Aesthetic surgery journal. Open forum最新文献

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:

Background: Facelift surgery remains the gold standard for facial rejuvenation, yet limitations such as suture pull-through failure, superficial musculoaponeurotic system (SMAS) laxity, and the need for secondary procedures persist. Although novel facelift techniques have emerged, none have effectively addressed the inherent biomechanical challenges. Photochemical tissue passivation (PTP) is a promising method to enhance tissue durability and improve facelift longevity by modifying the biomechanical properties of the SMAS itself.

Objectives: In this study, the authors investigated whether PTP enhances the biomechanical properties of SMAS, strengthens tissue integrity, and improves suture retention strength, thereby reducing the likelihood of recurrent laxity and the need for revision facelifts.

Methods: SMAS tissue was harvested from facelift patients (n = 7) and Lewis rats (n = 16). The harvested SMAS underwent treatment with PTP. After treatment, the biomechanical properties, including modulus of elasticity, maximum load, and suture pull-through resistance, were assessed. Additionally, an in vivo rat SMAS plication model was established, and tissue laxity was evaluated at 4 and 12 weeks postoperatively.

Results: PTP-treated human SMAS demonstrated a 229% increase in suture pull-through resistance (P = .21) and significantly higher modulus of elasticity in both human and animal specimens (P = .011 and P = .013, respectively). In the in vivo rat model, the laxity of SMAS plication was significantly lower by 58% at 4 weeks (P = .005) and 54% at 12 weeks (P < .0001) compared with untreated controls.

Conclusions: PTP significantly enhances the biomechanical strength of the SMAS, reduces postoperative laxity in a rat model, and improves suture retention capacity in human SMAS tissue. These effects indicate that PTP has the potential to substantially increase the durability of facelifts and reduce revision rates, positioning it as a valuable adjunct technique in facial rejuvenation surgery. Additional clinical studies are needed to confirm these findings. Level of Evidence: 5 (Therapeutic).

Background: Patient satisfaction following cosmetic neurotoxin treatment has been widely studied, but little is known about how this affects downstream behavior.

Objectives: To investigate the actions taken by patients following cosmetic neurotoxin injection, with regard to their most and least positive treatment experiences.

Methods: This was an online, self-administered survey conducted among adults residing in Brazil, Canada, United Kingdom, and United States. Eligible participants had received 4 or more previous neurotoxin treatments to temporarily improve the appearance of upper facial lines, at least one of which was in the past 12 months.

Results: A total of 1612 respondents completed the questionnaire (61% female; mean age: 38.1 ± 9.6 years). After their most positive experience, 81% said they engaged in actions directed toward their healthcare professional (HCP) (eg, scheduled another treatment or posted a review on the HCP's website), and 81% took actions directed at others (eg, talked to friends and family or posted a review online). After their least positive experience, 58% engaged in actions directed toward their HCP (with 22% expressing dissatisfaction directly), and 73% took actions to inform other people; many said they discouraged others from using their HCP (52%) or from seeking cosmetic neurotoxin injections altogether (27%).

Conclusions: Respondents were less likely to inform their HCP of their satisfaction level after their least positive experience of cosmetic neurotoxin treatment compared with the most positive. Thus, practitioners may often be unaware of dissatisfied individuals. Patient-centered care and consistent proactive follow-up are essential to understanding patient perspectives on outcomes.

Level of evidence: 5 (Therapeutic).

Background: Upper facial lines are early signs of aging that impact self-image, underscoring the need for objective, evidence-based tools to support the growing demand for aesthetic interventions.

Objectives: The authors of this study aim to develop and validate 4-point photonumeric scales for clinical assessment of glabellar, lateral canthal, and forehead lines at rest and dynamic expression, and evaluate their clinical relevance and alignment with patient-reported perceptions of wrinkle severity.

Methods: Six 4-point photonumeric scales were developed to assess glabellar, lateral canthal, and forehead lines at rest and during maximum expression. Validation was conducted by 5 board-certified physicians over 2 live rating sessions, spaced at least 2 weeks apart. Participants (n = 96-114 per scale) reflected a diverse range of ages, sexes, and Fitzpatrick skin types. Intrarater and interrater reliability were evaluated using weighted kappa and intraclass correlation coefficient (ICC), respectively. Correlation with participant self-assessments and the Facial Line Distress Scale (FINE) assessed patient alignment. Clinical relevance was confirmed through physician rating of image pairs with known score differences.

Results: All scales demonstrated high intrarater (mean κ = 0.83-0.91) and interrater reliability (ICC = 0.94-0.98), indicating "almost-perfect" agreement. FINE scores showed a strong correlation with physician and participant scale ratings. Clinically meaningful 1-grade score differences were supported by nonoverlapping 95% CIs between image pairs rated as clinically different and not clinically different, with statistically significant mean differences exceeding 1 point.

Conclusions: The validated scales demonstrated high reliability, clinical relevance, and strong alignment with patient-reported outcomes, supporting their use as objective tools for clinical assessment.

Level of evidence 5 therapeutic:

Capsular contracture (CC), a common complication of breast implants, has an unclear etiology. Subclinical infection around the implant is widely considered a potential cause. Microorganisms, such as Staphylococcus epidermidis, have been associated with CC, but the specific role of bacteria from the breast capsule, glandular tissue, or skin remains unclear. No molecular studies have definitively investigated this association. The authors of this systematic review aim to evaluate the relationship between breast microbiota, bacterial biofilms, and CC in patients undergoing cosmetic or reconstructive breast augmentation. Data were extracted from studies identified through different search engines, including Medline and Embase. Inclusion criteria focused on patient, surgical, and implant-related factors influencing CC. Only English-language articles were considered. The review included 428 women (453 breast implants) aged 27 to 53 years, with an average age of 31. Most studies lacked detailed reporting on implant characteristics or surgical techniques. The majority employed cell culture or pathology for microbiota assessment, with 1 study using polymerase chain reaction (PCR). Frequently identified bacteria included S. epidermidis, Propionibacterium acnes, and Streptococcus spp. This systematic review of 428 women with 453 breast implants found that S. epidermidis, P. acnes, and Streptococcus spp. were the most frequently isolated microorganisms in CC cases. The majority of studies used cell culture or pathology for microbiota assessment, with 1 employing PCR. Bacterial biofilm, particularly involving S. epidermidis, was consistently reported in contracted capsules, suggesting a strong association between specific breast microbiota and CC. Level of Evidence: 2 (Risk).

Background: Aesthetic plastic surgery fellowships endorsed by The Aesthetic Society participated in the San Francisco (SF) Match in 2017 to 2018. Despite streamlined applications and increases in available positions, participating applicants did not increase through the 2022 match cycle.

Objectives: The authors of this study compare match statistics for aesthetic plastic surgery, facial plastic surgery, and oculofacial surgery, with analysis extended through the 2025 match cycle.

Methods: SF Match data for aesthetic plastic surgery (2018-2025), facial plastic surgery (2018-2024), and oculofacial surgery (2018-2024) were analyzed. Relevant data included the number of participating programs, positions, applicants, filled positions, and match rates. The 2017 to 2024 Accreditation Council for Graduate Medical Education Data Resource Books provided resident graduation data by subspecialty.

Results: Aesthetic plastic surgery positions increased significantly (P = .047) between 2018 and 2022, whereas applicant numbers remained unchanged (P > .99). Participating aesthetic plastic surgery applicants more than doubled from 28 in 2022 to 59 in 2025 (P = .026), whereas available position numbers slightly decreased (P > .99). No significant changes occurred in filled positions (ie, applicants matched), fill rates, or match rates between match cycles. Facial plastic surgery and oculofacial surgery fellowship trends were stable, with no significant changes in these metrics.

Conclusions: Efforts to improve the postgraduate plastic surgery aesthetic application process and training model have had a significant, although delayed, impact on application numbers. Applications to facial plastic surgery and oculofacial surgery fellowships have seen only nominal increases during the same time period. Previously, facial plastic surgery fellowships greatly outnumbered aesthetic plastic surgery fellowships. This gap has now significantly narrowed. Oculofacial surgery fellowships remain highly competitive and limited in numbers.

Level of evidence: 5 (Therapeutic).

The use of injectable aesthetic treatments (including fillers, neurotoxins, polynucleotides, and biostimulators) and nonenergy surface-active aesthetic treatments (such as chemical peels, microneedling, and microdermabrasion) is increasing. To date, little guidance is available in the literature concerning periprocedural skincare for these aesthetic procedures. The aim of the authors of this study is to provide periprocedural skincare recommendations and an algorithm to guide holistic skincare that will enhance and retain procedural effects and optimize skin health in the longer term. A panel of 6 Australian aesthetic practitioners (5 dermatologists and 1 plastic surgeon) developed generalized periprocedural skincare recommendations for injectable and surface-active aesthetic treatments. Recommendations were stratified into 2 categories: skin barrier nondisruptive procedures (fillers, threads, neuromodulators, and polynucleotides) and skin barrier disruptive procedures (nonenergy surface-active procedures). Establishing a good preprocedural basic skincare routine (cleanser, moisturizer, and broad-spectrum sun protection factor 50+ sunscreen) 2 to 4 weeks before a procedure is recommended. Actives including vitamin A, vitamin B3, antioxidants, hyaluronic acid, and lipids may also be advised and tailored to an individual's skin condition. It is suggested that toners and exfoliants can be avoided, whereas antioxidants, tranexamic acid, and growth factors can be used immediately following needling procedures. Hyaluronic acid and antioxidants may be used immediately following chemical peels along with bland skincare. Postprocedural makeup and skincare actives should be avoided immediately post surface-active procedures. The implementation of periprocedural skincare regimens may improve treatment-related outcomes and reduce recovery time. Furthermore, frequency and severity of potential side effects may be reduced. Level of Evidence: 5 (Therapeutic).

Background: Liposuction in lipedema is a safe and effective treatment, but there currently are no studies analyzing the individual complications of water-jet-assisted liposuction in lipedema or the impact of the cannula's design.

Objectives: The aim of the authors of this study is to answer the question which WAL cannula is the safest in lipedema patients and provide practitioners with the data they need to make an informed decision about the cannula they choose.

Methods: The authors retrospectively analyzed complications and their underlying risk factors in 117 patients across 243 cases. Groups were formed by diameter (Ø) and number of ports of the used cannulas. Unpaired t-tests, Fisher's exact tests, and χ² tests were used to analyze the patients' characteristics for the complication rates across the cannulas.

Results: Cannulas with 8 ports showed statistically significantly higher hemoglobin loss (P = .011), shorter incision-to-suture time (P = .023), and higher volume of aspirated fat (P < .001). The same results occurred when comparing the Ø3.8 mm cannulas that differ in the number of ports (4 vs 8 ports). The Ø4.8 mm group showed a significantly increased rate of wound-healing disorders compared with the Ø3.8 mm group (P = .041) and a statistically significantly higher aspirated fat volume (P = .014).

Conclusions: No specific cannula showed superior safety in terms of complication rates. However, 8-port cannulas facilitated a faster aspiration of large volumes and reduced the incision-to-suture time compared with 4-port cannulas. This benefit was accompanied by a greater loss of hemoglobin. In contrast, cannula diameter played a less significant role in aspiration speed and did not increase the hemoglobin loss.

Level of evidence 3 therapeutic: