Aesthetic Plastic Surgery最新文献

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 .

Background: Removal of the skin and preseptal orbicularis oculi is the initial step in upper eyelid surgery. Preseptal orbicularis oculi removal has been strongly associated with dry eye symptoms due to sluggish eyelid closure and lagophthalmos. We aimed to investigate the effects of concurrent upper blepharoplasty and external levator advancement (ELA) surgery with or without orbicularis oculi resection on dry eye syndrome and eyelid morphology in Southeast Asian populations.

Methods: This prospective, single-centre, double-blind, randomised controlled trial involved 20 Thai patients (40 eyes) with aponeurotic blepharoptosis and excess eyelid skin undergoing combined upper blepharoplasty and ELA surgery. Patients were randomised into a skin-muscle excision group (group A) or a skin-only excision group (group B). Dry eye parameters including tear break-up time, Oxford ocular surface staining, Ocular Surface Disease Index, eyelid appearance, and patient satisfaction were evaluated preoperatively and on postoperative days 7, 30, and 90.

Results: Preseptal orbicularis oculi excision had no statistically significant impact on dry eye parameters, eyelid appearance, or patient satisfaction. For both groups, surgery increased the marginal reflex distance 1 without causing significant lagophthalmos, indicating successful ptosis correction irrespective of muscle excision. There were no discernible differences in postoperative appearance between the two groups, and the patients reported high satisfaction with their treatment.

Conclusions: Combined upper blepharoplasty and ELA surgery, with or without resection of the preseptal orbicularis oculi, may be a safe and potentially effective procedure for patients with aponeurotic blepharoptosis and excess eyelid skin. Our findings demonstrate no evidence of a difference in correlation between either of these techniques and postoperative dry eye parameters or eyelid appearance. Further studies with larger sample sizes and longer follow-up periods are warranted.

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: Lower eyelid aging manifests as several distinct issues, including tear trough deformities, eye bags (with or without skin laxity), and infraorbital dark circles. As lower eyelid aging represents a complex and multifactorial problem, the current approaches, relying on a single surgical technique or injection of single product, often yield unsatisfactory results. The present study describes a simplified strategy utilizing fat derivatives transplantation: the Pyramidal Multi-type, Multi-method, and Multi-layer (3M) strategy. This approach achieved favorable outcomes by simultaneously addressing all these lower eyelid aging problems.

Methods: This study included 53 patients (106 sides), with a median follow-up of 15.5 months (range from 6 to 24 months). All patients received Pyramidal 3M fat grafting for lower eyelid aging by deep transplantation of macrofat, superficial transplantation of microfat or microfat/superficial enhanced fluid fat (SEFF), and subdermal transplantation of nanofat or stromal vascular fraction (SVF). We retrospectively analyzed the histories and photographs of patients who underwent Pyramidal 3M fat grafting for lower eyelid aging. Patients were followed up before and 6 months after the treatments by modified Goldberg scale and subject satisfaction assessment (SSA) scale.

Results: Only mild adverse effects such as mild edema and transient ecchymosis were observed, occurring in 3.8% of patients. More severe complications like infections, calcification, fibrosis, fat liquefaction, visible grafts, occlusion of the ophthalmic artery, or vision loss were not encountered in any participants. 11 patients (22 sides) underwent revision surgery 3-6 months after the initial procedure due to suboptimal outcomes. Both the Goldberg scale and SSA scale demonstrated statistically significant improvements to varying degrees.

Conclusion: The Pyramidal 3M autologous fat grafting strategy provides a convenient, effective, and safe solution for infraorbital rejuvenation in middle-aged patients, with rapid recovery. This technique effectively addresses tear trough deformities, mild eye bags (without skin laxity), and dark circles.

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 .

This paper is a response to the paper "Breast Implant Illness, Outcomes with Explantation, and Potential Etiologies, a Systematic Review and Meta-Analysis". There are scientific inconsistencies and misleading statements in this paper that we felt needed to be addressed.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 resident aesthetic clinic is a practice in which plastic surgery residents oversee patient care, thereby gaining autonomy and hands-on experience in cosmetic surgery.

Objective: This study evaluates outcomes of resident-led cosmetic breast surgeries in a resident aesthetic clinic compared to attending-led procedures.

Methods: A retrospective analysis was conducted of patients who underwent cosmetic breast surgery at a single institution's resident clinic from 2012 to 2021. Resident-led cases were matched with attending-led cases, and comparisons in demographic information, procedure type, operation details, follow-up, re-operations, and complications were performed.

Results: Among 134 female patients at a resident aesthetic clinic, 27 (20.1%) underwent breast augmentation, 7 (5.2%) had mastopexy, and 12 (9.0%) received augmentation mastopexy, with a matched control group of attending-led cases. Residents favored silicone implants and inframammary incisions, while the attending preferred saline implants and peri-areolar incisions (p < 0.001). For breast augmentation, complication rates for breast augmentation were similar between residents and attendings (18.5% vs. 11.1%, p = 0.704), with identical re-operation rates (11.1%; p = 1.000). In mastopexy, residents had no complications, while attendings had a 25% complication rate (p = 0.467). In augmentation mastopexy, complication rates were 25.0% for residents and 33.3% for attendings (p = 0.500), with lower re-operation rates in residents (0.0% vs. 16.7%, p = 0.238).

Conclusion: Resident-led cosmetic breast procedures demonstrate comparable safety outcomes to attending-led surgeries, supporting the efficacy of resident training in aesthetic surgery and highlighting the importance of resident-led clinics in surgical education.

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: A novel minimally invasive surgical technique is proposed to treat the contour of the lower face, jowls and upper neck. The procedure is mainly used in patients who wish to undergo less extended surgery, with minimal scarring and less downtime.

Methods: In the described technique, a V-shaped incision is made between the middle of the tragus and the insertion point of the posterior auricular muscle at the back of the auricle. The incision goes around the earlobe. The skin in a radius of 4 cm around the earlobe is undermined with Metzenbaum or Solz scissors. The platysma below the mandibular angle is also undermined 3-4 cm. Then, we plicate the superficial musculoaponeurotic system (SMAS) with permanent sutures. The excess skin is excised, and the final skin sutures are made. No drains are placed.

Results: The technique was successfully applied to 132 consecutive patients over a period of 2.5 years. There was no downtime, no pain and no facial edema after the operation in the majority of the patients. No major complications occurred during the follow-up period. The satisfaction of most patients was extremely high. A follow-up of at least 2 years after the operation indicates the long-lasting results of the operation.

Conclusion: The authors present a simple, effective and safe approach to correct soft tissue ptosis and skin laxity in the lower third of the face and upper neck. General anesthesia is not required, there is no downtime, patient discomfort is minimal, there are very few complications and the results are satisfactory.

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: Microvascular fragments (MVFs) are intact vascular segments derived from adipose tissue that possess considerable potential for promoting tissue vascularization in regenerative medicine. However, conventional single-step enzymatic digestion methods often lead to incomplete adipose tissue dissociation and poor MVF quality.

Methods: We developed and validated a sequential enzymatic digestion protocol optimized for isolating MVFs from human lipoaspirate. Adipose samples were processed using either a conventional one-step collagenase digestion or a three-step sequential method. MVFs were evaluated for yield, viability, structural integrity, cellular phenotype, and angiogenic function both in vitro and in vivo.

Results: Compared with the conventional approach, the sequential protocol produced a 2.2-fold increase in MVF yield and significantly reduced undigested tissue residues (p < 0.0001). MVFs isolated by the sequential protocol showed superior cell viability (93.3% vs. 75.6%), a greater proportion of long fragments, preserved endothelial and perivascular architecture, and enhanced angiogenic performance in collagen gel assays and mouse subcutaneous implantation models.

Conclusions: This optimized sequential digestion protocol enables the efficient and producible isolation of high-quality MVFs from human adipose tissue. It holds great promise for applications in vascularized tissue engineering and regenerative therapies.

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 .