Aesthetic Plastic Surgery最新文献

Background: The success of virtual surgical planning (VSP) in bimaxillary orthognathic surgery relies on the precise translation of digital plans into operative outcomes. Although computer-assisted design and 3D-printed surgical guides are increasingly adopted to improve surgical accuracy, clinical data on the performance of systems employing Mimics software-particularly concerning long-term postoperative stability-remain scarce.

Methods: Twelve consecutive patients undergoing bimaxillary surgery between July 2023 and September 2024 were prospectively enrolled. Preoperative cone-beam computed tomography (CBCT) and dental models were integrated into Mimics software for multimodal registration, 3D reconstruction, and VSP. Surgical procedures included Le Fort I osteotomy, bilateral sagittal split osteotomy (BSSO), and genioplasty. A fully customized 3D-printed surgical guide system, including osteotomy guides, repositioning guides, and occlusal splints was employed. Postoperative CBCT scans were acquired at 10 days (T1), 1 month (T2), 3 months (T3), and 6 months (T4). CBCT scans from T1 and T4 were analyzed in 3-Matic to quantify 3D deviation. Clinical success was defined as linear deviations ≤ 1.5 mm and angular deviations ≤ 2°. Longitudinal comparisons of CBCT datasets across all postoperative intervals (T1-T4) were performed to assess stability. Statistical analysis was conducted using paired t-tests in SPSS 26.0 (α= 0.05).

Results: Mean linear deviation was 1.34 ± 0.28 mm at T1 and 1.17 ± 0.22 mm at T4, while angular deviation was 1.95° ± 0.41°and 1.81° ± 0.35°, respectively. All values were within the predefined clinical thresholds. Maxillary landmarks (ANS, A-point, dental cusps) remained stable throughout the observation period (P > 0.05), whereas mandibular landmarks (B-point, pogonion, menton, dental cusps) demonstrated statistically significant progressive stabilization (P < 0.05). Directional analysis revealed the highest accuracy in the horizontal plane (0.58 ± 0.16 mm) and the greatest deviations in the sagittal direction (1.71 ± 0.61 mm at T4).

Conclusions: The 3D-printed digital guide system achieved clinically acceptable accuracy and demonstrated favorable postoperative stability. Maxillary skeletal landmarks exhibited superior precision compared to dental references. Notably, mandibular structures showed significant positional improvement over time, suggesting distinct healing dynamics between the jaws. All observed deviations fell within published tolerances, validating the system's reliability for clinical application in orthognathic surgery.

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: Double eyelid surgery is a common cosmetic procedure that creates a crease in the upper eyelid. Due to insufficient understanding of the procedure, numerous consultations have emerged, placing a heavy burden on plastic surgeons. The rise of large language models (LLMs) offers a potential solution to this issue.

Methods: This study collected sixteen questions commonly of concern to individuals seeking the surgery via an online questionnaire and assessed the efficacy of fifteen popular LLMs in answering these questions with both English and Chinese inputs. All responses from the LLMs were scored multidimensionally by three expert eyelid plastic surgeons across dimensions including professionalism, patient friendliness, informativeness, practicality, and logical clarity. The scoring results were statistically analyzed using the Friedman test and Nemenyi post-hoc test.

Results: With English input, ERNIE-Bot, ChatGPT-4o, and Gemini-2.0-Flash consistently ranked among the top three across most evaluation dimensions. In contrast, Claude-3.7-Sonnet, HuatuoGPT, ZoeGPT, CompliantGPT, and BastionGPT ranked lower across all dimensions, with performance significantly lagging behind the top performers. For Chinese input, DeepSeek-R1 maintained a leading position across all dimensions, forming the first tier alongside DeepSeek-V3, Gemini-2.0-Flash, and ERNIE-Bot. Meanwhile, Claude-3.5-Haiku, ZoeGPT, Llama3.3-70B-Instruct, CompliantGPT, HuatuoGPT, and BastionGPT ranked lower in multiple dimensions, with a significant gap relative to first-tier models.

Conclusion: This study demonstrated LLMs' potential as medical consultation tools for double eyelid surgery, providing useful guidance for both English and Chinese users. Future research should focus on fine-tuning LLMs with more specialized medical data and exploring workflows for surgeon-LLM collaboration to validate their clinical utility.

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: Craniomaxillofacial trauma is a common occurrence in adults, often resulting from vehicle accidents, assaults, sports injuries, working accidents, and others. The primary goal of craniomaxillofacial trauma surgery is to restore function and aesthetics, while also supporting the patient's social reintegration. However, many patients develop post-traumatic complications and sequelae such as malocclusion, facial asymmetry, unsatisfactory aesthetic outcomes, pseudoarthrosis, airway disturbances, and nasal or ocular dysfunction. A multistage reconstruction approach involves sequential procedures: first-stage hard tissue correction using orthognathic surgery and bone reconstruction, followed by orbital reconstruction and rhinoplasty in the second stage, and concluding with soft tissue facial plastic surgery in a third stage.

Materials and methods: This case series includes patients treated with a multistage approach between 2004 and 2025. The procedures performed included orthognathic surgery, bone grafting, rhinoplasty, orbital reconstruction, and facial plastic surgery.

Results: A total of 25 patients with complete records were reviewed. Data collected included age, gender, trauma etiology, diagnosis, functional sequelae, surgical procedures performed, post-surgical complications, treatment of complications, and follow-up duration.

Conclusions: Correcting post-traumatic craniofacial anomalies is challenging due to the involvement of both functional and anatomical structures, often leading to issues such as soft and hard tissue loss, fibrosis, bone fragment malunion, infection, malocclusion, facial asymmetry, airway disturbances, and orbito nasal dysfunction. Successful multistage craniofacial reconstruction requires an interdisciplinary team skilled in trauma, orthognathic, reconstructive, and facial plastic surgery. We propose a multistage treatment algorithm based on clinical evidence to guide practitioners in treatment planning and decision-making.

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: Vaginal hyaluronic acid (HA) filler is a minimally invasive option primarily aimed at functional improvement (sexual function and pelvic muscle performance), with aesthetic effects considered secondary. The procedure aims to address changes in the female genitalia that may occur due to aging, childbirth, or other factors. This review aims to provide a detailed overview of the techniques involved, anatomical considerations, safety profiles, and clinical outcomes associated with vaginal filler injections.

Methods: In this study, 42 women (24 premenopausal, 18 postmenopausal) underwent posterior vaginal wall augmentation using cross-linked hyaluronic acid, volume ranging from 3-5 cc (e.p.t.q.® Lidocaine S 300 and e.p.t.q.® eve X, JETEMA Co., Ltd. Korea), which has an expected reabsorption period of approximately 9-12 months. Outcomes were assessed at baseline, 6, and 12 months. Female sexual function was evaluated using the Female Sexual Function Index (FSFI), which measures six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Pelvic floor muscle strength and function were objectively assessed using the Peritron perineometer, which records resting pressure, peak pressure, average pressure, and contraction duration.

Results: All 42 participants completed the 12 month follow-up, with improvements in every FSFI domain and Peritron parameter observed at 6 months and maintained through 12 months. Participant satisfaction increased from 71% at 6 months to 81% at 12 months, and no participants reported dissatisfaction at any time point.

Conclusion: This study demonstrates the potential of vaginal filler treatment to positively impact female sexual well-being. Both subjective reports of satisfaction and objective physiological measures indicate improvements following the procedure.

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 study aimed to evaluate the clinical efficacy and safety of a modified wedge resection technique for composite reduction of labia minora hypertrophy and redundant clitoral hood.

Methods: A retrospective analysis was conducted on patients who underwent the modified wedge resection procedure for concurrent labia minora and clitoral hood reduction at the Department of Plastic & Cosmetic Surgery, Women's Hospital of Nanjing Medical University (Nanjing Women and Children's Healthcare Hospital) between July 2019 and December 2024. Descriptive statistics were used to analyze patient demographics, self-reported symptoms, postoperative complications, symptom improvement, aesthetic satisfaction, and overall satisfaction.

Results: The study included 738 patients with a mean age of 27.6 ± 6.1 years (range: 18-49). Preoperative motivations and symptoms primarily included vulvar friction discomfort (98.8%), aesthetic concerns (87.1%), dyspareunia (7.9%), and increased residual secretions (7.5%). The mean follow-up duration was 1.9 months (range: 1-6). Postoperative complications consisted of delayed wound healing (24 cases, 3.3%) and perceived asymmetry (10 cases, 1.4%). Preoperative symptoms improved in 99.3% of patients, and 99.2% were satisfied with the aesthetic outcome. Overall, 710 patients (96.2%) reported satisfaction with the surgical results.

Conclusion: The modified wedge resection technique enables simultaneous correction of labia minora hypertrophy and redundant clitoral hood in a single procedure, yielding consistent and satisfactory aesthetic outcomes. This approach is straightforward, reproducible, and demonstrates favorable clinical safety.

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: Implementing new strategies and developing future research to reduce the rate of necrosis of skin flaps, reduce damage caused by ischemia-reperfusion, raise the survival rate of skin flaps, help improve patients' quality of life, and obtain a suitable result from treatment with skin flaps are very important and have been considered. Fucoidan (Fuc) is important worldwide in pharmaceutical manufacturing due to its therapeutic properties. Its remarkable physiological roles can be credited to its distinct and specialized biological composition.

Materials and methods: In this study, skin flap surgery was performed in rats using the McFarlane method on 50 male Sprague Dawley rats (weighing 200-240 g). The study group consisted of five groups. Groups included those who underwent: (1) sham surgery for the first time (8×3 cm skin cut, without elevation); (2) flap surgery (control group, 8×3 cm skin flap with elevation from its bed;), (3) Fuc 5 mg/kg + flap surgery; (4) Fuc 10 mg/kg + flap surgery; and (5) Fuc 15 mg/kg + flap surgery. Survival percentage of necrotic area, the amount of interleukin 1β (IL-1β), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), and histopathological changes were investigated on the 7th day after skin flap operation.

Results: Fucoidan, in a dose-dependent manner, remarkably reduced the amounts of TNF-α, IL-6, and IL-1β in skin flap tissue. In parallel with this reduction, the fucoidan group's incidence of flap necrosis decreased to the minimum level of 15% (P < 0.05). Moreover, the group treated with Fuc 15 showed a higher fibroblastic migration rate and granulation tissue than the control group (P < 0.05). Furthermore, fucoidan in higher doses could inhibit the release of inflammatory cytokines (P < 0.05).

Conclusion: Fucoidan could increase skin flap survival, decline necrosis, alleviate inflammation, and enhance tissue granulation and collagen synthesis after skin flap surgery, which is remarkable in skin formation and regeneration.

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: Previous studies on oncoplastic breast-conserving surgery (OBCS) have focused primarily on European-descent populations. However, Chinese women have distinct breast morphological characteristics, such as smaller volume and denser glandular tissue. These anatomical differences may influence the choice of procedure and postoperative outcomes. This study aimed to compare differences in aesthetic outcomes and patient-reported outcomes between volume replacement (VR) and volume displacement (VD) techniques in Chinese patients with breast cancer to clarify the applicability of different surgical approaches.

Methods: This study analyzed patients who underwent OBCS with chest wall perforator flaps (CWPFs) or VD at the Affiliated Hospital of Southwest Medical University (Luzhou City, China) from 2022 to 2024. Demographic, surgical, oncological, and complication data were collected. Patients completed the BREAST-Q questionnaire preoperatively and at 12 months postoperatively, and aesthetic outcomes were evaluated using the criteria proposed by Ueda et al. Statistical analysis was performed on baseline characteristics, questionnaire scores, and aesthetic scores.

Results: A total of 159 patients were included in the analysis. Of these, five underwent mastectomy due to positive margins. The two cohorts showed no significant difference in preoperative BREAST-Q scores. Patients who underwent OBCS with CWPFs reported significant improvements in satisfaction with breasts, physical well-being: chest, and aesthetic outcomes.

Conclusion: Chest wall perforator flaps demonstrated significant advantages in aesthetic and patient-reported outcomes compared with volume displacement. Therefore, they should be offered as an alternative to volume displacement for women with small-to-medium breasts.

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: Labiaplasty has emerged as a widely accepted procedure for addressing both aesthetic and functional concerns of the female external genitalia. However, the heterogeneity of vulvar aging patterns presents a challenge for standardized surgical planning. To address this, we developed a novel six-type clinical classification of vulvar aging aimed at guiding individualized surgical strategies.

Methods: We conducted a multicenter observational study over an eight-year period (2016-2024) across two private aesthetic surgery centers in Italy. A total of 142 patients presenting with vulvar complaints underwent clinical evaluation, photographic documentation, and surgical intervention. Of these, 14 were excluded due to incomplete follow-up or documentation, leaving 128 patients for final analysis. Patients were classified into one of six clinical types based on labial morphology, including hypertrophy, hypotrophy, and tissue laxity. Surgical techniques were selected according to classification type and included established and customized procedures.

Results: Type 1 (isolated labia minora hypertrophy) was the most common presentation (32.8%), followed by Type 2 (labia majora hypotrophy, 21.9%) and Type 3 (combined hypotrophy and hypertrophy, 17.2%). Tailored surgical approaches-ranging from resection and lifting to volumization-were applied. The overall satisfaction rate was 91.4%, with complication rates remaining low (7.8%), including minor wound dehiscence, transient edema, and fat graft resorption. Functional improvements and enhanced body confidence were reported in over 80% of sexually active patients.

Conclusions: This study introduces a new clinical classification of vulvar aging that enables precise, anatomy-based surgical planning in labiaplasty. The system proved practical, reproducible, and closely aligned with patient-reported outcomes. Its implementation may standardize future research and improve the personalization of vulvar aesthetic surgery.

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: Therapeutic mammoplasty is a well-established option for breast cancer treatment when indicated by oncological evaluation. At sternal notch-to-nipple (SN-N) distances above 35cm, the inferior pedicle (IFP) technique is often considered most reliable due to its vascular supply, potentially reducing complications. However, the superomedial pedicle (SMP) technique is associated with better aesthetic outcomes. We compared SMP and IFP outcomes at SN-N distances of 35-40 cm.

Methods: A retrospective cohort study was conducted, including 81 breast cancer patients (43 SMP, 38 IFP), who underwent therapeutic mammoplasty with an SN-N distance of 35-40 cm. Outcomes compared included operative time, nipple-areola complex (NAC) viability, postoperative complications, and patient satisfaction with breasts, outcomes, and nipples.

Results: The mean SN-N distance was not statistically different between groups. Mean operative time was shorter with SMP than with IFP (88.21 ± 5.07 vs. 119.3 ± 5.60 minutes, p < 0.001). NAC viability did not differ significantly, with partial necrosis in 4.7% of SMP patients and 2.6% of IFP patients (p = 1.000). Other postoperative complications were rare, with one infection in each group. SMP patients reported higher satisfaction with breasts (88.77 ± 7.23 vs 75.71 ± 8.03, p <0.001) and outcomes (90.60 ± 8.19 vs 76.42 ± 8.76, p < 0.001). Satisfaction with nipples was high in both groups without a significant difference.

Conclusion: SMP demonstrates comparable or superior outcomes to IFP at SN-N distances of 35-40 cm, expanding the applicability of the superomedial pedicle technique.

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: Autologous fat grafting is limited by unpredictable resorption and complications, largely due to inadequate revascularization and persistent inflammation. The molecular mechanisms underlying these processes remain poorly understood.

Methods: Human fat grafts were implanted into nude mice and harvested at days 3, 7, 14, 21, and 28 for RNA sequencing. Differentially expressed genes (DEGs) were identified and functionally annotated using GO and KEGG analyses. Key candidates were validated via RT-PCR.

Results: Human-derived RNA decreased sharply after day 3, indicating graft cell death. Grafts at day 3 showed upregulation of hypoxia-response pathways (HIF-1, glycolysis) and downregulation of oxidative metabolism and adipogenesis. Recipient-derived transcriptomes revealed sustained upregulation of angiogenesis and ECM-related genes (Fgf1, Plau, and Ccbe1) and downregulation of inflammatory genes (Ccr2 and Relt). Dynamic changes were most pronounced between days 3 and 14, followed by stabilization.

Conclusion: Early fat grafting is characterized by metabolic adaptation to hypoxia and active host-mediated angiogenesis and inflammation resolution. Key genes identified may serve as therapeutic targets to enhance graft survival. This study provides a temporal transcriptomic atlas that elucidates the molecular basis of graft integration.

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.