Aesthetic Plastic Surgery最新文献

Background: Post-traumatic breast implant and tissue expander (TE) complications are increasingly relevant as more patients undergo reconstructive or cosmetic breast surgery. Prior studies are limited to case reports, with little known about the mechanisms of injury or timing of clinical recognition.

Methods: Using the Nationwide Readmission Database (2017-2020), we identified adults with trauma admissions followed by breast implant-related diagnoses or procedures. Mechanisms of injury (MOI) and clinical presentations were characterized using ICD-10 codes. Patients were classified as having received "immediate" management (diagnosis or procedure during index admission) or "delayed" (on readmission). Cox regression identified predictors of earlier diagnosis or intervention.

Results: A total of 573 patients with post-traumatic implant complications were included (488 breast implants, 85 TEs). Falls were the most common MOI (53.2%), followed by transport accidents (25.0%). TEs were disproportionately associated with burn injuries (20.5% vs. 4.9% in non-TEs). At presentation, 78.2% of patients were diagnosed with implant rupture or underwent surgical correction. Rib or clavicle fractures (21.1%) and breast symptoms (12.6%) were associated with earlier diagnosis, but not with likelihood of surgery. Plastic surgery consultation significantly decreased time to surgery. Age, sex, and ZIP code did not have notable effects on diagnostic and surgical timing.

Conclusions: Post-traumatic breast implant complications often present without breast-specific symptoms, resulting in diagnostic delays. Trauma protocols should include routine breast imaging in patients with implants, especially after transport, burn, or blunt-force injuries. TE patients may be uniquely susceptible to thermal injury and warrant focused preventive counseling.

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 .

No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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: Protein intake plays a critical role in postoperative recovery and wound healing, particularly in procedures such as abdominoplasty. While ERAS protocols emphasize nutritional optimization, evidence in non-bariatric patients undergoing elective body contouring remains limited.

Objectives: To evaluate the effects of early postoperative protein supplementation on wound healing outcomes, complication rates and recovery time in patients undergoing full abdominoplasty.

Methods: A retrospective, observational cohort study was conducted on 200 non-bariatric patients undergoing standardized full abdominoplasty. Participants were divided into two groups: one receiving daily protein supplementation (≥1.2 g/kg/day using whey isolate or hydrolyzed collagen peptides) initiated within 24 h postoperatively for at least 14 days, and a control group with no supplementation. Outcomes measured included wound dehiscence, seroma formation, surgical site infections (SSI), time to complete healing, and patient satisfaction. Data were analyzed using chi-square tests, t-tests, and multivariate regression models.

Results: The supplemented group showed significantly lower wound dehiscence (6% vs. 17%, p = 0.018) and reduced seroma incidence (9% vs. 18%, p = 0.048). Time to complete healing was shorter in the supplemented group (16.8 ± 3.4 days vs. 20.5 ± 4.2 days; p < 0.001). While SSI incidence was not significantly different (4% vs. 10%, p = 0.092), a favorable trend was noted. Multivariate regression confirmed protein supplementation as an independent predictor of faster healing (β = - 2.94; 95% CI - 4.36 to - 1.52).

Conclusions: Postoperative protein supplementation significantly improves wound healing and reduces complications in patients undergoing abdominoplasty, even outside the bariatric population. These findings support the incorporation of targeted nutritional protocols into routine perioperative care pathways for abdominoplasty. While the study did not formally evaluate an ERAS protocol, its results are consistent with the general principles of enhanced recovery, emphasizing the role of early nutritional support in improving postoperative outcomes.

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: Bone hyperplasia after reduction mandibuloplasty can impair the aesthetic outcome of the surgery which may require a revision. The adjacent masseter has been reported to be a decisive factor in postoperative mandibular hyperplasia. Our clinical practice suggested that simultaneous reduction malarplasty with zygomatic arch elevation may reduce masseter accumulation after reduction mandibuloplasty and contribute to less mandibular hyperplasia. Thus, a retrospective study was conducted to clarify our observation.

Methods: From September 2015 to April 2024, patients who underwent reduction mandibuloplasty with or without simultaneous reduction malarplasty with zygomatic arch elevation were retrospectively reviewed. Computed tomography data were utilized to measure the preoperative, immediate postoperative, and follow-up postoperative mandibular volume. The volume of resected mandibular bone and regenerated mandibular bone was calculated. The measurements of masseter thicknesses, elevation distance of the zygomatic arch, as well as correlations analysis between them were performed.

Results: Fifty-two patients receiving reduction mandibuloplasty with simultaneous reduction malarplasty (combined-operation group) and 35 patients receiving reduction mandibuloplasty only (single-operation group) were included. After the operation, the masseter muscle in both groups became significantly thicker. The average masseter thickness increase was 0.89 ± 1.21 mm in the combined-operation group and 2.70 ± 1.10 mm in the single-operation group. Single-operation group had severer masseter thickening and mandibular hyperplasia. Pearson correlation analysis revealed that masseter thickening was positively correlated to mandibular resected volume, and that mandibular hyperplastic volume was positively correlated to masseter thickening with statistical significance.

Conclusion: Simultaneous reduction malarplasty with zygomatic arch elevation induced less masseter redundancy and mandibular hyperplasia. In maxillofacial contouring surgeries, if necessary, performing the two procedures simultaneously and applying the bracing technique with zygomatic arch elevation can effectively improve the aesthetic outcomes of reduction mandibuloplasty.

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 .

Introduction: Botulinum toxin (BoNT) is increasingly recognized for vascular effects beyond its established neuromuscular use. Evidence indicates a dose-dependent mechanism in which BoNT either promotes vasodilation and perfusion or inhibits cholinergic vasodilatory activity, making it relevant for ischemic, vasospastic, and inflammatory conditions. This review evaluates current data on the dose-dependent vascular actions of BoNT and outlines its therapeutic relevance in aesthetic and reconstructive medicine.

Materials and methods: A narrative review was performed using PubMed, MEDLINE, Embase, and Google Scholar, focusing on studies published from 2000 to 2025. Search terms combined "botulinum toxin" with "vasodilation," "ischemia," "flap survival," "angiogenesis," and related concepts. Eligible publications included clinical trials, animal studies, in vitro models, and systematic reviews assessing vascular outcomes after BoNT exposure. Of 163 records identified, 57 met inclusion criteria and were analyzed.

Results: BoNT demonstrates dual vascular mechanisms. At higher doses, it enhances perfusion and promotes angiogenesis through vascular endothelial growth factor and nitric oxide pathways, supporting applications in ischemic flaps and Raynaud's phenomenon. At lower doses, it reduces excessive cholinergic vasodilation and neurogenic inflammation, offering benefits in conditions such as rosacea and hyperhidrosis. These effects are dose-dependent and tissue-specific, with variability across experimental models. Concentrations above 20 IU/ml may be considered high-dose, whereas lower levels represent low-dose BoNT.

Conclusion: BoNT exhibits versatile vascular activity. Higher doses support vascular regeneration and angiogenesis, while lower doses modulate hyperreactive vascular responses. Further research is needed to clarify mechanisms, refine dose-response guidelines, and assess long-term safety across clinical indications to optimize its vascular applications.

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.

Introduction and hypothesis: The vaginal tightening surgery is on the rise all over the world, with improved sexual function being one of the benefits proposed for this surgery. This study aims to investigate the satisfaction of sexual partner with vaginal tightening surgery.

Methods: Electronic databases were systematically searched for related articles published between January 2000 and April 2025. The selection criteria included original English articles evaluating partner's satisfaction after any type of vaginal tightening surgeries in healthy women. After removing duplicates, a total of 2579 articles related to the topic of this study were retrieved.

Results: Six articles with 266 participants met the inclusion criteria. Only two articles had applied standardized tools such as International Index of Erectile Function-5 (IIEF-5), New Sexual Satisfaction Scale (NSSS), Golombok Rust Inventory of Sexual Satisfaction (GRISS), and Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD). The rest of articles had used a single question for assessing partners' satisfaction. All of the included studies indicated an increase in the partner's sexual satisfaction after surgery.

Conclusion: Findings of this systematic review show that satisfaction of sexual partners increases after vaginal tightening surgery. This is while, several factors influence this outcome.

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 blepharoplasty, a preaponeurotic fat pad has been considered to provide padding and structural support for the eyelid. In our practice, we have identified a dense fibrous membrane surrounding the preaponeurotic fat pad, which can transmit the uplift force of the levator muscle.

Objectives: As the preaponeurotic fat pad and its relationship with the surrounding layers remain controversial, this study aims to determine the histological characteristics of the preaponeurotic fat pad and to introduce a procedure involving the advancement of the posterior layer of the preaponeurotic fat membrane in blepharoptosis correction.

Methods: This retrospective study enrolled 42 eyes from 28 blepharoptosis patients who underwent a preaponeurotic fat membrane advancement procedure with or without levator aponeurotic advancement between October 2020 and June 2023. Six cadaveric upper eyelids from three fresh cadaver heads were harvested for histological examination, and one formalin-treated cadaver head was used for macroscopic anatomic evaluation.

Results: The mean preoperative MRD1 was 1.89 ± 0.89 mm. Among the forty-two upper eyelids, thirty-six underwent advancement of the preaponeurotic fat membrane. The other six upper eyelids had inadequate correction after performing the levator aponeurosis advancement, and therefore, a combined preaponeurotic fat membrane advancement was performed. Nine patients reported lagophthalmos during the first three months postoperatively, but this condition significantly improved by six months postoperatively. In anatomic evaluation, multilayered fibrous tissue structures were identified in and around the preaponeurotic fat pad.

Conclusions: Based on our clinical observations and anatomical studies, we believe that this fibrous envelope can be used to correct mild-to-moderate ptosis. The indications for this procedure range from mild-to-moderate ptosis. It can be used alone in patients with mild- or pseudo-ptosis due to overloading of the upper eyelid, or it can be used in conjunction with levator aponeurosis advancement in patients when the procedure is insufficient to achieve a proper correction.

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 .

Purpose: To analyze the clinical efficacy and differences between minimally invasive modified levator palpebrae complex and conjoint fascia sheath-levator muscle complex suspension surgeries in correcting severe congenital ptosis.

Methods: This retrospective analysis included 40 patients with severe congenital ptosis, of whom 22 (25 eyes) and 18 (21 eyes) underwent minimally invasive modified levator palpebrae complex and conjoint fascia sheath-levator muscle complex suspension, respectively. Palpebral fissure height, marginal reflex distance 1, scleral exposure, and eyelid mobility at 1 week and 1 and 3 months postoperatively were compared between the surgical groups.

Results: The overall correction rates did not differ significantly between the minimally invasive modified levator palpebrae complex and conjoint fascia sheath-levator muscle complex suspension surgeries (88% vs. 66.67%). At 1 month postoperatively, the average scleral exposure was significantly lower in the modified levator palpebrae complex group than in the conjoint fascia sheath-levator muscle complex group (1.28 ± 1.29 mm vs. 2.17 ± 0.96 mm). Additionally, at both 1 and 3 months postoperatively, eyelid mobility was significantly greater in the modified levator palpebrae complex group than that observed in the conjoint fascia sheath-levator muscle complex group (6.84 ± 1.16 mm and 7.08 ± 1.18 mm vs. 5.54 ± 1.43 mm and 5.91 ± 1.69 mm).

Conclusion: Both minimally invasive modified levator palpebrae complex and conjoint fascia sheath-levator muscle complex suspension surgeries effectively correct severe congenital ptosis; however, the former demonstrates superior eyelid mobility and closure function recovery as postoperative outcomes.

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: Postoperative fibrosis is a frequent complication following liposuction for lipedema. Serrapeptase, a proteolytic enzyme with purported anti-inflammatory and antifibrotic effects, is used empirically, but robust evidence supporting its efficacy is lacking. This study aimed to assess the clinical effectiveness of postoperative serrapeptase supplementation in reducing fibrosis following lower limb liposuction for lipedema.

Methods: This retrospective, observational cohort study included 50 female patients with a confirmed diagnosis of lipedema undergoing tumescent liposuction. Patients were allocated to either a serrapeptase group (n = 25), receiving 60,000 IU daily for 4 weeks, or a control group (n = 25) receiving standard care alone. The primary outcome was tissue stiffness measured by quantitative ultrasound elastography (QUS). Secondary outcomes included B-mode ultrasonography, patient-reported pain (VAS), and clinical assessment of induration. Evaluations were performed at baseline, 4 weeks, and 3 months.

Results: Baseline characteristics were comparable between groups. No statistically significant differences were observed in the primary outcome of tissue stiffness at 4 weeks (14.8 ± 3.1 kPa vs. 15.2 ± 3.0 kPa; p = 0.62) or 3 months (13.7 ± 2.9 kPa vs. 14.0 ± 3.2 kPa; p = 0.78). Similarly, no significant benefits were seen in secondary outcomes, including fibrotic changes on ultrasound, VAS pain scores, or clinical induration (p > 0.05 for all). Serrapeptase was well-tolerated with no adverse events reported.

Conclusions: Oral serrapeptase supplementation did not demonstrate measurable efficacy in preventing postoperative fibrosis or improving patient-reported outcomes following liposuction for lipedema. These findings do not support its routine use in this clinical setting.

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 .