Aesthetic Plastic Surgery最新文献

Background: Chinese individuals may seek chin enhancement to address esthetic perceptions regarding chin retrusion. Because studies of the injectable hyaluronic acid gel VYC-25L (Allergan Aesthetics, an AbbVie Company, Irvine, CA) contained few Asian subjects and none from China, its effects on chin retrusion in Chinese individuals are unclear. This 12-month, real-world evidence study evaluated the safety and effectiveness of VYC-25L for chin enhancement in Chinese adults.

Methods: At Hainan Bo'ao Super Hospital, 2 cohorts of prospectively and retrospectively enrolled adults received VYC-25L treatment (maximum 4 mL). Cohort 1 only underwent 3D imaging before and after treatment for digital analysis. The primary effectiveness measure was mean change from baseline in glabella-subnasale-pogonion (G-Sn-Pog) angle at month 3 based on 3D facial images. Both cohorts completed the Global Aesthetic Improvement Scale (GAIS; subjects and investigators) and a satisfaction questionnaire (subjects). Injection site response (ISR) and adverse events were recorded.

Results: Of 90 subjects enrolled (cohort 1, n=36; cohort 2, n=54), 89 completed the study. Mean change from baseline in G-Sn-Pog angle at month 3 was 3.19 degrees (95% CI, 2.55-3.83; P < 0.001 vs 0), with improvement maintained through 12 months. Month 3 "improved"/"much improved" GAIS responder frequencies were 94.3% (investigators) and 97.1% (subjects); 91.5% of subjects were "satisfied"/"very satisfied" with treatment at month 3. Most (>70%) ISRs were mild or moderate in severity. Four treatment-related adverse events occurred (all mild).

Conclusion: VYC-25L was safe and effective for enhancement of the chin and jaw in Chinese adults.

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 .

The tear valley deformity represents a challenging area for aesthetic correction due to its anatomical complexity and the risk of complications from improper filler placement. In our article, we introduced the Matador Stab technique, emphasizing precise filler deposition to address anatomical challenges while minimizing complications. Key points include the importance of individualized treatment plans, the role of the tear trough ligament, and the consideration of adjacent regions for optimal results. We highlight the value of surgical alternatives, such as lower blepharoplasty, for specific cases. Continued interdisciplinary dialog and further studies are essential to refine techniques and enhance patient outcomes.

Background: The caseload of breast reduction is on the rise. Despite this popularity, the association between body mass index (BMI) and postoperative outcomes remains unclear. We hypothesize that BMI is a significant determinant of postoperative morbidity after breast reduction and leverage a multi-institutional database to investigate this correlation.

Methods: We queried the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2008-2022) to identify female adult patients who underwent breast reduction. We categorized all patients into six BMI subgroups, and compared their outcomes (i.e., 30-day surgical and medical complications, reoperation, readmission, and mortality) via multivariate logistic regression analyses.

Results: 45,373 patients (mean age: 40 ± 14 years; mean BMI: 31 ± 6.1 kg/m²) were identified, of whom 0.1% (n = 61) were underweight, 12% (n = 5635) healthy weight, 34% (n = 15,346) overweight, 30% (n = 13,795) had obesity I, 15% (n = 6843) obesity II, and 8.1% (n = 3693) obesity III. Overall, 2881 (6.4%) patients experienced complications, with 1936 (4.3%) cases of surgical complications and 317 (0.7%) cases of medical complications. The risk for complications increased stepwise above the healthy BMI range. Compared to women with healthy weight, patients with obesity I, II, and III had a significantly higher risk of any complication (OR 1.5, p < 0.001; OR 1.87, p < 0.001; and OR 2.6, p < 0.001, respectively), medical complications (OR 2.4, p = 0.005; OR 2.99, p = 0.001; and OR 5.2, p < 0.001, respectively), and surgical complications (OR 2.2, p < 0.001; OR 2.81, p < 0.001; and OR 4.2, p < 0.001, respectively). Overweight patients were also at higher risk for any complication (OR 1.2, p = 0.09), medical complications (OR 2.1, p = 0.02), and surgical complications (OR 1.4, p = 0.004). The odds for reoperation did not increase with higher BMI classes.

Conclusion: Our multi-institutional data analysis revealed a significant correlation between elevated BMI and the occurrence of both surgical and medical complications after breast reduction surgery. The postoperative risk increased progressively with BMI above the healthy range. These findings are essential for informing preoperative counseling, refining risk assessment, and developing tailored protocols.

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 .

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: Reconstruction of the bony nasal dorsum is a challenge due to the unique anatomy of the nasal bones. The nasal bones by virtue of their shape, angulation and size provide an aesthetic and pleasing contour of the upper nose. The anatomy of the nasal bones can get deformed in many situations like congenital anomalies, iatrogenic and post-traumatic situations leading to nasal deformity. Many options for reconstruction of nasal dorsum are available including soft tissue and bony material. It is always desirable to reconstruct like tissue with like tissue. This paper describes the use of a cored out tent shaped fibular graft for total reconstruction of the bony nose dorsum.

Methods: A bony defect-appropriate full thickness segment of the fibula was harvested. This was contoured and cored out to mimic the appearance and angulation of the bilateral articulated nasal bones. The bone graft extends from the radix to the upper part of the lateral cartilage. This graft was inserted into a pocket created under the nasal dorsum to recreate the normal appearance and slope of the nose. The graft if needed may be fixed to the underlying bone using a screw.

Results: A total of 20 patients with total destruction of the bony nasal vault were operated using this technique from 2017 to 2021. The average dimensions of a fibular graft are a length of 4.5 cm, a width of 12 mm and a thickness of 3 mm. Only 4 out of 20 patients required fixation with a screw. All patients reported significant improvement in the appearance and profile of their nose after surgery. The visual analogue scale revealed a Gaussian normal distribution curve (range, 0.5 to 10) with a significant improvement and p value <0.05. There has been an improvement in the mean nasofrontal and nasofacial angles postoperatively. The complications have been minimal and temporary.

Conclusion: The specially contoured fibular bone graft most closely mimics the natural shape and contour of the nasal bones and hence gives satisfactory results with minimal intraoperative manoeuvring and sculpturing and has natural stability owing to the unique shape that often obviates the need of fixation to the underlying skeleton. This type of graft is suitable in cases where total nasal reconstruction of the bony dorsum is desired.

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: Telemedicine has been increasingly utilized by plastic surgeons since the start of the COVID-19 pandemic as it minimizes visit time, costs, and viral exposures. However, patient comfort level and preference for telemedicine visits in the aesthetic surgery perioperative period remains unknown. The purpose of this study was to evaluate patient comfort and preferences regarding perioperative telemedicine visits for aesthetic surgery.

Methods: An IRB-approved cross-sectional survey was conducted in January 2022 on Amazon's Mechanical Turk (MTurk) platform to assess respondents' comfort and preferences regarding periprocedural telemedicine visits. Survey responses were compared using descriptive and multivariate analyses.

Results: A total of 505 participants (54% male, 46% female; mean age 37.7±11.5 years) completed the survey. The majority of respondents reported feeling either very or somewhat comfortable having their initial consult via telemedicine for both aesthetic surgery (72%) and non-surgical aesthetic procedures (74%). Respondents were most comfortable having an initial telemedicine consult for head and neck procedures, and least comfortable having telemedicine consults for sensitive areas, including the breast and buttocks. Respondents were significantly more comfortable scheduling non-surgical procedures than surgical procedures after a telemedicine consult alone (65% vs 58%; p < 0.001).

Conclusions: Our data suggests that the majority of aesthetic surgery patients are comfortable with having initial consultations via telemedicine. Particularly in young patients seeking non-surgical aesthetic procedures, telemedicine consults alone may be substituted for in-office visits prior to procedural scheduling. However, for operations and procedures requiring physical examination of sensitive areas, including the breasts and gluteal regions, in-person visits remain the preferred modality.

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 .