Aesthetic Surgery Journal最新文献

Background: Intraoperative tranexamic acid (TXA) is used increasingly during implant-based breast reconstruction to reduce hematoma and seroma formation. However, evidence supporting the effectiveness of TXA in this setting remains limited.

Objectives: The authors of this study aim to compare the risk of hematoma and seroma in patients treated with and without intraoperative intravenous TXA during implant-based breast reconstruction.

Methods: Medical records of patients who underwent breast reconstruction at 3 plastic surgical departments between 2010 and 2023 were retrospectively reviewed. We compared the risk of hematoma and seroma between patients treated with and without intraoperative intravenous TXA using robust multivariable Cox regression with inverse probability of treatment weighting.

Results: We included 1782 patients who underwent implant-based breast reconstruction, of whom 352 received intraoperative intravenous TXA. A multivariable analysis showed a nonsignificant reduction in the risk of hematoma (hazard ratio [HR] 0.81; P = .51) and seroma (HR 0.88; P = .68) in patients who received TXA. Furthermore, the time to hematoma was significantly longer (2 vs 1 day, P = .03), as well as the time to drain removal (7 vs 6 days, P < .001) for patients treated with TXA. However, the time to discharge was significantly shorter (4 vs 5 days, P < .001).

Conclusions: Intraoperative administration of TXA was associated with a nonsignificant reduction in the risk of hematoma and seroma, suggesting a limited clinical effect in patients undergoing implant-based breast reconstruction. However, future studies are needed to definitively determine the effects in implant-based breast reconstruction.

Level of evidence: 3 (therapeutic):

Background: Weight loss induced by glucagon-like peptide-1 receptor agonists (GLP-1 RAs) can lead to facial volume loss, wrinkles, and sagging skin, resulting in an aged and gaunt appearance that negatively affects subject satisfaction and self-perception.

Objectives: This study assessed the treatment regimen of poly-L-lactic acid (PLLA-SCA) and 2 hyaluronic acid midface fillers (HA-LYF, HA-CON) on restoring facial balance, correcting contour deficiencies, and improving skin quality in subjects who experienced weight loss from GLP-1 RA therapy.

Methods: This multicenter, open-label study enrolled 41 subjects with cheek wrinkles and midface contour deficiencies following GLP-1 RA-driven weight loss. Subjects received 2 to 3 treatment sessions of PLLA-SCA and 1 to 2 treatment sessions of HA-LYF or HA-CON, with follow-ups through 9 months since the last PLLA-SCA treatment. Efficacy evaluations included objective skin quality assessments using bioinstrumentation, improvements in facial contour deficiencies using standardized photography, and subject self-assessment questionnaires. Safety was also monitored throughout the study.

Results: The PLLA-SCA and HA-LYF or HA-CON treatment regimen significantly improved facial skin quality and enhanced contour in the cheek, jawline, and perioral areas, and demonstrated objective improvement in hydration and skin radiance. Additionally, subjects were satisfied with the treatment results, with no treatment-related adverse events reported.

Conclusions: PLLA-SCA and HA-LYF or HA-CON provided effective, safe, and sustained improvements in facial balance, contour, and skin quality in subjects who experienced facial volume loss and aging from weight loss following GLP-1 RA therapy.

Background: The female reproductive system undergoes progressive degeneration with age, among which the imbalance of collagen metabolism in vaginal wall tissue is a key pathological feature.

Objectives: The authors of this study aim to deeply investigate the dynamic trend of collagen within the vaginal wall of women of different ages and the interrelationship of its subtype proportions to determine whether there are age-related changes in collagen.

Methods: A total of 40 healthy women were included and divided into 4 groups according to age: Group A (20-30 years), Group B (30-40 years), Group C (40-50 years), and Group D (>50 years). The morphological characteristics of the mucosa were assessed through colposcopy, and histological changes in the vaginal wall were analyzed using hematoxylin-eosin, Masson, and Sirius Red staining.

Results: With increasing age, the color of the vaginal mucosa gradually changed from pink (Group A) to pale or dark red (Group D), the density of the rugae decreased, and the surface moisture decreased. Histological staining showed that epithelial thickness significantly decreased with age, and the collagen content in the lamina propria was greatly reduced. The collagen in the muscularis remained relatively stable but still showed a significant decrease after the age of 40. Sirius Red polarized light staining showed that the ratio of Type I/III collagen significantly increased with age.

Conclusions: The authors of this study systematically revealed for the first time the dynamic characteristics of vaginal wall collagen with aging, confirming that collagen in the lamina propria shows more significant loss compared with the muscularis. We found that the Type I/III collagen ratio increases in an age-dependent manner, and this imbalance in collagen subtype ratio may lead to vaginal functional decline. These findings not only provide evidence for the aging of the female reproductive system but also open up new research directions for developing precise interventions targeting collagen metabolism.

Level of evidence: : 3 (Therapeutic).

Background: Liposuction is the most common plastic surgery procedure performed in the United States. Continued advancements have led to the development of five common approaches to liposuction.

Objectives: The authors of this study aim to compare complications and associated risk factors between liposuction modalities.

Methods: Patients undergoing liposuction from March 2015 to December 2022 were identified using the CosmetAssure database (Birmingham, AL). Demographics and major complications were reported. Findings were compared between five types of liposuction: conventional, infusion-assisted, laser-assisted, power-assisted, and ultrasound-assisted. Risk factors and complications associated with each type were identified. A subgroup analysis of patients who received liposuction alone was also completed.

Results: A total of 69,424 patients underwent liposuction, with an average age of 43 and a female predominance of 93.2%. Conventional liposuction (56.5%) was the most prevalent method, followed by power-assisted (32%), laser-assisted (8%), ultrasound-assisted (4%), and infusion-assisted (0.4%). Complication rates varied, with infusion-assisted liposuction showing a 6.7 times higher risk and laser-assisted liposuction having a 50% lower risk compared with conventional liposuction. The overall complication rate among patients receiving liposuction alone was 1.16%, with infusion-assisted liposuction having the highest risk. Patients who underwent infusion-assisted liposuction had a higher rate of infection (0.54%, P < .05).

Conclusions: Liposuction is associated with low complication rates, with hematoma and infection being the most prevalent. Although power-assisted liposuction had the highest rate of major complications, regression analysis controlling for confounders showed that infusion-assisted liposuction had the highest risk of serious complications. Factors such as diabetes and being underweight correlate with a higher complication risk.

Level of evidence: 4 (risk):

Biostimulants, including calcium hydroxyapatite, poly-L-lactic acid, and polycaprolactone, have become popular in aesthetic medicine as they lead to long-term tissue rejuvenation. However, their efficacy (eg, dermal, volume, and anatomic outcomes), patient satisfaction, and safety remain unclear. This systematic review and meta-analysis collates and appraises the available data on biostimulants, examining their efficacy, adverse events, and patient satisfaction. A comprehensive search was conducted in PubMed/Medline (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, Amsterdam, the Netherlands), Embase (Elsevier), and Web of Science (Clarivate, Philadelpha, PA), up to January 14, 2025. Studies were included that assessed the effects of biostimulants on efficacy, adverse events, and patient satisfaction in observational studies. Meta-analyses using random-effects models were performed on individual proportions and applied to 7 outcomes (satisfaction, bruising, ecchymosis, edema, erythema, nodule development, pain). A total of 197 articles were screened, and 25 studies were included in the systematic review. The results of meta-analyses indicate that the pooled satisfaction rate of biostimulants was estimated to be 91% (95% CI, 67%-98%; I2 = 87.3%), with the following adverse event rates: bruising, 27% (95% CI, 12%-50%; I2 = 96%); ecchymosis, 22% (95% CI, 11%-40%; I2 = 95.5%); edema, 5% (95% CI, 1%-18%; I2 = 93.6%); erythema, 16% (95% CI, 4%-47%; I2 = 94.3%); nodule development, 5% (95% CI, 2%-10%; I2 = 85.5%); pain, 92% (95% CI, 63%-99%; I2 = 87.7%). Among studies not included in the meta-analysis, all parameters studied showed significant improvements in terms of dermal, volume, anatomic, and satisfaction outcomes. Biostimulants demonstrate clinical promise and a favorable tolerability profile in aesthetic medicine despite the common occurrence of minor adverse events, most notably pain. Level of Evidence: 3.

The global demand for cosmetic procedures is accelerating, with over 1.6 million aesthetic surgical procedures performed in the US in 2023. Concurrently, AI is transforming surgical practice through advanced analytics, predictive modeling, and computer vision. Cosmetic surgery, characterized by subjective outcomes and limited standardized metrics, presents a unique opportunity for AI integration to enhance precision, objectivity, and patient communication. Following PRISMA 2020 guidelines, we systematically searched MEDLINE/PubMed, Embase, and the Cochrane Library (January 2020-July 2025) for studies applying AI, machine learning, deep learning, computer vision, or large language models to cosmetic or aesthetic procedures. Eligible designs included randomized controlled trials, observational studies, diagnostic accuracy studies, feasibility studies, and prediction model development. Two reviewers independently screened titles/abstracts, assessed full texts, extracted data, and evaluated risk of bias using ROBINS-I for non-randomized studies.Of 3,941 records, 38 met the inclusion criteria. AI applications spanned preoperative planning (predictive risk modeling, 3D outcome simulation), intraoperative guidance (augmented reality overlays), and postoperative monitoring (smartphone-based complication detection, objective aesthetic scoring). Benefits included improved patient-surgeon communication, enhanced risk stratification, and standardized outcome measurement. However, most studies were early-phase, with limited external validation, heterogeneous datasets, and inconsistent outcome metrics. Risk of bias was moderate to serious in most studies. AI in cosmetic surgery shows significant potential but remains in early clinical adoption. Progress requires multicenter validation, standardized datasets, explainable algorithms, and clear regulatory frameworks. Large language model-driven tools may accelerate development and integration, provided ethical, equitable, and patient-centered principles guide implementation.

Background: The chin is a crucial facial feature for overall attractiveness. Lower third imbalance can lead to signs of premature ageing, as well as loss of jawline contour. Effective chin augmentation using hyaluronic acid fillers have been demonstrated in the literature. Currently, however, no study in the literature has examined the comparison of safety and effectiveness of two high G' fillers.

Objectives: The objective of this current study is to examine each's effectiveness in the correction of chin retrusion through a prospective, randomized, comparator-controlled, evaluator-blinded trial.

Methods: The aim of this study was to compare the safety and effectiveness of HASHA (Restylane Shaype) versus HAVLX (Juvederm Volux) for chin augmentation and correction of chin retrusion. A prospective, randomized, comparator-controlled, evaluator-blinded trial was conducted at a single research center. Fourty participants aged 18 years or older with mild to severe chin retrusion were included and randomized 1:1 to either HASHA (n = 20) or HAVLX (n = 20). The primary study endpoint was to examine differences in parameters associated with determining chin shape. Secondary endpoints included adverse events and patient satisfaction.

Results: Of the forty (40) participants enrolled in the trial, 37 (92.5%) were female and three (7.5%) were male. Although an independent-samples t-test revealed no statistically significant difference in total volumes of filler used with HAVLX (M = 1.85, SD = 0.69), or HASHA (M = 1.86, SD = 0.89); (p = 0.953). When focused on the menton/pognion injections, HAVLX required 15.27% more product when compared to HASHA (Mean: 1.48cc vs 1.27cc) (p=0.28). There was a statistically significant difference in efficiency score of correcting labiomental angle with the mean efficiency score for HASHA was 2.57 (SD: 1.67) and for HAVLX 1.50 (SD: 1.11) (p=0.02).

Conclusions: With no statistically significant difference in overall volume utilized between HASHA and HAVLX, HASHA injections required 15.27% less volume in the menton/pognion to achieve visual correction. Additionally, HASHA demonstrated a significantly higher efficiency score for correction of nasomental angle. Secondary endpoints were not significantly different and demonstrate both products as being safe and effective.

Background: Previous studies suggest higher revision rates after primary breast augmentation after massive weight loss (MWL), yet specific risk factors remain unclear. Robust predictive models are lacking.

Objectives: The study aimed to create a nomogram to predict five-year revision risk after primary breast augmentation in women with massive weight loss, providing a clinical tool to guide surgical decision-making.

Methods: A nationwide, population-based study was conducted within the Breast Reconstruction After Bariatric Surgery project (ClinicalTrials.gov NCT07059104). Data from the Scandinavian Obesity Surgery Registry and the Swedish Breast Implant Registry (2008-2022) were linked with national healthcare and prescription databases. Univariable logistic regression and group LASSO with 1,000 bootstrap iterations were applied to identify predictors of revision within five years. A final multivariable model informed the development of a clinical nomogram.

Results: Among 810 women undergoing 1,604 primary breast augmentations after massive weight loss, 84 (10%) required revision during a median follow-up of 5.5 years. Revisions were associated with smaller implant volumes (p = 0.032) and shorter intervals between bariatric surgery and augmentation (p = 0.042). In bootstrap analyses, implant volume (92% selection), surgical timing, and medications impairing wound healing were consistently retained. The final model included these three predictors, forming the basis of the nomogram.

Conclusions: Implant volume, timing of augmentation, and relevant medications were independent predictors for revision. The nomogram provides a tool to support surgical planning and patient counselling in this high-risk population.

Background: Vaginal laxity negatively affects sexual satisfaction and psychological well-being. Vaginoplasty is increasingly performed to address these issues in both women and their partners.

Objectives: The aim of this study was to evaluate the effects of vaginal laxity (VL) on postoperative sexual satisfaction, sexual function and psychological well-being of women who underwent vaginoplasty and their male partners.

Methods: 162 women who underwent vaginoplasty between 2021 and 2024 and their spouses were included in the study. Turkish questionnaires with proven validity and reliability were administered preoperatively and postoperatively. FSFI, SQoL-F, FGSIS, QSES, FSDS-R, NSSS, BDI and STAI-I/II questionnaires were administered to women; MSHQ-EjD, GRISS and NSSS questionnaires were administered to male partners.

Results: Significant improvements were found in sexual function (FSFI total score, p<0.001), genital body perception (FGSIS, p<0.001), sexual quality of life (SQoL-F, p<0.001) and anxiety levels (STAI-I/II, p<0.001) in women. In male partners, ejaculation function (MSHQ-EjD, p<0.001) and sexual satisfaction (NSSS, p<0.001) increased, while a significant decrease was observed in GRISS scores. The increase in NSSS in male partners was statistically higher than in female partners (p=0.034). In addition, a significant decrease in vaginal width was found in the postoperative period (p<0.001).

Conclusions: Vaginoplasty surgery appears to provide significant gains not only anatomically but also psychosexually in both male and female individuals. The fact that the increase in sexual satisfaction level is more pronounced especially in male partners emphasises the positive effect of this surgical intervention on couple dynamics.