Aesthetic Surgery Journal最新文献

Background: Autologous fascia has been widely applied in rhinoplasty, yet prospective data on the supramastoid donor site remain scarce. This region provides a dense, pliable fascial layer with concealed scarring, potentially suitable for moderate nasal dorsal augmentation.

Objectives: To prospectively evaluate the clinical outcomes, long-term stability, and patient satisfaction of supramastoid fascia as an autologous graft material for dorsal augmentation.

Methods: This multicenter observational study enrolled patients between June 2022 and April 2024. Dorsal projection and fascial thickness were measured by 3D photogrammetry and 15-MHz ultrasound at 1, 6, 12, 24, and 36 months, with patient satisfaction assessed using the FACE-Q Rhinoplasty Module. Longitudinal changes were analyzed using repeated-measures ANOVA and linear mixed-effects models.

Results: Among 73 patients, 67 (91.8%) completed ≥12 months of follow-up; 65% were observed beyond 24 months and 19% to ≥36 months. Dorsal height increased significantly at 1 month and remained stable through 36 months (P > 0.05 after 12 months). Mean resorption rate was 8.6 ± 3.7% at 12 months and 9.4 ± 4.1% at 36 months. FACE-Q satisfaction scores remained >80 across all domains without late decline. No graft displacement, irregularity, or donor-site morbidity was observed.

Conclusions: The supramastoid fascia is a practical, minimally invasive autologous donor-site alternative for moderate dorsal augmentation, showing stable projection and high satisfaction through 36 months. Longer follow-up and multi-ethnic cohorts are warranted.

Background: Achieving breast symmetry represents a critical endpoint in reduction mammoplasty. Historically, surgeons have been predominantly depended on anthropometric parameters, such as linear measurements and tactile evaluation, to guide intraoperative decision-making. Nonetheless, there remains a substantial unmet need for objective, intraoperative volumetric assessment techniques. While three-dimensional volumetric analyses have become well-established tools for preoperative planning and postoperative evaluation, the literature on intraoperative volumetric assessment is still quite limited and relies on scanning devices lacking rigorous validation.

Objectives: In this study, following extensive preliminary investigations, we present the first evaluation of the validated Vectra H2 3D photogrammetric imaging system applied intraoperatively during reduction mammoplasty. The primary aim was to investigate if integrating this objective intraoperative volumetric data could facilitate improved postoperative breast volume symmetry.

Methods: We analysed 100 patients undergoing reduction mammoplasty with supero-medial pedicle and wise pattern skin resection. We compared volumetric differences of the last 50 reduction mammoplasty procedures before using intraoperative volumetric measurements (group A; control) to the first 50 reduction mammoplasties after implementation of intraoperative volumetric analysis using Vectra H2 3D photogrammetry (group B; intraoperative 3D). The follow-up period was 12 months.

Results: 50 patients were included in group A and 50 patients in group B. Patient demographics, mean resection weight and complications did not differ statistically significantly. The 3-month-postoperative volumetric differences between the breasts of the same patient averaged 5.8% ± 3.0% (mean ± SD, 0.1% - 12.2%) in Group A (control) and 2.9% ± 1.5% (mean ± SD, 0.8% - 6.9%; ) in Group B (intraoperative 3D). These differences were statistically significant (p<0.05).

Conclusions: In our study, intraoperative 3D photogrammetry for volumetric analysis significantly improved volumetric symmetry following reduction mammoplasty. Although the volumetric differences in both groups were relatively small, the technique facilitated the intraoperative identification of outliers and resulted in superior volumetric symmetry.

Background: The efficacy of one-stage augmentation mastopexy has been well established throughout the literature. Limited evidence exists examining outcomes in the secondary augmentation mastopexy patient.

Objectives: To evaluate the long-term safety and efficacy of secondary augmentation mastopexy through an analysis of clinical outcomes.

Methods: A retrospective review of 847 patients who underwent 1664 consecutive secondary augmentation mastopexy procedures from January 2009 to January 2021 was performed. Demographics, operative characteristics, and post-operative outcomes, including complication and re-operation rate were collected and analyzed.

Results: Over a mean follow-up period of 47 months (3 to 131 months), the complication rate was 11% (n = 94) with a reoperation rate of 8.7% (n = 74). Tissue related complications occurred in 7.3% (n = 62) and implant related complications in 3.8% (n =32). Indications for reoperation were primarily due to tissue-related complications in 5.4% (n=46), most commonly recurrent ptosis in 3.4% (n=29). Implant-related indications for reoperation (3.3%, n=28) were most commonly capsular contracture (Baker III or IV) (n=21, 2.5%) and implant malposition in (n=11, 1.3%). Comparing the incidence of reoperation with the number of previous breast procedures, identified a significant increase in re-operation rate for patients with 3 or more previous breast implant procedures (p=0.041), as well as a significantly higher re-operation rate in patients with a history of tobacco use (p =0.013).

Conclusions: Secondary augmentation mastopexy can be performed safely with low complication and reoperation rates. Success with this procedure is directly proportional to control of the soft tissue envelope, implant, pocket, and the nipple to inframammary fold distance. An individualized approach coupled with a thorough preoperative evaluation of these components should be employed for optimal results.

Background: The FDA requires implant manufacturers to continue collecting safety and efficacy data annually through year ten. Investigators are encouraged to follow their enrolled subjects in person to obtain the most accurate and complete data.

Objectives: The authors reviewed the 5-year data on the safety and effectiveness of Motiva SmoothSilk® silicone gel filled breast implants submitted to the FDA. The reported data includes both the Primary and Revision Breast Augmentation cohorts.

Methods: The five-year clinical data from the breast augmentation cohorts of the Motiva IDE, 10-year pivotal study was submitted to the FDA in 2024. Data was collected from on adverse events, reoperation, patient and physician satisfaction, connective tissue and rheumatologic diseases, and quality of life instruments. MRIs were obtained at years 1, 2, 3, and 5 for patients enrolled in the MRI sub-study.

Results: There were 451 primary augmentation patients and 109 revision augmentation patients enrolled in the pivotal study. Follow-up rates were 87% of expected patients at both years 4 and 5. Of the 218 patients enrolled in the MRI cohort, 152 underwent MRI screening at year 5, an overall compliance of 79.2% of expected screenings. The reported re-operation rates for any reason were 8.8% in the Primary Augmentation Cohort and 36.0% in the Revision Augmentation Cohort.

Conclusions: The five-year data from the Primary and Revision Breast Augmentation cohorts reveal low rates of device rupture. Size change and malposition were the most common causes of reoperation in the Primary Augmentation Cohort, while capsular contracture and size change were the leading drivers of reoperation in the Revision Augmentation Cohort.

Autologous fat grafting has become an important tool in reconstructive and aesthetic surgery, particularly for breast reconstruction and soft tissue augmentation. Despite its promise, long-term outcomes remain unpredictable. To address this, research has increasingly focused on optimizing graft survival by enriching the lipoaspirate with additional substances. A systematic search of PubMed and Web of Science identified studies on enhancement methods of autologous fat grafting in both animal models and clinical settings, published up to February 2025. In vitro trials, case reports, and studies comparing techniques without specific enhancement of the lipoaspirate were excluded. Twenty-seven studies fulfilled the criteria, including 15 animal studies and 12 clinical studies, most of which investigated applications in breast reconstruction and augmentation. The included studies showed substantial heterogeneity in enhancement strategies, case numbers, follow-up duration, and outcome measures. The most frequently examined approaches involved enrichment with stromal vascular fraction (SVF) and/or adipose-derived stem cells (ADSCs). Both methods demonstrated favorable results in many trials, though statistical significance was not always achieved. Other strategies included the use of Vitamin D3, Botulinum toxin A, platelet-rich plasma (PRP), and less frequently studied agents such as N-acetylcysteine and Salvia miltiorrhiza. Overall, enrichment of lipoaspirate appears to enhance graft survival, with SVF/ADSC-based methods and PRP emerging as the most promising approaches. Nevertheless, marked variability in protocols and outcome measures hampers comparability between studies. Larger randomized controlled trials employing standardized methodologies are essential to confirm clinical feasibility and provide a basis for evidence-based guidelines.

Background: The Baker classification is used to grade capsular contracture after breast-implant surgery, yet its correlation with patient-reported outcomes is poor.

Objectives: To determine whether histopathological verification of capsular contracture status strengthens the association between Baker grade and BREAST-Q scores.

Methods: Women scheduled for implant exchange or removal completed the BREAST-Q "Physical Well-Being-Chest" module. Raw BREAST-Q sum scores were transformed to a 0-100 scale, where higher scores indicate increased comfort. The attending surgeon classified breasts using the Baker scale (I-IV). Capsule biopsies were scored with a validated histopathological scoring system;Baker grades were deemed "confirmed" when histology and Baker grade were aligned and otherwise deemed "misclassified". Linear regressions compared the relationship between BREAST-Q scores and Baker grade in confirmed versus misclassified cases.

Results: A total of 103 patients (58 augmentation, 45 reconstruction) were included. The Baker classification was confirmed histologically in 53/58 augmentation patients (91%), and 36/45 reconstruction patients (80%). In confirmed augmentation cases, each one-grade increase in Baker significantly worsened chest well-being by -8.80 BREAST-Q points (95% CI [-14.42, -3.18]; P=.003). No correlation was found in the misclassified augmentation cases (-3.21 points; P=.57), confirmed reconstruction cases (-5.00 points; P=.19), or in the misclassified reconstruction cases (-5.72 points; P=.54).

Conclusions: Histologically confirmed Baker classification correlates significantly with chest well-being assessed with BREAST-Q for the patients with breast augmentation, whereas no such correlation was observed in cases where the histology and Baker classification showed a mismatch. This suggests that histopathological scoring can increase diagnostic accuracy when assessing capsular contracture status.

Background: Traditionally, dorsal reconstruction is required after osseocartilagenous resection in patients with large noses where the cartilaginous dorsum is overdeveloped and wide, rendering it impossible for preservation. We aim to reduce the need for dorsal reconstruction by changing the resection technique in such noses.

Objectives: The present article describes and evaluates a technique, which consists of an anatomic resection of the nasal dorsum that we propose to be used in those patients who fall in the grey zone between requiring traditional DP and structural techniques. Dorsal Y preservation pre-cuts the intended dorsal aesthetic lines defining a central platform that can be flexed, lowered or moved laterally.

Methods: A total of 77 patients who underwent low septal strip dorsal Y preservation by two different surgeons were studied retrospectively.

Results: Of the total patients, 85.7% (66) were female and 14.3% (11) were male. A closed approach was used in all cases. The patients were followed up from 6-36 months with a median follow up of 13 months.

Conclusions: The central platform (Libra flap) technique provides anatomical results in patients with large, wide noses and an axis deviation. For those cases with other challenges, dorsal preservation and structure techniques should remain as preferred treatment modalities.

Background: Enhancing fat graft survival is a key goal in adipose regenerative medicine. Although botulinum toxin type A (BoNTA) has shown potential benefits, its effects beyond muscle paralysis remain incompletely understood.

Objectives: The authors of this study aim to investigate the nonmuscle-mediated effects of BoNTA on fat graft survival and quality.

Methods: BALB/c-nu nude mice, with the subcutaneous skull area selected for fat transplantation because of its minimal muscular activity, were assigned to 3 groups (n = 5/group/time point): a control group receiving only fat graft and saline, and 2 experimental groups receiving BoNTA either simultaneously (BoNTA group) or 1 week (Pre-BoNTA group) before grafting. Graft volume was measured through liquid overflow at 1, 4, 8, and 12 weeks. Histological analysis and immunostaining were performed to assess adipose integrity, vascularization, inflammation, fibrosis, apoptosis, and proliferation.

Results: At Week 12, fat retention rates reached 33.67% in the Pre-BoNTA group and 35.16% in the BoNTA group, both significantly higher than the control (20.79%, P < .01). Histological analyses demonstrated superior outcomes in these treatment groups, characterized by improved vascularization, preserved adipocyte morphology, reduced inflammation and fibrosis, and favorable apoptotic and proliferative profiles. Notably, the BoNTA group showed greater preservation of adipocyte architecture, lower inflammatory cell presence, and stronger antiapoptotic effects than the Pre-BoNTA group, despite comparable volume retention.

Conclusions: BoNTA improves the survival rate and quality of fat grafts through nonmuscle-mediated effects. Additionally, the timing of BoNTA administration exerts a significant influence on graft outcomes.

Background: Recent anecdotal reports from respected surgeons suggest a potential link between tranexamic acid (TXA) in local anesthetic solutions and wound healing complications during facelift procedures.

Objectives: The authors of this study evaluate outcomes in patients undergoing facelift with and without local TXA injection.

Methods: A single-surgeon retrospective cohort study was conducted on patients who underwent facelift surgery under general anesthesia between 2014 and 2024. All received subcutaneous injections of 0.5% lidocaine with 1:200,000 epinephrine, with or without TXA. Patients were matched for age, BMI, sex, and hypertension. Operative time and postoperative complications were assessed.

Results: Each group had 261 patients with a median follow-up of 232 days. No significant differences were observed in age (P = .22), BMI (P = .59), sex (P = 1.00), hypertension (P = .52), primary vs secondary facelifts (P = .19), fat grafting (P = .66), or chemical peels (P = .83). Minor wound healing complications were similar (P = .16). Delayed healing occurred in 4.6% (non-TXA) vs 2.3% (TXA) (P = .15). Minor skin necrosis was noted in 1 non-TXA patient (0.4%) and 2 TXA patients (0.8%) (P = 1.00). Two major complications, major skin necrosis, were reported in the non-TXA group, none in TXA (P = .5). Hematoma rates were comparable (P = 1.00).

Conclusions: The authors of this large-scale, single-surgeon, retrospective cohort study of matched patients challenge previous claims associating TXA use with wound healing complications. Local administration of TXA in a concentration of 1 to 2 mg/mL is not associated with an increased risk for minor or major wound healing complications in patients undergoing facelift procedures with wide skin undermining. TXA appears safe when used with appropriate dosing, screening, and technique.

Level of evidence: : 3 (Therapeutic).

Background: Capsular contracture remains a prevalent complication following breast implant augmentation. Despite growing interest in pharmacological prevention, optimal drug selection and administration timing remain unclear.

Objectives: The authors of this study aim to compare the efficacy of tranilast vs montelukast and evaluate prophylactic vs postoperative administration in preventing capsular contracture.

Methods: Eighty male C57BL/6J mice were randomized into 5 groups: control, post-montelukast, pre-montelukast, post-tranilast, and pre-tranilast. For 1 preoperative month, the control group received daily saline (1 mL) through gavage, whereas drug-treated groups received montelukast (10 mg/kg/day) or tranilast (50 mg/kg/day). Prophylactic groups initiated drug administration preoperatively. Miniature implants were bilaterally placed dorsally, followed by 3 months of postoperative drug continuation. Histopathological evaluation assessed capsule thickness, macrophage infiltration, collagen density, and inflammatory response.

Results: At 90 days post surgery, all drug interventions significantly reduced capsular thickness compared with the control group (control: 232.4 ± 43 μm; post-montelukast: 137.5 ± 24 μm; pre-montelukast: 107.7 ± 20 μm; post-tranilast: 93.3 ± 22 μm; pre-tranilast: 70.2 ± 11 μm; P < .0001). The pre-tranilast group demonstrated the lowest collagen deposition at 90 days (16.0 ± 5% vs control: 76.6 ± 13%; P < .001). Pre-tranilast exhibited superior macrophage inhibitory effects compared with post-tranilast administration. Furthermore, tranilast outperformed montelukast in efficacy regardless of administration timing.

Conclusions: Prophylactic tranilast administration significantly attenuates capsular contracture by reducing inflammation, macrophage infiltration, and collagen deposition, surpassing both postoperative tranilast and montelukast. These findings support prioritizing preoperative tranilast in clinical trials to improve breast implant outcomes.