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Soil heavy-metal contamination is characterized by toxicity, environmental persistence, and bioaccumulation, and commonly involves multi-metal coexistence and complex co-contamination scenarios. These characteristics, together with strong variations in soil properties and contamination conditions, make efficient remediation difficult to achieve through conventional experimentation and empirical decision-making alone. This review summarizes recent advances in applying machine learning (ML) to soil heavy-metal remediation, with particular emphasis on the development of remediation materials and the optimization of process parameters. We first outline the major classes of remediation materials and their underlying mechanisms, and then discuss how ML has been used to predict remediation performance, optimize process conditions, and support the screening and design of remediation materials. Existing studies show that ML can improve assessment efficiency, reduce trial-and-error costs, and provide new opportunities for data-driven remediation research. However, current progress remains constrained by limited data quality, inconsistent evaluation frameworks, and insufficient model interpretability. Overall, ML offers considerable potential for advancing soil heavy-metal remediation, but further efforts are still needed to strengthen data foundations, improve model reliability, and enhance practical applicability in complex soil environments.Kindly check and confrim the affliations of the authors are correctly processed.Thank you for your query. The author affiliations have been carefully reviewed and the necessary corrections have been made. It is confirmed that the affiliations of all authors have been correctly processed. I would also like to confirm one minor formatting point: according to the general convention in academic publishing, figure captions are usually placed below the figures, while table titles are placed above the tables. Could you please confirm whether the current placement and formatting of the figure captions and table titles are correct according to the journal's style?
The coleoid cephalopods (octopus, cuttlefish, and squid) are emerging model organisms for neuroscience, development, and evolutionary biology. Determining their sex early in life is critical for population management and controlled experiments. Here, we present a protocol to non-invasively determine the sex of multiple cephalopod species as young as 3 h post-hatching using a skin swab and quantitative PCR (qPCR). We describe steps for designing qPCR primers, swabbing live animals, extracting DNA, running the qPCR, and analyzing the results. For complete details on the use and execution of this protocol, please refer to Rubino et al.1.
In this segment, I am pleased to be joined by AANP Region 6 Director, Dr. Robert Metzger, who shares his insights on the importance of leadership development in preparing the next generation of NP leaders.
To explore a reasonable grading system for puffy eyelids and corresponding clinical management strategies. We retrospectively analyzed 132 patients with puffy eyelids who underwent double-eyelid blepharoplasty at the Department of Plastic and Laser Cosmetology of Hunan Provincial People's Hospital from January 2023 to June 2024. Patients were classified into mild, moderate, or severe based on preoperative appearance and intraoperative anatomical characteristics. Depending on the severity, either the three-point method or the incision method (orbital septum method) was selected for double-eyelid blepharoplasty, allowing for targeted treatment of the orbital fat and retro-orbicularis oculi fat (ROOF). Postoperative follow-up was conducted at 3 months to 1 year to assess the appearance of the double eyelids, complications, and patient satisfaction. Of the 132 patients, 68 cases were mild, with 55 treated by the incision method and 13 by the three-point method; 34 cases were moderate, with 29 treated by the incision method and 5 by the three-point method; and all 30 severe cases were treated by the incision method. Only 1 case required revision surgery postoperatively, with an overall satisfaction rate of 99.24%. There were no serious complications such as hematomas or infections, and all scars healed well. Establishing a clear grading system for puffy eyelids based on preoperative appearance and intraoperative anatomical characteristics, and formulating corresponding surgical plans according to these grades, is a reasonable and feasible clinical strategy. 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.
Tear trough deformity is a prominent periorbital aging manifestation, and minimally invasive filler injection has become a preferred alternative to surgical correction. However, the optimal mixing ratio of collagen (Col) and hyaluronic acid (HA) fillers, as well as refined injection techniques for the delicate infraorbital region, remains a further in-depth investigation. To screen the optimal volume ratio of collagen-HA mixed fillers, verify its anti-photoaging mechanism, and evaluate its clinical efficacy and safety for infraorbital rejuvenation. A multi-modal study was conducted, the in vitro experiments including cell viability, ROS detection, and ELISA assay for effect of the mix fillers on UV-induced photoaged human dermal fibroblasts (HDFs), as well as the injection forces of the mix fillers. The in vivo study was conducted on UV-induced photoaging mice model with histological, immunofluorescence, and ELISA detections. Additionally, a prospective randomized controlled clinical trial combined with an innovative injection technique was performed to further verify the efficacy and safety of the mix fillers. In vitro, the Col/HA (2:1) mix filler treated group showed the highest cell viability, most significant ROS reduction, and strongest collagen synthesis promotion. In vivo, this mix filler effectively alleviated UV-induced skin photoaging, restored collagen and elastic fiber structure and content, suppressed cellular senescence and inflammation. In clinical practice, this mix filler treated group maintained the highest AIHS improvement rate and optimal GAIS scores at 6 months, with the lowest incidence of postoperative complications, such as Tyndall phenomenon, and lumpiness. The other two mix filler (Col/HA(1:1) and Col/HA(1:2)) treated groups exhibited inferior efficacy and safety. The Col/HA (2:1) mix filler, combined with the innovative short fine needle vertical layered injection technique, exhibits excellent anti-photoaging effects and safety, providing a standardized and refined clinical strategy for minimally invasive infraorbital rejuvenation. 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 conjoint fascial sheath (CFS) is a fibrous structure essential for the dynamic movement of the upper eyelid. This study investigates the anatomy of the CFS and assesses the efficacy and safety of modified ''-shaped fixation CFS suspension in treating congenital moderate-to-severe blepharoptosis. This study included a cadaveric anatomical analysis and a single-center retrospective observational study. The anatomical study was conducted on 10 eyes from five adult cadavers, and the study analyzed outcomes from 51 patients (65 eyes) who underwent surgery from March 2019 to January 2024. The CFS appeared as a dense, white sheath between the levator muscle and superior rectus muscle, measuring approximately 11.3 ± 2.3 mm (8-14.8 mm) in length and 1.0 ± 0.28 mm (0.5-1.5 mm) in thickness, located about 3.7 ± 0.9 mm (2.2-5.4 mm) from the upper conjunctival fornix, with a trapezoidal shape. Satisfactory correction was achieved in 62 eyelids (95.4%), with good or fair symmetry observed in 48 patients (94.1%). The most common complications were undercorrection and recurrence, each occurring in three eyelids (4.6%), with no instances of conjunctival prolapse. Transient incomplete eyelid closure was noted early postoperatively but resolved within 1-6 months. The CFS, located between the levator muscle and superior rectus muscle, provides effective correction of congenital moderate-to-severe ptosis. The modified ''-shaped fixation CFS suspension technique shows promising functional and esthetic outcomes, minimizing postoperative conjunctival prolapse and establishing itself as an effective approach for ptosis correction. 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 .
This study aimed to investigate the associations between dietary fat quantity and quality and the incidence of metabolic syndrome (MetS) over a 2-year follow-up period. Additionally, we explored the cross-sectional association between dietary fat characteristics and MetS prevalence at baseline. This prospective cohort study followed 1,090 adults aged 18-65 years for 2 years. Dietary fat intake (quantity and quality) was assessed at baseline using a validated food frequency questionnaire. Anthropometric, blood pressure, and biochemical measurements were collected annually. Associations with incident and prevalent of MetS were analyzed using multivariable logistic regression and prospective cox-regression adjusted for major confounders. Among adults (mean age 39.6 ± 10.2 years; 45% men), higher intake of vegetable oils at baseline was associated with greater MetS prevalence (highest vs. lowest tertile: OR = 1.46; 95% CI 1-2.15; P-trend = 0.04). However, no significant associations were observed between overall dietary fat quantity and quality indices and the incidence of MetS during the 2 year follow-up. we found that while specific dietary fat sources like vegetable oils may relate to the current metabolic status (prevalence), their role in the development (incidence) of MetS requires further investigation with potentially different methodologies or longer follow-up periods.Please check and confirm the edit made in article title.
In the digital age, the internet has become a major source of health information for patients considering aesthetic surgery. Given that most cosmetic procedures are elective rather than medically necessary, patients often have sufficient time to search for information and develop expectations before seeking professional consultation. This study aimed to investigate how internet use influences patients' preoperative decision-making, expectations, and postoperative satisfaction, while also identifying practical strategies for plastic surgeons to improve patient communication through online platforms. We conducted a multicenter, prospective observational study involving patients undergoing aesthetic plastic surgery. Preoperative and postoperative questionnaires were administered to evaluate patients' sources of information, surgical preferences, expectations, and satisfaction. In addition, we analyzed user engagement characteristics of the most popular Chinese social media platforms for cosmetic surgery information to explore factors contributing to their influence on patient decision-making. The internet significantly influenced patients' preoperative decision-making and increased the likelihood that patients developed specific surgical preferences before their first consultation (both p 0.0001). Internet users also reported significantly higher preoperative satisfaction with their eyes than clinicians' assessments (p 0.02); however, their satisfaction was significantly lower seven days after surgery compared with both non-internet users and clinicians' assessments (p ≤ 0.02). Analysis of the most popular Chinese social media platforms demonstrated that RedNote exhibited significantly greater user interaction than TikTok. Furthermore, patients were significantly more willing to ask questions on RedNote (p = 0.01), facilitating more active communication between users. Internet-based information substantially influences patients' preoperative decision-making, expectations, and short-term postoperative satisfaction. As online platforms continue to shape patients' perceptions of aesthetic surgery, plastic surgeons may benefit from establishing a stronger social media presence and actively responding to patient inquiries. Such engagement could help optimize patient education, better align expectations with achievable outcomes, and ultimately improve the consultation experience and patient satisfaction. 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 .
Frontal bone contouring and forehead lifting are widely performed for aesthetic purposes. Emerging evidence suggests that these procedures may also alleviate frontal headache syndromes through mechanisms involving neurovascular decompression and soft tissue repositioning. This study aimed to evaluate postoperative changes in headache severity following frontal bone contouring and forehead lifting and to determine the relationship between specific intraoperative maneuvers, including frontal recess widening and supraorbital nerve decompression, and clinical outcomes METHODS: A retrospective observational cohort of 39 patients undergoing frontal bone contouring and forehead lifting (April 2022-November 2024) was analyzed. Pre- and postoperative headache severity was assessed using the validated Persian Brief Pain Inventory (BPI-P). Intraoperative details regarding frontal recess status and supraorbital nerve management were collected. Statistical analysis included Wilcoxon signed-rank test, Mann-Whitney U test, and multivariable regression modeling. Patients had a mean age of 36.4 ± 7.5 years (33 males, 3 females, 3 transgender). Significant improvements were observed in worst pain (median 7 → 2), average pain (5 → 0), total pain intensity (4.66 → 0.66), and pain interference (4.28 → 0), all p < 0.001. Subgroup analysis demonstrated a trend toward greater improvement in patients with frontal recess widening (n = 13 vs. 26) and supraorbital nerve decompression (n = 20 vs. 19), although limited by sample size. Frontal bone contouring and forehead lifting, while primarily aesthetic procedures, are associated with clinically meaningful reductions in headache burden. These findings support the hypothesis that aesthetic craniofacial surgery can exert therapeutic effects through neurovascular and musculoskeletal mechanisms. Prospective controlled trials with larger cohorts are needed to confirm efficacy and optimize surgical protocols. 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 .
Fibrous dysplasia (FD) is caused by activating mutations in GNAS that disrupt skeletal progenitor differentiation and promote osteoclast-mediated bone resorption. Here, we describe a protocol to isolate bone marrow stromal cells from doxycycline-inducible Gαs∧R201C mice and assess osteoclast formation using tartrate-resistant acid phosphatase (TRAP) staining. We also detail procedures for confirming transgene induction by X-gal staining to detect β-galactosidase activity. This workflow provides a reproducible ex vivo platform to evaluate stromal-driven osteoclastogenesis in a controlled setting. For complete details on the use and execution of this protocol, please refer to Whitlock et al.1.
The rapid expansion of social media has significantly altered the landscape of patient communication, professional branding, and ethical practice in plastic surgery. In China, where the aesthetic medicine market is growing rapidly, surgeons increasingly rely on platforms such as Xiaohongshu and Douyin to engage with patients. However, the implications of this digital transformation for clinical practice remain insufficiently explored. A national cross-sectional survey of 800 licensed plastic surgeons was conducted from December 2024 to March 2025. The questionnaire assessed platform usage, perceived benefits, patient interactions, and ethical concerns. Data were analyzed using descriptive statistics and correlation analysis. WeChat Video (62.75%) and Xiaohongshu (61.13%) were the most utilized platforms. A majority reported enhanced professional visibility (84.00%) and income growth (57.50%), though 52.87% attributed ≤ 10% of income to social media. Key challenges included unrealistic patient expectations (69.43%), negative feedback (62.18%), and exposure to misleading advertisements (76.68%). Platform-specific risks emerged: Douyin was associated with privacy breaches (p = 0.015) and patient dissatisfaction (p = 0.008), while Xiaohongshu correlated with patient acquisition (p < 0.001). Subgroup analyses suggested heterogeneous patterns across experience levels and institution types, with private-sector surgeons with 6-10 years of experience reporting consistently favorable social media-related outcomes. Social media was perceived as a useful adjunct for professional visibility, patient communication, and practice development among Chinese plastic surgeons. Its use was also associated with ethical and operational challenges, including unrealistic expectations, privacy concerns, misinformation, and patient dissatisfaction. These association-based findings support the need for platform-specific guidance, transparent risk disclosure, and stronger privacy safeguards in digital aesthetic practice. 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 .
Eight years have passed since the introduction of the term "preservation rhinoplasty." This approach has now gained worldwide popularity, and it is clear that preservation rhinoplasty has become an accepted philosophy due to its ability to produce stable, reliable, and beautiful results while minimizing the likelihood of secondary deformities that often arise from deconstruction-reconstruction (structural) rhinoplasty. Compared to only 5 years ago, the techniques are now more accessible than ever to learn, due to the publication of textbooks and academic journal articles on the topic as well as in-person courses. This article serves as a brief synthesis of the important evolutions in preservation rhinoplasty to date, and in addition provides: an up-to-date review of the history and development of preservation rhinoplasty; a description of the prevailing techniques such that a novice rhinoplasty surgeon can approach them in a logical order; and an overview of known complications and pitfalls. Level of Evidence: 5 (Therapeutic) For image description, please refer to the figure legend and surrounding text.
Nonmelanoma skin cancers (NMSCs), including squamous cell carcinoma in situ (SCCIS), are common and considered curable with early intervention; however, management must be individualized based on tumor characteristics and patient-specific factors. While surgical approaches such as Mohs micrographic surgery are the standard of care for high-risk anatomical sites, nonsurgical modalities are essential for patients with significant comorbidities. We present the case of an 80-year-old male with recurrent SCCIS of the right nasal ala whose medical history was significant for renal transplantation on chronic immunosuppressive therapy, chronic obstructive pulmonary disease (COPD) requiring supplemental oxygen, and impaired mobility, making him a poor surgical candidate for Mohs surgery or complex reconstruction. The patient elected treatment with image-guided superficial radiation therapy (IG-SRT), a noninvasive modality that incorporates high-resolution dermal ultrasound (HRDUS) for precise tumor measurement and treatment planning. Initial HRDUS demonstrated a tumor depth of 2.34 mm. He subsequently completed 20 fractions over six weeks, receiving a total dose of 5666.20 cGy. Expected radiation-induced skin changes developed during treatment, with a peak Radiation Therapy Oncology Group (RTOG) toxicity score of 2. Serial HRDUS demonstrated progressive tumor regression and no detectable residual tumor six weeks after treatment completion. The patient was pleased with the cosmetic outcome and experienced no alar distortion or airway compromise. This case highlights IG-SRT as a feasible, tissue-sparing treatment option for recurrent SCCIS in medically complex patients who are poor surgical candidates while emphasizing the value of HRDUS for treatment planning and response monitoring.
Whether dogs' pronounced human proximity-seeking is motivated by a selection for hypersociability or deferential behavior (i.e., will to please the human) remains contested. Since disentangling these motivations has been challenging in amicable contexts, this study investigated the human-directed behavior of human-socialized dogs (n = 11) and wolves (n = 12) in a resource conflict, wherein a bonded human engaged in a tug of war over food with the animal while protesting loudly. Non-conflict trials served as controls. The deferential behavior hypothesis would be supported if dogs engaged less in conflict compared to non-conflict trials and to wolves, while conflict should not impact dogs if hypersociability drives them primarily. Results were mixed: dogs engaged less vigorously during the conflict than wolves but approached the task quicker. This suggests dogs may have been conflicted between the compliance of participating in the trained task and complying with the protesting human. Moreover, dogs showed more human directedness than wolves. While both species approached the human faster after conflict (suggesting reconciliation), the self-directed and adverse behaviors did not clearly indicate whether the animals perceived the situation as a strong conflict. To more definitively tease the two hypotheses apart, future studies should use stronger conflict scenarios and avoid pre-trained tasks.
Previous in vitro 3D skin models are limited by their reliance on animal-derived collagen, a poor representation of the human dermis, and low throughput. Here, we present a protocol for reconstructing 3D human skin equivalents on an endogenous dermal matrix, in 12- and 24-well format, with optional pigmentation. We describe the expansion and seeding of fibroblasts, keratinocytes, and melanocytes in non-contractile polystyrene scaffolds. We then detail air-lifting and epidermal maturation, resulting in a fibroblast-derived dermal matrix with a fully stratified epidermis. For complete details on the execution of this protocol, please refer to Tham et al.1.
Frequent coexistence of sunken upper eyelid and tear trough deformities presents a common esthetic concern, yet little attention has been paid to concurrent surgical management of the two conditions. A single-institution retrospective study was conducted on patients who underwent tear trough deformity correction combined with upper eyelid surgery, performed either with isolated orbital fat release or orbital fat release combined with lower eyelid fat transfer. Park's grading and Hirmand classification systems were employed to assess the severity of deformities. The FACE-Q questionnaire was utilized to evaluate changes in patient satisfaction regarding periorbital appearance, psychological well-being, and social function. A total of 37 female patients were included: 13 in the fat release group and 24 in the fat release with transfer group. The loss to follow-up rate was low (10.8%). Significant improvements in eyelid esthetics and aging appraisal VAS scores were observed in both groups (p < 0.001). Intergroup comparison showed that the fat release with transfer group had greater improvement in upper eyelid appraisal compared with the fat release group (p < 0.05). Minor complications in six eyelids (8.1%) were resolved with conservative management. Overall, most patients were satisfied with the treatment outcome and their decision to undergo surgery. Lower eyelid fat transfer provides ideal volume augmentation in patients with moderate to severe sunken deformities. The combined one-stage procedure concurrently addresses two distinct esthetic concerns and avoids additional donor sites, offering a comprehensive approach to enhancing periorbital esthetics in patients with sunken upper eyelid and tear trough deformities. 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 tear trough is one of the areas that most reflects aging. The anatomy of the preseptal, premaxillary, prezygomatic and deep pyriform spaces are essential for successful planning of filler treatments. This work analyzes the anatomic relationship between the origin of the orbital septum and the tear trough/ orbicularis retaining ligaments, and between the anatomical spaces and the cheek fat compartments, to classify patients who undergo a filler treatment for tear trough deformity. Patients are classified in 'innie' or 'outie' and blending technique is described based on this classification. A total of 38 patients were evaluated, comprising 21 females and 17 males, with a mean age of 53 years (range, 31-72 years). The mean follow-up period was 10.4 months (range, 5-22 months). All patients presented with an innie-type tear trough deformity. Prior to treatment, 76.3% of patients (n = 29) were classified as Hirmand Type II, and 23.7% (n = 9) as Type III. Following treatment, 84.2% (n = 32) of patients were rated as "very much improved" (GAIS score of 1), and 15.8% (n = 6) as "much improved" (GAIS score of 2). The mean volume of hyaluronic acid injected per unilateral tear trough was 0.35 cc (range of 0.2-0.5 cc), and for the unilateral midcheek was 0.65 cc (range of 0.5 to 2 cc). No complications were reported. The blending technique is an effective technique to improve the appearance of the lid-cheek junction, correcting the TT deformity and the palpebromalar groove. Patients are classified as innies or outies based on the position of the AM on the orbital bone. Innie patients are more favorable to the injection of HA in the gap between AM and ORL (preseptal space) to correct the TT groove. Outie patients benefit from the volumization and support of the DMCFP, but not from direct injection into the TT and preseptal space. 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 .
Congenital microtia reconstruction often introduces unwanted hair onto the new auricle. Laser hair removal can address this issue, but conventional external treatments require multiple sessions, increasing the overall treatment time, discomfort, and cost. Preclinical studies suggest that delivering laser energy from the flap's underside may improve efficiency by directly targeting hair follicles. We evaluated an intraoperative subcutaneous laser depilation approach applied during stage-III surgery to improve hair removal in this setting. A prospective cohort study included 44 microtia patients undergoing stage-III auricular reconstruction. 23 patients received an intraoperative 755 nm Alexandrite laser via subcutaneous route during surgery, while 21 patients had a standard external laser session one week before surgery. Laser settings were adjusted for each: subcutaneous treatments used 10-12 J/cm2 with 3 ms pulses, versus 14-20 J/cm2 with 20 ms pulses externally. Hair counts per cm2 were measured before treatment and two months after. Percentage hair reduction, complications, and patient satisfaction were compared between groups, with P < 0.05 considered significant. Both methods produced significant hair reduction at 2 months. The subcutaneous group achieved 48.3% mean hair count reduction versus 44.7% in the epidermal group (P < 0.001). The subcutaneous approach required lower laser fluence (11.04 vs 16.29 J/cm2, P < 0.001). No laser-related complications were observed. Patient satisfaction was high in both groups. Intraoperative subcutaneous 755 nm Alexandrite laser depilation integrated into stage-III ear reconstruction appeared to be a safe and effective approach for reducing hair on the reconstructed auricle. Compared with conventional preoperative external laser treatment, this method showed a trend toward greater hair reduction while using lower fluence. This technique may reduce the need for multiple separate laser sessions and improve patient convenience. 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 .
Nonsurgical skin tightening and lifting devices have gained significant popularity because of their ability to provide facial rejuvenation without the downtime and risks associated with surgery. Technologies utilizing high-intensity facial electrical stimulation (HIFES) in combination with synchronous radiofrequency (RF) have shown promise in achieving lifting effects in the upper and midface. The aim of this study was to evaluate the effectiveness of combined HIFES and synchronous RF treatment of the midface in producing lifting of the modiolus relative to 2 fixed anatomical landmarks: the superior tragal point (STP) and lateral canthal point (LCP). A prospective single-arm cohort study was conducted with 8 participants completing 4 weekly HIFES and synchronous RF treatments. The position of the modiolus was measured at 3 time points: pretreatment, immediately after the first treatment, and 3 months after the final session. The modiolus was localized with ultrasound, and distances to the STP and LCP were recorded. Means were compared using repeated-measure analysis of variance with pairwise t-tests; the Wilcoxon signed-rank test was performed as a robustness check. The modiolus demonstrated statically significant elevation in an oblique cephaloposterior vector toward the tragus. Modiolus-STP distance decreased from baseline to 3 months posttreatment (right: 0.56 cm, P < .01; left: 0.31 cm, P = .04). Modiolus-LCP distance also decreased (right: 0.28 cm, P = .06; left: 0.14 cm, P = .45), although not statistically significant. In this preliminary study, HIFES and synchronous RF treatment produced significant measurable lifting of the modiolus consistent with the anatomical pull of the zygomaticus complex. Larger studies with longer follow-up are warranted to further characterize these effects. Level of Evidence: 4 (Therapeutic) For image description, please refer to the figure legend and surrounding text.