The importance of "appearance psychology" in understanding and supporting patients with coping difficulties in plastic surgery is increasingly recognized. For patients with psychological vulnerabilities, visible differences can impair the quality of their social interactions, which may lead to additional psychosocial challenges. To support patients effectively, it is important to understand the social comparison process and their need to seek approval and avoid rejection. The "stepped care model" is a practical intervention technique that has four levels. Levels 1 and 2, which are for the majority of patients with minor illnesses, consist mainly of counselling and information that is provided by medical staff, whereas levels 3 and 4, which are for a small number of severe cases, involve intensive treatment with psychologists/psychiatrists working with frontline staff. Visible differences themselves are not the target of intervention in appearance psychology. This difference from the focus of plastic surgery allows for complementary approaches to improving outcomes for the patient. The Japanese Psychological Association provides workshops that also include medical professionals.

 Introduction: In cases of myelomeningocele with large soft tissue defects, it is often difficult to achieve temporary closure; therefore, reconstructive surgery is required. However, the optimal surgical methods and indications have not been established.
 Method: Twenty-five patients diagnosed with myelomeningocele at our hospital were assessed based on sex, surgical timing, postoperative observation period, size and location of skin defect, presence or absence of spinal kyphosis, surgical method, and perioperative complications.
 Results: The local flap group accounted for 24% of the total cases. These patients presented with wide skin defects, kyphosis, or skin defects located at the narrowest part of the waist. Bilateral bipedicled flaps were selected for all flaps. No flap necrosis or wound dehiscence was observed postoperatively, and wound closure was achieved in all cases.
 Discussion and Conclusion: In cases where the skin defects were located at the narrowest part of the waist, a local flap may be required. Our findings suggest that the bilateral bipedicled flap is a useful method because it can accommodate relatively large skin defects, and its design and technique are easy to use. The results of this study may inform the decision-making process regarding surgical methods for closing myelomeningocele.

 Muir-Torre syndrome, a rare hereditary autosomal dominant cancer syndrome, is characterized by a predisposition to cancers of the colon and genitourinary tract, as well as skin lesions such as keratoacanthomas and sebaceous tumors. Herein, we report a case of an 87-year-old man with a history of colon cancer, who presented with an extraocular sebaceous carcinoma on the face in close proximity to his ear. We suspected Muir-Torre syndrome. We resected the tumor and histopathological examination of the resected specimen confirmed the presence of sebaceous carcinoma, squamous cell carcinoma, and basal cell carcinoma. We report a unique case of concomitant development of three types of malignant skin lesions at the same site. To our knowledge, this is the first report of this extremely rare condition.

 Chronic subdural hematoma (CSDH) is a disorder that typically develops after head trauma. It is rare following isolated facial trauma. Herein, we report a case of CSDH in a 49-year-old man with no medical history who fractured his right zygomatic bone in a fall. The symptoms of CSDH appeared 12 weeks after the initial treatment for the facial fracture. A neurosurgeon performed burr hole surgery on the patient. He recovered successfully. This case highlights the possibility of CSDH after isolated facial trauma, emphasizing the importance of plastic surgeons to remain vigilant. Early detection and appropriate management are essential in such cases.

 Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell non-Hodgkin lymphoma that develops after breast implant insertion. The patient was a 60-year-old woman who had undergone breast augmentation with silicone implants 18 years previously and presented to our hospital with right breast swelling for 1 year. Magnetic resonance imaging showed capsular formation, fluid retention, and swollen axillary lymph nodes, suggesting BIA-ALCL. Following the diagnostic flow chart, aspiration biopsy was performed under ultrasound guidance without detecting abnormal cells. We performed total tumorectomy, which included the lymph nodes. The pathological diagnosis was silicone granuloma. The resected breast implant was manufactured by Poly Implant Prothèse (PIP). The patient remains alive 1 year postoperatively without recurrence. This is the first reported case in Japan of silicone granuloma in a patient with PIP breast implants, where BIA-ALCL was suspected. We present this case as well as a review of the literature.