Aesthetic Surgery Journal最新文献

Although microfocused ultrasound with visualization (MFU-V) and calcium hydroxylapatite- carboxymethylcellulose (CaHA-CMC) have their individual strengths and have demonstrated effectiveness in aesthetic improvement and improving skin laxity, a combined treatment may sometimes be required to achieve comprehensive aesthetic enhancements that meet patients' needs and preferences. This review systematically summarizes the available evidence on combined MFU-V and CaHA-CMC treatment. A comprehensive search was conducted in Embase, MEDLINE ALL (Ovid), Web of Science Core Collection, and Cochrane Central. We included studies conducted in adults that examined the effectiveness, safety, and/or mechanism of action of combined MFU-V and CaHA-CMC treatment. Out of 4019 references, 11 studies, mainly pre-post studies, were included in this analysis. Overall, regardless of the area treated, improvements in global aesthetic scales, skin quality parameters, and patients' satisfaction following combined treatment, accompanied by mild to moderate adverse effects, were found. In addition, histological studies indicated increased neocollagenesis and elastin synthesis posttreatment. Our review highlights promising outcomes from combined MFU-V and CaHA-CMC treatment. Nevertheless, due to the limited number of studies, further research is essential to gain a deeper understanding of this combined treatment's efficacy, safety, and applicability.

Level of evidence: 3 (therapeutic):

Background: Closed preservation rhinoplasty continues to grow in popularity. Nevertheless, many surgeons remain wary of doing closed preservation rhinoplasty in certain patient populations. Mestizo noses have a thick soft-tissue envelope and weak nasal tip support. These inherent characteristics have led many surgeons to favor open structural techniques when addressing the tip in the Mestizo patient.

Objectives: The present article describes a set of techniques that have been successfully employed by the authors for maximizing tip support and definition when doing closed preservation rhinoplasty in a patient population for which structural techniques were once thought as the only viable option.

Methods: A total of 417 primary rhinoplasty cases were studied retrospectively between January 2022 and December 2023. All the cases were performed using a closed approach and dorsal preservation of the soft-tissue envelope. All patients underwent one of the four types of surgical techniques for the tip area (Type I - 105 patients, Type II - 124, Type III - 181, and Type IV - 7).

Results: Of the total patients, 331 (79.3%) were female and 86 (20.6%) were male. Patient age varied from 15 to 66, with a median age of 23. Patients were followed for a period of six months to a year postoperatively. Seven patients underwent revision surgery (1.7%).

Conclusions: Even with its various potential benefits, there is still apprehension about doing closed preservation rhinoplasty in certain patient populations. The authors present several techniques that have been successfully employed to maximize tip support and definition when performing closed preservation rhinoplasty in the Mestizo patient.

Background: The description of the aesthetically ideal neck was first described by Ellenbogen and colleagues in 1980. Since then, visual and aesthetic goals of patients have evolved as new surgical techniques have been described.

Objectives: Our study aims to provide current objective data regarding the aesthetically ideal neck in a young Caucasian female and evaluate Ellenbogen's original criteria for a youthful neck in this specific population.

Methods: A survey was created and deployed using the Amazon MTurk platform. Respondents rated a panel of digitally altered female necks from most to least attractive.

Results: These results concur with Ellenbogen's findings and suggest new criteria for defining the ideal neck: 1. Defined anterior two thirds of the mandible; 2. Presence of a subhyoid depression; 3. Subtle thyroid cartilage bulge; 4. Partial sternocleidomastoid definition; 5. Cervicomental angle of 100 degrees.

Conclusions: While the visual criteria proposed by Ellenbogen mostly hold true, surgeons should focus on communicating with patients to determine their specific anatomic surgical goals and implementing the appropriate operative intervention.

Background: Breasts with a broad base, constricted inframammary fold (IMF) and a short distance between the nipple and the IMF are predisposed to form a double bubble (DB) deformity. Most publications have focused on the correction of a DB rather than on its prevention and thorough analysis of the IMF.

Objectives: Introduction of a third dissection plane in breast augmentation for preventing or correcting DB deformities.

Methods: This study is a retrospective analysis conducted by a single surgeon, involving 46 patients with a well-defined constricted IMF who underwent breast augmentation with the 'Plus One' technique between 2019 and 2021. Women who required mastopexy were excluded. All procedures were analyzed for lower pole curvature using visual and graphical photographic analysis. The lower pole breast contour was plotted as a graph for better comparison of outcomes. Breast-Q surveys were conducted before and 3 months after surgery. Follow-ups were done at 2 weeks, 6 months, and 12 months after surgery.

Results: The curve of the postoperative lower pole was convex in 96% of the cases. In 4%, the curve tends to straighten out in the lower pole. In one case, the curve became concave at one point indicating a DB deformity, making a DB complication rate of 2%. The mean preoperative satisfaction score was 43±2, and the postoperative satisfaction score was 94±3 on the BREAST-Q scale.

Conclusions: The "plus one" method showed stable and satisfying results and is easily reproducible with a low complication rate. This can also be used as either a prophylactic or corrective measure.

Background: Artificial intelligence (AI)-driven technologies offer transformative potential in plastic surgery, spanning pre-operative planning, surgical procedures, and post-operative care, with the promise of improved patient outcomes.

Objectives: To compare the web-based ChatGPT-4o (omni; OpenAI, San Francisco, CA) and Gemini Advanced (Alphabet Inc., Mountain View, CA), focusing on their data upload feature and examining outcomes before and after exposure to CME articles, particularly regarding their efficacy relative to human participants.

Methods: Participants and LLMs completed 22 multiple-choice questions to assess baseline knowledge of CME topics. Initially, both LLMs and participants answered without article access. In incognito mode, the LLMs repeated the tests over 6 days. After accessing the articles, responses from both LLMs and participants were extracted and analyzed.

Results: There was a significant increase in mean scores after the article was read in the resident group, indicating a significant rise. In the LLM groups, the ChatGPT-4.o (omni) group showed no significant difference between pre- and post-article scores, but the Gemini Advanced group demonstrated a significant increase. It can be stated that the ChatGPT-4.o and Gemini Advanced groups have higher accuracy means compared to the resident group in both pre and post-article periods.

Conclusions: The analysis between human participants and LLMs indicates promising implications for the incorporation of LLMs in medical education. As these models increase in sophistication, they offer the potential to serve as supplementary tools within traditional learning environments. This could aid in bridging the gap between theoretical knowledge and practical implementation.

Background: There are several articles discussing the use of a hemostatic net to close dead spaces, but no in-vivo experimental studies have simultaneously examined the histology and tissue perfusion of these techniques.

Objectives: Our aim is to compare variations of the hemostatic net technique commonly used in current practice.

Methods: Two different hemostatic net suturing techniques and two times of suture removal were tested, with a control group for comparison. In the modified McFarlane flap model, hemostatic net sutures are placed in either a vertical or horizontal pattern. Suture removal times are set at 60 hours and 7 days. Perfusion in the proximal, middle and distal parts of the flap was assessed by SPY device assisted immunofluorescence angiography at 0 minutes, 60 hours and 7 days after the first surgery. The rat dorsal flap was photographed in a standardised manner one week after surgery. Flap survival areas were calculated as a percentage using ImageJ software (US National Institute of Health, Bethesda, MD). On day 20, all rats were sacrificed and sent for histological examination.

Results: There was no statistically significant difference in macroscopic flap survival between groups (p>0.05). Group 5 (control) was statistically different with lower neovascularisation scores than the other groups in all three segments (p<0.01).

Conclusions: The hemostatic net may improve neovascularisation at the flap base but does not significantly affect overall flap survival.

Background: Cryolipolysis is an established method for noninvasive focal subcutaneous fat reduction.

Objectives: To highlight the safety and real-world use of this technology.

Methods: Electronic medical records of all patients treated with a commercially available cryolipolysis technology (CoolSculpting and CoolSculpting Elite, Allergan Aesthetics, Irvine, CA) between 01/2016 and to 06/2023 at a multi-location group practice was retrospectively reviewed. Extracted procedure-related data included number of total sessions and cycles, number of sessions and cycles per body area, and treatment-related adverse events. A cycle was defined as 1 applicator treating 1 body area.

Results: 3262 patients (2797 female, 465 male) treated with 18,203 cycles across 6245 sessions were included. Mean age at first treatment was 45.0±12.8 (15-83) years. Mean number of cycles per patient was 5.6±6.5 (1-177), with a median of 4 cycles per patient. Mean number of sessions per patient was 1.9±1.7 (1-38), with a median of 1 session per patient. The most commonly treated area was the lower abdomen (n=1761, 4734 cycles), and the most frequently treated body area combination was the upper/mid + lower abdomen (n=937, 5140 cycles). Dual submental treatment was more common than single applicator therapy. Eighty-seven patients exhibited 180 adverse events (2.05% of cycles), including 3 body areas (n=2) with paradoxical adipose hyperplasia (PAH).

Conclusions: This retrospective chart review of cryolipolysis treatment, among the largest to-date, demonstrates its overall safety and broad use across numerous body areas. PAH risk per cycle is between 0.018% (1 in 5501) and 0.048% (1 in 2063), depending on the calculation method.