Aesthetic Surgery Journal最新文献

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

Results: One hundred and six patients underwent abdominoplasty, 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=0.73), and number of previous open hernia repairs (P=0.09). 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=0.978), cosmetic complications (OR 0.80 [0.14-4.57] P=0.805), procedure length (-21.5 minutes [-46.92-22.93] P=0.501), readmissions (2.8% vs. 0%, P=0.336), or reoperations (8.8% vs. 10%, P=0.766), compared to patients who underwent abdominoplasty alone.

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.

Background: An injection method called cranial ceiling elevation is used 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 used to evaluate the blood vessels in the scalp of 50 cadaver heads and anatomical studies were performed. Each scalp was divided into two segments (L1/L2) and six 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.

Background: Microfocused ultrasound with visualization (MFU-V) and hyperdilute calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) dermal injections are effective for improving skin laxity in the lower face and submentum by stimulating neocollagenesis and neoelastogenesis.

Objectives: Combining these treatments in an optimal order may inform best practices in aesthetic dermatology. Despite their frequent concurrent use, no study has evaluated the impact of treatment order. This study aimed to determine the optimal sequence for administering MFU-V and hyperdilute CaHA-CMC.

Methods: Twelve healthy women aged 35-65 were randomized into two groups. Group A received MFU-V followed by hyperdilute CaHA-CMC six weeks later, while Group B received the treatments in the opposite order. Evaluations included histological assessments, aesthetic outcomes, and safety measures.

Results: Group A showed greater improvements in subjective global aesthetic improvement scale (sGAIS), investigator global aesthetic improvement scale (iGAIS), and FACE-Q patient-perceived age visual analog scale (VAS) scores. Both groups exhibited similar improvements in FACE-Q Satisfaction with Lower Face and Jawline scores. Histologically, both groups demonstrated significant elastin production at the 120-day follow-up. Group A showed a 143% relative increase in elastin coverage, compared to a 63% increase in Group B. Consequently, Group A exhibited superior qualitative and histologic improvements.

Conclusions: Administering MFU-V first, followed by hyperdilute CaHA-CMC six weeks later, is the optimal sequence for this combination therapy. Although both groups experienced increased elastin synthesis and aesthetic improvements, the order of treatments significantly impacted the outcomes, favoring the sequence used in Group A. This finding provides valuable insight for optimizing combination therapies in aesthetic dermatology.

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 versus structural rhinoplasty.

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

Methods: Patients' preoperative and postoperative photos were divided two cohorts. Photos were evaluated by crowdworkers using a secure online rating platform on the overall nasal appearance, the dorsal profile, the dorsal aesthetic line symmetry, the dorsal contour, and rate their confidence on 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 using 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. The correlation coefficient in the dorsal preservation cohort (-0.0554) suggested the raters were unable to identify which patients had surgery.

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

Background: Efforts in browlifting longevity, desire for minimally invasive procedures, patient individualization, and minimization of complications led to the development of the gliding brow lift (GBL). The GBL has proven to be a successful, minimally invasive technique targeting brow elevation in combination with the hemostatic net.

Objectives: To evaluate maintenance of cutaneous brow elevation with the GBL technique at specific post-operative time points.

Methods: A retrospective review was conducted of 63 patients (59 females; 4 males) who underwent a GBL by the senior author (JCG) between 2019 and 2022 for co-morbidities, maintenance of brow lift, and incidence of complications at four post-operative time points: 3, 6, 9, and 12 months. Pre- and postoperative photographs were analyzed at four anatomic locations: supraorbital rim, lateral canthus, mid pupil, and medial canthus.

Results: The cohort consisted of 59 female-only patients; male patients were excluded due to small sample size. The average age of 62.8 years old (SD ±7.01) and a mean BMI of 24. Only one patient required return to the operating room for hematoma evacuation; this was a result of a concomitant rhytidectomy and not involving the brow. All locations maintained a statistically significant lift (p<0.01). The most significant lift was at the lateral canthus (3.09 mm) and tail of the brow (2.74 mm) at 1 year post-operatively.

Conclusions: The GBL is a successful innovation in aesthetic brow surgery. Depending on patient needs, it is an excellent choice for selective and long-term elevation of the lateral brow.

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

Objectives: This study aimed to analyze dynamic naturalness after double-eyelid blepharoplasty using a simple smartphone method involving slow-motion videos.

Methods: This prospective observational study enrolled patients who underwent double-eyelid blepharoplasty using the flexible suspension technique (FST) and rigid fixation technique (RFT) and individuals with congenital double-eyelids. Demographic information was collected, and super-slow-motion videos of the eye-opening processes were recorded using 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 women (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<0.0001). The Puffy score showed a linear correlation with the mean third-party static naturalness rating (SNR) (R2=0.53, p<0.0001). 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<0.05), the Puffy scores were 49.8±11.9, 55.9±11.0, and 62.6±12.4 (Congenital vs FST, p=0.055; others p<0.05), the mean third-party DNRs were 3.21±0.67, 2.47±0.62, and 1.78±0.74 (all p<0.0001), and the mean third-party SNRs were 3.01±0.78, 2.61±0.55, and 2.14±0.69 (all p<0.05).

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

Background: Two randomized, double-blind, placebo-controlled, Phase III studies of incobotulinumtoxinA for treating upper facial lines (UFL; combination of glabellar frown lines [GFL], horizontal forehead lines [HFL] and lateral canthal lines [LCL]) were conducted in the US (ULTRA I: NCT04594213) and Germany (ULTRA II: NCT04622254).

Objectives: To evaluate safety and efficacy of simultaneous intramuscular injections for UFL. Longer-term safety and efficacy were assessed in open-label extension periods (OLEX).

Methods: Healthy participants (≥18 years) with moderate-to-severe GFL, HFL and symmetrical LCL at maximum contraction on the five-point Merz Aesthetics Scales (MAS) were randomized 2:1:1 to receive up to 64 Units of incobotulinumtoxinA in the main period (MP) for each trial. Treatment groups were: UFL, GFL & HFL (ULTRA I), LCL (ULTRA II) and placebo. Primary efficacy endpoints were the proportions of GFL, HFL and LCL responders, defined as a MAS score for the respective area of 0 (no) or 1 (mild) and ≥2-grade improvement from baseline to Day 30, as assessed by both investigator and participant.

Results: Overall, 362 and 368 participants received treatment in ULTRA I and ULTRA II, respectively. In both studies, incobotulinumtoxinA treatment was significantly more effective than placebo with respect to the primary endpoint (p < 0.0001) and key secondary endpoints (p < 0.0001). OLEX results were consistent with those seen in the MP. No new safety findings were identified.

Conclusions: In ULTRA I and ULTRA II, safety and efficacy of incobotulinumtoxinA for the simultaneous treatment of moderate-to-severe UFL were demonstrated, with significant improvements across all primary and secondary endpoints versus placebo.

Background: Platysma prominence (PP) describes the noticeable appearance of the platysma muscle upon contraction, causing less defined jawline contour and vertical neck bands.

Objectives: To assess safety and efficacy of onabotulinumtoxinA for improvement of PP in adults.

Methods: Participants with moderate-to-severe (Grade 3 to 4) PP at maximum contraction received onabotulinumtoxinA or placebo on Day 1 and were monitored for 120 days. OnabotulinumtoxinA dosage (26, 31, or 36 U) was customized based on baseline PP severity on each side of the neck.

Results: Efficacy analyses were conducted in the intent-to-treat (ITT) population (all randomized participants), and modified ITT population (mITT; psychosocially impacted by PP appearance). Results from ITT and mITT populations were comparable. As assessed by investigators, 76.7% of onabotulinumtoxinA mITT participants achieved ≥1-grade improvement versus 21.2% in the placebo group, and 41.0% versus 2.2% (P < 0.0001) achieved ≥2-grade improvement at Day 14. As assessed by participants, 79.9% of onabotulinumtoxinA mITT participants versus 21.8% in the placebo group and 40.8% versus 3.9% (P < 0.0001) achieved ≥1- or ≥2-grade improvement, respectively, at Day 14. OnabotulinumtoxinA responder rates remained higher than placebo through Day 120, gradually declining over time. OnabotulinumtoxinA participants reported significantly higher satisfaction with treatment effect, lower bother from jawline and vertical neck bands, and lower psychosocial impact from PP than placebo at Day 14 (P < 0.0001). OnabotulinumtoxinA effectively improved self-perceived jawline definition and was well tolerated.

Conclusions: OnabotulinumtoxinA was well tolerated and effective in improving moderate-to-severe PP, including neck bands and jawline definition.

Background: Predictors for permanent nipple-areola complex (NAC) insensitivity after reduction mammoplasty are sparsely defined.

Objectives: We analyze factors associated with NAC insensitivity over a long-term follow-up.

Methods: A retrospective analysis of reduction mammoplasties on 1598 breasts performed by four surgeons from March 2015-February 2023 was conducted. Data on patient demographics, intraoperative factors, and postoperative complications were collected from patient records. Analysis was conducted by breast, separated into breasts with NAC insensitivity (permanent and transient) and those without. Wilcoxon rank sum test for continuous variables and Fisher's exact test or Pearson's Chi-square test for categorical variables evaluated differences between the groups. Univariate and multivariate logistic regression analyzed the association of pedicle choice with NAC insensitivity onset and permanence.

Results: Of 1598 breasts, 9.8% had loss of NAC sensation, of which 49.0% had permanent loss. 51.0% regained sensitivity, taking an average of 116 days (median 64, range 6-798) to regain sensation. NAC-insensitive breasts had a longer sternal notch-NAC (p<0.001) and NAC-IMF (p<0.001) measurements, greater weight removed (p<0.001), and fat necrosis co-complication (p=0.022). Greater weight removed (p=0.044) and longer sternal notch-NAC measurements (p=0.011) were associated with permanent insensitivity. The superomedial pedicle was associated with an increased rate of transient NAC insensitivity, while the inferior pedicle with a decreased rate. There was no significant association between pedicle choices and permanent insensitivity.

Conclusions: Transient loss of NAC sensitivity is associated with pedicle choice, while breasts with permanent insensitivity were more likely to have longer breast measurements and a greater amount of tissue removed.

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 its musculature description.

Objectives: This article aims to reveal the detailed musculature using micro-computed tomography (micro-CT) combined with histological staining.

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

Results: The orbicularis oculi muscle (OOM), frontalis muscle (FM), depressor supercilii (DS) and procerus muscle (PM) were situated superficially. The FM terminated and connected with its antagonistic muscles at 2-5 mm above the brow but the fusion line descended in lateral third. The corrugator supercilii muscle (CSM) originated from the periosteum, extending laterally and superficially. During its course, it mainly penetrated the FM. 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.