Aesthetic Surgery Journal最新文献

Background: Preservation of septal cartilage harvested during primary septoplasty can reduce the need for secondary donor sites in future revision rhinoplasty. However, the optimal storage conditions for maintaining tissue viability and extracellular matrix (ECM) integrity remain unclear.

Objectives: To evaluate the histological structure and chondrocyte viability of autologous septal cartilage stored at -40 °C without a preservation solution for 1 week, 1 month, and 3 months.

Methods: This prospective study, conducted between May 2024 and May 2025, included septal cartilage samples from 40 patients who underwent primary septoplasty. Specimens were randomly assigned to four groups without the use of any preservation solution: fresh control, and storage at -40 °C for 1 week, 1 month, or 3 months. All samples were analyzed histopathologically in a blinded manner for chondrocyte viability, peripheral proliferation, stromal degradation, and extracellular matrix (ECM) integrity.

Results: The mean chondrocyte viability rate progressively decreased from 95% in the fresh group to 89%, 85%, and 81% in the 1-week, 1-month, and 3-month groups, respectively (p < 0.001). Prolonged storage correlated with increased stromal loss, vascularization, inflammation, ossification, and calcification (p < 0.05), while fibrosis and peripheral chondrocyte proliferation did not differ significantly.

Conclusions: Short-term storage of autologous septal cartilage at -40 °C without a preservative maintains substantial histological and cellular integrity. Nonetheless, longer storage durations lead to gradual ECM degradation and decreased chondrocyte viability. These findings highlight the importance of optimizing storage duration to preserve the structural and functional reliability of cartilage grafts in revision septorhinoplasty.

Background: Postoperative hematoma and oozing can compromise outcomes after mastectomy with immediate reconstruction. Intravenous tranexamic acid (TXA) is antifibrinolytic, but prospective evidence in this setting is limited.

Objectives: To determine whether a single pre-incision dose of intravenous TXA reduces perioperative blood loss and fibrinolytic activation versus placebo.

Methods: In this randomized, triple-blinded, placebo-controlled trial, 60 women (ASA I-II, 18-75 years) undergoing bilateral mastectomy with immediate implant-based reconstruction received TXA 10 mg/kg in 100 mL saline or placebo 10 min before incision. The primary outcome was total blood loss within 24 h (intraoperative suction+swab plus drain output). Secondary outcomes were perioperative change in hemoglobin, D-dimer and fibrinogen, and complications within 30 days. Intention-to-treat analyses were performed.

Results: All patients completed follow-up. Total blood loss was lower with TXA than with placebo (mean ± SD: 221.1 ± 72.4 vs. 298.1 ± 90.6 mL; mean difference -77.0 mL; 95% CI -122.4 to -31.6; p=0.001). Intraoperative loss and 24-hour drain output were also reduced. Postoperative D-dimer rise was attenuated with TXA (0.31 ± 0.15 vs. 0.49 ± 0.22 µg/mL; p=0.002); hemoglobin decline was smaller. No thromboembolic, neurologic, or allergic events occurred; no skin-flap necrosis was observed.

Conclusions: Pre-incisional intravenous TXA safely reduces perioperative bleeding and fibrinolytic activity after mastectomy with immediate implant-based reconstruction. These findings suport incorporation of IV TXA into perioperative protocols.

Background: Deep-plane facelift (DPF) and its extended modification (EDPF) have been developed to address age-related changes in the lower face, particularly marionette lines, jowls, and neck laxity. Although both techniques provide durable rejuvenation, direct comparative data remain limited.

Objectives: The authors of this study aim to compare the clinical effectiveness of DPF and EDPF in correcting lower facial aging, with emphasis on marionette lines, cervical laxity, and jowling.

Methods: A prospective cohort study was conducted on 70 patients (mean age: DPF 51.7, EDPF 55.1 years; 95.7% female) between April 2023 and March 2025. Patients were randomized to undergo DPF or EDPF by a single surgeon. Standardized preoperative and 9-month postoperative photographs were independently assessed by 2 blinded ENT surgeons using validated photonumeric scales. Statistical analyses included Wilcoxon signed-rank and Mann-Whitney U tests.

Results: Both facelift methods achieved significant postoperative improvements (P < .001). However, EDPF consistently demonstrated superior outcomes in reducing marionette lines (P < .001), improving cervical laxity (P < .01), and correcting jowls (P < .05). No permanent facial nerve injuries or major complications were observed.

Conclusions: Although both DPF and EDPF are effective in lower facial rejuvenation, the extended technique provides greater and more consistent improvements, particularly in marionette line correction and jawline-neck contouring. These findings support EDPF as a safe, anatomically sound advancement in facial rejuvenation, warranting further longitudinal and multicenter evaluation.

Level of evidence: 3 (therapeutic):

Background: Cataract surgery, one of the most commonly performed surgery worldwide, not only restores visual function but may also influence patients' psychosocial behavior.

Objectives: This study aimed to investigate whether cataract surgery influences the trend for cosmetic surgery, particularly facial aesthetic procedures, by utilizing the TriNetX database. We hypothesized that improved postoperative vision may prompt patients to seek cosmetic procedures due to the change of self-perception.

Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Two cohorts were defined: patients with cataract extraction status (CES) and those who did not (nCES). 1:1 propensity score matching was applied. We assessed the relative risk (RR) of cosmetic procedures and applied Cox proportional hazards models to identify independent predictors of blepharoplasty. Adverse events, including dry eye syndrome and visual disturbances, were evaluated in the CES subgroup.

Results: Patients in the CES cohort were significantly more likely to undergo blepharoplasty (RR: 1.83, 95% CI: 1.70-1.96) and rhytidectomy (RR: 1.67, 95% CI: 1.22-2.28). Adverse events, including dry eye syndrome (RR: 1.80, 95% CI: 1.66-1.95) and impaired vision (RR: 1.35, 95% CI: 1.24-1.47), were observed more frequently in patients undergoing blepharoplasty post-cataract surgery. Multivariable Cox regression confirmed cataract surgery as an independent predictor of blepharoplasty (HR: 6.31, 95% CI: 2.57-15.50, p < 0.0001).

Conclusions: Cataract surgery is associated with an increased trend for certain cosmetic surgeries, particularly facial procedures. However, blepharoplasty after cataract surgery may elevate the risk of ocular complications, emphasizing the need for careful postoperative care.

Background: Dermal fillers are a primary treatment for chin retrusion. However, current options have limitations in longevity and biomechanical properties.

Objectives: To evaluate the efficacy and safety of a novel filler, comprised of polyvinyl alcohol (PVA) microspheres suspended in hyaluronic acid (PVA-HA), for chin augmentation..

Methods: The physicochemical properties of PVA were were compared to traditional filler materials using contact angle, Young's modulus, friction-wear, and scanning electron microscopy tests. Biocompatibility was assessed in animal models via histopathological and immunofluorescence analyses. Subsequently, a prospective, randomized controlled trial was conducted from June 2021 to March 2023 in 144 subjects with chin retrusion, randomized 3:1 to receive PVA-HA or no treatment. Efficacy was assessed by changes in the Glabella-Subnasale-Pogonion (G-sn-Pog') angle, a chin retrusion scale and Global Aesthetic Improvement Scale (GAIS).

Results: Preclinical tests demonstrated that PVA microspheres had favorable hydrophilicity, softness, and mechanical properties comparable to natural periosteum. In animal models, PVA-HA exhibited excellent biocompatibility with only a mild, transient inflammatory response. In the clinical trial, the PVA-HA group showed a mean G-sn-Pog' angle increase of 1.12° (95% Confidence Interval [CI]: 0.83°, 1.41°) at 60 weeks, compared to a mean decrease of 0.42° (95% CI: -0.87°, 0.03°) in the control group (between-group difference, 1.54°; p<0.01). Significant improvements were also observed on GAIS and chin retrusion scale (both p<0.001). Adverse events were primarily mild-to-moderate, transient injection site responses.

Conclusions: The novel PVA-HA filler demonstrates favorable physicochemical and biocompatibility properties. It provides clinically significant and safe outcomes in chin augmentation, representing a promising new option for soft tissue filling.

Background: Concerns regarding information inaccuracy when using general-purpose large language models have prompted the quest for alternative tools. OpenEvidence has emerged as a healthcare-focused large language model trained exclusively on data from peer-reviewed medical literature.

Objectives: This study compared the quality, accuracy, and readability of aesthetic surgery patient education materials generated by OpenEvidence and ChatGPT.

Methods: A standardized prompt requesting comprehensive postoperative discharge instructions for twenty of the most common aesthetic surgery procedures was entered into OpenEvidence and ChatGPT-5. Outputs were evaluated using four validated assessment tools: the DISCERN instrument for information quality (1-5), the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) for information understandability and actionability (0-100), the Flesch-Kincaid scale for estimated grade level (fifth grade to professional level) and reading ease (0-100), and a Likert scale for citation accuracy (1-4).

Results: OpenEvidence scored significantly higher than ChatGPT-5 in DISCERN (3.3 ± 0.4 vs. 1.7 ± 0.4, p<0.001) and the citation accuracy scale (2.4 ±1.3 vs. 1.5 ± 0.7, p=0.007). Scores were comparable among both tools in PEMAT-P understandability (71 ± 5 vs. 69 ± 0, p=0.3) and actionability (52 ± 12 vs. 54 ± 5, p=0.6), as well as on the Flesch Kincaid Grade Level (9.3 ± 1.0 vs. 9.2 ± 0.6, p=0.8) and the Flesch Reading Ease Score (40.0 ± 6.6 vs. 41.0 ± 5.5, p=0.6).

Conclusions: OpenEvidence generated materials of significantly higher quality and reliability than ChatGPT, suggesting it may serve as a more reliable alternative for patient education in aesthetic surgery practice.

Background: Autologous fascia has been widely applied in rhinoplasty, yet prospective data on the supramastoid donor site remain scarce. This region provides a dense, pliable fascial layer with concealed scarring, potentially suitable for moderate nasal dorsal augmentation.

Objectives: To prospectively evaluate the clinical outcomes, long-term stability, and patient satisfaction of supramastoid fascia as an autologous graft material for dorsal augmentation.

Methods: This multicenter observational study enrolled patients between June 2022 and April 2024. Dorsal projection and fascial thickness were measured by 3D photogrammetry and 15-MHz ultrasound at 1, 6, 12, 24, and 36 months, with patient satisfaction assessed using the FACE-Q Rhinoplasty Module. Longitudinal changes were analyzed using repeated-measures ANOVA and linear mixed-effects models.

Results: Among 73 patients, 67 (91.8%) completed ≥12 months of follow-up; 65% were observed beyond 24 months and 19% to ≥36 months. Dorsal height increased significantly at 1 month and remained stable through 36 months (P > 0.05 after 12 months). Mean resorption rate was 8.6 ± 3.7% at 12 months and 9.4 ± 4.1% at 36 months. FACE-Q satisfaction scores remained >80 across all domains without late decline. No graft displacement, irregularity, or donor-site morbidity was observed.

Conclusions: The supramastoid fascia is a practical, minimally invasive autologous donor-site alternative for moderate dorsal augmentation, showing stable projection and high satisfaction through 36 months. Longer follow-up and multi-ethnic cohorts are warranted.

Background: Achieving breast symmetry represents a critical endpoint in reduction mammoplasty. Historically, surgeons have been predominantly depended on anthropometric parameters, such as linear measurements and tactile evaluation, to guide intraoperative decision-making. Nonetheless, there remains a substantial unmet need for objective, intraoperative volumetric assessment techniques. While three-dimensional volumetric analyses have become well-established tools for preoperative planning and postoperative evaluation, the literature on intraoperative volumetric assessment is still quite limited and relies on scanning devices lacking rigorous validation.

Objectives: In this study, following extensive preliminary investigations, we present the first evaluation of the validated Vectra H2 3D photogrammetric imaging system applied intraoperatively during reduction mammoplasty. The primary aim was to investigate if integrating this objective intraoperative volumetric data could facilitate improved postoperative breast volume symmetry.

Methods: We analysed 100 patients undergoing reduction mammoplasty with supero-medial pedicle and wise pattern skin resection. We compared volumetric differences of the last 50 reduction mammoplasty procedures before using intraoperative volumetric measurements (group A; control) to the first 50 reduction mammoplasties after implementation of intraoperative volumetric analysis using Vectra H2 3D photogrammetry (group B; intraoperative 3D). The follow-up period was 12 months.

Results: 50 patients were included in group A and 50 patients in group B. Patient demographics, mean resection weight and complications did not differ statistically significantly. The 3-month-postoperative volumetric differences between the breasts of the same patient averaged 5.8% ± 3.0% (mean ± SD, 0.1% - 12.2%) in Group A (control) and 2.9% ± 1.5% (mean ± SD, 0.8% - 6.9%; ) in Group B (intraoperative 3D). These differences were statistically significant (p<0.05).

Conclusions: In our study, intraoperative 3D photogrammetry for volumetric analysis significantly improved volumetric symmetry following reduction mammoplasty. Although the volumetric differences in both groups were relatively small, the technique facilitated the intraoperative identification of outliers and resulted in superior volumetric symmetry.

Background: The efficacy of one-stage augmentation mastopexy has been well established throughout the literature. Limited evidence exists examining outcomes in the secondary augmentation mastopexy patient.

Objectives: To evaluate the long-term safety and efficacy of secondary augmentation mastopexy through an analysis of clinical outcomes.

Methods: A retrospective review of 847 patients who underwent 1664 consecutive secondary augmentation mastopexy procedures from January 2009 to January 2021 was performed. Demographics, operative characteristics, and post-operative outcomes, including complication and re-operation rate were collected and analyzed.

Results: Over a mean follow-up period of 47 months (3 to 131 months), the complication rate was 11% (n = 94) with a reoperation rate of 8.7% (n = 74). Tissue related complications occurred in 7.3% (n = 62) and implant related complications in 3.8% (n =32). Indications for reoperation were primarily due to tissue-related complications in 5.4% (n=46), most commonly recurrent ptosis in 3.4% (n=29). Implant-related indications for reoperation (3.3%, n=28) were most commonly capsular contracture (Baker III or IV) (n=21, 2.5%) and implant malposition in (n=11, 1.3%). Comparing the incidence of reoperation with the number of previous breast procedures, identified a significant increase in re-operation rate for patients with 3 or more previous breast implant procedures (p=0.041), as well as a significantly higher re-operation rate in patients with a history of tobacco use (p =0.013).

Conclusions: Secondary augmentation mastopexy can be performed safely with low complication and reoperation rates. Success with this procedure is directly proportional to control of the soft tissue envelope, implant, pocket, and the nipple to inframammary fold distance. An individualized approach coupled with a thorough preoperative evaluation of these components should be employed for optimal results.