Aesthetic Surgery Journal最新文献

Background: The transverse facial artery (TFA) is a key vascular structure supplying the lateral region of the face. Because of its central location, the artery is vulnerable to transection during lateral facial rejuvenation and other invasive facial procedures.

Objectives: The authors of this study aim to determine the location of the TFA origin relative to 2 palpable bony landmarks: the head of the mandible and the upper border of the zygomatic arch.

Methods: Thirty hemifaces from 15 embalmed cadaveric heads were examined. Two palpable landmarks-the upper border of the zygomatic arch and the tip of the mandibular head-were marked using pins. After intra-arterial injection of a mixture of liquid latex and red acrylic paint, a vertical skin incision was made anterior to the tragus to expose the TFA origin. Vertical distances from the TFA origin to each landmark were then measured.

Results: In all specimens, the TFA originated from the superficial temporal artery. The mean vertical distance from the origin of the TFA to the upper border of the zygomatic arch was 26.6 ± 8.2 mm and to the tip of the mandibular head was 17 ± 6.87 mm.

Conclusions: The small diameter and deep anatomical location of the TFA complicate its visualization on radiologic imaging. However, its origin can be reliably approximated using palpable landmarks. Preoperative identification of these landmarks may reduce the risk of iatrogenic vascular injury and improve the safety of lateral facial interventions.

Background: Noninvasive neck treatments, including lipolysis injectables, cryolipolysis, and energy-based devices, have become popular alternatives to surgery. Although marketed as safe and effective, these procedures may induce fibrosis, tissue destruction, and anatomical changes that complicate secondary surgical interventions.

Objectives: In this study we aimed to assess the impact of previous noninvasive neck treatments on surgical complexity, intraoperative findings, and outcomes in secondary neck lift procedures.

Methods: A retrospective review of 180 neck lift procedures performed in 2023 by a single surgeon was conducted. Patient demographics, previous treatments, intraoperative findings, and postoperative outcomes were analyzed.

Results: Of 180 patients, 123 (68%) had had previous neck treatments, including surgical neck lift and/or noninvasive therapies including chemolipolysis (Kybella), cryolipolysis (CoolSculpting), radiofrequency-assisted lipolysis (FaceTite, Morpheus8, SmartLipo, Ultherapy, Profound), and suture suspension (MyEllevate, PDO threads). Intraoperative findings in patients having undergone nonsurgical treatments revealed fibrosis, loss of normal tissue planes, platysma and deep fascia rigidity, and unpredictable fat distribution. A deep cervicoplasty with management of subplatysmal structures was required in 94% of the cases. Although no major complications occurred, nearly all patients exhibited contour irregularities postoperatively from the destruction of the supraplatysmal fat and platysma. In all cases there was an increased operative time.

Conclusions: Noninvasive neck treatments significantly alter tissue architecture, increasing surgical complexity and impacting aesthetic outcomes. Surgeons should anticipate these challenges, modify techniques accordingly, and emphasize thorough preoperative evaluation and patient counseling to anticipate increased risk and optimize results.

Level of evidence: 4:

Facial rejuvenation is one of the most sought-out procedures in the field of aesthetic medicine and surgery. The advent of various lasers, energy-based devices, skincare products, fillers, and neuromodulators has spurred interest in rejuvenation at younger ages. Furthermore, as well as the ever-evolving range of noninvasive facial rejuvenation methods, surgical innovation in the field continues, with various facelift techniques gaining popularity. With all these interventions, an anatomic and scientific understanding of facial aging is essential to determine the best treatment plan for a patient. This article provides a scientific overview of facial aging and rejuvenation by assessing the changes to the various layers of the face with an emphasis on soft tissue and skin rejuvenation. Level of Evidence: 5 (Therapeutic).

Submandibular gland prominence can undermine aesthetic outcomes in neck and lower face rejuvenation, even after deep-plane facelifts and platysmaplasty. In selected patients, gland reduction has emerged as an effective adjunct to improve cervicomental contour. In this systematic review, the authors analyze 51 studies involving 2971 patients undergoing submandibular gland reduction across 6 surgical approaches, including transcervical, necklift-integrated, intraoral, retroauricular, endoscopic, and robotic-assisted techniques. The overall complication rate was 15.1%, with marginal mandibular nerve injury being most common (9.8%). Minimally invasive methods, particularly endoscopic and intraoral, showed lower hematoma rates and faster recovery with high patient satisfaction. Retroauricular approaches yielded excellent aesthetic outcomes but had the highest nerve injury rates. LigaSure-assisted and partial reductions reduced bleeding and preserved function. Despite generally favorable results, variation in technique, outcome reporting, and patient selection limits broader adoption. Standardized protocols and prospective studies are needed to optimize safety, aesthetic benefit, and long-term results in submandibular gland contouring for facial rejuvenation. Level of Evidence: 3 (Therapeutic).

Background: Patient-reported outcomes (PROs) are essential in evaluating aesthetic procedures. RealSelf is an online platform for cosmetic and reconstructive feedback. Currently, no validated PRO tools exist to compare Kybella (synthetic deoxycholic acid; AbbVie Pharmaceuticals, North Chicago, IL) with submental liposuction.

Objectives: Robust optimizing Bidirectional Encoder Representation from Transformers, a deep learning natural language processing (NLP) model, can analyze emotions and sentiment in text and was used compare patient-reported experiences for Kybella and submental liposuction on RealSelf.

Methods: RealSelf was queried for English reviews of Kybella and submental liposuction from 2014 to 2024. Reviews were excluded if they lacked procedural details, focused on the provider, or included adjunct procedures such as a necklift or Botox. Two NLP models analyzed posts: 1 characterized posts as positive or negative (scored 0-1); The latter scored each post from 0 to 1 ∼7 emotions-fear, sadness, anger, disgust, neutral, surprise, and joy.

Results: Overall, 1338 posts met the inclusion criteria: 753 for submental liposuction and 585 for Kybella. A greater proportion of liposuction reviews were positive compared with Kybella (83.4% vs 55.2%, P < .00001). Liposuction also had significantly higher mean positive scores (0.73 vs 0.41, P < .0001). Joy was the most common emotion for liposuction reviews (51.3%), whereas Kybella reviews more often reflected sadness (17.9%) and fear (12%), with fewer expressing joy (22.7%).

Conclusions: The authors of this study applied NLP to extract structured sentiment from unstructured reviews RealSelf. Our findings suggest that submental liposuction patients report greater satisfaction and more positive emotional experiences than those who receive Kybella.

Level of evidence: 4 (therapeutic):

Background: Industry relationships are common in plastic surgery but can introduce bias through conflicts of interest (COI). In 2010, the Physician Payment Sunshine Act mandated biomedical companies to disclose and publish physician payment records on the Open Payments database. Inconsistent author disclosures have been identified in peer-reviewed plastic surgery literature, but opinion-based plastic surgery literature (i.e., letters, commentaries, editorials) remain overlooked, despite a greater risk for bias and subjectivity.

Objectives: This study aimed to compare author disclosures in opinion-based plastic surgery articles with Open Payments records.

Methods: COI disclosures amongst plastic surgeon authorships in all opinion-based articles published in Aesthetic Surgery Journal and Plastic and Reconstructive Surgery from 2021 to 2023 were systematically reviewed and cross-referenced with Open Payments. The primary outcome was discrepancies of COIs with Open Payments records and vice versa. Secondary outcomes included proportion of discrepancies over $250 and predictive factors for discrepancies.

Results: 1,108 authorship disclosures were compared with Open Payments data. 62% (n=689) of authorships had at least one discrepancy; 61% (n=678) received undisclosed payments, while 12% (n=128) disclosed relationships without corresponding Open Payments record. Authorships with payments over $250 were more likely to have a discrepancy (99.6% vs 62%, p <0.0001). Publication year and author position were predictive of discrepancies, but there was no significant difference between journals.

Conclusions: COI is under-reported in opinion-based plastic surgery literature, leaving readers unaware of potential biases. Accurate COI disclosure is essential to maintain ethical and high-quality research, therefore collaboration between authors, editors, and regulatory bodies is needed to improve reporting standards.

Background: Artificial intelligence (AI) has transformed clinical decision making, yet its application to forecasting the evolution of surgical science remains underdeveloped. Anticipating future research trajectories represents a critical unmet need for strategic planning, workforce allocation, and innovation stewardship in aesthetic surgery.

Objectives: The aim of this study was to develop and validate an AI-assisted forecasting framework capable of modeling and predicting global aesthetic surgery research activity.

Methods: We performed a population-level observational analysis of all PubMed-indexed aesthetic surgery publications from 2010 to 2024. A fully autonomous AI pipeline conducted large-scale data ingestion, followed by high-fidelity semantic classification of publications by research domain and country (validated accuracy >97%). Annualized outputs were analyzed using optimized exponential-smoothing and autoregressive time-series models to generate long-horizon forecasts with 95% CIs.

Results: The framework processed 24,026 records, yielding 23,521 eligible publications across 13 journals. Exponential smoothing demonstrated superior predictive performance (R2 = 0.94, root mean square error = 166.6). Global research output is projected to increase by 21.9% by 2030, reaching 2939 publications annually (95% CI, 2612-3265). Minimally invasive and injectable research exhibited the steepest projected growth (+46.1 publications/year).

Conclusions: This study establishes AI-driven forecasting as a next-generation analytic paradigm for surgical meta-research. By integrating autonomous data ingestion, semantic intelligence, and rigorously validated time-series modeling, the framework operationalizes predictive intelligence-shifting aesthetic surgery research from retrospective surveillance to prospective trajectory mapping. The resulting system is scalable, reproducible, and continuously recalibratable, positioning AI as a strategic instrument for anticipatory research governance, resource allocation, and human-capital planning in surgical science.

Level of evidence: 5 (therapeutic):

Background: The most common deformity of the ear or earlobe appearing after a facelift is the pixie ear deformity.

Objectives: The purpose of this study was to devise and exercise a method to prevent ear deformity, including pixie ear, when performing a facelift and to correct it if it has already occurred.

Methods: Extended deep-plane rhytidectomy was performed between January 2017 and May 2024, and 76 patients who had passed 12 months post-surgery were included in this study. Group 1 consisted of 40 patients, who underwent W-plasty of incision and combined Botulinum neurotoxin type A (BoNTA) injection around the incision site. Group 2 consisted of 36 patients, who underwent rotation of the lower earlobe after W-plasty of incision and combined Botulinum neurotoxin type A (BoNTA) injection around the incision site.

Results: In a postoperative comparison between the two groups, Group 2 demonstrated superior outcomes over Group 1 by 8.4% on the right and 8.9% on the left, which was statistically significant (p=0.007, p=0.006).

Conclusions: Partial rotation of the earlobe is demonstrated as a practical and effective surgical approach to prevent and correct pixie ear deformity.

Energy-based devices are widely used for facial rejuvenation; as a result, an increasing proportion of patients presenting for facelift or necklift surgery have a history of prior treatment with ultrasound- or radiofrequency-based technologies. While the efficacy and safety of these devices are well-established, their cumulative effects on facial soft tissues critical to deep-layer facelift surgery remain under-recognized. This article examines three commonly used energy-based facial tightening modalities - microfocused ultrasound, high-frequency parallel beam ultrasound, and fractional radiofrequency microneedling - from the perspective of the facelift surgeon. Device-specific mechanisms of action and tissue-level effects are reviewed, followed by discussion of their potential operative implications and the senior author's experience-informed strategies for managing these patients. Recognition of these effects is essential for patient counseling, operative planning, and preservation of long-lasting surgical outcomes.