Aesthetic surgery journal. Open forum最新文献

{"title":"Global Insights Into Confidence and Self-Perception in Aesthetic Medicine: A 15-Country Survey Analysis.","authors":"Shannon Humphrey, Claudia Andrea Hernández, Jose Raul Montes, Je-Young Park, Daria Voropai, Katherine Warnell","doi":"10.1093/asjof/ojag058","DOIUrl":"https://doi.org/10.1093/asjof/ojag058","url":null,"abstract":"<p><strong>Background: </strong>Nonsurgical aesthetic treatments have been found to improve patient confidence; however, the interplay between patient attitudes and aesthetic treatment expriences is not fully understood.</p><p><strong>Objectives: </strong>The aim of this study was to further characterize the role of confidence and self-perception in the decision to pursue aesthetic treatments and in patient experience of outcomes.</p><p><strong>Methods: </strong>A total of 15,155 adults from 15 countries were recruited to participate in a device-agnostic online survey. Qualified participants were adults 21 to 70 years of age who had an aesthetic treatment in the past 12 months or would consider one in the next 24 months.</p><p><strong>Results: </strong>Respondents reported a mismatch between their inner self and outward appearance, which may influence self-perception and social interactions. Individuals viewed aesthetic treatments as more than appearance enhancements, and many considered aesthetic treatments to be acts of self-care and empowerment, integrating them into their regular beauty routines. The strongest influence on individuals' self-image was close personal relationships, whereas societal norms and social media played a secondary role.</p><p><strong>Conclusions: </strong>Results suggest that confidence derived through aesthetic treatments can shape self-perception and social well-being; moreover, the decision to obtain aesthetic treatment is not at odds with self-confidence and can be an empowering experience.</p><p><strong>Level of evidence 5 therapeutic: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag058"},"PeriodicalIF":1.9,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyaluronic Acid Injection Techniques for Lip Augmentation-Comparison of Linear, Retrograde, and Microdeposit Approaches: A Systematic Review.","authors":"Victor Rene Miranda Cerna","doi":"10.1093/asjof/ojag059","DOIUrl":"https://doi.org/10.1093/asjof/ojag059","url":null,"abstract":"<p><p>Hyaluronic acid (HA) is widely used for lip augmentation; however, the safety and performance of injection techniques and instruments (needle vs cannula) remain unclear. The aim of this study was to evaluate the safety of HA injection techniques for lip augmentation and to assess patient satisfaction, injected volume, and associations with technique, instrument, and HA product. A systematic review was conducted accordance with PRISMA 2020 and registered in PROSPERO (CRD420251123328). PubMed/MEDLINE, Embase, Cochrane Library, LILACS, SciELO, and Scopus were searched from January 1, 2010, to August 16, 2025, for studies involving adults undergoing HA lip augmentation. Eligible designs included randomized and nonrandomized clinical trials, cohort studies, and systematic reviews. The primary outcome was safety, defined by type and timing of complications. Secondary outcomes included patient satisfaction, injected volume, and associations with technique, instrument, and HA product. Risk of bias was assessed using RoB 2 and ROBINS-I, and findings were synthesized narratively. Sixteen studies including 3692 patients were analyzed. Most protocols used 1 to 2 mL per session, commonly employing linear retrograde techniques with serial puncture, fan patterns, or microdeposits. Adverse events were mild and transient, including edema, ecchymosis, tenderness, and nodularity, with no reported cases of vascular occlusion or vision-threatening events. Needle-only and combined needle plus cannula approaches showed comparable safety profiles. Patient satisfaction was high in most patients. HA lip augmentation appears effective and generally safe when performed by experienced injectors. Current evidence does not support a single superior technique, instrument, or HA formulation. Standardized studies are needed to define best-practice protocols. <b>Level of Evidence: 3 (Risk)</b>.</p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag059"},"PeriodicalIF":1.9,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study on Age-Related Facial Fat Changes Using 3D MRI and a Novel Algorithm.","authors":"Mingxia Sun, Qi Zhou, Yingtong Wu, Jian Hu, Xiaoling Luo, Xueni Lin, Wenjun Wang, Jin Zhou, Chao Zou, Zhiwei Li","doi":"10.1093/asjof/ojag028","DOIUrl":"https://doi.org/10.1093/asjof/ojag028","url":null,"abstract":"<p><strong>Background: </strong>Age-related changes in facial and cervical fat distribution play a critical role in aesthetic appearance; yet, quantitative evidence remains limited.</p><p><strong>Objectives: </strong>This study aimed to quantitatively characterize regional fat distribution patterns of the neck and face across different age groups using advanced imaging, and to examine the relationships between age, body mass index (BMI), and fat distribution.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in 47 healthy female participants aged 18-65 years. High-resolution 3-dimensional magnetic resonance imaging (3D MRI) was used to measure fat thickness and volume across predefined anatomical compartments.</p><p><strong>Results: </strong>Neck fat thickness and volume showed significant positive correlations with both age and BMI, with the greatest increases observed in midlife. Facial fat demonstrated region-specific remodeling rather than uniform descent. Buccal fat pad and nasolabial fold volumes significantly decreased with age, whereas upper facial superficial fat remained stable. Infraorbital fat volume and thickness exhibited a distinct age-related increasing trend, particularly between young and middle-aged groups.</p><p><strong>Conclusions: </strong>This study reveals potential heterogeneous age-related changes in facial and cervical fat distribution through quantitative imaging analysis. Our findings suggest that distinct fat compartments may age at different rates, which could have implications for understanding facial ageing and related interventions.</p><p><strong>Level of evidence 3 therapeutic: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag028"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13042247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 Receptor Agonist-Associated Weight Loss and Aesthetic Breast Surgery: A Narrative Review and Experience-Based Recommendations for Plastic and Reconstructive Surgeons.","authors":"Maurice Y Nahabedian, Anand K Deva, Deeba Ahmed, Paolo Fanzio, Jason Hammer","doi":"10.1093/asjof/ojag054","DOIUrl":"https://doi.org/10.1093/asjof/ojag054","url":null,"abstract":"<p><p>The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for inducing weight loss has increased in recent years, resulting in a parallel reduction in demand for bariatric surgery. Consequently, the need for patients to undergo aesthetic procedures, including aesthetic breast surgery, following successful GLP-1 RA-induced weight loss is expected to increase while the demand created by postsurgical weight loss is expected to decrease. The objective of this narrative review is to examine the literature on the use of GLP-1 RAs and other mechanisms used for medical weight loss to assist plastic surgeons in achieving optimal aesthetic outcomes with breast surgery after weight loss occurs. To provide an overview of GLP-1 RAs in the context of aesthetic breast surgery, a PubMed literature search was performed using terms such as \"glucagon-like peptide-1 receptor agonist,\" \"GLP-1,\" and \"breast.\" Relevant studies in English published before December 6, 2024 were identified. Experience-based considerations from the authors (M.N. and A.D.) are provided to complement the currently available literature, and 2 case studies of patients who received aesthetic breast surgery following weight loss with GLP-1 RAs are presented. Because drastic changes in breast appearance may occur following weight loss treatment, including ptosis and asymmetry, surgeons should consider overall weight, body composition, and breast aesthetics and counsel patients prior to breast surgery. As our knowledge surrounding the effects of GLP-1 RA use expands, it is likely that surgical protocols and preoperative/postoperative patient counseling recommendations will need to be amended. <b>Level of Evidence</b>: 5 (Therapeutic).</p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag054"},"PeriodicalIF":1.9,"publicationDate":"2026-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Preoperative Botulinum Toxin Use in Abdominal Wall Reconstruction: A Propensity-Matched Analysis of More Than 5000 Patients Over 5 Years.","authors":"Yousef Tanas, Stephen Chen, Philong Nguyen, Joshua Wang, Haidara Bohsas, Dora Lena Fedorcsak, Tue Dinh","doi":"10.1093/asjof/ojag055","DOIUrl":"10.1093/asjof/ojag055","url":null,"abstract":"<p><strong>Background: </strong>Preoperative botulinum toxin (BTX) has been proposed to facilitate myofascial medialization and tension reduction in abdominal wall reconstruction (AWR), but long-term comparative outcomes are unclear.</p><p><strong>Objectives: </strong>To compare short- and long-term postoperative outcomes after AWR in patients receiving preoperative BTX vs no BTX.</p><p><strong>Methods: </strong>We performed a retrospective cohort study using the TriNetX National Health Research Network. Adults undergoing AWR were identified by ICD-10/CPT codes and assigned to BTX or no-BTX cohorts. Propensity score matching (1:1) balanced demographics, comorbidities, related procedures, and medications at each follow-up point. Outcomes included hernia recurrence, infections, wound disruption, seroma, hematoma, surgical site infection (SSI), and reoperation, assessed at 6 months, 1, 3, and 5 years.</p><p><strong>Results: </strong>At 6 months, BTX was associated with lower hernia recurrence (32.1% vs 35.6%; <i>P</i> = .013) but higher risks of infections (14.4% vs 10.5%; <i>P</i> < .001), wound disruption (8.7% vs 4.7%; <i>P</i> < .001), hematoma (1.3% vs 0.5%; <i>P</i> = .003), SSI (3.9% vs 2.4%; <i>P</i> = .002), and reoperation (10.7% vs 7.8%; <i>P</i> = .001). From 1 to 5 years, recurrence rates no longer differed significantly between groups (eg, 5 years: 42.6% vs 44.8%; <i>P</i> = .112). The BTX cohort continued to demonstrate higher rates of infections, wound disruption, hematoma, SSI, and reoperation across later time points (all <i>P</i> < .05).</p><p><strong>Conclusions: </strong>Preoperative BTX for AWR was linked to an early reduction in recurrence but higher postoperative complications and reoperation over time. These observational data highlight the need for standardized BTX protocols and prospective trials to define patient selection and to balance potential short-term mechanical benefits against complication risks.</p><p><strong>Level of evidence 3 risk: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag055"},"PeriodicalIF":1.9,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonsurgical Rhinoplasty: Patient Satisfaction and Progression to Surgery.","authors":"Kanad Ghosh, Lauren Greger, Alissa Zarder, Parit Patel","doi":"10.1093/asjof/ojag043","DOIUrl":"https://doi.org/10.1093/asjof/ojag043","url":null,"abstract":"<p><strong>Background: </strong>Nonsurgical rhinoplasty (NSR) may achieve a satisfactory aesthetic result. However, if NSR falls short of patient goals, patients may then elect to undergo surgical rhinoplasty. This latter cohort of patients has not been well studied in terms of satisfaction and motivation to pursue surgical rhinoplasty.</p><p><strong>Objectives: </strong>The objectives of this study are to determine when NSR may be most beneficial and why patients may choose to undergo surgical rhinoplasty following NSR.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients undergoing NSR from 2019 to 2024 by a single surgeon. All patients received injection of hyaluronic acid filler. Demographic data, satisfaction scores using FACE-Q data, progression to surgical rhinoplasty, and complications following injection and rhinoplasty were recorded.</p><p><strong>Results: </strong>About one hundred and sixty-two patients were included in the study. About 90.7% were females, and average patient age was 30.5 ± 9.2 years. On average, patients had 1.7 ± 1.2 injections with an average of 0.38 + 0.08 cc volume per injection. Also, 8/162 (4.9%) of patients went on to surgical rhinoplasty with an average of 8.1 ± 5.8 months between last injection and surgery. The main motivations for proceeding to surgical rhinoplasty were patient readiness for more permanent results. FACE-Q surveys were completed by 36/162 (22.2%) of patients, which showed an average satisfaction of 79.8% + 15.7%.</p><p><strong>Conclusions: </strong>Nonsurgical rhinoplasty is a safe aesthetic procedure with low rate of progression to surgical rhinoplasty. In patients who elect to proceed to surgical rhinoplasty, the main motivation is readiness for permanent surgical outcomes.</p><p><strong>Level of evidence 3 therapeutic: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag043"},"PeriodicalIF":1.9,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Clinical Evaluation of Combined Targeted Verifiable Subcision and Helium Plasma Radiofrequency for the Treatment of Cellulite and Skin Laxity.","authors":"Barry E DiBernardo","doi":"10.1093/asjof/ojag047","DOIUrl":"https://doi.org/10.1093/asjof/ojag047","url":null,"abstract":"<p><p>Cellulite affects 85% to 98% of postpubertal females and is characterized by fibrous septa contraction, dermal thinning, and fat lobule herniation, resulting in visible skin dimpling and textural irregularities. Although multiple treatment modalities exist, most target only select aspects of this multifactorial condition. This study evaluates the safety and efficacy of a novel approach combining targeted verifiable subcision (TVS) and helium plasma radiofrequency (RF) to disrupt fibrous septa, stimulate collagen remodeling, and improve skin elasticity. A prospective, single-center, investigator-initiated trial enrolled 22 patients who received a single-session treatment. Efficacy was assessed using quantitative imaging, the Physician and Subject Global Aesthetic Improvement Scale (PGAIS, SGAIS) at Day (D) 30, D90, and D180. Histological analysis evaluated collagen remodeling, elastin regeneration, and epidermal restructuring. Safety assessments included adverse events and procedural tolerability. Quantitative imaging showed progressive improvement through D180. By D180, improvement was observed in 77.3% (right thigh) and 81.8% (left thigh). PGAIS scores increased from 38% at D30% to 68% at D90 and D180. SGAIS peaked at D30 (57%), declining to 55% at D90% and 45% at D180. Histology confirmed progressive remodeling and increased extracellular matrix integrity. Two mild, self-resolving adverse events were reported (9%).Combining TVS and helium plasma RF may be a safe, well-tolerated, and effective treatment for improving cellulite appearance and skin laxity. Objective, histological, and physician-assessed outcomes confirmed dermal regeneration and clinical improvement, supporting integration of mechanical and energy-based therapies for minimally invasive cellulite treatment. <b>Level of Evidence</b>: 4 (Therapeutic).</p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag047"},"PeriodicalIF":1.9,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13112431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The SibUS-In Finger Probe: An Alternative Device and Method for Ultrasound-Guided Injections.","authors":"Audrey Melin, Diala Haykal, Jaoued Diboun, Hugues Cartier, Sebastien Garson, Jair Mauricio Cerón Bohórquez, Peter Velthuis, Leonie Schelke, Benjamin Ascher","doi":"10.1093/asjof/ojag046","DOIUrl":"https://doi.org/10.1093/asjof/ojag046","url":null,"abstract":"<p><p>Conventional ultrasound systems in aesthetic medicine are often bulky, single-hand operated, and poorly adapted to facial anatomy, limiting their practicality during injectable procedures. These ergonomic and workflow constraints have restricted the integration of ultrasound guidance into routine practice. The SibUS-In (safe injection by ultrasound) probe was specifically designed for aesthetic injections, integrating a high-frequency transducer onto the injector's fingertip to enable simultaneous palpation, scanning, and injection. This configuration restores 2-hand coordination and allows real-time visualization of facial structures while maintaining dexterity. In clinical use, the device combines ergonomic comfort, intuitive handling, and high-quality imaging that supports continuous vascular mapping and procedural control. The present article illustrates the practical application of the SibUS-In probe across different facial regions and procedural stages, highlighting its potential to facilitate ultrasound-guided injections. Further studies are warranted to evaluate quantitative outcomes and define standardized protocols for its broader clinical adoption. <b>Level of Evidence</b>: 5 (Therapeutic).</p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag046"},"PeriodicalIF":1.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13098122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonfacial Use of Injectable Poly-L-lactic Acid: Safety Data From a Multicenter Observational Study in the United States.","authors":"Kalpna Kay Durairaj, Ali Vafa, Shino Bay Aguilera, Sabrina G Fabi, Neil Sadick, Melanie D Palm, Jennifer Levine, Sachin M Shridharani, Flor Mayoral, Daniel Bråsäter, Inna Prygova, Charlotta Wolgast, Felipe Weinberg","doi":"10.1093/asjof/ojag053","DOIUrl":"10.1093/asjof/ojag053","url":null,"abstract":"<p><strong>Background: </strong>Poly-L-lactic acid (PLLA-SCA) was approved for facial aesthetic use in the USA in 2009. Nonfacial aesthetic treatment using PLLA-SCA, a collagen-stimulating injectable implant, is a frequent clinical practice, and initial studies support its safety.</p><p><strong>Objectives: </strong>The objective of this study was to evaluate the safety of PLLA-SCA when used in nonfacial areas in real clinical practice in the USA.</p><p><strong>Methods: </strong>In this retrospective chart review, subjects treated in a nonfacial area with ≥2 vials of PLLA-SCA in ≥2 treatment sessions were eligible. Medical charts from 9 US sites were reviewed to collect demographics, treatment details, and treatment-related adverse events (AEs). The primary endpoint was treatment-related AEs.</p><p><strong>Results: </strong>Among the 498 subjects included, most subjects (72%) had 2 or 3 treatment sessions, with an average of 4.0 vials/treatment session. Reconstitution volumes were generally ≥10 mL/vial for all treatment areas, with 47% of treatments using volumes of 10-15 mL, and another 47% using ≥15 mL/vial. The most common treatment area was the gluteal region (buttocks or hip dip; 60.3% of sessions) and decolletage (8.2% of sessions). Most treatment-related AEs were injection related and mild or moderate in intensity. The most common AE was injection site bruising (5.0%), and AEs were mainly reported in the buttocks (4.0%) or posterior thigh (1.0%). Nodule occurrence was low (1 subject, 0.2%).</p><p><strong>Conclusions: </strong>Poly-L-lactic acid was well tolerated in real-world use for treatment of a range of nonfacial areas, with typically larger volumes than usually used for facial treatment.</p><p><strong>Level of evidence 3 therapeutic: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag053"},"PeriodicalIF":1.9,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Plastic Surgery Education: A Global Multimodel Benchmark of Large Language Models on the Plastic Surgery In-Service Training Examination.","authors":"Ibrahim Güler, Gerrit Grieb, Armin Kraus, Henrik Stelling","doi":"10.1093/asjof/ojag052","DOIUrl":"https://doi.org/10.1093/asjof/ojag052","url":null,"abstract":"<p><strong>Background: </strong>Large language models (LLMs) are increasingly utilized in plastic surgery education. Previous studies have shown that flagship models can achieve high scores on medical examinations, including the Plastic Surgery In-Service Training Examination (PSITE). Yet evaluations often rely on single-shot accuracy of proprietary systems, neglecting stochastic variability and open-source or non-US alternatives.</p><p><strong>Objectives: </strong>The aim of this study was to comprehensively benchmark a globally representative cohort of 14 LLMs on the PSITE, assessing not only accuracy but also inter-run reliability and stochastic variability and to evaluate their role as educational tools in plastic surgery training.</p><p><strong>Methods: </strong>A cross-sectional study evaluated 7 proprietary and 7 open-source models using 100 text-based PSITE questions from the 2017-2018 examinations. Each model underwent 5 independent runs (<i>n</i> = 7000 evaluations). Performance metrics included mean accuracy (%), Fleiss' kappa (<i>κ</i>) for reliability, and the coefficient of variation (CV) for stability. Stratified analyses assessed performance across clinical domains, proprietary vs open-source architectures, and paid vs free subscription tiers.</p><p><strong>Results: </strong>Claude Opus 4.5 (Anthropic, San Francisco, CA) (90.2%) and GPT-5.2 Pro (Open AI, San Francisco, CA) (87.0%) achieved the highest accuracy. Proprietary models significantly outperformed open-source alternatives (mean 76.1% vs 60.2%) and demonstrated superior reliability (<i>κ</i> = 0.84 vs <i>κ</i> = 0.70). Stability varied, ranging from consistent error in Falcon H1 (CV = 0.00%) to erratic instability in Mistral Medium (Mistral AI, Paris, France) (CV = 32.2%).</p><p><strong>Conclusions: </strong>Contemporary LLMs possess substantial plastic surgery knowledge, yet meaningful disparities in reliability persist. Although proprietary models currently demonstrate superior reliability as educational tools, the presence of stochastic instability necessitates cautious adoption. Accuracy alone is insufficient to judge clinical utility; stability metrics are essential for selecting AI tools in surgical education.</p><p><strong>Level of evidence 5 therapeutic: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"8 ","pages":"ojag052"},"PeriodicalIF":1.9,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}