Aesthetic Surgery Journal最新文献

Background: The emergence of acellular dermal matrices (ADMs) revolutionized prepectoral breast reconstruction, allowing partial or complete implant coverage. ADM had been described to possess several important benefits; nevertheless, the literature described an increased postoperative complication rate.

Objectives: The aim of this study was to delineate H.Y.K.'s experience with ADM in direct-to-implant (DTI) breast reconstruction, and to describe complication rate and patient satisfaction.

Methods: This was a retrospective patient cohort that underwent primary or revisional breast reconstruction (DTI) utilizing DermaCell, from Jan 2017 to Jan 2024.

Results: A total of 230 consecutive patients, 410 breasts, and 801 DermaCell sheets were evaluated. All were DTI breast reconstructions. Complication rate was described per breast. A total of 92 cases of complication occurred (22.4%). Rippling was seen in 18 breasts (4.39%), skin ischemia in 21 breasts (5.12%), hematoma in 5 (1.21%), and seroma in 9 (2.19%). Seventeen breasts experienced capsular contraction. In the nonirradiated group, capsular contracture (CC), Baker grade 3 to 4, was seen in 4 breasts (1.11%), with 9 (18%) in the irradiated group. The postoperative follow-up period was 18 months (range: 6-84 months). BREAST-Q satisfaction with the breast increased by a mean of 10.45. Satisfaction with the implant was 6.61 out of 8.

Conclusions: This cohort study represents the most comprehensive and up-to-date experience with DermaCell for DTI breast reconstructive surgery. The favorable complication profile suggests that DermaCell ADM offers a safe and reliable option, making it an important tool in the armamentarium of reconstructive plastic surgeon. DermaCell is an important component in prepectoral breast reconstruction, contributing to better results, an improved complication profile, and patient satisfaction.

Level of evidence: 4 (therapeutic):

Background: Breast cancer is a prevalent cancer worldwide, leading many women to undergo mastectomy and breast reconstruction surgery. Nipple-areolar complex (NAC) reconstruction is critical in achieving aesthetic and psychological satisfaction. Recently, 3-dimensional (3D) NAC tattooing has become an option for this purpose.

Objectives: The aim of this study was to evaluate patient-reported outcomes for satisfaction among Hispanic women who underwent NAC reconstruction with 3D tattooing after breast reconstruction.

Methods: Data were collected from a retrospective database covering a number of academic settings between 2014 and 2024. Participants were Hispanic women aged 32 to 60 years who had undergone various NAC reconstruction techniques. Follow-up was conducted no more than 6 months after surgery, utilizing the BREAST-Q version 2.0 questionnaire to measure satisfaction in 2 groups: Group 1, in which patients received alternative NAC reconstruction methods; and Group 2, which received 3D NAC tattooing.

Results: Patients who underwent 3D NAC tattooing (Group 2) demonstrated increased psychosocial well-being, with a mean [standard deviation] score of 84.73 [8.56]. Regarding surgeon experience, Group 2 achieved a mean score of 86.21 [10.33], which was lower than the Group 1 mean of 88.70 [10.78]. Notably, Group 2 expressed greater satisfaction with nipple reconstruction, with a mean score of 3.73 [0.44] compared with the Group 1 mean score of 3.48 [0.65].

Conclusions: The findings indicate that 3D NAC tattooing may enhance aesthetic outcomes of the NAC and psychosocial well-being in Hispanic women. This highlights the importance of incorporating unique techniques in breast reconstruction and the need for a multidisciplinary approach.

Level of evidence: 4 (therapeutic):

Background: Efforts in brow lifting longevity, desire for minimally invasive procedures, patient individualization, and minimization of complications led to the development of the gliding brow lift (GBL). The GBL has proven to be a successful, minimally invasive technique targeting brow elevation in combination with the hemostatic net.

Objectives: The aim of this study was to evaluate maintenance of cutaneous brow elevation with the GBL technique at specific postoperative time points.

Methods: A retrospective review was conducted of 63 patients (59 females, 4 males) who underwent a GBL by J.C.G. between 2019 and 2022 for comorbidities, maintenance of brow lift, and incidence of complications at 4 postoperative time points: 3, 6, 9, and 12 months. Preoperative and postoperative photographs were analyzed at 4 anatomic locations: the supraorbital rim, lateral canthus, midpupil, and medial canthus.

Results: The cohort consisted of 59 female-only patients; male patients were excluded due to small sample size. The average age was 62.8 years old (SD ±7.01) and the mean BMI was 24. Only 1 patient required return to the operating room for hematoma evacuation; this was a result of a concomitant rhytidectomy and did not involve the brow. All locations maintained a statistically significant lift (P < .01). The most significant lift was at the lateral canthus (3.09 mm) and tail of the brow (2.74 mm) at 1 year postoperatively.

Conclusions: The GBL is a successful innovation in aesthetic brow surgery. Depending on patient needs, it is an excellent choice for selective and long-term elevation of the lateral brow.

Level of evidence: 4 (therapeutic):

Background: Two randomized, double-blind, placebo-controlled, Phase III studies of incobotulinumtoxinA for treating upper facial lines (UFLs; ie, a combination of glabellar frown lines [GFLs], horizontal forehead lines [HFLs], and lateral canthal lines [LCLs]) were conducted in the United States (ULTRA I: NCT04594213) and Germany (ULTRA II: NCT04622254).

Objectives: The aim of this study was to evaluate the safety and efficacy of simultaneous intramuscular injections for UFLs. Longer-term safety and efficacy were assessed in open-label extension periods.

Methods: Healthy participants (≥18 years) with moderate-to-severe GFLs, HFLs, and symmetric LCLs at maximum contraction on the 5-point Merz Aesthetics Scales were randomized 2:1:1 to receive up to 64 units of incobotulinumtoxinA in the main period for each trial. Treatment groups were: UFLs, GFLs, and HFLs (ULTRA I), LCLs (ULTRA II), and placebo. Primary efficacy endpoints were the proportions of GFL, HFL, and LCL responders, defined as a Merz Aesthetics Scale score for the respective area of 0 (no) or 1 (mild) and a ≥2-grade improvement from baseline to Day 30, as assessed by both investigator and participant.

Results: Overall, 362 and 368 participants received treatment in ULTRA I and ULTRA II, respectively. In both studies, incobotulinumtoxinA treatment was significantly more effective than placebo with respect to the primary endpoints (P < .0001) and key secondary endpoints (P < .0001). The open-label extension period results were consistent with those seen in the main period. No new safety findings were identified.

Conclusions: In ULTRA I and ULTRA II, the safety and efficacy of incobotulinumtoxinA for the simultaneous treatment of moderate-to-severe UFLs were demonstrated, with significant improvements across all primary and secondary endpoints vs placebo.

Level of evidence: 1 (therapeutic):

Background: Tuberous breast (TB) is a congenital anomaly characterized by morphological, structural, and breast region alterations. The pectoralis major muscle (PMM) is crucial for correction when placing breast implants. Alterations at this level have received little attention in the literature.

Objectives: In this study we aimed to define the anatomical characteristics of the PMM in TB patients with radiomics data extracted from MRI sequences.

Methods: The PMMs of 30 TB patients and 30 controls were analyzed by manual segmentation with 3D-Slicer v.5.4.0 software and radiomics techniques. A total of 46 features were extracted, both first-order statistical features and shape features (eg, median, mean, standard deviation, volume, area, centroid, number of voxels, flatness, roundness, elongation, principal axis length x, y, z, diameter).

Results: A statistically significant difference was found in favor of the TB group for PMM roundness; PMM elongation was greater in the TB group. Principal axes 1, 2, and 3 were analyzed in the 3 planes x, y, and z. In the TB group, principal x axis 3 was lower than in the control group. Also, between the axes, principal z axis 2 was on average higher in the TB group than in the non-TB group.

Conclusions: These results provide the first quantitative evidence of alterations affecting the PMM in TB patients. These differences were found in different planes and volumetric shape features, with potential surgical implications.

Level of evidence: 4: (Therapeutic).

Background: Microfocused ultrasound with visualization (MFU-V) and hyperdilute calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) dermal injections are effective for improving skin laxity in the lower face and submentum by stimulating neocollagenesis and neoelastogenesis.

Objectives: Combining these treatments in an optimal order may inform best practice in aesthetic dermatology. Despite their frequent concurrent use, no study has evaluated the impact of treatment order. This study aimed to determine the optimal sequence for administering MFU-V and hyperdilute CaHA-CMC.

Methods: Twelve healthy women aged 35 to 65 years were randomized into 2 groups. Group A received MFU-V followed by hyperdilute CaHA-CMC 6 weeks later, while Group B received the treatments in the opposite order. Evaluations included histological assessments, aesthetic outcomes, and safety measures.

Results: Group A showed greater improvements in subjective Global Aesthetic Improvement Scale, investigator Global Aesthetic Improvement Scale, and FACE-Q Patient-Perceived Age visual analog scale scores. Both groups exhibited similar improvements in FACE-Q Satisfaction with Lower Face and Jawline scores. Histologically, both groups demonstrated significant elastin production at the 120-day follow-up. Group A showed a 143% relative increase in elastin coverage, compared with a 63% increase in Group B. Consequently, Group A exhibited superior qualitative and histologic improvements.

Conclusions: Administering MFU-V first, followed by hyperdilute CaHA-CMC 6 weeks later, is the optimal sequence for this combination therapy. Although both groups experienced increased elastin synthesis and aesthetic improvements, the order of treatments significantly impacted the outcomes, favoring the sequence used in Group A. This finding provides valuable insight for optimizing combination therapies in aesthetic dermatology.

Level of evidence: 4 (therapeutic):

Background: A range of cosmetic treatments to improve skin quality of the décolletage are available. To measure outcomes from the patient perspective, a rigorously developed patient-reported outcome measure (PROM) is needed.

Objectives: The aim of this study was to develop and validate the BODY-Q Décolletage scale.

Methods: Appearance-related codes from BODY-Q concept elicitation interviews were re-examined and 13 items drafted and refined through qualitative interviews with patients and clinicians. The scale was tested in an online international sample of women aged ≥25 years who had previously received a treatment for the décolletage, or in the past 12 months had received a cosmetic treatment at a plastic surgery or dermatology clinic. Data were analysed with both Rasch measurement theory and classical test theory. Construct validity involved testing 20 hypotheses. Convergent validity tests included correlations between the décolletage scale and other BODY-Q scales and the SKIN-Q.

Results: Interviews conducted with 15 patients and 5 clinicians led to a 16-item scale with items that covered scenarios (mirror, photographs, low neckline, lay on side, breasts together, arms crossed, get up, up close), comparisons (with other people), age concerns (youthful, age), qualitative concerns (attractive, healthy), skin tone (even-colored), and texture (smooth, texture). The field test included 334 participants. An item with poor fit to the Rasch model was dropped. Data for the remaining 15 items fit the Rasch model (χ2 = 76.72, df = 60, P = .07). All items had ordered thresholds and good item fit. All reliability statistics were >0.93. A total of 19 of 20 predefined hypotheses (95%) were met, providing evidence of construct validity.

Conclusions: The BODY-Q Décolletage scale is available to incorporate the perspective of patients into clinical care and clinical trials of minimally invasive treatments to improve skin quality.

Microfocused ultrasound with visualization (MFU-V) is an advanced, noninvasive cosmetic procedure widely performed for skin lifting and tightening. We performed a systematic review and meta-analysis to evaluate the aesthetic effectiveness, patient satisfaction, skin quality, and safety profile of MFU-V treatment. A comprehensive search of 5 bibliographic databases up to 2023 was conducted. Pooled effect estimates with random effects models and corresponding 95% confidence intervals were calculated. Out of 4019 references, 42 studies were included. Meta-analysis showed 89% of patients (95% CI: 81%-94%; I2: 63%, n = 411) demonstrated some degree of global aesthetic improvement, as assessed by investigators. Similarly, 84% of patients (95% CI: 73%-91%; I2: 64%, n = 312) reported improvement following treatment. Satisfaction of any level was reported by 84% of patients (95% CI: 61%-94%; I²: 52%, n = 326), and 62% (95% CI: 37%-82%; I²: 3%, n = 172) when "neutral" as a response option was provided for patients. Skin quality (eg, wrinkles, texture) also improved. Patients reported a pooled mean pain score of 4.85 (95% CI: 4.35, 5.35; I2: 97%, n = 785), indicating moderate pain. Common adverse events included erythema, edema, swelling, bruising, and tenderness, all of which were generally mild to moderate in severity. Overall, our analysis demonstrated a notable increase in global aesthetic improvement and patient satisfaction following MFU-V treatment, accompanied by moderate pain and a generally favorable safety profile. However, the potential misclassification of neutral responses as positive may result in an overestimation of the treatment's efficacy. These findings highlight the need for well-designed trials to further explore MFU-V's clinical applications.

Level of evidence: 3 (therapeutic):