Aesthetic surgery journal. Open forum最新文献

Radiofrequency (RF) devices are increasingly utilized in facial and neck rejuvenation for their ability to remodel the dermis and stimulate neocollagenesis. Although efficacy and safety have been widely reported, patient-centered outcomes remain less well synthesized. The study aims to map global research trends on RF for facial and neck rejuvenation (2015-2025), focusing on efficacy, safety, and patient-reported outcomes. A bibliometric-systematic literature review was conducted following PRISMA 2020. PubMed, Embase, Cochrane CENTRAL, and LILACS were searched for English-language studies from 2015 to 2025. Bibliometric data from Scopus were analyzed in R (Bibliometrix, Biblioshiny). Performance indicators, co-authorship, co-citation, keyword analyses, and thematic evolution were assessed. Of 1446 records, 44 studies met the inclusion criteria. Publication growth averaged 7.2% annually, peaking in 2021. The United States led output (36.4%) and citations, followed by South Korea (22.7%) and China (18.2%). International collaboration networks were limited and centered on a few prolific authors. Early studies emphasized device parameters and safety, whereas post-2020 research shifted toward clinical outcomes and patient satisfaction. Keywords highlighted wrinkles, skin laxity, and patient satisfaction as central axes. Research on RF rejuvenation has matured over the past decade, shifting from technical evaluation to patient-centered outcomes. Nevertheless, productivity is concentrated in a few regions and among a few authors, with an underrepresentation of Latin America and Africa. Broader international collaboration and consistent use of patient-reported outcome measures are needed. Level of Evidence: 3 (Therapeutic).

Background: A detailed understanding of the anatomy of the soft tissue layers of the forehead can help guide clinical treatment, but to date there is a lack of large-scale and comprehensive research in this area.

Objectives: The aim of the authors of this study is to evaluate the effects of age, gender, BMI, and other factors on the thickness of the soft tissue layers of the forehead.

Methods: A total of 238 volunteers were examined using ultrasonography, and the thickness of each forehead layer was measured. The effects of age, gender, BMI, and region on the thickness of each layer of the forehead were statistically analyzed using an analysis of variance.

Results: In men, the thickness of the skin, superficial subcutaneous tissue (SST), and frontalis muscle were significantly greater than those in women (skin: 0.95 vs 0.73 mm; SST: 0.75 vs 0.67 mm; frontalis muscle: 0.35 vs 0.25 mm), whereas the thickness of the deep subcutaneous tissue (DST) was significantly thicker in women than in men (1.26 vs 1.42 mm). An increased BMI was associated with increased thickness of the skin, SST, and DST. In addition, as age increases, the thickness of SST also increases.

Conclusions: Factors, such as gender, age, BMI, and the left vs right sides, all affect the thickness of each forehead tissue layer. These findings can provide a treatment reference for the forehead region.

Level of evidence 3 therapeutic:

The use of fillers for cosmetic purposes has increased in recent years. Although generally considered safe, fillers are not exempt from complications, including ischemic events. Arterial ischemia is a rare but potentially serious complication that requires prompt recognition and management. Ultrasound-guided hyaluronidase injection is emerging as a precise and effective treatment approach. The authors present a pictorial case series of filler-induced arterial ischemia managed with ultrasound-guided hyaluronidase injections, and systematically review the literature on ultrasound findings, enzyme dosage, time to resolution, and overall effectiveness of this approach. They present 3 cases of filler-induced arterial ischemia in the frontal, nasal, and temporal regions with visible intravascular thrombosis managed with ultrasound-guided intravascular hyaluronidase injections. Additionally, the authors systematically reviewed literature from PubMed/Medline, Scopus, Embase, and Web of Science up to August 2024 to evaluate the effectiveness, dosage, and ultrasound techniques utilized in the ultrasound-guided treatment of vascular complications from hyaluronic acid fillers. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we screened 88 studies, finally including 9 studies after full-text evaluation. Data from these studies, alongside our 3 cases (totaling 83 cases), showed rapid resolution of symptoms and ultrasound abnormalities following ultrasound-guided hyaluronidase injections. Delayed hyaluronidase administration was associated with slower or incomplete recovery, highlighting the importance of early intervention. Ultrasound-guided hyaluronidase injections effectively resolve arterial ischemia caused by filler injections, with early intervention significantly enhancing outcomes. Prompt diagnosis and timely ultrasound-guided intervention should be emphasized in clinical practice. Further large-scale randomized studies are necessary to establish standardized treatment protocols for dosage and timing. Level of Evidence: 3 (Therapeutic).

Lip lift surgery has grown in popularity because of changing aesthetic ideals and social media influence. Despite high reported satisfaction rates, patient dissatisfaction, especially regarding aesthetic outcomes and emotional impact, remains underexplored in the literature. The authors of this study aim to identify common causes of patient dissatisfaction after lip lift surgery and evaluate the psychosocial impact of these experiences using publicly available online reviews. Twenty-five publicly available patient narratives from RealSelf (New York, NY) describing dissatisfaction following lip lift surgery were analyzed in this qualitative descriptive study. No exclusions were made based on geography or demographics. A hybrid thematic analysis was conducted using Braun and Clarke's 6-phase framework, coded with NVivo 15 (Lumivero, Denver, CO). Coding combined inductive (data-driven) and deductive (theory-driven) approaches, referencing the FACE-Q and PHQ-9 validated domains. Emotional distress was scored from 0 to 3 based on language intensity. Among 25 patient reviews following lip lift surgery, most procedures were performed in the United States (n = 21). Scar-related concerns were the most common (n = 15, 60%). Other common sources of dissatisfaction were nasal/alar distortion (n = 6) and lip asymmetry (n = 5). PHQ-9 scoring revealed high emotional impact, with 59.3% in severe and 25.9% in moderate distress. Based on FACE-Q domains, 54.8% experienced appearance-related distress, 35.7% psychological, and 9.5% social distress. Although lip lift surgery is generally well tolerated with favorable outcomes, a notable minority report aesthetic dissatisfaction and psychological distress. Recognizing these concerns aids counseling, whereas future studies should integrate dissatisfaction rates with quantitive assessments of aesthetic improvement. Level of Evidence: 4 (Therapeutic).

Background: Nipple-sparing mastectomy in medium-large, ptotic breasts presents challenges because of redundant skin and risks to the nipple-areola complex (NAC). Advances in skin-reducing techniques and immediate prepectoral reconstruction aim to improve both oncological safety and aesthetic outcomes.

Objectives: The authors of this study present a novel surgical approach designed to enhance NAC vascularization by performing a nipple-sparing skin-reducing mastectomy exclusively through the lower lateral triangle of a Wise-pattern incision with immediate prepectoral polyurethane-coated breast implant (Microthane, POLYTECH, Dieburg, Germany) reconstruction. This approach seeks to minimize implant exposure risks by limiting the scar laterally, thus optimizing breast contour and patient satisfaction.

Methods: A prospective analysis of 10 patients undergoing monolateral procedures was conducted between April and August 2023. Inclusion criteria included Grade 2 ptosis with an expected nipple repositioning of ≤8 cm. The technique preserved vascular connections through precise de-epithelialization and assessed intraoperative flap perfusion. Implant selection ensured symmetry. Postoperative outcomes were evaluated using the BREAST-Q questionnaire and routine follow-ups (18 months). Associations between BREAST-Q scores and patient characteristics were analyzed through Pearson correlation and analysis of variance.

Results: Mean patient age was 52 years, BMI 24 kg/m², and implant volume 328 cc. Complication rates were low, with no cases of capsular contracture or implant displacement. BREAST-Q scores demonstrated high satisfaction, and a significant positive correlation was found between BMI and physical well-being (P = .03).

Conclusions: This single-stage technique for immediate prepectoral breast reconstruction in ptotic breasts may be safe and provide good aesthetic and functional outcomes. Further studies with extended follow-up and greater numbers are warranted.

Level of evidence 4 therapeutic:

A boom in the online popularity of conservative mechanical facial rejuvenation techniques, such as facial exercises, myofunctional therapy, and manual massages, has proliferated as noninvasive alternatives to aesthetic procedures. Despite this, scientific evidence regarding their efficacy and safety remains unclear. The aim of this study is to determine the efficacy of conservative mechanical facial exercises and related paraphernalia or adjuncts in achieving optimal facial aesthetic outcomes. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on PROSPERO. Databases, including PubMed/MEDLINE, Embase, Web of Science, SciELO, AMED, PROQUEST, Google Scholar, CENTRAL, OVID, and SCOPUS, were searched for studies evaluating mechanical facial exercises in adults. Studies reporting objective and validated subjective facial aesthetic outcomes were included. Risk of bias was assessed using the Cochrane and JBI tools. Twelve studies comprising 321 women aged 30 to 70 met the inclusion criteria. Interventions included facial exercises (n = 6), myofunctional therapy (n = 4), and manual massage (n = 2). Reported improvements were confined to localized regions, such as the cheeks, jawline, and periorbital areas. Tools used included Cutometers (Courage + Khazaka electronic GmbH, Cologne, Germany), ultrasound, expert/self-assessments, and quality-of-life metrics. No adverse events were reported; however, methodological heterogeneity, small sample sizes, and a lack of male participants limited generalizability. Although some region-specific aesthetic improvements have been observed, current evidence remains insufficient to establish the efficacy of these mechanical facial rejuvenation techniques with confidence. The literature lacks standardized protocols that account for hormonal status and facial anatomy variability. Larger, randomized controlled trials with diverse populations are necessary to improve the current body of evidence. Level of Evidence: 3 (Therapeutic).

Background: Machine learning (ML) gained recent popularity because of its usefulness and applicability in medicine. Surgical specialties utilize ML for patient selection, optimization, and prediction of outcomes.

Objectives: The aim of the authors of this study is to develop, validate, and compare ML algorithms for prediction of gender-affirming mastectomy complications.

Methods: Analysis of gender-affirming mastectomies performed by the senior author was performed retrospectively. Six ML algorithms were trained and optimized based on a portion of the data and tested on the remainder. Models were compared in accuracy of prediction, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Receiver operating characteristic (ROC) curves were computed for each model, and the area under the curve (AUC) was calculated.

Results: A total of 268 patients comprised the entire dataset, of which 214 were utilized to train the models. Random forest (RF) and K-nearest neighbors demonstrated the highest model accuracies of 92.6%, closely followed by XGBoost with 90.7%, and neural networks and support vector machine with 88.9%. Logistic regression recorded the lowest final accuracy of 87.0%. Sensitivity ranged from 61.90% for the K-nearest neighbors model to 90.48% for the neural networks model, whereas specificity reached 100% in RF and XGBoost. Logistic regression, RF, and support vector machine showed strong PPV and NPV metrics. AUC score was led by RF, at 0.904.

Conclusions: RF demonstrated the highest accuracy and AUC, with similarly high specificity value and PPV. Application of ML algorithms may be useful for predicting gender-affirming mastectomy complications and could aid surgeons in patient selection.

Level of evidence 5 therapeutic:

Paradoxical adipose hyperplasia (PAH) is a rare complication of cryolipolysis, characterized by an unexpected overgrowth of adipocytes in the treatment area. Emerging literature suggests that PAH may be underrecognized and underreported. Because of the increasing popularity of cryolipolysis for nonsurgical fat reduction, we sought to identify the overall incidence of PAH as well as the incidence by sex and treatment device, time to diagnosis, and any additional complications of cryolipolysis. In this systematic review and meta-analysis, databases (MEDLINE, Embase, CINAHL, Web of Science, Scopus, and CENTRAL) were searched from inception to May 11, 2025, for studies reporting on PAH incidence in cryolipolysis patients. The primary outcome was the literature-pooled PAH incidence, estimated using a nonpairwise generalized linear mixed model for meta-analysis. Secondarily, we descriptively reviewed treatment devices utilized, time to PAH diagnosis, and additional cryolipolysis complications. Twenty-eight studies encompassing 13,078 patients were included in the review. Low-certainty evidence suggested that the pooled incidence of PAH was 0.22% (95% CI, 0.10-0.47), with 29 cases identified (1 in 455 patients). Sex-based risk differences were not statistically significant. Only 4 studies reported sufficient follow-up duration (≥16 weeks). PAH cases were reported with various devices and applicators, and although 10 of the 29 PAH cases (34.5%) involved the CoolCore applicator, insufficient data precluded device-based meta-analysis. Overall, the incidence of PAH following cryolipolysis appears to be higher than manufacturer reports. These findings emphasize the need for comprehensive risk disclosure, improved awareness and adverse event reporting, risk factor identification, and further investigation into the pathogenesis of PAH. Level of Evidence: 3 (Therapeutic).

Background: Although COVID-19 infection rates have declined from pandemic peaks, recent infection may pose a potential concern in aesthetic surgery. Of note, the surgical risks associated with recent infection are not well defined. Previous studies, constrained by small cohorts and early-pandemic data, have not conclusively established whether recent COVID-19 infection continues to influence surgical outcomes.

Objectives: The authors sought to determine whether COVID-19 infection within 30 days before body-contouring procedures is associated with increased postoperative complications.

Methods: Adult patients who underwent body-contouring surgery between August 2020 and March 2025 were identified from the US Collaborative Network on TriNetX (TRINETX, LLC, Cambridge, MA). Patients were categorized based on documented COVID-19 infection within 30 days preoperatively. Propensity score matching (1:1) was performed to balance demographics and comorbidities. Thirty-day postoperative complications were compared using risk ratios (RRs), with statistical significance defined as P < .05.

Results: A total of 3941 patients were matched in each of the COVID-19 and non-COVID-19 groups. Patients in the matched COVID-19 group had a significantly increased risk of surgical-site infection (RR 1.56, P = .010), wound disruption (RR 1.69, P = .003), postoperative pain (RR 1.66, P = .002), anticoagulant use (RR 1.77, P < .0001), and emergency department visits (RR 1.50, P = .010).

Conclusions: Despite reduced overall prevalence, recent COVID-19 infection remains associated with increased risk of postoperative complications following body-contouring surgery. Delaying elective aesthetic procedures by at least 30 days following recent infection appears prudent to enhance patient safety and minimize complications.

Level of evidence 3 therapeutic: