Aesthetic Surgery Journal最新文献

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.

Background: The increasing prevalence of implant-based breast surgeries highlights a critical gap in patient knowledge regarding implant information, exacerbated by inadequate record-keeping and emerging safety concerns.

Objectives: The authors of this study address the need for reliable implant identification methods by developing a deep learning model capable of classifying breast implants using ultrasound images.

Methods: Retrospective data of 28,712 breast ultrasound PNG files from 4136 breast implants in 2580 patients obtained from multiple institutions were utilized to train and validate this model.

Results: The findings demonstrate that the deep learning model achieved high diagnostic accuracy, with a balanced accuracy of 0.893 for manufacturer classification and 0.971 for implant texture classification in external test datasets. The model's performance was enhanced by employing Gradient-Weighted Class Activation Mapping (Grad-CAM) for interpretability.

Conclusions: By automating the identification process, this tool alleviates the reliance on specialized training among plastic surgeons regarding breast ultrasound, streamlining patient care. Despite limitations, the model shows promise for improving clinical workflows and patient outcomes.

Hypertrophic scars and keloids are fibroproliferative disorders arising from aberrant wound healing, often leading to aesthetic disfigurement, functional impairment, and psychosocial burden. Intralesional therapies remain a mainstay of treatment, yet the comparative efficacy and recurrence profiles of different agents have not been definitively established. We conducted a systematic search of PubMed (National Institutes of Health, Bethesda, MD), Cochrane Library (Wiley, Hoboken, NJ), US National Institutes of Health Ongoing Trials Register, EMBASE (Elsevier, Amsterdam, the Netherlands), and Google Scholar (Alphabet, Inc., Mountain View, CA) from inception through May 2025, restricted to English-language publications, to identify randomized controlled trials comparing 2 or more intralesional treatments for hypertrophic scars or keloids. Twenty-four eligible trials were included in a frequentist random-effects network meta-analysis integrating direct and indirect comparisons. Pooled estimates demonstrated that triamcinolone acetonide combined with 5-fluorouracil (TAC + 5-FU) achieved the most consistent improvements in treatment efficacy and recurrence control. Botulinum toxin A (BTA) ranked highest in treatment response but did not significantly reduce recurrence risk. Verapamil was associated with significantly lower efficacy compared with TAC, whereas bleomycin and 5-FU monotherapies provided intermediate outcomes without statistical superiority. Overall, TAC + 5-FU offered the most favorable balance between efficacy and recurrence reduction, whereas BTA showed strong response efficacy. These findings provide a comprehensive synthesis of intralesional therapies for hypertrophic scars and keloids, support the consideration of combination regimens in scar management, and underscore the need for further well-designed head-to-head trials with standardized endpoints to refine individualized treatment strategies. Level of Evidence: 3 (Therapeutic).

Background: A clear understanding of the superficial musculoaponeurotic system (SMAS) perfusion during extended SMAS rhytidectomy is helpful for surgical planning and for elucidating the structural characteristics of the SMAS.

Objectives: To determine the vascularity of the SMAS during extended SMAS rhytidectomy, as assessed using indocyanine green angiography (ICGA), and to discuss the clinical relevance of the SMAS perfusion pattern for surgical practice.

Methods: A total of 20 patients who underwent extended SMAS rhytidectomy were evaluated intraoperatively. The perfusion patterns of the buccal-mandibular area SMAS and the superficial temporal fascia before and immediately after dissection were assessed by means of ICGA.

Results: Perfusion of the buccal-mandibular area SMAS originated from a transverse facial artery perforator in the deep layer before dissection, but was absent after dissection. No perfusion was observed after elevation of the buccal-mandibular area SMAS. In contrast, a prominent axial vessel was visible within the superficial temporal fascia. When this fascia was dissected, it was predominantly perfused by the parietal branch of the superficial temporal artery, which was present bilaterally in all patients. The superficial temporal fascia showed a marked peak in blood perfusion after dissection.

Conclusions: Perfusion of the buccal-mandibular area SMAS originated from a transverse facial artery perforator in the deep layer and remained poor during extended SMAS rhytidectomy. Because of the poor perfusion of the buccal-mandibular area SMAS after elevation, high-risk patients may benefit from composite facelifts, less extensive skin dissection, or preservation of the transverse facial artery perforator. The superficial temporal fascia can be harvested as an inferior-pedicled flap down to the zygomatic arch, whereas the buccal-mandibular area SMAS cannot be reliably harvested in this manner.

Background: East Asian women often present with mild nasal contour imperfections for which they are unwilling to undergo open rhinoplasty because the potential risks outweigh the modest severity. Autologous fat grafting is a mature technique for soft-tissue augmentation and has been applied in rhinoplasty; however, when solely used, its efficacy in this demographic remains obscure.

Objectives: The authors of this study aim to evaluate the clinical effectiveness of autologous fat grafting for mild nasal contour imperfections in East Asian women.

Methods: Cadaveric head dissection was performed to verify the anatomical accuracy of fat placement using the described techniques. A retrospective examination was conducted on 130 East Asian female patients (median age, 31 years; median follow-up, 18 months) that underwent rhinoplasty with autologous fat grafting between May 2013 and April 2024. Preoperative and postoperative profile photographs were measured for objective results. Patient satisfaction was assessed using FACE-Q questionnaires, and the results were also evaluated by 3-party ratings.

Results: Cadaveric dissections confirmed precise and predictable fat placement within targeted anatomical planes. Clinically, significant postoperative changes were observed in nasofrontal angle (mean change, +0.99°), nasolabial angle (+1.41°), nasal base convexity (+0.73%), and dorsal inclination angle (-0.38°; all P < .05); subgroup analyses identified nasal spine augmentation driving nasolabial angle increases. Both FACE-Q scores and 3-party ratings reflected high postoperative satisfaction. No severe complications were reported; minor complications included nodule formation and fat migration.

Conclusions: Autologous fat grafting is effective for correcting mild nasal contour imperfections in East Asian women. As corroborated by clinical results and dissection, the described techniques ensure precise fat placement in different nasal esthetic units.

Level of evidence: 3 (therapeutic):

Background: Reduction mammoplasty is an established treatment for symptomatic macromastia. Understanding risk factors associated with complications is essential for counseling and patient selection. The modified frailty index (mFI-5) has been proposed as a simple tool to assess risk in surgical candidates.

Objectives: We sought to determine if the mFI-5 can accurately predict wound healing complications following reduction mammoplasty.

Methods: A retrospective review was performed of primary bilateral reduction mammoplasty cases between 2017 and 2019 at one institution. MFI-5 scores were calculated for each patient. 30-day wound healing complications were defined as incisional dehiscence, T-point breakdown, nipple-areolar complex necrosis, and fat necrosis. Univariate and multivariate logistic regression were used to evaluate predictive value.

Results: 474 patients were stratified into three age groups: 15-30, 31-50, and over 51. Twenty-six percent of patients developed 1 wound healing problem. On univariate analysis, ages 31-50 and 51+ (OR 2.75 and 3.16) and mFI score of 1 (OR 2.07) were associated with an increased risk of wound healing complications. Adjusted multivariate analysis indicated that age greater than 51 years significantly predicted wound healing issues (OR 2.89; p=0.001) when controlled for American Society of Anesthesiologists (ASA) score, smoking, and body mass index (BMI). The mFI-5 did not significantly predict wound healing issues when controlled for age, ASA, BMI, or smoking.

Conclusions: In our population, the mFI-5 was not a statistically significant predictor of wound healing complications following reduction mammoplasty. When controlling for confounders, advanced age alone seems to place patients at higher risk for wound healing complications.

Background: Rhinoplasty is an ergonomically demanding procedure that subjects surgeons to prolonged unfavorable postures and repetitive fine motor movements, increasing the risk of work-related musculoskeletal disorders (WRMDs). Nevertheless, ergonomic awareness and training in rhinoplasty remain limited.

Objectives: The aim of the authors of this study is to evaluate the prevalence of WRMDs among rhinoplasty surgeons and to assess ergonomic factors, training, and attitudes toward strategies to improve well-being and career longevity.

Methods: A 36-item electronic survey was distributed to members of the Evidence-Based Rhinoplasty Research Group (Feb-May 2025) to gather demographic, professional, and ergonomic data, including Likert-scale assessments of comfort and strain during rhinoplasty.

Results: A total of 109 consultant surgeons completed the survey. Mean comfort and strain scores were 6.7 ± 1.7 and 5.2 ± 2.3, respectively; 72% experienced discomfort (mainly neck, shoulders, and lower back), with greater experience correlating with better scores (P < .05). No significant differences were observed with gender, BMI, height, average duration of each rhinoplasty, weekly time spent on rhinoplasty, or the use of headlights or loupes. Only 5.3% had received formal ergonomics training; however, 81.4% expressed interest in ergonomic assessments, and 93.8% believed exercise benefits career longevity.

Conclusions: WRMDs are highly prevalent among rhinoplasty surgeons. Comfort and strain appear more related to posture, case volume, and cumulative experience than to specific instruments or techniques. Despite the prevalence and impact of these symptoms, ergonomic training remains rare, although interest is high. Targeted interventions-such as optimizing operating room setup, promoting intraoperative microbreaks, and encouraging physical exercise-are essential to reduce discomfort and support long-term career sustainability.

Level of evidence: 4 (therapeutic):

Background: Optimizing plastic surgeon distribution is essential to meeting rising consumer demand for aesthetic operations.

Objectives: This study aimed to identify aesthetic surgery demand-supply mismatches across U.S. Designated Market Areas (DMAs) and quantify regional demand changes from pre- to post-COVID periods.

Methods: This cross-sectional ecological analysis used Google Trends (Google LLC, Mountain View, CA, USA) Relative Search Volume (RSV) averaged for nine aesthetic operations as a proxy for demand across 210 DMAs from August 2024-2025. Surgeon concentration was calculated as board-certified plastic surgeons per 10,000 residents. Demand-Supply Ratio (DSR) was defined as RSV divided by surgeon concentration. DMAs were grouped into quintiles (Tiers 1-5, highest to lowest DSR).

Results: Median RSV was 45.03 (Interquartile Range [IQR] 39.52-54.90) and median surgeon density was 0.10 (IQR 0.06-0.17). Seventeen DMAs (8.1%) were "plastic surgery deserts," with search activity but no surgeons, clustering in the South, Midwest, and West. Median DSR was 426.16 (IQR 307.35-565.08), with highest DSRs concentrated in Southern and rural/interior DMAs, whereas coastal hubs were saturated. While surgeon concentration increased across DSR Tiers 1-5, RSV did not significantly differ. Nationally, median RSV increased 22.54% (IQR 16.65%-32.34%) from 2018-2019 to 2024-2025, with rising RSV in 95.2% of DMAs and highest growth in the Midwest (+32.58%, IQR 24.90%-47.55%).

Conclusions: Southern and rural DMAs are disproportionately represented among underserved aesthetic markets and plastic surgery deserts. Aesthetic demand is rising nationwide, particularly in the American interior, underscoring high-growth regions where strategic expansion of aesthetic services by board-certified plastic surgeons may improve patient access and safety.

Background: It remains unclear how long a plastic surgeon should wait for the optimal vasoconstrictive effect of epinephrine as local anesthetic before incision for aesthetic facial surgery.

Objectives: In this study we investigate the optimal timing for epinephrine-induced vasoconstriction in facelift procedures by measuring cheek skin temperature changes with forward-looking infrared thermography (FLIR).

Methods: A retrospective chart review was conducted on all patients who underwent facelift surgery by J.E.Z. between July 2023 and June 2024. Skin surface temperature was recorded at baseline and at predetermined time points up to 15 minutes following injection of the standardized epinephrine-containing local anesthetic solution. Additional patient data were obtained from electronic medical record review.

Results: Twenty-seven patients were included in the study. The median time for each patient to reach the lowest recorded cheek temperature was 5 minutes postinjection (mean 5.1 ± 2.9 minutes). Injected cheeks exhibited the largest median temperature decrease of 2.3°C at 7 minutes, followed by gradual rewarming to baseline. Uninjected nasal skin warmed steadily throughout the observation period. Of the 27 patients, 15 (55.6%) reached their minimum cheek temperature by 5 minutes, 23 (85.2%) by 7 minutes, and all 27 (100%) by 11 minutes.

Conclusions: These findings demonstrate that the maximal vasoconstrictive effect of epinephrine in facelift surgery occurs approximately 5 to 7 minutes after injection. We recommend that facelift surgeons wait 5 to 7 minutes before initiating incisions and dissection to balance optimal hemostasis with procedural efficiency.

Level of evidence: 4 (therapeutic):