Aesthetic Plastic Surgery最新文献

Background: In nasal surgery, autologous cartilage grafts are routinely used to correct structural weakness, contour deformities, and irregularities, yet current techniques still face challenges related to long-term cartilage graft viability and resorption. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate that may improve graft survival through its sustained release of bioactive molecules within a natural fibrin matrix.

Objective: To evaluate the biochemical and histopathological effects of combining PRF with autologous cartilage grafts of different forms (block, crushed, and diced) in a rabbit model and to determine which combination provides optimal cartilage viability and matrix stability.

Methods: Twenty-four New Zealand rabbits divided into six groups based on their form: block, crushed, and diced. PRF was applied to three groups, while the remaining three served as controls. The grafts were placed in subcutaneous pockets on the rabbits' backs and harvested after 8 weeks for histopathological and biochemical analyses. Cartilage tissues, growth factors, matrix components, angiogenesis, oxidative stress, and apoptosis markers were evaluated.

Results: PRF-treated groups demonstrated significantly higher growth factor levels, antioxidant status, lower oxidative stress and apoptosis markers compared with controls (p < 0.05). Histological analyses showed better cellular proliferation and extracellular matrix preservation, particularly in PRF-combined diced and block cartilage grafts, whereas crushed cartilage exhibited marked degeneration.

Conclusion: PRF enhanced the viability, proliferation, and angiogenic response of autologous cartilage grafts through its sustained release of growth factors and scaffold-like fibrin matrix. These findings suggest that PRF may improve graft stability and reduce postoperative complications in nasal surgery.

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: Health literacy is an understudied topic among published Spanish resources. Research focused on resources written in English demonstrates that content exceeds the recommended reading level for patients. Given the prevalence of breast reduction procedures and the increase in diverse patients undergoing the procedure in the last few years, this study explores the readability of Spanish information discussing breast reduction surgery by private and academic organizational websites.

Methods: Using a de-identified Google search engine, we identified the first 20 Spanish websites that provided breast reduction information. Two independent reviewers used the Patient Education and Materials Assessment Tool (PEMAT) and Cultural Sensitivity Assessment Tool (CSAT) to assess understandability, actionability, and cultural sensitivity of each website. The Spanish SMOG readability formula (SOL), Gilliam-Peña-Mountain, the Fry Readability Adaptation for Spanish Evaluation (FRASE), and Crawford assessments were used to assess readability.

Results: Both private- and academic-based websites scored above 70% for understandability but had lower scores for actionability. CSAT scores were just marginally above the threshold. Both private and academic readability assessments revealed consistently high reading grade levels 2 ranging from ninth to eleventh grade, except Crawford scores, which assessed a mean reading level of 6th grade.

Conclusion: Websites displaying Spanish content exceed the recommended level for patient educational materials. While the average understandability scores may be satisfactory on some websites, many have room for improvement, specifically regarding actionability. A limited sample size also emphasized the need to advocate for institutions to cater to patients who speak languages other than English. Important Points: Online Spanish resources on breast reduction are often too complex and exceed the recommended reading level for patients. Spanish resources need to be more than simple English translation to promote more cultural sensitivity. There is a significant gap in published online Spanish resources on breast reduction, particularly from academic and private organizations.

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: Labiaplasty, a surgical procedure aimed at reducing the size of the labia minora, represents the most frequently performed female genital cosmetic surgery. This study aimed to systematically investigate the factors motivating women to undergo labiaplasty and to assess the surgery's impact on body image, genital self-image, sexual satisfaction, and body confidence, both pre- and postoperatively.

Methods: This prospective study included 88 patients who underwent labiaplasty, all performed by the same surgical team. Postoperative follow-up assessments were carried out during the first week, first month, and third month. All patients were allowed to practice sexual intercourse one month after the surgery. Any complications or cases requiring revision surgery were documented. All patients completed the 19-item Female Sexual Function Index (FSFI) and the 7-item Female Genital Self-Image Scale (FGSIS) questionnaires before the surgery and at the third month postoperatively.

Results: When comparing the preoperative and postoperative total scores of the Female Genital Self-Image Scale (FGSIS), the postoperative score indicated a statistically significant improvement. The total score of the Female Sexual Function Index (FSFI) increased from 15.8 ± 2.6 preoperatively to 28.2 ± 2.7 postoperatively, also showing statistical significance (p < 0.001).

Conclusions: In our study, both total FSFI and total FGSIS scores were significantly higher post-surgery. This improvement can be attributed to the psychological recovery and confidence gained by the patients, leading to greater sexual and social fulfillment.

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: Breast-Conserving Therapy (BCT) has become a widely accepted treatment option for selected breast cancer cases. Nipple-Sparing Mastectomy (NSM) is considered an effective and oncologically safe approach for certain patients, as it preserves the native skin and nipple, allowing for one- or two-stage reconstruction with optimal cosmetic outcomes. This study aimed to provide our department's experience utilising the Omega and Reverse Omega incision techniques for immediate or delayed breast reconstruction for patients who had undergone NSM.

Method: Our study included sixteen cancer patients with mildly ptotic and large breasts who underwent immediate or delayed breast reconstruction using prosthetic implants following NSM, where the Omega incision was utilised, either bilaterally or unilaterally, from January 2022 to December 2024, at the Plastic and Reconstructive Surgery Department of Nicosia General Hospital. Patient demographics, co-morbidities, pre- and postoperative breast anthropometric measurements, and surgical complications were recorded and analysed.

Results: Sixteen patients underwent a total of twenty-one nipple-sparing mastectomy procedures for either breast cancer (90.47%) or risk reduction (9.52%), followed by breast reconstruction. The average age at the time of reconstruction was 64.4 years. The mean preoperative body mass index was 26.73 kg/m², and 25% were smokers. The mean follow-up was 11.62 months. From the patients who had undergone NSM, 12 (75%) were in the immediate reconstruction group, while the other 4 (25%) belonged to the delayed reconstruction group. Unilateral breast reconstruction was performed in 11 (52.38%) breasts. Bilateral NSM and immediate reconstruction with pre-pectoral implants was performed in 10 (47.61%) breasts. The Reverse Omega technique was performed in seven breasts. Single-stage breast reconstruction was performed for 17 (80.95%) breasts, while two-stage reconstruction for 4 (19.05%). Complications were reported, including a case of haematoma 1 (4.76%) and three cases of implant loss (14.28%).

Conclusion: The Omega incision appears to be a safe and effective technique for immediate or delayed reconstruction for selected cases of NSM eligible cancer patients with slightly ptotic and/or larger breasts.

Level of evidence iv: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Background: Drainage is used to prevent complications such as hematoma and seroma formation during liposuction. This study aims to place the drain into the desired area in patients undergoing liposuction with the liposuction canulae. This technique enables the procedure to be completed without the need for instruments or additional incisions.

Innovative technique: In this technique, we used a thick, long liposuction cannula with a wide hole at its tip. The cannula was advanced along the desired tract through the liposuction trocar incision. Once the cannula reached the most distal point where the drain was intended to be placed, a 2/0 Vicryl suture was sequentially passed through the skin, between the holes of the cannula, and then through the skin again, exiting externally. The end of the suture emerging from the trocar site was tied to the distal end of the drain that was intended to remain within the tissue. Then, by gently pulling the externalized end of the suture at the skin, the drain was advanced through the tissue. No additional scars were created during the drain placement in any of the patients. Furthermore, no complications, such as hematoma or seroma, were observed in the liposuction area.

Conclusion: No additional incisions are made, thereby preventing the formation of extra scars. The drainage tube can be placed precisely within the desired area or tract. Only instruments already utilized during the surgical procedure are employed, resulting in reduced overall cost.

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: Significant weight loss often results in severe deformities affecting multiple body regions, negatively impacting patients' social and personal lives. Many massive-weight-loss patients (MWLP) seek treatment for multiple anatomical areas. Combining procedures in a single surgical session offers perceived benefits such as a single recovery period, reduced costs, and faster patient satisfaction. However, the associated risks and reliability require further evaluation. This study compares the safety and reliability of combined body-contouring procedures versus single procedures performed in a staged approach.

Patients and methods: A retrospective study was conducted on 1182 MWLP patients undergoing body-contouring surgery. Patients were divided into four groups: Group A (single procedure, 389 patients), Group B (two procedures, 312 patients), Group C (three procedures, 272 patients), and Group D (four procedures, 209 patients). Medical records were reviewed for complications and patient satisfaction (BODY-Q).

Results: A total of 2665 procedures were performed with follow-up ranging from 12 to 34 months (mean 14.2 months). Overall complication rates were 3.6% in Group A, 5.1% in Group B, 20.2% in Group C, and 22.4% in Group D. Complication rates were similar between Groups A and B but significantly higher in Groups C and D, predominantly due to wound dehiscence. Major complications such as transfusions were significantly increased in Groups C (2.9%) and D (3.3%). Longer operative times and increased hospital stays were observed in Groups C and D, although drain durations were comparable across groups. Notably, despite the higher complication rate, patients in Group D reported the highest satisfaction scores on the BODY-Q questionnaire, with overall satisfaction increasing alongside the number of combined procedures.

Conclusion: Combining body-contouring procedures in MWLP patients is safe and effective, especially for the combination of two procedures, when rigorous inclusion criteria (well-optimized MWLP with BMI ≤ 30 kg/m², stable weight ≥ 6 months, corrected micronutrient deficiencies, and ASA I-II) and patient management are followed. The benefits of combined procedures may outweigh the drawbacks for certain groups of patients, as the higher number of complications is considered as "minor." Treatment decisions should be tailored to individual patient needs and preferences, balancing risks and benefits to achieve optimal outcomes.

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: The dissection technique can influence abdominoplasty complication rates. New "bovie" tips have been developed to minimize thermal damage and optimize tissue dissection.

Objectives: The purpose of the present study was to perform a randomized controlled trial to evaluate the effect of the dissection technique on several outcomes and complications after a Scarpa-sparing abdominoplasty, comparing a high-precision electrosurgical scalpel (HPES) with the conventional electroscalpel.

Methods: This prospective study was conducted at a single medical facility between June 2020 and February 2022 and enrolled patients who underwent Scarpa-sparing abdominoplasty. Forty female patients were included in the study and randomly assigned to either abdominoplasty performed using the conventional "bovie" tip (Group A) or a similar procedure using the HPES tip (Group B). The following variables were analyzed: patient characteristics, duration of suction drain use, drain output, complications (local and systemic), unscheduled visits, readmissions, and reoperation requirements.

Results: Both groups exhibited similar general characteristics, differing only in body mass index. The HPES group showed a 23.6% significant reduction in total drain output and a trend toward lower daily outputs, peaking on day two with a 60.0% reduction in drain output. Local and systemic complications were similar, except for a trend toward lower wound dehiscence in the HPES group. Notably, no systemic complications occurred in either group.

Conclusion: Our findings support the safety and efficacy of the HPES tip for Scarpa-sparing abdominoplasty. This pilot randomized controlled trial demonstrated the benefits of substantially reducing drain output.

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 .

Background: Forehead augmentation is a foundational procedure for facial harmonisation, particularly in Asian populations where a smooth, convex forehead is aesthetically desirable. Existing modalities such as implants, hyaluronic acid fillers, and fat grafting alone have limitations including irregular contours, surgical risks, or inconsistent long-term retention.

Objective: To evaluate the 12-month safety, efficacy, and volume stability of sequential poly-D,L-lactic acid (PDLLA) and autologous fat transfer for forehead augmentation.

Methods: A retrospective case series of 44 Korean patients (32 females, 12 males; mean age 42.3 years) treated between January-December 2024. All patients received 1 vial of Juvelook GLAM (reconstituted in 15 ml) followed by 20-25 ml of purified autologous fat injected using a multi-directional cannula fanning technique. Outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS), modified Carruthers Forehead Contour Scale, standardised photography, and patient-reported satisfaction at 6 and 12 months.

Results: At 12 months, 39 patients (88.6%) maintained moderate-to-marked improvement on the GAIS, compared with 40 patients (90.9%) at 6 months. Mean satisfaction at 12 months was 8.1/10 (compared with 8.3/10 at 6 months). Clinical assessment confirmed sustained convexity and contour retention, with an estimated 72-78% mean fat graft retention. Complications remained minor and transient: swelling (29.5%), bruising (11.3%), and mild erythema (15.9%). No granulomas, vascular events, infections, or long-term adverse events occurred.

Conclusions: The combined PDLLA-fat technique provided stable 12-month outcomes, with minimal decline from 6-month results. PDLLA appears to support adipocyte viability and scaffold integration, contributing to improved retention beyond traditional fat grafting. Longer prospective comparative studies are needed to confirm additive effects and 24-month durability.

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 .