Aesthetic Surgery Journal最新文献

Epidemiologic and preclinical studies suggest a potential protective effect of breast implants against breast cancer, but underlying mechanisms remain unclear. The authors hypothesize that local inflammation after breast implant placement induces immunosurveillence. The authors of this study investigated whether serum from implant-exposed (IE) women reduced breast cancer cell viability compared with implant-naive (IN) women, and whether antibodies mediated this effect. Serum from IE and IN women with high or low antibody levels against estrogen receptor-alpha, mucin-1, or mammaglobin-A was incubated with cancer cell lines overexpressing each antigen (MCF7, T47D, and SKBR3, respectively). 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide (MTT) assays measured cell viability. Rescue experiments utilized recombinant antigen to neutralize antibodies. Thirty-six patients were enrolled, and 12 samples were used to assess viability for each cell line. Serum with high antibody concentrations reduced cell viability compared with serum with low antibody concentrations across all cell lines. IE serum reduced cell viability compared with IN serum across all cell lines. Rescue experiments reversed differences between high and low antibody serum, as well as between IE and IN serum, implicating antibodies as the mediators of reduced viability. Peripheral serum from IE women decreased breast cancer cell viability compared with IN women, even when matched for the same antibody levels. Antibody neutralization reversed differences. This suggests implant exposure altered antibody function or other serum components. These findings support the hypothesis that the inflammatory response to breast implants may increase breast cancer immunosurveillance, although significantly more work is needed to confirm a mechanism. Level of Evidence: 3 (Therapeutic).

Background: Worldwide, the use of soft tissue fillers for aesthetic purposes has significantly increased as have the number of associated complications. Vision loss is a rare but catastrophic complication of injecting tissue fillers.

Objectives: We formed a UK multidisciplinary steering group in 2024 to develop consensus guidelines for the management of tissue filler-induced vision loss.

Methods: The multidisciplinary steering group consisted of various specialists with significant expertise in aesthetics, emergency ophthalmology, oculoplastic surgery and retina. Consensus statements were formulated by the group.

Results: Recommendations focussed on immediate emergency measures, access pathways to specialist care, improved consent processes, and increasing awareness of vision-related complications.

Conclusions: These guidelines aim to provide pragmatic, evidence-based steps for frontline clinicians to optimise patient outcomes in this rare but devastating complication.

Background: Serotonergic antidepressants have been associated with increased risk for gaining weight. As being overweight is strongly linked to macromastia development, which is a primary indication for breast reduction, it is highly important to assess whether those mediations pose a risk for postoperative complications.

Objectives: To evaluate the association between preoperative serotonergic antidepressants and the incidence of postoperative complications following breast reduction.

Methods: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Female patients > 18 years who underwent breast reduction were divided into two groups: those who had documented serotonergic antidepressants use prior to surgery and those with no history of serotonergic antidepressants use. Propensity score matching (PSM) was applied to balance demographic and clinical variables. Primary outcomes included postoperative complications at three-time intervals: 30 days, 60 days, and 90 days. Secondary outcomes included long-term complications after 1- and 2-years.

Results: After 1:1 PSM, each cohort consisted of 8,625 patients. Within 30 days following breast reduction, patients in the serotonergic cohort had a significantly increased risk of surgical site infection (RR: 1.42, p=0.003), wound dehiscence (RR: 1.524, p<0.0001), inpatient hospitalization (RR: 1.375, p=0.004), opioid use (1.474, p<0.0001), and any surgical site complication (1.28, P<0.0001) compared to control cohort. These elevated risks persisted at 60- and 90-days post-surgery. For long-term outcomes, similar rates were noted after 1- and 2-years.

Conclusions: Serotonergic antidepressants use is associated with increased risk for short-term postoperative complications following breast reduction surgery.

Background: The columella is a complex structure comprised of skin, subcutaneous tissue, and cartilage, and surgical intervention is necessary to correct columella that is deformed or defective. Due to the limitations associated with the techniques described in the literature, the authors have developed a local flap that aims to treat nasal columella defects based on lip lifting markings.

Objectives: This study aims to evaluate the efficacy of the newly developed Columella Flap technique for reconstructing nasal columella defects and short columella. The objectives include assessing aesthetic and functional outcomes following the surgical intervention and documenting the complication rates associated with this innovative approach in a retrospective series of patients over a 1-year follow-up.

Methods: A retrospective analysis of patients' medical records was performed looking at patients who underwent columella reconstruction using a flap developed by the authors. Each patient received outpatient follow-up for a minimum of one year after surgical intervention, from October 2023 to December 2025. Patients completed a questionnaire to assess how the patient perceives their nose before and after rhinoplasty, including expectations, aesthetic satisfaction, and the impact on social and professional life, in order to evaluate surgical outcomes and overall satisfaction. The same questionnaire was provided again one year after the procedure. Patient satisfaction was assessed by comparing the responses from both time points.

Results: Twenty patients underwent this technique, with a follow-up period of one year. The proposed flap significantly improved columella reconstruction, with the majority of patients reporting aesthetic and functional benefits. Only a few minor and common complications were observed.

Conclusions: The columella flap is a versatile tool used to reconstruct these deformities. The use of this new flap can help correct most columella deformities, bring functionality and be aesthetically acceptable, with minor complications.

Background: Plastic surgeons have a variety of treatment options for perioral rejuvenation, including chemical peels, energy-based skin tightening devices, microneedling, micro-coring, fat grafting, fillers, neuromodulators, and surgical lip lifts.

Objectives: The current study aims to determine the effect of perioral phenol-croton oil peeling on philtrum length in patients undergoing primary facelift.

Methods: A retrospective cohort study was performed on Caucasian females undergoing primary facelift with perioral heavy formula phenol-croton oil peels (33% phenol, 1.1% croton oil). Propensity matching was performed with BMI and age for comparison to control patients undergoing facelift without adjunct peel. Mirror Medical Imaging Software was used to estimate pre- and post-operative philtrum length for each patient from the nadir of cupid's bow to subnasale. Mann Whitney and independent t-tests were used to compare percent change in philtrum height amongst and between cohorts.

Results: 100 female primary facelift patients were included (50 with perioral peel, 50 without perioral peel). Mean age was 67.0 years, mean BMI was 24.6 kg/m2, and mean follow up for first appointment at least three months postoperatively was 6.4 months (± 3.3, range 3.0 -16.1). Peel patients had significantly shorter philtrum lengths postoperatively, with average shortening of 9.3% (± 4.6%, p <0.001). Control patients had no difference in philtrum length postoperatively (p > 0.05).

Conclusions: Phenol-croton oil peeling powerful tool for tightening skin and softening rhytides in the perioral region. This study demonstrates an additional, previously unreported benefit of average philtrum length shortening of nearly 10%. These findings are largely welcomed, as philtrum lengthening is a classic finding in the aging face.

Background: Rhinoplasty is among the most frequently performed aesthetic procedures worldwide but also carries the highest litigation risk. Malpractice claims often arise less from surgical error than from poor patient selection and overlooked psychological comorbidities.

Objectives: This study aimed to identify clinical and psychological predictors of malpractice litigation after rhinoplasty, highlighting the importance of patient selection. We hypothesized that litigating patients would exhibit higher rates of BDD traits, somatization, and dissatisfaction with body image and self-esteem.

Methods: A case-control design was applied. 55 patients referred for forensic evaluation after malpractice claims were compared with 85 rhinoplasty patients without litigation. Structured forensic assessments included functional endoscopy and standardized photographic analysis. Psychometric evaluation was performed using the Symptom Checklist-90-Revised (SCL-90-R), Body Image Quality of Life Inventory (BIQLI), Rosenberg Self-Esteem Scale (RSES), and Satisfaction with Appearance Scale (SWAS).

Results: Litigation patients were significantly older (p = 0.002), had lower educational attainment (p < 0.05), and were more often operated on by specialists rather than professors (p < 0.001). They were also more frequently operated in private hospitals (p = 0.010). Psychologically, litigation patients showed higher somatization prevalence (p = 0.019) and significantly lower BIQLI, SWAS, and RSES scores (all p < 0.05). Logistic regression identified low BIQLI scores and specialist-level surgery as independent predictors of litigation.

Conclusions: Failure to recognize BDD traits, somatization, or unrealistic expectations strongly increases malpractice risk. Effective prevention requires rigorous preoperative screening, transparent communication, and multidisciplinary evaluation. Correct patient selection remains the surgeon's strongest safeguard-enhancing outcomes, protecting professional credibility, and minimizing litigation.

Background: Tranexamic acid (TXA) is widely used to reduce postoperative edema and ecchymosis; however, evidence comparing topically applied and locally injected routes following rhinoplasty remains limited and inconsistent.

Objectives: To compare the efficacy of topically applied versus locally injected TXA in reducing periorbital edema and ecchymosis after primary rhinoplasty and to explore whether route of administration influences clinical outcomes.

Methods: In this triple-blind, randomized, controlled clinical trial, 75 patients undergoing primary open rhinoplasty were allocated into three groups: topical TXA (2.5 mL of 100 mg/mL applied via soaked pad for 5 minutes after osteotomy), locally injected TXA (2.5 mL of 100 mg/mL injected just before surgery), and saline control. A single surgeon performed all procedures using standardized piezo-assisted osteotomies. Postoperative edema and ecchymosis were evaluated on postoperative days 1, 3, and 7 by a blinded assessor using validated photographic grading scales. Statistical analyses were performed using the Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction.

Results: Both TXA groups demonstrated significantly reduced edema and ecchymosis compared with the control at all time points (P < 0.05). The topical TXA group exhibited greater reductions than the injection group on days 1 and 3, though differences were not statistically significant by day 7. No adverse events were observed.

Conclusions: Compared with locally injected TXA, topically applied TXA administered immediately after osteotomy achieved greater early reduction in postoperative periorbital edema and ecchymosis. These findings underscore the importance of the administration route in optimizing aesthetic recovery after rhinoplasty.

Background: In rhinoplasty, the open approach carries potential risks such as hypertrophic scarring, while synthetic implants carry potential risks like infection. Therefore, we propose a new technique that utilizes exclusively auricular cartilage for both framework construction and dorsal augmentation via closed approach.

Objectives: To evaluate the efficacy and safety of this new technique.

Methods: Patients who underwent rhinoplasty between October 2022 and June 2024 at Zhejiang Provincial People's Hospital were included. Incisions were made in both nostrils. The strut, septal extension graft, and nasal tip grafts were sutured to construct the framework, and the nasal dorsum was filled with diced auricular cartilage. Adobe Photoshop 6.0 was used to measure a series of aesthetic indices preoperatively and 12 months postoperatively. Patient satisfaction was assessed using the visual analog scale (VAS) and rhinoplasty outcome evaluation (ROE) scores. A paired t-test was used for data analysis, with P<0.05 considered significance.

Results: A total of 63 patients aged 18-45 years (mean age: 25.6 years) were enrolled. Statistically significant improvements were observed in all measurements (P<0.05), suggesting that aesthetic defects of the nose were corrected. VAS and ROE scores indicated significant improvements in patient satisfaction (P<0.05). Three-dimensional image analysis revealed that the nasal volume increased by an average of 2.9 mL postoperatively compared to the preoperative status. No significant difference in nasal volume was observed between 6 and 12 months postoperatively (P>0.05).

Conclusions: This technique is a promising approach and merits broader application.

Background: Facial aging is characterized by soft tissue atrophy, subcutaneous fat redistribution, and dermal laxity, most pronounced in the lower face and submental region. High-intensity focused ultrasound (HIFU) is the benchmark non-invasive lifting modality, whereas microwave-energy-based devices (MEBD) have recently emerged, targeting adipose tissue and dermis. While MEBD has been validated in body contouring, evidence for facial efficacy and safety remains limited.

Objectives: This study aimed to compare the efficacy and safety of MEBD and HIFU for facial rejuvenation in an East Asian population, emphasizing temporal improvement patterns, tolerability, and adverse events.

Methods: We retrospectively analyzed 171 patients (MEBD: n = 89; HIFU: n = 82) treated at a single institution. MEBD used 7 mm and 3 mm handpieces for subcutaneous lipolysis and dermal tightening, guided by fat compartment mapping. HIFU applied 600 shots at 3.0 mm and 4.5 mm depths targeting dermis and SMAS. Outcomes included blinded evaluator GAIS, Cutometer elasticity, FACE-Q satisfaction, pain, and adverse events, assessed at baseline, 1 month, and 3 months.

Results: MEBD showed greater early improvements in GAIS, Cutometer parameters (R2, R5), and FACE-Q scores at 1 month, with lower pain (2.3 vs. 4.7, p < 0.001) and fewer adverse events. By 3 months, HIFU surpassed MEBD in sustained GAIS, FACE-Q, and elasticity gains. Both modalities were safe, with only mild, transient effects.

Conclusions: MEBD demonstrated rapid onset, superior tolerability, and lower complication rates, while HIFU provided stronger long-term lifting and elasticity improvements. These findings support complementary clinical roles and a compartment-based rationale for facial MEBD.