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2025 英卡思亚洲年会
大会日程

Non-sponsored scientific lectures

会议室： Open Stage - Level 2
日期： 2025年 6月 6日星期五从 14:00 至 18:00
组织形式： 开放式舞台演讲 > 在展区内的专用舞台上录制口头演讲

本场演讲内容

小时	讲者	演讲标题	讲稿摘要	数字
14:00	Francesca Mari SUMILANG SY ALVARADO 医师	Laser fiber lifting and lipolysis with the 1470-nm wavelength: Our experience across different age groups	查看	149485
14:12	Kumiko KOROMOHARA 医师	Anatomy-Based Optimization of HIFU and RF for Facial Rejuvenation: Clinical Evaluation of Diverse Device Characteristics	查看	149535
14:24	Young Seok SEO 医师	In Vivo Preclinical Evaluation of Thermal Safety for Monopolar RF Devices	查看	149536
14:36	Kenta FUJIO 医师	Fractional HIFU for Non-Invasive Skin Tightening and Rejuvenation focusing on the 1.5mm and 2.0mm treatment cartridges	查看	149537
14:48	Karen Florencia DE LOS SANTOS 医师	Neuroaesthetics and Facial Harmonization: Image, Self-Esteem, and Mental Health	查看	149538
15:00	Sheena KAPOOR 医师	Potpourri of Interesting Cases In Histopathology of Dermatological Diseases	查看	149539
15:12	Fairouz ROUABHIA 医师	Hair transplant and Exosomes	查看	149540
15:24	Thi Thanh Phuong NGUYEN 医师	MULTIMODAL THERAPY FOR CORTICOSTEROID-INDUCED ROSACEA-LIKE DERMATITIS	查看	149541
15:36	Saowapak PONGSASITORN 医师	Dual-Molecular PDLLA Injection for Full-Face Rejuvenation and Lifting	查看	149542
15:48	Su Phyo AUNG 医师	A Review of Novel Approaches in Melasma Management	查看	149543
16:00	Hosung CHOI 医师	Topical Management of Melasma Using Microinvasive Peptide & Tranexamic Acid Delivery: A Novel Approach Using Spicule-Mediated Delivery System	查看	149544
16:12	Monisha KAPOOR 医师	Use of BBL on all Indian skin types: a study of close to 600 patients	查看	149545

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紧肤

面部除皱 (非手术）

Francesca Mari SUMILANG SY ALVARADO 医师

皮肤科医师

菲律宾

其他作者 : Jose Victor Alexis R. Sy-Alvarado, Jadiel Nadine A. Tabuena-Uy

Laser fiber lifting and lipolysis with the 1470-nm wavelength: Our experience across different age groups

Objectives: We aim to discuss a series of cases with patients from age groups in the 30's to 60's who have undergone laser fiber lifting and lipolysis with the 1470-nm wavelength. This series will also present variations in treatment goals and corresponding settings, as well as individual variations in post-treatment care.

Introduction: There is an increased demand for skin tightening and facial contouring procedures with lasting results. The 1470-nm diode laser is an emerging option due to its cost-effectiveness as a non-surgical means of skin tightening via neocollagenesis and collagen remodeling, adipocytolysis, and improvement of skin quality via photobiomodulation.

Materials / method: All patients underwent laser fiber lifting and lipolysis through insertion of the 1470-nm diode laser fiber at the subdermal and subcutaneous planes. Different parameters were used depending on patients' goals (skin tightening only vs. fat loss vs. both), age, and facial characteristics. The treatments were done on the mid- to lower face, submentum, and neck. Some patients opted for additional treatment on the undereyes.

Results: Before and after photos show significant improvement in skin laxity, appearance of localized fat on the face and neck (e.g., jowling, submental fat), and prominence of facial folds. In younger patients, fat loss and facial contouring is a goal aside from skin tightening. In older individuals, fat loss is less desired and is only preferred in areas such as the jowls and submental fat.

Conclusion: The overall improvement in facial and neck characteristics are attributed to a "shrink-wrap effect" from the neocollagenesis and collagen remodeling induced by the 1470-nm diode laser. The improved skin quality is also attributed to the photobiomodulation brought about by this wavelength.

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Kumiko KOROMOHARA 医师

皮肤科医师

日本

其他作者 :

Anatomy-Based Optimization of HIFU and RF for Facial Rejuvenation: Clinical Evaluation of Diverse Device Characteristics

Objectives: This presentation aims to anatomically analyze age-related changes in facial structure and demonstrate that selecting appropriate non-invasive skin tightening devices—such as high-intensity focused ultrasound (HIFU), monopolar radiofrequency (RF), and other RF or laser-based technologies—based on those changes leads to successful clinical outcomes. The study also clarifies differences in treatment effects resulting from device-specific concepts and examines their influence on facial fat volume.

Introduction: In Japan, two major topics dominate discussions on non-invasive skin tightening: (1) how conceptual differences between devices affect treatment outcomes, and (2) whether these treatments reduce facial fat. However, the essence of facial aging lies in anatomical changes such as gravitational descent of superficial fat compartments and the weakening of supportive structures. Therefore, assessing how each device’s energy characteristics and depth of action respond to these anatomical aging patterns is crucial to achieving optimal clinical results.

Materials / method: Subjects aged 20–70 underwent treatments using multiple skin tightening devices, including HIFU and monopolar RF. Device selection was made based on individual anatomical findings. Three-dimensional imaging analysis was performed to evaluate skin and tissue movement, as well as volume changes, across 14 superficial facial fat compartments. Differences in tissue responses were analyzed based on each device’s mechanism of action.

Results: HIFU predominantly produced vertical lifting, particularly in the lateral facial regions, while RF induced multidirectional tissue mobilization, especially in the central face including the nasolabial area. No significant reduction in fat volume was observed with any device, confirming the ability to achieve lifting while preserving facial volume. Combination treatments tailored to anatomical goals yielded more pronounced lifting effects than either modality alone.

Conclusion: Accurate identification of anatomical aging changes and the selection of suitable HIFU or RF devices accordingly can greatly enhance the effectiveness of non-invasive skin tightening. This study provides clear answers to ongoing debates regarding differences in device concepts and concerns over fat reduction. As new technologies continue to emerge, understanding device mechanisms and designing anatomy-guided treatment plans will remain essential to successful facial rejuvenation.

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Young Seok SEO 医师

PhD - Research

韩国

其他作者 :

In Vivo Preclinical Evaluation of Thermal Safety for Monopolar RF Devices

Objectives: This study aims to evaluate the thermal safety of the monopolar RF medical device. The study used in vivo porcine skin to analyze thermal damage, inflammatory responses, and changes in skin condition. The goal is to verify the safety of RF-based skin treatment and explore its potential for human application.

Introduction: Radiofrequency technology has emerged as a leading modality for preserving facial elasticity due to its sustained effects and notable improvements in skin firmness and texture. RF therapy delivers high-frequency electrical currents that generate heat within the dermal layers, stimulating collagen remodeling and tissue tightening. This study provides objective, quantifiable data on temperature distribution and tissue responses, contributing valuable reference points for the broader development and evaluation of RF-based medical devices.

Materials / method: This study used a crossbred miniature pig weighing approximately 50 kg as the animal model. The procedure was performed under anesthesia using the monopolar radiofrequency device, with two different energy settings applied. Changes in the skin surface condition were visually assessed using a Folliscope. For histopathological analysis, various staining methods were employed. An infrared thermography camera was used to measure changes in skin surface temperature, the maximum intradermal temperature, and the depth of heat penetration.

Results: The small-area tip setting demonstrated noticeable efficacy, resulting in temporary erythema and mild epidermal damage that resolved entirely within 14 days. Histological analysis affirmed these findings, revealing only mild thermal effects and transient inflammation. The large-area tip exhibited exceptional performance with no visible abnormalities or histopathological issues. Notably, while the small-area tip generated higher surface temperatures, the large-area tip successfully achieved deeper heat penetration and covered a more extensive treatment area without any adverse effects.

Conclusion: This study represents the in vivo preclinical evaluation of the monopolar RF device, offering critical insights into the thermal safety of its treatment protocol. The results validate the high safety profile of the large area tip for skin applications, showing no adverse effects despite deeper thermal penetration. Furthermore, the study provides objective, quantifiable data on temperature distribution and tissue responses, contributing valuable reference points for the broader development and evaluation of RF-based medical devices.

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请注明名称（个人，公司，学会等等）: WONTECH Co., Ltd.

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这项工作的完成感谢以下机构的支持： WONTECH Co., Ltd.

Kenta FUJIO 医师

皮肤科医师

日本

其他作者 :

Fractional HIFU for Non-Invasive Skin Tightening and Rejuvenation focusing on the 1.5mm and 2.0mm treatment cartridges

Objectives: To present the unique clinical application of fractional high-intensity focused ultrasound (HIFU), which can be performed without anesthesia. Attendees will learn how dot- and pen-type cartridges at 1.5 mm and 2.0 mm depths effectively deliver thermal energy to the dermis, promoting collagen remodeling and skin tightening. The session will also provide comparative insights into differences between this approach and high-intensity parallel beam ultrasound devices in terms of pain, depth targeting, and treatment flexibility.

Introduction: Skin laxity from collagen loss due to aging or excess skin after liposuction or rapid weight loss is a serious concern. Treatments like radiofrequency or thread lifts often lack effectiveness and longevity. While high-intensity parallel beam ultrasound targeting 1.5 mm shows tightening effects, pain and cost remain issues. Our clinic utilizes a fractional HIFU system designed to deliver controlled thermal energy precisely into the dermis using dot and pen-type cartridges (1.5 mm/2.0 mm), promoting collagen remodeling for skin tightening and rejuvenation.

Materials / method: Patients aged 20 and older who visited our clinic between February and March 2025 were included. High-intensity focused ultrasound (HIFU) was performed on the full face and neck, delivering 400–1000 shots. Cartridges included 2.0 mm dot-type and 1.5 mm dot-type and pen-type transducers. Standardized facial photos were taken before, immediately after, and 2 and 4 weeks post-treatment using a smartphone camera and a 3D imaging system. Pain was evaluated immediately post-treatment using an 11-point numerical rating scale (NRS).

Results: Four participants (mean age 43.6, median 44), all female, were included. VECTRA 3D showed skin laxity improvement immediately after treatment compared to baseline, with continued improvement at one month. All procedures were performed without anesthesia. The average pain score was 4.0 ± 2.3 on the NRS. No adverse effects such as burns or nodules were observed. One patient showed improvement in pre-existing acne.

Conclusion: Our fractional HIFU is an effective treatment for skin tightening and rejuvenation, particularly for skin laxity caused by excess skin. Notably, it can be performed without anesthesia and utilizes an existing HIFU platform in a unique way to achieve dermal tightening effects. This approach offers a distinctive, minimally invasive option for patients seeking both efficacy and comfort in non-surgical skin laxity treatments.

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Karen Florencia DE LOS SANTOS 医师

医师

乌拉圭

其他作者 : Dr. Florencia de los Santos

Neuroaesthetics and Facial Harmonization: Image, Self-Esteem, and Mental Health

Objectives: This presentation aims to explore the scientific foundations of facial harmonization through the lens of neuroaesthetics. It will examine how facial proportions and symmetry impact brain perception, self-image, and emotional well-being. The session will provide medical insights into the role of aesthetic interventions in improving self-esteem and promoting mental health, based on current evidence and clinical experience.

Introduction: Facial harmonization has evolved beyond aesthetic enhancement to become a tool for improving self-perception and emotional well-being. Grounded in neuroaesthetics, this presentation explores how the brain processes facial balance and beauty, and how medical interventions can positively influence self-esteem and mental health. Understanding the neurobiological impact of facial aesthetics opens new dimensions in patient-centered care.

Materials / method: A narrative review of scientific literature was conducted, focusing on recent studies related to neuroaesthetics, facial harmonization, and their psychological impact. In addition, clinical insights are drawn from over 10 years of medical experience in aesthetic medicine, integrating evidence-based practice with real-world patient outcomes.

Results: Scientific literature confirms that facial symmetry, proportion, and balance positively influence neural reward circuits and self-perception. Clinically, patients undergoing facial harmonization report increased self-esteem, improved emotional well-being, and enhanced social confidence. These outcomes support the role of facial aesthetics as a therapeutic tool beyond beauty, contributing to mental health and quality of life.

Conclusion: Facial harmonization, when approached from a neuroaesthetic and clinical perspective, transcends cosmetic goals. It becomes a valuable medical intervention to support self-esteem and emotional well-being. Understanding the neurological and psychological impact of aesthetic treatments allows for more comprehensive, patient-centered care. Beauty, in this context, is not superficial—it is a reflection of internal balance and health.

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Sheena KAPOOR 医师

皮肤科医师

印度

其他作者 :

Potpourri of Interesting Cases In Histopathology of Dermatological Diseases

Objectives: I present here an assortment of diverse and interesting cases with study of their clinical, histopathological and dermoscopic features. Awareness of occurrence of such cases and their atypical presentation is necessary to avoid misdiagnosis and for initiation of appropriate treatment along with better outcome in such patients. The importance of clinicopathological outcome and dermoscopic findings in such cases have also been discussed.

Introduction: As we know dermatopathology plays an important role not only in interpreting accurate diagnosis of unusual skin disorders but also helps in specific treatment an disease prognosis. Discussing here, few interesting cases in dermatopathology ranging from vascular and lymphatic malformations to genodermatoses to cutaneous dermatoses/infections and cutaneous tumours.

Materials / method: not a study

Results: not a study

Conclusion: The importance of clinicopathological outcome and dermoscopic findings in rare and interesting dermatological cases have also been discussed.

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Fairouz ROUABHIA 医师

医师

土耳其

其他作者 :

Hair transplant and Exosomes

Objectives: Hair Loss and Exosome Therapy
By the end of this learning module, learners will be able to:
1. Understand the Causes of Hair Loss
2. Describe the Role of Exosomes in Regenerative Medicine
3. Explain How Exosome Therapy is Used to Treat Hair Loss
4. Evaluate the Efficacy and Safety of Exosome Therapy
5. Understand the Procedure and Patient Considerations

Introduction: Hair loss is a common concern that affects millions of people worldwide, often impacting self-confidence and quality of life. While many treatments exist—like medications, hair transplants, and lifestyle changes—newer and more advanced therapies are being explored. One of the most promising areas of research involves exosomes.

Materials / method: 1. Study Design
A controlled study was conducted to evaluate the effects of exosome treatment on hair regeneration in models of androgenetic alopecia (AGA).
2. Materials
2.1 Exosome Preparation
• Source: Human mesenchymal stem cells (MSCs) derived from adipose tissue / Rose derived stem cells.
3. Methods
3.1 Exosome Treatment
• Scalp injections administered monthly for multiples sessions.
3.2 Assessment Techniques
• Gene Expression: qRT-PCR for hair growth-related genes (e.g., VEGF, IGF-1, β-catenin).
• Hair Density /Length Measurements: Trichoscopy.

Results: Clinical cases shows that exosomes can induce hair growth by transitioning hair follicles from the telogen (resting) phase to the anagen (growth) phase. Additionally, exosomes from adipose-derived stem cells (ADSCs) and roses have been shown to stimulate proliferation and migration of DPCs, further promoting hair growth.

Conclusion: Exosome therapy represents a promising frontier in the treatment of hair loss, offering a regenerative and minimally invasive approach that harnesses the body’s own cellular communication system. By delivering powerful growth factors and signaling molecules directly to hair follicles, exosomes can potentially stimulate hair growth, improve scalp health, and reverse thinning. Exosomes may become a key player in the future of hair restoration.

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Thi Thanh Phuong NGUYEN 医师

皮肤科医师

越南

其他作者 :

MULTIMODAL THERAPY FOR CORTICOSTEROID-INDUCED ROSACEA-LIKE DERMATITIS

Objectives: To explore the rationale and clinical efficacy of a multimodal treatment strategy in managing corticosteroid-induced rosacea-like dermatitis.

Introduction: Corticosteroid-induced rosacea-like dermatitis (CIRD) induced by prolonged or inappropriate use of topical corticosteroids presents a therapeutic challenge due to its chronic inflammation, skin barrier disruption, vascular changes and patient hypersensitivity. Multimodal therapy has emerged as an effective approach to address the complex pathophysiology of this condition.

Materials / method: This approach integrates anti-inflammatory agents, skin barrier repair formulations, vascular changes and microbiome-modulating therapies; including topical anti-inflammatory agents (e.g., calcineurin inhibitors, metronidazole), barrier-repair moisturizers, systemic agents such as low-dose doxycycline and topical probiotics. In addition, vascular-targeted lasers (e.g., pulsed dye laser) and EBDs (e.g., intense pulsed light – IPL) are employed to reduce persistent erythema, telangiectasia, and inflammation. These technologies also contribute to skin rejuvenation and microbiome modulation.

Results: Multimodal therapy has demonstrated significant improvements in symptom control, reduced flare frequency, and enhanced skin tolerance. Early corticosteroid withdrawal, patient education, and tailored regimens based on disease severity are critical to therapeutic success.

Conclusion: A comprehensive multimodal treatment strategy offers a safe and effective pathway for managing corticosteroid-induced rosacea-like dermatitis, addressing both symptom relief and long-term skin health restoration.

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Saowapak PONGSASITORN 医师

皮肤科医师

泰国

其他作者 :

Dual-Molecular PDLLA Injection for Full-Face Rejuvenation and Lifting

Objectives: 1. Understand the principles and characteristics of dual-molecular PDLLA biostimulators.
2. Learn a personalized injection technique using small and large PDLLA for full-face rejuvenation and lifting.
3. Apply targeted PDLLA injection mapping to address volume loss, skin laxity, and texture refinement.

Introduction: - This presentation proposes a structured, dual-molecular PDLLA injection protocol as a novel alternative to conventional fillers for full-face rejuvenation. By integrating small and large particle types across anatomical zones, the technique provides natural volumization, contour lifting, and skin refinement. With growing concern over filler-related complications, this method represents a forward-looking, safe, and reproducible injectable strategy in aesthetic medicine.

Materials / method: - Small-particle PDLLA was reconstituted with 5 cc normal saline and 1 cc Xylocaine (no adrenaline), injected into infraorbital and medial midface using fanning and bolus techniques in sub-dermal plane. Large-particle PDLLA was mixed with 7 cc normal saline and 1 cc Xylocaine, injected via fanning technique into temporal, zygomatic arch, preauricular, and jawline areas for volumization and lifting. Both used 25G cannula or 30G needle depending on area.

Results: - Visible facial lifting observed 1 month post-treatment with dual-molecular PDLLA. Brow elevation, jawline contour, and infraorbital hollowness improved. Skin showed enhanced firmness, refined texture, and reduced pore size. Rejuvenation effects were seen across treated areas. No major adverse events reported. Technique highlights the synergy of small and large PDLLA in layered facial biostimulation.

Conclusion: - This study supports the efficacy of dual-molecular PDLLA injection for full-face rejuvenation. Objective improvements were observed in brow elevation, jawline definition, pore size reduction, and skin texture at 1-month follow-up. No significant adverse events were reported. The protocol demonstrates a safe, anatomy-guided, and customizable approach with high patient satisfaction and minimal downtime.

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Su Phyo AUNG 医师

皮肤科医师

缅甸

其他作者 :

A Review of Novel Approaches in Melasma Management

Objectives: This review explores the latest treatment strategies for managing melasma, focusing on advancements in topical and oral agents, energy-based devices, bio-regenerative therapies, and combination approaches. By evaluating these emerging therapies, the review aims to assess their effectiveness, safety, and potential for improving clinical outcomes, while emphasizing strategies to minimize the risk of recurrence, which remains a significant challenge in the long-term management of melasma.

Introduction: Melasma is a chronic pigmentary disorder, most common in individuals with darker skin tones, and is caused by a combination of factors like genetics, hormonal imbalances, and sun exposure. Due to its complex nature, melasma has a high recurrence rate, and complete cure is not possible, making long-term management the main goal. Conventional treatments, such as hydroquinone and sunscreen offer limited success and unpredictable results. Recently, newer therapies have shown promise in treating stubborn melasma by targeting different components of its etiology, including pigmentation, vascular fac

Materials / method: This review compiles and analyzes recent studies on emerging therapies for melasma. It focuses on novel topical treatments like tranexamic acid and cysteamine, as well as advancements in laser technologies including laser toning, fractional lasers, picosecond lasers, and pulse-type MNRF. Additionally, regenerative therapies such as exosomes, PDRN, and PDLLA are explored. Studies on combination therapies that integrate these approaches were reviewed to determine the most effective treatment protocols for improving patient outcomes in melasma management.

Results: Novel topical agents like cysteamine have shown significant improvements in reducing pigmentation with fewer side effects than traditional treatments. Low-fluence Q-switched laser toning and picosecond lasers have also been more effective in treating melasma, minimizing risks of post-inflammatory hyperpigmentation and hypopigmentation. Addressing solar elastosis has led to better outcomes in resistant cases. Studies suggest that combining these treatments enhances overall results, offering longer-lasting benefits and reducing the recurrence of melasma.

Conclusion: Emerging treatments in melasma, including advanced topical agents, energy-based devices, and bio-regenerative therapies, offer significant improvements over traditional methods. Combination approaches, which target multiple aspects of melasma like pigmentation, vascular issues, and photoaging, have shown the most success. While these innovations provide hope for better outcomes, recurrence remains a challenge, and further research is needed to enhance treatment protocols and long-term effectiveness.
 

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Hosung CHOI 医师

美容整型外科医师

韩国

其他作者 : None

Topical Management of Melasma Using Microinvasive Peptide & Tranexamic Acid Delivery: A Novel Approach Using Spicule-Mediated Delivery System

Objectives: To evaluate the efficacy of a novel microinvasive treatment for melasma using spicule-mediated delivery in combination with topical agents.

To enhance pigment reduction and skin regeneration by improving transdermal delivery and addressing the root causes of dermal pigmentation recurrence.

Introduction: Melasma is a chronic, relapsing pigmentation disorder caused by UV-stimulated tyrosinase activity and basement membrane damage due to MMP-driven collagen degradation. Conventional treatments like lasers and peels reduce surface pigment but often fail to resolve deeper structural damage, resulting in high relapse rates and limited durability.

Materials / method: Spicule-mediated delivery uses 16 μm mineral spicules to create approximately 1.5 million microchannels per session, allowing signal peptides to reach the papillary dermis. These peptides, activated by glutathione, stimulate collagen regeneration. A topical booster containing tranexamic acid, glutathione, and exosomes was applied immediately post-treatment.

Results: Clinical results showed that combining spicule-mediated delivery with a topical booster achieved up to 182% greater pigment reduction compared to spicules alone. The synergistic method enhanced melanin clearance, supported basement membrane repair, and improved epidermal renewal, offering superior clinical outcomes in melasma management.

Conclusion: Spicule-mediated delivery presents a safe, non-invasive alternative for treating melasma. When combined with active topical agents, it targets both pigment formation and structural damage, offering a comprehensive and long-lasting solution for pigment reduction and skin health restoration.

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Monisha KAPOOR 医师

整形外科医师

印度

其他作者 :

Use of BBL on all Indian skin types: a study of close to 600 patients

Objectives: To evaluate the safety and effectiveness of Broadband Light (BBL) therapy, particularly BBL Hero, across all Indian skin types (Fitzpatrick types IV–VI), and to explore its expanded applications in treating conditions such as postoperative scars, keloids, hemangiomas, and melasma.

Introduction: Broadband Light (BBL) therapy is an advanced form of Intense Pulsed Light (IPL) technology. While Western literature suggests BBL is not ideal for darker skin tones due to higher risks of burns and post-inflammatory hyperpigmentation, this study investigates its efficacy and safety on Indian skin types. Our centre is currently the only one in India equipped with the Sciton BBL Hero device, allowing us to explore its full therapeutic potential.

Materials / method: A study was conducted on approximately 600 Indian patients with Fitzpatrick skin types IV to VI. BBL Hero was used to treat a range of conditions, including postoperative scars, keloids, hemangiomas, and melasma. Customized treatment parameters were applied based on individual conditions. In melasma cases, Visia scans guided the use of BBL, melasma due to deep dermal pigmentation, BBL vascular was added along with pigmentation mode to clear off the melasma in 2-3 sessions. The response was assessed over multiple sessions, with most patients showing significant results in 2–3 sittings.

Results: BBL Hero showed promising results across all Indian skin types with no significant adverse effects such as burns or hyperpigmentation. Melasma patients demonstrated visible improvement, particularly with the combined use of vascular and pigmentation modes. Remarkable outcomes were also observed in the treatment of keloids, hemangiomas, and postoperative scars, indicating broader applicability of the technology in pigmented skin types. The most interesting usage of the BBL was its effect on keloids.

Conclusion: This study confirms that BBL Hero is a safe and effective treatment for various dermatological concerns in Indian skin types. Its versatility in addressing difficult conditions like melasma and keloids opens new avenues for non-invasive aesthetic treatments in darker skin tones, challenging previous limitations suggested by Western studies.

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