Aesthetic surgery journal. Open forum最新文献

Intramuscular lipomas, although rare, are benign growths within muscle tissue. Typically occurring between ages 40 and 70, they present as infiltrative masses, with the thigh being the most common location. Lipomas exceeding 5 cm are termed giant lipomas. Instances within the trapezius muscle are notably scarce, necessitating further research due to their relative rarity. A 40-year-old male presented with a 2-year history of a tumor on his right shoulder, causing mild limitation but no pain or tingling. Initial attempts at removal failed due to depth. Imaging revealed a well-defined, vascular mass, confirmed by MRI as a 1041 cm3 intramuscular lipoma in the right trapezius muscle. Surgical extraction was successful without complications. Few cases of intramuscular lipomas in the trapezius muscle have been reported. These slow-growing masses can cause discomfort and mimic other conditions. MRI is crucial for accurate diagnosis, distinguishing them from other soft tissue tumors. Surgical excision is preferred for symptomat cases, with low recurrence rates. This case highlights a rare giant intramuscular lipoma in the trapezius muscle, emphasizing the importance of precise imaging for diagnosis. Further epidemiological research on intramuscular lipomas is needed, particularly in the trapezius muscle.

Level of evidence 5 therapeutic:

Background: Noninvasive treatment with a 1064 nm diode laser, generating hypodermal temperatures between 42 and 47 °C, induces adipocyte cell death, offering a solution to reduce fat in problematic areas.

Objectives: The objective of the authors of this study is to determine whether a 15 min treatment provides similar efficacy as the standard 25 min treatment.

Methods: Pigs underwent a 15 or 25 min 1064 nm laser treatment on 6 × 6 cm areas of abdominal skin. Single treatments were administered 14 or 28 days before biopsy, whereas dual treatments were performed at both 14 and 28 days prebiopsy. Hematoxylin and TUNEL staining were used to detect histological changes and apoptosis in harvested skin tissue.

Results: Pig skin subjected to a 25 min diode laser treatment exhibited nearly twice the apoptotic counts in the hypodermis compared with the 15 min treatment (10.5 vs 5.7) at 28 days following treatment. The degree of apoptosis increased with time following the treatment, with nearly twice the apoptosis counts at 28 days than at 14 days following a single 25 min treatment (10.5 vs 5.8). When testing 1 vs 2 treatments, 2 treatments (28 and 14 days before harvesting the tissue) did not result in significantly higher apoptosis than 1 treatment 28 days before harvesting. Apoptosis was primarily localized to adipocytes in the hypodermis and the dermis/hypodermis junction. There were no adverse side effects in the animals.

Conclusions: The degree of apoptosis following a 1064 nm laser treatment was proportional to the treatment duration. The 25 min treatment produced significantly more apoptosis than the 15 min treatment. The process of apoptosis continued over several weeks.

Level of evidence 4 therapeutic:

Background: Osteotomies are important maneuvers in the plastic surgeon's arsenal for the nasal dorsum treatment. However, there is a concern regarding a possible medialization of the inferior turbinate's heads and narrowing of the internal nasal valve if the Webster's triangle is not preserved.

Objectives: To analyze the mobilization of the inferior turbinates during primary rhinoplasty after lateral osteotomies.

Methods: This is a retrospective study in which we analyzed 37 patients who underwent very low-to-low osteotomies in our service, during primary rhinoplasties. Axial and coronal computed tomography scans were obtained, and preoperative and 6 months postoperative images were compared with Radiant DICOM Viewer software (Medixant, Poznan, Poland) in 3-dimensional multiplanar reconstruction.

Results: There were no statistically significant differences between preoperative and postoperative measurements of the lower turbinate's osseous bases, both in axial (P = .305) and coronal (P = .08) images.

Conclusions: Low-to-low osteotomies showed no medialization of the inferior turbinate's heads or narrowing of the internal nasal valve in this study.

Level of evidence 4 therapeutic:

Background: Asymmetry, a prevalent phenomenon throughout the human body, prompts this retrospective study, in which the authors aim at discerning potential patterns in its manifestation. Building upon our previous investigations in which left-sided chest wall and pelvic bone width surpassed their right-sided counterparts, a hypothesis is formulated suggesting the likelihood of the right breast being narrower and longer compared with the left.

Objectives: Our objective in this study is to investigate the correlation between the left-sidedness phenomenon in the chest wall and breast shape and appearance, with the aim of understanding its potential impact on outcomes in breast aesthetic surgery.

Methods: A random selection of pictures from 600 female patients undergoing various aesthetic breast procedures formed the basis of this study. Exclusion criteria involved the elimination of 254 pictures with nonstandard photography. Horizontal and vertical parameters of breasts and chest walls were measured, and the results on both sides were systematically compared to validate our hypothesis.

Results: On the left side, the chest wall, the distance between the nipple and the midline, and that of the nipple and the anterior axillary line were significantly wider. Vertical measurements, including the sternal notch to the nipple, the clavicle to the nipple, and the clavicle to inferior breast distance, although longer, did not exhibit statistical significance.

Conclusions: Approximately 77% of patients displayed wider breasts and chest walls on the left side. However, this observed asymmetry did not yield a statistically significant impact on the length of the breasts.

Level of evidence 3 diagnostic:

Background: Glycolic acid (GA) is an α-hydroxy peeling agent that causes controlled removal of the epidermis, with or without the dermis. Studies have shown the ability of GA to stimulate fibroblast proliferation, induce collagen synthesis, and decrease collagen degradation. The VoluDerm radiofrequency microneedling (RFMN; Pollogen, Tel Aviv, Israel) utilizes an array of microelectrodes to penetrate the epidermis and deliver energy to the skin. The controlled fractional thermal injury promotes neocollagenesis in the correction of skin laxity and wrinkle reduction. It was theorized that GA and VoluDerm could synergistically boost collagen production in combined treatment.

Objectives: Safety and efficacy of the combination treatment were investigated in patients seeking corrections of the age-related skin deteriorations.

Methods: Seven female patients (aged 42-70 years, Fitzpatrick II-IV) with photo- and chrono-damaged skin received 5 treatments of VoluDerm followed by the GA peel at increasing 30% to 70% concentrations.

Results: Clinical photography taken 6 months after the treatment demonstrated improvement in elasticity, wrinkling, roughness, pigmentation, erythema, and pore size across the entire treated group. Efficacy quantified by the physician and patients per 1 to 5 Global Aesthetic Improvement Scale was average 4.3 and 4.5, respectively. The treatments were tolerated well without preprocedural anesthesia. Skin phenomena observed after GA application were suggestive of the acid passing to deeper layers.

Conclusions: A novel combination of VoluDerm RFMN and GA at increased concentrations provided safe and effective synergy in the treatment of aging facial skin. Visible results demonstrated skin tightening, reduction of rhytidids, and improvement of the skin texture which may be a result of the combination.

Level of evidence 4:

Background: Tranexamic acid (TXA), a fibrinolysis inhibitor, is widely used in various surgical fields to minimize blood loss. However, its efficacy and safety in plastic surgery, especially in reduction mammaplasty and abdominoplasty, remain underexplored. This study investigates the utility of intravenous (IV) TXA in these procedures, focusing on reducing postoperative complications and evaluating its safety in the context of venous thromboembolism (VTE).

Objectives: To evaluate the efficacy and safety of TXA in reduction mammaplasty and abdominoplasty.

Methods: Using data from the TriNetX LLC (Cambridge, MA) National Health Research Network database, this retrospective study compared adult patients undergoing reduction mammaplasty or abdominoplasty who received intraoperative IV TXA against those who did not. Primary outcomes included postoperative seroma and hematoma incidences, whereas secondary outcomes assessed the necessity for procedural drainage and the occurrence of VTE within 1-year postsurgery.

Results: No significant differences in the rates or risks of hematoma, seroma, or the need for procedural drainage between patients administered IV TXA and those who were not, for both reduction mammaplasty and abdominoplasty. Additionally, IV TXA did not increase the risk of VTE in either patient group.

Conclusions: IV TXA application in reduction mammaplasty and abdominoplasty does not provide added benefits in reducing postoperative complications such as seroma, hematoma, or the necessity for procedural drainage. Furthermore, it does not alter the risk of thromboembolic events. These findings highlight the need for further research, particularly through randomized control trials, to understand TXA's efficacy in plastic surgery.

Level of evidence 3 therapeutic:

Background: Lip augmentation procedure with hyaluronic acid (HA) fillers can make patients younger with more attractive. After the injection on the lips, the result is temporary. Physicians and patients wonder how long the HA filler last on the lips.

Objectives: The main goal of this study is to determine how much volume of HA is reduced after injection on the lips utilizing a "9-point" injection technique.

Methods: In this prospective study, 25 females were injected using HA filler and evaluated using noninvasive 3-dimensional-scanner analysis before, 1 h, 1 week, 1 month, 6 months, and 9 months after injection. The changes in projection of lips were evaluated using sonography. The patients were treated as usual manner in a single clinic. Using 29-gauge needle, 20 mg/mL of HA filler was injected into the lips. Default injection amount was 1 cc. HA filler was injected submucosally using linear thread and fanning technique.

Results: Twenty-three patients were followed up. The mean age was 34.8 years (range, 20-48 years). The volume of lips became 181.34% (±61.14) at 1 h, 91.18% (±10.12) at 1 week, 75.09% (±11.02) at 1 month, 55.36% (±10.48) at 6 months, and 39.21% (±4.54) at 9 months. The projection of upper lip areas increased 25.3% at 1 h, 22.8% at 1 week, 17.7% at 1 month, 14.8% at 6 months, 11.5% at 9 months in sonography. The projection of lower lip areas increased 23.1% at 1 h, 20.7% at 1 week, 15.9% at 1 month, 13.9% at 6 months, and 10.6% at 9 months in sonography.

Conclusions: Lip augmentation with HA showed improved shape during 9 months. The volume of HA decreased at a constant rate after injection, except for the first week. Injected HA was absorbed at a constant rate, and more than half was absorbed after 9 months utilizing a "9-point" injection technique.

Level of evidence 4 therapeutic:

Background: Menopause involves a range of bodily changes, with impacts on physical and psychological well-being. Around half of the postmenopausal women experience genitourinary syndrome of menopause (GSM). Fractional CO₂ laser treatment can promote tissue regeneration in the vaginal wall to potentially assist with managing GSM. However, the results from clinical trials of this treatment have been mixed, and the personal perceptions and experiences of women receiving this treatment have been largely unexplored.

Objectives: To qualitatively explore the motivations and outcomes of women who have undergone vaginal fractional CO₂ laser treatment.

Methods: Fourteen postmenopausal women were involved in the study. These women had undergone vaginal fractional CO₂ laser treatment between 2 and 48 months earlier (M = 32.1, standard deviation = 14.9 months). Telephone interviews were conducted to explore women's motivations and their experiences after treatment. Interviews were recorded and transcribed verbatim. Deductive and inductive thematic analysis was conducted to analyze interviews.

Results: Analyses produced 4 major themes. First, motivations mostly revolved around participants seeking relief from menopausal symptoms. Second, some participants noted positive sexual outcomes, including improved sexual pleasure after treatment. Third, participants noted positive physical and psychological effects, including improvements in incontinence and overall confidence. Lastly, a subset of participants reported no discernible changes.

Conclusions: This novel qualitative exploration of women's motivations and outcomes of fractional CO₂ laser therapy demonstrates the multifaceted impact of treatment. These findings highlight the importance of considering the holistic effects of fractional CO₂ laser therapy on women's health during midlife, particularly amid menopausal changes.

Level of evidence 4:

Background: Implant-based breast reconstruction following radiotherapy can lead to significant postoperative complications. Closed-incision negative pressure wound therapy (ciNPWT) has emerged as a potential intervention to reduce these complications.

Objectives: To assess the effectiveness of ciNPWT in reducing postoperative complications in patients undergoing implant-based breast reconstruction after radiotherapy.

Methods: A retrospective single-center cohort study was conducted, including patients who underwent implant-based breast reconstruction after mastectomy and radiotherapy between January 1, 2015, and December 31, 2022. We utilized a procedure-level analysis model with patients contributing distinct observations for multiple procedures. Our primary outcome measures included fluid collection, infection, and wound complications. Propensity score analysis was employed to adjust for potential confounders, such as BMI, smoking history, and diabetes history, creating a balanced comparison between the ciNPWT-treated and untreated groups.

Results: In our study of 301 breast reconstructions postradiotherapy from 2015 to 2022, encompassing 218 unique patients, we found significant benefits of ciNPWT. During an average of 2.2-year follow-up, the ciNPWT group demonstrated no infections, contrasting with a 10.4% rate in the non-ciNPWT group (P < .0001). Wound complications were also significantly lower in the ciNPWT group (1.9% vs 11.2%; P = .00848). Demographic differences were adjusted using inverse probability of treatment weights. The findings suggest ciNPWT's promising role in enhancing postoperative outcomes in breast reconstruction postradiotherapy.

Conclusions: Our study suggests that the use of ciNPWT in implant-based breast reconstruction postradiotherapy can potentially reduce postoperative complications. This intervention can improve patient outcomes and may offer cost-saving benefits in the long run.

Level of evidence 3 therapeutic:

Background: The regenerative properties of stromal vascular fraction (SVF) in wound healing and scar formation are a subject of increasing clinical interest.

Objectives: Although preclinical studies have confirmed the angiogenetic, proliferative, and antifibrotic properties of SVF, there is limited clinical evidence from randomized controlled clinical trials.

Methods: Twelve patients who underwent abdominoplasty were included in this clinical study. Nanofat was mechanically obtained intraoperatively and infiltrated intradermally in the sutured surgical wound, randomly assigned to either the left or the right side. The abdominal scar was evaluated with the Patient and Observer Scar Assessment Scale, whereas erythema and pigmentation were measured with a reflectance spectrophotometry device (Mexameter, Courage + Khazaka electronic GmbH, Köln,Germany). Histological analysis and electron scan microscopy of tissue biopsies were performed at 8 months.

Results: The treated side of the scar showed significantly less erythema at 3- and 6-month follow-ups, but this difference reduced after 12 months. Patients reported better scar scores at the 6-month follow-up with a significantly better color at the treated side. Observers reported better overall scar scores at the treated side at 3-, 6-, and 12-month follow-ups, with better vascularization, pigmentation, and thickness. There was no statistically significant difference in terms of histological analysis between the 2 groups. There was no difference in the occurrence of adverse events between both sides.

Conclusions: Infiltration of nanofat exhibited promising results in surgical scar maturation characterized by less erythema and better texture. More clinical trials with a larger sample size are warranted to better elucidate the possible benefits of SVF on surgical scar formation.

Level of evidence 5: