Aesthetic Surgery Journal最新文献

{"title":"The Cosmetic Surgery in Adolescents: Psychological, Social, and Medico-Legal Responsibilities.","authors":"Fortunato Pititto, Giuseppe Pulin, Elisa Paladini, Roberto Bellacicco, Maricla Marrone","doi":"10.1093/asj/sjaf025","DOIUrl":"https://doi.org/10.1093/asj/sjaf025","url":null,"abstract":"<p><p>The increasing prevalence of cosmetic surgery among adolescents raises critical questions regarding medical responsibility and the legal standards for informed consent. While the desire to meet aesthetic standards promoted by media and social networks is a key factor driving demand for these procedures, the psychological vulnerability typical of adolescence calls for careful evaluation of patient rights and medical obligations. Informed consent for adolescents, in particular, must be assessed within a multidimensional framework that considers psychological conditions, personal motivations, and the social and cultural pressures that can negatively affect young patients' self-perception. This article examines the complexities of informed consent in adolescent cosmetic surgery, focusing on the physician's responsibility to ensure patients have a clear understanding of both the risks involved and realistic expectations of the procedure. It also discusses the value of a multidisciplinary approach, involving psychologists and legal professionals, to address the specific needs of adolescents. Emphasis is placed on the necessity for preoperative psychological assessments to distinguish between genuine desires and social pressures, with the goal of protecting adolescents' psychological and physical well-being and preventing decisions driven by unstable motivations. The article concludes with recommendations for adopting guidelines and enhancing education, advocating for an approach that respects young patients' rights and emphasizes physicians' accountability for ethical and safe practice.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254009","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":"https://doi.org/10.1093/asj/sjaf020","url":null,"abstract":"","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-05","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":"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":"https://doi.org/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) versus long-term chemoprophylaxis (LTC) for VTE prevention. This systematic review and meta-analysis compared the efficacy and safety of STC versus 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, though this was not statistically significant (p=0.62). 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=0.62). 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>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-05","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":"Utilizing Artificial Intelligence for Predicting Postoperative Complications in Breast Reduction Surgery: A Comprehensive Retrospective Analysis of Predictive Features and Outcomes.","authors":"Gon Shoham, Tom Zuckerman, Ehud Fliss, Orel Govrin, Arik Zaretski, Roei Singolda, Daniel J Kedar, David Leshem, Ehab Madah, Ehud Arad, Yoav Barnea","doi":"10.1093/asj/sjaf021","DOIUrl":"https://doi.org/10.1093/asj/sjaf021","url":null,"abstract":"<p><strong>Background: </strong>Breast reduction is a common procedure with growing rates in the USA, aimed at alleviating the physical and psychological burdens of macromastia. Despite high success rates, it carries a risk of complications, with incidence rates ranging from 6.2% to 43%.</p><p><strong>Objectives: </strong>The authors developed a machine learning model using gradient-boosting decision trees to predict severe breast reduction complications up to 30 days following surgery requiring inpatient care.</p><p><strong>Methods: </strong>This retrospective study included 322 cases of breast reduction surgery performed at the Tel Aviv Medical Center from 2017 to 2024. Model performance was evaluated using 5-fold cross-validation, and key metrics such as area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were reported. An interpretability tool was also created to visualize complication risks based on clinical features.</p><p><strong>Results: </strong>Severe complications occurred in 7.4% of cases. Key predictive factors included specimen weight, SN-N distance, and liposuction volume. The model achieved an AUC-ROC of 0.83, with an accuracy of 0.93, negative predictive value of 0.95. The interpretability tool clearly visualized complication risks, aiding preoperative counseling.</p><p><strong>Conclusions: </strong>This is the first study to use AI to predict severe complications in breast reduction surgery. Our AI model, with an AUC-ROC of 0.83 and NPV of 0.95, offers a reliable tool for surgical planning and patient education. Further validation across diverse populations is recommended to confirm its clinical utility.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078402","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":"Effect of Synchronized Radiofrequency and High-Intensity Facial Electrical Stimulation (HIFES) of the Upper Face.","authors":"Konstantin Frank, Kai O Kaye, Gabriela Casabona, Emily Glaue, Rui Zeng, Nicholas Moellhoff, Vanessa Brebant, Lukas Prantl, Michael Alfertshofer, Sebastian Cotofana","doi":"10.1093/asj/sjaf009","DOIUrl":"https://doi.org/10.1093/asj/sjaf009","url":null,"abstract":"<p><strong>Background: </strong>Effects of upper facial aging can present as static forehead and periorbital rhytids as well as soft tissue volume loss. The latter can prompt in conjunct with bony changes of the calvaria eyebrow and eyelid ptosis. Injection-based treatments can yield positive outcomes but are not free of procedural risks.</p><p><strong>Objectives: </strong>To assess the clinical outcome of synchronized radiofrequency (RF) and high intensity facial electric stimulation (HIFES) when targeting the upper face with special focus on the effects of musculature, subcutaneous fatty layer, and eyebrow position.</p><p><strong>Methods: </strong>This non-randomized, prospective study included 37 subjects with a mean age of 45.46 years and a mean BMI of 21.84 kg/m2. Subjects received four synchronized RF and HIFES treatments spaced seven days apart. Efficacy measurements were taken at 4-, 16-, and 24-weeks post-treatment using three-dimensional surface imaging, surface electromyography (EMG), and high-resolution facial ultrasound.</p><p><strong>Results: </strong>Forehead and lateral canthal line severity improved statistically significantly at each follow-up visit when compared to baseline with all p<0.001. At week 24, the position of medial/central/lateral eyebrows increased by 3.18/3.02/2.27 mm when compared to baseline with p < 0.001, respectively. At week 24, no statistically significant changes were observed in the thickness of frontalis muscle or of the overlying fatty layer.</p><p><strong>Conclusions: </strong>The application of synchronized RF and HIFES to the frontal region reduced frontal and lateral canthal rhytids and elevated the position of the eyebrow until week 24 after the initial treatment. Based on the results obtained, this non-invasive energy-based treatment option could be a viable alternative to injectable treatments of the upper face when trying to ameliorate the signs of upper facial aging.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063150","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":"Outcomes and Perceptions of Masculinizing Mammoplasty Among Transgender Men in Brazil.","authors":"Gabriel de Almeida Arruda Felix, Miguel Sabino Neto, Jorge Manuel Rodrigues Oliveira Filho, Paulo Cesar Greimel de Paiva Filho, Ariane Garcia, Luciano Eduardo Grisotto Junior, Daniela Francescato Veiga","doi":"10.1093/asj/sjaf011","DOIUrl":"https://doi.org/10.1093/asj/sjaf011","url":null,"abstract":"<p><strong>Background: </strong>Transgender men often experience body image dissatisfaction due to incongruence between their gender identity and physical appearance. Masculinizing mammoplasty (MM) aligns physical appearance with gender identity; however, its impact on body image satisfaction in Brazil has not been comprehensively assessed using validated tools.</p><p><strong>Objectives: </strong>To evaluate satisfaction with chest appearance, nipple aesthetics, and body investment among transgender men in Brazil, comparing those who have undergone MM with those who have not, using validated tools, such as the BODY-Q Chest, BODY-Q Nipple, and Body Investment Scale.</p><p><strong>Methods: </strong>This cross-sectional study included 90 transgender men aged ≥18 years recruited between June and September 2024. Participants were allocated to two groups: those who had undergone MM (n=45) and those eligible but had not yet undergone surgery (n=45). Inverse probability of treatment weighting and regression models adjusted for age, BMI, and education level were used.</p><p><strong>Results: </strong>Participants had a mean age of 32.2 years (SD ± 8.1, range: 19-62) and BMI of 27.9 kg/m² (SD ± 4.8). The MM group had a mean time since surgery of 40 months (SD ± 29.2). After adjustment, MM was associated with significantly greater satisfaction with chest appearance (ATE, 60.98; 95% CI 53.02-68.93), nipple aesthetics (ATE, 50.61; 95% CI 38.99-62.23), and body investment (ATE, 11.02; 95% CI 5.66-16.38). Chest binding was significantly reduced in the MM group (P < 0.001).</p><p><strong>Conclusions: </strong>Transgender men in Brazil who underwent MM reported higher body image satisfaction and quality of life, supporting the role of this procedure in enhancing mental health.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063168","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":"Silicone Leakage From Breast Implants and its Association With Capsular Contracture in 657 Patients.","authors":"Andreas Larsen, Erik Eiler Frydshou Bak, Tim Kongsmark Weltz, Mathilde Nejrup Hemmingsen, Pia Cajsa Leth Andersen, Rikke Bredgaard, Tine Engberg Damsgaard, Jens Jørgen Elberg, Jesper Trillingsgaard, Louise Vennegaard Mielke, Lisbet Rosenkrantz Hölmich, Peter Vester-Glowinski, Mathias Ørholt, Mikkel Herly","doi":"10.1093/asj/sjaf012","DOIUrl":"https://doi.org/10.1093/asj/sjaf012","url":null,"abstract":"<p><strong>Background: </strong>Capsular contracture is a common complication following breast reconstruction and augmentation, but there is limited evidence for the association between silicone leaking from the implant and capsular contracture.</p><p><strong>Objectives: </strong>To determine the association between silicone leaking into the surrounding fibrous capsule and the risk of capsular contracture.</p><p><strong>Methods: </strong>This multicenter cross-sectional study included patients undergoing revisional surgery for any indication following breast reconstruction or augmentation with silicone implants. Silicone in the fibrous capsule was quantified using histopathological analysis, and capsular contracture was diagnosed using the Baker classification. Multivariable logistic regression was used to assess the association between the amount of silicone leakage and the predicted risk of capsular contracture. The association was tested in a sensitivity analysis excluding potential confounders and misclassifications.</p><p><strong>Results: </strong>Among 657 included patients (1147 breasts), 272 patients (346 breasts) had either unilateral or bilateral capsular contracture. Capsular contracture was significantly associated with the amount of silicone in the fibrous capsule (p<.001), independent from the time of implantation (p<.001). The risk of capsular contracture increased rapidly by 12% (95%CI 5.0-18), going from 0.00 mL (0-32nd percentile) to 0.26 mL (60th percentile) of silicone in the fibrous capsule. The association was confirmed in the sensitivity analysis of 421 patients (654 breasts) with intact implants.</p><p><strong>Conclusions: </strong>Even small amounts of silicone leakage are associated with a significantly increased risk of capsular contracture. This highlights the importance of using breast implants with low silicone leakage rates such as highly cohesive implants to prevent capsular contracture.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063172","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":"Aesthetic Efficacy and Safety of Combined Microfocused Ultrasound With Visualization and Calcium Hydroxylapatite Treatment: A Systematic Review of Human Evidence.","authors":"Mojgan Amiri, Renald Meçani, Christa D Niehot, Guido Muharremi, Julieta Spada, Rossana Vasconcelos, Tatjana Pavicic, Sonja Sattler, Melissa K Levin, Siew Tuck Wah, Julia Carroll, Sonya Cook, Taulant Muka","doi":"10.1093/asj/sjae239","DOIUrl":"https://doi.org/10.1093/asj/sjae239","url":null,"abstract":"<p><p>Although microfocused ultrasound with visualization (MFU-V) and calcium hydroxylapatite- carboxymethylcellulose (CaHA-CMC) have their individual strengths and have demonstrated effectiveness in aesthetic improvement and improving skin laxity, a combined treatment may sometimes be required to achieve comprehensive aesthetic enhancements that meet patients' needs and preferences. This review systematically summarizes the available evidence on combined MFU-V and CaHA-CMC treatment. A comprehensive search was conducted in Embase, MEDLINE ALL (Ovid), Web of Science Core Collection, and Cochrane Central. We included studies conducted in adults that examined the effectiveness, safety, and/or mechanism of action of combined MFU-V and CaHA-CMC treatment. Out of 4019 references, 11 studies, mainly pre-post studies, were included in this analysis. Overall, regardless of the area treated, improvements in global aesthetic scales, skin quality parameters, and patients' satisfaction following combined treatment, accompanied by mild to moderate adverse effects, were found. In addition, histological studies indicated increased neocollagenesis and elastin synthesis posttreatment. Our review highlights promising outcomes from combined MFU-V and CaHA-CMC treatment. Nevertheless, due to the limited number of studies, further research is essential to gain a deeper understanding of this combined treatment's efficacy, safety, and applicability.</p><p><strong>Level of evidence: 3 (therapeutic): </strong></p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063146","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":"Closed Preservation Rhinoplasty in the Mestizo Patient: Challenges and Techniques for Nasal Tip Support.","authors":"Cesar Valdivia, Paul D Durand, Baris Cakir","doi":"10.1093/asj/sjaf017","DOIUrl":"https://doi.org/10.1093/asj/sjaf017","url":null,"abstract":"<p><strong>Background: </strong>Closed preservation rhinoplasty continues to grow in popularity. Nevertheless, many surgeons remain wary of doing closed preservation rhinoplasty in certain patient populations. Mestizo noses have a thick soft-tissue envelope and weak nasal tip support. These inherent characteristics have led many surgeons to favor open structural techniques when addressing the tip in the Mestizo patient.</p><p><strong>Objectives: </strong>The present article describes a set of techniques that have been successfully employed by the authors for maximizing tip support and definition when doing closed preservation rhinoplasty in a patient population for which structural techniques were once thought as the only viable option.</p><p><strong>Methods: </strong>A total of 417 primary rhinoplasty cases were studied retrospectively between January 2022 and December 2023. All the cases were performed using a closed approach and dorsal preservation of the soft-tissue envelope. All patients underwent one of the four types of surgical techniques for the tip area (Type I - 105 patients, Type II - 124, Type III - 181, and Type IV - 7).</p><p><strong>Results: </strong>Of the total patients, 331 (79.3%) were female and 86 (20.6%) were male. Patient age varied from 15 to 66, with a median age of 23. Patients were followed for a period of six months to a year postoperatively. Seven patients underwent revision surgery (1.7%).</p><p><strong>Conclusions: </strong>Even with its various potential benefits, there is still apprehension about doing closed preservation rhinoplasty in certain patient populations. The authors present several techniques that have been successfully employed to maximize tip support and definition when performing closed preservation rhinoplasty in the Mestizo patient.</p>","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057647","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":"Hyaluronidase Availability Beyond the Aesthetic Office: A Shared Responsibility for Safety in Filler Complications.","authors":"Daniel P Zaki, Joseph M Firriolo, Idean Roohani, Lee L Q Pu","doi":"10.1093/asj/sjaf018","DOIUrl":"https://doi.org/10.1093/asj/sjaf018","url":null,"abstract":"","PeriodicalId":7728,"journal":{"name":"Aesthetic Surgery Journal","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057649","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}