Aesthetic surgery journal. Open forum最新文献

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:

Background: Driven by the influence of social media platforms, the "thigh gap" has emerged as a beauty ideal in modern culture. Despite its prevalence in popular culture, there is no scientific evidence to validate the thigh gap as a realistic or universally attainable beauty standard.

Objectives: The aim of the authors of this study is to evaluate the general public's perception of thigh-gap aesthetics, specifically examining preferences for varying thigh-gap widths and the influence of demographic factors on these preferences.

Methods: Four model images of varying thigh-gap widths and thigh gap-to-hip ratios (TGHRs) of 0.19, 0.09, 0.04, and 0.02 were created and presented to participants in an online survey using public crowdsourcing. Participants rated the attractiveness of these images and ranked them in order of preference. Demographic data, including gender, race, sexual orientation, and income, were collected to assess subgroup trends.

Results: A TGHR of 0.09 was rated as the most attractive by the general population, with preferences for moderate thigh gaps consistently emerging across most demographic groups. Significant variations in preferences were observed based on income, race, and sexual orientation, indicating the role of cultural and socioeconomic factors in shaping aesthetic ideals. Extreme thigh gaps and the absence of a thigh gap were rated as less attractive.

Conclusions: These findings suggest a general preference for moderate thigh gaps with a TGHR of 0.09 over extreme or absent thigh gaps. Our findings highlight the importance of understanding demographic differences in aesthetic preferences to tailor body contouring and reconstructive procedures that meet patient expectations while maintaining natural proportions.

Level of evidence 5 therapeutic:

Background: Facial aging is a multifactorial process involving tissue descent, volume depletion, and dermal degeneration. Minimally invasive modalities like thread lifting, autologous fat grafting, and laser treatments address different aging components. However, their synergistic impact remains underexplored.

Objectives: The aim of the author of this study is to assess the clinical efficacy and histologic rationale of combining permanent thread lifting, autologous fat grafting, and nonablative laser therapy for comprehensive facial rejuvenation.

Methods: In this retrospective study, a total of 65 female patients (aged 31-60, Fitzpatrick skin types II-IV) treated from January 2022 to January 2023 were included. Patients were divided into 3 groups: thread lifting alone (Group 1), thread + laser (Group 2), and thread + laser + fat grafting (Group 3). Evaluations were performed at 12 months by a plastic surgeon, a dermatologist, and the patients themselves using a 5-point Likert-scale assessing skin texture, fine wrinkles, lift effect, and overall satisfaction. Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction were utilized, alongside cumulative link regression models.

Results: Significant group differences were observed in skin texture (P = .00013) and overall satisfaction (P = .00421). Post hoc comparisons revealed that Groups 2 and 3 outperformed Group 1 in skin texture (P = .0155 and P = .0003, respectively). Fine wrinkle improvement was notable in Group 3 (P = .0239 vs Group 1). Ordinal logistic regression confirmed significant improvement with laser therapy per dermatologist ratings (odds ratio = 2.10, P = .019), with a favorable trend observed for fat grafting. Cliff's δ and Hodges-Lehmann estimates showed progressively larger improvements with increasing treatment complexity.

Conclusions: Combining thread lifting, autologous fat grafting, and laser therapy may provide superior aesthetic outcomes to thread lifting ± laser therapy alone. This is likely the result of the synergistic effects on mechanical lift, volume restoration, and dermal remodeling. These findings support an integrative treatment paradigm for nonsurgical facial rejuvenation and justify further prospective validation with histologic endpoints.

Level of evidence 3 therapeutic:

The authors of this study present a standardized approach for achieving consistent, natural-looking lip augmentation using cohesive polydensified matrix hyaluronic acid (CPM-HA) fillers. Developed by a panel of 5 global experts, 8 core injection techniques were established to guide procedures, including supporting the oral commissures, enhancing the vermillion border, increasing lateral lip show, increasing vertical height and eversion, improving lip curvature, enhancing lateral structure, and defining the Cupid's bow. The approach outlines a 5-step process: patient interview, documentation, anatomical assessment, lip structure assessment, and treatment, promoting results that are tailored to the patient's unique aesthetic goals and anatomy. Two examples of the application of these core principles are highlighted through the Beautification and Restoration pathways, chosen based on patient-specific needs. Beautification enhances existing lip features, whereas Restoration rebuilds structure lost to aging. Three case studies illustrate how these core principles and techniques are applied in practice, demonstrating how individual patient requirements guide treatment. Case 1 involves a 45-year-old patient seeking subtle lip enhancement. Case 2 outlines the treatment of a 39-year-old patient aimed at restoring lip proportions. Case 3 highlights the treatment for a 57-year-old patient requiring structural support. This methodology provides a flexible, structured framework that adapts to individual patient needs, promoting safe, effective, and consistent outcomes. Level of Evidence: 5 (Therapeutic).

Background: Aging signs of the upper face result from complex interactions among facial muscles and include forehead lines, glabellar lines, and crow's feet. Botulinum neurotoxin type A (BoNT-A) injections are widely utilized to address these concerns. An optimal treatment strategy should consider the interplay between elevator and depressor muscles. Comprehensive treatment approaches targeting the comprehensive upper face are gaining popularity but remain underreported in the context of newer products such as letibotulinumtoxinA.

Objectives: The aim of this study is to evaluate the efficacy and safety of a comprehensive upper-face treatment using letibotulinumtoxinA (Letybo) and to assess its effect on glabellar lines, forehead lines, and crow's feet using validated clinical scales.

Methods: In this prospective, observational study, 20 participants (mean age: 35.8 ± 9.3 years) received standardized injections totaling 64 units. Treatment included 16 intramuscular injections: glabella (5 sites), forehead (5 sites), and crow's feet (3 per side), with 4 units (0.1 mL) per site. Efficacy was evaluated at baseline, Week 2, and Week 16 using the Facial Wrinkle Scale, Clinician's Dynamic Forehead Line Assessment Scale, and Clinician's Dynamic Crow's Feet Assessment Scale.

Results: At Week 2, ≥2-point improvement was observed in 95% of glabellar, 90% of forehead, and 90% of crow's feet cases. At Week 16, ≥1-point improvements persisted in 70% to 80% of participants. Five participants (25%) required a touch-up at Week 2. No adverse drug reactions were reported.

Conclusions: Comprehensive upper-face treatment with letibotulinumtoxinA showed meaningful, sustained aesthetic improvement with good tolerability. These findings support further research in larger populations.

Level of evidence 4 therapeutic:

Background: Quilting sutures (QSs) are used to reduce dead space and may decrease the need for surgical drains. Their application in breast reduction surgery could improve postoperative outcomes and facilitate earlier discharge.

Objectives: The aim of the authors of this study is to evaluate whether QSs significantly reduce postoperative drainage and hospital stay in breast reduction surgery, compared with standard closure without quilting.

Methods: A prospective, randomized, controlled study was conducted involving 87 female patients who underwent bilateral breast reduction between June 2023 and December 2024. Patients were randomized into 2 groups: the QS group (n = 38) and control group (n = 49). All patients received closed suction drains. Patients were included in the study if complete inpatient follow-up data were available for at least 24 h postoperatively. Primary outcomes included drainage volume on Postoperative day 1 and duration of hospital stay. Secondary outcomes included postoperative complications. Data were analyzed using SPSS v22.0; P < .05 was considered significant.

Results: Mean drainage volume on Postoperative day 1 was significantly lower in the QS group (17.6 cc) compared with the control group (36.1 cc; P = .017). Hospital stay was also significantly shorter in the QS group (mean 1.02 days) vs controls (1.32 days, P = .032). No significant differences were found in infection rates or wound-healing complications between groups.

Conclusions: This randomized controlled trial demonstrated that the use of QSs in breast reduction surgery can significantly reduce postoperative drain output and hospital stay, without increasing complication rates.

Level of evidence: 2 (Therapeutic).

Biostimulators like hyperdiluted calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC; Radiesse, Merz North America, Franksville, WI) are effective in promoting neocollagenesis and restoring facial volume. The emergence of glucagon-like peptide-1 (GLP-1) receptor agonists (GLP1RAs) for weight loss has introduced a subset of patients experiencing rapid weight loss with associated facial-volume changes, colloquially known as "Ozempic Face" (Novo Nordisk, Bagsvaerd, Denmark). This case series describes 4 patients on GLP1RAs who, despite rapid weight loss, maintained facial volume following treatment with hypderilute CaHA-CMC in the lower face. Four patients undergoing rapid weight loss with GLP1RA were retrospectively evaluated following hyperdilute (1:3) CaHA-CMC treatment in the lower face. Patient demographics, BMI, average weight loss, and follow-up assessments were reviewed. Responses were evaluated using standardized photographs, the Global Aesthetic Improvement Scale (GAIS), and patient satisfaction surveys. All 4 GLP1RA users completed both treatment sessions and 6 months follow-up. They lost an average of 24.3 ± 10.4 lb, equivalent to -9.2 ± 4.8% of baseline body weight, yet objective facial metrics remained stable or improved. Average cheek volume increased 9.8%, jowl volume declined 55.8%, nasolabial-fold depth decreased 46.2%, and marionette-line depth decreased 20.6%. At 6 months, investigator GAIS rated every patient "improved" or "much improved," and 100% of patients reported being "satisfied" or "very satisfied." Hyperdilute CaHA-CMC may offer benefits in preserving facial volume for patients undergoing weight loss with GLP-1 agonists. Further studies are warranted to elucidate the mechanisms and optimize treatment protocols for this population. Level of Evidence: 4 (Therapeutic).

Background: Postoperative management following abdominoplasty varies widely, particularly regarding improving the time to return to baseline physical activity.

Objectives: The goal of the authors of this randomized controlled trial was to compare the rate of return to baseline activity after abdominoplasty between patients receiving activity reminders from a wearable fitness tracker (actigraphy) and those following standard postoperative activity recommendations.

Methods: Patients undergoing cosmetic abdominoplasties were enrolled between December 2020 and December 2022. Those using actigraphy devices with activity reminders before enrollment were excluded. Patients were randomized to receive a wearable actigraphy monitor either with or without movement reminders. Only those with at least 5 days of preoperative and 7 weeks of postoperative step data were included in the final analysis.

Results: A total of 51 patients were enrolled in the study with a mean age of 44 ± 10.2 years. The attrition rate was 30/51 (59%), with 67% and 52% of the intervention group not completing the study (P = .16). Among the 21 patients with complete data, the mean time to return to baseline steps was 5.4 weeks in the control group and 5.6 weeks in the intervention group (P = .81). By the end of postoperative Week 8, 87.5% of the control group and 84.6% of the intervention group had reached their baseline (P = 1).

Conclusions: Structured reminders through an actigraphy device did not significantly change the time to return to baseline after abdominoplasty. Most patients returned to their baseline steps at the end of the study period regardless of intervention, providing valuable insight into the typical recovery time following abdominoplasty.

Level of evidence 2 therapeutic:

Morel-Lavallée lesions (MLLs) are rare closed soft tissue degloving injuries caused by shear forces that separate subcutaneous tissue from the underlying fascia. Chronic MLLs can lead to persistent functional impairment and aesthetic deformities. Standardized treatment approaches are limited, particularly for long-standing lesions without overlying skin necrosis. We report the case of a 42-year-old female patient with a chronic MLL on the left thigh, >2 years after a traffic accident. She experienced discomfort, abnormal soft tissue mobility, and noticeable thigh asymmetry. MRI revealed a persistent subcutaneous cleft without hematoma or seroma. A water jet-assisted lipoaspiration (WAL) procedure was performed to create multiple subcutaneous tunnels, promoting scar formation and tissue adhesion to stabilize the mobile tissue. The postoperative course was uneventful, and the patient reported significant improvement in both function and appearance. Follow-up MRI demonstrated complete obliteration of the subcutaneous cavity. A second WAL procedure was performed because of residual asymmetry, again with favorable results. This case highlights the potential of WAL to induce scar formation and eliminate pathological dead space, restoring soft tissue stability. The patient experienced complete symptom resolution and improved contour symmetry. WAL may serve as a promising minimally invasive treatment for chronic MLLs. It allows functional restoration and satisfactory cosmetic outcomes while avoiding extensive surgical revision. Level of Evidence: 4 (Therapeutic).

Background: Scars are a common outcome of wound healing, affecting millions worldwide. These marks can result from various causes. However, current treatments, such as dermal fillers and laser therapy, often have limitations, including transient effects that do not stimulate the body's natural regenerative processes, high costs, and potential adverse reactions.

Objectives: The objective of this study is to explore the potential therapeutic synergistic effect of a novel combination therapy using agarose and autologous platelet-rich plasma (PRP) to improve the appearance and characteristics of acne, atrophic, and hypertrophic scars.

Methods: This retrospective case series included 8 patients with acne, atrophic, and hypertrophic scars. All participants received a 50/50% mixture of agarose 1% and autologous PRP injected into the affected areas. Acne scars were evaluated using the Goodman and Baron Qualitative Acne Scar Grading System and the Investigator Global Acne Scarring (IGAS) scale. Atrophic and hypertrophic scars were assessed using the Modified Scar Assessment Scale (MSAS) and Investigator Global Aesthetic Improvement Scale (IGAIS). Patient satisfaction for all scar types was measured using the Patient Satisfaction Scale (PSS) at the final follow-up.

Results: Combined agarose-PRP therapy demonstrated clinical improvement in all treated scars. Acne scar patients (n = 2) showed a mean improvement of 2 points on the Goodman and Baron scale and the IGAS. For atrophic scar patients (n = 6), the MSAS scores improved from Grade 3-4 to Grade 0-1. IGAIS scores ranged from +2 to +3. PSS was high, with most patients reporting being "very satisfied" or "moderately satisfied." Representative images show visible improvements in scar depth, texture, and overall appearance.

Conclusions: Agarose-PRP filler shows promise for scar treatment. Physicians should be aware that these findings may represent an effective treatment option for patients. These results may be helpful in guiding treatment decisions for scar management.

Level of evidence 4 therapeutic: