Aesthetic Surgery Journal最新文献

Background: The advent of general-purpose large language models (LLMs) like ChatGPT (OpenAI, San Francisco, CA) has revolutionized natural language processing, but their applicability in specialized medical fields like plastic surgery remains limited due to a lack of domain-specific knowledge.

Objectives: This study aims to develop and evaluate PlasticSurgeryGPT, a dedicated LLM fine-tuned on plastic surgery literature, to enhance performance in clinical decision support, surgical education, and research within the field.

Methods: A comprehensive dataset of 25,389 plastic surgery research abstracts published between January 1, 2010, and January 1, 2024, was retrieved from PubMed. The abstracts underwent rigorous preprocessing, including text cleaning and tokenization. We fine-tuned the pre-trained GPT-2 model on this dataset using the PyTorch and HuggingFace frameworks. The performance of PlasticSurgeryGPT was evaluated against the default GPT-2 model using BLEU, METEOR, and ROUGE-1 metrics.

Results: The fine-tuned model, named PlasticSurgeryGPT, demonstrated substantial improvements over the generic GPT-2 model in capturing the semantic nuances of plastic surgery text. PlasticSurgeryGPT outperformed GPT-2 across BLEU, METEOR, and ROUGE-1 metrics, with scores of 0.135519, 0.583554, and 0.216813, respectively, compared to GPT-2's scores of 0.130179, 0.550498, and 0.215494.

Conclusions: PlasticSurgeryGPT represents the first plastic surgery-specific LLM, demonstrating enhanced performance in generating relevant and accurate content compared to a general-purpose model. This work underscores the potential of domain-specific LLMs in improving clinical practice, surgical education, and research in plastic surgery. Future studies should focus on incorporating full-text articles, multimodal data, and larger models to further enhance performance and applicability.

Background: Limited resources combined with an increasingly 'cost-conscious' approach to healthcare has resulted in a reduction of preoperative investigations that have been deemed unnecessary. While this approach may work in the hospital setting where ancillary services and emergency support are readily available, it may actually be impacting patient safety in the ambulatory surgery center (ASC) setting.

Objectives: The purpose of this study was to determine the prevalence of abnormal results arising from routine preoperative workup amongst patients undergoing aesthetic surgery in the outpatient ASC setting. The goal was to examine whether abnormal results led to alterations in care that otherwise would not have been made had the workup not been performed, and to outline patient factors associated with alterations in care.

Methods: A retrospective chart review was performed of 2,596 consecutive patients who underwent aesthetic surgery over a 40-month period at a single Canadian ambulatory surgery center. Data collected included patient demographics, procedural characteristics, and outcomes. Preoperative workups were categorized as either required (for patients with positive findings on medical history and/or physical examination) or supplementary (for otherwise healthy patients).

Results: A total of 2,581 patients met inclusion criteria for the study. The majority of patients were female (91.2%) and underwent breast surgery (60.3%). All patients underwent independent preoperative medical history and physical examination with bloodwork/screening. In total, 838 patients (32.5%) had abnormal bloodwork results while 240 (9.3%) had abnormal ECGs. These abnormal tests resulted in alterations in care for 242 patients (9.4% of total patients with 293 unique care alterations). Alterations in care included pharmacotherapy (n=104, 35.5%), additional investigations (n=78, 26.6%), specialist consultations (n=67, 22.9%), and postponement of surgery (n=44, 15.0%). Demographic variables associated with alterations in care included: age ≥50 (p<0.00001), female sex (p=0.0235), higher ASA class (p<0.00001), and preexisting medical comorbidities (p<0.00001).

Conclusions: Preoperative workups are an important factor for improving patient safety in outpatient aesthetic surgery. These investigations can uncover occult issues that may increase the risk of complications in the ASC setting.

Background: Transaxillary (TAA) approach offers breast augmentation (BA) with inconspicuous scarring. Previous investigations of scar outcomes have involved limited follow-up/samples, and no clinical studies have specifically addressed scars utilizing scar-specific instruments.

Objectives: The primary outcomes were axillary incision evaluation and complications.

Methods: We identified a cohort of patients who underwent TAA BA. Scar outcome was evaluated using the POSAS v2.0 at 1, 6- and 12-months study endpoints.

Results: The cohort contained 71 patients (mean age: 28.1±6.1 years) and 142 axillary incisions, with average follow-up of 58.3±28.6 months. Eleven patients (15.4%) experienced at least one complication, most frequently axillary banding (4.2%). Mean axillary incision length was 37.1 mm (range: 25-66 mm). Non-use of implant sleeves (p<0.001), textured-surface implants (p<0.001) and implant volume >350 cc (p<0.001) were associated with larger incisions. At 12 months the poorest scores were related to color (2.35,1-6), 81 and 78.2% of patient and observer opinion scores were low/intermediate grade, respectively. Textured-surface implants (p<0.001), implant volume>350cc (p<0.001), non-use of sleeve (p<0.001) were significant risk factors for high/very-high POSAS overall scores in one year follow-up.

Conclusions: Despite extensive research on BA procedures, studies on the TAA are limited and have not analyzed long-term incision-related outcomes. Our data demonstrate that the TAA is a reliable technique, and evaluations using the POSAS tool showed that most patients presented satisfactory results and higher satisfaction with lower POSAS scores at 1-year post-surgery. Adequate preoperative planning and incision placement allows surgeons to perform this technique safely while minimizing risks of poor scar outcome.

Artificial intelligence (AI) technologies are rapidly transforming the field of plastic surgery, offering new opportunities for improving patient outcomes through enhanced diagnostic capabilities, personalized treatment planning, and outcome prediction. However, the integration of these technologies into clinical practice requires navigation of complex regulatory frameworks established by the U.S. Food and Drug Administration (FDA). This review outlines the current FDA regulatory pathways relevant to AI applications in plastic surgery, including the 510(k), De Novo, and Premarket Approval processes. We discuss the FDA's Digital Health Center of Excellence, established in 2020, which serves as a central resource for developers of AI-based medical devices. The unique challenges of regulating adaptive AI technologies in plastic surgery are examined, with particular focus on the FDA's "total product lifecycle" approach and real-world performance monitoring requirements. We highlight the importance of Good Machine Learning Practices (GMLP) and the collaborative framework developed by FDA, NIST, and international regulatory bodies. For plastic surgeons and researchers developing AI tools, we provide practical recommendations including early FDA engagement, emphasis on algorithm transparency and explainability, and strategies for addressing bias in training datasets. By understanding and effectively navigating these regulatory requirements, plastic surgeons can successfully develop and implement safe, effective AI technologies that advance patient care while maintaining compliance with evolving FDA standards.

High-Intensity Focused Ultrasound (HIFU) has emerged as a non-invasive technology for aesthetic applications, offering skin tightening, facial rejuvenation, and body contouring. This systematic review assesses its clinical efficacy, safety profile, patient satisfaction, and future advancements. A comprehensive search of studies published between January 2010 and October 2024 identified 45 clinical trials and cohort studies meeting inclusion criteria, which focused on measurable outcomes such as wrinkle improvement and circumference reduction. HIFU demonstrated significant efficacy in skin tightening, particularly in the lower face, neck, and periorbital regions, with improvements in skin laxity ranging from 18% to 30%. For body contouring, studies documented a reduction in circumference between 2.5 cm and 4.5 cm, notably in the abdomen and thighs. Compared to mild surgical outcomes, HIFU provided effective non-invasive lifting with a favorable safety profile; fewer than 5% of patients reported transient erythema, swelling, or mild discomfort. Advances in HIFU technology, such as parallel-beam ultrasound, have improved treatment precision and patient comfort. While HIFU has demonstrated consistent results across different anatomical areas, standardization of treatment protocols remains a key challenge, particularly regarding optimal energy settings and patient selection criteria. Additionally, further research is needed to establish its long-term efficacy and explore its applications across diverse skin types. HIFU continues to be a promising alternative to surgical interventions, enhancing skin rejuvenation and body contouring with minimal downtime. Future investigations should focus on refining treatment protocols and integrating emerging technologies to optimize clinical outcomes.

Background: Rhinoplasty is a common cosmetic and functional procedure, aims to enhance nasal aesthetics and airway function. Dorsal preservation rhinoplasty is increasingly favored for its ability to preserve the natural anatomy of the nose while minimizing complications. This study seeks to identify ideal candidates for DPR by analyzing anatomical parameters that affect surgical outcomes.

Objectives: Aim of this study was to determine the suitability of patients for dorsum preservation surgery through preoperative radiological measurements.

Methods: A prospective observational study was conducted in the otorhinolaryngology department of a tertiary hospital, involving 43 patients undergoing high-strip dorsal preservation rhinoplasty. Preoperative and intraoperative CT scans were used to assess nasal anatomy, focusing on features like nasal bone length, radix root-to-nasal tip distance, and Kyphion angle. The Overall Surgical Success score was used to measure outcomes, calculated by subtracting complications, reoperations, and hospitalizations from a base score of 10.

Results: The cohort included 43 patients (6 males, 37 females), with a mean age of X ± Y. Intraoperative data revealed that 55.8% required hump rasping, and 27.9% had residual humps at six months.Positive correlation was found between longer radix root-to-nasal bone tip distances and lower OSS scores (r=0.31, p=0.043). Shorter nasal bones were associated with higher OSS scores (r=-0.45, p=0.002), while larger Kyphion angles correlated with lower success rates (r=-0.30, p=0.049).

Conclusions: Shorter nasal bones and lower Kyphion angles are associated with better outcomes in dorsal preservation rhinoplasty. Tailoring surgical techniques to individual anatomical features can improve both aesthetic and functional results, enhancing patient satisfaction.

Background: Excessive weight gain, aging-related skin laxity, and weakened digastric muscle contribute to the formation of submental fullness.

Objectives: This study aims to investigate the efficacy and safety of combined HIFES and Sync RF+ energies for submental volume reduction, and in addition to examine HIFES and Sync RF treatment's effect on fat volume in the cheeks area.

Methods: Thirty-three subjects (n=33) received 4 treatments once weekly, on the submental and cheek area. 2D and 3D photographs were taken at baseline, after the 4th treatment and at both follow-ups at 1 and 3 months post-treatment. The MRI scanning took place at baseline, and both follow-ups.

Results: The overall submental volume decreased by 25.12% at 1 month and 36.20% at 3 months. The submental fat decreased by 20.54% at 1 month, and by 30.37% at 3 months. The average volume reduction assessed using 3D photography evaluation was 3.48 ± 3.60 ml immediately after the 4th treatment, 5.39 ± 5.93 ml at 1 month, and 10.25 ± 5.40 ml at 3 months. The mean CR-SMFRS grade improved by 0.56 ± 0.42 after the 4th treatment, at 1 month by 0.85 ± 0.53, and at 3 months by 1.03 ± 0.50 points. 84.8% of subjects found the treatment comfortable and 93.9% were satisfied with the treatment results.

Conclusions: Study findings suggest this novel approach as a notable option for submental volume reduction, indicating HIFES and Sync RF+ technology is capable of aesthetic enhancement as well as skin and muscle improvement.

Background: Breast Implant Illness (BII) is a spectrum of symptoms some people attribute to breast implants. While causality remains unproven, patient interest has grown significantly. Understanding patient perceptions of BII on social media is crucial as these platforms increasingly influence healthcare decisions.

Objectives: The purpose of this study is to analyze patient perceptions and emotional responses to BII on social media using RoBERTa, a natural processing model trained on 124 million X posts.

Methods: Posts mentioning BII from 2014-2023 were analyzed using two NLP models: one for sentiment (positive/negative) and another for emotions (fear, sadness, anger, disgust, neutral, surprise, and joy). Posts were then classified by their highest-scoring emotion. Results were compared over across 2014-2018 and 2019-2023, with correlation analysis (Pearson correlation coefficient) between published implant explantation and augmentation data.

Results: Analysis of 6,099 posts over 10 years showed 75.4% were negative, with monthly averages of 50.85 peaking at 213 in March 2019. Fear and neutral emotions dominated, representing 35.9% and 35.6% respectively. The strongest emotions were neutral and fear, with an average score of 0.293 and 0.286 per post, respectively. Fear scores increased from 0.219 (2014-2018) to 0.303 (2019-2023). Strong positive correlations (r>0.70) existed between annual explantation rates/explantation-to-augmentation ratios and total, negative, neutral, and fear posts.

Conclusions: BII discourse on X peaked in 2019, characterized predominantly by negative sentiment and fear. The strong correlation between fear/negative-based posts and explantation rates suggests social media discourse significantly influences patient decisions regarding breast implant removal.

Upper blepharoplasty addresses aging-related changes by removing excess skin, muscle, and fat from the upper eyelids. This systematic review, which was registered a priori, improves upon previously published reviews regarding functional and aesthetic outcomes following upper blepharoplasty. Custom search strategies were applied across multiple databases, namely MEDLINE (United States National Library of Medicine, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), Google Scholar (Alphabet, Inc., Mountain View, CA), Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library, London, UK), Science Citation Index (Clarivate Analytics, Philadelphia, PA), PubMed (United States National Library of Medicine), and PsychInfo (American Psychological Association, Washington, DC). Bias was assessed with the Cochrane RoB 2 tool, and methodological quality was evaluated with GRADE. Out of 6799 articles, 12 randomized controlled trials with 450 patients (39 men, 411 women) were included. The meta-analysis showed significant reduction in dry eye symptoms post-upper blepharoplasty compared with preoperative status (odds ratio [OR], 0.22; 95% CI, 0.13-0.36; P < .00001). No significant difference in postoperative dry eye incidence was found between orbicularis oculi muscle plus skin excision and skin-only excision (OR, 1.55; 95% CI, 0.86-2.80; P = .25). However, muscle plus skin excision had a higher incidence of lagophthalmos (OR, 7.98; 95% CI, 1.41-45.21; P = .02). No significant differences were observed in eye irritation (OR, 1.21; 95% CI, 0.51-2.84; P = .66) or patient satisfaction (OR, 1.14; 95% CI, 0.42-3.14; P = .80). Continuous suturing techniques increased eye irritation compared with subcuticular suturing (OR, 1.77; 95% CI, 1.07-2.91; P = .03). All studies were high quality with a low risk of bias. The findings support upper blepharoplasty's efficacy in reducing dry eye symptoms, with muscle-sparing techniques minimizing lagophthalmos and maintaining high patient satisfaction.

Level of evidence: 3 (therapeutic):

Background: Rhinoplasty is a common facial plastic surgery (FPS) procedure for both functional and aesthetic indications. The use of 3D models has been reported as a potential method to provide hands-on training for learning rhinoplasty without jeopardizing patient care.

Objectives: The objective of this study was to develop and validate a novel model that can be used for rhinoplasty training.

Methods: The rhinoplasty models were designed and produced using proprietary 3D printing technology. Face and content validity were assessed during a rhinoplasty course involving 53 surgeons. Whilst, criterion validity was evaluated in a training session with 20 surgical residents, measuring improvements in surgical skills after using the 3D models with an objective structured assessment of technical skills (OSAT).

Results: All surgeons (n=53, 100%) stated that the rhinoplasty model aided in their learning and development. 91% (n=48) of surgeons rated the realism of the model as excellent or very good in comparison to cadaveric specimens. Assessment of criterion validity showed a statistically significant improvement in OSAT scores among surgical residents, increasing from a baseline of 11.7/40 (SD ± 1.80) to 21.6/40 (SD ± 1.79) post session (p < 0.0001).

Conclusions: The 3D rhinoplasty models showed good content, face, and criterion validity, objectively improving residents' surgical performance. Rhinoplasty 3D models could serve as a pre-cadaveric training adjunct, equipping trainees with fundamental skills before cadaveric dissection, or as a primary training modality in countries with limited cadaver access. Thus, the models offer an innovative approach to training the next generation of rhinoplasty surgeons.