Aesthetic Surgery Journal最新文献

Background: Immediate prepectoral breast reconstruction has emerged as a prominent alternative to subpectoral techniques, offering favorable outcomes in selected patients. Among available options, implant coverage with acellular dermal matrix (ADM) and the use of polyurethane (PU)-coated implants without ADM represent 2 widely adopted strategies.

Objectives: The aim of the authors this study is to examine the comparative efficacy and complication profiles of implant coverage with ADM and the use of PU-coated implants without ADM.

Methods: This retrospective cohort study included 97 patients (135 breasts) undergoing immediate prepectoral breast reconstruction following nipple-sparing, skin-sparing, or skin-reducing mastectomy between April 2015 and October 2019. Patients were stratified into 2 groups: those receiving ADM-covered textured implants and those receiving PU-coated implants. Outcomes assessed included early (<4 weeks), mid-term (>4 weeks), and long-term (≥1 year) complications, as well as aesthetic results evaluated through blinded assessment using a standardized Likert scale.

Results: PU-coated implants were associated with significantly lower rates of early postoperative seroma (2.9% vs 33.8%, P < .001) and infection (1.4% vs 6.2%). At 5 years, the incidence of severe capsular contracture (Baker Grade 3-4) was markedly higher in the ADM group (47.7% vs 24.3%, P < .001), particularly in patients who had not received postmastectomy radiotherapy. No significant differences were observed in the incidence of rippling or step-off deformities. Aesthetic outcomes were superior in the PU group, with significantly better breast symmetry and global aesthetic evaluation (P = .021).

Conclusions: PU-coated implants offer a safer and more effective approach in immediate prepectoral breast reconstruction, with reduced complication rates and improved aesthetic outcomes compared with ADM-covered implants. Patient-specific anatomical and oncologic factors should guide implant selection to optimize surgical outcomes.

Level of evidence: 4 (therapeutic):

Background: Midface volume loss contributes significantly to facial contour changes. Congenital traits, genetic predisposition, and environmental factors can reduce collagen fiber quantity and quality, leading to decreased skin firmness, wrinkles, and midface depression. Type III collagen, abundant in the human body, has low immunogenicity, good tissue compatibility, and promising biomedical applications. However, employing animal-derived collagen, typically in liquid form, is limited by potential adverse reactions and disease transmission.

Objectives: To assess the safety and efficacy of localized injections of low-temperature gel recombinant humanized Type III collagen (rhCol III) in treating midface volume deficit.

Methods: In vivo animal experiments and retrospective clinical data analysis were conducted.

Results: Low-temperature gel rhCol III significantly improved facial volume and midfacial contour with a favorable safety profile in subchronic systemic toxicity tests in Sprague-Dawley rats, skin degradation studies in New Zealand white rabbits, and human clinical trials. In humans, the treatment group showed significant improvement in Merz Aesthetic Scale, Global Aesthetic Improvement Scale, and satisfaction scores vs controls at 1 month (P < .0001), with effects lasting at least 6 months.

Conclusions: Low-temperature gel rhCol III offers a safe, effective, and durable option for correcting midface volume deficit, with minimal risk of complications. These results suggest potential value in enhancing clinical strategies for facial volume restoration.

Level of evidence: 3 (therapeutic):

Background: Botulinum neurotoxins are used to treat masseter muscle prominence (MMP), benign bilateral masseter muscle enlargement which can be aesthetically undesirable. Limited data report botulinum neurotoxin injections in the muscles of mastication, with subsequent reduction in biomechanical loading, may impact mandibular bone density.

Objectives: This study evaluates whether changes in mandibular bone density occur after bilateral masseter treatment with a botulinum neurotoxin, onabotulinumtoxinA, in individuals with MMP.

Methods: Analyses were performed on a prespecified subpopulation (n = 123) from a 12-month, double-blind, placebo-controlled, dose-escalation, Phase 2 study (N = 187). Participants received 1 or 2 bilateral masseter treatments of onabotulinumtoxinA (48, 72, or 96 U) or placebo and had multi-detector computed tomography scans at baseline and Days 90 and 360 post-treatment. Cortical and trabecular bone densities, estimated in Hounsfield units, were calculated for the bilateral condyle, premolar dentoalveolus, and ramus.

Results: No clinically significant changes in mandibular bone density were observed in condyle, premolar area, or ramus of onabotulinumtoxinA-treated participants, when compared with placebo or baseline, after 1 or 2 treatments.

Conclusions: In healthy adults with MMP, 1 or 2 bilateral masseter treatments with onabotulinumtoxinA at doses of 48, 72, or 96 U over 1 year did not negatively impact mandibular bone density.

Level of evidence: 1 (therapeutic):

Background: Breast reduction surgery provides both functional and aesthetic benefits and enables incidental detection of breast pathology. Although high-risk or malignant lesions are uncommon, their long-term clinical relevance remains unclear.

Objectives: To evaluate the histopathological findings of breast reduction specimens and assess their relationship with long-term breast outcomes, including the development of new breast disease and need for subsequent biopsy or mastectomy.

Methods: This retrospective cohort study included 1349 patients (2630 breasts) who underwent breast reduction with a minimum 5-year follow-up. Long-term clinical outcomes were assessed only in the subset of 377 patients (731 breasts) who completed a follow-up questionnaire. Histopathological findings were classified into three risk categories according to their association with malignancy. A follow-up questionnaire assessed breastfeeding ability, adherence to imaging, and the occurrence of new breast masses or interventions. Associations between baseline risk category, follow-up duration, and long-term outcomes were analyzed using Pearson chi-square tests.

Results: High-risk or malignant lesions were identified in 1.3% of specimens, predominantly among women over 40 years. Specimen weight and prior contralateral breast cancer history were not associated with pathological risk. Among 731 breasts evaluated by questionnaire, 80.1% retained breastfeeding ability, while 38% reported no imaging follow-up. Biopsy incidence increased significantly with follow-up time (2.6%, 6.2%, and 13.8% at 5-10, 10-15, and >15 years; p<0.001). Mastectomy rates also rose with time (0%, 0.6%, and 8.3%; p<0.001), showing a trend toward higher incidence in baseline high-risk specimens.

Conclusions: Breast reduction surgery facilitates incidental detection of high-risk lesions, particularly in women over 40 years. Higher baseline pathological risk and longer follow-up were associated with increased likelihood of mastectomy, underscoring the need for structured, risk-adapted surveillance to optimize long-term oncologic safety.

Background: Dorsal preservation rhinoplasty (DPR) and conventional hump resection techniques (CHR) are two distinct methods for nasal hump reduction, affecting dorsal aesthetic lines (DALs) and midvault stability differently. There is limited existing evidence regarding variations in DALs width, between these techniques.

Objectives: To quantify DALs width variations and compare functional and aesthetic outcomes between DPR and CHR techniques in primary rhinoplasty patients.

Methods: A retrospective matched cohort study was conducted, including 30 patients who underwent DPR and 40 patients who underwent CHR. An artificial intelligence-driven analysis tool was employed to measure preoperative and postoperative DALs and axis angle changes. The SCHNOS (Sino-Nasal Outcome Test) was utilized to evaluate functional and aesthetic outcomes.

Results: The width of DALs at the midnose level increased significantly in both groups (DPR group: 8.835 mm to 10.120 mm; CHR group: 9.383 mm to 10.100 mm), with no statistically significant difference between the groups (p=0.089). SCHNOS-C scores indicated significant postoperative aesthetic improvement in all subgroups (p<0.001), with differences surpassing the Minimal Clinically Important Difference (MCID). In the combined cosmetic functional subgroup, postoperative SCHNOS-O scores decreased significantly in both groups (p<0.001), with improvement exceeding the MCID. Nasal axis deviation angles significantly decreased postoperatively in both DPR (1.715 to 1.207, p=0.008) and CHR groups (1.446 to 0.751, p=0.004).

Conclusions: Both DPR and CHR techniques effectively improve nasal aesthetics and function, with widening of DALs observed in both groups. The use of artificial intelligence technology for assessing DALs offers a valuable tool for objective evaluation in rhinoplasty.