Aesthetic surgery journal. Open forum最新文献

{"title":"Feminizing Gender Affirming Breast Surgery: Procedural Outcomes at a Single Academic Institution.","authors":"Nicole Sanchez Figueroa, Doga Kuruoglu, Vahe Fahradyan, Nho Tran, Basel Sharaf, Jorys Martínez-Jorge","doi":"10.1093/asjof/ojae032","DOIUrl":"10.1093/asjof/ojae032","url":null,"abstract":"<p><strong>Background: </strong>Implant-based breast augmentation is a gold standard procedure for transfeminine patients to create a more feminine-appearing chest. In many cases, ancillary procedures are performed simultaneously to achieve an optimal aesthetic result.</p><p><strong>Objectives: </strong>To determine the clinical outcomes of patients undergoing feminizing gender-affirming breast surgery in a single academic institution.</p><p><strong>Methods: </strong>A retrospective electronic chart review of feminizing gender-affirming breast surgery patients at Mayo Clinic, Rochester, from 2017 to 2022 was conducted. Patients' demographics and surgical outcomes were gathered. A survival analysis was performed to obtain the time-to-event complication rate.</p><p><strong>Results: </strong>Over 5 years, 46 patients (92 breasts) were included. The mean age was 39 years (standard deviation [SD] ±15), and most had an above-normal body mass index (BMI) (58.7%). Thirty (65%) had previous gender-affirming surgeries. The mean implant volume was 289 mL (SD ±95; 140-520). Most implants were placed in a subglandular plane (81%) with an inframammary fold incision (91.3%). All implants used were smooth, round cohesive silicone gel implants. Ancillary procedures were performed in 32 patients (69.57%). Eight patients presented complications (4 major vs 4 minor) in a median postoperative follow-up of 372 vs 392 days; at 1-month follow-up, the probability of a complication having occurred is 2.17% (95% CI: 0%-6.3%) vs 5% (95% CI: 0%-11.5%), and at 1 year, the probability is 10.21% (95% CI: 0%-20.9%) vs 12.5% (95% CI: 0%-23.4%), which remains the same up to 4 years.</p><p><strong>Conclusions: </strong>Breast augmentation with implants is a safe procedure to achieve feminization of the breast with a low rate of complications.</p><p><strong>Level of evidence 4: </strong></p>","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"6 ","pages":"ojae032"},"PeriodicalIF":0.0,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11134292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176955","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 Use of Next Generation Sequencing to Detect Early Implant Infections: The Future of Microbiology and Targeted Antibiotic Treatment","authors":"Jaime L Bernstein, Anna M. Vaeth, Karina Condez, Kristen Castellano, Grant Black, D. Otterburn","doi":"10.1093/asjof/ojae007.077","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.077","url":null,"abstract":"Abstract Goals/Purpose The presence of fluid around foreign bodies, particularly breast implants, is a well-established phenomenon; However scant data exists regarding the composition of this fluid. The difficulty in studying this fluid arises from the lack of safe access to aspirate fluid post-breast augmentation, and by the loss of sterility once fluid exits the body via a drain bulb as traditionally placed during breast reconstruction. Our innovative breast reconstruction approach utilizes a drainless technique with a dual chamber tissue expander (TE) in the pre-pectoral plane, offering a unique avenue to sterilely aspirate peri-implant fluid through a percutaneous drainage port. In this study, we employ Next Generation Sequencing (NGS), utilizing polymerase chain reaction technology, to discern the composition of microbial DNA within peri-prosthetic breast implant fluid. NGS, known for its precision and cost-effectiveness, circumvents the biases inherent in traditional culture methods. By integrating this cutting-edge technology with our breast reconstruction methodology, we sought to study peri-prosthetic breast implant fluid to better understand when implant infections arise and if peri-prosthetic fluid could detect infections before clinical symptoms arise. Methods/Technique This is a single surgeon, prospective study of patients undergoing mastectomy, followed by pre-pectoral, drainless, TE reconstruction. Peri-prosthetic fluid was collected through the TE drainage port in the OR immediately after closure, at 1 week post op, and 3 weeks post op. This fluid was sent for traditional culture and NGS. Patients were observed for signs of infection, antibiotics, return to OR, or implant loss. Results/Complications 33 breasts from 20 patients were included. Patients had a mean age of 50 years. The average length of drainage was 21 days post-operative, with a mean of 131 cc of fluid drained per breast per week. Eight breasts had concern for skin necrosis. In 25 breasts (76%), complete sterility was achieved at the end of the case with no NGS detection of microorganisms in the initial peri-implant fluid sample. However, NGS detected microorganisms in the initial sample in 8 breasts (24%). In 5 of these 8 breasts, microorganisms were cleared by the 1-week sample and another 2 cleared by 3 weeks. The remaining 1 breast continued to have positive NGS and developed clinical signs of infections by week 2, which were not picked up by traditional culture until week 3. One breast with skin necrosis developed a positive NGS at week 3 and clinical signs of infection at week 4. No other clinical infections were seen throughout the study. Conclusion We are one of the first groups to demonstrate the ability to achieve peri-implant sterility at the time of implant insertion in the operating room. This could have significant implications for understanding the necessity of peri-operative antibiotics following breast implant placement. Our investigation into the m","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"42 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709916","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":"Improving Tip Aesthetics Using Mastoid Fascia Tissue Graft in Rhinoplasty: A Reliable Alternative to Soft Cartilage Grafts","authors":"Paige Goote, Buğra Tugertimur, Shaishav Datta, Steven Hanna, Matthew Morris, David Mattos, R. Reish","doi":"10.1093/asjof/ojae007.029","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.029","url":null,"abstract":"Abstract Goals/Purpose Traditional rhinoplasty tip grafts often lead to visibility issues, prompting patients to seek revision surgery. The mastoid fascia tissue graft (MFTG) provides a natural-looking alternative with fewer complications. MFTG remains less visible through the skin, enhancing long-term aesthetic results. This eight-year study on 193 patients examines MFTG's effectiveness in nasal tip refinement, evaluating revision and infection rates. Methods/Technique A retrospective analysis of MFTG use for nasal tip refinement during open rhinoplasty in the senior author's practice was conducted from July 2014 to June 2022. Inclusion criteria encompassed open rhinoplasty cases using mastoid tissue for tip refinement with at least 12 months of follow-up. Among 2003 cases, 193 met these criteria and were evaluated for subsequent revision and infection rates. Results/Complications The average patient age was 34.2 years (175 females, 18 males). Primary rhinoplasties were done on 114 patients, with 79 receiving revision surgeries. Average follow-up was 14.8 months. 6 patients (3.1%) needed extended antibiotics. Overall, 6 (3.1%) patients required revision rhinoplasty, comprising of 2 (1.8%) primary and 4 (5.1%) secondary rhinoplasty patients. These revisions were unrelated to the use of MFTG for nasal tip refinement. Conclusion MFTG use for nasal tip refinement is associated with low revision rates for both primary and secondary rhinoplasty compared to rates in current literature, without increase in complications or prolonged operative durations. MFTG for nasal tip refinement is a safe and convenient technique delivering excellent aesthetic outcomes with minimal morbidity.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"5 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710703","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":"The Role of Surgeon Gender in Patient Surgeon-Selection in Plastic and Reconstructive Surgery: A Crowdsourcing Analysis","authors":"Helen Xun, M. J. Escobar-Domingo, J. Foppiani, James E. Fanning, A. H. Alvarez, Ashley Boustany, Bernard T. Lee","doi":"10.1093/asjof/ojae007.092","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.092","url":null,"abstract":"Abstract Goals/Purpose Plastic and reconstructive surgery (PRS), and especially aesthetic surgery, is uniquely characterized by an increased ability to research and select their surgeon. As the increasing number of female plastic surgeons begin to establish themselves in practice, it remains understudied if gender or implicit gender biases is a variable in patient surgeon-selection. Wallis, et al.’s landmark paper in 2023 suggested that female surgeons exhibited a lower risk-adjusted likelihood of adverse postoperative outcomes, including mortality, hospital readmission, and major medical complications, although the precise mechanisms remain unclear. Currently, it is unknown if the public is aware of these findings, and if it these findings would impact patient-surgeon selection. Patient-surgeon selection may be an opportunity where PRS may lead surgical subspecialties in addressing implicit surgeon gender biases due to the predominance of female patients, and improved gender representation in surgical training programs compared to other surgical subspecialties. The purpose of this study is to explore public preferences and perspectives on the role of surgeon gender in patient surgeon-selection in PRS, and if knowledge of gender-correlated surgical outcomes impact surgeon selection. A secondary aim is to examine if these public preferences differ between reconstructive versus aesthetic surgery. Methods/Technique A cross-sectional survey was distributed through Amazon’s Mechanical Turk (mTurk). Subjects were at least 18 years old and residents of the United States. Participants were briefed about hypothetical scenarios involving aesthetic and reconstructive surgical procedures, and then asked to choose either a male and female surgeon. They were then presented with an excerpt of Wallis, et al. (2023) findings, and reassessed for surgeon gender preference. The participant cohort was stratified by gender, classifying them as female and male responders. Differences between groups were evaluated using the unpaired t-test and Fisher exact tests. Multivariate logistic regression models were constructed to assess associations between plastic surgeon gender preference and sociodemographic characteristics. Stata statistical software (STATA Corp., BE, 18.0) was used to conduct all statistical analyses. Results/Complications A total of 547 participants were included. Of those, 310 (56.7%) were male and 237 (43.3%) were female. The mean age was 33.8 (SD 6.8) for the male group and 35.1 (SD 7.2) for the female group. Both groups had similar percentages of level of education (p=0.071). Significant differences were observed in race (p=0.004), ethnicity (p<0.001), U.S. region of residency (p<0.001), and religion (p<0.001) (Table 1). Both groups had similar percentages of previous PRS background/interest (M: 81.3%, F: 86.1%, p=0.164). However, female participants had higher percentages of aesthetic background/interest (86.1%) compared to the male counterparts (78.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"57 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709812","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":"A Mixed Methods Study Evaluating Public Understanding of “Plastic” and “Cosmetic” Surgery","authors":"Shirley Chen, Harrison C. Thomas, Benjamin Park, Alan T. Makhoul, G. Perdikis, Catherine M. Hammack-Aviran, B. Drolet","doi":"10.1093/asjof/ojae007.048","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.048","url":null,"abstract":"Abstract Goals/Purpose The aesthetic marketplace has expanded significantly over the past decade. There has been a corresponding expansion in the types of providers offering aesthetic procedures and the organizations certifying these providers. These include the American Board of Plastic Surgery (ABPS) and the American Board of Cosmetic Surgery (ABCS). Because patients self-pay for aesthetic procedures, they exercise a high degree of autonomy when choosing a provider. Given the need to support patients in making informed decisions, this study aimed to investigate how the public understands the distinction between “plastic” and “cosmetic” surgery using a mixed methods approach. Methods/Technique The study was completed in two parts: qualitative interviews and a survey. Semi-structured qualitative interviews were conducted with post-operative aesthetic surgery patients. An interview guide asking about participants’ understanding of “plastic” versus “cosmetic” surgery was developed in collaboration with content and methodology experts, then refined through pilot testing. Purposive sampling of patients maximized representation of demographic characteristics and type of surgery. A codebook was constructed using constant comparative grounded theory, which was then applied to interview transcripts to identify emergent themes. Next, a survey instrument investigating the public’s perception of “plastic” versus “cosmetic” surgery and ABPS versus ABCS was formulated from themes identified in the interviews. Pre-testing by cognitive interviews confirmed item validity, and pilot testing confirmed internal consistency. The survey was distributed on Mechanical Turk, with respondents receiving $1.50 as compensation. Results/Complications To achieve thematic saturation, 24 patients were interviewed. Intercoder reliability was high (κ > 0.8). Most (18/24) participants viewed plastic and cosmetic surgery as the same (Table 1). Almost all (23/24) discussed the aesthetic component of plastic surgery while fewer (16/24) participants mentioned the aesthetic component of cosmetic surgery (Table 1). Furthermore, some participants (7/24) misunderstood the scope of cosmetic surgery, including reconstructive procedures under its umbrella (Table 1). 600 respondents completed the survey. When asked how the scopes of plastic and cosmetic surgery relate to each other, a plurality of respondents believed plastic and cosmetic surgery overlap, but each has unique features (35.4%, Figure 1). 25.9% thought plastic and cosmetic surgery were the same, and only 13.9% correctly selected that plastic surgery is inclusive of all cosmetic surgery (Figure 1). When asked who they would go see for various procedures, a plurality of respondents chose a cosmetic surgeon (44.7-49.0% depending on the procedure, Figure 2). A minority stated they would see a plastic surgeon (23.4-29.9% depending on the procedure, Figure 2) or had no preference between a plastic surgeon and a cosmetic surgeon (23.4-","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"5 34","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712389","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":"Cartilage Warping in Rhinoplasty: An Assessment of Temperature, Carving, and Suturing Conditions","authors":"Yasmine Ibrahim, S. Khetpal, Wayne Ozaki, J. Roostaeian","doi":"10.1093/asjof/ojae007.036","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.036","url":null,"abstract":"Abstract Goals/Purpose Rhinoplasty is often contingent on the successful harvesting and allocation of cartilage in order to build the nasal framework. While autologous and cadaveric cartilage grafts have been utilized, it remains unclear how factors, such as suturing and carving techniques, as well as temperature, impact its short- and long-term warping potential. Our systematic review seeks to objectively assess how various carving (i.e. peripheral versus central, eccentric versus concentric), suture patterns (i.e. counter-balancing, oppositional), and temperature conditions impact the warping potential of cartilage grafts in rhinoplasty. In conducting this study, we hope to determine the optimal conditions for stable cartilage constructs in rhinoplasty. Methods/Technique A systematic literature review was conducted using a combination of terms including, “warp,” “rhinoplasty,” “cartilage,” “suture,” “temperature,” “carving,” and “cutting.” Removal of duplicates was performed, followed by further screening by abstract and full text. To reduce the possibility of bias, a standardized form was used for data extraction; variables including author, year of publication, journal of publication, study design, conditions, and results were recorded. Results/Complications A total of eleven studies were included in the analysis. Cartilage types included fresh frozen cadaveric graft, autologous costal cartilage, and bovine rib cartilage. Conditions associated with reduced warping include central and concentric based carving patterns, oppositional suturing; Peripherally and eccentric cut cartilage, as well as increased time, were associated with a higher degree of warping. Conclusion To the authors’ knowledge, our systematic analysis is the first to summarize the impact of various conditions on cartilage warping in rhinoplasty. Moreover, we determine the protective nature of certain carving and suturing methods - particularly central, concentric carving, and oppositional suturing - in minimizing cartilage warping. With this information, we hope to guide plastic surgeons in optimizing conditions to potentially prevent cartilage warping, and ultimately, provide reliable and sustainable results for patients undergoing rhinoplasty.","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"22 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710115","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":"Quality Improvement Initiative: Utilization of Video Postoperative Instructions in Breast Reduction Enhances Patient Experience","authors":"Ruya Zhao, Yi-hsueh Lu, Daniel Chernovolenko, Aravind Pothula","doi":"10.1093/asjof/ojae007.064","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.064","url":null,"abstract":"Abstract Goals/Purpose The current standard of care for providing postoperative instructions to patients undergoing elective, ambulatory surgeries often falls short in efficiency, clarity, and patient-centeredness. Patients are given a single set of written instructions at the time of discharge after their surgery, which often leads to confusion and increased reliance on phone calls, urgent clinic appointments, and even unnecessary visits to the emergency department. Recognizing this, we propose a quality improvement initiative to enhance postoperative instructions for breast reduction patients through a video format. Methods/Technique With institutional IRB approval, all adult patients undergoing bilateral breast reduction (CPT 19318) at an urban academic hospital were included over a 3-month period. A 2-minute video with standardized narrative instructions and visual aids was created. Patients viewed the video during the preoperative visit, and a QR code link to the video was provided in the visit summary on the day of surgery. A Spanish version of the video was available if a Spanish interpreter was used during informed consent. The number of phone calls and emergency department visits within 30 days were recorded and compared to a cohort of patients before this intervention. Qualitative surveys were administered pre- and post-operatively to collect patient feedback. Results/Complications During the study period, 59 patients received breast reduction surgery and were given the standardized video instructions pre- and post-operatively (video group). In comparison, 75 breast reduction patients from the prior 3 months, who received nonstandardized, written instructions post-operatively, served as the control group. In the video group, 47% of patients (28 out of 59) made at least one phone call to the clinic, averaging 0.7 calls per patient, while 56% of the control group patients (42 out of 75) made at least one phone call, averaging 1.1 calls per patient. Categorizing reasons for the calls, there was a significantly higher proportion of calls related to wound dehiscence or minor drainage in the video group (41%) compared to the control group (22%; p=0.03). This shift may be attributed to a reduction in routine postoperative care questions due to the clarity provided by the video instructions (FIGURE1). There were 4 unnecessary emergency department visits within 30 days post-surgery in the study period, slightly decreased from the control period's 6 visits (after excluding 1 visit with the patient diagnosed with pulmonary embolism); however, the difference was not statistically significant. Fifteen patients who received the video instruction completed a survey, with 80% rating the video as very helpful, and 80% were able to access the QR code without assistance. These patients scored an average of 81 out of 100 on satisfaction with information measured using the BREAST-Q module after receiving the video instruction. There was no difference in com","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"12 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710192","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":"Crowdsourced Assessment of Aesthetic Outcomes of Dorsal Preservation Rhinoplasty","authors":"Jake Alford, S. McCleary, J. Roostaeian","doi":"10.1093/asjof/ojae007.095","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.095","url":null,"abstract":"Abstract Goals/Purpose The inherent subjectivity in evaluating aesthetic outcomes presents a unique challenge in assessing rhinoplasty. Crowdsourcing has provided a new metric for objective analysis. The authors designed a study to compare the aesthetic outcomes of dorsal preservation rhinoplasty versus structural rhinoplasty using a reliable and valid crowdsourcing platform. We aim to objectively quantify the relative aesthetic advantages of performing a dorsal preservation technique. Additionally, we aim to demonstrate the efficacy of using crowdsourcing as an efficient and reliable method for evaluating any plastic surgery aesthetic outcome. Methods/Technique This retrospective observational study was approved by the IRB at UCLA. A total of 64 patients who had previously undergone rhinoplasty performed by the senior author were included. All surgeries were performed at the UCLA Ronald Reagan Medical Center. Patients with prior nasal surgery or trauma were excluded. All subjects were photographed using standard rhinoplasty views during the pre-and postoperative visits. Frontal and right profile photographs were then cropped in a standardized fashion (Photos, Version 8.0, Apple Inc.) and used for evaluation. All evaluations and ratings were collected using the HIPPA compliant and encrypted software via a secure online platform (LoveMyDelta, Inc., Philadelphia, PA). All crowd workers were recruited and vetted through this platform, with internal fidelity checks performed. Each crowd worker was shown a profile and frontal view of a patient and asked to score the overall appearance of the nose, the nasal dorsum profile, the symmetry of the dorsal aesthetic lines, and the dorsal contour using a visual analog scale. Scoring was performed using a provided validated visual assessment guide. They were asked whether they believed the subject had undergone rhinoplasty and asked to provide a level of confidence in their guess. Crowdworkers’ responses were aggregated to allow for high-powered intra-rater analysis. Intra-rater reliability and confidence intervals were calculated. Aggregate data from all raters were used to generate an absolute value of aesthetic state for each cohort. A \"delta\" was then obtained for each value by comparing the preoperative to the postoperative state to obtain a representative value of the improvement after undergoing surgery. Raters were asked if the patient appeared to have had surgery, and each correct and incorrect response was proportionally weighted based on the raters' confidence in their answer. The delta (difference in preoperative to postoperative aesthetic state) for each parameter for the dorsal and non-dorsal preservation cohorts was calculated using non-paired T-tests to determine significance. Results/Complications A total of 64 patients were included for evaluation. The structural rhinoplasty cohort consisted of 34 patients. The dorsal preservation cohort included 30 patients. Both dorsal preservation and non-","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"22 29","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711366","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":"Aesthetic Surgery Complications Disproportionately Burden Economically Disadvantaged Patients and Financially Strain Public Health Insurance: A Single Academic Center Retrospective Analysis","authors":"Scott Levin, J. Firriolo, Granger Wong","doi":"10.1093/asjof/ojae007.055","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.055","url":null,"abstract":"Abstract Goals/Purpose Complications of elective aesthetic surgery performed in private practice pose significant morbidity to patients and resource burden to healthcare systems. We aimed to characterize contemporary demographic and complication patterns among patients presenting to an academic center after aesthetic surgery, as well as the financial and resource burden of their postoperative care on the hospital and payor. Methods/Technique We performed a retrospective review of patients who presented to an urban, academic hospital emergency department in Northern California from September 1, 2020 to September 30, 2023. We included patients with primary complaints related to aesthetic procedures performed at outside centers resulting in a plastic surgery consultation. Demographics, outcomes, hospital charges, and insurance payments were determined. Univariable analyses identified associations with outcomes. Results/Complications We identified 36 patients with aesthetic procedure-related complaints. Mean age was 37.5 ± 9.8 years and all patients were female. Compared with the rest of the patient population presenting to the emergency department over the same time period (n=269,286), the identified patients were more likely to be black (34.3% vs. 20.4%, p=.04), Hispanic (40% vs. 24.6%, p=.03), and on Medicaid (80.6% vs. 31.7%, p<.001). Tobacco/cannabis use and obesity were prevalent in 25% and 47.2% of patients, respectively. Most patients underwent aesthetic procedures in the United States (51.4%), followed by Mexico (37.1%) and the Dominican Republic (11.4%). Body regions intervened upon were the abdomen (52.8%), breasts (52.8%), buttocks (33.3%), and arms (8.3%). In 36.1% of patients, multiple body regions were intervened upon during the index case. Abdominal cases included primary abdominoplasty (84.2%), panniculectomy (10.5%), and revision abdominoplasty (5.3%). Breast cases were primary augmentation (36.8%), revision augmentation (21.1%), augmentation mastopexy (15.8%), mastopexy only (15.8%), and other (10.5%). Buttocks cases were gluteal fat grafting (63.6%) and implant insertion (36.4%). Arm cases were all brachioplasty. Median postoperative day was 21 (Interquartile Range [IQR] 11.5, 36). Reasons for presentation included infection (44.5%), dehiscence (16.7%), pain (16.7%), seroma/drainage (11.1%), drain management (5.6%), and hematoma (2.8%). Nearly half received computed tomographic imaging (47.2%). Half of patients were admitted with a median length of stay of 2.5 days (IQR 1, 3). One-third underwent intervention, including implant removal (58.3%), image-guided aspiration (25%), and incision and drainage (16.7%). Patients using tobacco/cannabis were more likely to present with infection (88.9% vs. 25.9%, p=.001) and undergo intervention (66.7% vs. 22.2%, p=.01). There were recurrent emergency department visits among 22.2%. Overall, 44.4% of patients had outpatient follow-up visits for a median of 3 (IQR 2, 4) visits up to a median of ","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712058","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":"Periorbital Rejuvenation: Artificial Intelligence Highlights the Importance of Brow Lift","authors":"Laura Roider, Peter K. Firouzbakht, Caroline C. Kreh, Charles Nathan, Christian Prada, Herluf G Lund, Deniz Sarhaddi, Kevin Chen","doi":"10.1093/asjof/ojae007.011","DOIUrl":"https://doi.org/10.1093/asjof/ojae007.011","url":null,"abstract":"Abstract Goals/Purpose Well described facial changes occur over time, which collectively result in an increased perceived age of an individual. These changes affect everything including the bony framework, facial fat pads, soft tissue, skin quality, and facial muscles. Aesthetic surgery provides an opportunity to reverse the appearance of facial aging. With the recent increase in mask utilization following the COVID-19 pandemic, an increased focus on the upper face and the impact of age-related changes in the periorbital region has been observed. Blepharoplasty and brow lifts aim to restore a youthful, rested, and attractive appearance by addressing the periorbital region. Blepharoplasty is a commonly performed procedure and has consistently ranked the third most common aesthetic procedure performed by plastic surgeons since 2018. However, following the pandemic we saw a 28% increase in blepharoplasties performed, now totaling 1.4 million in 2022. Over the same time period, the number of brow lifts performed has increased by 60%, now accounting for 352,324 surgeries performed in 2022. Despite this increase, recent surveys demonstrate that nearly 30% of plastic surgeons feel that neuromodulators have completely replaced operative brow lifting procedures. Additionally, a recently published study demonstrated that 62% of patients presenting for blepharoplasty have unfavorable preoperative brow aesthetics. However, only 36% of patients underwent brow lifts.Those with preoperative unfavorable brows who underwent a brow lift procedure were found to have significantly higher postoperative aesthetic scores than those who did not. Despite the increase in popularity of periorbital procedures, the literature continues to lack objective evaluation and outcome measurements related to perceived facial aging and the impact of individual procedures. The goal of this study is to quantify the impact of different periorbital rejuvenation surgeries on perceived age through the utilization of artificial intelligence (AI) in the form of convolutional neural network algorithms. Methods/Technique A retrospective review of patients who underwent periorbital rejuvenation surgery (upper blepharoplasty, lower blepharoplasty, and brow lift) at a single cosmetic practice between 2018-2023 was performed. Charts were reviewed for demographic information, periocular history, prior surgeries, surgical technique utilized, and complications/revisions. Exclusion criteria included: simultaneous procedures, incomplete patient records, poor quality or missing photographs, periocular medical conditions with cosmetic impact, and facial aesthetic procedures performed in the postoperative period. Pre and post operative frontal photographs of each patient were analyzed using four facial analysis AI platforms (Face++, Betaface, Facelytics, and Everypixel). Each platform generated an age estimate. A collective pre-op and post-op age estimation was then calculated for each patient by averaging","PeriodicalId":72118,"journal":{"name":"Aesthetic surgery journal. Open forum","volume":"13 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711989","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}