> ## Content Index > Fetch the complete content index at: https://www.theplasticsfella.com/llms.txt > Use this file to discover other available public pages before exploring further. # Tariffs on Toxins,3 Extensor Tendon Truths, & Your Next Journal Club Pick - URL: https://www.theplasticsfella.com/april-13th/ - Published: 2025-04-11T18:52:39.000Z - Updated: 2025-04-11T18:58:25.000Z - Description: Also: Kessler technique in action, EURAPS annual meeting, & the Sunday quiz. - Author: PlasticsFella - Tags: thePlasticsPaper #### In this week's edition 1. ****✍️** [****Letter from P'Fella**](https://www.theplasticsfella.com/april-13th/#a-letter-from-pfella) Trump’s tariffs are coming for your forehead lines! 2. ****🤓** [****The Sunday Quiz**](https://www.theplasticsfella.com/april-13th/#the-sunday-quiz) How well do you know **extensor tendon injuries*? 3. 🖼️ [****Image of the Week**](https://www.theplasticsfella.com/april-13th/#image-of-the-week) Zone VI extensor tendon injury. 4. ****🚑** [****Technique Tip**](https://www.theplasticsfella.com/april-13th/#technique-tip) Kessler tendon repair in action. 5. ****🎈** [****Upcoming Events**](https://www.theplasticsfella.com/april-13th/#upcoming-events) New event added! 6. 🎓 [****JPRAS Journal Club**](https://www.theplasticsfella.com/april-13th/#jpras-journal-club) Make your call on the next article! 7. 📖 [****What Does the Evidence Say**](https://www.theplasticsfella.com/april-13th/#what-does-the-evidence-say) What's the best repair technique for extensor tendons? 8. ****🔥** [****Articles of the Week**](https://www.theplasticsfella.com/april-13th/#articles-of-the-week) Managing open extensor tendon injuries, repair for partial extensor tendon lacerations, & post extensor tendon repair protocols: with 1-sentence summaries. 9. 💕 [****Feedback**](https://www.theplasticsfella.com/april-13th/#feedback) Suggest ideas & give feedback! ## A Letter from P'Fella **Trump’s Tariffs Are Coming for Your Forehead Lines!* 👋 ****Hey Team!** **Botox might be Irish, but it’s not immune to American politics.* President Trump’s latest tariff blitz could hit closer to the face than you'd think. A 10–26% hike on imports from Europe and Asia? That’s not just bad news for iPhones — it’s coming for your neuromodulators and fillers. **Yes, your Botox might soon cost more.** ### The Hidden Geography of Injectables Let’s map it out. - **Botox:** Made in *Westport, Ireland* (yep, population 5,000). - **Xeomin:** Straight out of *Germany*. - **Jeuveau & Letybo:** Born in *South Korea*. - **Sculptra & Restylane:** Shipped from *Sweden*. - **U.S.-made** options? Just a few: **Daxxify** (*California*), **Radiesse** (*Wisconsin*). Bottom line? Injectables run on a global supply chain — and tariffs are about to poke that pipeline. ### The Price Is Not Right (Yet) “It becomes an issue if, because of tariffs, they increase my wholesale pricing, which means I have to charge patients more money.” — **Dr. Roy Kim**, Plastic Surgeon, San Francisco ([Allure](https://www.allure.com/story/will-tariffs-make-botox-filler-more-expensive?ref=theplasticsfella.com)) So far, many injectables are protected by a pharmaceutical exemption — but that’s just policy, not law. If that changes, prices won’t just rise — they’ll spike. Fillers and other injectables classified as *devices* aren’t protected. Evolus has already flagged that its upcoming **Evolysse** range may take a tariff hit. That uncertainty? It’s already inflating forecasts. ### The Real Takeaway This isn’t just about Botox — it’s about a specialty built on global supply chains. When one country imposes a tariff, every aesthetic practice downstream feels it. If exemptions tighten and prices rise, clinics may have to: - Pass the cost to patients - Absorb the margin loss - Or finally give Daxxify the moment it’s been waiting for But this isn’t just a pricing issue — it’s a reminder that our beauty economy is more global than we like to admit. With Love (and tariffs), P’Fella ❤️ ## The Sunday Quiz **How Well Do You Know Extensor Tendon Injuries?* ****Are you ready to make it to the leaderboard?** Welcome to the ****next round** of The Weekly Quiz. Each edition of thePlasticsPaper includes a quiz question designed to challenge and engage our readers. Keep your wits about you and join in every week — the winner at the end of six rounds will earn you a one-year subscription to thePlasticsPro. --- ## Image of the Week **Zone VI Extensor Tendon Injury* 🖼️ ****Image of the Week** This week’s image illustrates a Zone VI extensor tendon injury. This AI-generated image depicts a laceration over the ****dorsum of the hand** — a common site for open tendon injuries following sharp trauma. Zone VI contains the ****extensor digitorum communis tendons** and lies ****superficial to the dorsal interosseous muscles**. Surgical repair in this zone often requires precise tendon reapproximation and careful handling of surrounding soft tissue. ![An AI-generated image of a zone VI extensor tendon injury.](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2025/04/Main-Article-Images---2025-04-10T191038.702-1-1.png) An AI-generated image of a zone VI extensor tendon injury. ## Technique Tip **Kessler Tendon Repair in Action* 🚑 ****Technique Tip of the Week** This week’s tip highlights the Kessler repair, a core suture technique used in ****flexor and extensor tendon repair**. It provides strong ****central fixation** with minimal bulk, which is ideal for early mobilisation protocols. The method uses a modified ****grasping loop configuration** to reapproximate tendon ends under tension. ▶️ Watch the repair in action below. ## Upcoming Events **New Event Added!* 📅 ****P’Fella’s event calendar** highlights the most impactful conferences, high-yield webinars, and carefully curated courses for you. You can also ****submit your event** and get it featured! We've just added the ****35th Annual Meeting of EURAPS** to our calendar; sign up below👇 ## JPRAS Journal Club **Make Your Call on the Next Article* 🗞️ We’re handing the mic to you. Help us decide which paper to feature in next month’s Journal Club. Two super insightful articles, one winner, and a full breakdown coming your way. Cast your vote below 👇 ## What Does the Evidence Say? **Optimal Techniques for Extensor Tendon Repair* In this section, we dive deep into the latest research and evidence on medical practices and surgical techniques. Extensor tendon injuries are common and require proper repair techniques for optimal outcomes. Various methods have been described, including ****figure-of-8 sutures** for zones I-II and ****core sutures with running sutures** for zones III-VII (Arvind et al., 2024). The ****mattress suture** technique is simpler and quicker for multiple small flat tendons, while augmented ****Kessler and cruciate techniques** are stronger for thicker tendons (Al-Asadi, 2024). The ****roll stitch** technique showed superior outcomes compared to core sutures at the metacarpophalangeal joint level (Namazi et al., 2016). ****Four-strand repair** techniques demonstrated better results than two-strand techniques (Abdella et al., 2019). The running interlocking horizontal mattress (****RIHM**) suture technique yielded superior results compared to the modified Kessler technique (Shaju et al., 2021). Repair outcomes may vary based on the zone of injury, with ****zones 5-8** showing ****better final flexion** than zones 1-4 (Dalton et al., 2023). Early controlled motion protocols can improve tendon gliding after repair (Abdella et al., 2019). ## Articles of the Week **3 Interesting Articles with One-Sentence Summaries* ✅ ****Concepts in the Management of Open Extensor Tendon Injuries** ([Amirtharajah & Lattanza](https://www.jhandsurg.org/article/S0363-5023%2814%2900986-1/abstract?ref=theplasticsfella.com), 2015) Despite their superficial location, extensor tendon injuries demand precise zone-based management and adherence to evolving repair and rehabilitation strategies to optimise functional recovery. ✅ ****Is Repair Always Necessary for Partial Extensor Tendon Lacerations?** ([Dickson](https://www.jprasurg.com/article/S1748-6815%2823%2900330-3/abstract?ref=theplasticsfella.com), 2023) Contrary to common practice, evidence suggests partial extensor tendon lacerations may heal just as well without surgical repair, raising questions about the necessity of routine intervention. ✅ ****Early Motion & Relative Motion Splints in Extensor Tendon Repair** ([Merritt](https://journals.lww.com/plasreconsurg/abstract/2020/03000/recent%5Fdevelopments%5Fare%5Fchanging%5Fextensor%5Ftendon.44.aspx?ref=theplasticsfella.com), 2020) Early protected mobilization using relative motion splinting, combined with WALANT techniques is reshaping extensor tendon management, enabling functional recovery to begin as early as day 3 post-repair. ## Feedback ### I hope you enjoyed it 😄 ---