Aesthetic surgery journal. Open forum最新文献

[This corrects the article DOI: 10.1093/asjof/ojae097.].

Autologous costal cartilage (ACC) is commonly used for dorsal augmentation rhinoplasty because of its availability and strength, despite risks such as hypertrophic scarring and pneumothorax for the patient. Irradiated homologous costal cartilage (IHCC) offers an alternative, potentially mitigating these complications. Previous reviews comparing these materials have been methodologically weak. The aim of this study is to perform a robust systematic review and meta-analysis comparing the outcomes of ACC and IHCC in dorsal augmentation rhinoplasty to guide clinical decision making in nasal reconstruction. Medline, Embase, Google Scholar, and the Cochrane Central Register of Controlled Trials databases were searched. Data extraction and quality assessment were performed by 2 independent authors. The primary outcomes of interest were warping, revision rates, infection rates, and displacement. Methodological quality and risk of bias were assessed using Grading of Recommendations Assessment, Development, and Evaluation and Cochrane's ROBINS I tool, respectively. Thirty-six articles were reviewed, including 1 comparative and 35 single-arm studies (ACC: 29, IHCC: 8), encompassing 2526 patients from 13 countries. Adverse events included warping (ACC: 6%, P < .0001; IHCC: 6%, P < .0001). Resorption rates were 1% for ACC (P = .06) and 3% for IHCC (P < .0001). Revision surgery rates were similar (ACC: 4%, P < .001; IHCC: 4%, P < .001), as were infection rates (ACC: 1.8%, P = .03; IHCC: 1.3%, P = .03). Current evidence does not demonstrate the superiority of ACC or IHCC for dorsal augmentation rhinoplasty. Both grafts are viable, with the choice guided by patient and surgeon preferences. Prospective, high-quality data with standardized outcomes are needed to improve clinical decision making.

Level of evidence 2 risk:

In this bibliometric analysis, the authors analyze the top 100 (T100) most cited articles on cosmetic upper facial plastic surgery. Throughout this study, the objective of the authors is to delineate the trends in cosmetic upper facial surgeries to identify prevailing techniques, emerging trends, and potential areas of future investigation. The articles were indexed from the Web of Science database and were extracted in a double-blinded manner by 2 independent graders. The search phrase used covered a wide range of cosmetic upper facial plastic surgeries, of which a short sample is included: ("cosmetic*" AND "bleph*") OR ("cosmetic*" AND "upper eyelid blepharoplasty") OR ("cosmetic*" AND "lower eyelid blepharoplasty"). In their statistical analysis of the number of citations received in each article in the T100, the authors reveal an average of 55.1 citations (a standard deviation of 38.7). Surgical methods were the most commonly cited unique study area, with 30% of the T100, followed by botulinum toxin and complication management with 29% and 15% of the T100, respectively. The unique study area with the highest average citations received was botulinum toxin, with an average of 64.7 citations. Invasive procedures made up 55% of the T100 articles. The authors found that the late 1990s and 2000s were a burgeoning period of growth in this field and highlight the evolution of many contemporary popular cosmetic procedures over time. Particularly, a growth in minimally invasive procedures was noted, with noted impacts in aesthetics training and research focus.

Level of evidence 4 therapeutic:

Hyaluronic acid fillers rarely cause potentially devastating occlusive adverse events that require immediate hyaluronidase salvage infiltrations. An exploratory photographic investigation probed whether topical heparin's anticlotting and anti-inflammatory properties could synergize with and enhance the effectiveness of hyaluronidase. Based on heparin pharmacodynamics, the authors explored the rationale for associating topical heparins with hyaluronidase in treating occlusive side effects following accidental intra-arterial hyaluronic acid injections. In the first case, an occlusion in the right superior labial artery area, highlighted by reddish-blue net-like skin discoloration (livedo reticularis), developed below the nasal pyramid shortly after 3 intradermal injections of low-viscosity hyaluronic acid gel, rapidly progressing to the glabellar and forehead regions. Within 1 h after the hyaluronidase salvage injection (80 IU), topical low-molecular-weight heparin (40 mg enoxaparin) was uniformly applied, and the procedure was repeated every 8 h for 15 days. In the second case, a cluster of severe occlusive lesions developed in the nose and nasal tip areas after 3 hyaluronic acid injections (formulation and doses as previously stated). After the first week, enoxaparin (4000 IU) was applied topically every 8 h for an additional 3 weeks. Two sequences of photographs document the occlusions' evolution toward almost complete skin repair after 28 days (first case: immediate combined treatment) and 15 days (second case: sequential treatment spaced 1 week).The anti-inflammatory and antithrombotic pharmacodynamics of heparin and heparin derivatives offer a promising rationale as an add-on option (combined hyaluronidase and topical heparin) to treat the occlusive side effects caused by hyaluronic acid.

Level of evidence 5 therapeutic:

Buttock augmentation has emerged as a significant focus in cosmetic surgery, driven by advancements in techniques and increasing patient interest in body contouring. The evolution of this field, from early pioneering methods to modern, diverse approaches, highlights the need to understand the specific characteristics of each technique and their implications for aesthetic outcomes. The author aims to provide a detailed review of 4 major buttock augmentation techniques: gluteal implants, Brazilian butt lift (BBL), intramuscular polymethylmethacrylate (PMMA), and deep subcutaneous hyaluronic acid fillers. The goal is to assess the benefits and limitations of each method, helping practitioners and patients make informed decisions tailored to their preferences and needs. A comprehensive literature review was conducted, incorporating clinical studies, case reports, and expert opinions on these 4 techniques. Evaluation criteria included effectiveness, safety, recovery time, and patient satisfaction. Data were synthesized to provide a comparative analysis of each method. Gluteal implants offer predictable volume but involve surgical risks and lengthy recovery. The BBL, using autologous fat, delivers natural results and body contouring benefits but carries risks such as fat embolism and fat reabsorption. Intramuscular PMMA fillers provide permanent results with minimally invasive application but are challenging to remove. Hyaluronic acid fillers are reversible and minimally invasive but require periodic maintenance and may present risks like material migration. In this review, the author highlights the advantages and drawbacks of each technique, emphasizing individualized assessments and practitioner expertise. By outlining these methods, the author supports informed decision making in buttock augmentation.

Level of evidence 5 therapeutic:

Macroeconomic conditions significantly affect consumer spending patterns, including aesthetic surgery expenditures. This study examines the longitudinal relationship between unemployment rates, disposable income, stock indices, and aesthetic surgery spending from 2006 to 2019. Data on aesthetic surgery expenditures were collected from the American Society of Plastic Surgeons, whereas unemployment data were obtained from the US Bureau of Labor Statistics, disposable income from the US Bureau of Economic Analysis, and stock indices from the Federal Reserve Economic Data. Time series correlational analyses and Granger causality tests were used to explore these relationships. Unemployment was inversely related to total aesthetic surgery expenditures and most individual procedures. However, Granger causality tests did not reveal a significant predictive relationship between unemployment and aesthetic procedure spending for most procedures. Disposable income was most strongly associated with expenditures on injection procedures and had nonsignificant relationships with more invasive procedures, including breast augmentation, liposuction, abdominoplasty, and blepharoplasty. The analysis demonstrated a significant positive relationship between the NASDAQ, S&P 500, and Dow Jones with all aesthetic procedures, except rhinoplasty. Granger causality tests revealed significant predictive relationships for several procedures at different lags using disposable income and stock indices as predictive variables. These findings highlight a nuanced relationship between macroeconomic conditions and consumer spending on aesthetic surgery. Overall, this paper provides new insights offering a foundation for further investigation into aesthetic plastic surgery consumption on an individual level, rather than on an aggregate.

Level of evidence 5: (Risk).

Background: The increasing utilization of laser and light-based technologies in plastic surgery has heightened the need for comprehensive training programs within residency programs, allowing trainees to remain competitive in the cosmetic medicine field.

Objectives: This review intends to describe our trainees' experience with lasers in their last 2 years of training while participating in their resident cosmetic clinic.

Methods: This retrospective chart review examines laser procedures conducted from 2021 to 2023 within the Resident Cosmetic Clinic at the study institution. Data were gathered from internal records and patient charts, focusing on demographics, procedure types, complication rates, and training structures.

Results: This study analyzed 162 resident cosmetic laser, light-based device, and radiofrequency cases between 2021 and 2023. There were 90 patients with an average age of 46.8 years with the majority being females (95.6%). Intense pulsed light was the most frequently used modality used in 46.01% of procedures. The overall complication rate was 6.17%.

Conclusions: The findings suggest that resident laser clinics, under proper supervision, provide a safe and effective training ground for future plastic surgeons. This study underscores the need for standardized and comprehensive education to enhance resident knowledge and skills in laser and other energy-based devices.

Level of evidence 3 therapeutic:

Adipose tissue, or fat compartments, has long been considered a storage depot and an energy source. However, a large part of new research, starting with the discovery of adipose-derived stem cells, has redirected this thinking toward the tremendous regenerative capacity that adipose tissue possesses when it is healthy. This has resulted in multiple technologies being explored with fat as a basis or with fat as a target aiming at the stimulation of new small hyperplastic adipose cells exuding adipokines and encouraging the proliferation of a whole host of progenitor cells that can have positive effects on many organ systems. One of these organ systems is skin, and there is a direct correlation with various fat compartments and skin health. Dermal fat tissue, also known as dermal white adipose tissue, is one such compartment that originates from dermal preadipocytes transdifferentiating into adipocytes and progenitor adipose cells under the right cues. The author of this paper discusses these potential cues, including injectable fillers, fat grafts, and topical formulations, and their capacity to impact skin health through the generation of healthy fat tissue. In addition, small molecules such as glucagon-like peptide-1 peptides and their impact on fat tissue are discussed. Adipose tissue is being recognized as the next regenerative frontier with exciting prospects ahead.

Level of evidence 5 therapeutic:

Background: Liposuction is the most common cosmetic plastic surgery procedure in the United States, and lipo-aspiration for fat grafting is gaining in popularity. The results are effective, but complications include seroma, contour irregularities, skin necrosis, and even death. Scarring, dehiscence, and infection at the port site, although minor, are a common and less-discussed problem. To date, no study has examined the local complication profile of patients treated with and without port-site protection.

Objectives: To evaluate the efficacy of silicone port protectors to decrease local complications after liposuction.

Methods: A retrospective review was performed on 60 consecutive patients treated for cosmetic liposuction or autologous fat transfer between August 2022 and March 2024. The first 30 patients underwent tumescent-based lipo-aspiration without port-site protectors and the following 30 with placement of a segment of suction tubing to protect the skin. Records were reviewed to determine patient demographics, amount of tumescent and aspirate, and complications at the port site.

Results: Sixty patients completed the study. There were no significant differences in patient demographics and surgical data between groups. Ten patients in the unprotected group and 2 in the protected group experienced port-site complications (33.3% vs 6.7%, P = .0093). Significantly more patients in the unprotected group experienced wound dehiscence (P = .0095), and there was a trend toward more patients requiring steroid injections and excisions and reclosures (P = .088 and .167, respectively).

Conclusions: In this cohort, patients treated with a port protection device suffered fewer local complications, requiring less wound management, steroid injections, and revisions.

Level of evidence 3 therapeutic: