Aesthetic surgery journal. Open forum最新文献

Nonsurgical cosmetic facial procedures have become popular treatment options for individuals seeking aesthetic improvements. Despite a breadth of literature on patient satisfaction with treatment outcomes, there is a lack of information specific to changes in quality of life outcomes. The objective of this umbrella review is to report the effectiveness of nonsurgical facial aesthetic treatments on reported quality of life in cosmetic treatment-seeking patients. The authors also aim to identify gaps in the literature on measures of quality of life outside of patient satisfaction. The authors completed a comprehensive, systematic search of review articles across 6 databases, including Medline, CINAHL Plus, EMBASE, APA PsycINFO, Cochrane Reviews, and Google Scholar. They included review-level studies that examine the changes in quality of life measures following treatment. A critical appraisal was completed for each review article included. A total of 7 reviews were included. One review was of strong quality, 2 moderate, and 4 were weak. Several nonsurgical procedures were evaluated across reviews, including injectable neurotoxins, dermal fillers, and laser skin resurfacing. The majority of included studies reported increases in measures of quality of life, posttreatment in the same patient or compared with controls. The most commonly reported measure was psychological well-being, followed by self-perception. There was a lack of measures outside of improvements to aesthetics, including those specific to mental health (eg, depression). Overall, based on the studies on nonsurgical treatments, the authors report increases in overall quality of life. This conclusion should be interpreted with caution, as the majority of reviews included were of moderate-to-weak quality. A major gap in this literature includes mental health outcomes. Future research should focus on increasing the rigor of reporting for systematic reviews.

Level of evidence 2 risk:

Breasts have evolved as a functional and aesthetic unit. The perception of society toward social exposure of the breast has been extremely diverse, not only temporally through the same civilization but also among contemporary parallel societies in geographically diverse areas. This article explores the spatial and temporal evolution of the outlook toward social exposure of breast over the past 3000 years among different societies, countries, and religions. The level of "acceptance" or "tolerance" toward visibility of breast in social situations was historically guided by social conditioning. Recently, the personal attitudes and preferences of the women themselves have become more deterministic of the clothing choices. Consequently, the conventional oncoplastic notion of a "no-scar zone" being the upper-inner quadrant of the breast must also be redefined to match the dynamic personal preferences of the patient. It is important to know what the patient thinks is the "most social" area of the breast for her, and then to avoid scars in those areas if possible. The article discusses the quest to minimize scars and the importance of shared decision making.

Background: Management of dorsal dead space and the aesthetics of a supratip break are paramount to achieving reproducible and reliable results in rhinoplasty.

Objectives: The authors present a modified technique of redraping the nasal soft tissue envelope in structural rhinoplasty by utilizing the nasal superficial musculoaponeurotic system (SMAS) to help obliterate dorsal dead space and restore normal anatomy, thereby enhancing midvault and supratip contouring.

Methods: A standard open rhinoplasty approach is utilized. A planar transition from supraperichondrial to subperichondrial/subperiosteal is completed during the dorsal dissection. The open structural rhinoplasty then proceeds as previously published by the senior author. After any desired tip work is completed, the cephalically based SMAS layer is reconstituted with suture fixation laterally along the caudal border of the upper lateral cartilages. A more robust technical discussion is borne out in the manuscript.

Results: At submission, the senior author has performed >100 rhinoplasties employing this technique over roughly 1 year. Subjectively, patients have had better immediate supratip contour with less residual dorsal soft tissue edema. A case example with photographs is included at a 1 year postoperative time point.

Conclusions: Using this described technique, surgeons can employ an open, structural, approach to rhinoplasty while using restoration of natural anatomy to achieve a refined postoperative result, accentuating supratip break while minimizing dorsal soft tissue dead space.

Level of evidence 5 therapeutic:

Background: Biodegradable polymers are commonly used as dermal fillers in plastic surgery. Among these, poly-L-lactic acid (PLLA) distinguishes itself owing to its good biocompatibility, degradability, and ability to act as a collagen stimulator.

Objectives: In this study, the differential behavior of PLLA microspheres with varying microscopic morphology and surface hydrophilicity was investigated both in vitro and in vivo.

Methods: The introduction of short hydrophilic polyethylene glycol (PEG) chains into the PLLA molecule was employed to modify the morphology and enhance the surface hydrophilicity of the microspheres. The morphology and physicochemical properties of the PLLA and PLLA-b-PEG microspheres were characterized. Irregular PLLA particles, PLLA, and PLLA-b-PEG microspheres were implanted into the subcutaneous tissue of rabbit models, and at 4, 26, and 52 weeks after implantation, biopsy samples were collected for hematoxylin and eosin and Masson's trichrome staining to evaluate differences in the tissue response between different implants.

Results: The results of in vitro research demonstrated that while the addition of short-chain hydrophilic PEG afforded a smoother surface for the microspheres, it had no significant effect on the molecular weight and degradation rate of PLLA. The histological examination revealed that the PLLA-b-PEG microspheres exhibited enhanced biocompatibility compared with the pure PLLA microspheres, while the irregular PLLA particles showed the highest inflammatory response among the 3 materials.

Conclusions: In this study, we found that the properties of PLLA were improved upon modification by short-chain PEG without reducing the collagen regeneration ability, thereby affording a better histocompatibility.

Level of evidence 5 therapeutic:

Recently, mandated FDA patient decision checklists were developed with the goal of improving the informed decision-making process for patients considering breast implants. However, these checklists are written at reading levels far higher than recommended by the National Institutes of Health and the American Medical Association. This study aims to improve the accessibility, and therefore, the utility of the mandated FDA patient literature for the average breast implant patient using the assistance of artificial intelligence (AI). Patient decision checklists were obtained from the 3 most utilized breast implant manufacturers in the United States-Allergan, Mentor, and Sientra. A novel patient decision checklist was synthesized by AI, written at the sixth grade reading level, using these checklists as source material. The AI-assisted checklist was edited by plastic surgeons for both formatting and content. The overall readability of Allergan, Mentor, and Sientra patient checklists correlated with the college reading level. These documents were of a statistically significantly higher reading level than the AI-assisted checklist, which was written at the recommended sixth grade level. Text composition analysis similarly demonstrated substantial differences between the AI-assisted and FDA-mandated literature. The currently mandated breast implant patient checklists are written at a college reading level and are inaccessible to the average patient. The authors propose a new patient decision checklist, generated with the assistance of AI, to improve healthcare access within plastic surgery. This simplified material can be used as an adjunct to the current checklists to improve shared decision making.

Informed consent is a crucial requirement of a patient's surgical care but can be a burdensome task. Artificial intelligence (AI) and machine learning language models may provide an alternative approach to writing detailed, readable consent forms in an efficient manner. No studies have assessed the accuracy and completeness of AI-generated consents for aesthetic plastic surgeries. This study aims to compare the length, reading level, accuracy, and completeness of informed consent forms that are AI chatbot (ChatGPT-4; OpenAI, San Francisco, CA) generated vs plastic surgeon generated for the most commonly performed aesthetic plastic surgeries. This study is a cross-sectional design comparing informed consent forms created by the American Association of Plastic Surgeons (ASPS) with informed consent forms generated by ChatGPT-4 for the 5 most commonly performed plastic surgery procedures: liposuction, breast augmentation, abdominoplasty, breast lift, and blepharoplasty. The average word count of ChatGPT forms was lower than the ASPS-generated forms (1023 vs 2901, P = .01). Average reading level for ChatGPT forms was also lower than the ASPS forms (11.2 vs 12.5, P = .02). There was no difference between accuracy and completeness scores for general descriptions of the surgery, risks, benefits, or alternatives. The mean overall impression score for ChatGPT consents was 2.33, whereas it was 2.23 for ASPS consent forms (P = .18). In this study, the authors demonstrate that informed consent forms generated by ChatGPT were significantly shorter and more readable than ASPS forms with no significant difference in completeness and accuracy.

Level of evidence 5 risk:

Background: In the digital arena, wherein younger generations predominantly spend their time, social media continues to determine what is considered beautiful. Social media, particularly Instagram (Meta, Menlo Park, CA), is becoming a prominent aspect of the plastic surgeon-patient relationship. Therefore, the beauty ideal escalates without any barriers and breaks. The majority of influencers look alike. This sets a new trend for a beauty ideal.

Objectives: In this study, the authors aimed to analyze the facial proportions of 100 top female beauty influencers, to evaluate them for identifying the "ideal Instagram face," and to determine whether there existed a deviation from the standard golden ratio.

Methods: The authors identified the top 100 beauty influencers, according to the latest rankings of November 2022. A detailed facial analysis has been conducted using the Fiji biomedical image analysis software. The primary outcome parameters included facial proportions such as lip ratio, Ricketts' line, and nasal dimensions. Secondary outcomes comprised BMI, age, and ethnicity. The results were collected and analyzed descriptively using graphs and statistics.

Results: Complete datasets were obtained from the top 100 female beauty influencers with a mean age of 31.3 ± 6.3 years (range, 24-38 years). The majority of influencers were Americans, followed by Germans and British. Based upon the mean of the aforementioned parameters, we could design the ideal Instagram face. There was no significant difference between the golden ratio and the new trend of the ideal Instagram face.

Conclusions: Despite the existence of varied ethnic population groups and nonstandard measurements, the ideal Instagram face represents today's ideal trending face. The ideal Instagram face is symmetrical, matching the golden ratios, with a small and neat nose, full and lush lips, high cheekbones, as also a sharp and chiseled jawline. Further studies on this topic, involving a greater number of influencers with standardized measurements, should be advocated to identify the ideal facial proportions. This will lead to improvements in invasive and noninvasive cosmetic treatments.

Level of evidence 5 diagnostic:

Background: Despite the high demand of filler in the infraorbital area, there remains debate on injection practices, precise anatomical placement, and hyaluronic acid (HA) filler behavior.

Objectives: We aimed to contribute to the clinical and anatomic understanding of infraorbital HA injection through a prospective patient injection study in combination with a cadaveric analysis.

Methods: Patients were injected with Volbella XC (JUVÉDERM, Allergan Aesthetics, an AbbVie Company, Irvine, CA) into the tear trough region by a single experienced aesthetic plastic surgeon. Over a 90-day period, precise undereye volumetric measurements using 3-dimensional photogrammetry (VECTRA-M3, Canfield Scientific, Inc., Fairfield, NJ) and patient-reported outcomes (PROs; FACE-Q) were collected and analyzed relative to 2 pretreatment severity scales. Juvéderm Vycross (Allergan Aesthetics, an AbbVie Company, Irvine, CA) and Restylane NASHA (Galderma, Lausanne, Switzerland) products were injected into the infraorbital and malar region in 6 cephalus specimens and evaluated with regards to the anatomic injection location with and without common clinical physical manipulations.

Results: Eleven patients participated with a 100% retention rate. Infraorbital HA volume maintenance was 70% to 81% at 30 days and 50% to 70% at 90 days. Significant improvement was noted in the eyes, overall facial appearance, and cheekbones (P < .05) with FACE-Q outcomes, irrespective of pretreatment severity. In the cadaver examination, we observed differences in the anatomic locations occupied by Juvéderm and Restylane products as well as in behavior after physical manipulation between gel types.

Conclusions: Volbella XC effectively augments undereye volume to diminish infraorbital hollowing as measured over a 90-day period with significantly improved PROs. Enhanced knowledge of the behavior of Volbella XC and other HA fillers in this sensitive anatomic region will lead to improved patient outcomes.

Level of evidence 4 therapeutic:

Background: Lasers and energy-based devices are commonly employed in aesthetic medicine. In the United States, the FDA regulates lasers as medical devices, restricting marketing to approved indications and making off-label claims illegal. Despite this, no comprehensive analysis of off-label marketing prevalence exists.

Objectives: The authors of this study aim to compare the FDA-approved indications for 2 popular aesthetic lasers to their online advertising claims. Additionally, they seek to educate aesthetic providers on the current regulatory restrictions surrounding off-label advertising.

Methods: FDA-approved indications for 2 lasers-helium plasma dermal resurfacing and 2940 nm fractional erbium-doped yttrium aluminum garnet-were obtained from the publicly available Establishment Registration & Device Listings Database. Online advertisements regarding the capabilities of each laser were collected from practice websites in the United States.

Results: Our analysis of 100 online claims for each laser revealed that more than half of the websites advertising helium plasma (n = 59) and 44 websites advertising fractional lasers made at least 1 off-label claim. Both plastic surgeons and nonplastic surgeons made at least 1 off-label claim, with no statistically significant difference between the groups.

Conclusions: Despite FDA regulation of medical devices, online advertising regarding the indications and capabilities of popular medical lasers varies widely. Patients who seek information regarding aesthetic laser treatments may encounter inaccurate and differing claims for these treatments, potentially leading to false expectations and poor patient outcomes.

Level of evidence 4 risk: