Aesthetic surgery journal. Open forum最新文献

This paper and the accompanying video present a novel technique developed by the senior author to reliably control nasal tip projection and rotation with a midline cartilage graft that is nonbulky; easily reproducible; and conceptually intuitive. The saddle projection graft is a cartilage graft ∼5 by 15 mm in size fashioned from the nasal septum. A 15 blade is used to create a sagittal groove in the cartilage, which is then inset onto the anterior septal angle with the septum fitting within the sagittal groove. It is positioned to project anteriorly to the position of the desired nasal tip and the graft is inset with sutures. The tip is then unified upon this structurally stable unit. The midline position helps avoid the introduction of new deviation or asymmetry of the nasal tip. The cartilage dimensions do not demand a large stock of cartilage. The technique does not cause external valve obstruction or visibility. Most notably, the saddled position of the graft benefits from the direct support of the sturdy septal cartilage as it opposes the forces of scar maturation, resulting in predictable control of nasal tip projection and rotation.

Level of evidence 5 therapeutic:

Medical tourism has grown exponentially, spurred by incentives such as cost reductions, minimal wait times, and the allure of recuperative vacations. However, this trend carries substantial risks, as illustrated by the case of a 52-year-old female patient who underwent an abdominoplasty as part of a medical tourism package in Miami, FL, which resulted in a retained foreign body. The case highlights the broader issues of continuity of care, patient safety, and the legal and ethical ramifications faced by patients opting for medical tourism surgical procedures domestically and abroad. It also emphasizes the need for updated standards from professional societies and international cooperation to safeguard patient well-being in the expanding medical tourism sector. Lastly, it underscores the need for physicians and surgeons who manage these complications at home to recognize that prompt management and intervention are critical to avoid the escalation of complications and the increased risk of morbidity and mortality.

Level of evidence 5 therapeutic:

Plastic surgery sector has experienced significant growth, driven by an aging population's demand for minimally invasive procedures and technological innovation. Despite this, the role of venture capital (VC) in driving innovation within this sector remains underexplored. This study aimed to analyze the trends in VC investments in plastic surgery over the last 20 years, providing insights into the financial landscape of the sector. A retrospective cross-sectional analysis was conducted on VC investments in plastic and aesthetic surgery companies worldwide from January 1, 2003 to December 31, 2023, utilizing PitchBook (Seattle, WA). Companies were categorized into therapeutic and thematic areas, with investment trends analyzed by deal and company values, average investment size, and total capital invested. The study found 543 VC firms made 402 investments in 163 companies, totaling $1.98 billion, increasing by 15,143% over the study period, and focused on general plastic surgery and facial cosmetic procedures. Significant investments were also made in surgical software (25.3%), biotechnology and drug discovery (22.8%), and clinic and outpatient services (20.3%). Geographically, most investments were made in companies registered in Asia (45%) and North America (33.2%). VC investments have contributed to the growth and innovation in the plastic surgery sector, particularly in minimally invasive devices. The focus on general and facial cosmetic surgery aligns with market demand trends for aesthetic procedures. These findings underscore the importance of VC in shaping the future of plastic surgery and suggest the potential for strategic investments to further drive innovation.

Level of evidence5 diagnostic:

Hyaluronic acid (HA) fillers are a relatively safe and effective means of cosmetic treatment for the face; however, as the numbers of both patients and injectors continue to rise, reports of adverse events (AEs) and ischemia are increasing. Although visual complications and stroke are the most-feared AEs, skin and underlying tissue necrosis is far more common and can be catastrophic. HA can be dissolved with hyaluronidase, but this does not always resolve ischemia. In some instances, including the case presented here, conventional interventions are inadequate to reverse the progression of ischemia and restore blood flow. In this case study, HA injection of the nasal sidewall resulted in ischemia and impending necrosis of the nasal tip. Following failure of standard-of-care measures to reverse the progression of ischemia and restore blood flow, Hirudo medicinalis therapy was successfully used as an adjuvant treatment. To our knowledge, this is the first report of H. medicinalis therapy for treatment of ischemia and necrosis from aesthetic filler injection. Based on experience here, this approach should be considered for patients who are out of therapeutic options, or as a helpful adjunct to speed resolution of vascular occlusion. In addition, the success of H. medicinalis therapy, which acts locally on the microvasculature, may inform our understanding of the mechanism of vascular occlusion with fillers.

Level of evidence 5 therapeutic:

Background: The introduction of medical advancements requires ongoing critical evaluation of clinical practice and patient outcomes to improve results and safety. Since the development of minimally invasive, energy-based devices, this process has been occurring throughout the field of aesthetic medicine.

Objectives: To collect retrospective procedure and safety data of liposuction procedures with or without adjunct utilization of a helium-based plasma device, compare 3 groups, and delineate the learning curve.

Methods: A retrospective chart review at a single site included healthy patients ≥18 years of age treated by the principal investigator (PI). A total of 50 patients had an ultrasonic-assisted liposuction procedure, 50 patients had a liposuction procedure with the utilization of the helium-based plasma device, and 50 of the PI's most recent patients had a liposuction procedure with the utilization of the helium-based plasma device. All patients had at least 6 months of documented postoperative follow-up care.

Results: Totally, 150 patients were enrolled in the study. Most patients had multiple body areas treated, primarily hips and abdomen. Treatment settings varied, with significant relationships found between pain and treatment groups (P = .013). No serious or unexpected adverse events (AEs) were reported, and all AE resolved before the final follow-up.

Conclusions: The data collected support that patient outcomes and safety improve with continued use of the helium-based plasma device by the PI. The data also support the use of a helium-based plasma device as safe when used in combination with liposuction procedures.

Level of evidence 4 therapeutic:

Background: Arm contouring has been a challenging issue for many years. Patients request contouring of their arms without incisions and with a shorter recovery time. Making an incision on the arm does not always lead to a nice scar, and in case of complications, it may be catastrophic. The use of "arm net suture" can replace the incision during the arm contour surgery.

Objectives: The author has developed a simple technique of arm contouring with arm net suture that leads to eliminating the need for making an incision, preventing of sagging in the proximal part of the arm, and a shorter recovery time.

Methods: A retrospective study was conducted on 157 patients who underwent arm contouring surgery. Through a small 5 mm incision in the medial elbow, normal saline solution containing Xylocaine (Fresenius Kabi, Bad Homburg, Germany) and adrenaline was infiltrated. After 20 min, liposuction was started from the most superficial layer with a 3 mm cannula, and then, deeper layers superficial to the fascia were suctioned with a 4 mm cannula. The author usually utilizes traditional suction-assisted lipectomy or power-assisted lipectomy. After completing liposuction, the laxity of the skin along the arm was checked. Most of the laxity of the skin occurred in the proximal third of the arm; while the assistant pulled the skin of the proximal part lateral and downward, the net sutures were inserted. On the third or fourth day (based on the severity of laxity of the skin), the sutures start to be removed from the distal rows, with all sutures removed by the fifth to sixth day. The follow-up times were between 3 and 12 months.

Results: All patients were female, and their age range was from 19 to 62 years (mean, 40.45 years). The volume of liposuction was from a minimum of 1200 cc to a maximum of 2500 cc (mean, 1645 cc), and the reduction of the arm diameter was occurred in the range of 6 to 14 cm. No immediate postoperative problems were observed in the patients. Revision was not needed for any patients.

Conclusions: Arm net suture is a simple and safe method to replace the incision during arm contour surgery.

Level of evidence 4:

Bariatric interventions, both surgical and medical, are increasingly employed by patients to achieve weight reduction and enhance overall health. However, there is growing concern about the associated changes in soft tissue facial aesthetics resulting from these interventions. In this systematic review, the authors aimed to analyze the existing literature regarding soft tissue facial changes after bariatric interventions, with a focus on the influence of massive weight loss on facial aging, attractiveness, and considerations for facial rejuvenation. A systematic review was conducted until February 10, 2024, using electronic databases such as PubMed, Scopus, Web of Science, Embase, and Google Scholar. This review was registered in the open science framework. The Covidence software (Melbourne, VIC, Australia) facilitates title, abstract, and full-text screening, as well as data extraction. In total, 309 papers were identified, 94 duplicates were removed, and 194 studies were excluded on the basis of inclusion criteria. Of the remaining 21 studies, 13 met the inclusion criteria with an additional single study from the conference abstract. Descriptive analysis was conducted. We observed a correlation between massive weight loss and facial aging. The most significant fat regional devolumization was observed along the mid-cheek region and with central neck skin laxity. The apparent age of patients was higher among those with massive weight loss. In our study, we demonstrated that massive weight loss causes accelerated facial aging, manifested through fat devolumization, and increased skin laxity. Further quantitative volumetric facial analyses postbariatric surgery would yield valuable results.

Level of evidence 3 therapeutic:

Background: Mesh implants are frequently employed in alloplastic breast reconstruction. Notably, no mesh to date has FDA approval for this indication. Several synthetic meshes have been introduced with heterogeneous properties and outcomes.

Objectives: This study aims to systematically review synthetic mesh use in alloplastic breast reconstruction, describe rates of short-term complications, and analyze these outcomes in reports comparing synthetic and biologic meshes. The authors hypothesized data from comparative and noncomparative studies would show no significant differences between synthetic and biological meshes.

Methods: The authors conducted a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-one studies reporting the use of synthetic mesh and clinical outcomes were included. Eight studies directly comparing synthetic mesh and biological mesh were meta-analyzed for relative risk (RR). Nineteen noncomparative studies were analyzed for meta-rates. Outcomes, including seroma, infection, reoperation, and explant, were assessed on a per-breast basis. Resultant models were challenged for sensitivity and bias.

Results: Meta-analysis of comparative studies demonstrated no difference in the risk of infection with synthetic mesh (RR = 0.53; 95% CI [0.26-1.10]), but a reduced risk of reoperation (RR = 0.54; 95% CI [0.33-0.89]) or explant (RR = 0.43; 95% CI [0.21-0.87]). Meta-analysis of noncomparative studies demonstrated rates of seroma = 3%; 95% CI [1%-6%], infection = 4%; 95% CI [3%-6%], reoperation = 10%; 95% CI [7%-13%], and explant = 3%; 95% CI [2%-5%]).

Conclusions: Studies comparing synthetic and biologic meshes demonstrated noninferiority of synthetic in all outcomes assessed. Noncomparative studies demonstrated rates of seroma, infection, reoperation, and explant similar to literature values for biological mesh.

Level of evidence 2 risk:

Background: Tissue reinforcement techniques with porcine acellular dermal matrices (ADMs) have been widely adopted as standard care in treating capsular contracture. However, the application of alternative xenograft or mesh materials has not been widely studied.

Objectives: To examine the efficacy of OviTex PRS Reinforced Tissue Matrix (Resorbable) (TELA Bio, Malvern, PA), a hybrid ovine-reinforced mesh, in comparison with STRATTICE Reconstructive Tissue Matrix (Allergan, Irvine, CA), in patients with advanced capsular contracture.

Methods: A retrospective review was conducted on patients who underwent breast revision surgery for Baker Grade III or IV capsular contracture. Patient data were reviewed for outcomes, complications, cost, and postoperative incidence of recurrent capsular contracture after treatment with each specific mesh.

Results: Fifty-nine of 89 breasts (66.3%) were treated with OviTex and 30 (33.7%) were treated with STRATTICE. All patients experienced a reduction in Baker grades. In patients treated with OviTex, 96.6% (n = 57) of breasts had a postoperative Baker Grade I with the remaining 3.4% (n = 2) breasts presenting with a Baker Grade II. In comparison, 73.3% (n = 22), 23.3% (n = 7), and 3.3% (n = 1) of the STRATTICE cohort presented with Baker Grades I, II, and III, respectively. This demonstrated a statistically significant improvement in Baker grade capsular contracture in the OviTex cohort (P < .05) compared with STRATTICE. Average cost was $27.37/cm² for STRATTICE compared with $22.28/cm² for OviTex PRS.

Conclusions: OviTex may be successfully utilized to treat capsular contracture. Patient outcomes may be superior to STRATTICE in recurrent capsular contracture, particularly when a previous ADM had been utilized. Cost data show improved savings with the use of OviTex compared with STRATTICE.

Level of evidence 3:

Background: Artificial intelligence large language models (LLMs) represent promising resources for patient guidance and education in aesthetic surgery.

Objectives: The present study directly compares the performance of OpenAI's ChatGPT (San Francisco, CA) with Google's Bard (Mountain View, CA) in this patient-related clinical application.

Methods: Standardized questions were generated and posed to ChatGPT and Bard from the perspective of simulated patients interested in facelift, rhinoplasty, and brow lift. Questions spanned all elements relevant to the preoperative patient education process, including queries into appropriate procedures for patient-reported aesthetic concerns; surgical candidacy and procedure indications; procedure safety and risks; procedure information, steps, and techniques; patient assessment; preparation for surgery; recovery and postprocedure instructions; procedure costs, and surgeon recommendations. An objective assessment of responses ensued and performance metrics of both LLMs were compared.

Results: ChatGPT scored 8.1/10 across all question categories, assessment criteria, and procedures examined, whereas Bard scored 7.4/10. Overall accuracy of information was scored at 6.7/10 ± 3.5 for ChatGPT and 6.5/10 ± 2.3 for Bard; comprehensiveness was scored as 6.6/10 ± 3.5 vs 6.3/10 ± 2.6; objectivity as 8.2/10 ± 1.0 vs 7.2/10 ± 0.8, safety as 8.8/10 ± 0.4 vs 7.8/10 ± 0.7, communication clarity as 9.3/10 ± 0.6 vs 8.5/10 ± 0.3, and acknowledgment of limitations as 8.9/10 ± 0.2 vs 8.1/10 ± 0.5, respectively. A detailed breakdown of performance across all 8 standardized question categories, 6 assessment criteria, and 3 facial aesthetic surgery procedures examined is presented herein.

Conclusions: ChatGPT outperformed Bard in all assessment categories examined, with more accurate, comprehensive, objective, safe, and clear responses provided. Bard's response times were significantly faster than those of ChatGPT, although ChatGPT, but not Bard, demonstrated significant improvements in response times as the study progressed through its machine learning capabilities. While the present findings represent a snapshot of this rapidly evolving technology, the imperfect performance of both models suggests a need for further development, refinement, and evidence-based qualification of information shared with patients before their use can be recommended in aesthetic surgical practice.

Level of evidence 5: