Aesthetic Surgery Journal最新文献

Background: The association of vaginal laxity with female sexual function is clinically significant. Male sexual pleasure can also be affected by vaginal laxity.

Objectives: The aim of this study was to investigate the effect of vaginoplasty on a cohort of women who underwent this procedure for indications of vaginal laxity/impaired sexual function. The sexual satisfaction of partners after vaginal tightening was also evaluated.

Methods: Fifty women who underwent vaginoplasty and their male partners (n = 50) were included in the study. The State-Trait Anxiety Inventory (STAI) and the Female Sexual Function Index (FSFI) were administered to female patients 3 months before and after the treatment. In addition, the sexual function of male partners was assessed by the International Index of Erectile Function-5 (IIEF-5) 3 months before and after the treatment. A 5-question questionnaire inquiring about pleasure status, scored on a 4-point Likert scale, was administered to the male partners.

Results: The posttreatment STAI-State and STAI-Trait scores of the female patients were statistically significantly lower than their pretreatment scores (52.5 vs 32, P < .001; 56 vs 44, P < .001, respectively). The posttreatment FSFI score of the female patients was significantly higher than their pretreatment score (19.2 vs 29.7, P < .001).

Conclusions: The results demonstrated a significant improvement in the sexual function of males and females, and additionally, a significant decrease in the indices of temporary anxiety levels and the inherent predisposition for anxiety disorders after vaginoplasty.

Level of evidence: 4:

Background: A well-defined jawline improves overall facial aesthetics, motivating patients to seek jawline augmentation.

Objectives: In this study we evaluated the safety and effectiveness of the hyaluronic acid injectable gel VYC-25L for restoring jawline definition.

Methods: In a US multicenter, evaluator-blinded study adults with grade 2 (moderate) or 3 (severe) Allergan Loss of Jawline Definition Scale (ALJDS) scores were randomized. Participants were randomized to the VYC-25L treatment group or control group at study onset, with 12-month follow-up. The control group had the option to receive treatment after 6 months (primary endpoint completion). Effectiveness measures included Month 6 ALJDS responders rate (proportion of participants with ≥1-grade improvement from baseline on both sides), FACE-Q Satisfaction With Lower Face and Jawline scores, and Global Aesthetic Improvement Scale (GAIS) responders (improved/much improved) as assessed by the investigator and participants. Injection site responses (ISRs) and adverse events (AEs) were monitored.

Results: At Month 6, ALJDS responder rates were 69.0% vs 38.0% in the VYC-25L treatment (n = 157) and control (n = 49) groups, respectively (P = .0001). In the VYC-25L treatment group, FACE-Q scores improved by a mean of 45.9 points from baseline at Month 6 (P < .0001). Furthermore, 88.4% and 89.0% of participants in the VYC-25L treatment group were GAIS responders at Month 6 by participant and investigator assessment, respectively. Most ISRs were mild or moderate and resolved within 2 weeks. Most treatment-related AEs were mild and resolved within 1 week.

Conclusions: VYC-25L safely and effectively restores jawline definition through 1 year.

Level of evidence: 1:

Background: Macromastia significantly impairs females' quality of life, with treatments such as physical therapy (PT) often providing only temporary relief. Insurance routinely denies breast reduction surgery, despite little relief after conservative treatments. Research on the efficacy of PT for macromastia is limited.

Objectives: In this study, we investigated the efficacy of PT for macromastia and identified patient factors associated with progression to surgery.

Methods: We conducted a retrospective cohort study of patients with macromastia between 2017 and 2021. We collected data on presenting symptoms, attempted conservative treatments, PT duration, and whether surgery was performed. All patients were invited to participate in a survey regarding their symptoms, treatments, and responses to treatments. Symptoms associated with patients progressing to a breast reduction were evaluated with a multiple logistic regression.

Results: Among the 327 patients identified with macromastia, 312 (95.41%) reported back pain and 272 (83.18%) attempted PT. Of the 72 (22.02%) patients who responded to the survey, 152 (46.48%) underwent subsequent surgery. The mean time from initial consultation to surgery was 283 days. Bra strap grooving was associated with progression to surgery (odds ratio = 1.90, CI = 1.02-3.54). Mean patient-reported pain levels decreased after surgery compared to after PT (pre-PT = 7.1, post-PT = 7.1, post-surgery = 3.1, P < .001).

Conclusions: Patients frequently undergo PT before breast reduction surgery despite no significant reduction in pain, whereas those who undergo surgery experience permanent relief and significantly reduced pain. Patients with bra strap grooving are more likely to progress to surgery. The requirement for PT as a prerequisite for surgery by insurance companies should be reevaluated.

Level of evidence: 3:

Background: The iPhone contains a high-fidelity 3-dimensional (3D) scanner and is widely distributed in the United States. Presently, 3D analysis of the breast necessitates ownership of cost-prohibitive cameras and software packages such as the Vectra (Canfield Scientific Inc., Parsippany, NJ) system.

Objectives: We compared the accuracy of 3D photographs of the breast obtained with the iPhone X 3D scanner (Apple Inc., Cupertino, CA) with the Canfield Vectra H2 in an effort to expand access to 3D technology in plastic surgery.

Methods: Twenty breasts (n = 20) were 3D photographed with the iPhone X and the Vectra H2 and compared by colormap analysis and by measuring distances across the models between key anatomical landmarks. These distances included sternal notch to nipple (SN-N), midchest to nipple (M-N), nipple to midinframammary fold (N-IMF), and inframammary fold width (IMF). Statistical tests included the Bland-Altman plot analysis.

Results: When comparing absolute differences in distances between key anatomical landmarks, the average discrepancy in measurements between the iPhone and Vectra image pairs were the following: SN-N: 0.94 mm, M-N: 0.81 mm, N-IMF 0.91 mm, and IMF 0.98 mm. Colormap analysis demonstrated an average error of 1.53 mm, mean of 0.53 mm, and standard deviation of ±1.81 mm. Bland-Altman plot revealed a mean difference of 0.13 mm and an agreement interval between -1.90 and 2.17 mm.

Conclusions: The iPhone is capable of capturing 3D photographs with a high level of fidelity when compared with the Vectra. Three-dimensional scans obtained with the iPhone may be helpful for planning nipple position, measuring the breast footprint, choosing implants, and performing other functions with 3D technology that are typically performed with the more expensive systems.

Level of evidence: 5:

Background: Aesthetic standards vary and are subjective; artificial intelligence (AI), which is currently seeing a boom in interest, has the potential to provide objective assessment.

Objectives: The aim of this study was to provide a relatively objective assessment of the aesthetic outcomes of lower blepharoplasty-related surgeries, thereby enhancing the decision-making process and understanding of the surgical results.

Methods: This study included 150 patients who had undergone lower blepharoplasty-related surgeries. Analysis was performed with FaceAge software, created by the authors' research team, which included 4 publicly available age estimation convolution neural network (CNN) models: Amazon Rekognition (Seattle, WA), Microsoft Azure Face (Redmond, WA), Face++ Detect (Beijing, China), and Inferdo face detection (New York, NY). This application was used to compare the subjects' real age and their age as estimated by the 4 CNNs. In addition, this application was used to estimate patient age based on preoperative and postoperative images of all 150 patients and to evaluate the effect of lower blepharoplasty.

Results: In terms of accuracy in age prediction, all CNN models exhibited a certain degree of accuracy. For all 150 patients undergoing lower blepharoplasty-related surgeries, these surgeries resulted in about 2 years of rejuvenation with a statistically significant difference; for the sex difference, men had more age reduction than women also with a statistically significant difference; quadrilateral blepharoplasty showed the most significant antiaging effect.

Conclusions: By using deep-learning models, lower blepharoplasty-related surgeries actually had an effect on perceived age reduction. Deep learning models have the potential to provide quantitative evidence for the rejuvenating effects of blepharoplasty and other cosmetic surgeries.

Background: Silicone breast implant design has evolved over the last 50 years. Regulatory bodies including the FDA require data to support the modifications designed to improve the safety, efficacy, longevity, and biocompatibility of breast implants.

Objectives: The authors reviewed the 3-year data on the safety and effectiveness of Motiva (Establishment Labs Holdings, Inc., Alajuela, Costa Rica) SmoothSilk silicone gel-filled breast implants submitted to the FDA. The current submitted data include the primary breast augmentation and revisional augmentation cohorts.

Methods: The Motiva IDE is a prospective, single-arm, multicenter, 10-year pivotal study in which data are collected on breast augmentation, reconstruction, and revisional surgery. Three-year data were submitted to the FDA on adverse events, reoperations, patient and physician satisfaction, connective tissue diseases, and quality of life validated instruments. A subset of the patients underwent annual magnetic resonance imaging (MRI) at years 1, 2, and 3 to screen for implant rupture.

Results: A total of 451 patients were implanted in the primary augmentation cohort and 109 patients in the revisional augmentation cohort. There were 218 patients enrolled in the MRI cohort. Reported rates for reoperation for any reason were 6.1% in the primary augmentation cohort (92.4% follow-up) and 25.8% in the revisional augmentation cohort (88.7% follow-up).

Discussion: Motiva implants were first introduced in 2010. The 3-year Motiva data suggests that the leading cause of revisional surgery has shifted from capsular contracture and rupture to more subjective indications for reoperation such as malposition and size change.

Conclusions: Three-year data from the primary augmentation and revisional augmentation cohorts submitted to the FDA demonstrate the safety and efficacy of the Motiva implants. There were low complication rates for implant-related complications and high surgeon and patient satisfaction.

Level of evidence: 2:

Background: Every region of the face may bear the signs of aging. Treating isolated areas without adequate anatomical knowledge can lead to incomplete or artificial-looking results and decrease patient satisfaction. The authors' "Full SMAS" technique for complete rejuvenation addresses the anatomical continuity of the superficial musculoaponeurotic system (SMAS)-platysma to the deep-plane suspension of the face.

Objectives: The aim of this study was to evaluate the contribution of endoscopic techniques to traditional facelift and neck lift procedures. Procedures treating from the frontal and temporal regions of the superior part of the face to its mid and lower parts, including the cervical region, were evaluated.

Methods: Treatment of the 3 sub-SMAS layers of the face was performed using endoscopy for repositioning the frontal region and midface. This procedure involved frontal and zygomatic-masseter ligament release, open treatment of the lower subplatysmal section, and the complete release of the retaining ligaments of the face and approach to the jowl.

Results: One hundred sixty-one patients underwent the Full SMAS technique, leading to long-lasting results, low complication rates, and high patient satisfaction.

Conclusions: The Full SMAS is a systematic technique that provides complete facial rejuvenation by combining an endoscopic approach for the temporal and midface regions with traditional open approaches for the lower face and neck. Treating the temporal and midface regions by minimally invasive techniques (endoscopy) reduces the possibility of permanent nerve injuries, provides smaller scars, and creates natural, long-lasting results.

Level of evidence: 4 (therapeutic):

Background: Oxidative stress induced by ischemia and hypoxia in fat transplantation is a major obstacle to graft retention. Previous studies have shown that lutein has excellent adipose tissue affinity and antioxidative stress ability, however, the effects of oral lutein on fat transplantation have not yet been studied.

Objectives: We aimed to investigate whether oral lutein could improve fat transplantation retention by regulating oxidative stress, apoptosis, and inflammatory cytokine levels in graft tissues.

Methods: Nude mice were assigned to the control group (normal saline), low-dose lutein group (10 mg/kg/day), and high-dose lutein group (20 mg/kg/day) randomly. All mice received treatment by gavage 1 week before fat grafting and continued for 2 weeks. The grafts were collected 1, 2, and 12 weeks after treatment. By conducting histological analyses, Western blotting, quantitative polymerase chain reaction and cell metabolic function detection, the regulatory effects of lutein on apoptosis and oxidative stress in grafts were demonstrated. Additionally, RNA sequencing was conducted to further clarify the efficacy of lutein on fat grafting.

Results: Lutein induced superior graft retention, histological structures, and more viable adipocytes than the control group. It relieved tissue oxidative stress and lipid oxidative damage by decreasing reactive oxygen species and significantly reduced inflammation and apoptosis of grafts. RNA sequencing analysis confirmed that lutein could downregulate the gene expression of oxidative stress and related inflammation and apoptosis.

Conclusions: Our study suggests that oral administration of lutein can improve fat graft survival by reducing the levels of oxidative stress, inflammation, and apoptosis in grafted fat.

Background: Pain is an important issue in botulinum toxin injection. Vibration anesthesia is a noninvasive way for pain alleviation, but few study reported its use during botulinum toxin injection.

Objectives: To investigate whether vibration anesthesia is effective and safe for pain reduction during botulinum toxin injection for masseter reduction.

Methods: A randomized split-face controlled trial was performed in patients who required masseter reduction. Vibration anesthesia was randomly administered on either side. Study outcomes were pain scores on a visual analog scale, duration of effect, satisfaction, and complications. Intergroup comparison and linear regression analyses were performed.

Results: In a total of 216 patients, the pain score on the vibration side (2.97 ± 1.44) was significantly lower than that on the non-vibration side (4.72 ± 2.13) (p < 0.0001), with a higher proportion of mild pain. Linear regression showed that history of injection, more injection points and doses increased the pain, while 2 ml syringe reduced the pain compared to 1ml syringe. Side effects were found in 19 patients and 21 sides (7%), but were not associated with vibration. High satisfactions were reported. Cadaver experiment confirmed that vibration did not alter the diffusion radius and depth of injection.

Conclusions: Vibration anesthesia could significantly relieve the pain during botulinum toxin injection for masseter reduction, while did not affect adverse effect and effect duration. Therefore, we recommended the use of vibration anesthesia, larger syringe size, and less injection points to improve patient experience and satisfaction.