Background: After the introduction of orbital septal fat release and reposition in transconjunctival lower blepharoplasty (TCLB), few studies have addressed the thorough release of orbital fat tissue to adequately augment the tear trough and midface concavity. Additionally, limited literature exists regarding residual or recurrent eye bags and corresponding preventive measures after fat release and repositioning in TCLB.
Methods: From December of 2021 to May of 2023, 105 patients were treated with the full integration and repositioning of orbital septal fat tissue (F.I.R.S.T.) technique in TCLB. This study observed the effectiveness of correcting tear trough deformity (TTD) and midcheek depression using the technique, and we have documented all complications, especially the residual eye bags.
Results: This mean age was 34 years (range: 19-54 years) with a mean follow-up of 13 months (range: 3-17 months). The average operation duration was 55 ± 7.1 minutes (range: 45-89 mins). Among the cases, 70 eyes (33.33%) had Grade I TTD, 92 eyes (43.8%) had Grade II TTD, and 48 eyes (22.9%) had Grade III TTD. Successful correction was achieved in all Grade I cases, with 75 eyes (81.52%) improving to Grade 0 among Grade II cases. For Grade III cases, 28 eyes (58.33%) improved to Grade 0. Our technique has significantly improved the tear trough area for nearly 2 mm. Only one patient complained about fat residual and no patients had relapses.
Conclusions: The F.I.R.S.T. technique effectively prevents fat residual in the lower eyelid area and provides favorable postoperative filling effects in the tear trough and midcheek region.
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: Auricular cartilage is widely used in rhinoplasty, but there are few studies on its biological changes after transplantation.
Objectives: This study investigated the biological transition of cartilage free grafts with and without perichondrium, aiming to provide some theoretical basis for the selection of nasal cartilage stent.
Methods: Spare auricular cartilage from 14 patients undergoing postoperative auricular cartilage augmentation was prepared into two with-/without-perichondrium cartilage pieces of approximately 5*5 mm, which were implanted into the loose connective tissue layer of the left and right sides of the back of the same nude mouse. The auricular cartilage tissues were harvested 2 months later.
Results: Two months after transplantation, there was no obvious resorption in the with-perichondrium group and a small part of the edge of the without-perichondrium group became dull. The number of chondrocytes before and after transplantation was statistically significant (F = 6.88, P < 0.05). After transplantation, the extracellular matrix of chondrocytes was strongly secreted, and the content of collagen fibers was not significantly changed, but the arrangement showed a tendency of disarrangement and rearrangement, which seems more obvious in the without-perichondrium group. There were significant changes in the expression of collagen II protein in the auricular cartilage matrix before and after transplantation (F = 3.41, P < 0.05).
Conclusion: Autologous auricular cartilage survived well for 2 months after free transplantation, but the internal microstructure changed. The quality of auricular cartilages with perichondrium after transplantation is better than without. The perichondrium can support and protect the transplanted cartilage, so it is advisable to retain perichondrium in clinical rhinoplasty.
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 .
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: To evaluate the effectiveness of bromelain on periorbital oedema, subconjunctival haemorrhage, and ecchymosis after preservation rhinoplasty.
Study design: Randomised, double-blind, placebo-controlled trial SETTING: Tertiary referral centre METHODS: In this double-blind clinical trial, participants aged 18-45 who were scheduled for open preservation rhinoplasty using the push-down technique and lateral osteotomy were recruited. Twenty-three cases were assigned to the placebo group and twenty-three to the experimental group Bromelain.
Results: Regarding gender, 17.39% (8 cases) were male, and 82.61% (38 cases) were female. Comparing the severity of left and right eye ecchymosis between groups at different times showed that bromelain was significantly effective on both sides on the 7th day (p = 0.012). Like ecchymosis, the results demonstrated that bromelain was also considerably effective on subconjunctival haemorrhage on the seventh day post-operatively (p = 0.015). However, the intensity of oedema between groups at different times did not significantly differ.
Conclusion: Bromelain increases serum fibrinolytic activity and decreases plasma fibrinogen levels. It is significantly more effective on subconjunctival haemorrhage and ecchymosis compared with the placebo on the seventh day in both eyes after rhinoplasty. Hence, this study indicates that bromelain is remarkably more effective than a placebo in reducing subconjunctival haemorrhage and ecchymosis.
Trial registration: Iranian Registry of Clinical Trials ID: IRCT20180519039720N2 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 .
Introduction: Patients who experience massive weight loss often face extensive circumferential truncal deformities, including buttock deflation. Body lift surgery is an effective method for regaining body shape, and concomitant gluteal augmentation addresses deformed buttocks. This study aimed to compare complication rates among different gluteal autoaugmentation techniques.
Methods: A total of 273 patients were operated on between 2019 and 2024. Of these, 185 patients with complete records and follow-up for at least 3 months were included in the study. The patients were divided into two groups: Those with a body lift with combined autoaugmentation and those without. In addition, the gluteal autoaugmentation group was divided into three groups according to the gluteal autoaugmentation technique: lipofilling, deepidermised fasciocutaneous island flap and deepidermised fasciocutaneous transposition flap groups.
Results: No major complications were recorded in either group. There was no statistically significant difference in complications between patients who underwent concomitant gluteal autoaugmentation and those who did not. The early complication rates in the lipofilling and transposition flap groups were statistically significantly higher than in the island flap group (p < 0.05), while the lipofilling and transposition flap groups did not show any statistically significant difference (p < 0.05).
Conclusion: Gluteal autoaugmentation with flaps is a safe procedure with minimal complication rates. Combining body lift surgery with gluteal augmentation techniques such as island or transposition flaps or lipofilling does not increase the risk of complications.
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: Globally, vegan and vegetarian diets have grown in popularity. At the same time, it is well-known that nutrition plays a critical role in postoperative outcomes, including wound healing. The present investigation undertakes a systematic scoping review of the current literature that explores the impact of vegan or vegetarian diets on wound healing.
Methods: The protocol followed PRISMA-ScR guidelines. PubMed, Web of Science, and Cochrane Library were used to identify articles published until 2024. Studies comparing any wound healing outcome between vegan or vegetarian patients and omnivorous patients were considered eligible. A two-stage screening process was conducted for study selection. Data extraction focused on the primary outcome-any wound healing outcome-and secondary outcomes, which included study general information, laboratory values, limitations, and future perspectives.
Results: Eight studies were included in this review. The majority of publications (87.5%) were prospective studies. Papers reported diverse wound healing outcomes after the following interventions: fractional microneedle radiofrequency, laser surgery, microfocused ultrasound, narrow-band ultraviolet B phototherapy, ultrapulsed CO2 resurfacing, excisional biopsy, skin graft, and photodynamic therapy. In almost all studies (87.5%) wound healing outcomes were statistically inferior in vegan or vegetarian patients compared to omnivorous patients.
Conclusion: Our results suggest that wound healing outcomes may be suboptimal in patients adhering to vegan or vegetarian diets, indicating that these dietary patterns might contribute adversely to the wound healing process. Future research is needed to understand better the underlying mechanisms and the potential implications in the preoperative assessment and postoperative course of these patients.
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 Table of Contents or the online Instructions to Authors www.springer.com/00266.
The modiolus is a critical anatomical structure in facial expressions and oral competence, serving as a hub where multiple muscles converge. Our recent cadaveric study has identified a previously unreported structure, the ligament of modiolus, aligning with the line of ligament between the modiolus and its adjacent muscular and fascial attachments. This novel finding offers new perspectives on the anatomical organisation of the perioral region and its functional significance. Importantly, it has been identified as a false ligament rather than a true ligament, originating from the modiolus and extending to the dermal layer. The discovery has potential implications for aesthetic and reconstructive procedures involving the midface and oral commissures. Here, we present our findings and discuss their relevance to facial anatomy, surgical approaches, and clinical outcomes.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 .
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