia areata (AA) is estimated to be around 2%. However, the global disease burden of AA and current research hotspots in this field have received limited attention. The disability adjusted life years (DALYs), incidence rates, and prevalence rates of AA from 1990 to 2019 were collected from the Global burden of disease (GBD) 2019 database and analyzed using R software to elucidate the temporal trend in disease burden associated with AA. VOSviewer software was employed to cluster keywords within the field of AA for identification of research hotspots. On a global scale, areas with low socio-demographic index (SDI) exhibited the highest increase in DALYs, incidence rates, and prevalence rates for AA from 1990 to 2019, while regions with high SDI observed the most substantial decrease. However, it is noteworthy that high SDI regions continued to bear the highest burden of AA. AA imposes a higher disease burden on women than men within the same age bracket. Young individuals (aged between 25 and 39 years) experience a greater disease burden compared to other age cohorts. Bibliometric analysis reveals that recent research focus in the field of AA primarily revolves around clinical trials and evaluating various treatment modalities such as Janus kinases (JAK) inhibitors and platelet rich plasma. The disease burden of AA may still be on the rise worldwide. This study further validates the gender- and region-specific impacts of AA and its associated burden, offering valuable guidance for prevention strategies and resource allocation. JAK inhibitors and platelet rich plasma are currently favored by researchers, and further high-quality studies are required to assess their long-term efficacy and safety more comprehensively.

Background: Postinjection alopecia is a rare but significant complication of facial fillers, likely caused by compromised microcirculation and follicular damage. Effective treatments are needed, but regenerative therapies specifically for this etiology lack systematic investigation.Objective: This study evaluated the efficacy and safety of combined autologous chylated fat (ACF) and concentrated growth factors (CGF) for treating acute alopecia following facial filler injection.Methods: In this single‐center, retrospective case series, nine female patients with acute alopecia (2–4 weeks post‐HA filler) were treated between June 2021 and June 2024. Treatment involved three monthly subcutaneous injections of a 1:1 ACF and liquid CGF mixture (0.1 mL/cm²). Outcomes were assessed at 6 months posttreatment initiation, including hair density, diameter, terminal/vellus ratio, anagen/telogen ratio, Global Aesthetic Improvement Scale (GAIS), and adverse events.Results: All nine patients completed the 6‐month follow‐up. Significant improvements (p < 0.001) were observed at 6 months compared to baseline: hair density increased from 32.7 ± 13.4 to 92.4 ± 23.4 hairs/cm², hair diameter from 52.3 ± 15.2 to 75.8 ± 21.7 μm, terminal/vellus ratio from 0.31 ± 0.11 to 1.27 ± 0.35, and anagen proportion from 18.4% ± 6.5% to 63.7% ± 14.9%. GAIS scores indicated high satisfaction. Treatment was well‐tolerated, with only one patient reporting transient erythema.Conclusion: Combined ACF and CGF represent a promising and effective treatment for post‐filler alopecia, offering a novel therapeutic option for early intervention and improved esthetic outcomes.

Alopecia is a global dermatological challenge. Adipose-derived stem cells (ADSC) show therapeutic potential, but their mechanisms in promoting hair regrowth, particularly under oxidative stress conditions, remain unclear.. To investigate ADSC's role in promoting hair regrowth by mitigating oxidative stress. Using H₂O₂-stressed HaCaT cells, ADSC's protective effects were evaluated via conditioned medium (CM) and co-culture. Assessments included cell viability, colony formation, ROS, MDA, antioxidant enzymes, and 8-OHdG. Nrf2 activation was analyzed by immunofluorescence and Western blot. A mouse radiation injury model validated findings. Non-pretreated ADSC offered limited oxidative protection to HaCaT cells. Conversely, H₂O₂-pretreated ADSC significantly enhanced HaCaT viability and proliferation in both CM and co-culture systems. This involved paracrine activation of the Nrf2 pathway in HaCaT cells, boosting antioxidant enzymes, accelerating ROS clearance, and reducing lipid peroxidation. These effects were reversible with Nrf2 inhibition. In vivo, CM from H₂O₂-stimulated ADSC promoted hair regrowth in irradiated mice, outperforming CM from non-pretreated ADSC by activating Nrf2 and reducing tissue oxidative damage. Oxidative stress potentiates the protective capacity of ADSC against oxidative via Nrf2-dependent paracrine mechanisms, offering a promising strategy for alopecia treatment.

Background Autologous fat grafting (AFG) is widely used to treat progressive hemifacial atrophy (PHA), but accurate measurement of tissue defects in PHA patients remains a challenge due to varied facial defects and complex anatomy. Methods This retrospective study monitored patients undergoing AFG over 12–16 months. Using 3D computed tomography (CT), the midsagittal plane of the face was scanned, mirror-image analysis (MIA) was carried out, and soft tissue volume loss was predicted across facial regions. The patients were evaluated at four intervals (preoperatively and at 3, 6, and 12 months postoperatively) by calculating the asymmetry index (AI), asymmetry rate (AR), preoperative soft tissue volume deficiency (Preop STVD), volume deficiency rate (VDR), and percentage volume maintenance (PVM). Patient characteristics, satisfaction, and outcomes were also analyzed. Results Fifteen patients (mean age 22) underwent an average of 1.9 AFG surgeries. Preoperative soft tissue defect volume was measured at 101.96 ± 82.52 cm³, with an average fat injection volume of 93.38 ± 73.71 cm³. Tissue defect rates ranged from 1.43 to 10.16% (mean 4.42 ± 3.47%), and volume maintenance varied from 35.60 to 79.16% (average 56.64 ± 13.48%). Postoperatively, defect rates ranged from 0.78 to 4.86% (mean 2.11 ± 1.66%), with volume maintenance between 52.36 and 71.74% (average 63.50 ± 8.09%). Significant improvements in facial symmetry and patient satisfaction were noted, with no complications reported. Conclusion Digitally guided precision fat grafting is a promising method for predicting soft tissue loss and improving facial symmetry in patients with progressive hemifacial atrophy. 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.

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

Mesenchymal stem cell (MSC) -derived exosomes, especially adipose-derived mesenchymal stem cell exosomes (ADSC-Exos), have emerged as a promising alternative for skin damage repair with anti-inflammatory, angiogenic and cell proliferation effects while overcoming some of the limitations of MSC. However, the mechanism by which ADSC-Exos regulates inflammatory cells during wound healing remains unclear. This study investigated how ADSC-Exos regulate macrophages to promote wound healing. ADSC-Exos were isolated using ultracentrifugation, with subsequent quantification of exosomes particle number. To investigate their role in wound healing, the effects of ADSC-Exos on inflammation, angiogenesis, collagen deposition and macrophage polarization were evaluated through immunohistochemical staining, immunofluorescence and western blotting. Changes in gene expression associated with ADSC-Exos-induced macrophage polarization were analyzed using qPCR. RNA sequencing was performed to identify differentially expressed genes affected by ADSC-Exos. The critical role of IL-33 in the wound healing process was further confirmed using Il33−/− mice. Additionally, co-culture experiments were conducted to explore the effects of IL-33 on keratinocyte proliferation, collagen deposition and epithelialization. ADSC-Exos inhibited the expression of TNF-α and IL-6, induced M2 macrophage polarization, promoted collagen deposition and angiogenesis, and accelerated wound healing. RNA sequencing identified IL-33 as a key mediator in this process. In Il33−/− mice, impaired wound healing and decreased M2 macrophage polarization were observed. The co-culture experiments showed that IL-33 enhanced keratinocyte function through activation of the Wnt/β-catenin signaling pathway. These findings highlight the therapeutic potential of ADSC-Exos in wound healing by modulating IL-33. ADSC-Exos promote wound healing by regulating macrophage polarization and enhancing IL-33 release which drives keratinocyte proliferation, collagen deposition and epithelialization via the Wnt/β-catenin signaling pathway. These findings provide a mechanistic basis for the therapeutic potential of ADSC-Exos in tissue repair and regeneration.

Background: Hypertrophic scar (HS) is a fibroproliferative disorder resulting from abnormal healing of skin tissue after injury. Although various therapies are currently employed in clinical to treat HSs, there is no widely accepted standard therapy. Micro‐plasma radiofrequency (MPR) and autologous chyle fat grafting are emerging treatments for this condition, and they have demonstrated promising therapeutic outcomes in clinical applications. The aim of this study is to investigate the effectiveness and safety of combining MPR with autologous chyle fat grafting for the treatment of HSs. Methods: We performed a retrospective study on patients diagnosed with HS in a single center between January 2020 and December 2023. According to the treatments, patients were divided into three groups, with 6 months follow‐up. The single therapy group received MPR alone for two times. The combined therapy Group 1 first received the MPR treatment followed by the combined treatment. The combined therapy Group 2 first received the combined treatment and then received the MPR treatment. The effectiveness of treatment was evaluated using the Vancouver Scar Scale (VSS) and the Patient Scar Assessment Scale (PSAS). The Visual Analog Scale (VAS) was used to assess the patients' pain on the day of treatment and 1 day after treatment. Adverse events and complications were recorded to assess the safety of treatment. Results: A total of 73 patients diagnosed with HS were enrolled in this study, including 35 patients in the single therapy group, 18 patients in the combined therapy Group 1, and 20 patients in the combined therapy Group 2. After the treatments were completed, all three groups exhibited significant effectiveness. The two combined therapy groups scored lower after treatments in the VSS, which includes height, vascularity, pliability, and total scores, as well as in the PSAS, which includes color, stiffness, thickness, and total scores, compared to the single therapy group, with a statistically significant difference. Regarding pain response to treatment, there was no statistical difference in VAS among the three groups. No statistical difference in the overall incidence of adverse events was observed among the three groups, and no severe complications were recorded. Conclusions: This study revealed the combination of MPR and autologous chyle fat grafting showed superior effectiveness compared to MPR alone in treating HSs, without any observed increase in overall adverse event frequency. For patients diagnosed with HS, this combination therapy stands as a promising and effective clinical intervention.