Aesthetic Plastic Surgery最新文献

Purpose: To design and develop an AI-based plastic surgery recommendation system using 3D photographs and psychological questionnaire surveys, aiming to provide personalized treatment solutions for the plastic surgery industry.

Methods: Based on artificial intelligence technology, this study utilized patients' 3D photographs and psychological questionnaire results as training samples to construct a personalized AI-based plastic surgery recommendation system. This system comprehensively considers factors, such as patients' anxiety levels, economic status, and psychological expectations. The study selected 5543 cases of plastic surgery outpatients aged 18-55 years, collected their 3D photographs and questionnaire data, and used these for AI system training. The software predicted treatment projects and compared them with doctors' predictions to validate the system's accuracy and patient satisfaction. Third-party doctors evaluated the system's safety, ultimately developing an efficient and accurate plastic surgery recommendation system.

Results: The economic downturn in the post-COVID-19 era significantly impacted psychological health and the plastic surgery industry. Factors, such as age, education level, income, and gender, had significant effects on patients' psychological state and treatment willingness. The AI system integrated patients' psychological state, gender, income, and physical characteristics, providing personalized plastic surgery treatment suggestions and achieving a 93.25% patient satisfaction rate. These results indicate that the AI system offers comparable accuracy and safety to physicians while improving satisfaction, meaning that it could enhance clinical decision-making efficiency.

Conclusion: The AI-based personalized plastic surgery recommendation system offers an innovative solution for the industry, enhancing the accuracy of treatment suggestions and patient satisfaction, thereby promoting sustainable development. In the post-pandemic era, the plastic surgery industry should focus on patients' physical, psychological, and economic factors to achieve personalized services.

Level of evidence ii: Experiment/New Technology. 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: Soft tissue fillers are central to facial rejuvenation, but their impact on lymphatic drainage is poorly quantified. Lymphatic vessels operate at very low pressures and collapse with modest external load. Persistent oedema in regions such as the tear trough and malar area suggests filler-lymphatic interactions drive complications.

Methods: A multiscale finite element model was built in the AesthetiSIM™ platform to simulate filler-tissue-lymphatic interactions. A virtual cohort of 10,000 anatomically varied patients was generated from MRI, cadaveric, and lymphangiographic data. Seven facial regions (tear trough, malar, nasolabial fold, lips, chin, jawline, and temple) were represented as layered tissue blocks with embedded lymphatic collectors. Hyaluronic acid (HA) was modelled as a hygroscopic hydrogel and calcium hydroxylapatite (CaHA) as a stiffer, non-swelling suspension. Outputs included external pressure on lymphatic collectors, lumen collapse, interstitial flux, and a 24 h oedema index. Statistical analysis used hierarchical logistic regression, functional principal component analysis, copula modelling, and global Sobol sensitivity decomposition.

Results: Three reproducible volume thresholds emerged across the population: (1) lymphatic flow perturbation above 0.20 mL, (2) structural compromise with 25-30% lumen narrowing above 0.40 mL, and (3) critical obstruction near 0.93 mL. Tear trough and malar regions were more vulnerable, with HA obstruction at 0.54 mL and CaHA at 0.41-0.43 mL. CaHA produced earlier, sharper pressure peaks due to higher stiffness, whereas HA caused delayed, swelling-driven collapse. Posture and injection depth altered risk: dependent positioning increased early collapse in chin and jawline, and supraperiosteal placement concentrated stress on superficial collectors. Long threading tracks reduced peak pressure but widened areas of moderate compression.

Conclusion: Filler-induced lymphatic compromise occurs at volumes far below traditional "safe" doses. No injected volume is physiologically inert: even 0.2 mL measurably perturbs drainage. Safety requires region-specific dosing, avoidance of bolus injections in high-risk sites, and preference for distributed techniques to reduce lymphatic compression.

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 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 .

Background: Non-surgical genioplasty is one of the best choices in cases of chin retrusion, and it represents a solution for the aesthetic amelioration of facial profile. Recent concerns arose about the risk of bone resorption and vascular occlusion. Different procedures and products may lead to different results. This study reports the experience of a single facial plastic surgeon (M.G.) using non-surgical techniques to fill the chin.

Methods: This retrospective study assesses 225 patients injected from January 2019 through March 2024 in private clinics in Milan (Italy), London (UK), and Dubai (UAE). Forty-five patients were injected with hyaluronic acid (Genefill DX 1x1 ml, BioScience GmbH, Dümmer, Germany), 90 underwent a lipofilling procedure, and 90 underwent a Dermgraft procedure, that is, a personalized lipofilling, modified by the main author. Half of the last 180 patients underwent shock waves before fat harvesting. Patients were followed up for 12 months, and facial angles and satisfaction data were analyzed. Three experts scored the results over time.

Results: After all the treatments, facial angles were corrected, but the maintenance of the results varied for the different treatments. Notably, at 3 months, the levels of satisfaction were higher for the HA filler treatment, while at 1 year, the levels of satisfaction were very high for the Dermgraft.

Conclusions: Liquid genioplasty is a safe technique to correct chin retrusion, with good results and high levels of patient satisfaction. The maintenance of the results varies according to the type of product injected.

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: Botulinum toxin type A (BTX-A) is a simple and effective method for treating drooping mouth corners. However, the effective dosage and injection sites remain controversial. The authors propose a triangular three-point injection technique and compare the effects of different dosages tailored to varying severity levels of drooping mouth corners.

Methods: Before the start of this prospective self-controlled study, subjects with drooping mouth corners received two treatment methods. First, participants received a single-point injection of 3 U of BTX-A per side. Four months later, an individualized approach was adopted, with 3-15 U of BTX-A injected at three sites per side based on severity. Data were collected at baseline and at 4- and 12-week follow-ups.

Results: Fifty-one subjects were enrolled. At 4 weeks after injection, both methods significantly improved drooping mouth corners, with the indicators returning to baseline levels by 12 weeks (P < 0.05). Based on clinical manifestations, subjects were categorized into mild, moderate, severe, and most severe cases, receiving 3 U, 6/9 U, 9/12 U, and 12/15 U per side, respectively. The results showed that 3 U/side for mild cases, 6 U/side for moderate cases, and 12 U/side for severe cases were the safest and most effective dosages, while most severe cases still did not achieve satisfactory results even at 15 U/side. Overall, at 4 weeks post-treatment, the reduction in the vertical distance from the mouth corner to the pupillary line and the angle of drooping were significantly greater with the triangular three-point injection technique compared to the single-point injection (P ≤ 0.05). No adverse events were observed in any subjects.

Conclusion: It is necessary to increase the injection dosage according to the severity of drooping mouth corners. The new triangular three-point injection technique is safe and demonstrates favorable clinical outcomes.

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 .