The latest medical research on Cosmetic Surgery

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about cosmetic surgery gathered by our medical AI research bot.

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Modification of Skin Flaps for Single-Stage Reconstruction of the Nasal Ala Using All-Layer Suture-A Prospective Study.

Journal of Cutaneous Pathology

After local flaps, it may be necessary to reconstruct the contour of the nasal ala. This is possible with a single-stage all-layer shaping suture. In the present study, the functional and aesthetic results after single-stage reconstruction of the nasal ala were prospectively evaluated.

Patients who underwent surgery for skin tumors of the nose between 06/2019 and 06/2020 who required reconstruction of the nasal ala as part of the defect closure and had an all-layer suture used were prospectively included in the study. A standardized evaluation of aesthetic and functional outcome was conducted by the patient and a physician at discharge as well as 4 weeks later. Patients additionally underwent a follow-up survey 6 months later.

Thirty-seven patients were included in the study. Four weeks postoperatively, all flaps were found to be fully healed and vital. Aesthetic outcome at 4 weeks was rated as very good or good by physicians in 73% and by patients in 78.4%. Persistent complications due to reduced blood flow were not observed.

The reshaping of the nasal ala as part of the defect reconstruction with an all-layer suture demonstrates very good aesthetic as well as functional results and can be performed in a single-stage procedure. .

Cupid Lift: Advanced Lip Design using the Deep Plane Upper Lip Lift and Simplified Corner Lift.

Aesthetic Surgery Journal

The upper lip lift has been described using a variety of techniques over several decades, however many questions have remained unanswered regarding the benefits and drawbacks of each technique. The Deep Plane or Modified Upper lip lift procedure has been recently introduced to help mitigate risk and maximize outcomes. The CUPID Lip Lift design provides an additional formulary to guide the markings for the Deep Plane Lip Lift and provide more reproducible and successful outcomes.

To better characterize and simplify the complex and artistic decision-making process involved in the upper lip lift and corner lip lift. A mathematical guide is presented to maintain natural balance to the upper lip, optimizing muscle function, and when to add a corner lift. Design elements, aging and future treatment considerations are elucidated.

A PubMed search was performed in October 2021 by the primary author (BT) for all journal articles published regarding upper lip lift and corner lip lifts. The search was conducted from 1950 to present day in all languages and without exclusion criteria. Patient results and evolution of the deep plane upper lip lift design over 6 years was analyzed to provide a thorough discussion of elements to consider during lip lift design.

The deep plane upper lip design evolution has reached a point where a mathematical design may now be applied to an artistic concept. Following the patterns demonstrated in over 2440 consecutive lip lifts, we have been better able to understand the nuances involved in proper design that will avoid acceleration of aging, exaggeration of appearance, with a lower need for revision while maximizing results.

Upper lip lift design is more complex than most practitioners currently realize. This article outlines a mathematical concept that enables the practitioner to obtain more aesthetically pleasing and consistent outcomes. The modifications to this technique have largely been driven by desire to eradicate inadequacies as pointed out by patients. This novel approach to lip lift design enables the practitioner to improve lip balance, facial harmony, tooth show and obtain adequate exposure of the lateral vermillion.

Donor Site Satisfaction Following Autologous Fat Transfer for Total Breast Reconstruction.

Aesthetic Surgery Journal

With evolving breast cancer survival and patient preferences, it is essential that reconstructive surgeons worldwide keep searching for the best reconstruction technique for patients. Autologous fat transfer (AFT) is a relatively new technique for total breast reconstruction that has already proven to be effective and safe with all advantages of autologous tissue. However, little is known about aesthetic results and satisfaction concerning donor sites.

The aim of this study was to measure donor site satisfaction following AFT for total breast reconstruction in breast cancer patients.

Between May and August of 2021, participants of the BREAST- trial who were at least 24 months after their final reconstruction surgery were invited to fill out an additional survey concerning donor sites. The BODY-Q was utilized for data collection. Results of AFT patients were compared to a control group: implant-based reconstruction patients who do not have a donor site.

A total of 51 patients (20 control, 31 intervention) completed the questionnaire. No statistical differences in satisfaction with body were found between these groups. The most frequent complaint was contour irregularities (31 reports, 60.8%) with the least favorable donor site being thighs (23 reports, 53.5%) in the AFT group.

There is no difference in satisfaction with body between breast cancer patients receiving AFT or IBR, meaning that large volume liposuction does not aesthetically affect the utilized donor sites. Nevertheless, reconstructive surgeons should be aware of possible donor site complications, especially contour irregularities at the thighs, and discuss this with their patients.

Supplementation of Facial Fat Grafting to Increase Volume Retention: A Systematic Review.

Aesthetic Surgery Journal

For decades, facial fat grafting is used in clinical practice for volume restoration. The main challenge of this technique is the variable volume retention. Over the past years, studies reported the addition of supplements to augment the fat graft to increase volume retention.

The aim of this systematic review was to investigate which supplements increase volume retention in facial fat grafting as assessed with volumetric outcomes and patient satisfaction.

Central, MEDLINE, EMBASE, Web of Science Core Collection and Google Scholar were searched until 30th of November 2020. Only studies assessing volume after facial fat grafting with supplementation in human subjects were included. Outcomes of interest were volume or patient satisfaction. Quality of the studies was assessed using the Effective Public Health Practice Project tool.

After duplicates were removed 3724 studies were screened by title and abstract. After reading 95 full-text articles, 27 studies were eligible and included for comparison. Supplementation comprised of platelet rich plasma (PRP), platelet rich fibrin, adipose tissue-derived stromal cells or bone marrow-derived stromal cells, cellular or tissue stromal vascular fraction (SVF) or nanofat. In 13 out of 22 studies the supplemented group showed improved volumetric retention and 5 out of 16 studies showed greater satisfaction. The scientific quality of the studies was rated as weak for 20 of 27 studies, moderate for 6 of 27 studies and strong for 1 study.

Our results show that it remains unclear if additives contribute to facial fat graft retention while there is a need to standardize methodology.

Evolution of the Septal Extension Graft in Endonasal Rhinoplasty: Long-Term Efficacy and Reliability.

Aesthetic Surgery Journal

Proper nasal tip projection and rotation have a strong impact on nasal aesthetics. Septal extension graft is one of the tools used to improve tip projection and rotation when performing rhinoplasty. This graft typically overlaps the existing caudal septum in the midline position, lengthening it and facilitating the repositioning of the tip.

To describe the technical evolution of the septal extension graft in endonasal rhinoplasty and evaluate the reliability and long-term efficacy of the current technique.

Evaluation of pre- and post- surgical photographs of the nasolabial angle and nasal proportions in 60 patients who underwent endonasal rhinoplasty with septal extension graft.

The study demonstrated a clear improvement in tip projection and rotation at the one-year follow-up. The mean pre-operative nasolabial angle was 93.75±9.45° compared with 101.1±5.3° following surgery. Although both were normally distributed, the range of the post-operative nasolabial angle was narrower than one-year pre-operatively (SD=5.3° vs. 9.45°, respectively). The Crumley ratio, used to describe nasal proportions, presented significant changes in nasal proportions: 3.84 pre-operatively and 4.04 post-operatively (95%CI: -0.24 to -0.149; P<0.001).

The use of septal extension graft in endonasal rhinoplasty has significantly changed since first described in 2006. The adaptations made to this technique render it more reliable and our study demonstrates its efficacy in improving tip projection and rotation over the long-term.

Clinical Impact of Intraoperative Margin Assessment in Breast-Conserving Surgery With a Novel Pegulicianine Fluorescence-Guided System: A Nonrandomized Controlled Trial.

JAMA Surgery

Positive margins following breast-conserving surgery (BCS) are often identified on standard pathology evaluation. Intraoperative assessment of the lumpectomy cavity has the potential to reduce residual disease or reexcision rate following standard of care BCS in real time.

To collect safety and initial efficacy data on the novel pegulicianine fluorescence-guided system (pFGS) when used to identify residual cancer in the tumor bed of female patients undergoing BCS.

This prospective single-arm open-label study was conducted as a nonrandomized multicenter controlled trial at 16 academic or community breast centers across the US. Female patients 18 years and older with newly diagnosed primary invasive breast cancer or ductal carcinoma in situ DCIS undergoing BCS were included, excluding those with previous breast cancer surgery and a history of dye allergies. Of 283 consecutive eligible patients recruited, 234 received a pegulicianine injection and were included in the safety analysis; of these, 230 were included in the efficacy analysis. Patients were enrolled between February 6, 2018, and April 10, 2020, and monitored for a 30-day follow-up period. Data were analyzed from April 10, 2020, to August 5, 2021.

Participants received an injection of a novel imaging agent (pegulicianine) a mean (SD) of 3.2 (0.9) hours prior to surgery at a dose of 1 mg/kg. After completing standard of care (SOC) excision, pFGS was used to scan the lumpectomy cavity to guide the removal of additional shave margins.

Adverse events and sensitivity, specificity, and reexcision rate.

Of 234 female patients enrolled (median [IQR] age, 62.0 [55.0-69.0] years), 230 completed the trial and 1 patient with a history of allergy to contrast agents had an anaphylactic reaction and recovered without sequelae. Correlation of pFGS with final margin status on a per-margin analysis showed a marked improvement in sensitivity over standard pathology assessment of the main lumpectomy specimen (69.4% vs 38.2%, respectively). On a per-patient level, the false-negative rate of pFGS was 23.7% (9 of 38), and sensitivity was 76.3% (29 or 38). Among 32 patients who underwent excision of pFGS-guided shaves, pFGS averted the need for reexcision in 6 (19%).

In this pilot feasibility study, the safety profile of pegulicianine was consistent with other imaging agents used in BCS, and was associated with a reduced need for second surgery in patients who underwent intraoperative additional excision of pFGS-guided shaves. These findings support further development and clinical performance assessment of pFGS in a prospective randomized trial.

ClinicalTrials.gov Identifier: NCT03321929.

Comparison of Hepatic Arterial Infusion Pump Chemotherapy vs Resection for Patients With Multifocal Intrahepatic Cholangiocarcinoma.

JAMA Surgery

Intrahepatic cholangiocarcinoma (iCCA) is often multifocal (ie, satellites or intrahepatic metastases) at presentation.

To compare the overall survival (OS) of patients with multifocal iCCA after hepatic arterial infusion pump (HAIP) floxuridine chemotherapy vs resection.

In this cohort study, patients with histologically confirmed, multifocal iCCA were eligible. The HAIP group consisted of consecutive patients from a single center who underwent HAIP floxuridine chemotherapy for unresectable multifocal iCCA between January 1, 2001, and December 31, 2018. The resection group consisted of consecutive patients from 12 centers who underwent a curative-intent resection for multifocal iCCA between January 1, 1990, and December 31, 2017. Resectable metastatic disease to regional lymph nodes and previous systemic therapy were permitted. Patients with distant metastatic disease (ie, stage IV), those who underwent resection before starting HAIP floxuridine chemotherapy, and those who received a liver transplant were excluded. Data were analyzed on September 1, 2021.

Overall survival in the 2 treatment groups was compared using the Kaplan-Meier method and log-rank test.

A total of 319 patients with multifocal iCCA were included: 141 in the HAIP group (median [IQR] age, 62 [53-70] years; 79 [56.0%] women) and 178 in the resection group (median [IQR] age, 60 [50-69] years; 91 [51.1%] men). The HAIP group was characterized by a higher percentage of bilobar disease (88.0% [n = 124] vs 34.3% [n = 61]), larger tumors (median, 8.4 cm vs 7.0 cm), and a higher proportion of patients with 4 or more lesions (66.7% [94] vs 24.2% [43]). Postoperative mortality after 30 days was 0.8% (95% CI, 0.0%-2.1%) in the HAIP group vs 6.2% (95% CI, 2.3%-9.7%) in the resection group (P = .01). The median OS for HAIP was 20.3 months vs 18.9 months for resection (P = .32). Five-year OS in patients with 2 or 3 lesions was 23.7% (95% CI, 12.3%-45.7%) in the HAIP group vs 25.7% (95% CI, 17.9%-37.0%) in the resection group. Five-year OS in patients with 4 or more lesions was 5.0% (95% CI, 1.7%-14.3%) in the HAIP group vs 6.8% (95% CI, 1.8%-25.3%) in the resection group. After adjustment for tumor diameter, number of tumors, and lymph node metastases, the hazard ratio of HAIP vs resection was 0.75 (95% CI, 0.55-1.03; P = .07).

This cohort study found that patients with multifocal iCCA had similar OS after HAIP floxuridine chemotherapy vs resection. Resection of multifocal intrahepatic cholangiocarcinoma needs to be considered carefully given the complication rate of major liver resection; HAIP floxuridine chemotherapy may be an effective alternative option.

Motivations and Psychological Characteristics of Men Seeking Penile Girth Augmentation.

Aesthetic Surgery Journal

The popularity of penile augmentation procedures is increasing, but little is known about the motivations and psychological characteristics of men who seek these procedures.

To investigate the motivations and psychological characteristics of men seeking a penile girth augmentation using valid psychological measures.

Men seeking to undergo a penile girth augmentation (n = 37) completed an online questionnaire containing standardized measures assessing their motivations to undergo augmentation, penile size self-discrepancy, psychological distress, self-esteem, body image related quality of life, body dysmorphic disorder (BDD), and cosmetic procedure screening scale-penile focused dysmorphic disorder (PDD).

Men's motivations for seeking penile girth augmentation were characterized as "improve self-confidence", "change penile size/appearance", "sexual function/pleasure", "feelings of insecurity", and "medical issues", with self-confidence being the most commonly reported motivation. The men perceived their actual penis size (girth, flaccid length, erect length) as significantly smaller than ideal size, the size they believed their penis should be and their expected size post-augmentation. Compared to non-clinical norms, the men seeking penile augmentation had higher PDD symptoms, lower self-esteem and lower body image related quality of life, but comparable psychological distress. In addition, four of the men met diagnostic criteria for BDD according to self-reported questionnaire (11%, n = 4/37) and clinical interview (14%, n = 4/29).

Men seek penile girth augmentation for a variety of reasons and perceive all their penile dimensions to be smaller than ideal sizes. They differ from non-clinical samples in some psychological characteristics and a small but sizeable portion experience BDD.

Total Intravenous Anesthesia With Dexamedatomadine for Hemodynamic Stability and Enhance Recovery in Facial Aesthetic Surgery.

Aesthetic Surgery Journal

Patients undergoing facial rejuvenation surgery have unique risk of perioperative complications that are directly affected by adverse consequences of the anesthetic utilized during the procedures. The ideal anesthetic agent is one that is safe to use in the outpatient population, has analgesic, sedative, and anesthetic properties, yet does not cause respiratory depression or hemodynamic irregularities.

A retrospective analysis of a large outpatient facelift cohort was preformed to determine if dexmedetomidine, an alpha2- adrenergic receptor agonist, meets the criteria of an ideal adjunct with propofol in a TIVA protocol.

The charts of 791 patients who underwent rhytidectomy with total intravenous anesthesia were reviewed and data of patients' operative risk factors, perioperative management including medications administered, perioperative vital signs and postoperative adverse events were recorded. Statistical univariate analyses were performed on the data.

Dexmedetomidine resulted in a significant reduction and maintenance of the B/P from onset of anesthesia until discharge from the post-anesthetic recovery unit (130/74 pre-op to 105/57 in mmHg). The utilization of opioids and anxiolytics was significantly less than previously reported for other anesthetic types. The PONV rate was 0.8% (6 patients). There were no postoperative admissions for in patient management. Forty-three (5.3%) of patients required a conversion to general endotracheal anesthesia and statistically significant risk factors include increased BMI, ASA of class II or higher, preoperative hypertension, and multiple procedures performed.

In this large cohort of outpatients undergoing facelift with TIVA utilizing dexmedetomidine as the primary anesthetic agent we have demonstrated the safety and efficacy of dexmedetomidine and demonstrated that it meets the requirements for an ideal adjunct anesthetic within a TIVA protocol.

SUB-SMAS Reconstructıon of Retaınıng Lıgaments.

Aesthetic Surgery Journal

Retaining ligaments must be fully released for effective soft tissue mobilization during Sub-SMAS facelifts. Standart deep temporal fascia and lateral SMAS fixation techniques may fail earlier than anticipated, which may cause a relapse of facial aging signs. Reconstruction of retaining ligaments has been previously proposed to enhance facelift fixation.

To assess the effect of the author's ligament reconstruction technique on early relapse rates and complication rates.

This study was a comparative analysis of 188 consecutive facelift cases where retaining ligaments were reconstructed using the described techniques. 104 patients with standard fixation were analyzed in the control group. A novel set of criteria was established for the diagnosis of early relapse after facelift surgery, based on the validated Merz scale.

Early relapse rate was significantly lower (0.53% versus 5.76%) in the ligament reconstruction group in comparison to the control group. Ligament reconstruction was associated with an increased rate of temporary nerve paralysis (8.5%).

Sub-SMAS reconstruction of retaining ligaments enhance facelift fixation and reduce the rate of early relapse. Increased risk of temporary neuropraxia is a reasonable trade-off.

Volume-Outcome Associations for Parathyroid Surgery in England: Analysis of an Administrative Data Set for the Getting It Right First Time Program.

JAMA Surgery

Previous studies have suggested an association between surgical volume and patient outcomes for parathyroid surgery. However, most previous studies are relatively small and the literature is dominated by studies form the US, which might not be readily generalizable to other settings.

To investigate volume-outcome associations for parathyroid surgery in England.

Cohort study that included all National Health Service hospital trusts in England with secondary analysis of administrative data using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Participants included all adult, elective hospital admissions for parathyroid surgery without a diagnosis of multiple endocrine neoplasia, parathyroid cancer, or kidney disease over a 5-year period (April 2014-March 2019 inclusive).

The number of procedures conducted in the year prior to the index procedure by each surgeon and each hospital trust.

Repeat parathyroid surgery within 1 year of the index procedure.

This study included data for 17 494 participants who underwent parathyroidectomies conducted across 125 hospital trusts. The median (IQR) age of patients was 62 (53-71) years, and 13 826 were female (79.0%). Across the period, the number of surgeons conducting parathyroid surgery changed little (280 in 2014-2015 and 2018-2019), although the number of procedures conducted rose from 3331 to 3848 per annum. Repeat parathyroid surgery at 1 year was significantly associated with surgeon volume (odds ratio [OR], 0.99; 95% CI, 0.98-0.99), but not trust volume, in the previous 12 months. Extended length of stay (OR, 0.98; 95% CI, 0.98-0.99), hypoparathyroidism/calcium disorder (OR, 1.0; 95% CI, 0.99-1.0), and postprocedural complications (OR, 0.99; 95% CI, 0.99-1.0) were also associated with lower surgeon volume.

In this cohort study, higher surgeon annual volume was associated with decreased rates of repeat parathyroid surgery. A minimum volume threshold of 20 procedures per annum should improve patient outcomes, although possible negative effects on access to services should be monitored.

Use of Machine Learning Consensus Clustering to Identify Distinct Subtypes of Black Kidney Transplant Recipients and Associated Outcomes.

JAMA Surgery

Among kidney transplant recipients, Black patients continue to have worse graft function and reduced patient and graft survival. Better understanding of different phenotypes and subgroups of Black kidney transplant recipients may help the transplant community to identify individualized strategies to improve outcomes among these vulnerable groups.

To cluster Black kidney transplant recipients in the US using an unsupervised machine learning approach.

This cohort study performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in Black kidney transplant recipients in the US from January 1, 2015, to December 31, 2019, in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. Each cluster's key characteristics were identified using the standardized mean difference, and subsequently the posttransplant outcomes were compared among the clusters. Data were analyzed from June 9 to July 17, 2021.

Machine learning consensus clustering approach.

Death-censored graft failure, patient death within 3 years after kidney transplant, and allograft rejection within 1 year after kidney transplant.

Consensus cluster analysis was performed for 22 687 Black kidney transplant recipients (mean [SD] age, 51.4 [12.6] years; 13 635 men [60%]), and 4 distinct clusters that best represented their clinical characteristics were identified. Cluster 1 was characterized by highly sensitized recipients of deceased donor kidney retransplants; cluster 2, by recipients of living donor kidney transplants with no or short prior dialysis; cluster 3, by young recipients with hypertension and without diabetes who received young deceased donor transplants with low kidney donor profile index scores; and cluster 4, by older recipients with diabetes who received kidneys from older donors with high kidney donor profile index scores and extended criteria donors. Cluster 2 had the most favorable outcomes in terms of death-censored graft failure, patient death, and allograft rejection. Compared with cluster 2, all other clusters had a higher risk of death-censored graft failure and death. Higher risk for rejection was found in clusters 1 and 3, but not cluster 4.

In this cohort study using an unsupervised machine learning approach, the identification of clinically distinct clusters among Black kidney transplant recipients underscores the need for individualized care strategies to improve outcomes among vulnerable patient groups.