Aesthetic Surgery Journal最新文献

Background: Management of the dorsum continues to present challenges for rhinoplasty surgeons, especially regarding the inherent asymmetry of the bony and cartilaginous vaults and the need for a highly individualized approach for each case.

Objectives: The aim of this study was to assess the efficiency of superficial dorsal modification to improve the shape and symmetry of the dorsum, without resecting/reconstructing the main parts that maintain dorsal stability.

Methods: A total of 147 patients who underwent superficial dorsal modification between October 2020 and March 2024 were retrospectively reviewed. A step-by-step algorithm was applied to achieve the required dorsal improvement.

Results: The average postoperative follow-up period was 27 months (range, 12-41 months). No patients required revision surgery of their dorsum. No complications were reported. A retrospective analysis of the 147 patients demonstrated aesthetic and functional improvement.

Conclusions: Dorsal modification as a separate philosophy is a very conservative, fast, and reliable approach. In cases where there is no need to significantly change dorsal dimensions (height and width), dorsal modification improves the dorsum quickly and efficiently without significant resection and no reconstruction, while maintaining stability and maximum predictability.

Background: Reduction mammaplasty can provide symptomatic relief to patients suffering from macromastia; however, complications such as dehiscence are common. It is unknown if the presence of complications affects patient-reported outcomes.

Objectives: The aim of this study was to determine the risk factors for the development of complications, and to examine the correlation between postoperative complications and patient-reported outcomes in reduction mammaplasty.

Methods: A single-center retrospective chart review was undertaken of patients who received reduction mammaplasties (CPT 19318), performed by 13 surgeons, between January 2017 and February 2023. Breast cancer cases and oncoplastic reconstructions were excluded. Patients with >1 complication were grouped into the complications cohort. Satisfaction was assessed by administering the BREAST-Q survey.

Results: A total of 661 patients were included for analysis, 131 of whom developed at least 1 complication. Patients in the group with complications had significantly higher average ages and BMIs, and a higher likelihood of hypertension and diabetes (P < .01). Among 180 BREAST-Q responders, 41 had at least 1 complication. There were no significant differences between the 2 groups (complications vs no complications) across survey outcomes. Although obese patients were more likely to develop infection and require revisions (P < .01), no significant differences in subgroup analysis of patient-reported outcomes focusing on obese patients were observed.

Conclusions: Obesity, hypertension, and diabetes were associated with postoperative complications of reduction mammaplasty. Patients with complications had similar postoperative BREAST-Q satisfaction to patients without complications. Although risk optimization is critical, patients and surgeons should be reassured that satisfaction may be achieved even in the event of a complication.

Level of evidence: 3:

Background: A delayed seroma around breast implants is the most common clinical presentation of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Interleukin-9 (IL-9), IL-10, and IL-13 concentrations are significantly higher in BIA-ALCL than in benign seromas, offering a means to distinguish between these conditions.

Objectives: The aim of this research was to test the ability of a lateral flow assay (LFA) to detect high concentrations of IL-9 rapidly. In addition, the authors compared CD30 and IL-9 LFAs for distinguishing BIA-ALCL from benign seromas.

Methods: Samples of 26 seromas (15 benign, 11 malignant) were tested on in-house-prepared LFA strips for IL-9 and CD30. Nanoparticle-conjugated antibodies specific to IL-9 and CD30 were used for detection. The intensity of both the test line (TL) and a control line (CL) were analyzed and the TL/CL ratio was calculated. IL-9 protein and IL-9 transcription factor PU.1 were stained in BIA-ALCL lines and clinical samples.

Results: The IL-9 LFA could reliably distinguish BIA-ALCL from benign seromas when the IL-9 concentration was >10 ng/ml. The CD30 LFA was positive in all 11 malignant cases. In 1 case with only faint CD30 and IL-10 TLs, the IL-9 LFA was clearly positive. Immunohistochemistry showed that IL-9 and PU.1 were present in tumor cells in BIA-ALCL lines and clinical samples.

Conclusions: Concentrations of IL-9 >10 ng/ml reliably distinguished BIA-ALCL from benign seromas. Moreover, the IL-9 LFA could detect BIA-ALCL when both the CD30 and IL-10 LFAs were not definitive, suggesting a multiplex LFA measuring IL-9, CD30, and IL-10 might be more effective in detecting BIA-ALCL in selected cases.

Background: The BODY-Q is a widely used patient-reported outcome measure for comprehensive assessment of treatment outcomes specific to patients undergoing body contouring surgery (BCS). However, for the BODY-Q to be meaningfully interpreted and used in clinical practice, minimal important difference (MID) scores are needed. A MID is defined as the smallest change in outcome measure score that patients perceive as important.

Objectives: The aim of this study was to determine BODY-Q MID estimates for patients undergoing BCS to enhance the interpretability of the BODY-Q.

Methods: Data from an international, prospective cohort from Denmark, Finland, Germany, Italy, the Netherlands, and Poland were included. Two distribution-based methods were used to estimate MID: 0.2 standard deviations of mean baseline scores and the mean standardized response change of BODY-Q scores from baseline to 3 years postoperatively.

Results: A total of 12,554 assessments from 3237 participants (mean age 42.5 ± 9.3 years; BMI 28.9 ± 4.9 kg/m2) were included. Baseline MID scores ranged from 1 to 5 on the health-related quality of life (HRQL) scales and 3 to 6 on the appearance scales. The estimated MID scores from baseline to 3-year follow-up ranged from 4 to 5 for HRQL and from 4 to 8 on the appearance scales.

Conclusions: The BODY-Q MID estimates from before BCS to 3 years postoperatively ranged from 4 to 8 and are recommended for interpretation of patients' BODY-Q scores, evaluation of treatment effects of different BCS procedures, and calculation of sample size for future studies.

Level of evidence: 3:

Microfocused ultrasound with visualization (MFU-V) is an advanced, non-invasive cosmetic procedure widely used in skin lifting and tightening. We performed a systematic review and meta-analysis to evaluate the aesthetic effectiveness, patients' satisfaction, skin quality, and safety profile of MFU-V treatment. A comprehensive search of 5 bibliographic databases up to 2023 was conducted. Pooled effect estimates using random effects models and corresponding 95% confidence intervals (95% CI) were calculated. Out of 4,019 references, 42 studies were included. Meta-analysis showed 89% of patients (95% CI: 81- 94%; I2: 63%, n=411) demonstrated some degree of global aesthetic improvement, as assessed by investigators. Similarly, 84% of patients (95% CI: 73- 91%; I2: 64%, n=312) reported improvement following treatment. Satisfaction of any level was reported by 84% of patients (95% CI: 61- 94%; I²: 52%, n=326), and 62% (95% CI: 37- 82%; I²: 3%, n=172) when 'neutral' as a response was provided for the patients. Skin quality (e.g., wrinkles, texture) also improved. Patients reported a pooled mean pain score of 4.85 (95% CI: 4.35, 5.35; I2: 97%, n=785), indicating moderate pain. Common adverse events included erythema, edema, swelling, bruising, and tenderness, all of which were generally mild to moderate in severity. Overall, our analysis demonstrated a notable increase in global aesthetic improvement and patients' satisfaction following MFU-V treatment, accompanied by moderate pain and a generally favorable safety profile. However, the potential misclassification of neutral responses as positive could result in an overestimation of the treatment's efficacy. These findings highlight the need for well-designed trials to further explore MFU-V's clinical applications.

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. This systematic review aims 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 using 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. 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 for 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 in endoscopic brow lifts. These data guide a better understanding of the patient candidates and the technique for endoscopic brow lifts. Sharing more objective data over the long term with different fixation methods will contribute to a better understanding of the criteria related to the indication of this surgery.

Background: In plastic surgery, costal cartilage is an excellent support material. However, postoperative pain from costal cartilage harvesting can impact patient recovery and satisfaction with the surgery. Recent reports have shown that methylene blue (MB) is an effective local analgesic in postoperative management.

Objectives: We aimed to evaluate the safety and effectiveness of MB for pain relief in patients undergoing costal cartilage harvesting.

Methods: A total of 106 patients undergoing costal cartilage harvesting surgery were selected from the plastic surgery department between December 2022 and March 2024. They were randomly divided into 2 groups: the MB group and the ropivacaine group, with 53 patients in each group. Pain levels were assessed with a numerical rating scale, the Insomnia Severity Index (ISI), arm elevation angle, and postoperative satisfaction scales at 1 day, 3 days, 5 days, 1 week, 1 month, and 3 months postoperatively.

Results: Patients receiving MB exhibited a significant decrease in pain scores from 5 days to 1 month of treatment compared to the ropivacaine group. Additionally, in the MB group there was an improvement in ISI scores from 5 days to 1 month compared to the ropivacaine group. Furthermore, during the 3-month follow-up, the MB group had significant increases in satisfaction scores compared to the control group. Arm elevation angle in the MB group was significantly higher compared to the ropivacaine group at 5 days, 1week, and 1month. No serious adverse events were reported, with only 2 patients experiencing an allergic rash.

Conclusions: Methylene blue demonstrated significant pain reduction with minimal adverse effects.

Level of evidence: 3 (therapeutic):

Background: A range of cosmetic treatments to improve skin quality of the decolletage are available. To measure outcomes from the patient perspective, a rigorously developed patient-reported outcome measure is needed.

Objectives: To develop and validate the BODY-Q Decolletage scale.

Methods: Appearance-related codes from BODY-Q concept elicitation interviews were reexamined and 13 items drafted and refined through patients and clinician debriefing interviews. The scale was tested in an online international sample of women >25 years who had previously received a treatment for the decolletage, or in the past 12 months had received a cosmetic treatment at a plastic surgery or dermatology clinic. Data were analysed with both Rasch measurement theory and classical test theory.

Results: Interviews conducted with 15 patients and 5 clinicians led to a 16-item scale with items that covered scenarios (mirror, photos, low neckline, lay on side, breasts together, arms crossed, get up, up close), compared (other people), age (youthful, age), qualitative (attractive, healthy), color (even-colored) and texture (smooth, texture). The field-test included 334 participants. An item with poor fit to the Rasch model was dropped. Data for the remaining 15 items fit the Rasch model (Chi-square=76.72, df=60, p=0.07). All items had ordered thresholds and good item fit. All reliability statistics were >0.93. A total of 19 of 20 pre-defined hypotheses (95%) were met providing evidence of construct validity.

Conclusions: The Decolletage scale is available to incorporate the perspective of patients into clinical care and clinical trials of minimally invasive treatments to improve skin quality.