Aesthetic Surgery Journal最新文献

Background: The CDC/Kaiser Adverse Childhood Experiences (ACE) study documented that ACEs predict adult health and self-harming behaviors. ACEs have been documented in physicians and are higher in physicians treated for problematic behavior. Plastic surgeons have never been assayed.

Objectives: Might ACE prevalences in plastic surgeons predict their adult health and/or behavior?

Methods: A total of 252 ABPS-certified plastic surgeons (72% men, 28% women) completed the 10-question CDC/Kaiser ACE survey by deidentified email. Data were collected on adult health and behaviors previously associated with ACEs in the literature.

Results: In total 42% of plastic surgeons had 1 or more ACEs; 9.9% had 4 or more. Emotional abuse was 2 times higher than the control CDC/Kaiser population, although other ACEs were lower. Gender differences existed: female surgeons suffered more sexual abuse (17% vs 8%), physical neglect (7% vs 1%), violence against their mothers (7% vs 2%), and self-defined burnout (32% vs 17%). ACEs occurred in clusters. Total ACEs predicted autoimmune disorders, chronic pain/fatigue, self-defined depression, irritable bowel, antidepressant/anxiolytic use, alcohol abuse, >3 marriages, >10 sexual partners, sex and work addiction, eating disorders, and self-defined burnout (all P < .020). Emotional abuse predicted alcohol abuse. Sexual abuse predicted sex addiction. Emotional neglect predicted autoimmune disease, antidepressant/anxiolytic use, eating disorder, and work addiction. Physical neglect predicted chronic fatigue/chronic pain, depression, and burnout (all P < .001 or less).

Conclusions: Adverse childhood experiences occurred in 42% of our 252-member plastic surgeon cohort and predicted 13 adult illnesses and self-harming behaviors that can impair surgeons' lives and performances. This may facilitate their recognition and treatment.

Background: The inherent subjectivity in aesthetic outcomes presents a unique challenge in assessing rhinoplasty. Crowdsourcing has provided a new metric for objective analysis. The authors designed a retrospective study to compare the aesthetic outcomes of dorsal preservation rhinoplasty vs structural rhinoplasty.

Objectives: We aimed to objectively quantify the relative aesthetic advantages of performing a dorsal preservation technique. Additionally, we aimed to demonstrate the efficacy of crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome.

Methods: Patients' preoperative and postoperative photographs were divided into 2 cohorts. Photographs were evaluated by crowdworkers on a secure online rating platform based on the overall nasal appearance, dorsal profile, dorsal aesthetic line symmetry, and dorsal contour, and rated their confidence about whether a patient had undergone surgery. A delta was calculated by comparing preoperative to postoperative states to represent an absolute value of improvement after surgery. Each cohort was compared with non-paired t tests.

Results: The structural rhinoplasty cohort included 34 patients. The dorsal preservation cohort included 30 patients. Both cohorts demonstrated improved aesthetic outcomes (dorsal preservation 0.300, 95% CI 0.047; structural 0.377, 95% CI 0.055). When raters were asked to predict whether a patient had surgery, the correlation coefficient of the structural cohort (0.74) suggested that a crowdworker was better able to identify whether a patient had surgery in those patients. The correlation coefficient in the dorsal preservation cohort (-0.0554) suggested that the raters were unable to identify which patients had surgery.

Conclusions: We found significant improvements in overall aesthetic outcomes with both techniques, although a more natural "unoperated" outcome was achieved when performing a dorsal preservation technique. We also provide evidence of the efficacy of crowdsourcing as an efficient and reliable method for evaluating aesthetic outcomes.

Level of evidence: 4 (therapeutic):

Background: The risks and benefits of performing small fat-containing ventral or umbilical hernia repair (HR) during cosmetic abdominoplasty remains a reconstructive and aesthetic challenge for plastic surgeons.

Objectives: In this study, we aimed to compare clinical outcomes in patients undergoing abdominoplasty with concurrent HR and abdominoplasty alone.

Methods: Retrospective review of patients undergoing abdominoplasty with and without concurrent HR from January 2015 to June 2022 was performed. Patients were stratified by concurrent HR. All hernia patients underwent primary fascial repair, without mesh. Demographics, surgical site occurrences (SSO), and cosmetic complications, including delayed healing and necrosis, were assessed. Multivariate analysis was performed to compare association of umbilical hernia repair with clinical outcomes.

Results: One hundred and six patients underwent abdominoplasty, and 68 (64%) had concurrent HR. No significant difference in demographics was identified between groups, including mean BMI (HR = 27.2 kg/m2 and no HR = 26.3 kg/m2, P = .73), and number of previous open hernia repairs (P = .09). After a mean follow-up of 1.5 years, hernia recurrence rate was 1.4% (n = 1), with a time to hernia recurrence of 12.2 months. After controlling for confounders, there was no difference in risk of SSO (OR 1.02 [0.31-3.36] P = .978), cosmetic complications (OR 0.80 [0.14-4.57] P = .805), procedure length (-21.5 minutes [-46.92-22.93] P = .501), readmission (2.8% vs 0%, P = .336), or reoperation (8.8% vs 10%, P = .766) between groups.

Conclusions: Abdominoplasty with concurrent HR can be performed safely and effectively, with no increase in adverse outcomes or cosmetic complications. The benefit of performing mesh-free HR with abdominoplasty can achieve an enhanced aesthetic outcome and reduce long-term abdominal wall morbidity.

Level of evidence: 3 (therapeutic):

Background: Alar nostril ring correction in patients with multiple previous surgeries is one of the most challenging procedures in reconstructive rhinoplasty. Assessment of patient satisfaction and the technique's failure rate is essential in evaluating its effectiveness.

Objectives: In this study, we aimed to assess the outcomes of alar nostril ring correction with auricular composite grafts (ACGs) in patients with severe postrhinoplasty deformities from multiple previous surgeries.

Methods: A retrospective review of medical records from April 2016 to October 2023 was conducted. Patient demographics, surgical techniques, and functional and aesthetic outcomes were analyzed. Patient satisfaction was measured with the Obstruction and Cosmesis scores from the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS).

Results: A total of 45 cases (38 female and 7 male) ages 36.4 ± 7.64 years underwent alar nostril ring correction with ACGs from the antihelix, with an average of 2 previous rhinoplasties. Preoperative SCHNOS-O and SCHNOS-C scores were 88.44 (SD = 14.41) and 88.30 (SD = 12.44), respectively. The shape of the ACGs was similar to parabolic cylinders, with arc lengths between 15 and 21 mm and flat dimensions of 6 to 9 by 3 to 7 mm. No graft failures were observed, even in 10 patients with a history of nasal skin necrosis. Postoperative SCHNOS-O and SCHNOS-C scores after 1 year were 35.44 (SD = 21.07) and 35.85 (SD = 19.04), representing significant improvement (P < 0.05).

Conclusions: ACGs from the antihelix effectively address external valve stenosis due to aggressive alar-sill junction tissue resection in reconstructive rhinoplasty, even in complex cases.

Level of evidence: 4 (therapeutic):

Long-term stability and recurrent ptosis are among the most debated topics in endoscopic brow lifts. Although there are many publications on endoscopic brow lifts, more research is needed on long-term brow elevation and stability. In this systematic review we aimed to evaluate the amount of elevation and stability achieved by endoscopic brow lifts in the long term. To evaluate the long-term outcomes of endoscopic brow lifts, the databases PubMed, Web of Science, Scopus, and Google Scholar were searched with the keywords "endoscopic brow lift," "endoscopic forehead lift," "forehead lift," "foreheadplasty," "brow lift," "endoscopic brow fixation," and "brow fixation." Studies published between September 1994 and May 2024, including isolated or combined endoscopic brow lift surgeries, were included. In total, 5324 articles were screened, and 85 full texts were reviewed. Of these studies, 12 (14.1%) were found suitable for systematic review and meta-analysis. Brow elevation values were evaluated separately by medial, central, and lateral parts. The pooled effect sizes for medial, central, and lateral brow elevations were found to be 3.25 mm (2.44-4.06), 3.86 mm (2.93-4.8), and 4.35 mm (3.06-5.64), respectively. This study is the first meta-analysis to present the average elevation values that can be achieved in the long term by endoscopic brow lifts. These data guide a better understanding of patient candidates and endoscopic brow lift technique. Sharing more objective data over the long term about different fixation methods will contribute to a better understanding of the criteria related to indications for this surgery.

Level of evidence: 3 (therapeutic):

Background: Recent studies on postoperative measurements for upper blepharoplasty utilized static photographs, which fail to accurately reflect the postsurgical dynamic naturalness of the eyelids.

Objectives: In this study we aimed to analyze dynamic naturalness after double-eyelid blepharoplasty with a simple smartphone method involving slow-motion videos.

Methods: In this prospective observational study we enrolled patients who underwent double-eyelid blepharoplasty with the flexible suspension technique (FST) and rigid fixation technique (RFT), and individuals with congenital double eyelids. Demographic information was collected, and ultra-slow-motion videos of the eye-opening processes were recorded with a smartphone. Four keyframes were selected from each video, from which several parameters were measured. A third party evaluated the degree of naturalness of the photographs and eye-opening videos.

Results: Sixty females (20 per group) were enrolled. The fold-emerging delay (FED) score showed a linear correlation with the mean third-party dynamic naturalness rating (DNR) (R2 = 0.71, P < .0001). The puffy score showed a linear correlation with the mean third-party static naturalness rating (SNR) (R2 = 0.53, P < .0001). For the congenital, FST, and RFT groups, respectively, the FED scores were 62.9 ± 18.9, 52.2 ± 17.7, and 26.3 ± 18.3 (all P < .05); the puffy scores were 49.8 ± 11.9, 55.9 ± 11.0, and 62.6 ± 12.4 (congenital vs FST, P = .055; others P < .05); the mean third-party DNRs were 3.21 ± 0.67, 2.47 ± 0.62, and 1.78 ± 0.74 (all P < .0001); and the mean third-party SNRs were 3.01 ± 0.78, 2.61 ± 0.55, and 2.14 ± 0.69 (all P < .05).

Conclusions: The 2 new indices obtained from the analysis of smartphone-captured ultra-slow-motion videos are good indicators of the dynamic naturalness of double eyelids created with upper blepharoplasty.

Level of evidence: 4 (therapeutic):

Background: The brow area is an important aesthetic unit. Accurate anatomical understanding of the brow is important for clinical treatments related to this region. Due to the complexity of the brow area and limitations of methods, there are still some controversies regarding description of its musculature.

Objectives: In this article, we aimed to reveal the detailed brow musculature with micro-computed tomography (micro-CT) combined with histological staining.

Methods: Eight fresh cadavers (16 hemifaces) were obtained. Eight hemifaces were processed with phosphotungstic acid contrast staining for micro-CT scanning and reconstruction. The corresponding other 8 hemifaces were prepared with Masson staining.

Results: The orbicularis oculi muscle, frontalis muscle (FM), depressor supercilii, and procerus muscle were situated superficially. The FM terminated and connected with its antagonistic muscles at 2 to 5 mm above the brow but the fusion line descended in the lateral third. The corrugator supercilii muscle (CSM) originated from the periosteum, extending laterally and superficially. During its course, it mainly penetrated the FM. The CSM had broad subcutaneous insertion, covering about 77.9% ± 7.5% of the hairy brow. CSM fibers connected to the subcutaneous fiber septa to directly transmit contraction force. The soft tissue on the lateral side of the brow was looser than that on the medial side.

Conclusions: Our study deepens the understanding of the precise anatomy of the brow area and helps guide clinical practice.

Background: An injection method called cranial ceiling elevation is performed in Asian countries to reduce facial proportions. Scalp injections carry risks such as arterial embolism or compression, leading to adverse events including scalp necrosis and hair loss.

Objective: No arterial studies or injection recommendations exist for the injection of specific scalp regions. We aimed to examine blood vessel types and distributions to identify relatively safe areas for scalp injections.

Methods: Computed tomography scans were performed to evaluate the blood vessels in the scalp of 50 cadaver heads, and anatomical studies were performed. Each scalp was divided into 2 segments (L1 and L2) and 6 areas (S1/S1'-S3/S3'). The total number of arteries and the probability of each named artery occurring in each section were recorded.

Results: The total number of arteries in L1 was higher than that in L2 (L1, 78.76 ± 31.07; L2, 75.28 ± 28.68). The most frequently distributed artery in both L1 and L2 was the parietal branch of the superficial temporal artery. No significant difference was observed between the total number of arteries and the number of each named artery in the S1/S1'-S3/S3' segments. Except for S2' and S3', the number of named arteries in L1 was higher than that in L2.

Conclusions: Large-volume scalp injections are not recommended. For injections within 30° above the ear, it is advisable to inject at L2. For other regions, it is also recommended to inject at L2. The periosteal layer should be selected for injection. The L2 region is preferable for right-sided injections, and the L1 region is recommended for left-sided injections.