Aesthetic Surgery Journal最新文献

The advent of artificial intelligence (AI)-generated transformation videos, primarily utilizing models like Kling 2.1 (Kuaishou Technology, Beijing, China), represents a paradigm shift in the presentation of before-and-after results in aesthetic plastic surgery. These hyper-realistic animations interpolate between authentic preoperative and postoperative photographs, creating dynamic visualizations that significantly enhance social media engagement, algorithmic visibility, and patient comprehension of potential outcomes. Advantages include superior digital storytelling, increased viewer arousal and retention compared to static images, and facilitated surgeon-patient communication. However, there are also significant ethical challenges that must be navigated. Aesthetic surgeons must adhere to existing professional society guidelines emphasizing truthful marketing and patient safety, mandating conspicuous disclaimers, application of standardized photographic principles, and robust consent protocols. Professional organizations should expeditiously develop targeted AI-specific policies to mitigate emerging risks, including fully fabricated results by bad actors. This evolving landscape necessitates vigilant ethical stewardship to responsibly integrate these compelling tools while prioritizing patient welfare and professional integrity.

Background: Breast surgery often compromises structures, potentially leading to complications that affect aesthetic outcomes, lactation, breast tissue health, and the patient experience. Tissue-Preserving Breast Augmentation (TPBA) is a novel concept designed to enhance breast and implant stability by preserving the breast's stabilization system, including the circummammary ligament and Cooper's suspensory ligaments.

Objectives: This study presents the TPBA approach, performed in a minimally invasive manner to minimize surgical stimuli and protect the parenchymal breast tissue, along with outcomes observed over a three-year period.

Methods: This two-center, multi-surgeon retrospective observational study included consecutive female patients undergoing primary breast augmentation or primary augmentation-mastopexy using TPBA between December 2022 and June 2025. All procedures involved an inframammary incision and creation of a pre-pectoral pocket via balloon expansion. Complications were assessed by monitoring cumulative incidence during follow-up visits at 2 weeks, 6-, 12-, and 24-months.

Results: A total of 330 procedures were performed. At a mean follow-up of 18 months, the complication rate was 0.9%. No cases of acute complications including seroma, wound breakdown, or infection were observed. Follow-up evaluations revealed no capsular contracture (grade III and IV), implant rupture, lateralization, or inferior malposition. Superior malposition occurred in 2 patients (0.6%), and bleeding was observed in 1 patient (0.3%). Implant rippling was reported by 3 patients (0.9%).

Conclusions: TPBA offers a standardized, reproducible approach to breast enhancement via the IMF, performed under general or local anesthesia. It preserves stabilization structures, features a short learning curve, and carries a low risk of complications.

Background: Dual-plane breast augmentation has traditionally been the standard approach in aesthetic breast surgery, while prepectoral placement was reserved for selected anatomical indications. Advances in implant technology and growing clinical experience have led to a renewed reassessment of these beliefs.

Objectives: To describe a shift in clinical practice from predominantly dual-plane to more frequent prepectoral breast augmentation, supported by years of retrospective data and qualitative clinical insight.

Methods: We reviewed all primary breast augmentations performed over a four-year period (2021-2024) and compared these data with cases performed by the same author between 2009 and 2020. The analysis focused on the rationale for plane selection, patient characteristics, and implant volume. The discussion integrates reflections from an experienced plastic surgeon with more than 2,000 augmentations.

Results: Subglandular placement increased substantially over time. It accounted for only 3.25% of augmentations performed between 2009 and 2020, rising to 21.7% in 2021-2022 and reaching 42.2% in 2023-2024. This progressive shift reflects growing clinical confidence in the technique and increasing patient preference.

Conclusions: Implant plane selection should be individualised. The increased use of prepectoral augmentation reflects a shift in surgical strategy driven by anatomy, patient activity level, and aesthetic objectives. When appropriately indicated, avoiding muscle manipulation can yield favourable and reliable outcomes.

Background: Temple hollowing represents a prevalent aesthetic concern traditionally addressed with autologous fat grafting or hyaluronic acid fillers. Poly-L-lactic acid (PLLA) offers gradual, collagen-mediated volumization and is increasingly utilized for soft-tissue augmentation. Nevertheless, to date, no approved study has evaluated its use for temporal augmentation.

Objectives: To evaluate the efficacy and safety of a PLLA facial filler for the augmentation of temple hollowing.

Methods: This randomized, no-treatment control, evaluator-blinded, multicenter clinical trial enrolled 174 participants with moderate to severe temple hollowing, randomized 2:1to the treatment or control group. The treatment group received 2 to 3 sessions of PLLA bilateral temporal injections with a 12-month follow-up, while the control group received no treatment within 6 months after randomization. Efficacy was assessed using the Allergan Temple hollowing Scale (ATHS), Global Aesthetic Improvement Scale (GAIS), three-dimensional volume change of temples, and participant-reported satisfaction. Safety evaluations included adverse events (AEs), injection-site reactions, vital signs, and laboratory tests.

Results: At month 6, 96.5% of participants in the treatment group achieved at least 1-grade improvement on the ATHS, in contrast to 0% in the control group (P < 0.0001). Consistent and significant improvements were observed across all secondary endpoints, including ATHS efficacy rates assessed by both blinded evaluating and injection investigators at all follow-up visits up to 12 months, GAIS improvement rates, and temporal volume measured by 3D imaging. Aesthetic improvement and participant satisfaction were rated highly at all follow-up visits. PLLA was safe and well tolerated, with no therapy-related adverse events reported.

Conclusions: PLLA facial filler effectively improved temple hollowing and achieved aesthetic enhancement for up to 12 months with an excellent safety profile.

Background: Upper-face botulinum toxin type A (BoNT-A) treatments are capable of reducing muscular activity in the glabella, forehead, and lateral canthal region, which play pivotal roles for core emotional expressions. Although concerns about reduced expressivity are common, little is known about how observers perceive emotional expressions in individuals following upper-face BoNT-A.

Objectives: To examine whether upper-face BoNT-A treatments alter observers' emotion attribution and perceived emotion intensity of facial expressions, while examining whether any emotion-specific changes occur in alignment with the treated musculature.

Methods: A total of 118 raters (71 female, 47 male; mean age 37.0 ± 11.6 years) evaluated standardized images of BoNT-A-treated individuals posing four emotional expressions (anger, joy, surprise, neutral) at three time points: pre-treatment (V1), peak effect at 2 weeks (V2), and follow-up at 16 weeks (V3). Motion in the glabellar, frontalis, and lateral canthal regions was quantified using 3D surface scans to assess treatment-related changes in facial movement. Raters identified the posed emotion and rated its perceived intensity.

Results: Upper-face BoNT-A produced the expected reduction in upper-face muscle movement at peak effect with partial recovery at follow-up. Emotion attribution showed small overall changes but pronounced emotion-specific differences: attribution of anger and surprise decreased substantially from baseline to peak effect, whereas attribution of joy and neutral expressions remained stable. Perceived intensity showed a similar but less pronounced pattern.

Conclusions: Upper-face BoNT-A leads to a temporary, anatomically aligned, and emotion-specific attenuation of anger and surprise attribution while preserving pleasant and neutral emotional signaling. Importantly, no evidence of a global "frozen face" appearance emerged. These findings emphasize the importance of integrating facial emotional expression into pre-treatment assessment and using precise, region-specific neuromodulation to align aesthetic outcomes with individual patient intentions.

Adipose-derived stromal vascular fraction (SVF) is a cornerstone of regenerative medicine, yet traditional enzymatic digestion faces significant regulatory and technical hurdles. This scoping review systematically categorizes mechanical micronization and purification techniques as viable alternatives, following PRISMA-ScR guidelines across PubMed (National Institutes of Health, Bethesda, MD), MEDLINE (National Institutes of Health), and Embase (Elsevier, Amsterdam, the Netherlands). A total of 89 studies were analyzed, identifying three primary micronization techniques: shuffling-based emulsification, rotating blade systems, and filtration bag systems. Furthermore, we summarize four major post-processing purification methods, including filtration, centrifugation, combined filtration-centrifugation, and fluid-washing. Based on these techniques, final adipose-derived products are categorized into two distinct types: mSVF combined with adipocytes, and mSVF concentrates, each offering unique structural and functional properties. Our findings highlight that mechanical processing provides a promising, regulatory-friendly approach that prioritizes the preservation of the adipose niche. This review offers plastic surgeons a comprehensive guide to selecting optimal mechanical processing parameters to enhance clinical outcomes in fat grafting and regenerative procedures. Future advancements should focus on further optimizing these parameters to develop next-generation regenerative products tailored to specific therapeutic applications.

Background: Silicone implant rupture is a common complication of breast augmentation, with silicone axillary lymphadenopathy (SAL) a recognized sequela.

Objectives: To evaluate SAL associated with surgically confirmed rupture of fourth-generation cohesive silicone breast implants and correlate imaging with operative findings.

Methods: A retrospective review included 260 consecutive patients undergoing surgery for removal of one or more ruptured cohesive silicone implants identified by non-contrast breast/axillary MRI and ultrasound. The implant-side was the unit of analysis, with bilateral ruptures counted separately. Implant characteristics, including manufacturer, volume, rupture type, and implant age at explantation, were correlated with ipsilateral axillary findings. All patients had primary augmentation with Allergan plc (Irvine, CA) or Mentor Worldwide LLC (Irvine, CA) fourth-generation cohesive implants and available implant records. Operative findings confirmed implant type, size, rupture presence, and rupture characteristics.

Results: Among 260 patients, 299 ruptured implant-sides were identified, with imaging findings corroborated surgically. Intracapsular rupture accounted for 81.6% of ruptured implant-sides with 18.4% extracapsular ruptures. SAL occurred with both intracapsular and extracapsular rupture types but was more commonly seen with extracapsular rupture. Increasing implant age at explantation showed a strong independent association with SAL, while extracapsular rupture demonstrated a modest independent association. No significant differences in SAL were observed by implant manufacturers.

Conclusions: SAL was frequently observed in patients undergoing surgical management of ruptured smooth, fourth-generation cohesive silicone implants. Increasing implant age at explantation was independently associated with SAL, while extracapsular rupture showed a modest independent association. These findings strongly influence patient counseling and surgical evaluation of aging fourth-generation silicone implants. Further study of newer fifth-generation highly cohesive implants is warranted.

Female genital cosmetic surgery (FGCS) is performed, like other aesthetic procedures, for non-medical reasons to alter genital appearance or function. However, it can be distinguished by unique ethical, psychological, and sexual health considerations. While patients often cite aesthetic, sexual, functional, or psychological discomforts, broader social and cultural influences are key drivers of demand. This study aims to examine the representation of FGCS in the media. This systematic review employed a hybrid deductive-inductive content analysis to examine media representations of FGCS, following PRISMA guidelines. A comprehensive search of six databases (PubMed, Web of Science, Scopus, PsycINFO, Embase, Cochrane Library) was conducted for English-language studies (2000-2025). After removing duplicates, 545 related articles were identified. Finally, a total of 15 eligible studies that investigated the media's content related to FGCS were included in this review. The analysis revealed six predominant thematic domains: (1) justifications for FGCS, (2) presentation of FGCS results, (3) genitalia depiction, (4) FGCS warning, (5) marketing practice and (6) quality evaluation. Our findings indicated that the media's content influence public perceptions about genitalia, sexuality and femininity, and this has contributed, in part, to the rising demand for FGCS.

Macromastia, characterized by excessive breast tissue growth, causes physical symptoms, psychosocial distress, and diminished quality of life. Despite the effectiveness of reduction mammaplasty, progress remains limited by inconsistent diagnostic criteria and incomplete mechanistic understanding. We combined bibliometric analysis with transcriptomic profiling to map research evolution and identify candidate molecular pathways. Bibliometric analysis of 499 macromastia publications from the Web of Science Core Collection (Clarivate Analytics, Philadelphia, PA, USA) employed keyword co-occurrence, thematic clustering, and temporal trend analysis. Complementarily, transcriptomic sequencing was performed on breast tissue from 3 severe macromastia patients (unilateral specimen >500 g) and 4 controls undergoing mammoplasty for benign conditions, with standardized preprocessing, differential expression analysis, and functional enrichment. Bibliometric mapping revealed a paradigm shift from subjective assessments toward quantitative evaluation in diagnosis, surgical planning, and quality-of-life measurement. Emerging terms (2021-2025) including 3D imaging, digital modeling, and inframammary fold measurements reflected growing emphasis on objective standards. Core themes centered on surgical outcomes, complications, and patient satisfaction. Mechanistic keywords increasingly highlighted hormonal regulation-particularly estrogen metabolism (aromatase/CYP19A1) and prolactin-related dysfunction-alongside emerging interest in cell communication and stem cells. Transcriptomic profiling identified differential expression patterns consistent with endocrine and growth signaling, with pathway enrichment implicating immune regulation, extracellular matrix remodeling, and oxidative stress. Downregulated pathways were enriched for DNA repair and transcriptional regulation.By integrating bibliometrics with transcriptomics, this study synthesizes two decades of macromastia research, documents the transition toward quantitative standards, and nominates molecular pathways warranting further validation.