Aesthetic Surgery Journal最新文献

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):

Background: Palpebral bags are commonly managed with infraorbital fat excision during lower blepharoplasty. This surgical approach is based on the assumption of age-related anterior herniation of infraorbital fat. However, controversy remains regarding the true volumetric changes of infraorbital fat with aging.

Objectives: The authors of this study aimed to investigate longitudinal anatomical changes in the infraorbital region.

Methods: A retrospective longitudinal analysis of serial MRI images from 50 healthy individuals (20 males and 30 females) aged 20 to 60 years was conducted; the mean interval between scans was 18.3 years. Six parameters were measured at the mid-pupillary level: the vertical height of orbital aperture (VHOA), infraorbital fat protrusion length (IPL), soft tissue thickness at the orbicularis retaining ligament (TORL), Anterior globe protrusion (GP), nasion-sella-orbital rim angle (NSO), and maxillary angle (MA). Statistical analyses evaluated parameter changes and correlations with the follow-up interval.

Results: Significant increases in the VHOA and NSO and decreases in the TORL and MA were observed (P < .05), indicating progressive orbital skeletal remodeling and soft tissue thinning. IPL and GP remained unchanged in the supine position, suggesting no volumetric change of infraorbital fat or displacement of the globe. A regression analysis confirmed follow-up interval as the key predictor of VHOA and NSO changes.

Conclusions: Palpebral bags primarily result from structural changes that contribute to pseudoherniation of infraorbital fat and increased prominence above the tear trough. The volume of infraorbital fat itself remains relatively stable. These findings support a lower blepharoplasty approach that prioritizes correcting structural changes over aggressive fat excision.

Level of evidence: 3 (therapeutic):

Background: Immediate prepectoral breast reconstruction has emerged as a prominent alternative to subpectoral techniques, offering favorable outcomes in selected patients. Among available options, implant coverage with acellular dermal matrix (ADM) and the use of polyurethane (PU)-coated implants without ADM represent 2 widely adopted strategies.

Objectives: The aim of the authors this study is to examine the comparative efficacy and complication profiles of implant coverage with ADM and the use of PU-coated implants without ADM.

Methods: This retrospective cohort study included 97 patients (135 breasts) undergoing immediate prepectoral breast reconstruction following nipple-sparing, skin-sparing, or skin-reducing mastectomy between April 2015 and October 2019. Patients were stratified into 2 groups: those receiving ADM-covered textured implants and those receiving PU-coated implants. Outcomes assessed included early (<4 weeks), mid-term (>4 weeks), and long-term (≥1 year) complications, as well as aesthetic results evaluated through blinded assessment using a standardized Likert scale.

Results: PU-coated implants were associated with significantly lower rates of early postoperative seroma (2.9% vs 33.8%, P < .001) and infection (1.4% vs 6.2%). At 5 years, the incidence of severe capsular contracture (Baker Grade 3-4) was markedly higher in the ADM group (47.7% vs 24.3%, P < .001), particularly in patients who had not received postmastectomy radiotherapy. No significant differences were observed in the incidence of rippling or step-off deformities. Aesthetic outcomes were superior in the PU group, with significantly better breast symmetry and global aesthetic evaluation (P = .021).

Conclusions: PU-coated implants offer a safer and more effective approach in immediate prepectoral breast reconstruction, with reduced complication rates and improved aesthetic outcomes compared with ADM-covered implants. Patient-specific anatomical and oncologic factors should guide implant selection to optimize surgical outcomes.

Level of evidence: 4 (therapeutic):

Background: Midface volume loss contributes significantly to facial contour changes. Congenital traits, genetic predisposition, and environmental factors can reduce collagen fiber quantity and quality, leading to decreased skin firmness, wrinkles, and midface depression. Type III collagen, abundant in the human body, has low immunogenicity, good tissue compatibility, and promising biomedical applications. However, employing animal-derived collagen, typically in liquid form, is limited by potential adverse reactions and disease transmission.

Objectives: To assess the safety and efficacy of localized injections of low-temperature gel recombinant humanized Type III collagen (rhCol III) in treating midface volume deficit.

Methods: In vivo animal experiments and retrospective clinical data analysis were conducted.

Results: Low-temperature gel rhCol III significantly improved facial volume and midfacial contour with a favorable safety profile in subchronic systemic toxicity tests in Sprague-Dawley rats, skin degradation studies in New Zealand white rabbits, and human clinical trials. In humans, the treatment group showed significant improvement in Merz Aesthetic Scale, Global Aesthetic Improvement Scale, and satisfaction scores vs controls at 1 month (P < .0001), with effects lasting at least 6 months.

Conclusions: Low-temperature gel rhCol III offers a safe, effective, and durable option for correcting midface volume deficit, with minimal risk of complications. These results suggest potential value in enhancing clinical strategies for facial volume restoration.

Level of evidence: 3 (therapeutic):

Background: Botulinum neurotoxins are used to treat masseter muscle prominence (MMP), benign bilateral masseter muscle enlargement which can be aesthetically undesirable. Limited data report botulinum neurotoxin injections in the muscles of mastication, with subsequent reduction in biomechanical loading, may impact mandibular bone density.

Objectives: This study evaluates whether changes in mandibular bone density occur after bilateral masseter treatment with a botulinum neurotoxin, onabotulinumtoxinA, in individuals with MMP.

Methods: Analyses were performed on a prespecified subpopulation (n = 123) from a 12-month, double-blind, placebo-controlled, dose-escalation, Phase 2 study (N = 187). Participants received 1 or 2 bilateral masseter treatments of onabotulinumtoxinA (48, 72, or 96 U) or placebo and had multi-detector computed tomography scans at baseline and Days 90 and 360 post-treatment. Cortical and trabecular bone densities, estimated in Hounsfield units, were calculated for the bilateral condyle, premolar dentoalveolus, and ramus.

Results: No clinically significant changes in mandibular bone density were observed in condyle, premolar area, or ramus of onabotulinumtoxinA-treated participants, when compared with placebo or baseline, after 1 or 2 treatments.

Conclusions: In healthy adults with MMP, 1 or 2 bilateral masseter treatments with onabotulinumtoxinA at doses of 48, 72, or 96 U over 1 year did not negatively impact mandibular bone density.

Level of evidence: 1 (therapeutic):

Background: Breast reduction surgery provides both functional and aesthetic benefits and enables incidental detection of breast pathology. Although high-risk or malignant lesions are uncommon, their long-term clinical relevance remains unclear.

Objectives: To evaluate the histopathological findings of breast reduction specimens and assess their relationship with long-term breast outcomes, including the development of new breast disease and need for subsequent biopsy or mastectomy.

Methods: This retrospective cohort study included 1349 patients (2630 breasts) who underwent breast reduction with a minimum 5-year follow-up. Long-term clinical outcomes were assessed only in the subset of 377 patients (731 breasts) who completed a follow-up questionnaire. Histopathological findings were classified into three risk categories according to their association with malignancy. A follow-up questionnaire assessed breastfeeding ability, adherence to imaging, and the occurrence of new breast masses or interventions. Associations between baseline risk category, follow-up duration, and long-term outcomes were analyzed using Pearson chi-square tests.

Results: High-risk or malignant lesions were identified in 1.3% of specimens, predominantly among women over 40 years. Specimen weight and prior contralateral breast cancer history were not associated with pathological risk. Among 731 breasts evaluated by questionnaire, 80.1% retained breastfeeding ability, while 38% reported no imaging follow-up. Biopsy incidence increased significantly with follow-up time (2.6%, 6.2%, and 13.8% at 5-10, 10-15, and >15 years; p<0.001). Mastectomy rates also rose with time (0%, 0.6%, and 8.3%; p<0.001), showing a trend toward higher incidence in baseline high-risk specimens.

Conclusions: Breast reduction surgery facilitates incidental detection of high-risk lesions, particularly in women over 40 years. Higher baseline pathological risk and longer follow-up were associated with increased likelihood of mastectomy, underscoring the need for structured, risk-adapted surveillance to optimize long-term oncologic safety.