Aesthetic Surgery Journal最新文献

Background: Although percutaneous external fixation has gained popularity in transconjunctival blepharoplasty due to its simplicity and minimal incision, internal fixation remains the standard approach in transcutaneous blepharoplasty.

Objectives: The aim of this study was to assess the safety and effectiveness of percutaneous external fixation specifically in transcutaneous fat repositioning blepharoplasty.

Methods: A consecutive cohort of 97 patients underwent this surgical technique between May 2022 and December 2023. Building upon the principles of transconjunctival fat repositioning, the procedure involved a minimal incision targeting the muscle layer, a conservative release of the tear trough ligament, and the repositioning of fat secured with percutaneous external fixation. Surgical outcomes were evaluated using the Barton grading system and FACE-Q scales for patient-reported outcomes.

Results: Following a mean follow-up of 7.2 months (range, 6-17 months), a resolution of tear trough deformities and eyelid bags was achieved in over 92% of cases. Notably, significant improvements (P < .05) were observed in lower eyelid aesthetics as measured by the FACE-Q scale, with a concomitant enhancement in patients' social confidence (P < .05). Overall, patients expressed satisfaction with their decision to undergo the procedure (71.0 ± 19.1). Complications necessitating revision surgery included isolated cases of hematoma evacuation, fat injection, excision of excess fat, and skin excision.

Conclusions: External fixation in transcutaneous blepharoplasty is technically less complex and minimally invasive, effectively securing transposed fat pedicles safely, and presents a viable alternative to conventional fixation techniques.

Level of evidence: 4 (therapeutic):

Background: Several psychological risk factors are associated with patient dissatisfaction with aesthetic procedures, such as body dysmorphic disorder (BDD), unmanaged mental health concerns, and unrealistic expectations. Identifying these risks by preoperative screening may protect patients from adverse psychological outcomes and provide reputational or legal protection for practitioners.

Objectives: In this study we aimed to further develop and validate the Cosmetic Readiness Questionnaire (CRQ), a comprehensive psychological screening tool to assess patient suitability for surgical and nonsurgical aesthetic procedures.

Methods: The CRQ was validated across 2 studies in clinical contexts, examining structural and construct validity in a sample of 8031 individuals who completed the CRQ as part of routine clinical care. In a further sample (n = 574), criterion validity was explored through the relationship between the CRQ and dissatisfaction with past aesthetic treatments. Risk category cutoff scores were developed.

Results: Results supported the reliability and validity of a 5-factor CRQ that measured body dysmorphia, psychological distress, self-criticism, unrealistic expectations, and lack of openness. High scorers on the CRQ were 78% more likely to report dissatisfaction with a past cosmetic procedure than low scorers.

Conclusions: The CRQ is a comprehensive and valid screening measure for identifying patients who may require further psychological assessment or additional support before aesthetic treatment. Instructions are provided on how to implement the CRQ in clinical practice.

Level of evidence: 3 (diagnostic):

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

Objectives: The objective of this study was to assess the 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 vs 21.2% in the placebo group, and 41.0% vs 2.2% (P < .0001) achieved ≥2-grade improvement at Day 14. As assessed by participants, 79.9% of onabotulinumtoxinA mITT participants vs 21.8% in the placebo group and 40.8% vs 3.9% (P < .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, less bother from jawline and vertical neck bands, and lower psychosocial impact from PP than placebo at Day 14 (P < .0001). OnabotulinumtoxinA effectively improved self-perceived jawline definition and was well tolerated.

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

Level of evidence: 1 (therapeutic):

Background: Acne is an inflammatory skin disease afflicting the majority of the world's population at some point in their lifetime, and is seen to be chronic in about 50% of cases. Acne leads to significant social withdrawal, depression, and disfiguring scars in many cases. Available treatments are characterized by high rates of relapse, dangerous side effects, and social stigma, which often leads to poor patient compliance and treatment failure.

Objectives: The aim of this article was to discuss and share the authors' experiences utilizing fractional radiofrequency (RF) (Morpheus8; InMode Ltd., Lake Forest, CA) in the treatment of both active acne and acne scars.

Methods: A retrospective review was conducted comparing 3 treatment modalities. In total, 356 patients received acne scar treatments. The cohort comprised a high-dose isotretinoin topical therapy series (n = 128, 36%), a 6-session ablative laser series (n = 89, 25%), and a 3-session fractional RF microneedling series (n = 139, 44).

Results: Of the patients with extended 3-year follow-up, the relapse rates were: isotretinoin group, 36 of 54 (67%); laser group, 12 of 16 (75%), and fractional RF microneedling group, 7 of 29 (24%).

Conclusions: In treating older acne scars, fractional RF microneedling technology has served as an effective tool to tighten skin and fill in atrophic scars when used in conjunction with other techniques. This technology is very effective and very safe for treating all skin types with acne and acne scars.

Background: Postmastectomy radiation therapy (PMRT) improves disease-free survival in breast cancer but reduces aesthetic satisfaction. Proton PMRT has gained popularity because it results in fewer systemic complications. There is a lack of data regarding revision surgeries for prepectoral implant-based breast reconstruction (PP-IBBR) following radiation.

Objectives: The aim of this study was to compare revision surgeries in PP-IBBR with photon vs proton PMRT.

Methods: A single-institution retrospective cohort study was performed that included breast cancer patients undergoing mastectomy and PP-IBBR with PMRT between January 2020 and October 2022. The mean follow-up duration for the cohort was 1056.4 days (2.89 years). Revision surgeries evaluated were fat grafting, conversion to autologous flaps, implant replacement, implant removal, capsulectomy, and scar revision.

Results: The 116 PP-IBBR subjects were divided into 2 cohorts, receiving either photon (75, 64.66%) or proton (41, 35.34%) radiation. Overall corrective surgeries were higher with photon therapy (27.5% overall; 32.4% photon vs 19.5% proton, P = .132). The odds of any revision surgery were nearly double with photon therapy (odds ratio [OR] = 1.98), and the conversion to an autologous flap was significantly more likely with photon therapy (OR = 4.55, P = .025). Multivariable analysis showed an increased tendency for photon therapy patients to require any revision surgeries (OR = 1.62, P = .359), autologous flaps (OR = 5.97, P = .049), fat grafting (OR = 1.52, P = .664), and scar revision (OR = 4.51, P = .273).

Conclusions: Compared to proton therapy, traditional photon therapy has a higher conversion rate to autologous flaps with PP-IBBR. Photon therapy had higher rates of overall revision surgeries, but the difference was not statistically significant. Proton therapy is safer and requires fewer revision surgeries, warranting larger studies and broader utilization.

Level of evidence: 3 (therapeutic):

The incidence of female genital cosmetic surgery (FGCS), and specifically labiaplasty, is on the rise. Common motivators for labiaplasty include hygiene concerns, functional impairment, difficulties with physical or sexual activity, and dissatisfaction with genital appearance, among others. However, there have been few reports on long-term functional and aesthetic outcomes and complications of labiaplasty. The aim of this literature review was to report on long-term outcomes of labiaplasty, defined as ≥1 year postoperatively, to inform safety and efficacy recommendations for the procedure. A comprehensive literature review was conducted on PubMed (National Institutes of Health, Bethesda, MD) and Embase (Elsevier, Amsterdam, the Netherlands) from inception to December 1, 2023, following PRISMA guidelines. Articles were selected according to predetermined eligibility criteria. A manual search was performed to identify additional relevant studies. Nine studies reported on the long-term postoperative complications associated with labiaplasty, with a cumulative total of 748 patients. The most commonly reported complications included postoperative asymmetry (n = 45, 6.02%), scarring (n = 14, 1.87%), and the need for revisional surgery (n = 42, 5.61%). Of note, the majority of patients (n = 621 of 748) were reported to not have any postoperative complications. In the 7 studies that reported on psychological outcomes associated with labiaplasty, all reported sustained improvement in genital appearance scores as well as aesthetic and sexual satisfaction over the long term.

Level of evidence: 3 (therapeutic):

Background: Periorbital rejuvenation surgery aims to restore a youthful appearance to the face. Despite the popularity of these procedures, few objective measurements exist to evaluate their impact on perceived facial aging.

Objectives: In this study we aimed to quantify the impact of brow lift and blepharoplasty on age as perceived by convolutional neural network (CNN) algorithms.

Methods: A retrospective review was performed on patients who underwent upper blepharoplasty, lower blepharoplasty, and/or brow lift at a single cosmetic practice between 2018 and 2023. Collected data included patient demographics, procedure performed, fat pad resection, and preoperative and postoperative frontal images. Each photograph was analyzed by 4 artificial intelligence (AI) platforms to estimate the change in perceived age following surgery. The estimated age reduction was compared between procedures.

Results: Of the 153 included patients, 118 underwent blepharoplasty, 12 underwent brow lift, and 23 had both blepharoplasty and brow lift. Across all AI platforms, the mean age estimation percentage error was 10.6%, with a tendency for AI to underestimate true age. Univariate analysis revealed an age reduction following any surgery of 1.03 years (P < .001). When controlling for other variables, brow lift patients saw a mean age reduction of 1.432 years (P = .031). Upper and lower blepharoplasty, patient characteristics, and ancillary procedures were not found to be independently associated with significant age reduction.

Conclusions: Brow lifts provide significant reduction in perceived age. When planning for periorbital rejuvenation, a thorough preoperative evaluation should be performed, and additional consideration should be given to brow lifting procedures.

Level of evidence: 3 (therapeutic):