Aesthetic Surgery Journal最新文献

Background: Utilization of GLP-1 receptor agonists (GLP-1ras) has increased dramatically in recent years. While GLP-1ras appear safe to use overall, it remains unclear if pre-operative GLP-1ra use impacts body contouring surgery outcomes.

Objectives: This study evaluated the post-operative course of patients receiving body contouring procedures by GLP-1ra use.

Methods: This retrospective cohort study examined patients who received panniculectomies, brachioplasties, thighplasties, and abdominoplasties at a large academic institution between November 2014 and November 2024. Propensity score matched analysis paired cohorts by age, smoking status, and body mass index and hemoglobin A1c at the time of surgery. Univariate analyses and multivariable logistic regression were performed.

Results: In total, 590 patients were included in this study. Of these, 100 patients utilized GLP-1ras before surgery. Propensity score matched analysis paired 72 GLP-1ra and 143 non-GLP-1ra patients. 30-day readmissions and emergency department visits in matched and unmatched cohorts were similar by GLP-1ra use (p > 0.05). Post-operative cellulitis occurred less frequently among GLP-1ra users in matched cohorts (p = 0.008); however, GLP-1ra use did not predict cellulitis on multivariable logistic regression. Duration of GLP-1ra use and timing of discontinuation prior to surgery did not predict the incidence of wound dehiscence, seromas, or hematomas. Patients using GLP-1ras for obesity had lower rates of wound dehiscence than patients using GLP-1ras for diabetes (p = 0.028).

Conclusions: Compared to non-GLP-1ra controls, GLP-1ra users have similar post-operative outcomes following body contouring surgery. Wound dehiscence is more prevalent among patients taking GLP-1ras for diabetes compared to weight loss, potentially due to worse glycemic control or associated comorbidities.

Background: Increasing the effectiveness and longevity of a rhytidectomy is a constant pursuit. The cervicomental angle and jaw line contouring is perhaps the most contentious area in regards to searching for improvements of outcomes. Full release of the platysma and SMAS unit near its inferior border is perhaps the most powerful technique to resuspend and bolster the newly surgically restored acute cervicomental angle.

Objectives: The goal of this study is to demonstrate the effectiveness and longevity of this technique.

Methods: A retrospective chart review was performed on all face/lower face/neck lift patients. The operative reports were reviewed to ensure that full release of the platysma-SMAS unit was performed for resuspension. Retrospective photographical analysis was performed to evaluate the objective results of increased cosmesis of the rejuvenated neck and jaw line.

Results: Impressive cosmetic results were demonstrated in patients who had full release and re-suspension of a plicated platysmas and SMAS unit. These results were objectively appreciated. The increased cosmetic appearance was demonstrated to have sufficient longevity and a profound effect on augmenting the acuteness of the cervicomental angle and cosmetic appearance of the mandibular border.

Conclusions: Release and resuspension of the platysma SMAS unit is an incredible powerful and long lasting modality for improving the cervicomental angle and delineation of the mandibular border in facelift patients.

Background: The reduction in collagen content within the subcutaneous fat layer due to aging results in thinning and weakening of the fibrous septum, leading to an unstable fat pad. Studies on the mechanism of action of polycaprolactone (PCL) collagen stimulators in the adipose layer are lacking.

Objectives: This research aimed to explore the effectiveness of PCL-based filler in enhancing the fibrous septum within adipose tissue, thereby facilitating collagen and elastin synthesis in the adipose layer, while also comparing the disparities in the process between juvenile and aged individuals.

Methods: A rat model was utilized to study subcutaneous fat implantation effects of PCL-based filler. Over 4 months, the impact on fibrous septum formation was evaluated with Masson's trichrome staining and immunostainings for Types I and III collagen, and a structural evaluation through scanning electron microscopy analysis. PCL-induced collagenization mechanisms were explored by quantitative polymerase chain reaction (qPCR). Elastin regeneration was examined with Elastica van Gieson (EVG) staining.

Results: Histological analysis demonstrated that PCL-based filler effectively stimulated collagen fiber formation in subcutaneous adipose tissue in both juvenile and aged rats. Immunostainings indicated significant promotion of Types I and III collagen regeneration, primarily within the interstitial spaces among adipocytes, as well as its confirmation at the genetic level through qPCR analysis. EVG staining further unveiled the role of PCL in promoting elastin production while mitigating age-related decline.

Conclusions: PCL-based filler enhanced fat septum regeneration and deposition, demonstrating a robust, age-independent response. These findings suggest PCL-based fillers as promising therapeutic agents for rejuvenating subcutaneous adipose tissue and enhancing skin volume and elasticity in cosmetic and reconstructive contexts.

Background: The FACE-Q Aesthetics is a validated tool for assessing patient-reported outcomes related to surgical and non-surgical facial aesthetic treatments. Recognizing patient-specific variables that may influence FACE-Q scores is essential to control for potential confounders in research.

Objectives: This study aimed to identify factors that predict FACE-Q Aesthetic scale scores.

Methods: A cross-sectional survey was conducted among an international cohort of participants recruited through the Prolific platform. Participants aged 20 years or older who had undergone non-invasive facial aesthetic procedures within the past year were included. Demographic and clinical information was collected, and univariable and multivariable linear regression analyses were employed to assess predictors of FACE-Q Face Overall, Psychological, and Social scale scores.

Results: A total of 1,259 participants were analyzed, with an average age of 42.6 years (±11.9). The mean scores were 52.4 (±18.3) for the Face Overall scale, 56.5 (±23.7) for the Psychological scale, and 62.7 (±24.0) for the Social scale. Several factors were significantly associated (p < 0.05) with higher scores, including lower body mass index (BMI), African American ethnicity, male gender, Fitzpatrick skin type V, residence in the United States, financial stability, and residual effects of prior aesthetic treatments. Younger participants were more likely to report higher Face Overall scores (p<0.05).

Conclusions: This study identified several patient characteristics that predict Face Overall, Psychological, and Social scale scores. These findings offer valuable insights into how patient-specific factors influence outcomes following facial aesthetic procedures and underscore the need to account for these variables in future research using the FACE-Q Aesthetics tool.

Background: Patients with gynecomastia may experience hormonal imbalances and sexual dysfunctions such as erectile and ejaculatory disorders.

Objectives: This study evaluates the changes in hormonal parameters and sexual function following gynecomastia surgery.

Methods: Thirty-two male patients (aged 15-65) without systemic or genetic comorbidities underwent gynecomastia surgery. Preoperative and postoperative hormonal parameters free and total testosterone, estrogen, prolactin, follicle-stimulating hormone [FSH], luteinizing hormone [LH], sex hormone-binding globulin [SHBG], and sexual function scores (International Index of Erectile Function [IIEF], Premature Ejaculation Diagnostic Tool [PEDT]) were assessed. A urologist blinded to the study evaluated patients andrologically.

Results: The mean age of the patients was 25.69 ± 10.37 years. Postoperative prolactin and estrogen levels significantly decreased (p=0.03 and p<0.001, respectively). All IIEF subscale scores showed significant postoperative improvements (p-values ranging from <0.001 to 0.006). PEDT scores significantly decreased postoperatively (p<0.001).

Conclusions: Surgical treatment of gynecomastia leads to significant improvements in hormonal parameters and sexual function. These benefits should be considered in surgical planning.

The increasing prevalence of cosmetic surgery among adolescents raises critical questions regarding medical responsibility and the legal standards for informed consent. While the desire to meet aesthetic standards promoted by media and social networks is a key factor driving demand for these procedures, the psychological vulnerability typical of adolescence calls for careful evaluation of patient rights and medical obligations. Informed consent for adolescents, in particular, must be assessed within a multidimensional framework that considers psychological conditions, personal motivations, and the social and cultural pressures that can negatively affect young patients' self-perception. This article examines the complexities of informed consent in adolescent cosmetic surgery, focusing on the physician's responsibility to ensure patients have a clear understanding of both the risks involved and realistic expectations of the procedure. It also discusses the value of a multidisciplinary approach, involving psychologists and legal professionals, to address the specific needs of adolescents. Emphasis is placed on the necessity for preoperative psychological assessments to distinguish between genuine desires and social pressures, with the goal of protecting adolescents' psychological and physical well-being and preventing decisions driven by unstable motivations. The article concludes with recommendations for adopting guidelines and enhancing education, advocating for an approach that respects young patients' rights and emphasizes physicians' accountability for ethical and safe practice.

Venous thromboembolism (VTE) is a significant complication following deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. The optimal duration of chemoprophylaxis remains debated, with differing recommendations on short-term chemoprophylaxis (STC) versus long-term chemoprophylaxis (LTC) for VTE prevention. This systematic review and meta-analysis compared the efficacy and safety of STC versus LTC in preventing VTE and hematoma in patients undergoing DIEP flap reconstruction. Four studies with a total of 1114 patients were included, with no significant differences in patient characteristics, including Caprini scores, between the STC and LTC groups. The pooled incidence of VTE was 1.83%, with 2.19% in the STC group and 1.33% in the LTC group, yielding a risk ratio (RR) of 1.42 for STC compared to LTC, though this was not statistically significant (p=0.62). The mean incidence of hematoma was 8.65%, with 8.32% in the STC group and 9.02% in the LTC group, resulting in an RR of 0.78 for STC compared to LTC, which was also not statistically significant (p=0.62). These findings suggest that extending chemoprophylaxis beyond hospitalization does not significantly reduce VTE incidence and underscores the importance of individualized risk-based anticoagulation strategies. Future studies are necessary to further refine guidelines for chemoprophylaxis duration in this population, balancing the risks of VTE and anticoagulation-related complications to optimize patient outcomes.

Background: Breast reduction is a common procedure with growing rates in the USA, aimed at alleviating the physical and psychological burdens of macromastia. Despite high success rates, it carries a risk of complications, with incidence rates ranging from 6.2% to 43%.

Objectives: The authors developed a machine learning model using gradient-boosting decision trees to predict severe breast reduction complications up to 30 days following surgery requiring inpatient care.

Methods: This retrospective study included 322 cases of breast reduction surgery performed at the Tel Aviv Medical Center from 2017 to 2024. Model performance was evaluated using 5-fold cross-validation, and key metrics such as area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were reported. An interpretability tool was also created to visualize complication risks based on clinical features.

Results: Severe complications occurred in 7.4% of cases. Key predictive factors included specimen weight, SN-N distance, and liposuction volume. The model achieved an AUC-ROC of 0.83, with an accuracy of 0.93, negative predictive value of 0.95. The interpretability tool clearly visualized complication risks, aiding preoperative counseling.

Conclusions: This is the first study to use AI to predict severe complications in breast reduction surgery. Our AI model, with an AUC-ROC of 0.83 and NPV of 0.95, offers a reliable tool for surgical planning and patient education. Further validation across diverse populations is recommended to confirm its clinical utility.

Background: Effects of upper facial aging can present as static forehead and periorbital rhytids as well as soft tissue volume loss. The latter can prompt in conjunct with bony changes of the calvaria eyebrow and eyelid ptosis. Injection-based treatments can yield positive outcomes but are not free of procedural risks.

Objectives: To assess the clinical outcome of synchronized radiofrequency (RF) and high intensity facial electric stimulation (HIFES) when targeting the upper face with special focus on the effects of musculature, subcutaneous fatty layer, and eyebrow position.

Methods: This non-randomized, prospective study included 37 subjects with a mean age of 45.46 years and a mean BMI of 21.84 kg/m2. Subjects received four synchronized RF and HIFES treatments spaced seven days apart. Efficacy measurements were taken at 4-, 16-, and 24-weeks post-treatment using three-dimensional surface imaging, surface electromyography (EMG), and high-resolution facial ultrasound.

Results: Forehead and lateral canthal line severity improved statistically significantly at each follow-up visit when compared to baseline with all p<0.001. At week 24, the position of medial/central/lateral eyebrows increased by 3.18/3.02/2.27 mm when compared to baseline with p < 0.001, respectively. At week 24, no statistically significant changes were observed in the thickness of frontalis muscle or of the overlying fatty layer.

Conclusions: The application of synchronized RF and HIFES to the frontal region reduced frontal and lateral canthal rhytids and elevated the position of the eyebrow until week 24 after the initial treatment. Based on the results obtained, this non-invasive energy-based treatment option could be a viable alternative to injectable treatments of the upper face when trying to ameliorate the signs of upper facial aging.