Aesthetic surgery journal. Open forum最新文献

Background: Facial feminization surgery has become a key component of the male-to-female transition.

Objectives: The authors of this study aim to determine which facial features are viewed as most masculine or feminine across biological sex and ethnicity.

Methods: Four web-based survey instruments were used, displaying an image set of artificial intelligence-generated cis-male and cis-female facial photographs from the following ethnicities: Black, Asian, Oceanic, South Asian, and Caucasian. Faces were divided into 11 unique components and were thus rated on a scale from 1 (most masculine) to 11 (most feminine).

Results: A total of 2566 respondents completed the survey instruments. Respondents identified the lips as the most feminine facial feature (range, 7.98-9.41, P < .0001). Female respondents found the lips to be the most feminine feature of all faces except those of the Black female and Caucasian male, in which the eyes were rated as the most feminine (8.09, 8.20, P < .0001). The most masculine facial features were the mandibular angle (4.67), laryngeal prominence (4.81), chin (4.94), and hairline (5.17), whereas the most feminine features were the lips (8.50), eyes (7.84), orbits (6.74), and cheeks (6.73), which were all statistically significant (P < .05).

Conclusions: The authors of this study provide valuable insight into the public's perception of inherently masculine and feminine facial features across ethnicity and gender.

Level of evidence 5 therapeutic:

Background: Postmastectomy breast edema is a common complication in patients undergoing immediate implant-based reconstruction, leading to physical and psychological consequences. Despite its clinical relevance, standardized prophylactic strategies remain lacking.

Objectives: The authors of this study aim to evaluate the efficacy of an anti-edema formulation containing diosmin, coumarin, and arbutin (Linfadren, Omega Pharma Srl, Italy) in reducing postmastectomy breast edema and improving postoperative outcomes.

Methods: A prospective, randomized clinical trial was conducted at a single tertiary care center. Women aged ≥18 years undergoing mastectomy with immediate implant-based reconstruction were randomized (1:1) into 2 groups: control (standard postoperative prophylaxis) and experimental (standard prophylaxis plus Linfadren, Omega Pharma Srl). Mastectomy flap thickness was measured using Vernier calipers, and breast edema symptoms were assessed with the Breast Edema Questionnaire (BrEQ). Follow-up visits were scheduled weekly during the first month, with additional evaluations at 6 weeks and 2 months.

Results: The experimental group demonstrated a significant reduction in mastectomy flap thickness (45.95% decrease at 2 months vs stable or increased thickness in the control group, P < .05). BrEQ scores improved more rapidly in the experimental group, reflecting reduced symptoms of breast edema. Pitting edema prevalence was consistently lower in the experimental group compared with the control group throughout the study (P < .05).

Conclusions: In this study, the authors highlight the potential of Linfadren (Omega Pharma Srl) as an effective prophylactic treatment for postmastectomy breast edema. By mitigating edema, this approach may improve postoperative recovery, reduce complications, and enhance patients' quality of life. Further large-scale studies are warranted to validate these findings.

Level of evidence 2 therapeutic:

Background: The rise in minimally invasive treatments (MITs) in aesthetic medicine has introduced new complexities for subsequent facial surgeries such as facelifts. Despite their popularity, there are limited data on how these treatments impact surgical outcomes.

Objectives: The authors of this paper explore the impact of MIT modalities on subsequent facial surgeries and provide guidelines for perioperative planning and management to optimize outcomes for patients with a history of MITs.

Methods: An expert panel of 7 plastic surgeons and 1 dermatologist conducted a comprehensive review of existing literature, combined with author surveys and case-based discussions, to develop perioperative recommendations for patients with previous MITs. Consensus was reached for each recommendation with a ≥75% agreement threshold.

Results: The authors of this paper present recommendations for perioperative planning, surgical techniques, and postoperative care for patients with previous MITs. Complication risks were found to vary by MIT modality: biostimulatory injectables, temporary fillers, and superficial energy-based devices (EBDs) generally present lower risks, whereas permanent fillers, deeply delivered EBDs, and recently placed temporary fillers or threads were associated with increased risks. The recommendations highlight strategies to support both aesthetic and functional surgical outcomes.

Conclusions: Patients with previous MITs can be candidates for facelift surgery if perioperative strategies are followed to mitigate risks associated with plane distortion and vascular compromise. These guidelines provide a framework to support aesthetic providers in enhancing surgical outcomes and patient satisfaction. Given the limited literature on MIT-related surgical implications, the authors emphasize individualized approaches to mitigate risks associated with previous MITs until further research is available.

Level of evidence 5 therapeutic:

Background: Nonsurgical rhinoplasty has gained popularity as a minimally invasive alternative to surgery; however, the nasal region's complex and variable vascular anatomy has led to a significant increase in complications. This underscores the need for a standardized, anatomy-based injection protocol supported by clinical evidence.

Objectives: The objective of this study was to evaluate the efficacy and vascular safety of a structured injection protocol for nonsurgical rhinoplasty using hyaluronic acid, guided by real-time Doppler ultrasound in Latin American patients.

Methods: The protocol included preinjection Doppler mapping, aspiration testing, and anatomically specific filler volumes. Real-time ultrasound guidance verified filler placement.

Results: Among 365 positive aspirations (8.3%), 73.97% occurred at the anterior nasal spine, yet no vascular occlusions were observed in this region. Twenty vascular events (0.45%) were recorded-18 in the nasal tip and 2 in the columella-all resolved without sequelae using a high-dose hyaluronidase protocol. Optimal outcomes were achieved with 0.2 mL in the nasal spine and columella and 0.15 mL in the tip. At baseline, 96% of patients rated outcomes as "Very Improved," decreasing slightly to 89% at 2 weeks.

Conclusions: This Doppler-guided, stepwise protocol demonstrated high efficacy and low complication rates in high-risk nasal zones. The findings support the routine integration of ultrasound and anatomically tailored injection techniques to enhance safety and reproducibility in nonsurgical rhinoplasty.

Level of evidence 4 therapeutic:

Background: Pliability, handling, and drape characteristics are important material properties of acellular dermal matrices (ADMs). There are few in vitro techniques that quantitatively assess these characteristics.

Objectives: The aim of the authors of this study is to compare data generated using a novel drape assay with surgeon handling of porcine-derived ADMs and evaluate material properties of human- and porcine-derived ADMs.

Methods: Three commercially available ADMs (human-derived AlloDerm [hADM], porcine-derived Strattice Pliable [pADM-S], and porcine-derived Artia [pADM-A]) were assessed. Eight prototype variations of pADM with varied mechanical properties were used for the handling assessment. Drape testing was conducted using a novel mechanical test fixture coupled with quantitative image analysis. Surgeon handling assessments of prototype pADM pliability were compared with quantitative drape measurements to establish a correlation. Commercially available ADMs were tensile tested mechanically at clinically relevant and higher loads to determine maximum strength.

Results: Benchtop testing demonstrated similar drapability for pADM-A and hADM; pADM-S had significantly less drapability than pADM-A, despite both being porcine derived. Surgeon semiquantitative ranking of pliability of prototype pADM samples positively correlated with drape measurements (R ² = 82.5%, P = .000). Tensile testing demonstrated that hADM had the greatest degree of strain/elongation across all applied loads, followed by pADM-A, then pADM-S. When tested to failure, hADM had the greatest average maximum stress compared with pADM-A and pADM-S.

Conclusions: The novel drape assay introduced here correlated with surgeon handling assessment of ADM pliability. Material testing and handling assessment demonstrated various mechanical properties (ie, strength, strain/elongation, drapability, and handling/pliability) for the ADMs evaluated, providing several unique options that may meet different surgical mechanical needs.

Level of evidence 5 therapeutic:

The authors report the first case of postoperative Pasteurella multocida infection following elective standard abdominoplasty caused by indirect contamination from a cat-punctured surgical drain. A 51-year-old previously healthy woman underwent uncomplicated standard abdominoplasty but subsequently developed fever, erythema, and abdominal pain. Imaging, aspiration, and microbiological analysis confirmed infection with P. multocida. Further questioning revealed her house cat had punctured the surgical drain, which was subsequently repaired by the patient using superglue to restore negative pressure. Targeted antibiotic therapy led to rapid clinical improvement. This case highlights a novel infection transmission pathway and underscores the need for patient education regarding drain management in pet-owning households.

Level of evidence 4 therapeutic:

Nanofat is an adipose tissue product obtained through mechanical emulsification, preserving stromal vascular fraction and extracellular matrix. Nanofat has been primarily investigated in the contexts of skin scar repair. This systematic review assesses existing evidence on the effectiveness of nanofat for various skin scar types. In this systematic review, we aim to evaluate the effectiveness of nanofat injections in improving skin scars compared with controls, considering clinical, radiographical, histological, and histomorphometrical outcomes. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases including MEDLINE, Embase, and the Cochrane Library were searched from January 2013 through March 2025. Studies involving human patients receiving nanofat for scar treatment were included. Risk-of-bias assessments were performed by the Cochrane RoB 2 tool for randomized controlled trials (RCTs) and the NIH Quality Assessment Tool for Pre-Post Studies lacking control groups. Of 415 identified publications, 12 studies were included, comprising 5 RCTs and 7 pre-post intervention studies. Participant numbers ranged from 12 to 48. Most studies reported substantial short-term improvements in scar appearance, texture, and patient satisfaction. Histologically, findings indicated increased skin thickness, improved neovascularization, and collagen deposition. However, 2 high-quality RCTs showed no sustained significant benefits beyond 12 months. Few minor complications were documented; no serious adverse events occurred. Overall, nanofat injections appear to be an effective, minimally invasive treatment for skin scars, particularly in the short term. Nonetheless, the long-term benefits are less certain, underscoring the importance of conducting further research by standardized protocols and extended follow-up periods to confirm these findings. Level of Evidence: 4 (Therapeutic).

Background: The understanding of nasolabial fold (NLF) change with aging is essential for facial rejuvenation.

Objectives: The aim of the authors of the study is to develop an objective method measuring the severity of NLFs and to evaluate the age-related characteristics of the NLF through quantitative parameters.

Methods: A total of 150 healthy participants (ages 21-70) were divided into 5 age groups. Ten NLF features were measured: length, NLF-fold area, maximum width, maximum color depth, area_{upper NLF}, width_upper-NLF, color depth_upper-NLF, area_lower-NLF, width_lower-NLF, and color depth_lower-NLF. These features were compared across age groups and genders, and their predictive values for age were evaluated.

Results: Significant increases in NLF length, width, fold area, and color depth were observed between the twenties and the thirties. Upper NLF features showed changes starting in the thirties, with gradual increases until the fifties, plateauing by 70. Lower NLF changes began in the thirties, peaked in the fifties to sixties, and leveled off thereafter. Males exhibited a more rapid increase in volume-related NLF features between 35 and 40 years, surpassing females in this regard. Males also had greater color depth between 35 and 40 years, whereas females predominated after age 56. Several NLF features demonstrated superior predictive value for age compared with the Wrinkle Severity Rating Scale.

Conclusions: Upper NLF changes begin in the thirties and continue through the fifties, whereas lower NLF changes peak from the forties to sixties. Gender differences were observed, with males showing earlier changes. These findings provide a reliable, objective method for assessing mid-facial aging in clinical practice.

Level of evidence 3 therapeutic: