Aesthetic surgery journal. Open forum最新文献

Background: East Asians have a high prevalence of orbital fat protrusion (eye bags) from a young age, but underlying changes over time have not been extensively assessed.

Objectives: The aim of the authors of this study is to evaluate age-related changes in orbital fat protrusion and the positional relationship between the eye globe and cheek in East Asians.

Methods: This was a retrospective analysis of adults undergoing head and neck computed tomography at a single center. Various parameters were assessed relative to a pupil-centered reference line, including the most anterior points of: the globe (A); inferior orbital fat pad (F); infraorbital rim (O); and cheek (C). Distances AF, AO, AC, and FO (eye bag prominence) were calculated. The East Asian group was also compared with historical Caucasian data through 1:1 matching.

Results: The East Asian population included 224 participants (age range, 20-79 years). Orbital fat (AF) protruded among young individuals, increasing with age; inferior orbital rim position (AO) remained unchanged over time; the cheek (AC) showed a high prevalence of negative vectors from youth, and increased projection with advancing age; eye bags (FO) were present even in young individuals and became somewhat more pronounced with aging. By comparison, the matched Caucasian cohort (n = 22) showed significant decreases in AO and AC and increases in FO with age.

Conclusions: From a young age, East Asians exhibit a high prevalence of orbital fat protrusion. This is largely attributable to inherent structural factors, whereas such protrusion in Caucasians may be primarily because of age-related retrusion of the orbital rim and cheek.

Level of evidence: 4 (Diagnostic).

Background: Vascular adverse events (VAEs) are among the most feared complications following filler injections. At the specialized filler-complication clinic, the authors observed that the lateral region of the face experiences a lower risk of VAE-associated necrosis compared with the medial region.

Objectives: The authors of this study aim to determine whether the medial facial region has a higher risk of necrosis following dermal filler injections compared with the lateral facial region. To assess this observation statistically, the authors analyzed all VAE cases reported between 2019 and 2024.

Methods: A retrospective analysis was undertaken. High-resolution photographs enabled precise anatomical localization and accurate staging of the VAEs. The face was anatomically subdivided utilizing 3 separate classification methods: (1) facial zones based on the 4 primary arteries (ophthalmic, superficial temporal, maxillary, and facial arteries); (2) classification based on whether subzones were supplied by branches of the external carotid artery or by both the external and internal carotid arteries; and (3) categorization into the medial or lateral region of the face, based on their relative location to the line of ligaments. The clinical patterns of VAEs were classified into 5 stages, distinguishing between non-necrotic (Stages 1 and 2) and necrotic (Stages 3-5) outcomes, reflecting a stepwise clinical development of symptoms over time. Statistical analyses, including χ ² and Fisher's exact tests, were utilized to evaluate the distribution of VAE stages within each of the 3 anatomical classification methods.

Results: In total, 120 patients with documented VAEs between 2019 and 2024 were included. Necrotic VAEs (Stages 3-5) occurred significantly more frequently in the medial facial region (P = .048). No significant correlation was found between these stages and distributions of both carotid artery branches nor the primary facial arteries.

Conclusions: In this study, the authors highlight a higher risk of necrosis following dermal filler treatments in the medial facial region compared with the lateral region. A correlation between necrosis and the distribution of facial primary arteries or the carotid arteries seems to be absent, suggesting that local factors (eg, number or function of anastomoses/choke anastomoses) may play an important role.

Level of evidence 4 therapeutic:

Background: Anterior chest asymmetry is common, with potential implications for aesthetic and reconstructive breast surgery. However, current assessments rely on visual inspection or linear measurements, and few studies offer a reproducible, quantitative framework for analyzing skeletal asymmetry in healthy populations.

Objectives: The aim of the study is to develop and evaluate a proof-of-concept methodology for quantifying anterior thoracic skeletal asymmetry using standardized, computed tomography (CT)-derived curve segmentation and polynomial modeling.

Methods: Chest CT scans from 50 female patients aged 18 to 45 with a BMI of 20 to 25 were evaluated using semi-automated segmentation. The right and left chest wall curvatures were extracted in both a horizontal and vertical plane at the level of the fourth rib insertion and one-fourth of the maximum thorax width, respectively.

Results: The left chest wall displayed significantly greater outward projection than the right chest in both planes (P < .001). The most pronounced differences were observed from 2 to 5 cm from the sternum in the horizontal plane and 0 to 1 cm from the manubrium in the vertical plane. Individual assessments showed that >65% of patients exhibited leftward prominence in the horizontal and vertical planes. The estimated mean volume discrepancy between the left and right chest walls was 19.3 cc.

Conclusions: This study introduces a reproducible, curve-based methodology for quantifying skeletal chest wall asymmetry using CT images. In this healthy female cohort, a statistically significant leftward asymmetry was common. Although the volumetric difference may be small and not clinically significant in isolation, these findings support individualized skeletal assessment as a basis for surgical planning, warranting future studies with 3D modeling and more diverse populations.

Level of evidence 4 therapeutic:

Background: Although breast augmentation is generally associated with high levels of patient satisfaction, the number of women undergoing the procedure is low.

Objectives: To evaluate global key drivers and barriers for women deciding to undergo breast augmentation.

Methods: Qualitative semi-structured interviews were conducted with women aged 18 to 65 years to identify key themes regarding decision-making about breast augmentation. This was followed by a quantitative study with more in-depth analysis conducted in women who had the procedure, who were considering breast augmentation, or who were not considering breast augmentation.

Results: In the qualitative interviews (n = 24), drivers of breast augmentation included feelings of dissatisfaction with breasts and wanting to improve confidence and self-esteem, whereas barriers included cost and safety concerns. For the quantitative study (n = 798 enrolled in the United States, United Kingdom, Brazil, and China), these themes were confirmed, with the strongest drivers being feeling more confident and deserving to feel satisfied with their breasts. For those women who had undergone or considered breast augmentation, there were an average of 6.5 reasons that were concerns or barriers to the procedure, including the safety of the procedure and implants, potential complications, and costs. These barriers were similar to those cited by participants who had not considered breast augmentation. The Net Promoter Score of participants who had undergone breast augmentation was 49, with 62% promoters.

Conclusions: Given the mix of positive and negative drivers that impact women's decisions regarding breast augmentation, it is essential that physicians educate potential patients regarding surgical details, possible outcomes, and potential procedure-related complications.

Level of evidence: 3 (Therapeutic).

Background: Lip augmentation has become increasingly accepted and popular. However, there are still a few approved lip fillers that are versatile, biocompatible, suitable for lip enhancement, and backed by large-scale clinical trials.

Objectives: To assess the safety and effectiveness of Janlane LIPs (Shanghai Qisheng Biopharmaceutical Co., Ltd, Shanghai, China), a new hyaluronic acid filler for lip augmentation.

Methods: This prospective, multicenter, randomized, controlled study randomized subjects to the treatment group or the concurrent no-treatment control group that received delayed treatment. The level of Lip Fullness Grading Scale (LFS) was evaluated by the blinded evaluator, and the Global Aesthetic Improvement Scale (GAIS) was evaluated by the blinded evaluator and the subjects at pre-injection and after injection. Adverse reactions were recorded. Statistical analysis of subject satisfaction was performed.

Results: A total of 176 subjects were enrolled. The scores of LFS after injection were higher than those before injection; the degree of GAIS evaluated by the evaluator and subjects improved significantly. Local redness, swelling, etc. occurred after injection, most of which resolved within 1 week. The patient satisfaction was high and statistically significant.

Conclusions: Janlane LIPs showed long-term aesthetic improvement and safety for lip augmentation, high patient satisfaction, and are worthy of clinical promotion.

Level of evidence 2 therapeutic:

Background: Given rising demand for botulinum toxin (BoNT) treatments and limited data on safety, ethics, and regulation, a national survey explored experiences with cosmetic BoNT in the United Kingdom.

Objectives: To conduct a national observational survey with the aim to capture real-world experiences of cosmetic BoNT in the United Kingdom.

Methods: A cross-sectional online survey gathered data on experiences with cosmetic BoNT injections across the United Kingdom. Participation was open to adults (≥18 years) who had received cosmetic BoNT treatment.

Results: A total of 919 participants completed the survey and were predominantly female, white, and had a high household income. Commonly reported acute complications were bruising/swelling (26.1%), and headache (24.7%). Commonly reported long-term complications were BoNT resistance (2.9%), social withdrawal (2.7%), nerve damage (2.5%), and dry eyes/vision problems (2.5%). In total, 66% stated their treatment was administered by a prescriber, 28% said it was not. Among those treated by a non-prescriber, 40% reported that a prescriber was present during the consultation, 42% said no prescriber was present, and 17% were unsure. Surprisingly, a few had not signed a consent form (8%), 11% were not informed of treatment risks, and 18% were not told how to respond to complications. A large majority expressed support for enhanced oversight, with 57.8% favoring significantly stricter regulation, and 31.3% somewhat stricter regulation.

Conclusions: Cosmetic BoNT can offer high satisfaction and a favorable safety profile when administered appropriately. However, findings highlight key vulnerabilities: inconsistent practitioner qualifications, gaps in informed consent, insufficient complication support, and weak regulation.

Level of evidence3 therapeutic:

Background: Permanent fillers can lead to long-term complications, including granulomas, infections, and migration. Their removal often causes significant facial defects, posing challenges in reconstructive surgery.

Objectives: The authors of this study aim to evaluate the clinical outcomes of deep-plane facelifts combined with temporoparietal fascial flap (TPFF) reconstruction in managing complications and restoring aesthetics following permanent filler removal.

Methods: This retrospective study included 160 patients who underwent deep-plane facelifts with permanent filler removal and TPFF reconstruction between 2014 and 2022. Those with unrealistic expectations, BMI >30, a recent infection (≤3 months), or severe malar edema were excluded. The average follow-up period was 16 months (range, 6-68 months).

Results: Of 160 patients (149 females, 11 males; mean age 48 ± 8.4 years), 131 (82%) completed follow-up. The complication rate was 22%, including transient swelling and bruising (15%), minor infections (4%), and hematomas (3%). Psychological outcomes improved significantly, with increased self-esteem and social interaction scores and reduced anxiety and depression levels. Hospital stays averaged 32 h (range, 24-48 h).

Conclusions: TPFF reconstruction during deep-plane facelifts is a reliable approach for addressing complications and defects following permanent filler removal. This technique provides reliable reconstruction and improved outcomes, with promising long-term stability. Further research is warranted to refine these methods and optimize patient care.

Level of evidence 4 therapeutic:

Background: Hybrid fractional lasers (HFLs) have revolutionized facial laser resurfacing treatments with their dual ablative and non-ablative wavelength technology. Although HFL therapy shows promising results, safety at skin depths beyond 150 μm is debated, particularly for its non-ablative wavelength. Some suggest deeper HFL delivery can enhance skin remodeling.

Objectives: To assess the clinical safety of delivering HFL therapy at increased dermal depths up to 425 μm to induce collagen production and improve skin quality in patients undergoing rhytidectomy, and to determine whether this combination increases postoperative complications.

Methods: A retrospective review (2017-2022) was conducted on patients undergoing rhytidectomy with or without concurrent intraoperative HFL therapy. Data on demographics, HFL parameters, and postoperative complications were collected and analyzed using descriptive statistics.

Results: Of 169 patients (94.7% female, 97.0% Caucasian, average age: 63.3 years, Fitzpatrick score: 2.7), 62.1% received HFL treatment and 37.9% were controls. Patient characteristics were similar between groups. The average non-ablative laser depth was 355 μm ± 25, with a maximum of 425 μm. In the 12 months post-rhytidectomy, 7.6% of the HFL group experienced complications vs 3.0% in the control group, a non-significant difference (P = .13). No known HFL complications (burns, skin breakdown, hypo- and hyperpigmentation) were observed.

Conclusions: HFL therapy at depths up to 425 μm may be safe for facial photorejuvenation. Patients with Fitzpatrick skin Types I to IV experienced no adverse effects. Combining HFL with rhytidectomy did not increase complication rates compared to rhytidectomy alone. These findings expand safety parameters for HFL use, optimizing clinical outcomes and long-term success of laser skin resurfacing.

Level of evidence: 3 (Therapeutic).

Hyaluronidase (HYAL) is an enzyme that degrades hyaluronic acid (HA), available in both animal-derived and recombinant formulations. Currently, there is limited evidence comparing the enzyme activity of different HYALs and their effects on various HA filler formulations. The authors of this in vitro study aim to evaluate and compare the effectiveness of animal-derived vs recombinant hyaluronidase on degrading different HA filler formulations. The authors tested 4 experimental groups (n = 5 per group): ART FILLER Universal with animal hyaluronidase, ART FILLER Universal with recombinant hyaluronidase, ART FILLER Volume with animal hyaluronidase, and ART FILLER Volume with recombinant hyaluronidase. HA filler degradation was measured using colorimetric assay (absorbance at 585 nm) at 1, 6, 24, and 48 h of incubation. The Kruskal-Wallis test was used for statistical analysis (significance set at P < .05). ART FILLER Universal showed significantly greater degradation than ART FILLER Volume at the 1 h time point (P < .05). Recombinant hyaluronidase demonstrated consistently higher degradation activity compared with animal-derived hyaluronidase at all measurement time points, but it was only statistically significant after 1 h of incubation (P < .05). ART FILLER Volume with animal hyaluronidase exhibited the lowest degradation rates among all groups at 6, 24, and 48 h (P < .05). Based on the findings, the authors indicate that recombinant hyaluronidase is more effective than animal-derived hyaluronidase for HA filler degradation over time. ART FILLER Universal degrades more rapidly than ART FILLER Volume during the first hour of enzyme activity. The results highlight important differences in degradation kinetics between HA filler types and hyaluronidase formulations. Further studies are needed to validate these findings and explore their clinical implications. Level of Evidence: 5 (Therapeutic).