Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.036
Yasmine Ibrahim, S. Khetpal, Wayne Ozaki, J. Roostaeian
Abstract Goals/Purpose Rhinoplasty is often contingent on the successful harvesting and allocation of cartilage in order to build the nasal framework. While autologous and cadaveric cartilage grafts have been utilized, it remains unclear how factors, such as suturing and carving techniques, as well as temperature, impact its short- and long-term warping potential. Our systematic review seeks to objectively assess how various carving (i.e. peripheral versus central, eccentric versus concentric), suture patterns (i.e. counter-balancing, oppositional), and temperature conditions impact the warping potential of cartilage grafts in rhinoplasty. In conducting this study, we hope to determine the optimal conditions for stable cartilage constructs in rhinoplasty. Methods/Technique A systematic literature review was conducted using a combination of terms including, “warp,” “rhinoplasty,” “cartilage,” “suture,” “temperature,” “carving,” and “cutting.” Removal of duplicates was performed, followed by further screening by abstract and full text. To reduce the possibility of bias, a standardized form was used for data extraction; variables including author, year of publication, journal of publication, study design, conditions, and results were recorded. Results/Complications A total of eleven studies were included in the analysis. Cartilage types included fresh frozen cadaveric graft, autologous costal cartilage, and bovine rib cartilage. Conditions associated with reduced warping include central and concentric based carving patterns, oppositional suturing; Peripherally and eccentric cut cartilage, as well as increased time, were associated with a higher degree of warping. Conclusion To the authors’ knowledge, our systematic analysis is the first to summarize the impact of various conditions on cartilage warping in rhinoplasty. Moreover, we determine the protective nature of certain carving and suturing methods - particularly central, concentric carving, and oppositional suturing - in minimizing cartilage warping. With this information, we hope to guide plastic surgeons in optimizing conditions to potentially prevent cartilage warping, and ultimately, provide reliable and sustainable results for patients undergoing rhinoplasty.
{"title":"Cartilage Warping in Rhinoplasty: An Assessment of Temperature, Carving, and Suturing Conditions","authors":"Yasmine Ibrahim, S. Khetpal, Wayne Ozaki, J. Roostaeian","doi":"10.1093/asjof/ojae007.036","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.036","url":null,"abstract":"Abstract Goals/Purpose Rhinoplasty is often contingent on the successful harvesting and allocation of cartilage in order to build the nasal framework. While autologous and cadaveric cartilage grafts have been utilized, it remains unclear how factors, such as suturing and carving techniques, as well as temperature, impact its short- and long-term warping potential. Our systematic review seeks to objectively assess how various carving (i.e. peripheral versus central, eccentric versus concentric), suture patterns (i.e. counter-balancing, oppositional), and temperature conditions impact the warping potential of cartilage grafts in rhinoplasty. In conducting this study, we hope to determine the optimal conditions for stable cartilage constructs in rhinoplasty. Methods/Technique A systematic literature review was conducted using a combination of terms including, “warp,” “rhinoplasty,” “cartilage,” “suture,” “temperature,” “carving,” and “cutting.” Removal of duplicates was performed, followed by further screening by abstract and full text. To reduce the possibility of bias, a standardized form was used for data extraction; variables including author, year of publication, journal of publication, study design, conditions, and results were recorded. Results/Complications A total of eleven studies were included in the analysis. Cartilage types included fresh frozen cadaveric graft, autologous costal cartilage, and bovine rib cartilage. Conditions associated with reduced warping include central and concentric based carving patterns, oppositional suturing; Peripherally and eccentric cut cartilage, as well as increased time, were associated with a higher degree of warping. Conclusion To the authors’ knowledge, our systematic analysis is the first to summarize the impact of various conditions on cartilage warping in rhinoplasty. Moreover, we determine the protective nature of certain carving and suturing methods - particularly central, concentric carving, and oppositional suturing - in minimizing cartilage warping. With this information, we hope to guide plastic surgeons in optimizing conditions to potentially prevent cartilage warping, and ultimately, provide reliable and sustainable results for patients undergoing rhinoplasty.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"22 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.064
Ruya Zhao, Yi-hsueh Lu, Daniel Chernovolenko, Aravind Pothula
Abstract Goals/Purpose The current standard of care for providing postoperative instructions to patients undergoing elective, ambulatory surgeries often falls short in efficiency, clarity, and patient-centeredness. Patients are given a single set of written instructions at the time of discharge after their surgery, which often leads to confusion and increased reliance on phone calls, urgent clinic appointments, and even unnecessary visits to the emergency department. Recognizing this, we propose a quality improvement initiative to enhance postoperative instructions for breast reduction patients through a video format. Methods/Technique With institutional IRB approval, all adult patients undergoing bilateral breast reduction (CPT 19318) at an urban academic hospital were included over a 3-month period. A 2-minute video with standardized narrative instructions and visual aids was created. Patients viewed the video during the preoperative visit, and a QR code link to the video was provided in the visit summary on the day of surgery. A Spanish version of the video was available if a Spanish interpreter was used during informed consent. The number of phone calls and emergency department visits within 30 days were recorded and compared to a cohort of patients before this intervention. Qualitative surveys were administered pre- and post-operatively to collect patient feedback. Results/Complications During the study period, 59 patients received breast reduction surgery and were given the standardized video instructions pre- and post-operatively (video group). In comparison, 75 breast reduction patients from the prior 3 months, who received nonstandardized, written instructions post-operatively, served as the control group. In the video group, 47% of patients (28 out of 59) made at least one phone call to the clinic, averaging 0.7 calls per patient, while 56% of the control group patients (42 out of 75) made at least one phone call, averaging 1.1 calls per patient. Categorizing reasons for the calls, there was a significantly higher proportion of calls related to wound dehiscence or minor drainage in the video group (41%) compared to the control group (22%; p=0.03). This shift may be attributed to a reduction in routine postoperative care questions due to the clarity provided by the video instructions (FIGURE1). There were 4 unnecessary emergency department visits within 30 days post-surgery in the study period, slightly decreased from the control period's 6 visits (after excluding 1 visit with the patient diagnosed with pulmonary embolism); however, the difference was not statistically significant. Fifteen patients who received the video instruction completed a survey, with 80% rating the video as very helpful, and 80% were able to access the QR code without assistance. These patients scored an average of 81 out of 100 on satisfaction with information measured using the BREAST-Q module after receiving the video instruction. There was no difference in com
{"title":"Quality Improvement Initiative: Utilization of Video Postoperative Instructions in Breast Reduction Enhances Patient Experience","authors":"Ruya Zhao, Yi-hsueh Lu, Daniel Chernovolenko, Aravind Pothula","doi":"10.1093/asjof/ojae007.064","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.064","url":null,"abstract":"Abstract Goals/Purpose The current standard of care for providing postoperative instructions to patients undergoing elective, ambulatory surgeries often falls short in efficiency, clarity, and patient-centeredness. Patients are given a single set of written instructions at the time of discharge after their surgery, which often leads to confusion and increased reliance on phone calls, urgent clinic appointments, and even unnecessary visits to the emergency department. Recognizing this, we propose a quality improvement initiative to enhance postoperative instructions for breast reduction patients through a video format. Methods/Technique With institutional IRB approval, all adult patients undergoing bilateral breast reduction (CPT 19318) at an urban academic hospital were included over a 3-month period. A 2-minute video with standardized narrative instructions and visual aids was created. Patients viewed the video during the preoperative visit, and a QR code link to the video was provided in the visit summary on the day of surgery. A Spanish version of the video was available if a Spanish interpreter was used during informed consent. The number of phone calls and emergency department visits within 30 days were recorded and compared to a cohort of patients before this intervention. Qualitative surveys were administered pre- and post-operatively to collect patient feedback. Results/Complications During the study period, 59 patients received breast reduction surgery and were given the standardized video instructions pre- and post-operatively (video group). In comparison, 75 breast reduction patients from the prior 3 months, who received nonstandardized, written instructions post-operatively, served as the control group. In the video group, 47% of patients (28 out of 59) made at least one phone call to the clinic, averaging 0.7 calls per patient, while 56% of the control group patients (42 out of 75) made at least one phone call, averaging 1.1 calls per patient. Categorizing reasons for the calls, there was a significantly higher proportion of calls related to wound dehiscence or minor drainage in the video group (41%) compared to the control group (22%; p=0.03). This shift may be attributed to a reduction in routine postoperative care questions due to the clarity provided by the video instructions (FIGURE1). There were 4 unnecessary emergency department visits within 30 days post-surgery in the study period, slightly decreased from the control period's 6 visits (after excluding 1 visit with the patient diagnosed with pulmonary embolism); however, the difference was not statistically significant. Fifteen patients who received the video instruction completed a survey, with 80% rating the video as very helpful, and 80% were able to access the QR code without assistance. These patients scored an average of 81 out of 100 on satisfaction with information measured using the BREAST-Q module after receiving the video instruction. There was no difference in com","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"12 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.095
Jake Alford, S. McCleary, J. Roostaeian
Abstract Goals/Purpose The inherent subjectivity in evaluating aesthetic outcomes presents a unique challenge in assessing rhinoplasty. Crowdsourcing has provided a new metric for objective analysis. The authors designed a study to compare the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We aim to objectively quantify the relative aesthetic advantages of performing a dorsal preservation technique. Additionally, we aim to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome. Methods/Technique This retrospective observational study was approved by the IRB at UCLA. A total of 64 patients who had previously undergone rhinoplasty performed by the senior author were included. All surgeries were performed at the UCLA Ronald Reagan Medical Center. Patients with prior nasal surgery or trauma were excluded. All subjects were photographed using standard rhinoplasty views during the pre-and postoperative visits. Frontal and right profile photographs were then cropped in a standardized fashion (Photos, Version 8.0, Apple Inc.) and used for evaluation. All evaluations and ratings were collected using the HIPPA compliant and encrypted software via a secure online platform (LoveMyDelta, Inc., Philadelphia, PA). All crowd workers were recruited and vetted through this platform, with internal fidelity checks performed. Each crowd worker was shown a profile and frontal view of a patient and asked to score the overall appearance of the nose, the nasal dorsum profile, the symmetry of the dorsal aesthetic lines, and the dorsal contour using a visual analog scale. Scoring was performed using a provided validated visual assessment guide. They were asked whether they believed the subject had undergone rhinoplasty and asked to provide a level of confidence in their guess. Crowdworkers’ responses were aggregated to allow for high-powered intra-rater analysis. Intra-rater reliability and confidence intervals were calculated. Aggregate data from all raters were used to generate an absolute value of aesthetic state for each cohort. A "delta" was then obtained for each value by comparing the preoperative to the postoperative state to obtain a representative value of the improvement after undergoing surgery. Raters were asked if the patient appeared to have had surgery, and each correct and incorrect response was proportionally weighted based on the raters' confidence in their answer. The delta (difference in preoperative to postoperative aesthetic state) for each parameter for the dorsal and non-dorsal preservation cohorts was calculated using non-paired T-tests to determine significance. Results/Complications A total of 64 patients were included for evaluation. The structural rhinoplasty cohort consisted of 34 patients. The dorsal preservation cohort included 30 patients. Both dorsal preservation and non-
摘要 目标/目的 在评估鼻整形术时，美学效果评估固有的主观性是一个独特的挑战。众包为客观分析提供了新的衡量标准。作者设计了一项研究，利用可靠有效的众包平台，比较鼻背保留整形术与结构性鼻整形术的美学效果。我们旨在客观量化保留鼻背技术的相对美学优势。此外，我们还希望证明使用众包作为评估任何整形手术美学效果的高效可靠方法的有效性。方法/技术 本项回顾性观察研究获得了加州大学洛杉矶分校研究委员会的批准。共纳入了 64 名曾接受过由资深作者实施的鼻整形手术的患者。所有手术均在加州大学洛杉矶分校罗纳德-里根医疗中心进行。之前接受过鼻部手术或外伤的患者被排除在外。所有受试者都在术前和术后就诊时使用标准鼻整形视角进行了拍照。正面和右侧轮廓照片按标准方式裁剪（照片，8.0 版，苹果公司）后用于评估。所有评价和评分均通过安全在线平台（宾夕法尼亚州费城，LoveMyDelta, Inc.）所有群众工作者都是通过该平台招募和审核的，并进行了内部真实性检查。向每位群众工作者展示患者的侧面和正面图，并要求他们使用视觉类比量表对鼻子的整体外观、鼻背轮廓、鼻背美学线条的对称性以及鼻背轮廓进行评分。评分使用提供的有效视觉评估指南进行。他们会被问及是否认为受试者接受过鼻整形手术，并要求他们对自己的猜测提供可信度。对群众的回答进行汇总，以便进行高强度的评分者内部分析。计算出评分者内部的可靠性和置信区间。所有评分者的汇总数据用于生成每个队列的审美状态绝对值。然后，通过比较术前和术后的状态，得出每个值的 "delta"，以获得手术后改善效果的代表值。评分者会被问及患者是否似乎接受过手术，根据评分者对其答案的信心，按比例对每个正确和错误的回答进行加权。采用非配对 T 检验法计算保留背侧和非保留背侧队列中每个参数的 delta 值（术前与术后美学状态的差异），以确定其显著性。结果/并发症 共有 64 名患者接受了评估。结构性鼻整形组包括 34 名患者。保留鼻背队列包括 30 名患者。保留鼻背和不保留鼻背的鼻整形术组群都与改善的整体众包美学效果和改善的所有子参数效果相关。总体而言，保背组（0.300，95% CI +/- 0.047）和结构组（0.377，95% CI +/- 0.055）的 delta (d) 均有所改善。当要求评定者预测患者是否做过手术时，预测的可信度与预测的正确性之间的相关系数为 0.74（结构组的 95% CI +/- 0.47），这表明人群工作者在确定患者是否做过结构性鼻整形手术时很可能是正确的。然而，保背组的相关系数为-0.0554（95% CI +/-0.058）。这表明评分者无法始终如一地确定哪些患者进行了保留鼻背的鼻整形手术。结论 在整形外科不断挑战更好的美学效果的过程中，众包是帮助衡量这些效果的宝贵工具。我们利用可靠有效的众包平台，比较了保背隆鼻术和结构性隆鼻术的美学效果。我们发现，两种技术都能明显改善整体美学效果，而在采用保留鼻背技术时，能获得更自然的 "未手术 "效果。通过这种类型的研究和评估工具，我们证明了众包作为一种高效可靠的方法在评估任何整形手术美学效果方面的有效性。
{"title":"Crowdsourced Assessment of Aesthetic Outcomes of Dorsal Preservation Rhinoplasty","authors":"Jake Alford, S. McCleary, J. Roostaeian","doi":"10.1093/asjof/ojae007.095","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.095","url":null,"abstract":"Abstract Goals/Purpose The inherent subjectivity in evaluating aesthetic outcomes presents a unique challenge in assessing rhinoplasty. Crowdsourcing has provided a new metric for objective analysis. The authors designed a study to compare the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We aim to objectively quantify the relative aesthetic advantages of performing a dorsal preservation technique. Additionally, we aim to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome. Methods/Technique This retrospective observational study was approved by the IRB at UCLA. A total of 64 patients who had previously undergone rhinoplasty performed by the senior author were included. All surgeries were performed at the UCLA Ronald Reagan Medical Center. Patients with prior nasal surgery or trauma were excluded. All subjects were photographed using standard rhinoplasty views during the pre-and postoperative visits. Frontal and right profile photographs were then cropped in a standardized fashion (Photos, Version 8.0, Apple Inc.) and used for evaluation. All evaluations and ratings were collected using the HIPPA compliant and encrypted software via a secure online platform (LoveMyDelta, Inc., Philadelphia, PA). All crowd workers were recruited and vetted through this platform, with internal fidelity checks performed. Each crowd worker was shown a profile and frontal view of a patient and asked to score the overall appearance of the nose, the nasal dorsum profile, the symmetry of the dorsal aesthetic lines, and the dorsal contour using a visual analog scale. Scoring was performed using a provided validated visual assessment guide. They were asked whether they believed the subject had undergone rhinoplasty and asked to provide a level of confidence in their guess. Crowdworkers’ responses were aggregated to allow for high-powered intra-rater analysis. Intra-rater reliability and confidence intervals were calculated. Aggregate data from all raters were used to generate an absolute value of aesthetic state for each cohort. A \"delta\" was then obtained for each value by comparing the preoperative to the postoperative state to obtain a representative value of the improvement after undergoing surgery. Raters were asked if the patient appeared to have had surgery, and each correct and incorrect response was proportionally weighted based on the raters' confidence in their answer. The delta (difference in preoperative to postoperative aesthetic state) for each parameter for the dorsal and non-dorsal preservation cohorts was calculated using non-paired T-tests to determine significance. Results/Complications A total of 64 patients were included for evaluation. The structural rhinoplasty cohort consisted of 34 patients. The dorsal preservation cohort included 30 patients. Both dorsal preservation and non-","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"22 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.055
Scott Levin, J. Firriolo, Granger Wong
Abstract Goals/Purpose Complications of elective aesthetic surgery performed in private practice pose significant morbidity to patients and resource burden to healthcare systems. We aimed to characterize contemporary demographic and complication patterns among patients presenting to an academic center after aesthetic surgery, as well as the financial and resource burden of their postoperative care on the hospital and payor. Methods/Technique We performed a retrospective review of patients who presented to an urban, academic hospital emergency department in Northern California from September 1, 2020 to September 30, 2023. We included patients with primary complaints related to aesthetic procedures performed at outside centers resulting in a plastic surgery consultation. Demographics, outcomes, hospital charges, and insurance payments were determined. Univariable analyses identified associations with outcomes. Results/Complications We identified 36 patients with aesthetic procedure-related complaints. Mean age was 37.5 ± 9.8 years and all patients were female. Compared with the rest of the patient population presenting to the emergency department over the same time period (n=269,286), the identified patients were more likely to be black (34.3% vs. 20.4%, p=.04), Hispanic (40% vs. 24.6%, p=.03), and on Medicaid (80.6% vs. 31.7%, p<.001). Tobacco/cannabis use and obesity were prevalent in 25% and 47.2% of patients, respectively. Most patients underwent aesthetic procedures in the United States (51.4%), followed by Mexico (37.1%) and the Dominican Republic (11.4%). Body regions intervened upon were the abdomen (52.8%), breasts (52.8%), buttocks (33.3%), and arms (8.3%). In 36.1% of patients, multiple body regions were intervened upon during the index case. Abdominal cases included primary abdominoplasty (84.2%), panniculectomy (10.5%), and revision abdominoplasty (5.3%). Breast cases were primary augmentation (36.8%), revision augmentation (21.1%), augmentation mastopexy (15.8%), mastopexy only (15.8%), and other (10.5%). Buttocks cases were gluteal fat grafting (63.6%) and implant insertion (36.4%). Arm cases were all brachioplasty. Median postoperative day was 21 (Interquartile Range [IQR] 11.5, 36). Reasons for presentation included infection (44.5%), dehiscence (16.7%), pain (16.7%), seroma/drainage (11.1%), drain management (5.6%), and hematoma (2.8%). Nearly half received computed tomographic imaging (47.2%). Half of patients were admitted with a median length of stay of 2.5 days (IQR 1, 3). One-third underwent intervention, including implant removal (58.3%), image-guided aspiration (25%), and incision and drainage (16.7%). Patients using tobacco/cannabis were more likely to present with infection (88.9% vs. 25.9%, p=.001) and undergo intervention (66.7% vs. 22.2%, p=.01). There were recurrent emergency department visits among 22.2%. Overall, 44.4% of patients had outpatient follow-up visits for a median of 3 (IQR 2, 4) visits up to a median of
{"title":"Aesthetic Surgery Complications Disproportionately Burden Economically Disadvantaged Patients and Financially Strain Public Health Insurance: A Single Academic Center Retrospective Analysis","authors":"Scott Levin, J. Firriolo, Granger Wong","doi":"10.1093/asjof/ojae007.055","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.055","url":null,"abstract":"Abstract Goals/Purpose Complications of elective aesthetic surgery performed in private practice pose significant morbidity to patients and resource burden to healthcare systems. We aimed to characterize contemporary demographic and complication patterns among patients presenting to an academic center after aesthetic surgery, as well as the financial and resource burden of their postoperative care on the hospital and payor. Methods/Technique We performed a retrospective review of patients who presented to an urban, academic hospital emergency department in Northern California from September 1, 2020 to September 30, 2023. We included patients with primary complaints related to aesthetic procedures performed at outside centers resulting in a plastic surgery consultation. Demographics, outcomes, hospital charges, and insurance payments were determined. Univariable analyses identified associations with outcomes. Results/Complications We identified 36 patients with aesthetic procedure-related complaints. Mean age was 37.5 ± 9.8 years and all patients were female. Compared with the rest of the patient population presenting to the emergency department over the same time period (n=269,286), the identified patients were more likely to be black (34.3% vs. 20.4%, p=.04), Hispanic (40% vs. 24.6%, p=.03), and on Medicaid (80.6% vs. 31.7%, p<.001). Tobacco/cannabis use and obesity were prevalent in 25% and 47.2% of patients, respectively. Most patients underwent aesthetic procedures in the United States (51.4%), followed by Mexico (37.1%) and the Dominican Republic (11.4%). Body regions intervened upon were the abdomen (52.8%), breasts (52.8%), buttocks (33.3%), and arms (8.3%). In 36.1% of patients, multiple body regions were intervened upon during the index case. Abdominal cases included primary abdominoplasty (84.2%), panniculectomy (10.5%), and revision abdominoplasty (5.3%). Breast cases were primary augmentation (36.8%), revision augmentation (21.1%), augmentation mastopexy (15.8%), mastopexy only (15.8%), and other (10.5%). Buttocks cases were gluteal fat grafting (63.6%) and implant insertion (36.4%). Arm cases were all brachioplasty. Median postoperative day was 21 (Interquartile Range [IQR] 11.5, 36). Reasons for presentation included infection (44.5%), dehiscence (16.7%), pain (16.7%), seroma/drainage (11.1%), drain management (5.6%), and hematoma (2.8%). Nearly half received computed tomographic imaging (47.2%). Half of patients were admitted with a median length of stay of 2.5 days (IQR 1, 3). One-third underwent intervention, including implant removal (58.3%), image-guided aspiration (25%), and incision and drainage (16.7%). Patients using tobacco/cannabis were more likely to present with infection (88.9% vs. 25.9%, p=.001) and undergo intervention (66.7% vs. 22.2%, p=.01). There were recurrent emergency department visits among 22.2%. Overall, 44.4% of patients had outpatient follow-up visits for a median of 3 (IQR 2, 4) visits up to a median of ","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.011
Laura Roider, Peter K. Firouzbakht, Caroline C. Kreh, Charles Nathan, Christian Prada, Herluf G Lund, Deniz Sarhaddi, Kevin Chen
Abstract Goals/Purpose Well described facial changes occur over time, which collectively result in an increased perceived age of an individual. These changes affect everything including the bony framework, facial fat pads, soft tissue, skin quality, and facial muscles. Aesthetic surgery provides an opportunity to reverse the appearance of facial aging. With the recent increase in mask utilization following the COVID-19 pandemic, an increased focus on the upper face and the impact of age-related changes in the periorbital region has been observed. Blepharoplasty and brow lifts aim to restore a youthful, rested, and attractive appearance by addressing the periorbital region. Blepharoplasty is a commonly performed procedure and has consistently ranked the third most common aesthetic procedure performed by plastic surgeons since 2018. However, following the pandemic we saw a 28% increase in blepharoplasties performed, now totaling 1.4 million in 2022. Over the same time period, the number of brow lifts performed has increased by 60%, now accounting for 352,324 surgeries performed in 2022. Despite this increase, recent surveys demonstrate that nearly 30% of plastic surgeons feel that neuromodulators have completely replaced operative brow lifting procedures. Additionally, a recently published study demonstrated that 62% of patients presenting for blepharoplasty have unfavorable preoperative brow aesthetics. However, only 36% of patients underwent brow lifts.Those with preoperative unfavorable brows who underwent a brow lift procedure were found to have significantly higher postoperative aesthetic scores than those who did not. Despite the increase in popularity of periorbital procedures, the literature continues to lack objective evaluation and outcome measurements related to perceived facial aging and the impact of individual procedures. The goal of this study is to quantify the impact of different periorbital rejuvenation surgeries on perceived age through the utilization of artificial intelligence (AI) in the form of convolutional neural network algorithms. Methods/Technique A retrospective review of patients who underwent periorbital rejuvenation surgery (upper blepharoplasty, lower blepharoplasty, and brow lift) at a single cosmetic practice between 2018-2023 was performed. Charts were reviewed for demographic information, periocular history, prior surgeries, surgical technique utilized, and complications/revisions. Exclusion criteria included: simultaneous procedures, incomplete patient records, poor quality or missing photographs, periocular medical conditions with cosmetic impact, and facial aesthetic procedures performed in the postoperative period. Pre and post operative frontal photographs of each patient were analyzed using four facial analysis AI platforms (Face++, Betaface, Facelytics, and Everypixel). Each platform generated an age estimate. A collective pre-op and post-op age estimation was then calculated for each patient by averaging
{"title":"Periorbital Rejuvenation: Artificial Intelligence Highlights the Importance of Brow Lift","authors":"Laura Roider, Peter K. Firouzbakht, Caroline C. Kreh, Charles Nathan, Christian Prada, Herluf G Lund, Deniz Sarhaddi, Kevin Chen","doi":"10.1093/asjof/ojae007.011","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.011","url":null,"abstract":"Abstract Goals/Purpose Well described facial changes occur over time, which collectively result in an increased perceived age of an individual. These changes affect everything including the bony framework, facial fat pads, soft tissue, skin quality, and facial muscles. Aesthetic surgery provides an opportunity to reverse the appearance of facial aging. With the recent increase in mask utilization following the COVID-19 pandemic, an increased focus on the upper face and the impact of age-related changes in the periorbital region has been observed. Blepharoplasty and brow lifts aim to restore a youthful, rested, and attractive appearance by addressing the periorbital region. Blepharoplasty is a commonly performed procedure and has consistently ranked the third most common aesthetic procedure performed by plastic surgeons since 2018. However, following the pandemic we saw a 28% increase in blepharoplasties performed, now totaling 1.4 million in 2022. Over the same time period, the number of brow lifts performed has increased by 60%, now accounting for 352,324 surgeries performed in 2022. Despite this increase, recent surveys demonstrate that nearly 30% of plastic surgeons feel that neuromodulators have completely replaced operative brow lifting procedures. Additionally, a recently published study demonstrated that 62% of patients presenting for blepharoplasty have unfavorable preoperative brow aesthetics. However, only 36% of patients underwent brow lifts.Those with preoperative unfavorable brows who underwent a brow lift procedure were found to have significantly higher postoperative aesthetic scores than those who did not. Despite the increase in popularity of periorbital procedures, the literature continues to lack objective evaluation and outcome measurements related to perceived facial aging and the impact of individual procedures. The goal of this study is to quantify the impact of different periorbital rejuvenation surgeries on perceived age through the utilization of artificial intelligence (AI) in the form of convolutional neural network algorithms. Methods/Technique A retrospective review of patients who underwent periorbital rejuvenation surgery (upper blepharoplasty, lower blepharoplasty, and brow lift) at a single cosmetic practice between 2018-2023 was performed. Charts were reviewed for demographic information, periocular history, prior surgeries, surgical technique utilized, and complications/revisions. Exclusion criteria included: simultaneous procedures, incomplete patient records, poor quality or missing photographs, periocular medical conditions with cosmetic impact, and facial aesthetic procedures performed in the postoperative period. Pre and post operative frontal photographs of each patient were analyzed using four facial analysis AI platforms (Face++, Betaface, Facelytics, and Everypixel). Each platform generated an age estimate. A collective pre-op and post-op age estimation was then calculated for each patient by averaging","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"13 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.051
Kelsey Lipman, Joshua Korman, Dung Nguyen
Abstract Goals/Purpose Incorporating adequate aesthetic surgery training into integrated plastic surgery programs in the United States has remained a challenge for several decades.[1-4] Specifically, residents report low confidence in performing facial cosmetic procedures compared to breast and body contouring.[1-2] This becomes increasingly relevant in the setting of heightened specialty creep and the rise in demand for cosmetic procedures overall according to the 2022 ASPS procedural statistics which show a 19% increase in cosmetic surgery procedures compared to the pre-pandemic 2019 report.[5] In a survey of 257 residents, 26.4% felt confident performing a lower blepharoplasty, 25% performing a facelift, 16.5% performing an endoscopic brow lift, and 14% performing a rhinoplasty.[2] This resident-reported difficulty with facial cosmetic procedures has shown little progress over time in reported survey data despite an increase in minimum cosmetic case numbers and length of training. A comprehensive aesthetic training also includes exposure to non-surgical interventions such as neuromodulators, injectables, non-surgical body contouring and facial rejuvenation technology. Though non-invasive fat reduction (ie. cryolypolysis) and non-surgical skin tightening (ie. radiofrequency micro-needling) have increased in demand since 2019 (77% and 22%, respectively), residents rarely have hands-on exposure to these treatment modalities.[5] Several integrated plastic surgery programs have a dedicated year of professional development or research, providing an opportunity for programs to fill this gap between cosmetic surgery training and real-world demand. Methods/Technique A junior cosmetic fellowship curriculum was created at a single institution focused on increasing confidence in performing aesthetic surgery, exposure to non-surgical cosmetic procedures, and increasing exposure to the business side of private practice. The fellowship was designed for a single resident during the professional development year of integrated plastic surgery training, completed between the third and fourth clinical years. The junior fellow spent the year within a single, multi-office private aesthetics practice in both the surgical and non-surgical setting. Over the course of the first four months (July 2023 - October 2023), the clinical experience of the Stanford junior cosmetic fellow was queried. Analysis of surgical case volume and non-surgical patient load was performed. This was then used to project surgical cases anticipated to be completed by year end. This was compared to case log minimums for graduating integrated plastic surgery residents in the United States, an essential metric of assessing resident experience and competence. Financial analysis of the non-surgical treatments by the junior fellow was performed. Using the initial four-month data, projections were also estimated to determine profitability for the practice over the course of the year-long fellowship.
{"title":"Addressing the Cosmetic Resident Education Gap – a Junior Cosmetic Fellowship Program","authors":"Kelsey Lipman, Joshua Korman, Dung Nguyen","doi":"10.1093/asjof/ojae007.051","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.051","url":null,"abstract":"Abstract Goals/Purpose Incorporating adequate aesthetic surgery training into integrated plastic surgery programs in the United States has remained a challenge for several decades.[1-4] Specifically, residents report low confidence in performing facial cosmetic procedures compared to breast and body contouring.[1-2] This becomes increasingly relevant in the setting of heightened specialty creep and the rise in demand for cosmetic procedures overall according to the 2022 ASPS procedural statistics which show a 19% increase in cosmetic surgery procedures compared to the pre-pandemic 2019 report.[5] In a survey of 257 residents, 26.4% felt confident performing a lower blepharoplasty, 25% performing a facelift, 16.5% performing an endoscopic brow lift, and 14% performing a rhinoplasty.[2] This resident-reported difficulty with facial cosmetic procedures has shown little progress over time in reported survey data despite an increase in minimum cosmetic case numbers and length of training. A comprehensive aesthetic training also includes exposure to non-surgical interventions such as neuromodulators, injectables, non-surgical body contouring and facial rejuvenation technology. Though non-invasive fat reduction (ie. cryolypolysis) and non-surgical skin tightening (ie. radiofrequency micro-needling) have increased in demand since 2019 (77% and 22%, respectively), residents rarely have hands-on exposure to these treatment modalities.[5] Several integrated plastic surgery programs have a dedicated year of professional development or research, providing an opportunity for programs to fill this gap between cosmetic surgery training and real-world demand. Methods/Technique A junior cosmetic fellowship curriculum was created at a single institution focused on increasing confidence in performing aesthetic surgery, exposure to non-surgical cosmetic procedures, and increasing exposure to the business side of private practice. The fellowship was designed for a single resident during the professional development year of integrated plastic surgery training, completed between the third and fourth clinical years. The junior fellow spent the year within a single, multi-office private aesthetics practice in both the surgical and non-surgical setting. Over the course of the first four months (July 2023 - October 2023), the clinical experience of the Stanford junior cosmetic fellow was queried. Analysis of surgical case volume and non-surgical patient load was performed. This was then used to project surgical cases anticipated to be completed by year end. This was compared to case log minimums for graduating integrated plastic surgery residents in the United States, an essential metric of assessing resident experience and competence. Financial analysis of the non-surgical treatments by the junior fellow was performed. Using the initial four-month data, projections were also estimated to determine profitability for the practice over the course of the year-long fellowship. ","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"15 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.018
Jennifer Bai, Sarah Ferenz, Megan Fracol, John Y S Kim
Abstract Goals/Purpose Capsular contracture is a local complication in which there is tightening of the capsule around the implant. This complication has been shown to occur in 15-30% of implant-based breast reconstruction patients and often requires revision surgery for correction. Prior investigations have suggested that the use of ADM can reduce the risk for development of capsular contracture, with more recent research suggesting that synthetic mesh may provide the same benefit. Several meta-analyses have attempted to compare ADM and mesh use for the prevention of capsular contracture, but they all emphasize the continued need for clinical investigation with direct comparisons. The goal of this study is to assess our own reconstruction patient population to compare capsular contracture rates between ADM and mesh cohorts, as well as to assess for other potential risks that may increase the rate of capsular contracture in these patients. Methods/Technique A 15-year retrospective review of all implant-based breast reconstructions performed by the senior author was performed. All operations occurred between 2008 and 2023 in a hospital setting. Patient demographics were assessed including age, BMI, implant size, radiation history, location of malposition, and use of either ADM or mesh. Post-operative complications including incidence of capsular contracture were recorded. Patients who had documented capsular contracture prior to scaffold insertion were excluded from the study. Wilcoxon signed rank test, 2-sided t-test, and Fischer’s Exact test were used to compare baseline demographics and capsular contracture rates between the two groups, along with a multivariate logistic regression analysis to control for potential confounders. Results/Complications Fifty-two breasts underwent capsulorraphy, of which 25 (48.1%) used ADM and 27 (51.9%) used mesh. Average age was 50.6 years, average BMI was 27.7, average implant size was 541.8 cc, and eight breasts (15.4%) had been irradiated. Average follow-up time was seven years (mean = 85.4 months, range 22 – 149 months, SD = 35.9). Fourteen (26.9%) capsulorraphies were for inferior malposition, 13 (25.0%) for lateral malposition, and 25 (48.1%) were for inferolateral malposition. Patients in the ADM group had significantly more lateral malposition prior to insertion as compared to the mesh group which had more inferior malposition (p=0.0246). There was no significant difference between the two groups for any other recorded baseline demographic; these demographics included age, BMI, hypertension, diabetes, history of tobacco use, radiation, chemotherapy, implant volume, and implant surface texture. Capsular contracture occurred in 2 ADM breasts (8.0%) and 4 mesh breasts (14.8%) with no significant difference between the two groups (p=0.6695). Five of these capsular contractures had documented Baker grades with three grade II, one grade III, and one grade IV. None of the recorded baseline demographics signific
{"title":"A Comparison of Capsular Contracture Rates after Implant-Based Breast Reconstruction Using ADM Versus Synthetic Mesh","authors":"Jennifer Bai, Sarah Ferenz, Megan Fracol, John Y S Kim","doi":"10.1093/asjof/ojae007.018","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.018","url":null,"abstract":"Abstract Goals/Purpose Capsular contracture is a local complication in which there is tightening of the capsule around the implant. This complication has been shown to occur in 15-30% of implant-based breast reconstruction patients and often requires revision surgery for correction. Prior investigations have suggested that the use of ADM can reduce the risk for development of capsular contracture, with more recent research suggesting that synthetic mesh may provide the same benefit. Several meta-analyses have attempted to compare ADM and mesh use for the prevention of capsular contracture, but they all emphasize the continued need for clinical investigation with direct comparisons. The goal of this study is to assess our own reconstruction patient population to compare capsular contracture rates between ADM and mesh cohorts, as well as to assess for other potential risks that may increase the rate of capsular contracture in these patients. Methods/Technique A 15-year retrospective review of all implant-based breast reconstructions performed by the senior author was performed. All operations occurred between 2008 and 2023 in a hospital setting. Patient demographics were assessed including age, BMI, implant size, radiation history, location of malposition, and use of either ADM or mesh. Post-operative complications including incidence of capsular contracture were recorded. Patients who had documented capsular contracture prior to scaffold insertion were excluded from the study. Wilcoxon signed rank test, 2-sided t-test, and Fischer’s Exact test were used to compare baseline demographics and capsular contracture rates between the two groups, along with a multivariate logistic regression analysis to control for potential confounders. Results/Complications Fifty-two breasts underwent capsulorraphy, of which 25 (48.1%) used ADM and 27 (51.9%) used mesh. Average age was 50.6 years, average BMI was 27.7, average implant size was 541.8 cc, and eight breasts (15.4%) had been irradiated. Average follow-up time was seven years (mean = 85.4 months, range 22 – 149 months, SD = 35.9). Fourteen (26.9%) capsulorraphies were for inferior malposition, 13 (25.0%) for lateral malposition, and 25 (48.1%) were for inferolateral malposition. Patients in the ADM group had significantly more lateral malposition prior to insertion as compared to the mesh group which had more inferior malposition (p=0.0246). There was no significant difference between the two groups for any other recorded baseline demographic; these demographics included age, BMI, hypertension, diabetes, history of tobacco use, radiation, chemotherapy, implant volume, and implant surface texture. Capsular contracture occurred in 2 ADM breasts (8.0%) and 4 mesh breasts (14.8%) with no significant difference between the two groups (p=0.6695). Five of these capsular contractures had documented Baker grades with three grade II, one grade III, and one grade IV. None of the recorded baseline demographics signific","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.025
Veronique Doucet, Avinash Islur
Abstract Goals/Purpose Marijuana use is increasing in Canada following its legalization in 2018. 27% of Canadians were reported to have consumed marijuana in 2022. Marijuana use in surgical patients is a topic that has had exponential growth in the literature recently. The drug has many therapeutic effects such as analgesia, muscle relaxation, sedation and mood improvement. However, it is also associated with deleterious cardiovascular, respiratory and coagulopathic effects that can significantly impact the care of surgical patients in the peri-operative period. Literature from other surgical specialities has shown similar recovery and ultimate surgical outcome between marijuana users and non-marijuana users despite increased pain and poorer quality of life associated with marijuana use. There is a paucity of information about the effects of marijuana on aesthetic plastic surgery outcomes. The prevalence of marijuana use in aesthetic plastic surgery patients is currently unknown and there is a need for more evidence to develop clinical practice guidelines regarding the use of marijuana in the perioperative period. The purpose of this study is to describe the effects of marijuana consumption on aesthetic plastic surgery outcomes. Methods/Technique A single-center retrospective review was completed including all patients who underwent abdominoplasty, mastopexy and/or other body contouring surgery (such as brachioplasty, thigh lift or lower body lift) between January 2021 and August 2023. Other procedures such as liposuction, fat grafting, implant insertion or removal were also reviewed if they took place during the same general anesthetic. Marijuana use was defined as use within 4 weeks pre- and/or post-operatively. Data collection included patient demographics, body mass index (BMI), marijuana use, smoking status, comorbidities, surgical procedure(s) performed, operative time, resection weight and/or liposuction volume (if applicable), complications and follow up. Results/Complications A total of 1000 procedures in 441 patients were reviewed during the 32-month study period. Average patient age was 43 years old and average patient BMI was 27.3 kg/m2. 20.4% of patients were marijuana users. The average number of procedures completed per patient was 2.3 and average operative time was 167 minutes (2 hours and 47 minutes). 79% of cases involved more than one surgical procedure. 63% of the 441 cases involved an abdominoplasty, 49% involved a mastopexy, 5% involved a brachioplasty and 4% involved a thigh lift procedure. 33% of cases included breast implants and 47% liposuction. Average follow up time was 5.2 months. Overall surgical complications consisted of a 5% superficial infection rate, 1% deep infection rate, 9% seroma rate, 1% hematoma and lymphocele rates, 3% rate of wound dehiscence requiring surgical intervention and 11% rate of superficial delayed wound healing. There were no cases of nipple necrosis or full thickness skin necrosis. A compari
{"title":"Marijuana Use in Aesthetic Surgery Patients: A Retrospective Review of 441 Cases","authors":"Veronique Doucet, Avinash Islur","doi":"10.1093/asjof/ojae007.025","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.025","url":null,"abstract":"Abstract Goals/Purpose Marijuana use is increasing in Canada following its legalization in 2018. 27% of Canadians were reported to have consumed marijuana in 2022. Marijuana use in surgical patients is a topic that has had exponential growth in the literature recently. The drug has many therapeutic effects such as analgesia, muscle relaxation, sedation and mood improvement. However, it is also associated with deleterious cardiovascular, respiratory and coagulopathic effects that can significantly impact the care of surgical patients in the peri-operative period. Literature from other surgical specialities has shown similar recovery and ultimate surgical outcome between marijuana users and non-marijuana users despite increased pain and poorer quality of life associated with marijuana use. There is a paucity of information about the effects of marijuana on aesthetic plastic surgery outcomes. The prevalence of marijuana use in aesthetic plastic surgery patients is currently unknown and there is a need for more evidence to develop clinical practice guidelines regarding the use of marijuana in the perioperative period. The purpose of this study is to describe the effects of marijuana consumption on aesthetic plastic surgery outcomes. Methods/Technique A single-center retrospective review was completed including all patients who underwent abdominoplasty, mastopexy and/or other body contouring surgery (such as brachioplasty, thigh lift or lower body lift) between January 2021 and August 2023. Other procedures such as liposuction, fat grafting, implant insertion or removal were also reviewed if they took place during the same general anesthetic. Marijuana use was defined as use within 4 weeks pre- and/or post-operatively. Data collection included patient demographics, body mass index (BMI), marijuana use, smoking status, comorbidities, surgical procedure(s) performed, operative time, resection weight and/or liposuction volume (if applicable), complications and follow up. Results/Complications A total of 1000 procedures in 441 patients were reviewed during the 32-month study period. Average patient age was 43 years old and average patient BMI was 27.3 kg/m2. 20.4% of patients were marijuana users. The average number of procedures completed per patient was 2.3 and average operative time was 167 minutes (2 hours and 47 minutes). 79% of cases involved more than one surgical procedure. 63% of the 441 cases involved an abdominoplasty, 49% involved a mastopexy, 5% involved a brachioplasty and 4% involved a thigh lift procedure. 33% of cases included breast implants and 47% liposuction. Average follow up time was 5.2 months. Overall surgical complications consisted of a 5% superficial infection rate, 1% deep infection rate, 9% seroma rate, 1% hematoma and lymphocele rates, 3% rate of wound dehiscence requiring surgical intervention and 11% rate of superficial delayed wound healing. There were no cases of nipple necrosis or full thickness skin necrosis. A compari","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"21 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.080
C. Siotos, Kelly A. Harmon, Nikki Rezania, Deana S Shenaq
Abstract Goals/Purpose Implant-based breast reconstruction remains the common method of reconstruction after mastectomy in the US. An increasing number of centers are now offering direct-to-implant (DTI) breast reconstruction, avoiding staged reconstructions with tissue expander placement first. However, little is known regarding the need for revisions following DTI. In this study we sought to investigate short- and long-term complications and revisions following DTI versus staged reconstruction. Methods/Technique We retrospectively reviewed all patients who underwent bilateral nipple-sparing-mastectomies seeking implant-based breast reconstruction between September 2016 to September 2021. We extracted demographic and clinical information for the selected patients. Patients were divided in two cohorts: the DTI cohort, and the staged cohort. Baseline differences among the two groups were assessed by performing non-parametric statistical tests. Number of complications and revisions were assessed by employing chi-square. Logistic regression was then employed to adjust for possible confounders. Results/Complications During the study period, we identified 143 patients, 69 in the DTI cohort and 74 in the staged cohort. Patients in the staged cohort were more likely to have higher BMI (mean 26 kg/m2 versus 24.3 kg/m2 in the DTI cohort) and have undergone prior radiotherapy than those in the DTI cohort. No differences based on age, race/ethnicity or comorbidities were present. According to our analysis and within the follow up period time of average 21 months, the two cohorts had similar rates of minor and major short- and long-term surgical complications. After adjusting for potential confounding factors, the DTI group had a significantly higher rate of overall revisions (OR 2.73, 95% CI 1.23-6.07, p-value 0.01) and specifically revisions with implant exchange (0R 3.06, 95% CI 1.06-8.85, p-value 0.03). Most common reason for reason was asymmetry or contour deformity. However, the DTI cohort had significantly lower charges associated with their care during the follow up period (d=-100,178.14 US dollars, p-value=0.001). Complications rates were similar among the two groups. Conclusion An increasing number of patients are now interested in DTI breast reconstruction. According to the results of our study, DTI patients may have increased number of revisions but share similar rates of complications. DTI breast reconstruction is also associated with lower charges, even after accounting for the additional necessary revision procedures. Careful selection of patients for DTI and appropriate education on the need for revisions in the future is paramount.
{"title":"To Stage or Not to Stage? Direct-to-Implant Versus Staged Reconstruction for Implant-Based Breast Reconstruction","authors":"C. Siotos, Kelly A. Harmon, Nikki Rezania, Deana S Shenaq","doi":"10.1093/asjof/ojae007.080","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.080","url":null,"abstract":"Abstract Goals/Purpose Implant-based breast reconstruction remains the common method of reconstruction after mastectomy in the US. An increasing number of centers are now offering direct-to-implant (DTI) breast reconstruction, avoiding staged reconstructions with tissue expander placement first. However, little is known regarding the need for revisions following DTI. In this study we sought to investigate short- and long-term complications and revisions following DTI versus staged reconstruction. Methods/Technique We retrospectively reviewed all patients who underwent bilateral nipple-sparing-mastectomies seeking implant-based breast reconstruction between September 2016 to September 2021. We extracted demographic and clinical information for the selected patients. Patients were divided in two cohorts: the DTI cohort, and the staged cohort. Baseline differences among the two groups were assessed by performing non-parametric statistical tests. Number of complications and revisions were assessed by employing chi-square. Logistic regression was then employed to adjust for possible confounders. Results/Complications During the study period, we identified 143 patients, 69 in the DTI cohort and 74 in the staged cohort. Patients in the staged cohort were more likely to have higher BMI (mean 26 kg/m2 versus 24.3 kg/m2 in the DTI cohort) and have undergone prior radiotherapy than those in the DTI cohort. No differences based on age, race/ethnicity or comorbidities were present. According to our analysis and within the follow up period time of average 21 months, the two cohorts had similar rates of minor and major short- and long-term surgical complications. After adjusting for potential confounding factors, the DTI group had a significantly higher rate of overall revisions (OR 2.73, 95% CI 1.23-6.07, p-value 0.01) and specifically revisions with implant exchange (0R 3.06, 95% CI 1.06-8.85, p-value 0.03). Most common reason for reason was asymmetry or contour deformity. However, the DTI cohort had significantly lower charges associated with their care during the follow up period (d=-100,178.14 US dollars, p-value=0.001). Complications rates were similar among the two groups. Conclusion An increasing number of patients are now interested in DTI breast reconstruction. According to the results of our study, DTI patients may have increased number of revisions but share similar rates of complications. DTI breast reconstruction is also associated with lower charges, even after accounting for the additional necessary revision procedures. Careful selection of patients for DTI and appropriate education on the need for revisions in the future is paramount.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"1 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1093/asjof/ojae007.084
Caroline C. Bay, Peter J. Wirth, E. Shaffrey, Sarah M. Thornton, Venkat K. Rao
Abstract Goals/Purpose Historically, demand for plastic surgery has been associated with the performance of the United States (US) economy. Over the past two decades, the US has weathered a recession, several presidential election cycles, and has seen a rise in the use and influence of social media. Each of these events has led to varying effects on the economy, which undoubtedly have had an impact on plastic surgery demand and expenditures. Thus, this study aims to evaluate the relationship between indicators of economic performance and the popularity and profitability of aesthetic surgery from 2006 to 2022. Methods/Technique Data from the Aesthetic Society’s (AS) Aesthetic Plastic Surgery National Databank and the American Society of Plastic Surgeons’ (ASPS) Plastic Surgery Statistics Report was collected from 2006 to 2022. Surgical procedures analyzed included the most commonly performed cosmetic surgeries: breast augmentation, breast reduction, mastopexy, abdominoplasty, liposuction, blepharoplasty, facelift, and rhinoplasty. The non-surgical botox injections and dermal fillers were also included. A total of 24 variables were examined, including the 10 procedures and two composite variables—total surgical procedures and total injectables; case change percent difference and patient expenditures percent difference were recorded for each of these. Within the corresponding period, economic indices were collected, including personal disposable income per capita (PDI), consumer price index (CPI), medical care services CPI, average gross domestic product per capita (GDP), and annual average closing prices of the NASDAQ, S&P 500, and the Dow Jones (DOW). Pearson correlation tests were used to analyze the strength of association between each financial indicator and case volumes and expenditures for each procedure included in the ASPS and AS reports. Results/Complications From 2006 to 2020 ASPS data demonstrated GDP year-over-year (YOY) change that was positively correlated with case volume and expenditures across 13 out of the 24 different procedure metrics (54.2%). From 2006 to 2016, AS data was positively correlated with the performance of NASDAQ, S&P500, and DOW in 12 of the 24 procedure metrics (50%). GDP YOY change closely followed suit with positive correlations to 11 variables (45.8%). YOY change of PDI, CPI, and medical care services CPI were less frequently associated amongst both data sets. For ASPS data, YOY medical services CPI change was negatively associated with five variables, indicating that as medical services CPI increased, volume of procedures and expenditures decreased. PDI YOY change was not significantly associated with any variables. In the AS dataset between 2006 and 2016, CPI YOY change was not found to be significantly associated with any variables. Across 2019–2022, CPI YOY and disposable YOY change were found to be significantly associated with three variables each. Conclusion Our study suggests that aesthetic plastic surg
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