Aesthetic Surgery Journal最新文献

Background: Complications after body-contouring surgery are a field of great interest. Recognition of patient-related characteristics contributing to a greater risk for complication is of the utmost importance in improving the quality of care and safety profile of aesthetic procedures. Previous history of cesarean section (CS) and its impact on adverse events after abdominoplasty has yet to be investigated and defined.

Objectives: Our objective was to evaluate the effect of previous cesarean section on the risk for adverse events in abdominoplasty.

Methods: The medical records of 746 eligible patients were reviewed, and relevant information was extracted. Stratification of patients based on a previous history of CS was followed by statistical analysis of differences between the groups. Relevant regression models were implemented to further understand the data.

Results: Seven hundred forty-six patients were included in the study, of which 308 (43.1%) had history of CS delivery. The group did not differ in baseline demographic and surgical details, except for a greater hemoglobin level in the non-CS patients (P = .007). Analysis of complication rates revealed a statistically significant increase in the risk for seroma development in the group of patients with a history of CS delivery (P = .031), which correlated to a 65% increase in the risk for complications (odds ratio = 1.65, 95% CI 1.07-2.56).

Conclusions: A medical history of CS increases the risk for seroma development in the postoperative period following abdominoplasty. Several potential pathogenic mechanisms exist, and further prospective research is needed to further characterize the association.

Level of evidence: 3:

Background: Venous thromboembolism (VTE) is the most dangerous complication of abdominoplasty. One relatively undefined risk factor is plication, which in theory increases VTE risk.

Objectives: The aim of this study was to assess the thromboembolic risk of plication.

Methods: A retrospective review of 1370 consecutive abdominoplasties by 1 surgeon was undertaken. Two groups were considered, plicated (n = 1089) and nonplicated (n = 281) patients, and VTE rates were compared between these groups.

Results: There were 25 of 1089 cases of VTE (2.3%) in plicated patients and 1 of 281 cases of VTE (0.36%) in nonplicated patients, which was statistically significant (Fisher's exact test, P = .028) despite the nonplicated group being a higher-risk population. Case-control matching yielded 225 pairs which differed statistically only by the presence or absence of plication; there were 12 of 225 (5.3%) VTE events in the plicated group and 0 of 225 in the nonplicated group (McNemar's test, P = .0015). Logistic regression demonstrated increased VTE risk with increasing age (odds ratio [OR] 1.08, P < .001), BMI (OR 1.34, P = .002), Caprini score (OR 2.17, P < .001), and especially plication (OR 16.76, P = .008). Adding 2 points for plication to Caprini scores offered better risk stratification at a level of 7, with an improved combination of sensitivity and specificity (0.31/0.98 vs 0.69/0.96) and a 27% improvement over the 2005 Caprini risk assessment model (RAM) in the area under a receiver operating characteristic curve (0.826 vs 0.651, Z value -3.596, P = .003).

Conclusions: Plication was shown to be a powerful risk factor for the development of VTE in abdominoplasty. Abdominal wall plication should be considered in risk assessment, and scoring for plication may improve the performance of the Caprini RAM.

Level of evidence: 3:

Background: Injectable poly-D,L-lactic acid (PDLLA), under the brand name of AestheFill (REGEN Biotech, Inc., Seoul, South Korea), is a biocompatible, biodegradable, and biostimulatory product utilized to correct soft tissue volume loss. Its efficacy and safety have not been fully studied in a large cohort.

Objectives: The aim of the study was to evaluate the efficacy and safety of a novel dermal filler injectable, poly-D,L-lactic acid.

Methods: This was an evaluator-blinded, multicenter, randomized controlled trial to compare the efficacy and safety of PDLLA vs hyaluronic acid in the correction of the nasolabial fold. Two hundred and sixty patients with moderate to severe nasolabial folds were enrolled and randomized to the treatment group (PDLLA) or control group (hyaluronic acid). Each patient received a PDLLA or hyaluronic acid injection for nasolabial fold augmentation and was followed for 52 weeks. The Wrinkle Severity Rating Scale (WSRS) and Global Aesthetic Improvement Scale (GAIS) were applied to evaluate topical nasolabial fold augmentation and overall improvement, respectively.

Results: At 24 weeks, 67.6% of patients in the PDLLA group had an at least 1-grade improvement on the WSRS, compared to 60.9% of patients in the control group with an at least 1-grade improvement on the WSRS (P < .05). At each visit, the PDLLA group showed more improvement on the baseline WSRS than the control group. PDLLA was safe and well tolerated, with no severe adverse events.

Conclusions: PDLLA shows noninferior efficacy in correcting nasolabial folds compared to hyaluronic acid.

Level of evidence: 2 (therapeutic):

Background: RelabotulinumtoxinA (RelaBoNT-A, Galderma, Uppsala, Sweden) is an innovative, ready-to-use liquid botulinum toxin A, produced with PEARL (precipitation-free extraction and activity-preserving refined liquid) manufacturing technology, which yields a potent, complex-free formulation.

Objectives: In the READY-1 study, efficacy and safety outcomes following a single RelaBoNT-A treatment for glabellar line correction were examined.

Methods: Adults with moderate to severe glabellar lines received RelaBoNT-A (50 U) or placebo in a 3:1 randomized, 6-month, phase 3, multicenter, double-blind study. Primary endpoints (examined at Month 1, maximum frown) comprised the composite ≥2-grade response, defined as ≥2-grades improvement from baseline on concurrent investigator (glabellar line investigator live assessment; GL-ILA) and participant (glabellar line subject live assessment; GL-SLA) severity scales (US endpoint), and the investigator-reported responder rate for participants scored as 0 (none) or 1 (mild) (GL-ILA scale only; EU endpoint). Participant satisfaction and treatment-emergent adverse events (TEAEs) were reported.

Results: Overall, 297 adults were randomized and treated. Month 1 composite ≥2-grade responder rate was 82.9% (RelaBoNT-A, n = 199) vs 0% (placebo, n = 67; P < .001). Month 1 investigator-reported none or mild responder rate was 96.3% (RelaBoNT-A) vs 4.5% (placebo; P < .001). GL-ILA scores remained higher with RelaBoNT-A (23.6% [none or mild]; 58.1% [≥1-grade improvement]) vs placebo (1.5%; 10.4%, respectively) through Month 6 (P < .001). In the Kaplan-Meier analysis, 75% still showed GL-ILA and GL-SLA improvements from baseline at 169 days (end of study). Participants reported onset of effect from Day 1 (39%) and satisfaction with natural-looking results (96.8%; Month 1). RelaBoNT-A-related TEAEs were low (3.6%) and typically mild.

Conclusions: A single RelaBoNT-A treatment was effective and demonstrated a favorable safety profile. RelaBoNT-A provided significant improvements in glabellar line severity, high satisfaction, rapid onset, and enduring effectiveness throughout the 6-month study period.

Level of evidence: 1:

Background: Over the past decade, the use of poly-4-hydroxybutyrate (P4HB) in aesthetic breast surgery has grown in popularity. Published data on long-term outcomes, however, is scarce.

Objectives: The purpose of this study was to assess long-term outcomes with utilization of P4HB in various aesthetic breast procedures.

Methods: A retrospective review of all patients undergoing breast procedures with P4HB was performed by the senior author between July 2012 and March 2022. All patients with greater than 1 year of follow-up were evaluated, including demographics, surgical indications, complications, secondary procedures, and patient satisfaction. A Kruskal-Wallis test was performed to assess the stability of satisfaction over time.

Results: A total of 248 patients were evaluated. The mean follow-up length was 2.9 years (range, 1-9.3 years). The most common surgical indication was breast ptosis, which comprised 68% (n = 167) of patients. The overall complication rate was 8.0% (n = 20), with an unplanned reoperation rate of 2.8% (n = 7). Across the entire study population, the mean satisfaction score was 3.42 out of 4. When satisfaction scores were compared to follow-up length, Kruskal-Wallis test demonstrated no statistical differences (H = 18.2, P = .89, degrees of freedom [df]= 2), suggesting stability of satisfaction over time.

Conclusions: This study presents the senior author's entire experience with P4HB across a wide range of aesthetic breast procedures. With an average follow-up length of almost 3 years, P4HB appears to be a both safe and effective tool to support soft tissue in aesthetic breast surgery. Further, high patient satisfaction appears stable.

Level of evidence: 4:

Background: Cosmetic breast surgeries such as augmentation, mastopexy, and reduction are common aesthetic medical procedures for enhancing physical appearance. Despite their popularity, the influence of these surgeries on subsequent breast reconstruction for cancer patients remains underexplored.

Objectives: In this study we sought to investigate the effects of previous cosmetic breast surgeries on the outcomes of breast reconstruction.

Methods: A retrospective chart review was conducted from January 2011 to May 2023. This analysis compared patients with histories of implant augmentation, breast reduction, mastopexy, and augmentation mastopexy with those receiving reconstruction without any cosmetic surgery history. Demographics, comorbidities, complications, revisions, and BREAST-Q surveys were collected. Statistical analysis was performed with SPSS, with significance set at P < .05.

Results: The study included 124 patients (50 autologous, 74 implant) with a history of cosmetic breast surgery (102 implant augmentations, 17 breast reductions, 5 mastopexies, and 9 augmentation mastopexies). They were analyzed in comparison with 1307 patients (683 autologous, 624 implant) without previous cosmetic breast surgery. Patients with previous cosmetic surgeries showed a higher incidence of hematoma with tissue expander placement. A preference for implant-based reconstruction was more common among patients with an augmentation history (P < .001), whereas autologous reconstruction was more common in those with a history of breast reduction (P = .047). Patients with a history of breast augmentation had on average significantly more breast revisions (P < .05).

Conclusions: In this study we demonstrate a significantly higher hematoma rate and number of revisions in patients with previous cosmetic breast surgery when compared to patients without a history of cosmetic surgery. Furthermore, we suggest that types of cosmetic breast surgery influence the decision-making process regarding implant vs autologous reconstruction.

Level of evidence: 4:

Background: A diagnosis of breast cancer has a significant impact on a patient's physical and emotional health. Breast reconstruction improves quality of life and self-esteem following mastectomy. However, many patients undergo additional elective revision procedures after reconstruction.

Objectives: The aim of this study was to assess the relationship between perioperative emotional well-being and elective revisions in breast reconstruction.

Methods: A retrospective review was performed of patients who underwent breast reconstruction with a single surgeon between January 2007 and December 2017. Revision procedures were defined as additional operations that fall outside the index reconstructive plan. Medical records were reviewed for a history of generalized anxiety disorder (GAD) and/or major depressive disorder. Multivariate analysis was performed to identify factors associated with revision.

Results: A total of 775 patients undergoing breast reconstruction were included, of whom 121 (15.6%) underwent elective revision. Overall, a history of any psychiatric history (P < .001), depression alone (P = .001%), and GAD and depression together (P = .003) were significantly associated with revision surgery. On multivariate logistic regression controlling for comorbidities and reconstruction modality, depression alone, and GAD and depression together were significantly associated with an increased likelihood of revision surgery (odds ratio, 3.20, P < .001; odds ratio, 2.63, P < .001).

Conclusions: Perioperative emotional well-being and reconstruction modality impact the rate of secondary revision surgery. An understanding of the surgical and patient-related risk factors for revision can provide more informed patient-decision making and improve surgical planning.

Level of evidence: 3: