Aesthetic Surgery Journal最新文献

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.

Background: Within the past decade, nontobacco nicotine dependence (NTND) has become more prevalent. However, the impact of nontobacco nicotine products on breast surgery remains less explored. Despite limited evidence, plastic surgeons routinely advise nicotine cessation regardless of source, which underscores the need to define the specific risks associated with NTND.

Objectives: The authors of the present study sought to assess the effect of preoperative NTND on postoperative complications and revisions in patients who underwent reduction mammaplasty.

Methods: The Research Network on TriNetX, a federated global database, was queried. Patients with a history of breast cancer or tobacco product usage were excluded. Two cohorts were formed: patients diagnosed with preoperative NTND (n = 1432) and those without any documented history of nicotine dependence (n = 44,149). A 1:1 propensity score matching was performed for demographics and comorbidities. Primary outcomes evaluated postoperative complications at 30 and 90 days. Secondary analysis assessed breast deformity and surgical revision at 2 years.

Results: Following 1:1 matching, 1424 patients remained in both cohorts. At 30 days after surgery, the NTND cohort had a significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications (P < .05). Within 90 days post-op, patients with NTND continued to have significantly elevated risks for these complications (P < .05). However, no significant differences were observed for postoperative breast deformity and revision at 2 years.

Conclusions: Although preoperative nontobacco nicotine use is not linked to increased rates of long-term deformity and revision rates, it is associated with significantly higher risks of early postoperative complications following reduction mammaplasty.

Level of evidence: 3 (therapeutic):

Background: Diced costal cartilage wrapped in autogenous fascia is favored by rhinoplasty surgeons because of its high stability and low resorption rate. However, the volume of fascial bags is difficult to adjust, and diced costal cartilage is prone to undernourishment.

Objectives: The aim of this study was to investigate the clinical effect, long-term absorption rate, and patient satisfaction of filling the nasal dorsum with autogenous diced costal cartilage semiwrapped in autogenous rectus abdominis fascia.

Methods: From May 2020 to December 2022, a total of 95 patients with costal cartilage nasal repair were enrolled in this study. After constructing a nasal tip scaffold with costal cartilage, the autologous rectus abdominal fascia was introduced into the stripped dorsal nasal space and fixed at the golden point of the nasal root. The prepared autologous diced costal cartilage was injected into the dorsal nasal space, and shaped according to the height and curvature of the preoperative design.

Results: During follow-up of 18 to 24 months, the morphology was satisfactory, the bilateral transition was natural and smooth, and there was no graininess at the back of the nose. Four cases had slight depression in the nasal tip turning area more than half a year after the operation. The absorption rate of the graft was about 10%.

Conclusions: Autogenous diced costal cartilage semiwrapped in autogenous rectus abdominis fascia has low absorption, a relatively natural postoperative effect, and high patient satisfaction as a nasal dorsum filler. It may be particularly suitable for those who have nose repair after infection, take nasal dorsal bone powder, or have thinning, redness, and light transmission after thread carving.

Level of evidence: 2 (therapeutic):

Background: There is obvious requirement for the improvement of expander-to-implant breast reconstruction due to the high rate of complications caused by radiotherapy.

Objectives: We aimed to decrease the complications by applying fat graft to obtain thicker mastectomy flaps and, more importantly, to replace part of the definitive implant volume with fat tissue.

Methods: Patients who underwent immediate prepectoral expander-to-implant placement for breast reconstruction were included in the study. In the fat graft group, 2 sessions of fat grafting were performed after radiotherapy to decrease the volume of definitive implant, whereas no additional intervention was performed for the no fat graft group. Patients were evaluated for wound dehiscence, skin necrosis, infection, implant loss, rippling, capsular contracture, and secondary interventions.

Results: The fat graft group demonstrated a statistically significant lower incidence of wound dehiscence, skin necrosis, infection, implant loss, rippling, and capsular contracture compared to the no fat graft group (P < .05), despite similar baseline characteristics and reconstructive protocols.

Conclusions: Autologous fat grafting before implant exchange was associated with a substantial reduction in the rates of wound dehiscence, skin necrosis, infection, implant loss, rippling, and capsular contracture compared to standard implant exchange without fat grafting in prepectoral breast reconstruction.

Level of evidence: 3 (therapeutic):