Aesthetic Surgery Journal最新文献

Background: Over the past decade, facial aesthetics has gained popularity, with a notable increase in upper-face lift procedures. Despite the popularity of brows and forehead lifts, the optimal fixation technique remains controversial. Common methods involve suturing of the temporal fascia or using monocortical miniscrews anchored to the frontal bone. Other options include the use of microscrews, percutaneous fixation posts, Kirschner wires, Mitek anchors, Endotine devices, bone tunnels, miniplates, and fibrin glue. This study introduces a new technique that transmits the pulling force directly to the brow/forehead skin through subperiosteal dissection using the scalp as a suspension point.

Objectives: To present a method in which pulling force is transmitted directly to the brow/forehead skin through subperiosteal dissection, utilizing the scalp as a suspension point.

Methods: This retrospective study included 129 patients who underwent surgery between May 2022 and June 2023. Patients with less than 12 months of follow-up, irregular follow-up, or a history of botulinum toxin or brow contouring were excluded. Preoperative and 12-month postoperative photographs were evaluated using the Brow Positioning Grading Scale (BPGS).

Results: No persistent dimples were observed, with resolution within four weeks. Postoperative edema, erythema, and bruising resolved within six days. Complications, including chemosis, stitch-site infections, muscle weakness, paresthesia, and asymmetry, were all resolved. Significant improvements in eyebrow height and BPGS scores were noted at the 12-month follow-up visit.

Conclusions: This technique offers a natural upper face rejuvenation option that is particularly suitable for patients with lower brow positions or advanced age.

Background: Midfacial aging involves skeletal changes, muscle weakening, and fat redistribution, resulting in volume loss, skin sagging, and deepened nasolabial folds. High-Intensity Facial Electrical Stimulation (HIFES) combined with Radiofrequency (RF) is a novel non-invasive method to address these changes by enhancing muscle mass and remodeling subcutaneous tissue.

Objectives: To assess the efficacy of HIFES and Synchronized RF in improving midfacial aesthetics, specifically muscle thickness, skin displacement, and facial volume.

Methods: This prospective, non-randomized study included 37 participants who underwent four HIFES and RF treatments over 24 weeks. Assessments at baseline, 4, 16, and 24 weeks used ultrasound imaging, electromyography (EMG), 3D surface imaging, and the modified Fitzpatrick Wrinkle Scale (FWS). A related porcine study evaluated the treatment's histological effects.

Results: Zygomaticus Major Muscle (ZMM) thickness increased from 2.06 mm to 2.80 mm, with a 39.3% rise in EMG signal strength, indicating improved muscle function. Skin displacement analysis revealed horizontal (0.90 mm) and vertical (1.01 mm) shifts, particularly laterally. Midface volume increased by 1.43 cm³ at 24 weeks. The porcine study confirmed increased muscle fiber size, myonuclei count, and mass density, aligning with human results.

Conclusions: HIFES and Synchronized RF treatments significantly improved muscle thickness, skin displacement, and facial volume, effectively rejuvenating the midface. These clinical findings, supported by histological evidence, suggest a promising non-invasive approach for facial rejuvenation. Further randomized studies are needed to confirm these results and assess long-term effects.

Background: Three-dimensional (3D) imaging enhances surgical planning and documentation in plastic surgery, but high costs limit accessibility. Mobile Light Detection and Ranging (LiDAR) technology offers a potential cost-effective alternative.

Objectives: To evaluate the accuracy and clinical utility of iPhone-based LiDAR scanning for breast measurements compared to traditional methods, and to establish standardized protocols for clinical implementation.

Methods: In this prospective validation study, 25 consecutive patients (mean age: 44 years; range: 32-64 years; mean BMI: 23.2 kg/m²) undergoing breast procedures were evaluated using the "3D Scanner App" on iPhone 15 Pro (Apple Inc., Cupertino, CA). Three standardized measurements (sternal notch-to-nipple, nipple-to-midline, nipple-to-inframammary fold) were compared between LiDAR and manual techniques. Technical error of measurement (TEM) and relative TEM (rTEM) were calculated. Inter-rater reliability, learning curve assessment, and cost-effectiveness analysis were performed.

Results: LiDAR measurements showed very good accuracy for sternal notch-to-nipple (rTEM 1.43%, 95% CI: 1.21-1.65) and nipple-to-midline distances (rTEM 3.45%, 95% CI: 3.12-3.78). Nipple-to-inframammary fold measurements showed moderate accuracy (rTEM 8.80%, 95% CI: 8.21-9.39). Inter-rater reliability was excellent (ICC=0.92). Learning curve analysis demonstrated measurement stability after 5 cases. Cost analysis revealed 97.8% reduction in initial investment compared to commercial 3D imaging systems.

Conclusions: Mobile LiDAR technology provides accurate breast measurements for most anatomical landmarks at a fraction of the cost of traditional 3D imaging systems. The technology shows excellent reliability after a short learning curve, offering an accessible solution for surgical planning and documentation.

Background: Cicatricial lower-eyelid ectropion is a serious complication resulting from undesired lower lid blepharoplasty or impaired wound healing. Surgical treatment for ectropion is challenging for oculoplastic surgeons due to the unpredictability of surgical outcome and the difficulty of surgical design.

Objectives: The authors aimed to fully describe the surgical decision-making strategy for cicatricial ectropion, and to potentially enhance treatment outcomes.

Methods: In this study, we conducted a retrospective review of the treatment of 26 patients (30 eyelids) with cicatricial ectropion between 2017 and 2021. We summarized the corresponding decision-making processes before and during surgery. Treatment involved scar tissue release combined with lateral canthal procedures and repair of the skin defect.

Results: During the early postoperative stage, no flap necrosis was observed, and complete surgical healing was achieved within 2 weeks. The Ectropion Grading Scale (EGS) showed a significant decrease after surgical treatment based on our approach, and most patient symptoms were alleviated. Additionally, the majority of the patients expressed high satisfaction with the aesthetic outcome of the procedure.

Conclusions: This treatment approach significantly enhanced both the appearance and function of lower lid, which holds considerable promise as an ideal surgical design for cicatricial ectropion.

Background: Infectious complications associated with implant-based breast reconstruction (IBBR) can be devastating and may lead to reconstructive failure. While there are known demographic risk factors for reconstructive failure, few studies have identified intraoperative findings that predict failure after attempted salvage.

Objectives: The objective of this study was to identify intraoperative findings in infected breasts that may be predictive of implant failure.

Methods: 837 patients undergoing IBBR between January 2017 and July 2023 were included. Intraoperative records of patients who developed a major infection were reviewed. Reconstructive salvage denoted any intervention not resulting in explantation. Failure denoted implant explantation.

Results: Of 837 patients, 8% developed a major infection (n=71). Within this group, 8% had successful treatment with IV antibiotics alone, 38% were salvaged after operative intervention, 28.2% failed without salvage attempt, and 25.4% underwent salvage attempt but ultimately failed. Overall, the rate of reconstructive failure was 53.5% and the rate of implant salvage was 46.5%. 51% of patients returning to OR were found to have unincorporated acellular dermal matrix (ADM). 78% of patients undergoing intervention had positive culture, most commonly MSSA, MRSA, Serratia, Enterobacter, or Proteus. Unincorporated ADM was significantly associated with reconstructive failure (Odds Ratio 5.4, p=0.02). Serratia infection, hematoma, and gram-negative infection were associated with implant failure, but these finding did not achieve statistical significance.

Conclusions: Presence of unincorporated ADM was associated with eventual implant failure. Surgeons should be aware that this finding may portend poor outcomes for patients. These results may be useful in informing intraoperative decision making.

Background: In order to obtain a natural but athletic contour through liposuction, the management of the male pectoral region is constantly changing. Cutting-edge methods including mammary gland excision and fat grafting to the pectoralis major have been created. There isn't yet a single method that can handle all long-term problems, like gynecomastia with eventual loss of pectoral definition, fat graft asymmetries, and/or unnatural definition..vic.

Objectives: This article proposes a surgical technique to improve the male pectoral region through liposuction in specific areas, muscular volumization with objectively established fat volumes based on intracompartimental pressure measurements, and the management and prevention of gynecomastia. This approach aims to ensure the maximal survival of the fat graft with reduced fat necrosis, long-term asymmetry, and sustained results over time.

Methods: Measurement of the pectoralis major pressure, following fat graft, was conducted between January 2021 and June 2023. Patients aged between 19 and 60 years at the time of surgery, with a body mass index below 30 kg/m², were included. The surgical technique is presented in this article.

Results: The two models used in this study exhibited strong explanatory power, indicating that a significant portion of the variability in fat graft resorption could be explained by the variables included in these models. Postoperative exercise, patients age, and intramuscular pressure of the transferred fat showed statistically significant results in the survival of fat grafts. BMI did not show a statistically significant relationship.

Conclusions: This technique can treat and prevent gynecomastia while simultaneously improving the appearance of the male chest through volumization of the pectoralis major with safe fat grafts volumes. The established volumes did not exceed 8 mmHg intracompartimental pressure. Higher volumes reduced fat survival. Large volumes lead to greater postoperative asymmetry and loss of fat grafts.

Background: Local flaps for breast reconstruction are becoming recognized as a viable alternative to remote flaps.

Objectives: The purpose of this manuscript is to describe the anatomy and clinical outcomes using the internal mammary artery perforators and the lateral intercostal artery perforator flaps for breast reconstruction.

Methods: Twelve cadaveric specimens were injected with colored latex and dissected to demonstrate the medial perforators of the 5th intercostal space. Twenty-two patients had partial or total breast reconstruction using the internal mammary artery perforator flaps that was combined with the lateral intercostal artery perforator flap in 4 patients. The study was performed at the Hospital de Clinicas Jose de San Martin that is affiliated with the Universidad de Buenos Aires in Argentina between March 2018 -December 2023. Outcomes were based on clinical evaluation and statistical analysis. Patient satisfaction was assessed on a 5-point Likert scale based on whether they were clothed or unclothed.

Results: All flaps survived without any evidence of partial flap necrosis. There were no major complications (total flap loss, partial necrosis); however, fat necrosis was demonstrated in two patients. Minor complications included a small hematoma and a minor wound dehiscence. Patient satisfaction was rated as very good or excellent in 100% of women when clothed and rated as good to very good in 93.3% of women when unclothed.

Conclusions: Submammary perforator flaps can be raised on numerous vascular pedicles. This study has demonstrated that the internal mammary and the lateral intercostal can be successfully used for partial or total breast reconstruction in properly selected patients.

Background: Understanding the interplay of muscle activity in the upper face is crucial as it can significantly impact the effectiveness and safety of aesthetic treatments. Traditional injection algorithms typically focus on the general 2D and 3D anatomy of muscles, often neglecting the areas where muscles exert the greatest force during facial expressions.

Objectives: To analyze the location of greatest morphological change in upper facial muscles procerus muscle (PM), corrugator supercilia muscle (CSM), orbicularis oculi muscle (OOM) and frontalis muscle (FM) during various facial expressions.

Methods: A total of 34 healthy young individuals (17 females, 17 males), with a mean age of 23.6±2.4 years [range 20-30], were examined using MRI to assess the length, thickness and width of upper facial muscles (PM, CSM, OOM, FM) for five different facial expressions: repose, anger, joy, surprise, and sadness.

Results: Facial muscle thickness is a key indicator of activity during expressions like anger, joy, surprise, and sadness. During anger, the PM and CSM decreased in length and width but increased in thickness, while FM passively contracted to stabilize the expression. The OOM showed increased thickness in its medial, inferior, lateral, and superior portions during various expressions, with specific regions activating differently depending on the expression, such as the medial and lateral parts during surprise and the inferior and lateral parts during joy. The medial third of the CSM was the most active region during contraction.

Conclusions: Upper facial muscles - regardless of them agonists or antagonists - act together during facial expressions to stabilize facial expressions, emphasizing the need to assess both groups in neuromodulator treatments. The medial third of the corrugator supercillii shows the most significant MRI changes, making it the primary target for injections.