Twenty-four months long-term follow-up report on the effect of poly lactic-co-glycolic acid suspension suture in Asian with mild-moderate face laxity

Lam Phoebe Kar Wai,Fung Chi Pun,Lam James Yui,Luk Wang Lung,Lee Alvin Ka Wai,Lee Cheuk Hung,Tam Paul Man Kei,Lau Edwin Kwan Chark 대한미용의학회 2022 대한미용의학회지 Vol.6 No.1

Background: There was evidence of improvement in mid-face laxity using three pairs of suspension sutures in mid-face lifting in our early and mid-term follow-up. Objective: This 24-month prospective follow-up study aimed to determine the efficacy of mid-face lifting and lower jawline contouring using poly lactic-co-glycolic acid (PLGA) sutures in Asian patients. Methods: Ten healthy volunteers received three pairs of 8-cones bidirectional cones sutures at the mid-face. One of the ten volunteers lost to follow-up, and all remaining patients followed up for 24 months. Our primary outcome measure is the change in the facial laxity rating scale (FLRS), an “improvement” defined as at least “one-grade change” in FLRS. Other assessment parameters include the severity of the nasolabial fold (NLF), assessed on the wrinkle severity rating scale (WSRS). The secondary outcome measures were the self-satisfaction rating scale (SSRS) and global aesthetic improvement scale (GAIS), rated by participants at each follow-up interval. Results: A linear improvement in the mid-face was observed almost immediately after treatment, with progressive improvement up to at least 12 months following the intervention and no deterioration by 24 months. This improvement was significant (p<0.05), and the differences between before and after treatment at each follow-up interval were large (Cohen’s d>0.8). Contour improvement for the lower face followed a similar trend, except for a delay in the observable differences at three months (Cohen’s d=0.29, 0.8 at six weeks and three months, respectively). The differences in the level of patient satisfaction were significant (p<0.05) from 6 weeks to 24 months, peaking between 12 and 18 months, based on both the GAIS and SSRS ratings. No observed complications. Conclusion: Mid-facing lifting in Asian patients with mild-to-moderate laxity is safe and effective with PLGA bidirectional cone sutures, with concurrent improvement in the lower face contour and elevated patient satisfaction over the 24-month follow-up period.

Outcome of mid- and lower face lifting using bidirectional cone sutures at 6 months and 1 year

Phoebe Kar Wai Lam,James Yui Lam,Alvin Kar Wai Lee,Clyde Wang Lung Luk,Paul Man Kei Tam,Cheuk Hung Lee 대한미용의학회 2021 대한미용의학회지 Vol.5 No.1

Soft tissue ptosis occurs with age, leading to loss of facial volume. The facial retaining ligamentous system is an intricate network of fibrous tissues connecting the whole face, restraining soft tissues from gravitational forces, and opposing facial movements. With proper positioning and anchorage within the ligamentous grid and superficial fat repositioning, lifting the mid-face and adjacent areas (e.g., jowl) is likely to occur. We aimed to determine whether inserting 3 pairs of bidirectional cone sutures can effectively improve the nasolabial fold (mid-face) and jowl (lower face) in Asian patients with mild to moderate mid-face laxity at 6 months and 12 months. Ten healthy volunteers with mild to moderate facial laxity received 3 pairs of bidirectional cone threads, inserted in a straight parallel technique. Based on validated evaluation parameters: facial laxity rating scale (FLRS) and the wrinkle severity rating scale, a total of 7 independent reviewers, among which 3 assessed the change in mid-face laxity (nasolabial fold), and the other 4 reviewers evaluated the change in jowl or lower face contour based on FLRS at 6 months and 12 months. All reviewers were experienced esthetic doctors. According to the reviewers’ evaluation based on the validated parameters, there was a linear improvement in the mid-face laxity/nasolabial fold and lower face laxity/jawline contour self-reporting patients’ satisfaction at 6 months and 12 months compared to baseline in all 10 patients. There was continuous improvement in mid-face laxity and lower face laxity from baseline, 6 months, and 12 months after treatment. The evaluation results among the reviewers were similar, apart from reviewer 7. All patients gave their best rating at 12 months, and their satisfaction almost doubled compared to that before treatment.

Early results of bidirectional cone sutures for mid-face lifting in Asian patients

Phoebe Kar Wai Lam,James Yui Lam,Edwin Kwan Chark Lau,Wang Lung Luk 대한미용의학회 2020 대한미용의학회지 Vol.4 No.1

Background: There are intrinsic difference facial aesthetics between Asian and Caucasian, as well as racial differences in beauty standards. Bi-directional cones threads are effective in mid-face lifting but there was yet no study in Asians. Objective: This study aimed to determine the effects on mid-face laxity the effect size of using bidirectional cone suture for facelifting in Asian patients. Methods: In this prospective study, three pairs of bidirectional cone threads were used for mid-face lifting in 10 healthy volunteers with mild-to-moderate facial laxity. Results: The validated assessment parameters used in the study were the facial laxity rating scale (FLRS) to evaluate the severity of mid-face laxity and the wrinkle severity rating scale (WSRS) to assess the severity of the nasolabial fold (NLF). Overall, there was a substantial improvement in mid-face laxity and the NLF after thread lifting, supported by treatment effect size (Kendall W’s value: 0.96 and 0.85, respectively). Significant improvements for both mid-face laxity and NLF were observed in all patients by 3 months (p<0.05), with significant differences in FLRS (p=0.000) and WSRS (p=0.001). At each follow-up, all patients would complete a selfadministered questionnaire that included the subjective satisfaction rating scale. The results showed that patient satisfaction was substantially improved; the differences between baseline and the 6-week and 3-month follow-up were significant (p<0.05), and the treatment effect size was W=0.950 (p<0.05). All subjects tolerated the procedure well with transient and minimal side effects. Conclusion: In Asians with mild-to-moderate laxity, absorbable cones sutures produced considerable improvement in mid-face laxity and NLF within three months. The findings were consistent among the three reviewers and were statistically significant (p<0.05). Patient satisfaction was higher at the 6-week and 3-month follow-up compared to the baseline (p<0.05).

Psychosocial impacts and academic motivation of nursing undergraduates under the normalization of COVID-19: A cross sectional study

LAM, Angie Ho Yan,LI, Polly Wai Chi,CHAN, Claudia Kor Yee,Chan, Maggie Mee Kie,WANG, Kelvin Man Ping 한국간호과학회 2023 한국간호과학회 학술대회 Vol.2023 No.11

Periorbital changes in patients with Poly(Lactic Acid/Caprolactone) threads for brow augmentation

Phoebe Kar Wai Lam,Wang Lung Luk 대한미용의학회 2020 대한미용의학회지 Vol.4 No.1

Background: Overlooked compensatory brow ptosis can lead to patients dissatisfaction and poor surgical results. Objective: To evaluate the quantitative changes in periorbital dimensions in 11 patients with mild to moderate brow ptosis after browlift with Poly(Lactic Acid/Caprolactone) (P[LA/CL]) sutures. Method: Retrospective analysis and data collected from reviewing clinical records, 11 patients, with mild to moderate brow ptosis, whom only has P(LA/CL) browlift, fulfilled the criteria and included in the analysis. All patients had 2-dimensional clinical photos and 3-dimensional clinical pictures in 5 standard views at baseline and follow-up. All periorbital measurements determined by the computer and collected for analysis. Results: There was a significant difference in all periorbital measurements at 4 to 6 months’ follow-up when compared with baseline (p<0.05). Moderate lifting refers to changes in brow height of at least 2 mm at follow-up. A higher proportion of patients with moderate brow lift were able to achieve moderate lifting compared with mild brow ptosis. Moderate lifting is observed in 30% to 60% medial brow and 45% to 60% lateral brow for patients with moderate brow ptosis compared with 25% in those with mild brow ptosis. Infection, significant bruising, or scarring did not occur. Transient side effects, such as bruising and dimpling, eventually resolved. Conclusion: Preoperative examination is vital to identify pre-existing compensatory brow ptosis. P(LA/CL) thread-lifting for brow augmentation is a simple and effective procedure which can be used as an adjunct to upper eyelid surgery to prevent secondary brow ptosis following eyelid surgery and in turn, improve patients’ satisfaction.

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

David Tak Wai Lui,Chi-Ho Lee,Wing-Sun Chow,Alan Chun Hong Lee,Anthony Raymond Tam,Carol Ho Yi Fong,Chun Yiu Law,Eunice Ka Hong Leung,Kelvin Kai Wang To,Kathryn Choon Beng Tan,Yu-Cho Woo,Ching Wan Lam 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.3

Background: The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. Methods: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. Results: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. Conclusion: Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

Understanding the trajectory and psychological predictors of ICD-11 complex PTSD: A six-month longitudinal study in Hong Kong

Stanley Kam Ki Lam,Wai Tong Chien,Albe Sin Ying Ng,Suet Lin Hung,Hong Wang Fung 한국간호과학회 2023 한국간호과학회 학술대회 Vol.2023 No.11

Study on Treatment Planning for the Prostate in Proton Therapy with Oxygen Enhancement Ratio Effect

Yoo Seung Hoon,Geng Hui,Lam Wai Wang,Kong Chi Wah,Yang Bin,Chiu Tin Lok,Wu Po Man,Cheung Kin Yin,Yu Siu Ki,Shin Dongho,Min Byung Jun 한국물리학회 2020 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.77 No.7

The purpose of this study was to investigate the oxygen enhancement ratio (OER) effects on treatment planning for a hypoxic prostate tumor with proton scanning beams. Two different OER-based dose calculation models (the average model and the voxel model) were investigated by using hypoxic tumor models in this simulation study. For the hypoxic tumor model, an oxygen distribution with a range of 2.4-9.4 mmHg was used according to the clinical data. The results given by the average model and the voxel model were compared for 50% and 90% tumor control probabilities with variations in the hypoxic tumor volume and fractionation. Comparison between the treatment plans with OER-based higher predicted dose and with the conventional prescription dose was conducted to investigate the organ-at-risk (OAR) doses for the prostate case. The average model showed a higher calculated dose than the voxel model. The voxel model with a 50% control probability showed good agreement with the current prescription dose. The OER values of the average model ranged from 1.05 to 1.25, which were applied to the whole tumor volume in treatment planning. The voxel-model-based OERs were higher (1.50-1.75) than those of average model, and these OERs should be applied only for the hypoxic boost region. Regarding treatment plans, the doses of the rectum and the bladder were reduced to the tolerable range V80Gy (volume receiving equal to or greater than 80Gy) < 15% and V75Gy (volume receiving equal to or greater than 75Gy) < 15% respectively after an optimization, but the maximum dose to femoral heads was higher than 50 Gy. In conclusion, we investigated the possible ranges of the OER (1.3-1.8) for proton-beam treatment of prostate cases. A dose escalation of up to about 1.8 times can be applied for the small hypoxic region. This result, which was obtained using a model study, should be verified through clinical experiment.