Aesthetic surgery journal. Open forum最新文献

Background: Social media has become a major global force shaping beauty standards and aesthetic preferences. Although cosmetic procedures are increasingly normalized in Syria, the role of social media in influencing individuals' decisions to pursue these interventions remains underexplored.

Objectives: The aim of the authors of this study is to assess the influence of social media on attitudes and decision making regarding cosmetic procedures among the Syrian population, and to identify key demographic, psychological, and behavioral factors associated with this influence in the context of Syria's unique sociocultural and economic landscape.

Methods: A cross-sectional study was conducted among 2605 participants using both online and paper-based questionnaires. The survey assessed demographics, attitudes toward cosmetic procedures, social media usage patterns, and the influence of influencers and digital content. Statistical analysis identified associations between digital exposure and procedural interest.

Results: Participants spending >5 h daily on social media were significantly more likely to consider cosmetic procedures. Following a higher number of fashion influencers was strongly associated with appearance dissatisfaction and desire for cosmetic enhancements. Although 76% of participants accepted cosmetic procedures as socially valid, only 19% verified practitioner credentials, and 73% expressed distrust toward influencer promotions. Younger, female, and university-educated individuals were more susceptible to digital influence.

Conclusions: Social media plays a substantial role in shaping cosmetic interests in Syria. These findings support the need for targeted strategies, including body image screening tools, media literacy programs, ethical advertising regulations, and transparent medical verification systems to promote informed and safe cosmetic decisions.

Level of evidence 5 risk:

Background: Injectable hyaluronic acid (HA) is the gold standard for the aesthetic treatment of facial volume and wrinkles.

Objectives: The authors of this study aim to evaluate the safety and performance of 2 new HA fillers for the treatment of the lips and perioral area.

Methods: This multicenter prospective study enrolled 72 patients. All patients received lip enhancement with ESTYME LIPS (EST_LP, SYMATESE, Chaponost, France), and 61 of them also had correction for lip fine lines and nasolabial folds (NLFs) with ESTYME SMOOTH (EST_SM). Assessments were conducted by injector-investigators, the patients, and an independent evaluator. The primary endpoint was the proportion of patients with at least 1 injection-site reaction (ISR) lasting beyond 14 days. Secondary endpoints included adverse events, aesthetic improvements, lip functionality, and participant satisfaction, assessed over 12 months.

Results: After 30 days, at least 1 ISR was observed in 35% of the participants on the lips, 2% on the fine lines, and 2% on the NLF. At 12 months, an improvement of at least 1 point was still observed in 66% of participants on the lips, 74% on the fine lines, and 54% on the NLFs. Throughout the study, lip functionality was not affected by their treatment and both assessors and patients rated overall aesthetic improvement and good satisfaction.

Conclusions: In this limited cohort, EST_LP and EST_SM proved to be safe and effective options for lip enhancement as well as correction of NLFs and lip fine lines, demonstrating sustained results in the majority of patients for up to 12 months.

Level of evidence: 4 (Therapeutic).

Background: Most deaths after outpatient plastic surgery are because of thromboembolic events, particularly pulmonary embolism (PE). The effectiveness of QUAD A deep vein thrombosis (DVT) safety measures after recent policy changes remains undocumented.

Objectives: The aim of the authors of the study is to assess how adherence to DVT prophylaxis guidelines affects complications and mortality in QUAD A facilities.

Methods: Using the Patient Safety Data Reporting database, we retrospectively assessed DVT, PE, and mortality rates in adult patients at QUAD A facilities from 2019 to 2023, with subgroup analysis of plastic surgery centers. The authors analyzed demographics and complications relative to facility protocol compliance using descriptive statistics and regression analyses.

Results: The authors identified 3,338,519 surgeries and 247 DVT/PE events. Facility-level deficiencies in DVT/PE prophylaxis ranged from 7.4% to 14.17%; peak deficiencies coincided with the highest complications and mortality. Among DVT/PE patients, 67 underwent plastic surgery (mean age 47.7 years, standard deviation [SD: 11.8]; mean BMI 29.2 kg/m², [SD: 7.7]); 94% were women. The mean operative time was 220.4 min (SD: 115.9), with 98.5% of procedures under general anesthesia and nearly half of patients (49.3%) hospitalized postoperatively. Liposuction was most commonly associated with complications (38.8%), followed by multiple procedures (23.9%). Within plastic surgery, cosmetic procedures accounted for 73.1% of complications. Statistical analysis showed an association between liposuction and DVT/PE occurrence, with more favorable outcomes for cosmetic procedures (P = .038).

Conclusions: Following a QUAD A policy change, DVT/PE rates peaked alongside DVT/PE prophylaxis deficiencies. Based on the findings of this study, the authors suggest considering a standardized prophylaxis and preoperative evaluation to reduce morbidity and mortality. Liposuction patients may be at higher risk for these complications.

Level of evidence 3 therapeutic:

Background: Traditional upper blepharoplasty often involves skin excision, which can lead to complications such as hollowing, visible scarring, and unnatural result. A tissue-preservation approach may offer quicker recovery and improved cosmetic outcomes.

Objectives: In this preliminary report, the authors introduce the Minimally Invasive Eyelid Lift (MINEL), a novel tissue-preserving upper blepharoplasty technique that tucks excess skin inward, avoiding skin excision, and evaluates its effectiveness in achieving natural and lasting results.

Methods: We included patients with dermatochalasis and underwent MINEL procedure. The technique involved creating small incisions, tucking the excess skin inwards, and securing it with nonabsorbable sutures.

Results: Thirty-seven patients undergoing the MINEL procedure all reported positive functional and aesthetic outcomes, with 70% very satisfied. The technique effectively reduced redundant skin, preserved natural eyelid creases, and resulted in minimal scarring. The average procedure duration was 33.9 min, with rapid recovery and return to activities.

Conclusions: MINEL offers a promising tissue-preserving alternative to traditional upper blepharoplasty, providing natural aesthetic outcomes with minimal scarring and faster recovery. Further studies are needed to evaluate long-term results and compare its efficacy, including with traditional techniques, to validate its role in cosmetic eyelid surgery.

Level of evidence 4 therapeutic:

Background: Facial aging is a multifactorial process characterized by soft tissue atrophy, skeletal remodeling, and degradation of dermal extracellular matrix components such as collagen and elastin. Injectable biostimulators have gained popularity in recent years for their efficacy in reinforcing the structural foundation of the face by stimulating the body's natural regenerative processes.

Objectives: The authors of this study aimed to assess their multidepth injection technique with hyperdilute calcium hydroxylapatite (CaHA-CMC; Radiesse, Merz Aesthetics, Raleigh, NC) for multilayered collagen biostimulation to address laxity, jowling, and skin aging-related changes.

Methods: The authors of this study reviewed the charts of 22 patients who underwent 2 treatment sessions with hyperdilute CaHA-CMC (1:3 ratio) using the author's technique for targeted rejuvenation of the mid and lower face. At each visit, assessments included the Global Aesthetic Improvement Scale (GAIS), patient satisfaction, and rankings of aging parameters of the face measured by 5-point photonumeric scales. Volumetric changes were objectively measured with 3-dimensional (3D) imaging analysis via QuantifiCare's 3D Track software.

Results: Quantitative analysis at Day 150 revealed a significant improvement in cheek volume (P = .0012) and significant reductions in jowl volume, nasolabial fold depth, and marionette line depth (P < .0001, P < .0001, P = .0019, respectively). GAIS evaluations from the treating physician, a blinded evaluator, and patients demonstrated progressive improvement peaking at Day 150.

Conclusions: The results of this study support the safety and efficacy of the author's novel technique with hyperdilute CaHA for lower and midface rejuvenation, further enhancing the utility of biostimulators in aesthetic medicine.

Level of evidence: 4 (Therapeutic).

Background: Recent advancements in buttock aesthetics have largely focused on fat transfer, implants, and belt line lifts, all of which overlook the specific needs of the lower pole of the buttock, especially the inferomedial region. These areas are characterized by ptosis, exaggerated infragluteal creasing, and an L-shaped/boxy appearance, requiring targeted intervention.

Objectives: The authors of this study aim to investigate the utilization of an infragluteal thigh lift, termed the thong lift (TL), to correct isolated lower buttock ptosis and L-shaped/boxy buttock deformity.

Methods: A retrospective chart review and patient survey was conducted for consecutive patients who underwent the TL procedure at a single surgical center between January 2017 and April 2024. Clinical data collected included patient demographics, indications, surgical history, and postoperative outcomes. Patients were also administered a standardized satisfaction survey following the procedure to rate outcomes.

Results: In total, 26 consecutive female patients (mean age: 48.5 years, range, 27-69 years) underwent the TL procedure during the study period. The average follow-up was 48.7 months. Patient satisfaction was high, with contour and scar quality rated as "good" to "excellent," on average. All patients (100%) reported improved aesthetic appearance and satisfaction with their outcomes. Only minor complications were recorded (15.4%), all of which were resolved.

Conclusions: Based on the results of this study, the TL is a promising technique that can be utilized to correct lower buttock ptosis and contour irregularities overlooked by traditional techniques, offering a targeted solution with minimal complications and high patient satisfaction.

Level of evidence 4 therapeutic:

Biopolymers are frequently used for aesthetic or reconstructive purposes, often without adequate consideration of the potential long-term health complications they may cause. The use of these substances has been associated with autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA syndrome); however, the existing literature is limited, and there is currently no clear consensus regarding its management. This case report aims to describe a case of severe biopolymer-induced inflammatory disease in a patient with a diagnosis of rheumatoid arthritis, highlighting both the diagnostic and therapeutic approaches. This case report examines a 58-year-old female patient with a history of biopolymer application to the gluteal and facial region 20 years before and a diagnosis of rheumatoid arthritis for the past 2 years. She presented with severe inflammatory skin lesions with worsening arthralgia. An MRI scan revealed exogenous material with signs of severe inflammation of the surrounding tissues, and a biopsy was consistent with foreign body granulomas with a "Swiss cheese" morphology. The patient was hospitalized and received multidisciplinary management, achieving an excellent clinical response. This case highlights the importance of a comprehensive evaluation and a multidisciplinary approach in patients with autoimmune disease and previous exposure to biopolymers. The coexistence of autoimmune diseases can aggravate the inflammatory response, suggesting the need for additional studies exploring this interaction and its prognostic impact. Level of Evidence: 5 (Risk).

Instagram stories (Meta, Menlo Park, CA) are posted at higher volumes and incite increased engagement for accounts. This is because of Instagram's algorithm, which typically only shows static posts to 10% of an account's followers. Given the importance of social media in cosmetic surgery practices, a detailed analysis of trends is useful in guiding plastic surgeon marketing regimes. The aim of the authors of this study is to provide a detailed analysis of Instagram story content posted by top 100 most-followed plastic surgeons in the world. One hundred plastic surgery Instagram accounts in the world were identified by their total number of followers and using the keywords "plastic," "cosmetic," "aesthetic," and "surgeon." Accounts of each surgeon were monitored daily over 1 week, with story content categorically logged. Broad categories included personal, educational, surgical, and engagement, which were further divided into subcategories. Qualitative and quantitative measures were used to assess demographics and trends. The average number of followers by the top accounts was 437,917 ± 36,216. The majority of accounts were located in North America (64%). The average number of stories posted each week was 28.2 ± 3.7, with the highest number posted on Friday (5.01) and the lowest on Saturday (2.67). The most common content of stories posted was related to surgical procedures (57.6%), contributing 1577 total stories. In this descriptive study, the authors provide insight into the nature of Instagram story content posted by top-followed plastic surgeons in the world, providing guidance to new and existing plastic surgeons in their social media practices. Level of Evidence: 5 (Therapeutic).

Liposuction is the most common surgical procedure performed globally. It is generally associated with low rates of major complications. Cosmetic surgery tourism has seen a steep incline in popularity and is often favorable to patients because of lower costs. However, it can be associated with higher complication rates and poorer follow-up. In this case report, the authors describe a case of severe symptomatic subcutaneous emphysema following air travel post liposuction. A 49-year-old male presented to the emergency department in the United Kingdom with pain, bruising, and swelling post liposuction to the chest, abdomen, and flanks. At Day 5 postoperatively, the patient embarked on a 5-hour plane journey, during which they experienced a significant increase in pain and swelling. On examination, there was audible crepitus at the upper abdomen and chest. A computerized tomography scan revealed extensive subcutaneous emphysema with associated skin thickening, subcutaneous fat stranding, and fluid. In this case, subcutaneous emphysema is likely a direct result of surgical technique. This case is unique in the severity of the symptoms described and the presumed role of air travel in their exacerbation. It is important that patients are adequately counseled on risks that may arise because of flying in the close postoperative period. Another issue highlighted is the increasing number of presentations to UK public hospitals following cosmetic tourism. Subcutaneous emphysema is a recognized but rare complication of liposuction. Patients should be adequately informed of adverse events that can arise following cosmetic surgery and subsequent travel. Level of Evidence: 4 (Therapeutic).

Background: Lower body lift (LBL) is a powerful 360° contouring procedure, most commonly performed after massive weight loss.

Objectives: In this study, the author reviews outcomes of a large series of drainless LBL procedures performed by a single surgeon combined with high-volume liposuction and adjunctive body procedures. The surgeon's technique is described.

Methods: A retrospective review was conducted on 137 consecutive patients who underwent drainless LBL between 2023 and 2025 by a single surgeon. Data collected included demographics, adjunctive procedures, liposuction volumes, fat grafting, hemoglobin levels, estimated blood loss (EBL), complications, and reoperations. All patients received preoperative optimization, including iron supplementation, and a multimodal perioperative protocol was employed. No drains were used for the procedures.

Results: The mean age was 44.5 years, and the mean BMI was 26.8 kg/m². Average liposuction volume was 2518 cc, with 1976 cc of pure fat removed. Mean fat transfer volumes were 1075 cc (buttocks) and 628 cc (breasts). Average EBL was 572 cc. Adjunctive procedures included Brazilian butt lift (99.3%), 360 liposuction (96.4%), fleur-de-lis tummy tuck (41.6%), mastopexy (29.2%), and others. The complication rate was 6.6%, with 0.7% requiring reoperation. Complications included hematoma (n = 1), deep vein thrombosis (n = 1), transfusions (n = 2), and delayed healing (n = 5). No seromas or revisions were reported.

Conclusions: Drainless LBL with progressive tension sutures, scarpal flap preservation, and limited undermining is a safe and effective approach and can be combined with high-volume liposuction and multiple adjunctive procedures. This technique resulted in lower complication and revision rates compared with previously published series.

Level of evidence 4 therapeutic: