Aesthetic surgery journal. Open forum最新文献

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:

Background: Breast cancer is a prevalent malignancy among women, and advancements in treatment have shifted focus to enhancing both survival and quality of life. Oncoplastic surgery integrates oncological safety with aesthetic considerations.

Objectives: The authors of this study aim to evaluate the efficacy of the inferior pole adipose dermal (IPAD) flap for lower pole reconstruction in breast-conserving surgery (BCS).

Methods: A retrospective cohort study was conducted involving patients who underwent BCS with IPAD flap reconstruction. Inclusion criteria comprised female patients over 18 years with at least 12 months of follow-up. Data collected included demographics, clinical history, surgical details, complications, and patient satisfaction, assessed using the Visual Analog Scale (VAS).

Results: The study included 12 patients with a mean age of 52.7 years and a mean BMI of 28. Four patients (33.3%) required integration of a perforator flap for additional volume. No major complications, such as infections or flap necrosis, were observed. Minor complications included lower pole retraction (16.6%) and inferior dehiscence (8.3%). Patient satisfaction was high (VAS 7.5), and aesthetic outcomes were rated positively by surgeons (7.2). Adjuvant radiotherapy did not adversely affect flap viability.

Conclusions: The IPAD flap may be a viable and effective technique for lower pole reconstruction in BCS. This technique is particularly beneficial for patients with adequate breast volume. The authors of this study underscore the importance of personalized surgical planning and a multidisciplinary approach to optimizing breast cancer treatment.

Level of evidence 4 therapeutic:

Skin aging leads to changes such as dyschromia, rhytids, dermal atrophy, and reduced elasticity. Adipose-derived cell therapies (ADCTs), including stromal vascular fraction (SVF), adipose-derived stem cells (ADSCs), and adipose-derived mesenchymal stem cells (AD-MSCs), have gained attention for their regenerative potential. In this systematic review, the authors aim to evaluate the effectiveness of ADCT in improving skin quality such as elasticity, texture, pigmentation, and rhytid reduction. This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with a comprehensive search conducted across PubMed (National Library of Medicine, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), and Scopus (Elsevier). The authors of eligible studies must have assessed skin quality outcomes, such as rhytids, dyschromia, texture, and elasticity. Data on study design, treatment protocols, and outcomes were extracted. Risk of bias was assessed using the Cochrane RoB 2 tool (Cochrane, London, United Kingdom). Meta-analyses were conducted where appropriate. Seventeen studies met inclusion criteria. Rhytid severity decreased with SVF and ADSC-conditioned medium, particularly in periorbital and nasolabial regions. However, the authors of a meta-analysis of 2 studies showed nonsignificant reduction in rhytids (P = .12, I ² = 81%), and melanin index results were inconsistent. Combination therapies (eg, SVF with laser or platelet-rich plasma) outperformed SVF alone. Heterogeneity in follow-up duration, treatment protocols, and assessment tools limited direct comparisons. ADCTs show promise as a minimally invasive approach to enhance skin quality. However, variability across studies limits definitive conclusions. Standardized protocols, objective assessment tools, and long-term follow-up are needed to validate them as a reliable skin rejuvenation therapy. Future research should focus on objective assessment tools and larger sample sizes to establish ADCT as a viable skin rejuvenation therapy. Level of Evidence: 3 (Therapeutic).

Background: "Gummy smile" describes the aesthetically unappealing display of gums that extends more than 2 to 3 mm when individuals smile. The multifactorial etiology of the gummy smile leads to various surgical and nonsurgical treatment strategies, including orthodontic therapies, lip fillers, and primarily botulinum toxin as a nonsurgical treatment.

Objectives: In this paper, the authors present the preliminary report of a novel, minimally invasive, and non-neurotoxic treatment option for gummy smiles based on the insertion of smooth-surfaced resorbable polydioxanone threads along the vectors of the lip elevator muscles, offering long-lasting satisfactory aesthetic outcomes.

Methods: The proposed subcutaneous thread insertion technique utilizes 23 G, 38 mm cannulas with 14 smooth threads per cannula. Twenty-two female patients with subjectively distressing gummy smiles have been treated so far. The correction of gummy smiles is rapid and has been documented for up to 18 months, with the most protracted case lasting 20 months. The first cannula is positioned 1.5 cm from the labial commissure and 0.5 cm above it, following the vector of the orbicularis oris muscle from the modiolus to the upper white lip. The second cannula targets the levator labii superioris muscle vector, entering from the modiolus, and the third cannula follows the zygomaticus major and zygomaticus minor muscle vectors. The insertion points are the same for the first, second, and third cannula. The fourth cannula is inserted 2 cm from the insertion point of the first, second, and third cannulas toward the premasseteric area and the internal corner of the eye, crossing the third thread in a crossed pattern. Only the 2 threads along the levator labii superioris and orbicularis oris vectors were inserted in 1 of the 22 treated patients, who displayed no molar teeth exposure while smiling.

Results: No novel excessive gingival display has occurred in the 22 ambulatory patients treated so far for 9 to 12 months. In the patients treated so far, the mean distances between the diagnostic reference points decreased by 0.85 and 1.25 mm after 2 and 6 weeks, respectively, with negligible pain during the procedure and high satisfaction among all patients.

Conclusions: The proposed smooth thread technique could be a technically convenient and minimally invasive option for addressing disturbing gummy smile problems.

Level of evidence 4 therapeutic: