Aesthetic Surgery Journal最新文献

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.

Background: Rising obesity has surged demand for weight loss interventions and body contouring procedures. The independent and combined effects of prior bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) on abdominoplasty outcomes remain unclear.

Objectives: To estimate the independent and combined associations of prior BS and recent GLP-1RA use with 90-day postoperative complications after abdominoplasty.

Methods: This retrospective cohort study used TriNetX network data on adults undergoing abdominoplasty (January 2004-June 2025). Patients were grouped into no prior interventions, BS only, recent GLP-1RA use only, and both. Propensity score matching controlled for confounders and 90-day surgical complications were compared.

Results: Included were 4776 patients with prior BS, 2253 recent GLP-1RA users, and 465 with both. Bariatric surgery increased the risks of hematomas (RR = 1.55; 95% CI 1.11-2.17) and seromas (RR = 1.55; 95% CI 1.19-2.02), lowered hypertrophic scarring (RR = 0.74; 95% CI 0.62-0.87) and systemic infections (RR = 0.78; 95% CI 0.64-0.93). Glucagon-like peptide-1 receptor agonists use heightened hypertrophic scarring risk (RR = 1.79; 95% CI 1.374-2.352), a finding confirmed in a sensitivity analysis against DPP-4 inhibitors (RR = 2.40). Glucagon-like peptide-1 receptor agonist use in BS patients increased wound dehiscence risk (RR = 1.92; 95% CI 1.12-3.38) and constitutional symptoms (RR = 1.69; 95% CI 1.164-2.461).

Conclusions: Bariatric surgery is associated with higher hematoma and seroma risks but lower hypertrophic scarring and systemic infections. Glucagon-like peptide-1 receptor agonists are independently associated with hypertrophic scarring risk. When combined, these interventions are associated with significant wound dehiscence and increased constitutional symptoms, underscoring the need for tailored perioperative management and preoperative counseling.

Level of evidence: 3 (therapeutic):

Background: Striae distensae are a common and often emotionally distressing dermatologic condition among adults. While therapeutic modalities are available, none completely resolve the visual or morphological changes of stretch marks.

Objectives: This study sought to evaluate the safety and efficacy of microneedling as a stand-alone treatment for both immature (striae rubrae) and mature (striae albae) stretch marks.

Methods: Fifteen striae rubrae and 19 striae albae regions from 29 subjects received four microneedling treatments, spaced monthly. Site-matched regions on opposite sides of the body were evaluated as untreated controls. Manchester Scar Scale (MSS) and Clinician's Global Aesthetic Improvement Assessment Scale (CGAIS) assessments were completed at all visits including follow-up at 3- and 6-months post-last microneedling treatment. Secondary endpoints included length measurements, adverse event monitoring, safety assessments, post-procedure symptom severity, and subject satisfaction.

Results: Both striae rubrae and striae albae showed progressive improvements in clinical assessments across visits, including continued improvement between 3- and 6-months posttreatment. When comparing groups, striae rubrae had superior aesthetic outcomes, including 43.89% and 48.89% MSS score improvements over baseline at 3 and 6 months, respectively, compared with 36.69% and 41.61% for striae albae. While post-procedure reactions were also heightened for striae rubrae, all reactions were transient, and no adverse events were reported.

Conclusions: This study supports microneedling as a safe and effective treatment for striae rubrae and striae albae, offering preliminary evidence that intervening with microneedling in early-stage stretch marks (striae rubrae) can yield better cosmetic outcomes compared to mature stretch marks (striae albae).

Background: Dorsal preservation rhinoplasty maintains dorsum integrity while refining nasal aesthetics, but dorsal hump recurrence is a common limitation, especially after extensive reshaping. Electrocautery offers precise cartilage contouring, yet its role in dorsal preservation rhinoplasty is underinvestigated.

Objectives: To compare the outcomes of scalpel-based mechanical reshaping vs electrocautery-assisted thermal reshaping of the upper lateral cartilage shoulders in low septal strip dorsal preservation rhinoplasty.

Methods: The authors of this retrospective study included 205 patients who underwent low septal strip dorsal preservation rhinoplasty via the open approach between February 2021 and May 2023. Patients were grouped according to the method used for reshaping the upper lateral cartilage: Group I underwent mechanical reshaping with a scalpel (mechanical/scalpel group), and Group II underwent thermal reshaping using monopolar electrocautery (thermal/electrocautery group). Dorsal hump recurrence and patient-reported outcomes were evaluated using standardized 12-month postoperative photographs and the Rhinoplasty Outcome Evaluation (ROE) questionnaire, respectively.

Results: A total of 88 patients were included in the scalpel group and 117 in the electrocautery group. Demographic data, hump morphology, and amount of hump reduction were similar between groups. However, the recurrence rate of the dorsal hump was significantly lower in the electrocautery group (2.5%) than in the scalpel group (13.6%). ROE scores were high in both groups (84.4 vs 85.0, P > .05).

Conclusions: Electrocautery-assisted upper lateral cartilage reshaping in dorsal preservation rhinoplasty offers more consistent contouring and reduced recurrence rates compared with the scalpel-based technique. It represents a valuable technical adjunct, especially in patients with a challenging dorsal anatomy.

Level of evidence: 3 (therapeutic):

Buttock augmentation has become one of the most sought-after cosmetic procedures, but concerns over fat embolism-related fatalities have raised significant safety issues. Guidelines emphasize that fat grafting should remain in the subcutaneous layer, avoiding intramuscular injection. This systematic review and meta-analysis assess the efficacy and safety of ultrasound-guided gluteal fat grafting. A systematic search of PubMed, Cochrane Central Register of Controlled Trials, and Embase was conducted until July 2024, analyzing patient satisfaction, complication rates, mortality, fat embolism, fat necrosis, infection, and seroma. Statistical analyses, including the Freeman-Tukey Double Arcsine Transformation, were performed using R version 4.1.2. Four studies with a total of 6235 female patients (mean age 34 years, BMI 30.1 kg/m2) met the inclusion criteria. The pooled analysis showed no reported mortality (0.00 per 100, 95% CI, 0.00-0.00) or fat embolism (0.00 per 100, 95% CI, 0.00-0.00). Minor complications occurred at a rate of 6.32 per 100 (95% CI, 3.23-10.27), with seroma at 2.94 per 100 (95% CI, 0.97-5.75), infection at 0.23 per 100 (95% CI, 0.00-0.96), and fat necrosis at 0.09 per 100 (95% CI, 0.01-0.23; I2 = 0). The findings indicate that ultrasound-guided gluteal fat grafting is associated with low complication rates and no reported serious adverse events, such as death or fat embolism, reinforcing its role as a safer technique for buttock augmentation. Level of Evidence: 3 (Therapeutic).

Background: The zygomatico-orbital artery (ZOA) poses a potential risk during aesthetic and surgical procedures because of its anastomoses with the ophthalmic artery. Accurate knowledge of its anatomical course is crucial to define safe zones and reduce complications in the temporal region.

Objectives: The goal of the authors of this study is to define the course of the ZOA according to the reference points determined for guiding temporal procedures in a safer manner.

Methods: This retrospective cross-sectional study employed the analysis of head and neck computed tomography (CT) angiograms obtained from 197 patients aged 22 to 83 years. Patients with head trauma or craniotomy affecting the artery were excluded to ensure the accuracy of the results. The parameters were evaluated using 3-dimensional volume rendering, thin-slab axial, and thickness-enhanced sagittal maximum intensity projection images.

Results: The results obtained from the 103 ZOAs that were analyzed demonstrated that 82 (79.61%) of the arteries originated from the superficial temporal artery (STA), displaying an average diameter of 0.91 mm, whereas 21 (20.39%) originated from the frontal branch, with an average diameter of 0.85 mm. ZOAs originating from the STA were observed to be situated at a deeper level at the starting point in comparison with ZOAs originating from the frontal branch (5.78 and 4.91 mm depth from the skin, respectively, and P = .008).

Conclusions: Based on the findings of this study, the authors emphasize the necessity of a comprehensive understanding of the anatomical variations and the course and location of the ZOA to ensure safe clinical interventions.

Level of evidence: 4 (therapeutic):

Background: Hyaluronic acid (HA) filler-induced vascular occlusion is a serious complication in aesthetic medicine, yet the microvascular behavior of HA gels under physiologically relevant flow conditions remains poorly characterized.

Objectives: To evaluate the embolic fragmentation, dispersal, and occlusive behavior of 5 commercially available HA fillers within a physiologically calibrated microvascular perfusion model.

Methods: Five HA fillers were tested using a modified PULSAR system incorporating a branched microtubular adapter (200-1000 µm channels) with physiologic arterial flow parameters. Products were injected through 22 and 27 G microcannulas and assessed for occlusion patterns, fragment morphology, and particle size. Flow dynamics were recorded through videography, and fragment characteristics were analyzed using imaging software. Statistical comparisons were conducted across products and cannula gauges.

Results: HA gels fragmented extensively into microparticles (mean area = 0.140 mm2; interquartile range, 0.024-0.254 mm2) generating high rates of occlusion predominantly in channels ≤300 µm (P < .0001). A 22 G injection produced larger particles and higher occlusion rates than 27 G (31% vs 17%, P = .025), most notably with large-particle, high-elasticity products. Fragment morphology varied with rheology: solid gels fractured into ovoid embolic particles, whereas soft, high-tan δ gels formed filamentous, nonocclusive strands. Across all products, particle size was lower in the microvascular simulation compared with previous macrovascular experiments, indicating vessel-caliber-dependent fragmentation.

Conclusions: HA fillers behave as deformable embolic particles that disperse distally under physiologic microtubular conditions. These findings support a concurrent microembolic mechanism underlying filler-induced ischemia. Product rheology, cannula gauge, and vascular anatomy are important determinants of embolic particle behavior.