Aesthetic Plastic Surgery最新文献

Background: Ultrasound-guided maxillary nerve block (UGMNB) is applied in oral and maxillofacial surgery to improve perioperative analgesia, decrease the risk of postoperative nausea and vomiting, and enhance recovery. However, the optimum volume of ropivacaine used for UGMNB is undetermined. Thus, it was hypothesized that in patients undergoing double-jaw surgery, low- and high-volume ropivacaine reduces perioperative pain with similar efficacy.

Methods: Adults undergoing double-jaw surgery were enrolled in a randomized non-inferiority trial to receive a bilateral single-injection UGMNB with 2 mL (low-volume [LV] group) or 5 mL (high-volume [HV] group) of 0.375% ropivacaine on each side. A visual analog scale (VAS) score for maxillary pain at 2 h postoperatively was taken as the primary outcome. VAS score for maxillary and mandibular pain at 2, 4, 6, 8, 12, 24, and 48 h postoperatively, hemodynamic changes intraoperatively, consumption of intraoperative opioids and sedatives, vasoactive medication use, extubation time, postoperative rescue analgesia, time to the first analgesia, postoperative nausea and vomiting and UGMNB-related complications within 48 h post-surgery were assessed as the secondary outcomes.

Results: Sixty-four adults were included. The maxillary pain score in the LV group was not inferior to that in the HV group at 2 h postoperatively, with a non-inferiority margin of 1 (mean difference - 0.1; 95% confidence interval [CI] - 0.6 to 0.8, P = 0.414 for non-inferiority). Maxillary and mandibular pain demonstrated no difference in the measured times between groups. The incidence of postoperative nausea was significantly higher in the LV group than that in the HV group at 6-24 h (12 (37.5%) vs. 5 (15.6%), P = 0.048). Moreover, no differences in intraoperative hemodynamic parameters, medications during anesthesia, time to extubation, rescue analgesia, time to the first analgesia, and postoperative vomiting were observed. Only one patient in the LV group was observed to have maxillary nerve block-related complications.

Conclusions: To conclude, the efficacy of UGMNB with 2 mL of 0.375% ropivacaine has the same efficacy as the 5 mL drug in reducing perioperative pain in patients undergoing double-jaw 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 .

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: Renuvion was the first FDA approved helium plasma device utilized for subdermal tissue heating to reduce skin laxity. The purpose of this study was to demonstrate that the use of Renuvion improves the outcomes, skin quality and reduces the edema faster after lipoabdominoplasty.

Materials and methods: Patients with abdominal skin laxity after a weight loss of at least 20 kg, nonsmokers, without major comorbidities, with a minimum 2-year follow-up and standardized pre- and postoperative photographs were included in this study. They were randomly divided in two groups: group 1, lipoabdominoplasty alone; group 2, lipoabdominoplasty and Renuvion. Both the patients and two of the authors measuring outcomes were blinded to the treatment methods. Postoperatively, all patients were administered the BODY-Q satisfaction with abdomen and appraisal of excess skin scales. Two independent plastic surgeons reviewed photographs, rating the outcomes on a 1-5 visual analog scale (VAS). Pinch test and ultrasound of the subcutaneous tissue were also performed.

Results: Seventy-six patients were enrolled, 33 males and 43 females, aged between 20 and 50 years. The BODY-Q satisfaction with abdomen scores were higher in group 2 in the 6-month (p = 0.007), 1-year (p = 0.021) and 2-year (p = 0.024) evaluations. The BODY-Q appraisal of excess skin scores were significantly higher in group 2 in the 6-month (p < 0.0001), 1-year (p < 0.0001) and 2-year (p < 0.0001) postoperative evaluations. The VAS scale reported higher scores in group 2 (p = 0.01). Ultrasound at 6 months postoperatively demonstrated lower subcutaneous thickness in group 2 (31 mm ± 2.8 SD) compared to group 1 (42 mm ± 1.4 SD) implying a faster edema reabsorption.

Conclusions: Data showed a significantly greater improvement of abdominal skin laxity in patients treated with Renuvion compared to those who underwent lipoabdominoplasty alone. This is the first prospective randomized study about Renuvion and lipoabdominoplasty and could be considered a pilot study.

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 .

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: Facial trauma repair requires precise reconstruction while preserving aesthetic units. Traditional local anesthesia can distort tissue planes and compromise surgical precision.

Methods: This prospective study evaluated landmark-based nerve blocks versus local infiltration for complex facial laceration repair in emergency settings from January 2022 through February 2023. A total of 162 patients were randomized to receive either landmark-based nerve blocks (n = 80) or traditional local anesthesia (n = 82). The nerve block group received targeted injections at anatomical landmarks, while the control group received traditional wound margin infiltration.

Results: The nerve block group demonstrated significantly reduced anesthetic volume (2.03 ± 0.82 mL vs. 4.94 ± 1.71 mL, p < 0.001), lower pain scores (median 2 vs. 5, p < 0.001), and better preservation of facial topography with reduced tissue distortion (0.6 ± 0.5 vs. 1.8 ± 0.7, p<0.001). Superior maintenance of anatomical landmarks (96.3% vs. 88.4%, p = 0.02), aesthetic subunit symmetry (94.8% vs. 87.2%, p = 0.03), and cosmetic junction line alignment (95.5% vs. 86.9%, p = 0.02) was observed in the nerve block group. Three-month POSAS scores showed better outcomes in the nerve block group for both observer and patient assessments (p < 0.01).

Conclusions: While some technical challenges exist with zygomaticofacial and zygomaticotemporal blocks, landmark-based nerve blocks represent an effective approach for complex facial laceration repair, offering improved surgical precision and patient comfort.

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: External volume expansion (EVE) devices has been demonstrated to enhance the survival of fat grafts. Decellularized adipose tissue (DAT) serves as a promising scaffold for adipose regeneration; however, the effectiveness of adipose regeneration in DAT remains limited, and the underlying mechanisms of its regeneration require further investigation.

Objective: This study explores the potential of EVE technology to enhance DAT-mediated adipogenesis by facilitating cellular recruitment and establishing a microenvironment conducive to adipose tissue regeneration.

Methods: DAT was injected into the dorsal area of rats, followed by daily treatment with an EVE suction device for 10 hours per day over 14 days. Control groups underwent transplantation without suction. After the treatment period, tissue samples were collected and analyzed. This included volume measurement, H&E staining, immunofluorescence staining for CD34, CD90, CD68, CD31, and perilipin, electron microscopy for microscopic analysis, and ELISA analysis for IL1, TNFα, CCL2, and CXCL12.

Results: Fourteen days post-transplantation, the volume of DAT significantly increased in the EVE group compared to the control group. Histological H&E staining revealed a higher peripheral region in the EVE group. Electron microscopy examination showed that EVE suction led to increased porosity in the DAT material, with a greater number of cells adhering to the material. Immunofluorescence staining for CD34/CD90 adipose-derived stem cells also showed a significant increase in the EVE group. The presence of CD68-positive macrophages increased after EVE suction. Evaluation of vascularization using CD31 staining showed a higher level of vascularization in the EVE group compared to the control group. ELISA analysis of IL-1, TNF-α, CCL2, and CXCL12 levels demonstrated that the EVE group effectively increased the levels of adipogenic factors within the DAT.

Conclusion: EVE enhances DAT-mediated adipogenesis by promoting stem cell recruitment, macrophage activation, and adipogenesis-related cytokine expression, ultimately improving the regeneration of functional adipose tissue.

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 .

Background: Perioral rejuvenation is challenging due to the lack of spatial anatomical understanding of the labiomandibular fold (LMF). The LMF's formation mechanism remains underexplored due to intricate relationships between musculature and subcutaneous structures. This study aimed to clarify the three-dimensional structures of the LMF using micro-computed tomography and histology.

Methods: Twenty-two rectangular specimens, following the LMF as the diagonal line, were retrieved bilaterally from eleven fresh frozen cadavers (mean age, 69.3 years). Eleven specimens were imaged with phosphotungstic acid contrast staining for micro-computed tomography, and the rest were histologically examined using Masson and Verhoeff-van Gieson staining. The LMF was divided into three equal-width regions for analysis.

Results: The LMF serves as a border between the lateral fat-abundant zone and the medial fat-scant zone statically. Dynamically, the LMF is accentuated with age by the downward pull of depressor muscles via a compact slanted collagen-elastin-muscle (CEM) network composed of the depressor anguli oris, platysma, and buccinator muscle fibers.

Conclusions: The LMF formation is governed by subcutaneous composition differences between the lower lip and cheek region and vertical dermal insertions of mimetic muscles. Perioral muscle contractions transmit directly at the skin via the CEM network, governing regional wrinkle severity and appearance. The micro-CT findings provide crucial three-dimensional insights into the layered architecture and intricate musculature correlation of the LMF region, providing regional-specific evidence for holistic rejuvenation practices.

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 .