Aesthetic Plastic Surgery最新文献

Background: Measures of quality in resident training in plastic and reconstructive surgery (PRS) programs are scarce and often methodologically inconsistent. Our research provides insights from current PRS trainees globally, mapping their training inputs, expected outputs, and recommendations for program improvements.

Methods: A global online survey was conducted among PRS residents across 70 countries to gauge their satisfaction with residency training, capturing training inputs such as the number of surgeries attended and seminars they participated in. We also extracted residents' proposed recommendations for program improvement. We investigated the explanatory role of training inputs, demographics, hospital characteristics, and country income on resident satisfaction and graduate competence.

Results: The analysis incorporated data from 518 PRS residents. On average, residents attended 9.8 surgeries and 1.3 seminars per week. Simultaneously, there was a positive correlation between the perceived level of professional competency and training inputs, particularly seminars attended (p - value = 0.001). Male residents tended to report higher satisfaction (p - value = 0.045) with their training (67%) compared with their female counterparts (58%), while those with family responsibilities also demonstrated slightly higher satisfaction levels.

Conclusions: Our analysis expands the evidence base regarding a "global hunger" for more comprehensive seminar-based and hands-on surgical training. Resident recommendations on program improvement reveal the need to address gaps, particularly in aesthetic surgery training. The development of healthcare business models that allow for aesthetic procedures in training institutions is crucial in the promotion of aesthetic surgery training during residency. Policymakers, program directors, and stakeholders across the world can leverage these findings to formulate policies addressing the weaknesses of training programs.

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: Neoplasms in the head and neck often lead to peripheral facial paralysis (PFP), impacting facial expression and causing psychological distress. Standard treatments involve physiotherapy, but botulinum toxin type A (BTA) and hyaluronic acid (HA) injections have shown promise in promoting facial symmetry.

Aim: To assess the effectiveness of combined BTA and HA intervention in PFP patients, comparing it to conventional treatment (physiotherapy).

Method: A single-blind, randomized clinical trial at Hospital de Amor de Barretos included 18 patients, with the control group receiving standard therapy and the combined therapy (CT) group receiving BTA and HA. Evaluations utilized the Sunnybrook facial grading scale (SFGS) and Psychosocial Facial Asymmetry Scale (EPAF) questionnaires, along with photographic analysis.

Results: CT significantly improved facial symmetry and psychosocial aspects compared to the control group. The SFGS scores increased by 27 points in CT versus 3 points in the control group, while EPAF scores decreased by 16 points in CT and increased by 1 point in the control group. Photographic analysis showed improved dynamic smiles in CT patients. Functional gains were more evident at 30 days, with continued improvement over four months. Psychosocial scores increased throughout the study. Only two CT patients reported transient issues with drinking and chewing.

Conclusion: The study suggests the positive impact of combined therapy on psychosocial and functional aspects, emphasizing the need for further robust research to determine its therapeutic potential.

Level of evidence ii: 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 .

After the groundbreaking release of the highly acclaimed chatbot ChatGPT, which revolutionized the field of artificial intelligence (AI) last year, OpenAI has once again astounded the world with the unveiling of their latest generative AI model, Sora, on February 16, 2024. This cutting-edge model has the remarkable ability to generate videos up to a duration of 60 seconds solely through text instructions. With a series of AI-generated contents, such as AI chat, AI drawing, and AI music, emerging one after another, the era of "AI revolution" that had a disruptive impact on modern life has arrived. Meanwhile, AI has made significant achievements in the medical field, especially in diagnosing based on medical imaging. This article briefly describes the development history of text-to-video models and provides a detailed introduction to the Sora model, including its portrayal of the human face and contour, inspiring its potential applications in plastic surgery. It also provides a prospect for other AI-generated content technologies, such as text-to-holography and text-to-material objects.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 .

Fat graft applications are one of the most frequently used procedures in reconstructive and aesthetic surgery. Fat graft survival rate is variable and depends on many parameters. Those are the features of recipient area, method of obtaining the fat graft, the procedures applied to the harvest to get pure fat graft and the application techniques. In this study, we aimed to find the optimal revolutions per minute(rpm) and duration to be used in the centrifugation technique, which is one of the most frequently used methods in fat grafting. In our study, we used perilipin protein as a survival marker. Liposuction samples were obtained from 10 Caucasian women individuals; whose age range is between 22 and 29 years without any other reported health problem. Fat grafts from all patients were taken by the same surgical team by the same liposuction procedure. The grafts obtained in our study were divided into 6 different groups, these are A1 group (1 minute-1000 rpm) A2 group (3 minutes-1000 rpm) A3 group (5 minutes-1000 rpm) B1 group (1 minute-3000 rpm) B2 group (3 minutes-3000 rpm) and B3 group (5 minutes-3000 rpm). Perilipin expression measurements were made in the sections taken by immunohistochemistry technique. Three minutes-3000 rpm combination (B2 group) was found to be perilipin stained statistically significantly higher than other combinations. This study seeks to make a notable contribution to the literature by demonstrating the relation between frequently used centrifuge combinations and measuring the expression of perilipin. This protein's role in adipocyte regulation is becoming increasingly apparent.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 .

Introduction: Mild-to-moderate blepharoptosis can be aesthetically displeasing for patients, particularly in cases involving a single eyelid. However, certain patients are reluctant to undergo surgical intervention. Botulinum neurotoxin A (BoNT-A) injection offers a potential solution in such cases.

Material and methods: Patients meeting the following inclusion criteria were included in the study: mild-to-moderate eyelid ptosis of different etiologies (excluding myasthenic disorders), robust activity of the orbicularis oculi muscle, proficiency in Italian language, standardized pre- and postoperative photo-documentation, and signed consent for study participation. A 32-33 Gauge 4-mm needle was employed to inject the BoNT-A in the pretarsal orbicularis muscle. Standardized videos and photos were obtained before the treatment, 2 weeks, 4 weeks, and 24 weeks post-treatment. Outcomes were evaluated by measuring changes in the margin reflex distance-1 (MRD-1) and assessing patient point of view through two subjective questionnaires.

Results: Forty-nine patients were enrolled, 39 females and 10 males, aged between 30 and 88 years old. We observed a significant increase in the MRD-1 after 2 weeks and after 4 weeks compared to the baseline (p < 0.0001), with a mean elevation of the eyelid of 0.71 mm and 0.67 mm respectively. Patients ceased to require furrowing of the frontalis muscle to compensate for the eyelid elevation dysfunction. After 24 weeks, the BoNT-A effect diminished, and the treated eyelid returned to its baseline position. 67.4% of patients reported an improvement with only mild inconvenience in their blepharoptosis, and 16.3% of patients reported a complete improvement. 85.7% of patients expressed the desire to undergo the treatment again.

Conclusions: BoNT-A has demonstrated effectiveness in temporarily managing mild-to-moderate blepharoptosis and may represent a viable option for addressing minor eyelids asymmetries.

Level of evidence ii: 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: Cosmetic surgery tourism is a burgeoning field, attracting patients with the possibility of procedures at reduced costs. Patients are often unaware of the potential cost of managing complications, with the cost often passed on to the local healthcare systems. We report our experience at a single academic center which serves as a safety net hospital managing cosmetic surgery tourism patients.

Methods: Cosmetic surgery tourism patient demographics and outcomes were reviewed between March 2020 and September 2021 at our institution.

Results: We identified twenty-four female patients, averaging 35.6 years of age. All patients underwent body contouring procedures, most commonly abdominoplasty (17/24), frequently combined with liposuction or breast augmentation. On average, patients presented 32 days after their operation. All patients utilized emergency department resources, and 20/24 patients were admitted, averaging 5.5 days per admission. Fifteen required an additional procedure, including four who returned to the operating room. Twelve patients traveled internationally for surgery, ten to Mexico and two to the Dominican Republic. Domestically, Miami, Florida, was the most popular destination (8/12).

Conclusion: After developing a complication, patients frequently utilized emergency department resources and often were treated by non-surgeons before arriving at our institution. Surgical tourism continues to place the onus of finding appropriate postoperative care on patients, with their surgeon some hundreds of miles away. Additionally, the unanticipated cost of complications often exceeds the cost of their index procedure.

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: Chronic wounds present a significant challenge in clinical practice due to complications like infections and prolonged healing times. Conventional treatments often fall short, necessitating advancements in wound healing strategies. This article introduces a novel approach using a combination of adipose-derived stem cells (ADSCs) from fat and growth factors from platelet-rich fibrin (PRF) to enhance wound healing outcomes.

Methods: The Fakih-Manay fat membrane device was utilized to prepare fat membranes. Microfat was harvested and emulsified to produce nanofat, which was then combined with PRF to create a Nanofat-PRF membrane. The resulting membrane was uniform, versatile, and suture-friendly, making it ideal for various medical and surgical applications.

Results: Between April 2019 and April 2024, 172 patients received treatment using a nanofat membrane. The membrane showed significant improvement in wound healing in various cases including diabetic foot ulcers, cleft palate surgeries, facial dermabrasion, skin necrosis, revision rhinoplasties, and post-cosmetic surgery complications. Postoperative follow-up after healing ranged from 1 to 16 months, showing high patient satisfaction and significant improvements in wound healing and no reported complications.

Conclusion: The nanofat membrane presents a versatile and innovative approach to enhancing healing across a broad range of medical and surgical applications. This study provides the first evidence on the method for creating these membranes, demonstrating their clinical efficacy and safety, with no reported complications over a 5-year period.

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: Fat grafting is frequently employed in aesthetic and reconstructive plastic surgery with a low complication rate. However, fat necrosis may occur in dependence of the mode of fat aspiration, processing of the tissue and graft size. Graft survival is critically dependent on the contained adipose-derived stromal cells (ADSCs), adipocyte precursors and their potential for vascular supply. This work investigated the potential role of the expression of vascular endothelial growth factor A (VEGF) and various cytokines by ADSCs and differentiated adipocytes as key factors of fat grafting.

Methods: Adipokine expression of ADSCs and differentiated adipocytes were assessed using Proteome Profiler Arrays that detect 58 relevant proteins.

Results: Collected fat grafts could be categorized according to their adipokine expression into VEGF^high and VEGF^low ADSCs groups, the former exhibiting higher content of VEGF-related angiopoietin-like 2, nidogen-1/entactin, CCL2/MCP-1 and elevated expression of IGFBPs in association with a fourfold higher VEGF expression. Differentiation of ADSCs into adipocytes increased VEGF concentrations in VEGF^low ADSCs but not in ADSCs exhibiting initial high VEGF concentrations. The adipocytes revealed high expression of HGF, leptin, CCL2/MCP-1, nidogen-1/entactin, M-CSF but lower induction of angiopoietin-like 2.

Conclusion: Half of the ADSCs from fat grafts express high concentrations of VEGF and other adipokines that support angiogenesis and survival of this tissues following transfer. Differentiation of ADSC^low cells to adipocytes may make up for the initially low VEGF expression, but this activation is 7-10 days delayed compared to the VEGF^high ADSC cells and may fail to support angiogenesis from the beginning.

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 .

Introduction: Abdominoplasty aims to reduce the abdominal excess tissue and tighten the abdominal wall. The tightening of the abdominal wall has structural and habitual consequences on the body, which might have an early effect on electrocardiography (ECG) of the patients through volumetric and pressure changes in thoracic and abdominal cavities. ECG serves as a diagnostic tool for assessing cardiac electrical conductions in routine clinical practice. In this study, we aimed to examine whether abdominoplasty has any discernible effect on early ECG results, with the goal of assessing potential cardiological benefits for the patients undergoing this procedure by comparing pre- and early postoperative ECGs.

Method: Study population included 49 patients who had abdominoplasty. ECG records before the procedure and 12-24 h after the surgery were analyzed retrospectively. Patients had no known cardiac diseases and did not have any diagnosed arrhythmia.

Results: The mean age of the study population was 37.1 ± 8.5. The mean body mass index of the study population was 26.4. The mean weight of total removed abdominal skin tissue was 1057 grams. There were significant changes in ECG of the patients postoperatively. Heart rate was increased, and significant change was found in QRS axis (p < 0.001) and T wave axis (p < 0.001). Atrial conduction parameters such as PR duration (p  < 0.001), Pmax duration (p  =  0.001) and P-wave dispersion (p = 0.003) were significantly changed postoperatively. Ventricular conduction parameters such as QRS duration (p = 0.029), QT interval (p   < 0.001), QTc (p  < 0.001), TPe duration (p < 0.001), TPe / QT (p < 0.001) and TPe / QTc (p < 0.001) ratios were found significantly changed.

Conclusion: Abdominoplasty changes the intra-abdominal pressure in the first 24 h after the surgery, which may impact cardiac conduction. The understanding and recognition of possible early ECG changes is crucial during postoperative follow-up of the patients who undergo abdominoplasty surgery.

Level of evidence i: 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 .