Aesthetic surgery journal. Open forum最新文献

Pivotal Phase 3 randomized control trials have demonstrated a favorable safety profile for ATX-101 in submental fat (SMF) reduction; however, in real-world settings, several serious adverse events (SAEs) have been reported, most of which are procedure related and avoidable. Current understanding of the management of uncommon AEs and SAEs is based on the aesthetic surgeon's discretion, and overzealous protocols for sclerosis agents are being applied for ATX-101-induced arterial injury. This review focuses on showcasing the management of SAEs reported previously and updating it with personal clinical experiences with ATX-101 for SMF and jowl fat reduction. Along with adherence to the standard procedures for ATX-101 administration, the authors recommend investigating other potential causes of SMF accumulation and jowling mechanism, appropriate demarcation of the surface area to determine the number of vials, and assessment of the fat pad thickness to determine the number of required treatment cycles for optimal therapeutic outcomes. Surgery is preferable for jowling caused by compartment displacement (ptosis), whereas fat-reducing treatments such as ATX-101 are contraindicated for jowling caused by subcutaneous tissue atrophy. Some proactive measures that can be employed to prevent AEs include avoiding intradermal injections to prevent skin ulceration/necrosis, injecting lidocaine to check for smile asymmetry as an indication of marginal mandibular nerve proximity, administering 1 to 2 mm deeper injections in males to prevent alopecia, employing good aseptic techniques to prevent abscess formation, injecting 1 product at a time using correctly labeled syringes, and confirming the diagnosis of pyoderma gangrenosum before treating it as an infection.

Level of evidence 3:

Background: At a time when Internet and social media use is omnipresent among patients in their self-directed research about their medical or surgical needs, artificial intelligence (AI) large language models (LLMs) are on track to represent hallmark resources in this context.

Objectives: The authors aim to explore and assess the performance of a novel AI LLM in answering questions posed by simulated patients interested in aesthetic breast plastic surgery procedures.

Methods: A publicly available AI LLM was queried using simulated interactions from the perspective of patients interested in breast augmentation, mastopexy, and breast reduction. Questions posed were standardized and categorized under aesthetic needs inquiries and awareness of appropriate procedures; patient candidacy and indications; procedure safety and risks; procedure information, steps, and techniques; patient assessment; preparation for surgery; postprocedure instructions and recovery; and procedure cost and surgeon recommendations. Using standardized Likert scales ranging from 1 to 10, 4 expert breast plastic surgeons evaluated responses provided by AI. A postparticipation survey assessed expert evaluators' experience with LLM technology, perceived utility, and limitations.

Results: The overall performance across all question categories, assessment criteria, and procedures examined was 7.3/10 ± 0.5. Overall accuracy of information shared was scored at 7.1/10 ± 0.5; comprehensiveness at 7.0/10 ± 0.6; objectivity at 7.5/10 ± 0.4; safety at 7.5/10 ± 0.4; communication clarity at 7.3/10 ± 0.2; and acknowledgment of limitations at 7.7/10 ± 0.2. With regards to performance on procedures examined, the model's overall score was 7.0/10 ± 0.8 for breast augmentation; 7.6/10 ± 0.5 for mastopexy; and 7.4/10 ± 0.5 for breast reduction. The score on breast implant-specific knowledge was 6.7/10 ± 0.6.

Conclusions: Albeit not without limitations, AI LLMs represent promising resources for patient guidance and patient education. The technology's machine learning capabilities may explain its improved performance efficiency.

Level of evidence 4:

Background: Aesthetic medicine has traditionally focused on addressing perceived problem areas, with lack of long-term planning and engagement.

Objectives: This article describes a patient-centric model for nonsurgical aesthetic medical practice, termed the 360° approach to facial aesthetic rejuvenation.

Methods: The 360° approach was divided into 4 foundational pillars. Medical literature, the authors' clinical experiences, and results from patient satisfaction surveys were used to support the approach.

Results: Pillar 1 describes the development of a complete understanding of the patient, based on the use of active listening principles, to characterize the patient's current aesthetic concerns, lifestyle, medical and treatment history, treatment goals, attitude toward aesthetic treatment, and financial resources. Pillar 2 involves conducting a comprehensive facial assessment in contrast to a feature-specific assessment, considering multiple facial tissues and structures and their interrelationships, thus helping to prevent the unanticipated consequences of narrowly focused treatment. Pillar 3 describes leveraging all available treatments and techniques in the development of an initial treatment plan arising from the facial assessment. Pillar 4 adds a time dimension to treatment planning, working toward the goal of a long-term modifiable treatment timeline, with full patient support and involvement; this is designed to facilitate a durable, sustained relationship between the patient and aesthetic healthcare professional (HCP).

Conclusions: Although implementation involves substantial commitment and time, the patient-oriented focus of the 360° approach can help achieve optimal patient outcomes and the development of enduring patient-HCP relationships.

Level of evidence 5:

Background: Reduction mammoplasty techniques have evolved due to the continued search for optimal and sustainable results.

Objectives: The purpose of the study is to demonstrate the effectiveness of a novel technique, Gargano's Yin Yang breast reduction, in achieving a better breast shape, position, and volume distribution and to also evaluate the complication rate, operative time, and long-term effects on mammary base, projection, and pseudoptosis.

Methods: The author presents 185 consecutive patients who underwent the Yin Yang reduction mammaplasty technique, which utilizes a geometrical model to obtain a better breast shape. The key surgical steps of the technique are: (1) a superomedial pedicle flap and (2) an inferior pole laterally based flap. The glandular resection is performed in an S shape for the right breast and a mirrored S shape for the left breast; (3) the resection of the skin is in a Wise pattern.

Results: Forty-three of the 185 patients participated in a prospective morphometric study over an 18-month period. Patients who underwent the Yin Yang technique had a 15% vertical scar increase for reductions >1200 g, the mammary base and projection were unchanged over time compared with the immediate postoperative period.

Conclusions: The Yin Yang technique is an effective and reliable approach to correct breast hypertrophy, conducive to achieving and maintaining a better breast shape, volume, and position. The results are stable over time for mammary base, projection, and pseudoptosis or "bottoming out." In addition, the complication rate is relatively low and appears to decrease with experience.

Level of evidence 4:

Background: The driving force for many seeking plastic surgery is comfort in one's body. Along with comfort come satisfaction, improved self-awareness, and potential change in interoceptive awareness-a term defined as the conscious perception of one's body. Although conscious perception of bodily signals is influenced by many factors, sense of self and body image play significant roles. Studies show diminished interoceptive awareness in those with negative body image, but no research has assessed the impact of change in body image on interoceptive awareness.

Objectives: The purpose of this study is to investigate how interoceptive awareness changes following elective breast surgery.

Methods: The Multidimensional Assessment of Interoceptive Awareness Version 2 (MAIA-2) was administered to females undergoing breast surgery. A baseline survey was administered preoperatively, with follow-up surveys at 1 week, 1 month, and 3 months postoperatively.

Results: Data were collected from 39 females and analyzed using paired t-tests to compare MAIA-2 overall and subscores over time. Significance was seen at 1 week for subcategories of "not distracting" and "trust," at 1 month for "trust," and 3 months for "not worrying," "emotional awareness," "self-regulation," and "trust." Overall survey averages were significantly increased at all postoperative intervals.

Conclusions: From this study, it can be concluded that breast surgery positively impacts interoceptive awareness. These findings are clinically relevant as they offer providers' insight into the psychological effects of breast procedures. A comprehensive understanding of procedure outcomes enables providers to educate patients on both anticipated physical results and changes in sense of self.

Level of evidence 2:

Filler injection has become a commonplace aesthetic procedure. Although the incidence of infection following filler injections is typically low, ranging between 0.04% and 0.2%, the potential consequences can be serious. In this manuscript, we present the case of a 29-year-old female patient who presented to our emergency department after receiving a hyaluronic acid filler injection in the trochanteric area at a private center. She developed signs and symptoms shortly after the procedure, including bilateral hip pain and a fever that persisted for 3 days. Despite initial antibiotic and pain medication treatment, the patient's condition continued to worsen. Incision and drainage were performed, and pus culture revealed profuse Extended Spectrum Beta-Lactamase (ESBL)-producing Serratia marcescens. The patient experienced clinical improvement following the incision and drainage procedure and initiation of antibiotics sensitive to the pathogen. Although rare, S. marcescens infection following filler injections has been reported in 2 previous cases. Therefore, early recognition of infection signs and symptoms is crucial to mitigate the severity of consequences and improve outcomes. Aggressive surgical and medical interventions, such as incision and drainage, debridement, and appropriate antibiotic therapy, may be necessary to achieve a successful outcome.

Level of evidence 5:

Background: Upper blepharoplasty is a common procedure in aesthetic plastic surgery. Numerous techniques focus on removing excessive tissues, including skin, muscle, and fat. However, aging insights suggest tissues mainly undergo depletion rather than increase. Removing significant eyelid fat tissue can boost aesthetics but might result in a gaunt appearance with a recessed superior sulcus. Adjusting this can be achieved by moving a prominent nasal fat pad to the eyelid's center.

Objectives: We introduce a new surgical method combining the removal of excess skin, minimal resection of the orbicularis muscle, and redistribution of the orbital bags while preserving nasal fat. This method involves minimal detachment, with the medial bag anchored centrally.

Methods: We conducted a retrospective study on 11 patients eligible for this surgical technique between 2019 and 2023 who underwent preservation upper blepharoplasty. The Face-Q Upper Lid questionnaire was administered both before and 6 months postoperation, with the Face-Q Outcome assessed 6 months after the surgical procedure.

Results: All participants were females aged between 43 and 68 years. Fat necrosis was absent in all cases. The volume augmentation remained consistent over an average follow-up of 1 year. We recorded zero complications. There was an increase of 25 points in the Face-Q Upper Eyelids score between the preoperative and postoperative stages. The average score for Face-Q Outcome stood at 81.7.

Conclusions: Our preservation blepharoplasty approach reliably achieves upper lateral eyelid fullness, offering a naturally rejuvenated appearance.

Level of evidence 5:

Background: Autologous fat (AF) grafting is widely used in plastic surgery and is generally considered a safe and effective procedure. A combined approach utilizing vibration amplification of sound energy at resonance (VASER) to prepare AF grafts with a 4-layer fat grafting technique was explored in this study.

Objectives: To offer a customized solution that accommodates individual anatomical differences.

Methods: This retrospective, cross-sectional case series involved 40 breasts from 20 female patients who underwent primary augmentation-mastopexy. After removing excess breast tissue and exposing the pedicle, lateral pillars, and pectoral muscle, the 4-layer fat grafting was performed as follows: 150 mL of AF under the pectoral muscle directed toward the medial and central zones; 100 mL into the pectoral muscle toward these zones; 50 mL under the pectoral fascia, moving retrograde from cephalic to caudal portions at a 30° to 45° cannula angle. After closing the epithelial and subepithelial incisions, an additional 100 to 150 mL of AF was injected under the subcutaneous layer around the breast, depending on each patient's contour and breast shape. Patients were monitored for 2 years with MRI scans to assess breast volume, anatomy, and fat graft survival.

Results: The average follow-up was 26 ± 2.81 months. MRI evaluations indicated an efficient survival rate of the fat grafts. None of the patients experienced minor or major complications.

Conclusions: The 4-layer AF grafting technique appears to be a safe and effective procedure for customized breast sculpting in augmentation-mastopexy surgery, with a high rate of fat graft sustainability and survival.

Level of evidence 4:

Background: Labia minora length is used in classification systems and to determine labiaplasty candidacy, with shorter labia leading to nonsurgical recommendations.

Objectives: The aim of the study was to investigate the correlation between labia length and symptomatology.

Methods: Patients undergoing labiaplasty from January 2017 to May 2023 underwent chart review. Data collected included age, exposed, and total labia length. Patients completed a preoperative survey with possible scores from 0 to 13 to gauge complaints and symptoms.

Results: Out of 50 charts with complete data, the average age was 34. Exposed labia lengths were 10.1 mm (right) and 11.4 mm (left); total lengths from sulcus to edge measured 32.0 mm (right) and 33.4 mm (left). Survey scores averaged 6.5 (range, 2-11) median of 7. The correlation between exposed labia length and symptoms yielded Pearson correlation coefficient values (R) of 0.25 for both right and left sides, with coefficient of determination (r ²) values at 0.06. For total labia length, R values were 0.08 (right) and 0.06 (left), and r ² values were 0.007 (right) and 0.003 (left).

Conclusions: The correlation between a patient's exposed and total labia length and reported symptomatology is weak. Patients with longer labia can experience few symptoms, just as those with shorter labia can have a high degree of symptomatology. Rather than use labia length as a primary factor determining labiaplasty candidacy, the focus should be on patient-reported symptoms.

Level of evidence 2:

Background: Aesthetic breast surgery (ABS) encompasses breast augmentation, breast reduction, mastopexy, and mastopexy augmentation. This topic has seldom been assessed as a bibliometric study. This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. Bibliometrics, the quantitative analysis of publications, particularly scholarly literature, offers valuable insights into research trends and impact.

Objectives: This analysis aims to address this gap and identify trends in ABS literature to guide future research areas.

Methods: The 100 most-cited publications in ABS were identified on Web of Science (Clarivate Analytics, Philadelphia, PA), across all available journal years (from 1953 to 2024). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. The Oxford Centre for Evidence Based Medicine and levels of evidence (LOE) of each study were assessed.

Results: The 100 most-cited publications in ABS were cited by a total of 11,522 publications. Citations per publication ranged from 46 to 1211 (mean 115.2 ± 135.7), with the highest-cited study being the Pusic BREAST-Q paper (n = 1211). A majority of publications were LOE 4 (n = 30), representative of the large number of case series. The number of publications for LOE 5, 3, 2, and 1 was 12, 28, 21, and 9, respectively. The main content focus was "outcomes" in 52 publications, followed by "nonoperative management" (n = 12) and "surgical technique" (n = 12). Patient-reported outcome measures (PROMs) were used in 29 publications, and 53 publications reported aesthetic outcome measures.

Conclusions: This analysis highlights that research methodologies in ABS studies should be improved. This necessary improvement would be facilitated by vigorous, high-quality research, and the implementation of validated ABS-specific PROMs enhancing patient satisfaction, particularly in aesthetic procedures, such as BREAST-Q.

Level of evidence 4: