Aesthetic Plastic Surgery最新文献

Background: Medical tourism is a rapidly expanding multi-billion-dollar industry. Reduced costs, all-inclusive vacation packages that include cosmetic surgery, globalization, and affordable flight expenses have encouraged patients to seek aesthetic procedures in different countries. Cosmetic medical tourism is associated with high complication rates, such as severe infections, wound dehiscence, pain or discomfort, aesthetic dissatisfaction, and even death.

Patients and methods: A twelve-year survey of medical records was conducted using ADAMS healthcare database software. Data regarding patient demographics, the country of the original procedure, the operation type, complications, and subsequent treatment were recorded.

Results: Fifty-six patients have been admitted to the Department of Plastic and Reconstructive Surgery. The youngest patient was 18, and the oldest was 65, with an average age of 37.46. The majority were females (n = 51, 91.07%). The most common procedure was liposuction (n = 40), followed by abdominoplasty (38). Only eleven patients had a single procedure while travelling; on average, they had 2.34 procedures in a single trip. Patients presented with an average POD of 30.9. The most common complaint was dehiscence at the surgical site. Eleven patients required re-operation. The average hospitalization length in the Plastic and Reconstructive Surgery Department was 4.4 days.

Conclusions: Medical tourism has a positive impact on patients and caregivers alike. However, the combination of multiple procedures in a short time, relatively short follow-up, different microbial environments, and more led to substantial complications, which had a devastating effect on many patients.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: In the realm of implant-based breast reconstruction, mastectomy flap necrosis (MFN) is a prevalent yet grave complication that poses a threat to the stability of the inserted prosthesis. Although numerous investigations have scrutinized the risk factors for MFN development, few have delved into the aftermath, specifically implant failure or salvage. This study seeks to appraise the prognosis of the implanted prosthesis following MFN occurrence, as well as identify predictors of such outcomes.

Methods: Among patients who underwent immediate implant-based reconstruction between 2010 and 2022, individuals with MFN development were identified and scrutinized regarding the fate of their prosthesis (salvaged/failed). Independent risk factors were identified using multivariable analyses and subgroup analyses accounting for diverse clinical settings.

Results: Among a total of 3128 cases, 422 of MFN (194 partial, 228 full-thickness necrosis) were examined. Of them, 384 prostheses (91%) were salvaged, while 38 (9%) failed. Multivariate analysis revealed predictors of reconstruction failure included nipple-sparing mastectomy, larger skin excision, type of acellular dermal matrix used, previous radiotherapy, and full-thickness necrosis, while operation procedures, including type of operation and plane for prosthesis insertion (prepectoral/subpectoral), showed no significant associations. Risk factors differed by insertion plane, with obesity, larger skin excision, and previous radiation history significant in the prepectoral group, and only MFN degree influencing successful salvage in the subpectoral.

Conclusions: This study sheds light on the importance of understanding the prognosis and potential predictors of implant failure/salvage following MFN, emphasizing the need for tailored approaches to minimize the risk of reconstruction failure.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Background: In recent years, male aesthetic surgery has significantly risen in popularity, attributable to surgical technique advancements and societal changes. Research in this subject area has increased accordingly, underscoring the need to identify the most influential articles. This study evaluates the bibliometric characteristics of the top 100 most cited male aesthetic surgery articles published in the last 50 years.

Methods: The 100 most cited articles in male aesthetic surgery from 1974 to 2024 were identified using Web of Science. We examined key trends in authorship contribution, institutional affiliation, country affiliation, citation count, journal impact factor, eigenfactor score, article influence score, and funding agency contribution.

Results: As of June 2024, the top 100 articles were cited a total of 7,341 times, with individual citation counts ranging from 18 to 243. The top cited article was "A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery," published in 2004. Of the 100 articles, the top contributing authors were Dr. Joel E. Pessa (5%) and Dr. Rod J. Rohrich (4%). The top contributing organization was the University of Texas System (8%). The peak year for publications was 2008, accounting for 10% of articles. The USA contributed to 60 of 100 articles. Plastic and Reconstructive Surgery was the most prolific journal, publishing 33% of articles.

Conclusion: Through a historical analysis of the field's development up to its present state, our findings serve as a valuable resource for those interested in advancing their understanding of male aesthetic surgery literature.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Objective: Upper blepharoplasty is the gold standard procedure for upper eyelid dermatochalasis. Upper blepharoplasties procedures include removing the skin, orbicularis oculi muscle, preaponeurotic, or nasal fat pad. The purpose of this study is to report surgical outcomes and compare them to the most common techniques.

Material and methods: A retrospective review of 386 consecutive patients who underwent upper blepharoplasty at Turku University Hospital from January 1st, 2015 to June 30th, 2017 was conducted. Data collected include patient demographics, surgical details, and details regarding the type and frequency of complications.

Results: During the study period, 51 upper blepharoplasties with orbicularis oculi muscle excision, skin, preaponeurotic and nasal fat pads removal (study group) and 335 upper blepharoplasties with skin only removal (control group) were performed. Non-parametric tests showed that operative time (M=60.2min; SD=11.7min) and return to work (M=8.0days; SD=3.1days) were significantly shorter in the control group. No significant differences in the total amount of complications were detected (7.8% vs 2.4%, p=0.075). Subjective patients' satisfaction was significantly higher in the study group (from 0-10, mean 8.3 vs 7.0, p=0.034).

Conclusions: When compared to skin-only blepharoplasty, upper blepharoplasty with orbicularis oculi muscle excision, removal of skin, preaponeurotic and nasal fat pad appears to be a safe surgery with improved patient satisfaction and without carrying on additional complications.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: In implant-based breast surgery, microbial contamination of implant surfaces predisposes complications such as overt periprosthetic infection and has been linked to capsular contracture (CC). Anti-microbial practices, including povidone-iodine (PVP-I) breast pocket irrigation, are routinely employed to minimise these risks. No standardised protocol for using this antiseptic exists, particularly concerning the ideal concentration. This review investigates how PVP-I concentration affects outcomes in these procedures while highlighting research gaps.

Methods: Using PRISMA-ScR guidelines, a systematic search was conducted across MEDLINE, Embase, Scopus, and PubMed databases from their inception to June 2024. Studies were screened using pre-determined criteria for inclusion. The methodological quality of relevant studies was assessed using the MINORS tool. Data regarding basic characteristics, PVP-I irrigation implementation, and outcomes (primarily periprosthetic infection and CC) were extracted for analysis.

Results: Nine articles, primarily observational studies, and retrospective analyses were included. These mainly focused on breast augmentation with a few including reconstruction. There was considerable heterogeneity in surgical techniques, and reported PVP-I concentrations ranged from 4 to 20%. This was further confounded by frequent mixing of irrigation solution with antibiotics. Although infection and CC rates were frequently reported, most studies did not specify outcome data for patients receiving PVP-I irrigation.

Conclusions: While PVP-I irrigation is extensively used in implant surgeries, the current evidence base is insufficient to determine the optimal concentration and application techniques. This review underscores the need for further detailed research to establish evidence-based guidelines for PVP-I use, aiming to improve patient care and surgical outcomes in breast surgery.

Level of evidence iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors  www.springer.com/00266 .

Background: Upper eyelid ptosis is a common aesthetic concern among Asian patients, resulting in a tired and drowsy appearance that affects their attractiveness. The levator advancement technique is widely used for ptosis correction; however, achieving precise results remains challenging.

Objectives: This study introduces a modified approach to improve the accuracy of levator aponeurosis advancement by focusing on precise measurements and anterior displacement within a defined corneal range.

Methods: The study included patients with mild to moderate ptosis. We measured the mean margin reflex distance 1 (MRD-1) preoperatively and 12 months postoperatively. Histological evidence was obtained through staining of levator aponeurosis complexes using Hematoxylin and Eosin and Masson's trichrome.

Results: In this prospective study, 29 patients showed a significant increase in mean MRD-1 from 2.56 ± 0.84 mm (range 1.02-3.98 mm) preoperatively to 4.38 ± 0.55 mm (range 3.09-5.35 mm) at the 12-month follow-up (paired t-test; P < 0.001). Masson's staining revealed that the levator aponeurosis tissue primarily consists of collagen fibers, which minimize potential errors due to their toughness and lack of elasticity during the surgical procedure.

Conclusions: The modified technique enhances the accuracy of levator aponeurosis advancement in ptosis correction, resulting in minimal surgical trauma and high patient satisfaction. Our technique appears to have a low incidence of severe adverse effects, based on the available data from the current case series.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Deepening of the nasolabial fold (NLF), drooping of the nasal tip, and facial expressions perceived as angry face, are common esthetic concerns. However, no studies have correlated this set of signs and symptoms with common anatomical causes. We review anatomical considerations of the region and propose a combined treatment modality.

Methods: We performed a retrospective analysis of cases treated with combined botulinum toxin (abobotulinumtoxinA) using an injection pattern encompassing the nasal muscles and hyaluronic acid (HA) fillers in the deep pyriform space. Photographs were taken at rest and during motion (frontal and oblique views), before and after treatment.

Results: Results demonstrated effacement of the NLF, improved nasal tip positioning during smiling, and generally more favorable facial expressions.

Conclusions: Combined treatment with HA in the deep pyriform space and abobotulinumtoxinA in the nasal muscles can improve angry expression and aging stigma in patients with deep empty pyriform space, both in the static and dynamic conditions of facial mimic.

Level of evidence v: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: This project aims to provide guidance for surgeons' online interactions by reviewing key legal decisions.

Methods: The Nexis Uni database was queried to search for state and federal case law and law journal articles. Search terms were "social media" AND (facial w/s plastic!) and internet AND advice AND "plastic surgery."

Results: The first query returned two cases and a law review article. The second returned 39 cases. The 17 most relevant results were included.

Conclusions: On surgeons' websites, increased interactivity or opportunities for the sale of products or services make out-of-state courts more likely to have personal jurisdiction over them. There are also many cases involving plastic surgeons filing defamation complaints against patients who reviewed them negatively online. Success in these cases has been limited. Surgeons are instead vulnerable to the "Streisand Effect," where legal action can bring attention to patient complaints. Unique cross-complaints may require the plaintiff to pay the defendant's legal fees if no defamation is proven. Surgeons who appear on "Top Doctor" lists, publish articles, or otherwise display their expertise may unknowingly make themselves "limited purpose public figures." This adds the burden of proving false patient claims were made "with actual malice" rather than through negligence.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .