Chandler Hinson, Matthew Sink, Rudolf F Buntic, Bauback Safa, Douglas M Sammer, Andrew Y Zhang, Christopher Pannucci, Andrei Odobescu
{"title":"Extended vs Inpatient Chemoprophylaxis for Venous Thromboembolism in DIEP Flap Breast Reconstruction: A Systematic Review and Meta-analysis.","authors":"Chandler Hinson, Matthew Sink, Rudolf F Buntic, Bauback Safa, Douglas M Sammer, Andrew Y Zhang, Christopher Pannucci, Andrei Odobescu","doi":"10.1093/asj/sjaf024","DOIUrl":"10.1093/asj/sjaf024","url":null,"abstract":"<p><p>Venous thromboembolism (VTE) is a significant complication following deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. The optimal duration of chemoprophylaxis remains debated, with differing recommendations on short-term chemoprophylaxis (STC) vs long-term chemoprophylaxis (LTC) for VTE prevention. This systematic review and meta-analysis compared the efficacy and safety of STC vs LTC in preventing VTE and hematoma in patients undergoing DIEP flap reconstruction. Four studies with a total of 1114 patients were included, with no significant differences in patient characteristics, including Caprini scores, between the STC and LTC groups. The pooled incidence of VTE was 1.83%, with 2.19% in the STC group and 1.33% in the LTC group, yielding a risk ratio (RR) of 1.42 for STC compared to LTC, although this was not statistically significant (P = .62). The mean incidence of hematoma was 8.65%, with 8.32% in the STC group and 9.02% in the LTC group, resulting in an RR of 0.78 for STC compared to LTC, which was also not statistically significant (P = .25). These findings suggest that extending chemoprophylaxis beyond hospitalization does not significantly reduce VTE incidence and underscores the importance of individualized risk-based anticoagulation strategies. Future studies are necessary to further refine guidelines for chemoprophylaxis duration in this population, balancing the risks of VTE and anticoagulation-related complications to optimize patient outcomes.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"599-604"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary on: Aesthetic Efficacy and Safety of Combined Microfocused Ultrasound With Visualization and Calcium Hydroxylapatite Treatment: A Systematic Review of Human Evidence.","authors":"Lawrence S Bass","doi":"10.1093/asj/sjaf020","DOIUrl":"10.1093/asj/sjaf020","url":null,"abstract":"","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"643-644"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143253984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Response to: Perspectives on the Development of a Plastic Surgery-Specific Large Language Model.","authors":"Berk B Ozmen, Ibrahim Berber, Graham S Schwarz","doi":"10.1093/asj/sjaf081","DOIUrl":"https://doi.org/10.1093/asj/sjaf081","url":null,"abstract":"","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annemiek S Lieffering, Marc A M Mureau, Juliëtte E Hommes, Lotte Ramerman, Hinne A Rakhorst, René R W J van der Hulst, Robert A Verheij
{"title":"The Occurrence of Health Symptoms in General Practice Before and After the Explantation of Cosmetic Breast Implants.","authors":"Annemiek S Lieffering, Marc A M Mureau, Juliëtte E Hommes, Lotte Ramerman, Hinne A Rakhorst, René R W J van der Hulst, Robert A Verheij","doi":"10.1093/asj/sjaf030","DOIUrl":"10.1093/asj/sjaf030","url":null,"abstract":"<p><strong>Background: </strong>Explantation of breast implants is increasingly performed in response to concerns about breast implant illness (BII), an array of various health symptoms. However, the benefits of explantation remain unclear because of methodological limitations in previous studies.</p><p><strong>Objectives: </strong>To examine the occurrence of health symptoms before and after explantation of cosmetic breast implants.</p><p><strong>Methods: </strong>This is a retrospective cohort study linking data from the Dutch Breast Implant Registry and Nivel Primary Care Database. The study included 217 cosmetic explantation patients, control groups of 228 cosmetic replacement patients, and 433 female patients without breast implants (nonrecipients). BII-related health symptoms presented in general practice were compared between groups 1 year before and after explantation. Outcomes included any symptom, ≥2 symptoms, ≥3 symptoms, ≥3 consultations, and substantial symptoms (≥3 symptoms with ≥2 consultations for 2 symptoms).</p><p><strong>Results: </strong>The likelihood of ≥3 symptoms, ≥3 consultations, and substantial symptoms reduced significantly after explantation (odds ratio [OR] ≥3 symptoms 0.26, 95% CI [0.08-0.85]; OR ≥3 consultations 0.56, 95% CI [0.32-0.96]; OR substantial symptoms 0.36, 95% CI [0.14-0.94]). However, compared with nonrecipients, explantation patients still had higher odds of any symptom, ≥2 symptoms, and ≥3 consultations after explantation. Replacement patients also had a reduced likelihood of any symptom, ≥2 symptoms, and ≥3 consultations from pre- to postsurgery.</p><p><strong>Conclusions: </strong>Although explantation appears to improve BII-related health symptoms within a year, patients still showed an increased likelihood of symptoms compared with nonrecipients.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"589-598"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dominik Todorov, Sebastian Mitchell, Mustafa Al-Hashimi, Zaid Dajani, Kelvin Sunn Hoah Yap, Hassan Imtiaz, Kian Daneshi, Ankur Khajuria
{"title":"Functional and Aesthetic Outcomes After Upper Blepharoplasty: A Systematic Review and Meta-analysis of Randomized Control Trials.","authors":"Dominik Todorov, Sebastian Mitchell, Mustafa Al-Hashimi, Zaid Dajani, Kelvin Sunn Hoah Yap, Hassan Imtiaz, Kian Daneshi, Ankur Khajuria","doi":"10.1093/asj/sjaf022","DOIUrl":"10.1093/asj/sjaf022","url":null,"abstract":"<p><p>Upper blepharoplasty addresses aging-related changes by removing excess skin, muscle, and fat from the upper eyelids. This systematic review, which was registered a priori, improves upon previously published reviews regarding functional and aesthetic outcomes following upper blepharoplasty. Custom search strategies were applied across multiple databases, namely MEDLINE (United States National Library of Medicine, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), Google Scholar (Alphabet, Inc., Mountain View, CA), Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library, London, UK), Science Citation Index (Clarivate Analytics, Philadelphia, PA), PubMed (United States National Library of Medicine), and PsychInfo (American Psychological Association, Washington, DC). Bias was assessed with the Cochrane RoB 2 tool, and methodological quality was evaluated with GRADE. Out of 6799 articles, 12 randomized controlled trials with 450 patients (39 men, 411 women) were included. The meta-analysis showed significant reduction in dry eye symptoms post-upper blepharoplasty compared with preoperative status (odds ratio [OR], 0.22; 95% CI, 0.13-0.36; P < .00001). No significant difference in postoperative dry eye incidence was found between orbicularis oculi muscle plus skin excision and skin-only excision (OR, 1.55; 95% CI, 0.86-2.80; P = .25). However, muscle plus skin excision had a higher incidence of lagophthalmos (OR, 7.98; 95% CI, 1.41-45.21; P = .02). No significant differences were observed in eye irritation (OR, 1.21; 95% CI, 0.51-2.84; P = .66) or patient satisfaction (OR, 1.14; 95% CI, 0.42-3.14; P = .80). Continuous suturing techniques increased eye irritation compared with subcuticular suturing (OR, 1.77; 95% CI, 1.07-2.91; P = .03). All studies were high quality with a low risk of bias. The findings support upper blepharoplasty's efficacy in reducing dry eye symptoms, with muscle-sparing techniques minimizing lagophthalmos and maintaining high patient satisfaction.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"554-562"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wenyun Ting, Junxian Wen, Zhijin Li, Jiaming Sun, Jiaping Zhang, Maoguo Shu, Hongwei Liu, Li He, Bo Yu, Nan Jiang, Chunyu Xue, Qian Tan, Xuewen Xu, Sufan Wu, Dan Jian, Hongyi Zhao, Lei Wang, Nanze Yu, Xiaojun Wang
{"title":"A Randomized, Double-Blind, Placebo-Controlled, Multicentered Study to Evaluate the Efficacy and Safety of MEI005 in Reducing Submental Fat in Chinese Adults.","authors":"Wenyun Ting, Junxian Wen, Zhijin Li, Jiaming Sun, Jiaping Zhang, Maoguo Shu, Hongwei Liu, Li He, Bo Yu, Nan Jiang, Chunyu Xue, Qian Tan, Xuewen Xu, Sufan Wu, Dan Jian, Hongyi Zhao, Lei Wang, Nanze Yu, Xiaojun Wang","doi":"10.1093/asj/sjaf031","DOIUrl":"10.1093/asj/sjaf031","url":null,"abstract":"<p><strong>Background: </strong>Submental fat (SMF) is a common aesthetic concern traditionally treated with liposuction. Nonsurgical alternatives, like injectable deoxycholic acid, are gaining popularity. However, no related products have been clinically approved in China.</p><p><strong>Objectives: </strong>This study evaluated the efficacy and safety of MEI005, a deoxycholic acid-based injectable formulation, in reducing SMF in Chinese adults.</p><p><strong>Methods: </strong>This multicenter, randomized, double-blind, placebo-controlled Phase III trial included 325 Chinese adults with moderate-to-severe SMF. Participants received MEI005 or a placebo injection every 28 days for up to 6 sessions. Primary endpoints were ≥2-grade improvements in Clinician and Patient-Reported Submental Fat Rating Scales (CR-SMFRS and PR-SMFRS). Secondary endpoints included SMF volume reductions measured by MRI; patient-reported outcomes on the Patient-Reported Submental Fat Impact Scale (PR-SMFIS) and Subject Self-Rating Scale (SSRS); and SMF thickness reductions measured by caliper. Adverse events (AEs), self-reports, clinical examinations, and checks for skin laxity were monitored.</p><p><strong>Results: </strong>At 12 weeks posttreatment, 18.9% of MEI005 recipients demonstrated simultaneously ≥2-grade CR-SMFRS and PR-SMFRS improvement vs 1.8% for placebo (P < .001). Additionally, 68.9% of MEI005 group participants achieved simultaneously ≥1-grade improvement in CR-SMFRS and PR-SMFRS, compared with 21.6% of placebo (P < .001). MRI revealed ≥10% SMF volume reduction in 50% of MEI005 patients vs 15.2% of placebo (P < .001). Scores on the PR-SMFIS and SSRSs showed greater psychological improvement and satisfaction among MEI005 recipients. Vernier caliper measurements showed a 21.42% thickness reduction vs 6.32% (P < .001). AEs were mostly mild to moderate.</p><p><strong>Conclusions: </strong>MEI005 effectively reduces SMF, offering a safe, minimally invasive option for Chinese adults.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"629-637"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tansu Akdağ, Abdullah Akdağ, Mustafa Özkan, Osman Enver Aydın
{"title":"Evaluating the Role of Gynecomastia Surgery in Improving Sexual Function and Hormonal Profiles.","authors":"Tansu Akdağ, Abdullah Akdağ, Mustafa Özkan, Osman Enver Aydın","doi":"10.1093/asj/sjaf026","DOIUrl":"10.1093/asj/sjaf026","url":null,"abstract":"<p><strong>Background: </strong>Patients with gynecomastia may experience hormonal imbalances and sexual dysfunctions, such as erectile and ejaculatory disorders.</p><p><strong>Objectives: </strong>This study evaluates the changes in hormonal parameters and sexual function following gynecomastia surgery.</p><p><strong>Methods: </strong>Thirty-two male patients (aged 15-65) without systemic or genetic comorbidities underwent gynecomastia surgery. Preoperative and postoperative hormonal parameters free and total testosterone, estrogen (EST), prolactin (PRL), follicle-stimulating hormone, luteinizing hormone, sex hormone-binding globulin, and sexual function scores (International Index of Erectile Function [IIEF], Premature Ejaculation Diagnostic Tool [PEDT]) were assessed. A urologist blinded to the study evaluated patients andrologically.</p><p><strong>Results: </strong>The mean age of the patients was 25.69 ± 10.37 years. Postoperative PRL and EST levels significantly decreased (P = .03 and P < .001, respectively). All IIEF subscale scores showed significant postoperative improvements (P-values ranging from <.001 to .006). PEDT scores significantly decreased postoperatively (P < .001).</p><p><strong>Conclusions: </strong>Surgical treatment of gynecomastia leads to significant improvements in hormonal parameters and sexual function. These benefits should be considered in surgical planning.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"584-588"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lucas Gallo, Isabella Churchill, Patrick Kim, Charlene Rae, Sophocles H Voineskos, Achilles Thoma, Andrea L Pusic, Stefan J Cano, Anne F Klassen
{"title":"Patient Factors That Impact FACE-Q Aesthetics Outcomes: An Exploratory Cross-sectional Regression Analysis.","authors":"Lucas Gallo, Isabella Churchill, Patrick Kim, Charlene Rae, Sophocles H Voineskos, Achilles Thoma, Andrea L Pusic, Stefan J Cano, Anne F Klassen","doi":"10.1093/asj/sjaf027","DOIUrl":"10.1093/asj/sjaf027","url":null,"abstract":"<p><strong>Background: </strong>The FACE-Q Aesthetics is a validated tool for assessing patient-reported outcomes related to surgical and nonsurgical facial aesthetic treatments. Recognizing patient-specific variables that may influence FACE-Q scores is essential to control for potential confounders in research.</p><p><strong>Objectives: </strong>This study aimed to identify factors that predict FACE-Q Aesthetics scale scores.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among an international cohort of participants recruited through the Prolific platform. Participants aged 20 years or older, who had undergone noninvasive facial aesthetic procedures within the past year, were included. Demographic and clinical information was collected, and univariable and multivariable linear regression analyses were employed to assess predictors of FACE-Q Face Overall, Psychological, and Social scale scores.</p><p><strong>Results: </strong>A total of 1259 participants were analyzed, with an average age of 42.6 years (±11.9). The mean scores were 52.4 (±18.3) for the Face Overall scale, 56.5 (±23.7) for the Psychological scale, and 62.7 (±24.0) for the Social scale. Several factors were significantly associated (P < .05) with higher scores, including lower BMI, African American ethnicity, male gender, Fitzpatrick skin Type V, residence in the United States, financial stability, and residual effects of previous aesthetic treatments. Younger participants were more likely to report higher Face Overall scores (P < .05).</p><p><strong>Conclusions: </strong>This study identified several patient characteristics that predict Face Overall, Psychological, and Social scale scores. These findings offer valuable insights into how patient-specific factors influence outcomes following facial aesthetic procedures and underscore the need to account for these variables in future research using the FACE-Q Aesthetics tool.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"543-551"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Morphological Changes in Rectus Abdominis Muscle Associated With Pregnancy and Abdominoplasty.","authors":"Dong Wei, Xufeng Shi, Jie Ren, Xin Cui","doi":"10.1093/asj/sjaf037","DOIUrl":"10.1093/asj/sjaf037","url":null,"abstract":"<p><strong>Background: </strong>Pregnancy can alter the rectus abdominis, but abdominoplasty can potentially correct these changes.</p><p><strong>Objectives: </strong>The aim of this study was to examine these muscle changes during pregnancy and to evaluate how effectively abdominoplasty with double folds of the rectus abdominis tightens the muscle.</p><p><strong>Methods: </strong>Clinical data were obtained from nulliparous and pregnant patients who had undergone abdominoplasty with double folds of the rectus abdominis. Measurements were made of linea alba width, rectus abdominis width, thickness, and cross-sectional area, and abdominal circumference. Postoperative complications were also recorded. Patient satisfaction with the morphology of the rectus abdominis, both pre- and postsurgery, was assessed on a 5-point Likert scale.</p><p><strong>Results: </strong>The study included 400 women: 171 nulliparous, 106 with 1 pregnancy (Group 1), and 123 with 2 or more pregnancies (Group 2). Complete postoperative data were available for 32 patients (Group 3). Significant widening of the linea alba was found in Groups 1 and 2. The rectus abdominis width increased significantly in Group 1 but not in Group 2. Its thickness remained unchanged in Group 1 but decreased in Group 2, mirroring the pattern of its cross-sectional area. In Group 3, both the linea alba and rectus abdominis width decreased, while thickness and cross-sectional area increased. Satisfaction with muscle morphology improved significantly postsurgery, with no serious complications reported.</p><p><strong>Conclusions: </strong>Pregnancy can cause the rectus abdominis muscle to separate, widening the linea alba and flattening the muscle. Abdominoplasty, which reinforces the muscle with double folds, effectively resolves this, resulting in high patient satisfaction and few complications.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"621-628"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danny J Soares, Julia Fedorova, Yu Zhang, Akash Chandawarkar, Alexis Bowhay, Larry Blevins, Thomas J Kean, David K Funt
{"title":"Arterioembolic Characteristics of Differentially Diluted CaHA-CMC Gels Within An Artificial Macrovascular Perfusion Model.","authors":"Danny J Soares, Julia Fedorova, Yu Zhang, Akash Chandawarkar, Alexis Bowhay, Larry Blevins, Thomas J Kean, David K Funt","doi":"10.1093/asj/sjaf028","DOIUrl":"10.1093/asj/sjaf028","url":null,"abstract":"<p><strong>Background: </strong>Despite the recently increased incidence and improved awareness of filler-induced ischemic injuries, the arterioembolic behavior of filler products has not been well described.</p><p><strong>Objectives: </strong>To evaluate the embolic behavior of varying dilutions of calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) gel mixtures within an artificial macrovascular perfusion model of the proximal facial artery with correlation against published instances of ischemic injuries in the literature.</p><p><strong>Methods: </strong>CaHA-CMC gel mixtures were assessed through the Pulsatile Unit for the Laboratory Simulation of Arterioembolic Restrictions (PULSAR) system at different flow rates. The occlusive behavior, embolic particle size distributions, and morphological attributes were evaluated through direct photographic and videographic captures followed by digital image processing. The PubMed database was systematically queried for all published instances of CaHA-CMC-associated ischemic injuries.</p><p><strong>Results: </strong>Undiluted CaHA-CMC demonstrated highly cohesive behavior upon PULSAR inoculation, with a tendency toward proximal occlusion. Gel fragmentation resulted in a polydisperse embolic mixture averaging 0.151 ± 0.61 mm² (interquartile range: 0.006-0.022 mm²) in size. Product dilution had a profound effect on embolic behavior, with a significant reduction in average particle size (0.018 ± 0.03 mm²; interquartile range: 0.005-0.018 mm²; P < .0001) and complete elimination of proximally occlusive capacity for hyperdiluted mixtures compared with undiluted product (P = .002). Confirmed hyperdiluted CaHA-CMC-associated ischemic injuries represented only 3% of published reports, with a predominantly self-limited clinical course.</p><p><strong>Conclusions: </strong>Embolized CaHA-CMC gels produce polydisperse particle mixtures with a preponderance of microparticles. Hyperdilution profoundly reduced the proximally occlusive potential of the product.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":"645-653"},"PeriodicalIF":3.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}