Aesthetic surgery journal. Open forum最新文献

Background: Acellular dermal matrices (ADMs) originate from various tissues and are manufactured by different processes, which can influence material properties that affect host response upon implantation.

Objectives: The aim of the study was to compare material properties and host responses to ADMs derived from human or porcine dermis.

Methods: The morphology of commercially available ADMs (human-derived AlloDerm [hADM], porcine-derived Strattice Pliable [pADM-S], and porcine-derived Artia [pADM-A]) was evaluated through bright-field and scanning electron microscopy and compared with unprocessed human and porcine dermis. Collagen melting temperatures were assessed through differential scanning calorimetry. Host responses to ADMs were assessed in rat (pADM-A and pADM-S) and nonhuman primate (NHP) models (pADM-A, pADM-S, and hADM). Histologic responses were evaluated for inflammation, fibroblast infiltration, and revascularization.

Results: Morphologically, the extracellular matrix structures of hADM, pADM-A, and native human dermis were similarly loose, whereas the structures of pADM-S and native porcine dermis were tighter. Collagen melting temperatures were similar across all samples. Following 20 h exposure to collagenase enzyme, hADM retained the most undigested collagen, followed by pADM-A, then pADM-S. Following 2 and 4 weeks of implantation in the rodent and NHP models, pADM-A yielded the most favorable host response with ample cell infiltration, vascularization, and minimal inflammation vs other implanted ADMs. Minimal-to-moderate inflammatory responses were observed for all materials; hADM and pADM-A demonstrated the lowest responses.

Conclusions: In both short-term preclinical implantation models, comparable morphologies and biochemistry of pADM-A and hADM allowed for similarly favorable host responses vs pADM-S. All ADMs assessed demonstrated responses consistent with a favorable regenerative mechanism of action.

Level of evidence 4 therapeutic:

Background: Use of autologous flaps for postmastectomy reconstruction has increased. Public forums offer large-scale patient narratives that can be analyzed with natural language processing (NLP) models, such as RoBERTa.

Objectives: This study aims to assess patient-reported sentiment and emotions toward autologous reconstruction with deep inferior epigastric perforator (DIEP), transverse rectus abdominis myocutameous (TRAM), and latissimus dorsi (LD) flaps.

Methods: Public reviews from RealSelf (Seattle, WA) referencing DIEP, TRAM, or LD flaps were collected. Two NLP models were applied: (1) a binary sentiment classifier (positive/negative) and (2) an emotion model scoring fear, sadness, anger, disgust, neutral, surprise, and joy; each review was labeled by its highest-scoring emotion.

Results: Two hundred and twelve posts were analyzed: 153 DIEP, 20 TRAM, and 39 LD. DIEP had the highest mean positive sentiment (0.627); TRAM had the lowest (0.517). In the emotion model, "joy" was most common for DIEP (68/153; mean 0.389) and TRAM (7/20; mean 0.299). LD posts were most often "neutral" (9/39; mean 0.267).

Conclusions: NLP of public patient reviews suggests DIEP flaps are the most discussed and are associated with more positive sentiment than TRAM or LD reconstructions. Emotion profiles indicate generally joyful narratives for DIEP, neutral for LD, and comparatively less positive for TRAM. This approach complements traditional outcomes research by capturing real-world patient experience at scale.

Level of evidence 3 therapeutic:

Background: Rhinoplasty is acknowledged as one of the most commonly conducted facial plastic surgical procedures worldwide. Periorbital ecchymosis and edema pose considerable postoperative complications that influence patient satisfaction and recovery duration.

Objectives: This study aimed to examine the impact of local tranexamic acid (TXA) infiltration on periorbital ecchymosis and edema in patients undergoing rhinoplasty.

Methods: A randomized, triple-blind, controlled trial was conducted involving 80 patients scheduled for primary open septorhinoplasty at our university hospital between 2021 and 2022. Participants were randomly allocated to receive either local infiltration consisting of TXA (1 mg/mL) combined with lidocaine and epinephrine (n = 40) or a control solution containing identical components, except TXA (n = 40). Periorbital ecchymosis and edema were evaluated at 24 h and 1 week postoperatively, utilizing a standardized scale.

Results: No significant differences were observed between the TXA and control groups regarding periorbital edema at 24 h (P = .965) and 1 week (P = 1.000) postoperatively. Additionally, periorbital ecchymosis showed no substantial difference between the groups at 24 h (P = .597) or 1 week (P = .063). Intraoperative bleeding was marginally reduced in the TXA group (39.38 ± 23.699 vs 43.13 ± 26.435 mL), although this difference did not achieve statistical significance (P = .506).

Conclusions: The local infiltration of TXA did not lead to a statistically significant reduction in periorbital edema, ecchymosis, or intraoperative bleeding among rhinoplasty patients compared with a placebo. These findings suggest that local infiltration may not provide the same benefits in rhinoplasty procedures as those documented with systemic administration routes.

Level of evidence 2 therapeutic:

Background: Caudal septal deviation is a challenging condition that affects nasal function and aesthetics.

Objectives: The aim of the study was to evaluate surgical practices for caudal septoplasty among otolaryngologists in Saudi Arabia and compare them with international approaches.

Methods: A cross-sectional electronic survey was distributed to otolaryngologists across academic, governmental, and private healthcare institutions in Saudi Arabia. A parallel systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines using PubMed, Web of Science, and Scopus. Eligible studies published between 1954 and 2024 described techniques addressing caudal septal deviation with reported outcomes. The study protocol was prospectively registered before the study's start in PROSPERO (CRD42024621207).

Results: Sixty otolaryngologists completed the survey. The most commonly used techniques were swinging door (76.6%), cartilage reshaping (51.7%), and suturing (48.3%). Only 16.7% had facial plastic surgery training. In the systematic review, 559 records were identified with 53 studies meeting the inclusion criteria involving 3564 patients, splinting or grafting (47.2%), and cartilage reshaping (30.2%) predominated. Patient-reported outcome measures (PROMs) were used in 66% of studies, primarily the Nasal Obstruction Symptom Evaluation scale, with scores improving from 70.2 to 16.1 postoperatively.

Conclusions: Otolaryngologists in Saudi Arabia predominantly employ conservative caudal septoplasty techniques, with limited adoption of extracorporeal approaches and PROMs. These findings contrast with broader international practices and highlight the need for enhanced subspecialty training and standardized outcome evaluations.

Level of evidence 5 therapeutic:

Surgery results in external scars and internal scars (subcutaneous fibrous banding). Although external scarring is well understood, internal fibrous banding is less studied, despite its impact on comfort, mobility, and recovery in surgical patients. Alastin ReFORM & RePAIR COMPLEX with TriHex Technology (R&R) is a peptide-based formula that remodels the extracellular matrix (ECM). It has been tested in multiple clinical trials, showing it stimulates autophagy and macrophage repolarization. The aim was to outline the mechanistic and clinical evidence related to both internal and external scarring. They conducted a secondary analysis of 3 split-body clinical trials, with proposed mechanistic explanations extrapolated. Endpoints assessed included patient-reported outcome measures, blinded investigator ratings, ultrasound, histology, and photographic scar evaluations. Cellular secretome, interleukin-6 (IL-6) modulation, and autophagic clearance of lipid droplets and ECM remodeling provide a mechanistic explanation for the observed effects. In body contouring procedures, R&R significantly accelerated the resolution fibrous banding compared with comparators in split-body studies. Ultrasound confirmation and histology showed reconstituted ECM on the R&R-treated side. External scar assessment revealed improved subjective scar quality over time. These outcomes are mechanistically linked to the autophagic clearance of lipid droplets, ECM remodeling, and macrophage polarization, which are influenced by IL-6 and modulate the transition from inflammation to regeneration. R&R influences the spectrum of surgical scarring, affecting both internal and external scars. The scar spectrum broadens traditional views of postoperative healing, emphasizing internal fibrous banding as a measurable outcome and positioning a topical formulation as a credible additional tool in perisurgical care. Level of Evidence: 2 (Therapeutic).

The Schnur sliding scale is used by many insurance companies to determine eligibility for reduction mammaplasty. However, it overlooks anatomical features, symptoms, and physical findings, leading to inequities in coverage determinations. The aim of the study was to develop and validate the anatomical breast burden (ABB) model-a 0-6-point scoring system that quantifies the burden of breasts using breast measurements, physical findings, and symptoms-as an alternative tool to the Schnur scale. A retrospective chart review was conducted for 84 patients who underwent breast reduction at a single academic center. Resection weights, Schnur threshold weights, demographics, and preoperative breast measurements were recorded. ABB cutoff values for sternal notch-to-nipple, nipple-to-inframammary fold, and base width distances were determined statistically, and a score was assigned to each patient. Spearman correlation tested the associations between ABB score and BMI, body surface area, breast measurements, ptosis, resection weight, and the discrepancy between actual resection weight and the Schnur threshold weight. Among patients with an ABB score of 6 (very severe burden), 44% were ineligible for coverage under the Schnur scale, whereas 33% of patients with an ABB score of 2 (mild-to-moderate burden) were eligible. When stratified as low (0-2) and high (3-6) burden, the Schnur scale showed 47.5% sensitivity and 66.7% specificity for identifying patients with significant breast burden. Our model demonstrated stronger correlations with anatomical measurements and resection weight than the Schnur scale. The ABB model better reflects true breast burden and offers a more equitable tool for guiding coverage decisions in breast reduction. Level of Evidence: 3 (Therapeutic).

Background: Female genitourinary aging (because of childbirth, menopause, weight changes, and aging) causes genital shrinking, vaginal laxity, dyspareunia, and urinary issues, impairing quality of life. Current treatments (lubricants, hormone creams, and laser) are temporary, have drawbacks, or lack clear guidelines. Autologous fat grafting (AFG) enables safe volumization, and platelet-rich plasma (PRP) promotes tissue repair, but evidence for their combination here is scarce.

Objectives: The aim of this study was to explore the clinical efficacy and safety of AFG combined with PRP in female external genitalia and vaginal rejuvenation.

Methods: A retrospective study included 38 patients (January 2020 to December 2024) with genital/vaginal aging who received combined AFG (mons pubis, labia majora, G-spot, and perineum) and PRP. Postoperative evaluations were performed with the Vaginal Laxity Questionnaire (VLQ) and the Female Sexual Function Index (FSFI), and complication monitoring was conducted.

Results: Postoperative VLQ scores rose from 2.45 ± 0.81 to 5.03 ± 1.15 (P = .027). All 6 dimensions of the FSFI (sexual interest, sexual arousal, vaginal lubrication, orgasm, sexual satisfaction, and dyspareunia) and the total FSFI score also significantly improved (all P < .05), with a mean total FSFI increase of 9.0 ± 2.3 points (a ≥4-point increase is clinically meaningful); 92.1% (35/38) were "very satisfied" with appearance/tightness. Only 2 (5.3%) experienced mild redness (resolved with oral antibiotics); no severe complications occurred.

Conclusions: In this small cohort with limited follow-up, AFG combined with PRP treatment appears to improve the external appearance of female external genitalia and vaginal aging and enhance genital function, improve patient-reported sexual function (based on FSFI) and reduce urinary system problems.

Level of evidence: 4 (Therapeutic).

Horizontal neck lines are a common aesthetic concern among aging and younger populations. Hyaluronic acid (HA) fillers are increasingly used in this region, yet their effectiveness, safety, and optimal application strategies remain under-investigated. This systematic review and meta-analysis, conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024550863), aimed to evaluate the efficacy and safety of HA fillers for horizontal neck lines. Comprehensive searches of Ovid MEDLINE and Embase were performed up to May 2024. Eleven studies (n = 379) met the inclusion criteria. Pooled analysis demonstrated significant improvements in the Global Aesthetic Improvement Scale (mean, 1.75, 95% CI, 1.53-1.96) and wrinkle grading (mean difference, 1.43, 95% CI, 0.72-2.15). Instrumental assessments confirmed enhancements in hydration, elasticity, and dermal structure. The pooled retreatment rate within 12 months was 50%, and the complication rate 14%, with only mild, transient effects reported. Patient satisfaction was consistently high. In summary, HA fillers represent an effective and well-tolerated option for treating horizontal neck lines, producing sustained improvements in both aesthetic appearance and skin quality. Level of Evidence: 4 (Therapeutic).