Aesthetic Surgery Journal最新文献

Subfascial placement has been reported to reduce capsular contracture (CC) in primary breast augmentation. Given the shift toward smooth implants, it is unclear whether the perceived advantage reflects the surgical plane or historical implant selection. This study compares CC rates between subfascial and subglandular breast augmentation stratified by implant surface. A systematic review and meta-analysis were conducted. PubMed (National Institutes of Health, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), Scopus (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library, London, UK), and Google Scholar (Alphabet, Inc., Mountain View, CA) were searched through April 2025. Studies reporting CC in primary augmentation with specified implant surface and plane were included. Random-effects models generated pooled incidences and odds ratios. Subgroup analyses evaluated studies published in the last decade and with a mean follow up duration greater than 24 months. Thirty-three studies met inclusion criteria. Across all years, studies comparing subfascial versus subglandular placement for smooth implants demonstrated no statistically significant difference in capsular contracture rates (7.2% vs 17.1%, p=0.13). Studies evaluating textured implants similarly showed no significant difference between planes (0.9% vs 3.7%, p=0.08). In studies published since 2015, smooth implants demonstrated comparable capsular contracture rates between subglandular and subfascial placement (8.2% vs 10.3%, p=0.54). In studies with mean follow-up greater than 24 months, no significant differences were observed for smooth implants, while textured implants demonstrated lower rates with subfascial placement. Microtextured implants demonstrated the lowest CC rates. When controlling for implant surface, CC rates do not differ significantly between subfascial and subglandular placement. Previously reported reductions in CC with subfascial augmentation appear driven by textured-implant cohorts. In contemporary smooth-implant practice, CC rates are similar across prepectoral planes.

Background: RibXcar is a minimally invasive technique for waistline contouring that uses ultrasound-guided monocortical rib fractures to achieve controlled angulation while preserving thoracic stability. Although its safety profile is favorable, bicorticalization fracture extension through both cortices remains a potential complication requiring systematic evaluation.

Objectives: This study aimed to assess the incidence, clinical evolution, and radiologic characteristics of bicorticality in a prospective cohort of RibXcar patients.

Methods: A prospective cohort of 328 female patients (mean age 28.3 ± 6.7 years; BMI 25.3 ± 1.8 kg/m²) underwent RibXcar between January and December 2023, performed by a single surgeon. Eligible patients were women aged 18-40 years with BMI < 30 kg/m² and visceral fat < 13%. All completed one-year clinical and radiologic follow-up. Postoperative pain, complications, and imaging findings were analyzed using Wilcoxon tests (p < 0.05).

Results: Bicorticality occurred in 15 patients (4.6%), mostly within the first 20 postoperative days. Pain was reported by 41 patients (12.5%), but in 7.9% was related to corset misuse rather than fracture status. Bicorticality correlated with higher visceral fat (12.7% ± 0.5 vs. 8.0% ± 0.3; p < 0.001) and longer operative time (48.9 ± 6.3 vs. 43.3 ± 8.3 min; p = 0.01). No hemothorax or pneumothorax occurred. At one year, 98.2% demonstrated satisfactory healing; 1.5% showed callus irregularity; and only one patient (0.3%) had persistent bicorticality.

Conclusions: RibXcar achieves controlled monocortical fractures with a low bicorticalization rate and predictable consolidation. Visceral fat and operative duration appear more influential than BMI in complication risk, supporting the technique's safety and reproducibility.

Background: Although transconjunctival orbital fat removal (TOFR)-a minimally invasive procedure-is increasingly performed to correct lower eyelid bulging, multicenter prospective studies evaluating patient satisfaction across multiple dimensions-bulging, pigmentation, and skin laxity-remain scarce.

Objectives: To evaluate post-TOFR satisfaction and identify factors influencing patient-reported outcomes.

Methods: This prospective observational study included 920 consecutive patients undergoing standardized TOFR between July and August 2025 across 60 aesthetic surgery clinics in Japan. A 5-point Likert scale assessed satisfaction with bulging, pigmentation, and skin laxity; scores of ≥4 indicated high satisfaction. Adjunctive treatments-hyaluronic acid (HA), collagen filler, and extracellular matrix (ECM) products-were analyzed.

Results: Satisfaction with skin laxity-but not bulging and pigmentation-significantly declined with age (ρ=-0.093, p=0.005). Total removal yielded higher satisfaction than partial removal, but without statistical significance. HA adjunctive treatment significantly improved satisfaction with pigmentation (65.4 vs 75.9%, p=0.002) and skin laxity (76.2 vs 82.9%, p=0.026). In multivariate analysis, HA (odds ratio, 1.56, p=0.026) and HA+ECM (odds ratio 1.76, p=0.013) were independent predictors of higher pigmentation-related satisfaction. Age cutoffs identified via Youden's index indicated significant declines in satisfaction beyond 38-48 years, particularly for skin laxity. Overall satisfaction (high satisfaction across all three domains) ranged from 64% to 73%, with trends toward improvement in groups receiving HA and multiple adjunctive procedures.

Conclusions: TOFR yielded high satisfaction regarding lower eyelid bulging. However, satisfaction with skin laxity declined with age. Adjunctive HA treatment improved pigmentation and skin laxity outcomes, underscoring the importance of individualized multimodal treatment, particularly in older patients.

Background: Breast ptosis remains challenging, particularly when excess skin and parenchyma are pronounced. Inferior-pedicle techniques may be prone to recurrent ptosis with lower-pole elongation and loss of upper-pole projection.

Objectives: To describe and evaluate a mastopexy technique using an inferior-septal pedicle with dermal-muscular fixation designed to enhance long-term stability in severe ptosis (Regnault grade III).

Methods: Single-surgeon, single-center consecutive case series (level IV). One hundred sixteen women with grade III ptosis underwent surgery from January 2016 to June 2023. The technique uses an inferior-septal dermoglandular pedicle with dermal fixation to the pectoralis major. Outcomes were assessed via standardized examinations, photography, and the BREAST-Q Reduction/Mastopexy module at 3, 6, and 12 months.

Results: A total of 116 patients were analyzed (median follow-up, 12 months). Mean SN-N distance decreased from 36.3 to 22.0 cm, and N-IMF from 14.5 to 8.0 cm at 12 months. BREAST-Q scores at 12 months demonstrated high satisfaction (mean ≥80/100). No NAC-related vascular events, infections, or hematomas occurred (0%). Wound-healing disturbances were noted in 16/232 breasts (6.9%). Revisions occurred in 13/116 patients (11.2%), mainly scar adjustments; secondary ptosis correction was required in 5/116 (4.3%). No cases of persistent nipple sensory loss were observed.

Conclusions: The proposed mastopexy technique with inferior-septal pedicle provides effective correction of severe ptosis with good upper-pole fullness and stable long-term breast shape, while preserving NAC perfusion, innervation, and potential lactational function.

Background: Postoperative nasal obstruction and asymmetry can compromise satisfaction after rhinoplasty. Internal nasal dilators (INDs) may support early healing by maintaining valve patency and symmetry, but their postoperative efficacy has not been systematically evaluated.

Objectives: To determine whether IND use after septorhinoplasty improves functional, aesthetic, and symmetry outcomes compared with standard care.

Methods: In this single-center, randomized, single-blinded trial, 128 adults undergoing primary septorhinoplasty were allocated (1:1) to IND plus standard care or standard care alone. Assessments were performed at baseline, 3 months, and 12 months using the validated Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) and a nostril-symmetry item (0 = perfect, 4 = very asymmetrical). The primary outcome was patient-reported nostril symmetry; secondary outcomes included functional and aesthetic SCHNOS scores, comfort, and adverse events.

Results: Baseline characteristics were comparable. Nostril symmetry scores favored the IND group at 3 months (0.78 ± 0.92 vs 1.42 ± 1.09; p = .001) and 12 months (0.46 ± 0.71 vs 1.40 ± 1.20; p < .001). Functional SCHNOS improved in both groups, with a slightly greater gain in the IND group at 12 months (+10.2 ± 4.1 vs +7.9 ± 4.4; p = .048). Aesthetic SCHNOS scores improved similarly across groups (p = .73). Device comfort was high (VAS 8.1 ± 1.4/10), and no device-related complications occurred.

Conclusions: Internal nasal dilators improved postoperative nostril symmetry and maintained favorable functional and aesthetic outcomes without added risk or discomfort. These findings support the adjunctive use of INDs to enhance symmetry and patient satisfaction after rhinoplasty.

Social media has become a powerful tool in plastic surgery, offering opportunities to attract patients and share content. However, its use raises medicolegal challenges, including privacy, defamation, and professional boundaries. The impact of social media on lawsuits involving plastic surgeons remains underexplored. A systematic review of publicly available legal cases was conducted using WestLaw and Nexis Uni databases, covering January 2007 - January 2024. 135 unique cases were screened by three independent reviewers. Inclusion required involvement of social media and plastic surgeons or practices. Twenty-seven cases met criteria and were analyzed for plaintiff/defendant status, cause of action, use of anti-SLAPP statutes, and case outcomes. Of the 27 included cases, 17 were filed by plastic surgeons, seven by patients, two by practices, and one by a non-patient. Defamation was the most common claim (15/27). Plastic surgeons and patients were equally represented as defendants. Only three defamation cases resulted in court rulings favoring the plaintiff, and one case was settled in arbitration. Additional claims included invasion of privacy, copyright infringement, trademark violation, and misappropriation of likeness. Cases highlighted risks associated with improper handling of patient photographs and employee-managed accounts. Plastic surgeons face growing medicolegal exposure related to social media. Defamation lawsuits against patients rarely succeed. Surgeons should avoid litigation as a primary strategy and instead mitigate risk through clear policies, professional conduct, and strong physician-patient communication. Proactive reputation management and adherence to ethical standards remain the most effective tools to reduce litigation in the social media era.

Background: For gender-affirming mastectomy in patients with gender dysphoria and small/non-ptotic breasts, traditional periareolar techniques carry risks of visible scar complications. A scar-minimizing alternative is needed.

Objectives: To evaluate the outcomes of a novel non-endoscopic axillary approach mastectomy, aiming to eliminate areolar scars or diminish circumareolar incision while assessing safety and patient satisfaction.

Methods: This study included patients classified with Fisher 1, 2a, and a portion of 2b patients. Mastectomy was performed via an axillary incision without endoscopic assistance. Outcomes were evaluated through complication rates and patient-reported outcomes using the BODY-Q questionnaire (score 0-100).

Results: From December 2020 to August 2024, 48 patients (average age 33.65) underwent the procedure. The average operative time was 167.1 minutes. The overall complication rate was 45.8% (22/48), predominantly minor, reversible nipple-areola superficial skin necrosis (20.8%). Severe complications were rare: total NAC necrosis 2.0% (1/48) and acute hematoma 2.0% (1/48). Patient satisfaction on the BODY-Q scale was statistically very high.

Conclusions: This axillary approach for mastectomy successfully prioritizes minimal scarring, a key aesthetic concern particularly for East Asian patients. In a carefully selected cohort, it achieves high patient satisfaction with a low rate of severe complications, offering a valuable surgical alternative.

Background: The efficacy and safety of botulinum toxin type A (BoNTA) treatment for primary axillary hyperhidrosis (PAH) have not been explored in the Chinese population.

Objectives: The objective was to evaluate efficacy and safety of 1 intradermal BoNTA injection in Chinese PAH cases.

Methods: This was a Phase 3, multicenter, randomized, double-blind, placebo-controlled study. Patients were randomized to an experimental group or the control group at a ratio of 3:1 and received either BoNTA or a placebo once. The primary efficacy endpoint was the proportion of patients who experienced an over 50% reduction in axillary sweat weight at Week 4 posttreatment compared to baseline. The key secondary efficacy endpoints were the percentage changes in axillary sweat weight at Weeks 1, 4, 8, and 16 posttreatment.

Results: A total of 344 patients were randomized to the experimental group (n = 258) or the control group (n = 86). The proportions of patients who experienced an over 50% reduction in axillary sweat weight at Week 4 posttreatment were 83.72% (216/258) in the experimental group and 55.81% (48/86) in the control group, respectively. The between-group difference was 27.91% (P < .001). BoNTA treatment yielded a significant reduction in axillary sweat weight, hyperhidrotic area, hyperhidrosis disease severity scale (HDSS) scores, and grade of bromhidrosis. The patients in the experimental group reported significantly higher satisfaction scores than those in the control group. BoNTA treatment was well tolerated. Neither group experienced suspected unexpected serious adverse reactions, or adverse events or adverse drug reactions leading to withdrawal or death.

Conclusions: One intradermal 50-U BoNTA treatment led to a significant reduction in axillary sweat weight, axillary hyperhidrotic area, HDSS scores, and axillary bromhidrosis grades in Chinese PAH patients. The therapeutic effect was maintained for 16 weeks posttreatment, with a favorable safety profile.

Level of evidence: 1 (therapeutic):

Background: Nearly two thirds of patients who suffer from migraine headaches (MH) have a rhinogenic trigger site. A majority of rhinoplasty patients are female, and an estimated 18% of females suffer from MH. Rhinogenic MH and sinus headaches (SH) are commonly triggered by elements which can be readily addressed during septorhinoplasty. Consequently, this surgery may present a dual opportunity to address MH/SH and cosmetic concerns simultaneously.

Objectives: This study aims to quantify the incidence of MH and SH in patients presenting for primary rhinoplasty.

Methods: A retrospective review was conducted on a consecutive sample of patients who presented for primary rhinoplasty. The senior author's 2-page preoperative questionnaire which inquires about MH and SH was used to identify patients who self-reported MH and SH. MH and SH incidences were calculated as a percentage of the total number of patient responses.

Results: A total of 190 primary rhinoplasty patients (164 females (86.32%) and 26 males (13.68%)) were included in this study. In total, 64 (33.68%) had either SH or MH. Twenty-nine patients (15.26%) had SH only, 12 (6.32%) MH only, 23 (12.11%) both MH and SH, and 35 (18.42%) had MH with or without SH.

Conclusions: MH incidence (18.42%) in this patient sample was greater than the reported global migraine rate of 14-15%. By screening for and treating rhinogenic MH and SH, surgeons can both alleviate symptoms while fulfilling aesthetic objectives.