Autologous fat grafting (AFG) and facial fillers specially Hyaluronic acid fillers (HA) are widely used for facial rejuvenation, yet their comparative benefits for patient satisfaction remain uncertain. To compare AFG and facial fillers, using patient satisfaction as the primary outcome. Systematic review and meta-analysis (PRISMA-aligned). Nine comparative studies (n = 805) were pooled with random-effects models (standardized mean difference, SMD). Heterogeneity (Q, I2) and small-study effects (Egger's) were assessed. AFG showed higher patient satisfaction than HA (SMD 0.91, 95% CI - 0.32 to 2.14), but results varied across studies (I2=97%); subgroup analyses were directionally consistent but did not explain variability. Egger's test suggested possible small-study effects (p = 0.15), though interpretation is limited with <10 studies. On average, AFG provides higher satisfaction, likely due to its greater durability, while HA remains valuable for convenience and reversibility. Findings should be interpreted in light of between-study variability. Well-designed, standardized RCTs are needed. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
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.
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 .
Background/Objectives: Sapropterin dihydrochloride is an established treatment option for individuals with phenylketonuria (PKU) who demonstrate responsiveness, but uncertainty persists regarding dosing frequency, timing relative to meals, the influence of dietary composition, and efficacy of different formulations. Despite widespread use in the UK, real-world administration behaviours have not previously been characterised. This study aimed to characterise sapropterin administration behaviours among people with PKU in the UK. Methods: A 31-item questionnaire was developed and disseminated via the National Society for Phenylketonuria website and social media channels. The survey captured demographic information, dosing schedules, formulation use, administration techniques, co-ingestion with food, and changes in natural protein tolerance following initiation of generic sapropterin. Results: 124 current sapropterin users completed the survey. Most respondents were caregivers of children or adolescents (68.5% aged 0-18 years). Once-daily dosing was most common (66.1%, n = 82), typically administered at breakfast, followed by twice-daily (32.3%, n = 40) and three-times-daily (1.6%, n = 2). Tablets were the predominant formulation (92.7%, n = 115); 50.4% (n = 58/115) swallowed tablets whole, while the remaining (49.6%, n = 57/115) crushed or dissolved them in water or juice. Nine respondents (7.3%, n = 9/124) used powder sachets. Most participants (75%, n = 93/124) took sapropterin with food, with both low-fat (36.6%, n = 34/93) and high-fat (26.9%, n = 24/93) meals reported. Over a third of participants (33.9%, n = 42/124) tolerated a natural protein intake >30 g/day when this was measured, and a further 15.3% (n = 19) were able to maintain a fully unrestricted protein intake without protein substitute supplementation. The magnitude of protein intake improvement was significantly greater among adults (p < 0.001), those with higher baseline natural protein intake (≥30 exchanges/day) (p < 0.001), and individuals who swallowed sapropterin tablets whole (p = 0.038). Although 71.8% (n = 89/124) were pleased with their increased natural protein allowance, many expressed a desire for further improvement. Conclusions: Substantial heterogeneity in dosing schedules, formulation handling, and co-ingestion practices highlights the absence of standardised guidance. These findings emphasise the need for clearer clinical recommendations to optimise treatment effectiveness and support consistent, equitable care.
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.
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 .
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.
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 .
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.
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 .
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.
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 .
Nucleus-specific brain organoids enable precise human brain research, yet refined hindbrain models are rare. Here, we present a guided differentiation protocol for generating human medullary spinal trigeminal nucleus-like organoids (hmSpVOs). We describe steps for constructing spinal trigeminal nucleus (SpV)-thalamus assembloids. Moreover, we outline the assays to characterize functional connections within these assembloids. For complete details on the use and execution of this protocol, please refer to Pang et al.1.
Non‑surgical rhinoplasty is increasingly popular for nasal augmentation in East Asian patients. However, a standardized, anatomy‑driven protocol for the sequential and layered correction of the nasal tip, dorsum, and glabellar complex-key aesthetic units in the Asian nose-is still lacking. In this dual‑center retrospective study, 528 East Asian patients (490 females, 38 males; mean age 27.7 years) underwent non‑surgical rhinoplasty between 2020 and 2024. A high‑G' hyaluronic acid filler was injected via cannula in a predefined sequence: first, the nasal tip via fibrous septal deposition; followed by the dorsum and glabellar triangle. Outcomes were assessed using ·FACE‑Q and 3D facial scanning (MVS‑N1) preoperatively and at 9 months. Three‑dimensional analysis of the 426 patients who received the full three-site protocol showed significant improvements from baseline in nasal length (+ 2.62 mm), tip projection (+ 3.69 mm), nasolabial angle (+ 5.7°), and nasofrontal angle (- 9.4°) (all p < 0.001). FACE‑Q scores significantly improved across all 528 patients in satisfaction (+ 44.4 points), social function (+ 26.2), psychological well‑being (+ 28.1), and reduced distress (- 39.4) (all p < 0.001). No vascular complications occurred; 11 cases had transient erythema that resolved spontaneously or with conservative measures. The sequential "tip‑dorsum‑glabella" injection protocol, featuring a refined cannula‑based technique for fibrous septal tip augmentation, was associated with a low complication rate and significant short‑term improvements in patient‑reported and anthropometric outcomes in this retrospective analysis, suggesting that it is a clinically feasible approach for non‑surgical rhinoplasty in East Asian patients. 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 .
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?
Neck injections can be painful despite topical anesthesia. Blocking the transverse cervical nerve (TCN) may improve comfort, but clinicians need practical surface landmarks and attention to the external jugular vein (EJV). In an anatomical mapping series (46 heminecks), the TCN emergence point along the posterior border of the sternocleidomastoid muscle (SCM) was recorded as a percentage of the earlobe-to-lateral clavicular SCM insertion distance (0-100%). In a pilot split-neck study (n=9), the left neck received landmark-guided TCN block with lidocaine at the mapped point (~10 mm depth) before bilateral injections; the right neck received lidocaine 5% cream, applied according to the clinic's routine protocol for 30 minutes prior to injection RESULTS: The TCN emerged at a mean of 53% along the reference line. Complete cutaneous anesthesia occurred in 9/9 participants (95% CI, 66.4-100%). All participants reported lower VAS pain on the blocked side (sign test, p=0.0039). One bruise occurred (1/9; 11.1%; 95% CI, 0.3-48.2%). A proportional SCM landmark (~53%) provides a simple guide for landmark-based TCN block to reduce discomfort during neck injections. EJV awareness and aspiration are essential for safety. 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 .
Enlarged pores and fine wrinkles are common cosmetic concerns in Asian patients. While energy-based devices and injectables are widely available, many patients prefer procedures associated with minimal downtime, low risk, and natural outcomes. To evaluate the clinical outcomes of microneedle therapy system (MTS) followed by topical application of glucose 10% with hyaluronic acid (Sihler G, Seoul, Republic of Korea) in Korean patients seeking improvement in skin texture, pore size, and fine wrinkles. In this prospective single-arm observational study, forty Korean patients (24 women and 16 men; aged 28-72 years) underwent three to four MTS sessions at 4-week intervals. Immediately after microneedling, glucose 10% with hyaluronic acid was applied topically to the treated facial regions. In this prospective single-arm observational study, forty Korean patients (24 women and 16 men; aged 28-72 years) underwent three to four MTS sessions at 4-week intervals. Immediately after microneedling, glucose 10% with hyaluronic acid was applied topically to the treated facial regions. Clinical outcomes were assessed at baseline and at the final follow-up visit after completion of treatment (12 weeks for three sessions or 16 weeks for four sessions) by two independent physicians using the Global Aesthetic Improvement Scale (GAIS). Patients also self-rated outcomes using GAIS, and satisfaction was recorded using a visual analogue scale (VAS). Pore size was evaluated using a photonumeric pore grading scale, and fine wrinkles were assessed using the Wrinkle Severity Rating Scale (WSRS). Safety and tolerability were recorded. Given the exploratory nature of the study and absence of comparator arms, analyses were primarily descriptive. At the final follow-up evaluation (12-16 weeks, depending on number of sessions), two physicians rated 73 per cent of patients as "much improved" or "very much improved" on GAIS. Patient-reported GAIS was similar, with 80 per cent rating themselves in these categories. Mean satisfaction scores increased from 2.3 at baseline to 8.5 at study completion. Improvements in pore grading were observed in 78 per cent of patients, while WSRS scores improved in 68 per cent. The procedure was well tolerated, with only transient erythema and mild swelling. MTS combined with topical glucose 10% and hyaluronic acid was associated with clinical improvement in pore refinement and fine wrinkles in this cohort of Korean patients. Given the absence of a control group, these findings should be interpreted as preliminary and hypothesis-generating. 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 .