JPRAS Open最新文献

{"title":"Footplate releasing technique for correcting short noses in revision and Asian rhinoplasty","authors":"Ahmet Alp ,&nbsp;Alper Yenigun ,&nbsp;Orhan Ozturan","doi":"10.1016/j.jpra.2025.10.019","DOIUrl":"10.1016/j.jpra.2025.10.019","url":null,"abstract":"<div><h3>Background</h3><div>To achieve aesthetically pleasing results that are in harmony with the face, it is essential that the nose length is proportionate to facial proportions. Short and upturned noses can give the impression that the tip of the nose has been cut off when viewed from the front.</div></div><div><h3>Objective</h3><div>The aim of this study is to obtain a longer nose by increasing the prominence of the nasal tip through repositioning the medial and lateral crura using the Footplate Releasing Technique in patients with short noses, particularly in Asian patients.</div></div><div><h3>Materials and Methods</h3><div>The Footplate Releasing Technique was applied to 37 revision cases and 32 primary Asian noses. The technique consists of three stages. In the first stage, the medial crus was cut from the nasal base. Then, the lateral crus was lengthened by stealing from the medial crus. In the final stage, the cut and shortened medial crura were sutured to a strong columellar strut placed between them and extended to the nasal floor. Patients were followed up for an average of 12 months (range: 6–18 months).</div></div><div><h3>Results</h3><div>The Footplate Releasing Technique was successfully applied to 37 revision cases and 32 primary Asian noses. The nasal tip point was recreated at the desired level with extended lateral crura. The nasal tip was moved forward and downward, reducing cephalic rotation while achieving the desired projection. Targeted tip point, rotation, and projection results were obtained in all patients, with satisfactory aesthetic outcomes.</div></div><div><h3>Conclusions</h3><div>In revision cases and short nose deformities commonly seen in Asian patients, the Footplate Releasing Technique effectively extended the nasal tip forward and downward. This approach reduced nasal rotation while simultaneously lengthening the overall nasal structure.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 1-5"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertical scar reduction mammoplasty in massive macromastia: A prospective case series","authors":"Yahia Ahmed Alsiaghi ,&nbsp;Mohammed Hasan Al Shoaibi ,&nbsp;Mohaned Yahia Al-ajaly ,&nbsp;Jehad Yahya Al Mortada ,&nbsp;Aymen Mohammed Ghanem ,&nbsp;Ahmed A․ S․ AL-Magedi","doi":"10.1016/j.jpra.2026.01.012","DOIUrl":"10.1016/j.jpra.2026.01.012","url":null,"abstract":"<div><h3>Background</h3><div>Vertical scar superomedial pedicle breast reduction offers a shorter scar and improved breast projection, yet its safety and outcomes in cases of severe macromastia remain under discussion.</div></div><div><h3>Methods</h3><div>A prospective case series was conducted from October 2022 to January 2025, including fifteen female patients (30 breasts) with suprasternal notch-to-nipple distance ≥30 cm or resection weight ≥750 g per breast. All underwent vertical scar reduction mammaplasty using a superomedial pedicle technique and were followed for 12 months.</div></div><div><h3>Results</h3><div>The mean patient age was 33.7 ± 8 years, and the mean BMI was 28.3 ± 3.9 kg/m². Average resected tissue was 812.4 g (right) and 794.5 g (left). Common presenting symptoms were neck/back/shoulder pain (100%), shoulder grooving (93.3%), and social embarrassment (93.3%). Early complications were minimal, including wound dehiscence in two cases (13.3%), partial nipple-areolar necrosis in two cases (13.3%), and infection in one case (6.7%). No hematomas or seromas were observed. Late outcomes showed favorable results in breast shape (93.3%), volume (80%), scars (80%), and areola appearance (86.7%), with fair symmetry in 53.3% of cases. Patient satisfaction was high, with 80% rating the results as “very good” or “excellent.” Only 20% of patients required secondary revision. No statistically significant association was found between complications and smoking, obesity, or resection weight.</div></div><div><h3>Conclusion</h3><div>Vertical scar superomedial pedicle breast reduction is a safe and effective technique for patients with severe macromastia. It provides excellent aesthetic outcomes, minimal complications, and high patient satisfaction, even in high-BMI populations. These findings support its role as a reliable first-line surgical option in the management of extensive breast hypertrophy.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 759-777"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morel-Lavallée lesion—An overview and case report","authors":"Jephin Alex John ,&nbsp;Mathias Tremp ,&nbsp;Thomas R. Henkel","doi":"10.1016/j.jpra.2026.01.005","DOIUrl":"10.1016/j.jpra.2026.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Morel-Lavallée lesions (MLLs) are rare, post-traumatic, closed degloving injuries characterized by the separation of the skin and subcutaneous tissue from the underlying fascia, leading to fluid collection. This case study details the presentation, diagnosis, management, and outcomes of MLL in a 75-year-old obese male following a motor vehicle accident.</div></div><div><h3>Case Presentation</h3><div>The patient presented with significant swelling on the right thigh, measuring 30 × 20 cm, associated with erysipelas, chronic kidney disease, hypertension, and recurrent urothelial carcinoma. Diagnostic imaging, including MRI, confirmed a large, encapsulated hemolymphatic fluid collection consistent with MLL. Management included intravenous antibiotics, multiple rounds of debridement, capsulectomy, and local flap reconstruction. Despite initial improvement, the patient experienced recurrent fluid accumulation and persistent wound healing complications.</div></div><div><h3>Outcome</h3><div>Following additional surgical interventions, including gastrocnemius muscle flap reconstruction, the patient achieved satisfactory functional recovery and scar healing, with residual swelling managed via compression therapy. This case underscores the complexity of treating MLL in elderly patients with comorbidities and highlights the importance of a multidisciplinary approach in achieving favorable outcomes.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 862-867"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sweat gland carcinoma with neuroendocrine differentiation (SCAND) arising in the axilla: A case report highlighting diagnostic challenges and surgical management","authors":"Maiko Inada ,&nbsp;Takashi Nouchi ,&nbsp;Yoshifumi Iwahashi ,&nbsp;Miwako Miyasaka ,&nbsp;Yutaka Inaba ,&nbsp;Shinichi Asamura","doi":"10.1016/j.jpra.2026.01.013","DOIUrl":"10.1016/j.jpra.2026.01.013","url":null,"abstract":"<div><h3>Background</h3><div>Sweat gland carcinoma with neuroendocrine differentiation (SCAND) is a rare, newly recognized cutaneous adnexal tumor arising from sweat glands and characterized by neuroendocrine features. Given its rarity and resemblance to benign lesions, clinical diagnosis can be challenging.</div></div><div><h3>Case presentation</h3><div>A 73-year-old man presented with a 40-year history of intermittent discharge from a right axillary mass, which had initially been diagnosed as an epidermal cyst. Following lesion excision along the tumor margin at a local clinic, histopathological analysis revealed apocrine carcinoma, and the surgical margin could not be definitively confirmed to be negative. He was then referred to our department, where positron emission tomography-computed tomography demonstrated abnormal uptake in the right axillary lymph nodes, with a maximum standardized uptake value of 5.70. We performed wide local excision with a 1-cm margin, as well as a level Ⅱ axillary lymph node dissection. Histopathological evaluation showed tumor infiltration with nodular and trabecular pattern in the dermis and the subcutaneous tissue. Tumor cells contained eosinophilic cytoplasm and round-shaped nuclei with granular chromatin. 28 lymph nodes were resected, among which 19 showed metastatic involvement. Immunohistochemistry showed positivity for GCDFP-15, GATA3, ER and neuroendocrine differentiation markers. These findings were consistent with SCAND. The wound was closed primarily without the need for flap reconstruction. There has been no evidence of recurrence or metastasis at 12 months of postoperative follow-up.</div></div><div><h3>Conclusion</h3><div>This case highlights the potential for long-standing benign-appearing skin lesions to harbor rare malignant tumors such as SCAND. Accurate pathological diagnosis and increased clinical awareness among plastic surgeons are essential, and long-term surveillance is recommended owing to the possibility of delayed metastasis.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 857-861"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncoplastic breast reconstruction using a muscle sparing latissimus dorsi flap: A retrospective analysis of esthetic results and scapula-humeral function","authors":"Julia De Freitas,&nbsp;Augustin Reynard,&nbsp;Catherine Guérin-Charbonnel,&nbsp;Valérie Seegers,&nbsp;Alizée Contant,&nbsp;Jean-Luc Raoul,&nbsp;Pedro Raro","doi":"10.1016/j.jpra.2025.12.007","DOIUrl":"10.1016/j.jpra.2025.12.007","url":null,"abstract":"<div><h3>Purpose</h3><div>Muscle-sparing latissimus dorsi (MSLD) flap breast reconstruction offers a minimally invasive alternative to traditional latissimus dorsi flap procedures. By preserving muscle integrity, MSLD aims to reduce morbidity while maintaining esthetic and functional outcomes. This study retrospectively analyzes the outcomes of MSLD breast reconstruction in terms of scapula-humeral function and esthetic satisfaction.</div></div><div><h3>Methods</h3><div>Ninety patients undergoing MSLD flap reconstruction between January 2017 and February 2022 at the Institut de Cancérologie de l’Ouest, Angers, were included. Data collected included demographics, clinical history, surgical details, post-operative complications, esthetic satisfaction (evaluated by patients and health professionals), and shoulder functionality assessed using the DASH questionnaire.</div></div><div><h3>Results</h3><div>Median follow-up was 3.7 years. Most patients were under 65 years (91.1 %), with a median body mass index of 26 kg/m². Immediate reconstruction was performed in 74 % of cases, with a mean mastectomy weight of 576.7 g. Complications were rare, with a necrosis rate of 3.3 % and reoperation in 5.6 % of cases. Esthetic satisfaction was high, with a median score of 4 (out of 5) from both patients and evaluators. Functional outcomes demonstrated minimal impact on shoulder mobility, with a median DASH score of 11.</div></div><div><h3>Conclusion</h3><div>MSLD flap reconstruction is a reliable technique that balances functional preservation with esthetic satisfaction. It is suitable for a diverse patient population and demonstrates low complication rates. Future prospective studies comparing MSLD with prosthetic reconstruction may further confirm its advantages.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 679-690"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathological factors associated with trichilemmal cysts","authors":"Emrah Işıktekin,&nbsp;Salih Kılıç,&nbsp;Bilgen Can,&nbsp;Betül Gözel","doi":"10.1016/j.jpra.2025.11.013","DOIUrl":"10.1016/j.jpra.2025.11.013","url":null,"abstract":"<div><div>Trichilemmal cysts (pilar cysts) are common adnexal tumors that mostly affect the scalp. They are usually benign, but can sometimes be malignant. Despite being common, there is limited data on what factors influence lesion size, multiplicity and risk of infection. The present retrospective observational study evaluated 27 patients who underwent excision of trichilemmal or related cystic tumous between January 2020 and June 2025 at a tertiary plastic surgery centre. The clinical nkvariables encompassed age, sex, diabetes mellitus (DM), hypertension (HT), tobacco use, Fitzpatrick skin type, and, in female patients, headscarf use and Ludwig hair loss score. Tumou size, multiplicity and infection were assessed. The mean age was 44.4 ± 15.6 years (range 17–82), with 59 % (16/27) females. The median tumor size was recorded as 21 mm [8,30] and the median duration from first awareness to excision was 18 months [8,27]. Infection was identified histopathologically in a minority of cases and showed trends toward association with DM and HT. Patients with multiple lesions were older (median 54 vs. 38.5 years, p=0.009) and had larger tumors (median 30 vs. 9 mm, p&lt;0.0001). Linear regression revealed that age and DM independently predicted larger lesions, while HT was negatively associated. No correlations were identified with tobacco use, Fitzpatrick skin type, or headscarf status. These results emphasise the clinical importance of age and existing health conditions, especially diabetes, in affecting trichilemmal cyst development and the risk of infection. They provide new evidence for risk assessment, surgical planning and patient information.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 137-146"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public perception of facial vascularized composite allotransplants-insights from a cross-sectional survey of healthy individuals in the USA","authors":"Leonard Knoedler ,&nbsp;Thomas Schaschinger ,&nbsp;Raffaele Aguglia ,&nbsp;Curtis L. Cetrulo Jr. ,&nbsp;Max Heiland ,&nbsp;Carsten Rendenbach ,&nbsp;Rakan Saadoun ,&nbsp;Felix J. Klimitz ,&nbsp;Martin Kauke-Navarro ,&nbsp;Bohdan Pomahac ,&nbsp;Jakob Fenske ,&nbsp;Alexandre G. Lellouch","doi":"10.1016/j.jpra.2025.11.015","DOIUrl":"10.1016/j.jpra.2025.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Facial vascularized composite allotransplantation (fVCA) is an advanced reconstructive procedure for extensive facial defects. While clinical outcomes have improved, public perceptions remain underexplored. Gaining insights into societal attitudes is crucial for patient education, informed decision-making, and guiding future research.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted among 100 volunteers from the United States via the Prolific platform. The study population reflected the demographic distribution of the general population. The survey assessed awareness, willingness to undergo fVCA, decision-making factors, and ethical concerns. Responses were collected through Likert scales, multiple-choice questions, and aesthetic evaluations of post-transplant outcomes.</div></div><div><h3>Results</h3><div>Fifty-eight percent of participants had never heard of fVCA, with social media being the most common source of information (50 %) for those who had. Eighty-seven percent were potentially open to undergoing fVCA in case of an accident, although concerns about graft rejection risks (65 %) and lifelong immunosuppression (65 %) influenced decision-making. Functionality was prioritized over aesthetics by 51 % of respondents, yet 72 % preferred donor-recipient matching based on age, gender, and ethnicity. Psychological adaptation was a major concern for 51 %, with 82 % emphasizing the importance of pre- and postoperative psychological counseling. Ethical concerns included donor consent (61 %) and fairness in allocation (69 %). Respondents rated photographs of postoperative aesthetic outcomes with a mean score of 7.9 out of 10.</div></div><div><h3>Conclusion</h3><div>While public perception of fVCA is generally positive, concerns regarding rejection, immunosuppression, and psychological adaptation remain significant. Increased education, ethical transparency, and advancements in immunosuppressive strategies are needed to enhance acceptance and feasibility. Future research should explore novel immunosuppressants and psychological programs to improve long-term concerns.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 123-131"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended reality for perforator visualization in deep inferior epigastric perforator autologous breast reconstruction: A systematic review","authors":"Killian Zijlstra ,&nbsp;Chien Nguyen ,&nbsp;Koen Willemsen ,&nbsp;Henk Coert ,&nbsp;Eveline Corten ,&nbsp;Wiesje Maarse","doi":"10.1016/j.jpra.2025.11.025","DOIUrl":"10.1016/j.jpra.2025.11.025","url":null,"abstract":"<div><h3>Background</h3><div>Extended Reality (XR) technology is rapidly advancing and has shown promise in improving perioperative outcomes across various surgical specialties.</div></div><div><h3>Objective</h3><div>This systematic review aimed to evaluate the use of XR for perforator vessel visualization in autologous breast reconstruction.</div></div><div><h3>Method</h3><div>A systematic search was conducted following PRISMA guidelines, consulting Embase, Medline (Ovid), Web-of-Science, Cochrane, and Google Scholar on June 23, 2025. Articles describing the use of XR for perioperative perforator visualization in free flap breast reconstruction were included. Outcome measures included perforator identification rate, virtual model construction time, preoperative planning duration, flap dissection time, usability, complications, and costs.</div></div><div><h3>Results</h3><div>Ten articles were included, all focused on XR in deep inferior epigastric perforator (DIEP) flap breast reconstruction. Three XR modalities were identified: virtual reality (VR), augmented reality (AR) projection, and AR glasses. Perforator identification using XR ranged from 61.7 % to 100 %, with AR outperforming handheld Doppler ultrasound (US) in several studies. XR use decreased operative time, with AR reducing intraoperative perforator localization time from 20 min using handheld Doppler US to 2.3 min. The use of XR did not result in significant additional costs, and no differences in complication rates were identified.</div></div><div><h3>Conclusion</h3><div>XR may assist surgeons in perioperative perforator visualization during DIEP flap breast reconstruction by enhancing anatomical understanding. However, current evidence is constrained by small, low-quality studies and comparisons with handheld Doppler rather than the gold standard computed tomography angiography (CTA). Whether XR offers clinically meaningful advantages over conventional CTA imaging remains uncertain, as this was not explored in the included articles. Larger, high-quality comparative studies are needed to establish its true clinical value.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 253-268"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of cervicofacial flaps: From classical reconstruction to Freestyle Multiperforator Island Flap","authors":"Oswaldo J. Gómez ,&nbsp;Carlos E. Ruiz ,&nbsp;Erika Padilla ,&nbsp;Andrés F. Patiño","doi":"10.1016/j.jpra.2025.11.026","DOIUrl":"10.1016/j.jpra.2025.11.026","url":null,"abstract":"<div><h3>Background</h3><div>This study presents a cost-effective and safe alternative for facial reconstruction, introducing the concept of the Freestyle Multiperforator Island Flap (FMIF) a subcutaneously based flap that can be customized in both location and size. Its versatility stems from the extensive vascular cutaneous territories supplied by the dermal and facial plexuses, which branch in an arborescent pattern to ensure reliable perfusion across multiple facial regions.</div></div><div><h3>Methods</h3><div>A retrospective case series of 34 patients (37 flaps) with cheek defects treated between 2012 and 2022 is presented. Demographic profiles, defect etiology, flap characteristics, and postoperative outcomes were analyzed.</div></div><div><h3>Results</h3><div>A total of 37 flaps were performed in 34 patients. The most common etiology was malignant tumors (83.7 %), squamous cell carcinoma (43.2 %), basal cell carcinoma (29.7 %), and melanoma (10.8 %), followed by benign tumors (10.8 %) and others (5.4 %).</div><div>Twenty-five flaps were used for the reconstruction of the parotid-masseteric subunit, with 54 % designed at a flap-to-defect ratio ranging from 5:1 to 10:1.</div><div>In 29 flaps (78.37 %), the average pedicle area was 16.2 % (range: 10 %–20 %).</div><div>Regarding outcomes, major complications occurred in five flaps, with partial necrosis and dehiscence being the most frequent (5.4 % each). No total flap loss was reported.</div></div><div><h3>Conclusions</h3><div>The FMIF offers a safe, versatile, and cost-conscious option for facial reconstruction, providing reliable perfusion and minimal donor-site morbidity through its adaptable pedicle design. Although early outcomes are favorable, the absence of a control group limits definitive conclusions. Future comparative and anatomical studies are required to validate its vascular basis, safety, and role alongside established reconstructive techniques.</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 321-330"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstructing identity: Defining medical necessity in the context of facial surgery","authors":"Helen Jingshu Jin","doi":"10.1016/j.jpra.2025.11.009","DOIUrl":"10.1016/j.jpra.2025.11.009","url":null,"abstract":"<div><div>During the first World War, the amount of facial disfigurement resultant from nascent trench warfare was unprecedented. And because the face is so intricately linked with one’s sense of identity, the psychological impact of such disfigurement was devastating for veterans returning home from war. It was in this backdrop that the father of plastic surgery, Dr. Harold Delf Gillies, pioneered innovative new reconstructive techniques that revolutionized the field of facial surgery. Following the war, Gillies expanded his practice into the civilian realm, working on facial reconstruction for those marred by congenital defects, disease, or trauma. Controversy arose when he began work in the cosmetic realm, sparking debate on what is and should be considered essential surgery. This debate continues into current day, most notably in the context of gender confirmation surgeries (GCS).</div><div>While many forms of GCS for transgender individuals is now recognized as essential surgery, facial GCS (FGCS) remains predominantly classified as cosmetic. Despite current beliefs, there is increasing evidence showing marked quality of life following surgery, with official standards published by the World Professional Association for Transgender Health recognizing FGCS as medical necessary. Looking to historical precedents, many parallels between the movement of wartime facial reconstructive surgery from the realm of elective into essentiality can be drawn in comparison to FGCS. Using these two prominent examples in facial surgery, this paper explores the question: what should constitute essential surgery?</div></div>","PeriodicalId":37996,"journal":{"name":"JPRAS Open","volume":"48 ","pages":"Pages 231-233"},"PeriodicalIF":1.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}