Alveolar soft part sarcoma (ASPS) is a rare malignancy that is morphologically characterized by a distinctive nodular, organoid, or nested growth pattern in which the cells are separated by vascularized septa. The diagnosis is based on a combination of pathologic and immunohistochemical findings and the presence of an ASPSCR1-TFE3 gene fusion revealed by next-generation sequencing. ASPS most commonly occurs as a painless mass in the lower extremity, with likely involvement in the lungs if metastasis is present. Here we report a case of ASPS that exhibited the characteristic ASPSCR1-TFE3 gene fusion along with a reciprocal fusion of TFE3-ASPSCR1, which presented in the nasolabial fold of a 31-year-old female. An intraoral approach was utilized for complete surgical resection of the malignancy, resulting in continued remission after 11 months.

Tissue fillers injections remain to be one of the most commonly performed cosmetic procedures. The aim of this meta-analysis was to systematize and present available data on the aesthetic outcomes and safety of treating the nasolabial fold area with tissue fillers. We conducted a systematic review of randomized clinical trials that report outcomes concerning treatment of nasolabial fold area with tissue fillers. We searched the MEDLINE/PubMed, ScienceDirect, EMBASE, BIOSIS, SciELO, Scopus, Cochrane Controlled Register of Trials, CNKI and Web of Science databases. Primary outcomes included aesthetic improvement measured using the Wrinkle Severity Rating Scale score and Global Aesthetic Improvement Scale. Secondary outcomes were incidence rates of complications occurring after the procedure. At baseline, the pooled mean WSRS score was 3.23 (95% CI: 3.20-3.26). One month after the procedure, the pooled WSRS score had reached 1.79 (95% CI: 1.74-1.83). After six months it was 2.02 (95% CI: 1.99-2.05) and after 12 months it was 2.46 (95% CI: 2.4-2.52). One month after the procedure, the pooled GAIS score had reached 2.21 (95% CI: 2.14-2.28). After six months, it was 2.32 (95% CI: 2.26-2.37), and after 12 months, it was 1.27 (95% CI: 1.12-1.42). Overall, the pooled incidence of all complications was 0.58 (95% CI: 0.46-0.7). Most common included lumpiness (43%), tenderness (41%), swelling (34%) and bruising (29%). Tissue fillers used for nasolabial fold area treatment allow achieving a satisfying and sustainable improvement. Most common complications include tenderness, lumpiness, swelling, and bruising. LEVEL OF EVIDENCE II: \"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: Bellafill (Suneva Medical Inc) is a semipermanent injectable soft tissue filler composed of smooth and uniform polymethylmetacrylate (PMMA) microspheres suspended in a bovine collagen gel. It is a third generation PMMA filler, with more uniform shapes and sizes of the PMMA microspheres, which has been purported to decrease the incidence of granuloma formation.
METHODS: We performed a retrospective review of our clinical experience from 2014 to 2017 with Bellafill as a soft tissue injectable filler in the following clinical scenarios: deep nasolabial folds, depressed facial acne scars, malar volume loss, temporal wasting, tear trough deformity, chin augmentation, angle of jaw augmentation, and lip augmentation. The primary outcome is the rate of adverse events, and the secondary outcome is subjective patient satisfaction.
RESULTS: From 2014 to 2017, 842 syringes of Bellafill were administered to 212 patients, for a total of 417 procedures. Of the 417 procedures, 96 (23.0%) were for acne scars, 82 (19.7%) malar volume restorations, 65 (15.6%) nasolabial fold augmentations, 45 (10.8%) chin augmentations, 42 (10.1%) tear trough volume restorations, 28 (6.7%) temple volume restorations, 25 (6.0%) rhinoplasty touch-ups for small areas of nasal depression, 22 (5.3%) lip augmentations, and 12 (2.9%) jaw angle augmentations were performed. A range of 1 to 12 syringes were injected into each patient, over 1 to 3 sessions; 6 cases of adverse events occurred (1.4%). There were 4 cases of solitary nodules in the injection site, 1 case of lower eyelid oedema which persisted for 3 months and 1 case of lower lip oedema which resolved within hours. Patient satisfaction rates ranged from 83.3% for angle of jaw augmentation to 99.0% for improvement of acne scars.
CONCLUSIONS: Bellafill is a safe and effective option for a semipermanent soft tissue filler, with high patient satisfaction and a good safety profile.
BACKGROUND: Le Bellafill (Suneva Medical Inc.) est un produit de comblement injectable semi-permanent des tissus mous, composé de microsphères de polyméthymétracylate (PMMA) lisses et uniformes, suspendues dans un gel de collagène bovin. Il s’agit d’un produit de comblement de PMMA de troisième génération, dont les microsphères de PMMA, de formes et de dimensions plus uniformes, réduiraient l’incidence de granulomes.
UNASSIGNED: Les chercheurs ont procédé à une analyse rétrospective de leur expérience clinique du Bellafill utilisé comme produit de comblement injectable des tissus mous dans les scénarios cliniques suivants entre 2014 et 2017: sillons nasogéniens profonds, cicatrices déprimées d\'acné facial, perte de volume de l’os malaire, émaciation des tempes, dépression du rebord orbital inférieur, augmentation du menton, augmentation de l’angle des mâchoires et augmentation des lèvres. Le résultat primaire était le taux de réactions indésirables et le résultat secondaire, la satisfaction subjective des patients.
UNASSIGNED: Entre 2014 et 2017, les plasticiens ont injecté 842 seringues de Bellafill à 212 patients, pour un total de 417 interventions. De ce nombre, 96 (23,0 %) visaient des cicatrices d\'acné, 82 (19,7 %), la restauration du volume de l’os malaire, 65 (15,6 %), l’augmentation des sillons nasogéniens, 45 (10,8 %), l’augmentation du menton, 42 (10,1 %), la restauration du volume du rebord orbital inférieur, 28 (6,7 %), la restauration du volume des tempes, 25 (6,0 %), les retouches des petites zones de dépression nasale après une rhinoplastie, 22 (5,3 %), l’augmentation des lèvres, 12 (2,9 %), l’augmentation de l’angle de la mâchoire. Chaque patient s’est fait injecter de une à 12 seringues, réparties entre une et trois séances. Six cas de réactions indésirables se sont produits (1,4 %), soit quatre cas de nodules solitaires au point d’injection, un cas cas d’œdème de la paupière inférieure qui a persisté trois mois et un cas d’œdème de la lèvre inférieure qui a disparu en quelques heures. Le taux de satisfaction des patients a oscillé entre 83,3 % pour l’augmentation de l’angle de la mâchoire et à 99,0 % pour l’atténuation des cicatrices d’acnén.
CONCLUSIONS: Le Bellafill est un produit de comblement des tissus mous à la fois sécuritaire et efficace, qui suscite une satisfaction élevée de la part des patients et possède un bon profil d’innocuitfi.

Autologous fat grafting is a helpful supplement to facelift surgery that helps to combat age-related volume loss of facial structures. Despite the widespread prevalence of combined facelift and fat-grafting, significant procedural variation exists between providers.
The primary purpose of this systematic review was to study the efficacy and complication rates of facelift with lipofilling compared with facelift alone.
A systematic review of the Cochrane Library and MEDLINE databases as completed was undertaken to identify all clinical reports of fat grafting combined with facelift surgery based on the following key terms: (\"fat grafting\" OR \"lipotransfer\" OR \"lipofilling\" OR \"fat transfer\") AND (\"facelift\" OR \"rhytidectomy\" OR \"SMASectomy\" OR \"facial rejuvenation\"). Data on techniques, outcomes, complications, and patient satisfaction were collected.
The systematic review was performed in April 2017. In total, 248 articles were identified for review. After application of exclusion criteria, 15 primary studies were included in this review. Various facelift techniques were reported, including deep-plane or sub-superficial musculoaponeurotic system (SMAS) facelift, SMAS facelift, modified minimal access cranial suspension lift, component facelift, midface lift, SMAS plication, SMAS-stacking/SMASectomy, and SMASectomy. The most common locations of fat graft injection included the nasolabial folds, tear troughs, temporal regions, midface/cheek/malar eminence, marionette groove, lips, and ear lobes. The addition of fat grafting to facelift surgery resulted in significant improvements in facial volume and aesthetic assessments.
Combined facelift and fat grafting is a safe and efficacious means to simultaneously address age-related ptosis and volume loss. Further research is required to validate and improve existing treatment modalities.

Findings from photometric analysis of soft tissue on cranial magnetic resonance imaging demonstrate that the aging upper lip shows significant lengthening, thinning, volume loss, and deepening of the nasolabial folds. In this study, these findings are implemented in a review of 500 cases of upper lip rejuvenation to propose an evidence-based strategy for surgical rejuvenation of the upper lip.
The charts of 500 consecutive surgical perioral rejuvenation patients treated by the senior authors (P.L.T. and A.M.V.) from 2014 until 2018 were reviewed. The surgical methods of lip lift and fat grafting were described in relation to the cases and the metric data.
Of the 500 patients, 51 had an isolated procedure such as a lip lift (3 percent), lip augmentation (3 percent), augmentation of the nasolabial folds (2 percent), or skin resurfacing (2 percent). The remaining 449 patients underwent combinations of lip lift, augmentation of the lip and nasolabial fold (32 percent), lip lift with augmentation of the lip and nasolabial fold with resurfacing (30 percent), lip augmentation and resurfacing (14 percent), or lip lift and resurfacing (14 percent).
Rejuvenating the upper lip needs to address both lengthening and volume loss. This requires a combination of surgical shortening of the upper lip by a precisely designed lip lift and a differential filling of certain upper lip regions by microfat grafting. The combination of these two modalities works synergistically.
Therapeutic, IV.

BACKGROUND: Hyaluronic acid (HA) gel is a widely used dermal filler for the correction facial volume loss. The incorporation of lidocaine with HA provides a pain-relieving alternative for individuals considering facial rejuvenation. The aim of this systematic review and meta-analysis is to compare the effectiveness and safety of HA with lidocaine (HAL) with that of HA without lidocaine for the treatment of nasolabial folds (NLFs).
METHODS: Studies were identified using the electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials and Web of Science from inception up to January 2018. Randomized controlled trials (RCTs) were selected based on the inclusion criteria. Outcomes included 100-mm Visual Analogue Scale (VAS) score, Wrinkle Severity Rating Scale score and adverse events.
RESULTS: A total of 908 patients from 12 RCTs were included in the meta-analysis. VAS score within 30 min after injection in the HAL group was much lower than that with just HA group (MD = - 28.83, 95% CI - 36.38 to - 21.28). There was no significant difference in effectiveness between the two products 24 months post-injection (MD = 0.13, 95% CI - 0.15 to 0.41). The main adverse events, such as swelling, erythema, bruising, itching and induration, also showed no significant difference.
CONCLUSIONS: HAL is more effective for pain relief than HA alone, but both display similar effectiveness and safety for the correction of NLFs.
UNASSIGNED: 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 .

Labial adhesion is a preliminary surgical lip approximation used in the early management of unilateral and bilateral cleft lip and palate. Our objective was to evaluate its effects on the maxillary arch dimensions and nasolabial esthetics by means of a systematic review. The literature search (1955-2016) was based on MEDLINE via PubMed, Web of Science, EMBASE, and the Cochrane Library. Studies with labial adhesion as a single preliminary step for definitive lip closure, in combination with nasoalveolar molding or in combination with infant orthopedics were considered eligible. Fifteen articles were identified (1978-2015), including 587 patients who underwent labial adhesion. Reduction in alveolar cleft width was between 60.9% and 100% in unilateral cases and between 47.5% and 100% in bilateral cases. Reduction in palatal cleft width was between 28.4% and 59.8% in unilateral cases and between 37.5% and 50.5% in bilateral cases. No conclusive results could be drawn about the effect on nasolabial esthetics. This systematic review comprises the available literature of the last 50 years about labial adhesion. It showed reduction of alveolar and palatal cleft width after a treatment with labial adhesion with or without infant orthopedics. The treatment effect on nasolabial esthetics, especially in the long term, remains unclear.

BACKGROUND: Cohesive monophasic polydensified fillers show unique viscoelastic properties and variable density of hyaluronic acid, allowing for a homogeneous tissue integration and distribution of the material.
OBJECTIVE: The aim of this paper was to review the clinical data regarding the performance, tolerability, and safety of the Belotero(®) fillers for soft-tissue augmentation and rejuvenation.
METHODS: A literature search was performed up until May 31, 2015 to identify all relevant articles on Belotero(®) fillers (Basic/Balance, Hydro, Soft, Intense, Volume) and equivalent products (Esthélis(®), Mesolis(®), Fortélis(®), Modélis(®)).
RESULTS: This comprehensive review included 26 papers. Findings from three randomized controlled trials showed a greater reduction in nasolabial fold severity with Belotero(®) Basic/Balance than with collagen (at 8, 12, 16, and 24 weeks, n=118) and Restylane(®) (at 4 weeks, n=40), and higher patient satisfaction with Belotero(®) Intense than with Perlane(®) (at 2 weeks, n=20). With Belotero(®) Basic/Balance, an improvement of at least 1 point on the severity scale can be expected in ~80% of patients 1-6 months after injection, with an effect still visible at 8-12 months. Positive findings were also reported with Belotero(®) Volume (no reduction in hyaluronic acid volume at 12 months, as demonstrated by magnetic resonance imaging), Soft (improvement in the esthetic outcomes when used in a sequential approach), and Hydro (improvement in skin appearance in all patients). The most common adverse effects were mild-to-moderate erythema, edema, and hematoma, most of which were temporary. There were no reports of Tyndall effect, nodules, granulomas, or tissue necrosis.
CONCLUSIONS: Clinical evidence indicates sustainable esthetic effects, good safety profile, and long-term tolerability of the Belotero(®) fillers, particularly Belotero(®) Basic/Balance and Intense.

BACKGROUND: Despite its increasing usage of facial applications, there is a paucity of objective data regarding calcium hydroxylapatite (CaHA).
OBJECTIVE: To systematically evaluate the complications from CaHA injection for facial soft tissue augmentation.
METHODS: Published studies on CaHA injection for facial soft tissue enhancement were identified through searches of the PubMed, EMBASE, and Cochrane Controlled Trial databases. Only randomized, controlled trials comparing CaHA injection to either placebo or an active comparator for facial cosmetic use were included. The outcome measures were the count (n) and frequency (%) of each complication, including edema (swelling), erythema (redness), ecchymosis (bruising), pain, pruritus (itching), hematomas, nodules, and extrusions.
RESULTS: Four studies on nasolabial fold (NLF) injection of CaHA consisting of two subgroups were included: (i) a CaHA-lidocaine vs CaHA subgroup and (ii) a CaHA vs hyaluronic acid (HA) subgroup. The addition of lidocaine to CaHA therapy displayed no significant effect on edema (RR (95% CI): 1.07 (0.94-1.21), P = .311), erythema (RR (95% CI): 0.91 (0.66-1.24), P = .544), ecchymosis (RR (95% CI): 1.04 (0.71-1.52), P = .843), pain (RR (95% CI): 0.88 (0.58-1.33), P = .553), or pruritus (RR (95% CI): 0.82 (0.45-1.50), P = .515). There was no significant difference between CaHA vs HA for hematomas (RR (95% CI): 0.24 (0.01-4.31), P = .332) or nodules (RR (95% CI): 0.18 (0.01-6.62), P = .353). There was no significant publication bias detected in either subgroup (Begg\'s test P > 0.05).
CONCLUSIONS: These findings support the addition of lidocaine to NLF injection of CaHA and suggest an equivalence between CaHA and HA with respect to hematoma and nodule formation. LEVEL OF EVIDENCE 2: Risk.

Belotero Balance is a novel highly cross-linked hyaluronic acid that uses cohesive polydensified matrix technology to achieve cohesive gel; improved adaptation by the dermis; and a soft, smooth fill. Several studies have now compared Belotero Balance to bovine collagen and other hyaluronic acids. Two pivotal studies demonstrated the noninferiority and superiority of Belotero Balance to bovine collagen. In the first study, more than half of the patients maintained optimal correction at 6 months on the Belotero-treated side of the face. The second of those two studies followed patients to week 96 and demonstrated that the effects of Belotero Balance in this long-term, open-label study persisted in the majority of subjects without repeated treatment for at least one interval of 48 weeks. The filler was well tolerated, with only one of 34 total adverse events (injection-site bruising) considered to be related to the study device. A third study compared the safety and efficacy of other hyaluronic acids (i.e., Juvéderm and Restylane) with Belotero Balance. In this study, the safety profiles of all three hyaluronic acids were generally favorable, with site-specific adverse events mild to moderate and comparable across each hyaluronic acid. Aesthetic results were also similar, although Belotero Balance resulted in greater evenness than Restylane at 4 weeks by one indicator used in the study. Finally, a 5-year retrospective safety review of 317 patients treated with Belotero Balance over a 5-year period revealed no severe adverse events in any patients, including the absence of persistent nodules or granulomas.