Aesthetic Surgery Journal最新文献

To compare the outcomes of different supplements to autologous fat grafting for volume augmentation in plastic and reconstructive area, the mainstream databases were searched for qualified randomized controlled trails, with the terms of "fat transplantation", "lipotransfer", "platelet-rich plasma", "platelet-rich fibrin", "stromal vascular fraction", "mesenchymal stem cells", "growth factor" and "Botox". The primary outcome assessed the volume retention rate of various assisted-fat transplantation methods, and second outcomes of incidence of complications, effective rate, secondary operation rate and postoperative patient satisfaction were also calculated. A total of 47 articles with 2244 participants were incorporated. It is important to note that not all assisted fat grafting techniques were superior to placebo in increasing fat volume retention. Significant improvements were observed only in the Stem Cells, PRP, and SVF groups. Among these, Stem Cell-enriched grafts demonstrated the highest likelihood of being the most effective intervention, suggesting considerable clinical potential. Subgroup analyses based on recipient sites and sensitivity analysis revealed the consistent conclusion, which enhanced the robustness of the conclusion. Assisted-fat transplantation methods also exhibited various impacts on secondary outcomes. The CGF procedure presented the fewest surgical complications, and SVF, PRP and PRF-enriched fats outperformed the control group in terms of effectiveness. CGF and SVF-enriched fat were associated with the lowest reoperation rate, with the GF group showing the highest likelihood of achieving patient satisfaction. Assisted-fat transplantation methods demonstrated superior efficacy and safety, and stem cells-based products showed certain potential for clinical application. The selection of specific therapy should be guided by overall considerations in clinical settings.

Background: Upper and lower blepharoplasty are among the most commonly performed surgical procedures for both aesthetic and functional purposes. Postoperative complications such as edema, pain, dry eye, lower eyelid malposition, and scar formation are frequently observed, affecting patient comfort and outcomes.

Objectives: This study aimed to evaluate the effect of injectable Platelet-Rich Fibrin (i-PRF) on postoperative healing, early complication incidence, and scar quality in blepharoplasty. The hypothesis was that i-PRF application shortens the healing period, reduces early postoperative complications, and improves scar outcomes.

Methods: A prospective intraindividual clinical study was conducted at the Azerbaijan Medical University Teaching Surgery Clinic (March 2023-November 2025) involving 36 patients. Only one eyelid per patient received i-PRF injection, while the contralateral eyelid served as a control. Healing was assessed on postoperative days 1, 3, 7, 14, and at 1, 3, and 6 months. Edema, pain (VAS), erythema, and scar tissue were evaluated using the Vancouver Scar Scale (VSS). Statistical analyses were performed using SPSS, with significance defined as P<0.05.

Results: Eyes treated with i-PRF demonstrated significantly lower edema and pain scores (P<0.05). Scar erythema and VSS scores were more favorable in the i-PRF group (P=0.00055). Symptoms such as dry eye and irritation were also less frequent. These findings indicate a positive effect of i-PRF on postoperative healing and tissue regeneration.

Conclusions: i-PRF application accelerates postoperative recovery after blepharoplasty, reduces edema and pain, and improves early functional and aesthetic outcomes. Scar quality was enhanced, and periocular tissue integrity was better preserved, suggesting both aesthetic and functional benefits of i-PRF in blepharoplasty procedures.

Background: Collagenase clostridium histolyticum-aaes (CCH-aaes) is FDA-approved for cellulite treatment but was withdrawn due to high bruising incidence. Histological effects of CCH-aaes in humans remain poorly characterized.

Objectives: To evaluate histopathologic changes in human subcutaneous tissue following CCH-aaes injection and compare injection techniques to identify strategies that reduce bruising.

Methods: In this single-center, phase 2b, non-randomized, open-label exploratory study, eight women undergoing elective abdominoplasty received CCH-aaes injections using either a 3-aliquot or a 7-injection hexagonal grid technique. Dosing schedules varied across groups. Excised abdominal tissue was analyzed histologically and immunohistochemically. Pathologists were blinded to injection technique and timing.

Results: CCH-aaes induced targeted enzymatic subcision and remodeling (ESR) of subcutaneous tissue, with collagen degradation, neocollagenesis, and fat lobule reorganization. The 3-aliquot technique produced more localized, intense histologic changes and greater bruising, while the grid technique caused diffuse but milder tissue effects. Bruising correlated with subcutaneous vascular disruption rather than dermal injury. No serious adverse events occurred. AUX-I (clostridial collagenase I-one of the two purified bacterial collagenases in CCH-aaes) neutralizing antibodies developed in 5 of 8 subjects, with no impact on safety or efficacy.

Conclusions: CCH-aaes induces localized subcutaneous remodeling without dermal disruption. The 3-aliquot technique elicits more robust histologic effects but increases bruising risk, while the grid method offers a more diffuse, potentially safer alternative. These findings clarify the tissue-level mechanism of CCH-aaes and may guide safer clinical use should the product return to market.

Background: Conventional botulinum toxin type A (BoNT/A) products include non-therapeutic accessory proteins vary in composition and manufacturing processes, which may contribute to differences in purity and biochemical characteristics. YY001（Retoxin） is a novel recombinant BoNT/A manufactured via E. coli expression to reduce impurities, improve purity, and minimize immunogenic risk.

Objectives: To evaluate the efficacy, safety, and immunogenicity of YY001, a recombinant botulinum toxin type A (Chongqing Claruvis Pharmaceutical Co., Ltd., Chongqing, China), in the treatment of moderate to severe glabellar lines.

Methods: In this multicenter, randomized, double-blind, vehicle- and active-controlled Phase III trial, 529 adults aged 18-65 with moderate to severe glabellar lines were randomized 4:2:1 to receive a single 20 U injection of YY001, Botox®(Allergan Pharmaceuticals Ireland, Westport, Ireland), or vehicle. The primary endpoint was composite response rate (CRR) at Week 4, defined as a ≥2-grade improvement of glabellar line severity assessed by both investigator and participant. Secondary endpoints included onset time, duration, satisfaction, and safety.

Results: YY001 achieved a CRR of 86.7% at Week 4, significantly outperforming Botox® (66.7%, P < 0.0001) and vehicle (1.3%, P < 0.0001). It showed faster onset, longer median duration (97 days), and high participant satisfaction. Adverse events were mild and comparable across groups. Only one case of anti-drug antibody was observed; no neutralizing antibodies were detected. A 12-week follow-up and ethnically homogenous population may limit generalizability.

Conclusions: YY001 demonstrated strong efficacy and a favorable safety profile than Botox®. Longer-term and multicenter studies are needed to assess durability, immunogenicity, and applicability across broader populations.

Background: Rhinoplasty is a common facial aesthetic procedure. Rhinoplasty's candidates often present with a high prevalence of anxiety and depressive disorders. Serotonergic antidepressants are widely used to manage these disorders. Given recent reports linking these medications to increased postoperative complications, we find it important to assess whether their use carries a higher risk of complications following rhinoplasty.

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

Methods: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Patients > 18 years who underwent rhinoplasty 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-year.

Results: After 1:1 PSM, each cohort consisted of 4,917 patients. Within 30 days following rhinoplasty, patients in the serotonergic cohort had significantly increased risk readmission (RR: 1.793, p=0.01), opioid use (1.361, p<0.0001), and bleeding/hematoma rates (RR: 1.596, p=0.005) compared to control cohort. These risks persisted at 60- and 90-days post-surgery. For long-term outcomes, comparable rates of surgical revision rates were noted after 1-year.

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

Background: Poly-L-lactic acid (PLLA) is a biostimulatory injectable that restores midfacial volume through collagen neogenesis rather than gel-based filling. Controlled clinical evidence directly quantifying PLLA's volumetric efficacy remains limited.

Objectives: To evaluate the efficacy, safety, and patient-reported outcomes of a Norberg Medical PLLA formulation for midface rejuvenation in a prospective, evaluator-blinded, split-face controlled study. Participants were enrolled between January 2024 and March 2024, with follow-up completed in April 2025.

Methods: Ninety-five patients underwent three standardized PLLA sessions on one hemiface and saline placebo on the contralateral side. Each vial contained 150 mg PLLA in spherical microparticles, reconstituted with 5 mL sterile water without lidocaine. Assessments included Wrinkle Severity Rating Scale (WSRS), Vectra H1 3D volumetry (malar, zygomatic, mandibular), FACE-Q, and Global Aesthetic Improvement Scale (GAIS). Two blinded evaluators rated WSRS. Statistical analysis included paired testing, responder rates (≥1-grade WSRS improvement), and inter-rater reliability (ICC).

Results: At 12 months, PLLA-treated sides showed significant WSRS reduction versus baseline and saline control (Δ = -0.68, p < 0.001). 3D analysis confirmed sustained volumetric enhancement across all midface subunits. Inter-rater reliability was excellent (ICC = 0.91), and 82.1% achieved ≥1-grade WSRS improvement. Patient satisfaction remained high, mirroring objective findings. Adverse events were mild and transient, with no granulomas, nodules, or vascular events recorded.

Conclusions: Controlled split-face evaluation demonstrated that standardized PLLA treatment yields measurable, long-lasting midfacial volume restoration with excellent safety and high patient satisfaction. No granulomas or delayed-onset nodules were observed in this 12-month, 95-patient cohort, supporting a favorable safety profile for this PLLA formulation under these study conditions.

The advent of artificial intelligence (AI)-generated transformation videos, primarily utilizing models like Kling 2.1 (Kuaishou Technology, Beijing, China), represents a paradigm shift in the presentation of before-and-after results in aesthetic plastic surgery. These hyper-realistic animations interpolate between authentic preoperative and postoperative photographs, creating dynamic visualizations that significantly enhance social media engagement, algorithmic visibility, and patient comprehension of potential outcomes. Advantages include superior digital storytelling, increased viewer arousal and retention compared to static images, and facilitated surgeon-patient communication. However, there are also significant ethical challenges that must be navigated. Aesthetic surgeons must adhere to existing professional society guidelines emphasizing truthful marketing and patient safety, mandating conspicuous disclaimers, application of standardized photographic principles, and robust consent protocols. Professional organizations should expeditiously develop targeted AI-specific policies to mitigate emerging risks, including fully fabricated results by bad actors. This evolving landscape necessitates vigilant ethical stewardship to responsibly integrate these compelling tools while prioritizing patient welfare and professional integrity.

Background: Breast surgery often compromises structures, potentially leading to complications that affect aesthetic outcomes, lactation, breast tissue health, and the patient experience. Tissue-Preserving Breast Augmentation (TPBA) is a novel concept designed to enhance breast and implant stability by preserving the breast's stabilization system, including the circummammary ligament and Cooper's suspensory ligaments.

Objectives: This study presents the TPBA approach, performed in a minimally invasive manner to minimize surgical stimuli and protect the parenchymal breast tissue, along with outcomes observed over a three-year period.

Methods: This two-center, multi-surgeon retrospective observational study included consecutive female patients undergoing primary breast augmentation or primary augmentation-mastopexy using TPBA between December 2022 and June 2025. All procedures involved an inframammary incision and creation of a pre-pectoral pocket via balloon expansion. Complications were assessed by monitoring cumulative incidence during follow-up visits at 2 weeks, 6-, 12-, and 24-months.

Results: A total of 330 procedures were performed. At a mean follow-up of 18 months, the complication rate was 0.9%. No cases of acute complications including seroma, wound breakdown, or infection were observed. Follow-up evaluations revealed no capsular contracture (grade III and IV), implant rupture, lateralization, or inferior malposition. Superior malposition occurred in 2 patients (0.6%), and bleeding was observed in 1 patient (0.3%). Implant rippling was reported by 3 patients (0.9%).

Conclusions: TPBA offers a standardized, reproducible approach to breast enhancement via the IMF, performed under general or local anesthesia. It preserves stabilization structures, features a short learning curve, and carries a low risk of complications.

Background: Dual-plane breast augmentation has traditionally been the standard approach in aesthetic breast surgery, while prepectoral placement was reserved for selected anatomical indications. Advances in implant technology and growing clinical experience have led to a renewed reassessment of these beliefs.

Objectives: To describe a shift in clinical practice from predominantly dual-plane to more frequent prepectoral breast augmentation, supported by years of retrospective data and qualitative clinical insight.

Methods: We reviewed all primary breast augmentations performed over a four-year period (2021-2024) and compared these data with cases performed by the same author between 2009 and 2020. The analysis focused on the rationale for plane selection, patient characteristics, and implant volume. The discussion integrates reflections from an experienced plastic surgeon with more than 2,000 augmentations.

Results: Subglandular placement increased substantially over time. It accounted for only 3.25% of augmentations performed between 2009 and 2020, rising to 21.7% in 2021-2022 and reaching 42.2% in 2023-2024. This progressive shift reflects growing clinical confidence in the technique and increasing patient preference.

Conclusions: Implant plane selection should be individualised. The increased use of prepectoral augmentation reflects a shift in surgical strategy driven by anatomy, patient activity level, and aesthetic objectives. When appropriately indicated, avoiding muscle manipulation can yield favourable and reliable outcomes.