Aesthetic surgery journal. Open forum最新文献

Pre-pectoral (PP) direct-to-implant (DTI) breast reconstruction has gained popularity as a muscle-sparing alternative to subpectoral techniques. Polyurethane-coated implants, with their unique mechanical and biological properties, may further optimize outcomes by reducing capsular contracture and improving implant stability. This systematic review aimed to evaluate the safety, efficacy, and patient-reported outcomes of post-mastectomy PP DTI breast reconstruction using polyurethane-coated implants. A systematic search of PubMed, Embase, Scopus, and Cochrane Library databases was conducted in accordance with PRISMA guidelines. Data on study design, patient and surgical characteristics, complications, aesthetic outcomes, and patient satisfaction were extracted. Risk of bias was assessed using the ROBINS-I tool. Thirteen studies met inclusion criteria, comprising 1717 patients and 2502 breasts reconstructed with polyurethane-coated implants. Mean follow-up across included studies was 12.3 months (range 1-60 months). Mean implant size was 327 cc (range 160-680 cc). Across all studies, implant loss occurred in 1.0% of cases and infection in 0.9%. Capsular contracture with reported Baker grade III-IV cases occurred in 1.0% of cases within ≤12 months of follow-up, increasing to 12.3% in studies with ≥36 months' follow-up. The most frequent aesthetic drawback was rippling or contour deformity, affecting 183 breasts (7.3%). Patient-reported satisfaction was consistently favorable: 5 studies using the BREAST-Q reported mean scores ranging from 72.6 to 78.3 for Satisfaction with Breasts and 79.9 to 84.6 for Psychosocial Well-Being. Pre-pectoral DTI reconstruction with polyurethane-coated implants is a safe and effective technique, associated with low complication rates and high patient satisfaction. Careful flap selection and adjunctive fat grafting optimize results. Prospective multicenter studies with long-term follow-up are warranted to confirm durability and refine patient selection criteria.

Level of evidence 3 therapeutic:

Background: Breast reconstruction after mastectomy restores both physical and emotional well-being. Nipple-areolar complex (NAC) reconstruction represents the final stage of restoration, yet its psychological impact remains unclear.

Objectives: This study evaluates mental health outcomes following NAC vs non-NAC breast reconstruction.

Methods: The TriNetX Research Network was queried for female breast cancer patients ≥ 18 years who underwent mastectomy with subsequent breast reconstruction from 2003 to 2023. Cohorts were stratified by NAC reconstruction. Propensity score matching was performed for demographics, comorbidities, substance use, cancer treatment, and pre-existing psychiatric conditions. Outcomes included various psychological conditions such as anxiety, depression, and antidepressant use at 3-, 12-, and 24-months postoperatively. Risk ratios (RRs), 95% CIs, and P values were calculated.

Results: Nipple-areolar complex reconstruction was associated with significantly lower risks of several psychiatric outcomes. Anxiety was reduced at 3 months (RR = 0.40; P = .0004), 12 months (RR = 0.62; P = .0009), and 24 months (RR = 0.79; P = .026). Adjustment disorder was less frequent at 12 (RR = 0.52; P = .0099) and 24 months (RR = 0.65; P = .024). Substance use disorder (RR = 0.40; P < .0001) and antidepressant use (RR = 0.82; P = .034) were also significantly reduced at 24 months.

Conclusions: Nipple-areolar complex reconstruction is linked to lower long-term risks of various psychological conditions following mastectomy, suggesting psychosocial benefits beyond aesthetic restoration. These findings support holistic consideration of both surgical and mental health factors in reconstructive counseling.

Level of evidence 3 risk:

Background: Radiofrequency (RF) devices are widely used for noninvasive facial rejuvenation, but evidence on patient-centered outcomes remains heterogeneous and variably reported.

Objectives: To synthesize evidence on the aesthetic, safety, tolerability, and psychological outcomes of RF treatments for facial rejuvenation.

Methods: A systematic review was conducted in accordance with PRISMA and JBI guidelines. Databases (PubMed, Embase, CENTRAL, and LILACS) were searched for studies published between 2015 and 2025. Risk of bias was assessed using a JBI tool. A thematic synthesis was performed for aesthetic outcomes, patient satisfaction, and safety. The confidence of findings was evaluated using the GRADE-CERQual approach.

Results: Fifteen studies were included, comprising a total of 1230 participants. RF treatments consistently improved aesthetic outcomes. Skin texture improved in 71% to 100% of patients (4 studies), and skin firmness improved in 52.9% to 100% (2 studies). High patient satisfaction was demonstrated, with rates ranging from 82% to 100% (13 studies). The safety profile was favorable; adverse events were mild and transient (erythema: 17.6%-100%; edema: 5.3%-26.5%), and no serious complications were reported. Mean pain scores were low (1.94/10 VAS). GRADE-CERQual assessment showed moderate confidence in these findings. A key limitation was the universal underreporting of downtime.

Conclusions: Evidence indicates RF treatments for facial rejuvenation yield meaningful aesthetic improvements, high patient satisfaction, and an excellent safety profile. However, these conclusions are tempered by methodological limitations in the primary literature. Future research should employ rigorous designs, standardized outcome measures, and report on downtime to strengthen the evidence base.

Level of evidence 4:

Background: Hyaluronic acid (HA) fillers are among the most widely used aesthetic treatments, valued for their safety, biocompatibility, and reversibility. Product-specific adverse events (AEs) are important to understand, especially delayed AEs.

Objectives: To evaluate the incidence, severity, and risk factors of AEs following nasolabial fold (NLF) treatment with CPM-B (cohesive polydensified matrix hyaluronic acid filler with 22.5 mg/ml HA; Belotero Balance®; Anteis S.A., Switzerland) across 5 internal clinical studies.

Methods: Pooled data included treatments to 526 NLFs in 412 patients. Adverse events were categorized into 12 subtypes and rated as mild, moderate, or severe. Multivariable logistic regression was used to evaluate the independent association of patient (age, sex) and procedure-related factors (injection volume, NLF laterality) with AE risk (≥1 vs 0).

Results: Adverse events were observed in 41% of treated NLFs; the majority (97%) were mild, with no severe AEs documented. The most common AEs included swelling (23%), erythema (20%), and bruising/ecchymosis (17%). Adverse event risk significantly increased with injection volume; every additional 100 µl raised the odds of an AE by 2.38 (P = .00537). Patient age, sex, and NLF laterality were not significantly associated with AE risk.

Conclusions: This study supports the overall safety and tolerability of CPM-B, with most AEs being mild and transient; only 3.8% were moderate, and none were severe. When controlling for study, volume was the only significant predictor of AE risk, highlighting the need for physicians to minimize excessive volumes where possible. Future studies should explore AE predictors in more diverse populations and investigate additional risk factors to optimize safety and outcomes.

Level of evidence 3 risk:

Aesthetic surgery's present popularity contrasts with its late-nineteenth-century beginnings in commercial "beauty institutes," where limited, skin-only cosmetic procedures emerged outside the surgical mainstream and left little contemporaneous record. This article reassesses that early period and highlights a neglected primary source: Jules Poullet's 1908 lecture at the 21st French Surgical Congress, published with photographic documentation. Poullet describes a case of pan-facial surgical rejuvenation via cervicofacial rhytidoplasty and upper and lower blepharoplasties, addressing periorbital, midface/temporal, and cervical regions. In the same lecture, he details a mastopexy with periareolar nipple-areola transposition and inframammary reduction, emphasizing scar concealment and appropriate nipple-areola repositioning. Taken together, these contemporaneous reports constitute the earliest known published, photographically documented accounts of both facelifting and mastopexy, shifting the commonly cited timelines by more than a decade. Poullet's contributions, though a small part of his broader surgical career, anticipate core principles of modern facial and breast rejuvenation and clarify the early history of cosmetic surgery before it gained professional recognition.

Background: Male body contouring has evolved from conventional debulking to high-definition liposuction (HDL) etching and, more recently, a "real-definition" c (RDL) approach emphasizing natural contours. The role of helium-plasma skin tightening (HPST) as an adjunct remains uncertain.

Objectives: To compare long-term patient-reported outcomes, complications, and revision rates between RDL and HDL in men undergoing ultrasound-assisted liposuction (UAL), and to evaluate the selective role of HPST in improving skin quality.

Methods: A retrospective analysis was performed on 743 male patients who underwent primary UAL between 2008 and 2024. Patients were grouped by era: conventional (2008-2011), HDL (2011-2014), RDL (2015-2019), and RDL with HPST (2019-2024). Outcomes included BODY-Q satisfaction, complication severity, and revision rates. Regression, mediation, and propensity-score matching analyses were applied to identify predictors of durable satisfaction and recommendation.

Results: Mean satisfaction improved across eras: 59.3 (2008-2011), 57.7 (2011-2014), 66.8 (2015-2019), and 73.8 (2019-2024). HDL patients showed the lowest durable scores despite high early ratings and were most associated with self-reported "fake abs," which correlated with reduced BODY-Q domains. RDL produced more stable outcomes, particularly in men with BMI ≤25 and ≥4 exercise sessions/week. Sports frequency predicted higher satisfaction directly and indirectly via lower body mass index (BMI). Clinically meaningful complications declined from 15.4% to 4.6% across eras. Helium-plasma skin tightening was offered mainly to older, higher-BMI men and, after adjustment, was not independently associated with improved skin quality. RDL was linked to a lower revision risk (odds ratio (OR) 0.32, P = .029).

Conclusions: Real-definition liposuction provided natural, durable outcomes and fewer revisions than HDL. Over-etching increased unnatural contours and dissatisfaction. Careful patient selection-BMI ≤25, consistent exercise, and weight stability-is critical, while HPST may be reserved for older men with mild laxity.

Level of evidence 3 therapeutic:

As aesthetic dermatology integrates increasingly advanced injectable and energy-based interventions, the need for biologically informed decision-making becomes critical. Complications such as granulomas, fibrosis, and post-inflammatory hyperpigmentation still affect subsets of patients due to interindividual biological variability. This commentary explores the dual role of biomarkers (measurable indicators of process, risk, or response) and hallmarks (phenotypic patterns summarizing underlying biology) in identifying patients at risk of complications, offering real-world applications such as tape stripping to evaluate our molecular patient profile. The potential of artificial intelligence to interpret complex biological signatures is discussed, along with broader implications for long-term personalization in cosmetic care. By aligning treatment protocols with skin biology, aesthetic dermatology would shift toward a predictive and preventive model, ensuring safety, precision, and durable results. Level of Evidence: 5 (Therapeutic).

Background: T intersection breakdowns are a difficult problem encountered in Wise pattern breast reductions.

Objectives: This preliminary study aimed to evaluate the efficacy of the U-shaped triple lipo-dermal flap technique in reducing T junction necrosis in superomedial pedicle reduction mammoplasty limited to a fairly low risk group of patients.

Methods: Our prospective cohort study comprised 20 women who underwent breast reduction surgery between May 2023 and May 2024. All the patients who underwent breast reduction surgery for benign breast enlargement met the inclusion criteria. We excluded patients who were smokers, had autoimmune diseases, had a body mass index (BMI) of greater than 30, had diabetes, hypertension, were scheduled for onco-reconstruction or had complication other than wound healing. Data on BMI, ptosis severity, weight of the removed breast tissue, healing rates and follow-up duration were gathered. All patients were operated by a single surgeon. These patients were followed up on postoperative days 7, 10, 14, 21, 28, 40, and monthly. During follow-up complications with regard to wound healing, the scar quality and patient satisfaction were considered.

Results: One patient (5%) had experienced epidermolysis and subsequent full thickness dehiscence at the T zone.

Conclusions: The principle behind this strategy is that the incorporation of lipodermal flaps distributes the tension across the suture line, thereby reducing the risk of ischemia at the T junction. The technique is safe, versatile, and easy to execute. It provides a tension-free zone and acting as internal dermal sling. The use of the U-shaped triple lipo-dermal flaps in Wise pattern superior medial pedicle breast reduction demonstrated a 5% rate of wound breakdown at the T junction in a low-risk group of patients. Further studies need to be conducted on a broader breast reduction population is needed to more fully assess the efficacy of this technique.

Level of evidence 4 therapeutic:

Background: Aesthetic treatments are associated with positive psychological and psychosocial outcomes, but most data are from adults <60 years. As the global population ages, there is an opportunity to better understand perceptions about aging among older adults and whether engaging with aesthetic medicine influences these perceptions.

Objectives: This global survey sought to understand the psychology of aging among older adults with varying relationships to aesthetic medicine.

Methods: This online survey (July-September 2022) queried adults (50-80 years) in 8 countries. Respondents were divided into 3 groups: those that had ever received aesthetic treatments (aesthetics receivers); those naive to aesthetic medicine but considering (naive considerers); and those naive and not considering (naive non-considerers). Respondents were queried about perceptions and expectations of aging and perceptions of aesthetic treatments.

Results: Among 7588 total respondents, 39.8% were aesthetic receivers, 28.7% were naive considerers, and 31.5% were naive non-considerers. Overall, satisfaction with psychological self-perceptions (eg, level of self-confidence) was high (∼80%) regardless of respondents' engagement with aesthetic medicine. Naive non-considerers had the most positive view on aging, but there was strong agreement across all groups that aging was associated with benefits (eg, more time for hobbies/leisure) and potential challenges (eg, changes in mobility, losing independence). Most respondents (83%), regardless of their relationship with aesthetic medicine, agreed that aesthetic treatments had emotional benefits (eg, feeling like the best version of oneself).

Conclusions: The data from this multi-country survey of older adults gives key insights into perceptions of aging and aesthetic medicine among a previously underrepresented population.

Level of evidence 5: (Therapeutic).

Background: Refining the nasal dorsum to achieve a smooth and natural contour remains challenging, particularly in patients with thin skin who are prone to visible surface irregularities. Numerous techniques have been described to address these issues, including diced cartilage, fascial or dermal grafts, and synthetic implants.

Objectives: This study evaluates the outcomes of using morselized bone grafts (MBG), specifically, autologous bone rasp material that is typically discarded, as a method for nasal dorsum contour refinement.

Methods: A retrospective review was conducted of consecutive rhinoplasty procedures performed by the senior author between January 2021 and June 2022. Patients who underwent dorsal contouring with MBG and had at least 12 months of follow-up were included. The primary outcomes were postoperative infection and the need for revision surgery.

Results: A total of 953 patients met inclusion criteria. The mean patient age was 31.6 ± 11.3 years, and the mean follow-up duration was 23.5 ± 8.7 months. Postoperative infections occurred in 26 patients (2.7%), all of which resolved with antibiotic therapy. Sixteen patients (1.7%) required operative revision.

Conclusions: The use of MBG harvested from bone rasp material provides a safe and efficient option for achieving dorsal nasal smoothness and camouflaging minor contour irregularities in both primary and revision rhinoplasty. Additionally, MBG use is an efficient alternative to other techniques for addressing dorsal esthetics, specifically camouflaging minor irregularities, with no additional donor-site morbidity when paired with boney dorsal reduction.

Level of evidence 4 therapeutic: