Aesthetic surgery journal. Open forum最新文献

Background: The understanding of nasolabial fold (NLF) change with aging is essential for facial rejuvenation.

Objectives: The aim of the authors of the study is to develop an objective method measuring the severity of NLFs and to evaluate the age-related characteristics of the NLF through quantitative parameters.

Methods: A total of 150 healthy participants (ages 21-70) were divided into 5 age groups. Ten NLF features were measured: length, NLF-fold area, maximum width, maximum color depth, area_{upper NLF}, width_upper-NLF, color depth_upper-NLF, area_lower-NLF, width_lower-NLF, and color depth_lower-NLF. These features were compared across age groups and genders, and their predictive values for age were evaluated.

Results: Significant increases in NLF length, width, fold area, and color depth were observed between the twenties and the thirties. Upper NLF features showed changes starting in the thirties, with gradual increases until the fifties, plateauing by 70. Lower NLF changes began in the thirties, peaked in the fifties to sixties, and leveled off thereafter. Males exhibited a more rapid increase in volume-related NLF features between 35 and 40 years, surpassing females in this regard. Males also had greater color depth between 35 and 40 years, whereas females predominated after age 56. Several NLF features demonstrated superior predictive value for age compared with the Wrinkle Severity Rating Scale.

Conclusions: Upper NLF changes begin in the thirties and continue through the fifties, whereas lower NLF changes peak from the forties to sixties. Gender differences were observed, with males showing earlier changes. These findings provide a reliable, objective method for assessing mid-facial aging in clinical practice.

Level of evidence 3 therapeutic:

Background: AlloDerm (LifeCell, Branchburg, NJ) and DermACELL (LifeNet Health, Virginia Beach, VA) are 2 commonly used acellular dermal matrices (ADMs) in aesthetic and reconstructive breast surgery.

Objectives: In this head-to-head meta-analysis, the authors aim to compare the clinical outcomes, including complication rates and BREAST-Q patient satisfaction, associated with AlloDerm and DermACELL.

Methods: PubMed, Scopus, and Web of Science were searched for relevant studies in April 2024 and again in April 2025. The authors included all studies with data comparing AlloDerm and DermACELL. Statistical analyses were performed using RevMan 5.4. Heterogeneity was assessed using I ² statistics. A random-effects model was applied in case of significant heterogeneity followed by sensitivity analysis.

Results: The search yielded 1006 studies, of which 14 were included in the meta-analysis. A total of 1872 patients (2940 breasts) were analyzed, with 1724 breasts receiving AlloDerm and 1433 breasts receiving DermACELL. The analysis revealed that AlloDerm was associated with a slightly higher incidence of seroma formation (risk ratio = 1.49, 95% CI, 1.14-1.95, P = .003) compared with DermACELL, which may be because of surgical technique rather than ADM. No significant differences were observed in the rates of all other complications and BREAST-Q outcomes. Further, there was no statistically significant difference in the rate of red breast syndrome after sensitivity analysis.

Conclusions: DermACELL demonstrated a slightly lower incidence of seroma formation compared with AlloDerm. Further randomized trials are needed to confirm these results and explore the long-term outcomes associated with both ADMs.

Level of evidence 3 therapeutic:

Background: Standardized facial photography is critical in plastic surgery and medical aesthetics to ensure consistent preoperative and postoperative documentation. Current methods face challenges in maintaining uniformity because of patient variability, equipment limitations, and environmental inconsistencies. The authors of this study introduce a cost-effective photographic method validated through machine learning techniques to achieve reproducibility and precision in head positioning.

Objectives: The primary objective was to develop and validate a standardized photographic system that minimizes angular deviations across 3 axes (yaw, pitch, and roll). The hypothesis was that this method would achieve high reproducibility and consistency across different photographers and time points.

Methods: Participants were photographed in 5 standard positions (frontal, right lateral, left lateral, right 45° oblique, and left 45° oblique). A specialized setup, including a rotational chair and fixed lighting, was used. Images were analyzed using a pretrained machine learning model to quantify head angles. Statistical analyses included Shapiro-Wilk tests for normality and Hotelling's T ² test for reproducibility.

Results: A prospective study was conducted with 20 participants (18 females, 2 males; mean age 31 years). The mean differences between measured and theoretical yaw angles were within ±2° across all positions. Pitch and roll values remained close to zero, indicating minimal vertical or lateral deviations. Hotelling's T ² test showed no significant differences between 2 photo sessions (P = .7626), demonstrating high reproducibility and stability.

Conclusions: The authors of this study present a simple, reliable photographic method for consistent facial imaging in clinical practice. The integration of machine learning enhances accuracy and validates the approach. This method meets the high standards of standardization required for medical imaging and is particularly suitable for resource-limited settings.

Level of evidence 5 therapeutic:

Background: Noninvasive facial rejuvenation procedures have continued to grow in popularity, with botulinum toxin and injectable soft-tissue fillers being the most common.

Objectives: The purpose of this study was to evaluate trends in patient cost, provider product preferences, and complications of a single surgeon's 10-year experience with botulinum toxin and soft-tissue fillers. Additionally, this study aimed to quantify the crossover between patients receiving injectables and patients receiving aesthetic surgery.

Methods: This was a retrospective analysis utilizing internal/departmental records and Epic charting from January 2013 to January 2023. Botulinum toxin and soft-tissue filler cases were captured using select CPT codes, and patient demographics, complications, and follow-up data were recorded.

Results: One thousand three hundred and sixty-eight patients undergoing 5794 injectable cases were assessed. The study population was majority female (89.3%) and Caucasian (78.7%). Injectable cases increased over time, except for a decrease in 2020. Botulinum toxin was most common (59%), followed by fillers (18%), and combination therapy (19%). Common injection sites included the glabella, crow's feet, and forehead for neurotoxins and marionette lines and nasolabial folds for fillers. Complications were rare, with 35 from botulinum toxin and 33 from fillers. Of patients receiving injectables, 19.6% went on to receive an aesthetic surgery, and 0.6% of patients undergoing aesthetic surgery subsequently received injectables.

Conclusions: Botulinum toxin and soft-tissue fillers are safe with low complication rates when administered by an experienced provider. These procedures may serve as a starting point for patients pursuing antiaging treatments and an opportunity to establish continuity of care for providers.

Level of evidence 4 therapeutic:

Background: A poorly defined jawline and blunting of the submental angle by excess submental fat (SMF) contribute to the loss of jawline contour. The injectable adipocytolytic agent ATX-101 reduces SMF, and the hyaluronic acid filler VYC-20L restores facial volume in the chin and jaw.

Objectives: The objective of this study was to evaluate the benefits of ATX-101 followed by VYC-20L for improving overall jawline contour and definition.

Methods: In this Phase 4, prospective, open-label, multicenter trial, participants received 1 to 6 ATX-101 treatments (8 weeks apart), followed by VYC-20L with optional VYC-20L touch-up after 14 days. The primary endpoint was Allergan Loss of Jawline Definition Scale (ALJDS) responder rate (proportion achieving ≥1-point improvement from baseline in investigator-assessed ALJDS score 4 weeks after final VYC-20L treatment). Secondary and exploratory endpoints included clinician- and participant-assessed measures of jawline definition, satisfaction, skin laxity, and SMF. Treatment-emergent adverse events (TEAEs) were monitored.

Results: Overall, 53 adults were enrolled and treated. Among 42 evaluable participants, the ALJDS responder rate was 92.9% (95% CI, 80.5-98.5). Consistent improvement across a range of clinician- and participant-assessed scales was achieved, including improvements in SMF Rating Scale score, Submental Skin Laxity Grade, and Global Aesthetic Improvement Scale score. Improvements in FACE-Q Satisfaction with Lower Face and Jawline and Appraisal of Area Under Chin indicated high levels of patient satisfaction. All participants experienced at least 1 TEAE; the majority of TEAEs were moderate in severity.

Conclusions: Sequential treatment with ATX-101 and VYC-20L may be effective for improving overall jawline contour and definition, with an acceptable safety profile.

Level of evidence 2 therapeutic:

Background: The lower eyelid, because of its unique functional and anatomical characteristics, is highly susceptible to early signs of aging. There is overlap in the manifestation of age-specific senescent features across age groups, with progressive step.

Objectives: The authors of this study aim to identify the key features and treatment approaches for lower eyelid aging in East Asian patients by conducting a retrospective analysis of clinical presentations and treatment outcomes across different age groups. It also identifies which factors are more important to East Asians in recent decades.

Methods: Outpatients dissatisfied with their lower eyelid appearance were included. Data were collected on lower eyelid aging characteristics, including lower eyelid bags, tear trough deformities, wrinkles, and midface aging changes. Treatment experiences were documented based on these clinical presentations.

Results: A total of 439 patients were analyzed, comprising 61 males and 378 females, aged 20 to over 50 years, from 2014 to 2022. For younger patients exhibiting early signs of eyelid aging, treatment focused on dynamic periorbital wrinkles, protruding eye bags, and tear trough deformities. Patients with static wrinkles and lower eyelid laxity benefited from loose skin excision and septum fat resetting for restoring the volumetric displacement. Midface lifting was recommended for those with facial laxity to achieve optimal results. The percentage of orbital fat resetting surgeries of all surgeries was 53%. Among these patients, 10% expressed dissatisfaction, 58% were satisfied with the results, and 32% were very satisfied with the treatment outcome.

Conclusions: East Asians today are more concerned with the smoothness and fullness of the lower eyelid area, and the importance of orbital fat repositioning is emphasized across age groups. The proportional increase of transconjunctival blepharoplasty after age 40 is because of the enhanced facial care.

Level of evidence 3 therapeutic:

Osseous genioplasty (OG) and implant-based chin augmentation are 2 primary approaches for correcting microgenia. A comprehensive synthesis comparing their outcomes, safety profiles, and patient satisfaction is lacking. In this study, the authors aim to assess the safety and outcome profile of implant-based chin augmentation and OG. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, MEDLINE, Cochrane CENTRAL, and Google Scholar was performed in November 2024, utilizing keywords related to genioplasty, chin implants, and specific implant materials. Inclusion criteria required studies to provide original data on isolated procedures performed at a single institution, ensuring consistency in perioperative management. The authors included 7 single-center studies involving 1126 patients with microgenia (740 underwent OG; 386 received implants). Follow-up durations ranged from 6 months to 6 years. Implant materials included Medpor, silicone, Proplast, and PEEK. Patient satisfaction was high across both cohorts, with a trend toward higher satisfaction rates in the OG group. Complication profiles differed: implants had higher infection rates (up to 23.8%) and dehiscence, whereas OG was associated with transient neurosensory changes (up to 100%), occasionally persisting in 7.4% to 12.5% of patients. Relapse rates were similar but slightly higher for OG (2.63%-27.21%). OG was noted to provide greater soft-tissue predictability (85% bony to soft-tissue translation) than implants (66%). Both procedures are effective for managing microgenia, with distinct strengths and risks. Future studies should explore long-term outcomes and assess custom-fabricated implants to enhance fit, contour, and patient satisfaction. Tailored approaches based on individual patient needs remain critical.

Level of evidence 3 therapeutic:

The deep plane facelift isolates the superficial musculoaponeurotic system (SMAS) by direct lysis of retaining ligaments, allowing greater mobilization of the vascularized composite flap of skin and SMAS. The authors of this study describe a modification to the deep plane facelift, termed the "bucket handle" technique. This technique involves creating a triangle of SMAS tissue extending from the angle of the mandible posteriorly to the anterior aspect of the sternocleidomastoid muscle. The intact SMAS flap, which is not divided or myotomized, is draped over the angle of the mandible, augmenting the gonial angle, whereas the triangular bucket handle of the SMAS flap is sutured back to the mastoid crevasse, enhancing the posterior medial vector of the neck lift, providing a more sculpted, defined jawline. Level of Evidence: 5 (Therapeutic).

Background: Hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) are commonly used for facial volumization, with HA offering hydration and reversibility, whereas CaHA provides structural support and collagen biostimulation. Recently, a combination of HA and CaHA has been proposed to enhance both immediate volumization and long-term tissue remodeling. However, its efficacy for volume retention remains unclear.

Objectives: In this study, the authors aim to compare the volumetric retention and clinical outcomes of HA alone vs a manually prepared HA-CaHA mixture in the temporal region over a 90-day follow-up.

Methods: A randomized controlled trial included 20 patients (40 hemifaces) treated with either 0.5 mL of HA alone (G1) or a 40% HA and 60% CaHA mixture (G2). Fillers were injected subcutaneously using a 22 G cannula with a fan technique. Volumetric changes were assessed through 3-dimensional stereophotogrammetry, and the Allergan Temple Scale (ATS) evaluated qualitative outcomes.

Results: Both groups showed significant ATS score improvements over time (P < .001), but volumetric analysis demonstrated greater retention in G1 (0.231 ± 0.255 mL) compared with G2 (0.028 ± 0.135 mL, P = .016).

Conclusions: The hypothesized synergy of the HA-CaHA combination was not observed. HA alone provided superior long-term volumization, suggesting that manual HA-CaHA mixing may alter filler performance. Further studies should explore premixed formulations and optimize treatment protocols.

Level of evidence 2 therapeutic:

Background: Despite the general safety of liposuction and fat grafting procedures, surgical-site infections (SSIs) remain a significant concern. These infections, ranging from minor to severe, can arise from various sources and pose a substantial burden. The overuse of antibiotics has led to increased antimicrobial resistance, highlighting the need for alternative infection prevention strategies like stabilized hypochlorous acid (s-HOCl).

Objectives: The aim of the authors of this study is to evaluate the efficacy and safety of s-HOCl in preventing SSIs following liposculpture and other body contouring procedures.

Methods: A prospective cohort study and matched control cohort were conducted at a single plastic surgery center in Bogota, Colombia (Dhara Clinic). Adult patients scheduled for liposculpture and fat grafting from January 2020 to December 2023 formed the intervention group, receiving s-HOCl as a washing solution for adipose grafts. A matched control cohort was drawn from patients who underwent similar procedures from January 2017 to December 2019 without s-HOCl. Data on demographics, surgical characteristics, and SSI outcomes were collected and analyzed.

Results: A total of 1008 patients were included, with 502 in the s-HOCl group and 506 in the control group. The infection rate in the s-HOCl group was 0.2 per 100 grafted muscles, compared with 0.54 in the control group. Relative risk of SSIs in the s-HOCl group was 0.4, indicating a reduction in infection rates. The small absolute risk reduction of 0.59% underscores the clinical importance, considering SSIs, although rare, are severe and life-threatening events, with significant impact on outcomes and healthcare costs. A reduction in the severity of infection and the level of required treatment was also observed.

Conclusions: s-HOCl demonstrated potential to reduce SSI risk following liposuction and fat grafting. This intervention offers a valuable alternative to antibiotics, effectively reducing infection rates and contributing to improved patient outcomes and public health in postantibiotic era.

Level of evidence 3 therapeutic: