Aesthetic surgery journal. Open forum最新文献_第9页

Abdominal Etching with Renuvion Helium Plasma 用 Renuvion 氦等离子体进行腹部蚀刻

Aesthetic surgery journal. Open forum

Pub Date : 2024-04-12 DOI: 10.1093/asjof/ojae007.074

Dieter Brummund, Tarik Husain

Abstract Goals/Purpose Differential liposuction with abdominal etching is a powerful technique in high definition liposculpture to achieve an athletic aesthetic. Etching is performed in a superficial plane to create indentures mirroring the dermal-fascial inscriptions of the underlying desired musculature. Renuvion radiofrequency-helium plasma energy (Apyx Medical, Clearwater, FL) is an emerging technology that is used for subdermal coagulation and contraction of the subcutaneous tissue. This case series describes combination of differential liposuction with abdominal etching and Renuvion helium plasma subdermal coagulation in 68 patients and evaluates the outcomes. Methods/Technique A retrospective chart review of 68 patients undergoing differential liposuction with abdominal etching and Renuvion helium plasma subdermal coagulation between 2021 to 2023 by the senior author. The preoperative evaluation, markings, surgical technique and postoperative care are discussed. Clinical parameters assessed include age, gender, body mass index, combination of procedures, volume of lipoaspirate, degree of etching (light, moderate, deep), postoperative changes in weight, and complications such as contour irregularity, wound dehiscence, seroma, surgical site infection, patient dissatisfaction and operative revision. Results/Complications 68 consecutive patients who underwent abdominal etching with Renuvion by the senior author between July 2021 and August 2023 were included in this case series. There were 29 males (43%) and 39 females (57%). The average age of the patients was 39.11 (range, 22 to 64 years), with a non obese, average body mass index of 27.65 kg/m2 (range, 20.8 to 33.9 kg/m2). The average estimated intraoperative blood loss of patients was 104.68 ml (range, 75 to 150 ml); with an average tumescence of 4600 ml (range, 1400 to 8000 ml). The average lipoaspirate was 3920 ml (range, 500 to 9000 ml). In addition to the abdominal region, other areas liposuctioned at the time of etching included flanks (68, 100%), back (66, 97.05%), thighs (14, 20.58%), arms (9, 13.23%), neck (9, 13.23%), chest (8, 11.76%), axilla (3, 4.41%), calves (1, 1.47%). Use of ultrasound was used in 6 cases (8.82%), which were revisionary liposuction. Of our 68 abdominal etching with Renuvion cases the most common combined procedure was autologous fat transfer (20, 29.41%), platysmaplasty (4, 5.88%), mastopexy (5, 8%), breast augmentation (4, 5.88%), buccal fat pad excision (3, 4.41%), umbilical hernia repair (1, 1.47%) and rhytidectomy (1, 1.47%). There were 5 cases of seroma (7.35%) and 4 cases of contour irregularity (5.88%). There were 3 cases of surgical site infection (4.41%), but all in the area of fat grafting and not in the area of liposculpture. No cases of hyperpigmentation were identified. No major complications occurred including skin burns, skin necrosis, visceral injury, deep vein thrombosis, or pulmonary embolism. Overall 66 patients (97.05%) were satisfied fol

摘要目标/目的差异吸脂和腹部蚀刻是高清晰度脂肪塑形术中的一项强大技术，可达到运动美学效果。蚀刻是在浅表平面上进行的，以创建与所需肌肉组织的真皮筋膜刻痕相匹配的凹痕。Renuvion 射频-氦等离子能量（Apyx Medical，佛罗里达州清水市）是一种新兴技术，可用于皮下凝固和收缩皮下组织。本病例系列描述了在 68 例患者中结合使用差分吸脂术、腹部蚀刻术和 Renuvion 氦等离子皮下凝固术的情况，并对结果进行了评估。方法/技术由资深作者对 2021 年至 2023 年间接受差分吸脂术、腹部蚀刻术和 Renuvion 氦等离子皮下凝固术的 68 例患者进行回顾性病历审查。文中讨论了术前评估、标记、手术技巧和术后护理。评估的临床参数包括年龄、性别、体重指数、手术组合、吸脂量、蚀刻程度（轻度、中度、深度）、术后体重变化以及并发症，如轮廓不规则、伤口裂开、血清肿、手术部位感染、患者不满意和手术翻修。结果/并发症本病例系列共收录了 68 例在 2021 年 7 月至 2023 年 8 月期间由资深作者使用 Renuvion 进行腹部蚀刻的连续患者。其中男性 29 人（43%），女性 39 人（57%）。患者平均年龄为 39.11 岁（22 至 64 岁不等），非肥胖，平均体重指数为 27.65 公斤/平方米（20.8 至 33.9 公斤/平方米不等）。估计患者术中平均失血量为 104.68 毫升（范围在 75 至 150 毫升之间）；平均抽取量为 4600 毫升（范围在 1400 至 8000 毫升之间）。平均吸脂量为 3920 毫升（范围在 500 至 9000 毫升之间）。除腹部外，其他部位的抽脂包括：侧腹（68 例，100%）、背部（66 例，97.05%）、大腿（14 例，20.58%）、手臂（9 例，13.23%）、颈部（9 例，13.23%）、胸部（8 例，11.76%）、腋窝（3 例，4.41%）、小腿（1 例，1.47%）。使用超声波的有 6 例（8.82%），均为修正吸脂术。在 68 例使用 Renuvion 进行腹部蚀刻的病例中，最常见的联合手术是自体脂肪移植（20 例，占 29.41%）、板前成形术（4 例，占 5.88%）、乳房整形术（5 例，占 8%）、隆胸术（4 例，占 5.88%）、颊脂垫切除术（3 例，占 4.41%）、脐疝修补术（1 例，占 1.47%）和皱襞切除术（1 例，占 1.47%）。血清肿 5 例（7.35%），轮廓不规则 4 例（5.88%）。有 3 例手术部位感染（4.41%），但均发生在脂肪移植部位，而非脂肪塑形部位。没有发现色素沉着病例。没有发生皮肤烧伤、皮肤坏死、内脏损伤、深静脉血栓或肺栓塞等重大并发症。共有 66 名患者（97.05%）对手术表示满意。有两名患者（2.94%）进行了手术翻修，他们在接受雷诺维翁手术后出现了皮肤松弛残留，需要进行皮肤切除。结论差异化腹部吸脂术与腹部蚀刻术和 Renuvion 氦等离子结合使用，既安全又有效，可协同实现运动体型，增强腹部美感。只要手术技巧得当，并发症发生率很低。几乎所有接受审查的患者都对手术感到满意，并能保持长期效果。

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引用次数: 0

Marijuana Use Increases Risk of Hematoma Formation in Patients Undergoing Abdominal Body Contouring Surgery 吸食大麻会增加腹部塑身手术患者血肿形成的风险

Aesthetic surgery journal. Open forum

Pub Date : 2024-04-12 DOI: 10.1093/asjof/ojae007.004

Hayeem L. Rudy, Yi-hsueh Lu, Daniel Chernovolenko, Julia Grande, Michelle Park, Joseph A Ricci

Abstract Goals/Purpose The physiological effect of marijuana is thought to include platelet inhibition and poor wound healing, however, there is mixed clinical evidence in the plastic surgery literature regarding this topic. As marijuana usage continues to increase, this study sought to identify the effect of marijuana on postoperative complication rates in patients undergoing abdominal body contouring surgery (ABCS) while controlling for tobacco consumption and other comorbidities. Methods/Technique A retrospective cohort study was conducted in patients who underwent panniculectomy or abdominoplasty at our institution between 2016 and 2021. Patients were separated into groups of active (at time of surgery), former, and no marijuana use. Demographic characteristics, smoking history, laboratory results, comorbidities, operative details, and postoperative complications including hematoma, deep vein thrombosis (DVT) and pulmonary embolism (PE), and wound healing complications were analyzed. Parametric, nonparametric, and multivariable regression modeling was used for analysis. Results/Complications 815 patients who underwent panniculectomy or abdominoplasty were included in the study. 61 patients (7.5%) reported active marijuana use at time of their surgery, and 31 patients (3.8%) reported former marijuana use (defined as last use >2 months prior). Patients who reported any marijuana use were significantly younger (40.5 years vs 45.9 years; p<0.0001) and more likely to identify as Black (OR=2.34; p=0.005). Any marijuana use was significantly associated with reported tobacco use (OR=4.80; p<0.001; 95% CI 1.69-12.69) After adjusting for age, BMI, tobacco use, platelet count, and comorbidity index, active marijuana use was associated with significantly higher risk of hematoma formation (OR=2.55; P= 0.03; 95% CI 1.12-6.55) as well as any complication combined (OR=1.73; p=0.02, 95% CI 1.15-3.56). Other complications, including venous thromboembolism, infection, seroma, umbilical necrosis, wound dehiscence, or anesthetic-related complications were not significantly associated with reported marijuana use. Conclusion When controlling for multiple confounders, marijuana use appears to be independently associated with increased risk of hematoma development in patients undergoing abdominal body contouring surgery with either abdominoplasty or panniculectomy. Further research is warranted to investigate the exact relationships and mechanisms of action behind this finding.

摘要目标/目的人们认为大麻的生理效应包括抑制血小板和伤口愈合不良，但整形外科文献中有关这一主题的临床证据不一。随着大麻使用量的不断增加，本研究试图确定大麻对腹部塑身手术（ABCS）患者术后并发症发生率的影响，同时控制烟草消费和其他合并症。方法/技术对 2016 年至 2021 年期间在我院接受泛影葡胺切除术或腹壁整形术的患者进行了一项回顾性队列研究。患者被分为活跃组（手术时）、曾吸食大麻组和未吸食大麻组。对患者的人口统计学特征、吸烟史、化验结果、合并症、手术细节和术后并发症（包括血肿、深静脉血栓（DVT）和肺栓塞（PE）以及伤口愈合并发症）进行了分析。分析采用了参数、非参数和多变量回归模型。结果/并发症研究共纳入了 815 名接受了丹田切除术或腹壁整形术的患者。61名患者（7.5%）报告在手术时曾吸食大麻，31名患者（3.8%）报告曾吸食大麻（定义为最后一次吸食大麻>2个月前）。报告吸食大麻的患者明显更年轻（40.5 岁对 45.9 岁；P<0.0001），更有可能被认定为黑人（OR=2.34；P=0.005）。在对年龄、体重指数（BMI）、吸烟、血小板计数和合并症指数进行调整后，吸食大麻与血肿形成的风险（OR=2.55；P= 0.03；95% CI 1.12-6.55）以及任何合并症的风险（OR=1.73；P=0.02，95% CI 1.15-3.56）显著相关。其他并发症，包括静脉血栓栓塞、感染、血清肿、脐部坏死、伤口裂开或麻醉相关并发症与报告的大麻使用情况无显著相关性。结论在控制多种混杂因素的情况下，吸食大麻似乎与接受腹部塑形手术或卵巢切除术的患者发生血肿的风险增加有独立关联。需要进一步研究这一发现背后的确切关系和作用机制。

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引用次数: 0

Endoscopic Transaxillary Breast Augmentation – a Case Series of 1300 Patients 内窥镜经腋窝隆胸术 - 1300 例患者的病例系列

Aesthetic surgery journal. Open forum

Pub Date : 2024-04-12 DOI: 10.1093/asjof/ojae007.035

Y. Sardiwalla, S. Ching

Abstract Level of Evidence: V – case series Goals/Purpose Breast augmentation is currently one of the most common aesthetic surgical procedures performed in the United States. Transaxillary breast augmentation offers an advantageous hidden scar compared with other options for implant placement. While first described as a blunt and blind approach, endoscopic technique further refined this procedure to offer surgeons complete control and visualization of dissection for precise implant placement. Despite this, breast augmentation is done far more commonly as was initially described over 60 years ago with incisions on the breast that can result in visible scarring. The purpose of this study was to report surgical outcomes on the largest published series to date in a patient cohort of 1389 endoscopic transaxillary breast augmentations. We describe the refinement of this technique and statistical analysis of patient outcomes. Methods/Technique This study included all patients with breast hypoplasia who chose endoscopic transaxillary breast augmentation from 2006 to 2022 by a single surgeon (S.C.). All patients were followed for a minimum of 3 months post procedure. All implants used were smooth, round, silicone gel implants with volumes ranging from 180 to 800cc. Implants were placed in the subfascial or submuscular plane. An incision was marked in the most prominent axillary crease. If there were no creases, an incision was marked at the highest point of the armpit along Langer’s lines. A 30 degree endoscope (Karl Storz, USA) was placed in an endoscopic breast retractor (Karl Storz, USA) and dissection proceeded either in the submuscular plane between the pectoralis major and minor, or in the subfascial plane with an angled suction cautery (Black and Black Surgical, Texas). In the case of subfascial implant placement, the pocket was dissected according to the preoperative markings. With submuscular placement, pocket dissection also followed markings, but the pectoralis muscle was divided with cautery from the level of the areola along the sternal origins of the muscle to completely divide the muscle inferiorly and laterally. The inframammary fold was lowered as necessary by cautery dissection above the level of the pectoralis fascia inferiorly. Glandular scoring was performed with cautery when needed as well. After dissection was completed, saline breast implant sizers were inserted and filled with air to estimate implant size and confirm pocket dissection in the upright position. Adjustments were made to the implant pocket with endoscopic cautery dissection as was necessary. Results/Complications A total of 1389 patients were included in our data analysis for surgeries performed between March 2006 and December 2021. Overall complication rate in our cohort was 6.69%. Malposition of implants was the most common complication at 3.64%. Contracture rate was 1.74%. There was a significant increase noted in hematoma rate in subfascial placement (3.51% in

摘要证据等级：V - 病例系列目标/目的隆胸是目前美国最常见的美容外科手术之一。与其他植入假体的方法相比，经腋窝隆胸具有疤痕隐蔽的优点。内窥镜技术最初被描述为一种钝性和盲目的方法，后来它进一步完善了这一手术，为外科医生提供了完全可控和可视化的剥离，以实现精确的假体植入。尽管如此，假体隆胸术仍然像 60 多年前最初描述的那样，在乳房上进行切口，可能会留下明显的疤痕。本研究的目的是报告迄今为止已发表的最大规模的内窥镜经腋窝隆胸术的手术结果，该系列共有 1389 名患者。我们描述了这项技术的改进情况以及对患者疗效的统计分析。方法/技术这项研究包括2006年至2022年期间选择内窥镜经腋窝隆胸术的所有乳房发育不良患者，由一名外科医生（S.C.）负责。所有患者都在术后接受了至少 3 个月的随访。所有假体均为光滑的圆形硅凝胶假体，容量从 180cc 到 800cc 不等。植入物被放置在筋膜下或肌肉下平面。切口标记在最明显的腋窝皱褶处。如果没有腋窝皱褶，则在腋窝最高点沿朗格线标记切口。将 30 度内窥镜（Karl Storz，美国）置于内窥镜乳房牵引器（Karl Storz，美国）中，然后在胸大肌和胸小肌之间的肌肉下平面或筋膜下平面使用带角度的抽吸烧灼器（Black and Black Surgical，德克萨斯州）进行解剖。在筋膜下植入假体时，根据术前标记解剖袋。如果是肌肉下植入，也是按照标记解剖袋，但用烧灼器从乳晕水平沿着胸骨起源处分割胸肌，将肌肉向下和向外完全分割。必要时，在胸肌筋膜水平上方向下用烧灼器剥离乳房下皱襞。必要时还用烧灼法进行腺体扫描。剥离完成后，插入生理盐水乳房假体测量器并充入空气，以估算假体大小，并在直立位置确认假体袋剥离情况。必要时使用内窥镜烧灼法对植入袋进行调整。结果/并发症 2006年3月至2021年12月期间，共有1389名患者接受了我们的数据分析。总体并发症发生率为 6.69%。植入物错位是最常见的并发症，占 3.64%。挛缩率为 1.74%。与肌肉下植入相比，筋膜下植入的血肿率明显增加（增加 3.51%，P 值<0.05），而筋膜下植入组的植入体错位率则比肌肉下植入组有所下降（下降 6.58%，P 值<0.05）。这些并发症主要是通过内窥镜技术处理的。筋膜下、腺下和肌下口袋置入术在不对称、挛缩和肥大方面没有明显差异。结论我们描述了一种安全有效的内窥镜经腋窝隆胸方法，与乳房下直视技术相比，这种方法的长期效果非常明显。隐蔽疤痕的优势应成为外科医生采用该技术改善患者疗效的考虑因素。

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引用次数: 0

Breast Implant Illness (BII) As a Clinical Entity: A Systematic Review of the Literature 作为临床实体的乳房植入疾病 (BII)：文献系统回顾

Aesthetic surgery journal. Open forum

Pub Date : 2024-04-12 DOI: 10.1093/asjof/ojae007.073

Kshipra Hemal, Raeesa Kabir, Eloise Stanton, Thomas J Sorenson, C. Boyd, N. Karp, Mihye Choi

Abstract Goals/Purpose Breast implant illness (BII) has become a contentious subject in recent years, raising concerns among both patients and healthcare professionals. While some studies have reported associations between breast implants and autoimmune diseases, others have failed to establish a definitive link. Therefore, the objective of this systematic review is to provide a comprehensive evaluation of the existing literature with a specific emphasis on identifying any symptom or patient patterns to critically evaluate the existence of BII as a distinct entity. Methods/Technique A comprehensive search of relevant published studies up until 2023 was conducted across multiple databases, including PubMed and MEDLINE. A total of 31 studies met inclusion criteria in our analysis. To qualify for inclusion, studies had to focus on breast implant illness and associated systemic symptoms. Two reviewers independently assessed the abstracts, manuscripts, and extracted data from the selected papers. From the included studies, cohort size, reason for implantation, mean age, implant type, implant texture, plane of implant placement, mean follow-up time, implant explantation status, time to implant explantation, symptom resolution after explantation, infections, and complications were extracted. Descriptive statistics was used where appropriate. Results/Complications The mean age of patients was 44.2 ± 9.30 years for all studies included. For studies that included length of time between implant exposure and onset of clinical symptoms (9/31; 29.0%), the mean time from implant or biomaterial exposure to onset of clinical symptoms of BII was 13.4 ± 2.92 years. Fourteen (14/31; 45.2%) studies reported implant explantation status with 60% of the total patient population choosing to remove their implants. Among these, 9 studies reported symptom improvement in 657 patients (83.5%) from a total of 788 patients undergoing implant explantation. Eight studies (8/31; 25.8%) reported whether patients experiencing BII related symptoms were in the cosmetic or reconstructive group. Patients in the cosmetic cohort (899/1005; 89.5%) experienced significantly more BII-related symptoms compared to patients in the reconstructive cohort (213/352; 60.5%) (p < 0.001). Conclusion This systematic review provides a comprehensive overview of the current state of knowledge regarding BII. While the literature offers valuable insights into the potential associations and outcomes related to BII, there are several limitations stemming from heterogeneity in study designs, patient populations, and reporting practices. Our study highlights a relationships between BII and indication for implants (cosmetic vs. reconstructive), infection, and explantation, among other variables, offering valuable directions for future research.

摘要目标/目的近年来，乳房植入疾病（BII）已成为一个有争议的话题，引起了患者和医护人员的关注。虽然一些研究报告了乳房植入物与自身免疫性疾病之间的关联，但其他研究却未能确定两者之间的确切联系。因此，本系统性综述的目的是对现有文献进行全面评估，特别强调确定任何症状或患者模式，以批判性地评估 BII 是否作为一个独特的实体存在。方法/技术在多个数据库（包括 PubMed 和 MEDLINE）中对截至 2023 年已发表的相关研究进行了全面检索。共有 31 项研究符合我们的分析纳入标准。符合纳入标准的研究必须关注乳房植入疾病和相关的全身症状。两名审稿人独立评估了摘要、手稿，并从所选论文中提取了数据。我们从纳入的研究中提取了队列规模、植入原因、平均年龄、植入物类型、植入物质地、植入物放置平面、平均随访时间、植入物取出情况、植入物取出时间、取出后症状缓解情况、感染情况和并发症。适当时使用描述性统计。结果/并发症在所有纳入的研究中，患者的平均年龄为（44.2 ± 9.30）岁。对于包含植入物暴露与临床症状出现之间时间长度的研究（9/31；29.0%），从植入物或生物材料暴露到 BII 临床症状出现的平均时间为 13.4 ± 2.92 年。14项（14/31；45.2%）研究报告了植入物的取出情况，其中60%的患者选择取出植入物。其中，9 项研究报告称，在总共 788 名接受植入物取出手术的患者中，有 657 名患者（83.5%）的症状得到了改善。八项研究（8/31；25.8%）报告了出现 BII 相关症状的患者是属于美容组还是重建组。与整形组患者（213/352；60.5%）相比，美容组患者（899/1005；89.5%）出现 BII 相关症状的比例明显更高（P < 0.001）。结论本系统综述全面概述了目前有关 BII 的知识状况。虽然这些文献对 BII 的潜在关联和相关结果提供了宝贵的见解，但由于研究设计、患者群体和报告方法的异质性，这些文献还存在一些局限性。我们的研究强调了 BII 与植入适应症（美容与整形）、感染和切除等变量之间的关系，为未来的研究提供了宝贵的方向。

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引用次数: 0

The Impact of Metabolic Syndrome on Post-Operative Outcomes in Abdominal Body Contouring: A Propensity Score-Matched Nationwide Analysis 代谢综合征对腹部塑身术后效果的影响：倾向评分匹配的全国性分析

Aesthetic surgery journal. Open forum

Pub Date : 2024-04-12 DOI: 10.1093/asjof/ojae007.078

M. J. Escobar-Domingo, A. H. Alvarez, J. Foppiani, Iulianna C. Taritsa, Kirsten Schuster, James E. Fanning, Daniela Lee, Samuel J. Lin, Bernard T. Lee

Abstract Goals/Purpose Metabolic syndrome (MetS) represents cardiometabolic dysregulation, defined by hypertension, obesity, diabetes, and dyslipidemia. Its prevalence is on the rise, affecting approximately 47.3% of U.S. adults. In recent years, MetS has been associated with an elevated risk of postoperative complications. However, there remains a significant gap in our understanding of how patients with MetS fare after abdominal body contouring procedures. The objective of this study is to assess the influence of MetS on postoperative outcomes of abdominal body contouring by concurrent abdominoplasty and panniculectomy. Methods/Technique The ACS-NSQIP database was utilized to identify patients who underwent concurrent abdominoplasty and panniculectomy procedures from 2015 to 2021. Through propensity score matching, distinct cohorts were established based on the presence of MetS, characterized by patients receiving medical interventions for diabetes mellitus and hypertension, with a body mass index exceeding 30kg/m2. Disparities among groups were assessed via unpaired T-tests and Fisher's Exact tests. Logistic regression models were constructed to evaluate the occurrence of mild and severe systemic complications, reoperation rates, and wound complications between these groups. Results/Complications A total of 13,346 patients underwent abdominal body contouring. Following propensity score matching, 586 patients were included in the analysis, with 293 in each group (MetS vs. non-MetS). Bivariate analysis revealed a longer hospital length of stay (2.4 vs. 1.7 days; p=0.002) and higher readmission rates (11.9 vs. 6.5; p=0.031) in the MetS group in comparison to the non-MetS cohort. While surgical-related reasons for readmission were predominant across both groups, statistically significant differences were observed only for medical-related reasons (p=0.028). Logistic regression models demonstrated a statistically significant elevated likelihood of 30-day readmission in the MetS group (OR 1.96; 95% CI 1.091-3.507; p=0.024). No noteworthy disparities were observed in the rates of 30-day wound complications, mild systemic, and severe systemic complications between the groups. Conclusion Our findings revealed no increase in postoperative wound and systemic complications among patients with MetS who underwent concurrent abdominoplasty and panniculectomy. This suggests that abdominal body contouring remains a secure option for patients with MetS. Nonetheless, the higher readmission rates and longer hospital length stays observed in patients with MetS may potentially translate to increased overall costs. Continued research is warranted to comprehensively assess the economic implications of MetS in the context of abdominal body contouring.

摘要目标/目的代谢综合征（MetS）是指由高血压、肥胖、糖尿病和血脂异常引起的心脏代谢失调。其发病率呈上升趋势，约有 47.3% 的美国成年人受到影响。近年来，MetS 与术后并发症风险升高有关。然而，我们对 MetS 患者在腹部塑身术后的表现仍有很大的了解差距。本研究的目的是评估 MetS 对同时进行腹壁成形术和丹田切除术的腹部体形塑形术后效果的影响。方法/技术利用 ACS-NSQIP 数据库识别 2015 年至 2021 年期间同时接受腹壁成形术和丹田切除术的患者。通过倾向得分匹配，根据是否存在 MetS（以接受糖尿病和高血压医疗干预且体重指数超过 30kg/m2 的患者为特征）建立了不同的队列。组间差异通过非配对 T 检验和费雪精确检验进行评估。建立逻辑回归模型来评估这些组间轻度和重度全身并发症的发生率、再次手术率和伤口并发症。结果/并发症共有13346名患者接受了腹部塑形手术。经过倾向评分匹配，586 名患者被纳入分析，每组 293 人（MetS 与非 MetS）。双变量分析显示，与非 MetS 组群相比，MetS 组住院时间更长（2.4 天对 1.7 天；P=0.002），再入院率更高（11.9 对 6.5；P=0.031）。虽然两组患者再入院的主要原因都与手术相关，但只有与内科相关的原因才存在统计学意义上的显著差异（P=0.028）。逻辑回归模型显示，MetS 组 30 天再入院的可能性有显著统计学意义（OR 1.96；95% CI 1.091-3.507；P=0.024）。在 30 天伤口并发症、轻度全身性并发症和严重全身性并发症的发生率方面，观察到两组之间没有明显差异。结论我们的研究结果显示，MetS 患者同时接受腹壁成形术和丹田切除术的术后伤口并发症和全身并发症没有增加。这表明，对于 MetS 患者来说，腹部塑形仍然是一种安全的选择。然而，在 MetS 患者中观察到的较高的再入院率和较长的住院时间可能会导致总体费用的增加。要全面评估 MetS 对腹部塑形的经济影响，还需要继续开展研究。

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引用次数: 0

AI As the New Age Estimator: Pioneering Customized Facial Surgery Outcomes 人工智能是新时代的估算器：率先实现定制化面部手术效果

Aesthetic surgery journal. Open forum

Pub Date : 2024-04-12 DOI: 10.1093/asjof/ojae007.087

Khaled O Alameddine, Jess Rames, K. Bakri, Samir Mardini

Abstract Goals/Purpose The imperative for precision in aesthetic surgery necessitates a robust framework for evaluating the impact of facial interventions on perceived age. Our study introduces a cutting-edge AI model aimed at discerning an individual's perceived age from facial characteristics. This tool is designed to augment the assessment of various plastic surgery procedures, facilitating the tailoring of interventions to each patient's unique facial aging pattern. Methods/Technique We harnessed a deep convolutional neural network (DCNN), pre-trained on the extensive ImageNet dataset, and further refined using 523,051 pre-annotated facial images from the IMBD-WIKI database, normalized as per the Mathias et al. face detection paradigm. Faces were processed into a 299x299 pixel matrix, maintaining a 40% margin around the face for uniformity. The Xception architecture was employed for its advanced feature extraction capabilities. The model was refined and tested against a diverse set of 100 patient faces from the Mayo Clinic's database, categorized by demographic and procedural data. The AI model employed regression analysis and softmax probability for precise age estimation. Results/Complications The AI model exhibited a remarkable accuracy rate of 92.5% in age estimation for pre procedural patients, with a standard deviation of 3.2 years. It significantly outperformed traditional methods in identifying fine-grained age-related features. The AI model discerned an average perceived age reduction of 3.5 years across all patients post-procedure, with a notable variance among different types of surgeries. Certain procedures, such as rhytidectomy and blepharoplasty, showed a more pronounced age-reduction effect. Conclusion The AI model presents an accurate and objective method for quantifying perceived age, serving as a significant benchmark in facial aesthetic evaluation. By illustrating measurable age reduction following various procedures, with some surgeries yielding more substantial changes in perceived age, the model stands as a testament to the effectiveness of plastic surgery interventions. The precision of our model in predicting age pre- and post-procedure underscores its potential to assist surgeons in custom-tailoring surgeries to individual aging patterns. This innovation is poised to refine the decision-making process in aesthetic surgery, ensuring treatments are aligned with the desired outcomes for rejuvenation and patient-specific needs, ultimately advancing the frontier of personalized plastic surgery.

摘要目标/目的美容外科手术必须精确，这就需要一个强大的框架来评估面部干预对感知年龄的影响。我们的研究引入了一个尖端的人工智能模型，旨在从面部特征辨别个人的感知年龄。该工具旨在增强对各种整形手术的评估，促进根据每位患者独特的面部衰老模式量身定制干预措施。方法/技术我们利用深度卷积神经网络（DCNN），在广泛的 ImageNet 数据集上进行了预训练，并使用 IMBD-WIKI 数据库中的 523,051 张预先标注的面部图像进行了进一步改进，这些图像按照 Mathias 等人的面部检测范例进行了归一化处理。人脸被处理成 299x299 像素的矩阵，保持人脸周围 40% 的余量以保证一致性。Xception 架构具有先进的特征提取功能。对模型进行了改进，并根据梅奥诊所数据库中按人口和程序数据分类的 100 张病人面孔进行了测试。人工智能模型采用回归分析和软最大概率进行精确的年龄估计。结果/意义人工智能模型对术前患者年龄估计的准确率高达 92.5%，标准偏差为 3.2 岁。在识别细粒度年龄相关特征方面，它的表现明显优于传统方法。人工智能模型对所有术后患者的平均感知年龄降低了 3.5 岁，不同类型的手术之间存在明显差异。某些手术，如纹阜切除术和眼睑成形术，显示出更明显的减龄效果。结论人工智能模型是量化感知年龄的准确而客观的方法，是面部美学评估的重要基准。该模型展示了各种手术后可测量的年龄缩减效果，其中一些手术对感知年龄的改变更大，证明了整形手术干预的有效性。我们的模型能精确预测手术前后的年龄，这凸显了它在协助外科医生根据个人衰老模式定制手术方面的潜力。这项创新有望完善美容手术的决策过程，确保治疗符合预期的年轻化效果和患者的特定需求，最终推动个性化整形手术的发展。

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引用次数: 0

Hyperdilute Calcium Hydroxylapatite for the Treatment of Perioral Rhytids: A Pilot Study 超稀释羟基磷灰石钙治疗口周皲裂：试点研究

Aesthetic surgery journal. Open forum

Pub Date : 2024-04-05 DOI: 10.1093/asjof/ojae021

Michael Somenek

Abstract Background The perioral region plays a crucial role in facial aesthetics and is susceptible to age-related changes, such as wrinkles and fine lines due to its dynamic nature. Type I collagen is crucial in providing structural integrity and resilience to the skin. Calcium hydroxylapatite (CaHA-CMC) is a widely used dermal filler whose particles stimulate fibroblastic responses within the skin. When diluted, CaHA-CMC has emerged as a useful treatment for collagen stimulation. Objectives The objective of the study is to evaluate the efficacy and safety of hyperdilute CaHA-CMC at a 1:3 ratio, specifically administered in the perioral area, to assess its impact on deep rhytids and overall skin quality. Methods Females aged 40 to 70 years with moderate-to-severe wrinkles in the perioral region based on a validated wrinkle scale were injected with hyperdilute CaHA-CMC throughout the perioral region at 2 separate injection intervals (Weeks 1 and 8). This was followed by an injection of hyaluronic acid (CPM-HA22.5) into the perioral region at Week 16. The primary endpoint was a ≥1-point improvement from baseline on the wrinkle grading scale. Results Twelve female participants were treated. Investigator and patient ratings based on the 5-point Merz perioral/lip wrinkle grading scale showed at least 1 grade improvement in 83% of the patients with a P-value of .0156. A majority of both investigators and patients rated their lip wrinkles as improved in appearance compared with their baseline. Conclusions Hyperdilute CaHa-CMC at a 1:3 dilution may be a safe and effective treatment for improving the depth and overall appearance of perioral rhytids. Level of Evidence: 4

摘要背景口周区域在面部美学中起着至关重要的作用，由于其动态特性，很容易出现与年龄相关的变化，如皱纹和细纹。I 型胶原蛋白在提供皮肤结构的完整性和弹性方面至关重要。羟基磷灰石钙（CaHA-CMC）是一种广泛使用的皮肤填充剂，其颗粒能刺激皮肤内的成纤维细胞反应。稀释后，CaHA-CMC 已成为刺激胶原蛋白的有效疗法。研究目的评估以 1:3 的比例超稀释 CaHA-CMC 的疗效和安全性，特别是在口周部位的使用，以评估其对深层皱纹和整体皮肤质量的影响。方法对年龄在 40 至 70 岁之间、口周有中度至重度皱纹的女性（根据已验证的皱纹量表），在两个不同的注射间隔期（第 1 周和第 8 周）在整个口周注射超稀释 CaHA-CMC。之后，在第 16 周向口周注射透明质酸（CPM-HA22.5）。主要终点是皱纹分级比基线改善≥1分。结果 12名女性参与者接受了治疗。研究人员和患者根据 Merz 口周/唇部皱纹 5 级评分表进行评分，结果显示 83% 的患者至少改善了 1 级，P 值为 0.0156。大多数研究人员和患者都认为唇部皱纹的外观比基线有所改善。结论 1:3 稀释的超稀释 CaHa-CMC 是一种安全有效的治疗方法，可改善唇周皱纹的深度和整体外观。证据等级：4

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引用次数: 0

Picture Perfect: Standardizing and Safekeeping Clinical Photography in Plastic Surgery. 完美图片：整形外科临床摄影的标准化和安全性。

Aesthetic surgery journal. Open forum

Pub Date : 2024-03-20 eCollection Date: 2024-01-01 DOI: 10.1093/asjof/ojae012

Sarah M Thornton, Pradeep K Attaluri, Peter J Wirth, Ellen C Shaffrey, Robert E George, M Kristine Carbullido, Venkat K Rao

Plastic surgery relies heavily on clinical photography to document preoperative and postoperative changes, visualize surgical approaches, and evaluate outcomes. However, the contemporary landscape of plastic surgery photography faces challenges, including a lapse in standards due to the prevalence of smartphones, social media platforms, and security concerns related to data storage and cyberattacks. In this comprehensive review, the authors aim to provide plastic surgeons with practical guidelines for achieving standardized, high-quality clinical photography while navigating the evolving landscape of technology, security, and ethical considerations. We explore the security challenges associated with storing clinical photographs, emphasizing the legal obligations under the Health Insurance Portability and Accountability Act (HIPAA). We also discuss various storage options, including HIPAA-compliant cloud services, electronic medical records, and emerging technologies like blockchain and artificial intelligence.

Level of evidence 5:

整形外科在很大程度上依赖于临床摄影来记录术前和术后的变化、可视化手术方法和评估结果。然而，当代整形外科摄影面临着各种挑战，包括智能手机和社交媒体平台的普及导致的标准失效，以及与数据存储和网络攻击相关的安全问题。在这篇综合综述中，作者旨在为整形外科医生提供实用指南，帮助他们实现标准化、高质量的临床摄影，同时驾驭不断发展的技术、安全和道德考量。我们探讨了与存储临床照片相关的安全挑战，强调了《健康保险可携性和责任法案》（HIPAA）规定的法律义务。我们还讨论了各种存储选项，包括符合 HIPAA 标准的云服务、电子病历以及区块链和人工智能等新兴技术：

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引用次数: 0

Efficacy and Safety of LetibotulinumtoxinA in the Treatment of Moderate and Severe Glabellar Lines in Females 35 to 50 Years of Age: Post Hoc Analyses of the Phase 3 Clinical Study Data. 莱妥珠单抗（LetibotulinumtoxinA）治疗 35-50 岁女性中度和重度川字纹的有效性和安全性：第 3 期临床研究数据的事后分析。

Aesthetic surgery journal. Open forum

Pub Date : 2024-02-23 eCollection Date: 2024-01-01 DOI: 10.1093/asjof/ojae010

Michael Gold, Susan Taylor, Daniel S Mueller, Jeffrey Adelglass, Joely Kaufman-Janette, Sue E Cox, Michael Cecerle, Konstantin Frank, Mark Nestor

Background: Botulinum toxin type A (BoNT-A) injections continue to be widely used as a common treatment for both males and females. According to a recent survey conducted by the International Society of Plastic Aesthetic Surgeons, the majority of patients receiving these injections are females between the ages 35 and 50.

Objectives: A post hoc analysis was conducted to examine whether there were variances in the effectiveness and safety of letibotulinumtoxinA for treating vertical glabellar lines between the broader female study population and a particularly defined group of female participants aged 35 to 50.

Methods: For this post hoc analysis, data from females aged 35 to 50 were extracted and analyzed from the BLESS III study. In this Phase 3 clinical trial, 355 participants with moderate-to-severe glabella frown lines received either 20 U of letibotulinumtoxinA or a placebo. The study evaluated Glabella Line Severity (GLS) score, treatment onset, duration of effects, time to retreatment, and adverse events. A positive response was determined by achieving a GLS score of 0 or 1, as assessed by both patients and investigators, along with at least a 2-point improvement in GLS score relative to baseline at Week 4 after the injections.

Results: Composite responder rates for patients aged 35 to 50 receiving active treatment were significantly higher than for the remaining female population receiving active treatment at Weeks 1, 2, and 4. Females aged 35 to 50 showed higher rates of GLS improvement of ≥1 at Weeks 1, 2, 4, 8, 12, 16, and 20 compared with the remaining female population receiving active treatment. At Week 4, a higher percentage of females aged 35 to 50 achieved a GLS score of 0 upon maximum frowning compared with the remaining females. Females aged 35 to 50 had a shorter median time to onset of GLS improvement compared with the remaining female population. Safety assessments showed a low incidence of treatment-related adverse events in females aged 35 to 50.

Conclusions: LetibotulinumtoxinA showed significantly higher response rates in females aged 35 to 50 compared with other female patients at Weeks 1, 2, and 4. Response rates remained higher up to Week 16. The treatment demonstrated efficacy and safety in treating vertical glabellar lines in this patient group.

Level of evidence 2:

背景：A型肉毒杆菌毒素（BoNT-A）注射作为一种常见的治疗方法，继续广泛应用于男性和女性。根据国际整形美容外科医师协会最近进行的一项调查，大多数接受这种注射的患者是 35 至 50 岁的女性：目的：我们进行了一项事后分析，以研究莱博毒素 A 治疗垂直眉间纹的有效性和安全性在更广泛的女性研究人群和特定的 35 至 50 岁女性参与者群体之间是否存在差异：在这项事后分析中，我们从BLESS III研究中提取并分析了35至50岁女性的数据。在这项三期临床试验中，355 名患有中度至重度眉间皱纹的参与者接受了 20 U 的莱博毒素 A 或安慰剂治疗。研究评估了眉间皱纹严重程度（GLS）评分、治疗开始时间、疗效持续时间、再治疗时间和不良反应。根据患者和研究人员的评估，GLS 评分达到 0 分或 1 分即为阳性反应，同时在注射后第 4 周，GLS 评分与基线相比至少提高 2 分：在第 1、2 和 4 周，接受积极治疗的 35-50 岁患者的综合应答率明显高于接受积极治疗的其他女性患者。在第 1、2、4、8、12、16 和 20 周，35 至 50 岁女性患者的 GLS 改善率≥1，高于接受积极治疗的其他女性患者。与其他接受积极治疗的女性相比，在第 4 周，35 至 50 岁女性中最大皱眉时 GLS 得分为 0 的比例更高。与其他女性相比，35 至 50 岁女性的 GLS 改善中位时间更短。安全性评估显示，35至50岁女性中与治疗相关的不良事件发生率较低：来曲妥霉素A在第1周、第2周和第4周显示，35至50岁女性患者的应答率明显高于其他女性患者。直到第 16 周，反应率仍然较高。该疗法在治疗该患者群体的垂直眉间纹方面具有疗效和安全性：

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引用次数: 0

A Comparative Analysis of Local and Systemic Immunological Biomarkers in Females With Breast Implants and Capsular Contracture. 乳房假体和囊性挛缩女性的局部和全身免疫生物标志物比较分析。

Aesthetic surgery journal. Open forum

Pub Date : 2024-02-21 eCollection Date: 2024-01-01 DOI: 10.1093/asjof/ojae008

Karlinde A Spit, Siham Azahaf, Christel J M de Blok, Yara Bachour, Kitty C M Castricum, Victor L J L Thijssen, Manon A H Oudejans, Thomas Rustemeyer, Prabath W B Nanayakkara

Background: The etiology of capsular contracture (CC), the most common complication following breast augmentation, remains unclear. Chronic, fibrotic inflammation resulting in excessive fibrosis has been proposed as a potential mechanism.

Objectives: In this study, we aimed to investigate the relation between biomarkers that are associated with inflammation and fibrosis and the severity of CC.

Methods: Fifty healthy females were categorized into 3 groups: females with no-to-mild CC (Baker 1-2; n = 15), females with severe CC (Baker 3-4; n = 20), and a control group awaiting breast augmentation (n = 15). We assessed 5 biomarkers (galectin-1 [Gal-1], interferon-β [INF-β], interferon-γ [INF-γ], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]) in breast implant capsules and serum samples.

Results: No significant differences in intracapsular cytokine levels were observed between the Baker 1-2 and the Baker 3-4 groups, as the levels were generally low and, in some cases, almost undetectable. In the blood samples, no significant differences in Gal-1, INF-γ, IL-6, or TNF-α levels were found within the 3 groups. We identified significantly increased levels of INF-β (P = .009) in the blood samples of females with severe CC, driven mainly by 3 extremely high values.

Conclusions: The cytokines assessed in this study did not reflect the degree of CC among females with silicone breast implants. However, 3 females with severe CC, who all had prolonged silicone exposure, showed extremely elevated levels of INF-β in their serum samples. This possible association between prolonged silicone exposure and systemic inflammation in some females should be further investigated.

Level of evidence 3:

背景：包膜挛缩（CC）是隆胸术后最常见的并发症，其病因仍不清楚。慢性纤维化炎症导致过度纤维化被认为是一种潜在机制：本研究旨在探讨与炎症和纤维化相关的生物标志物与 CC 严重程度之间的关系：将 50 名健康女性分为 3 组：无轻度 CC（Baker 1-2；n = 15）、重度 CC（Baker 3-4；n = 20）和等待隆胸的对照组（n = 15）。我们评估了乳房植入物胶囊和血清样本中的 5 种生物标志物（galectin-1 [Gal-1]、干扰素-β [INF-β]、干扰素-γ [INF-γ]、白细胞介素-6 [IL-6]和肿瘤坏死因子-α [TNF-α]）：Baker 1-2 组和 Baker 3-4 组之间的囊内细胞因子水平没有明显差异，因为其水平普遍较低，在某些情况下几乎检测不到。在血液样本中，Gal-1、INF-γ、IL-6 或 TNF-α 的水平在 3 组中没有发现明显差异。我们发现，在重度CC女性患者的血液样本中，INF-β的水平明显升高（P = .009），这主要是受3个极高值的影响：结论：本研究评估的细胞因子并不能反映硅胶乳房假体植入女性的 CC 程度。然而，3 名患有严重 CC 的女性的血清样本中 INF-β 的水平极度升高，她们都曾有过长时间的硅胶暴露。应进一步研究某些女性长期接触硅胶与全身炎症之间可能存在的关联：

{"title":"A Comparative Analysis of Local and Systemic Immunological Biomarkers in Females With Breast Implants and Capsular Contracture.","authors":"Karlinde A Spit, Siham Azahaf, Christel J M de Blok, Yara Bachour, Kitty C M Castricum, Victor L J L Thijssen, Manon A H Oudejans, Thomas Rustemeyer, Prabath W B Nanayakkara","doi":"10.1093/asjof/ojae008","DOIUrl":"10.1093/asjof/ojae008","url":null,"abstract":"Background: The etiology of capsular contracture (CC), the most common complication following breast augmentation, remains unclear. Chronic, fibrotic inflammation resulting in excessive fibrosis has been proposed as a potential mechanism.Objectives: In this study, we aimed to investigate the relation between biomarkers that are associated with inflammation and fibrosis and the severity of CC.Methods: Fifty healthy females were categorized into 3 groups: females with no-to-mild CC (Baker 1-2; n = 15), females with severe CC (Baker 3-4; n = 20), and a control group awaiting breast augmentation (n = 15). We assessed 5 biomarkers (galectin-1 [Gal-1], interferon-β [INF-β], interferon-γ [INF-γ], interleukin-6 [IL-6], and tumor necrosis factor-α [TNF-α]) in breast implant capsules and serum samples.Results: No significant differences in intracapsular cytokine levels were observed between the Baker 1-2 and the Baker 3-4 groups, as the levels were generally low and, in some cases, almost undetectable. In the blood samples, no significant differences in Gal-1, INF-γ, IL-6, or TNF-α levels were found within the 3 groups. We identified significantly increased levels of INF-β (P = .009) in the blood samples of females with severe CC, driven mainly by 3 extremely high values.Conclusions: The cytokines assessed in this study did not reflect the degree of CC among females with silicone breast implants. However, 3 females with severe CC, who all had prolonged silicone exposure, showed extremely elevated levels of INF-β in their serum samples. This possible association between prolonged silicone exposure and systemic inflammation in some females should be further investigated.Level of evidence 3: ","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae008"},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10923288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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