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The latest medical research on Cosmetic Surgery

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Prevalence Patterns of Body Contouring Procedures Among Injectable Glucagon-Like Peptide-1 Receptor Agonist Users.

Aesthetic Surgery Journal

The introduction of injectable glucagon-like peptide-1 (GLP-1) receptor agonists like Ozempic and Wegovy has transformed weight loss in plastic surgery patients, often leading to excess skin and soft tissue amendable to body contouring procedures.

This project aims to examine the relationship between injectable GLP-1 receptor agonist use and the growing need for body contouring surgeries, focusing on trunk and extremity procedures.

A retrospective analysis was conducted using the PearlDiver database, examining prescription data for Ozempic, Wegovy, and liraglutide, and correlating these with body contouring procedures across 30 U.S. states from 2011-2022. Multimodal statistics were used to compare surgery rates and assess dosage and time interval patterns among GLP-1 receptor agonist users and non-users.

Significant correlations between GLP-1 receptor agonist use (881 Ozempic, 59 Wegovy, and 4,655 liraglutide users) and increased body contouring surgeries were found. Ozempic showed weak correlations with brachioplasty (r = 0.23) and panniculectomy (r = 0.21), and Wegovy with breast procedures (r = 0.28), while liraglutide showed consistent correlations across surgeries. Time to surgery varied from 87 days (Wegovy) to 1,018 days (liraglutide), with higher surgery rates among users (p < 0.01) and dose-related differences, especially in Ozempic and Wegovy users.

This study demonstrates a dose-dependent link between the use of GLP-1 receptor agonists and an increase in subsequent aesthetic body contouring surgeries, highlighting the need for surgeons to adapt to the merging of medicinal body transformation and aesthetic plastic surgery.

Classification of Breast Implant Malposition.

Aesthetic Surgery Journal

Implant malposition is a well-recognized complication when using prosthetic implants in the breast for both reconstructive and aesthetic indications. However, to date, no objective classification system has been described.

This study presents a prospective trial of an objective and reproducible classification system for implant malposition formulated using retrospective data from a large cohort of patients with implant malposition.

The authors retrospectively analyzed the degree of medial/lateral and inferior/superior implant malposition relative to their optimal position within the breast footprint in a series of 189 breasts (n = 100 patients). An objective classification system for implant malposition was devised and then applied to a prospective cohort of 53 breasts in 28 patients with implant malposition.

The degree of malposition in a single or combination of axes was categorised according to the distance from the ideal breast footprint and measured in centimeters (cms). The classification system incorporated the axis of malposition and distance to generate a treatment decision-making guide. Cases of Grade 1 malposition did not warrant surgical intervention, whilst surgical correction was warranted in all Grade 3 cases.In the combined patient cohort (n = 242 breasts, 128 patients), lateral, inferior, medial and superior displacement ranged between grades 1-3. There was no inter-observer variability in the grades assigned to nine out of ten patients in the prospective group.

We have created a simple and reproducible classification system for implant malposition that allows surgeons to objectively record the extent of malposition, guides surgical decision-making and can be used to document the results of any intervention.

Automated CT Analysis of Body Composition as a Frailty Biomarker in Abdominal Surgery.

JAMA Surgery

Prior studies demonstrated consistent associations of low skeletal muscle mass assessed on surgical planning scans with postoperative morbidity and mortality. The increasing availability of imaging artificial intelligence enables development of more comprehensive imaging biomarkers to objectively phenotype frailty in surgical patients.

To evaluate the associations of body composition scores derived from multiple skeletal muscle and adipose tissue measurements from automated segmentation of computed tomography (CT) with the Hospital Frailty Risk Score (HFRS) and adverse outcomes after abdominal surgery.

This retrospective cohort study used CT imaging and electronic health record data from a random sample of adults who underwent abdominal surgery at 20 medical centers within Kaiser Permanente Northern California from January 1, 2010, to December 31, 2020. Data were analyzed from April 1, 2022, to December 1, 2023.

Body composition derived from automated analysis of multislice abdominal CT scans.

The primary outcome of the study was all-cause 30-day postdischarge readmission or postoperative mortality. The secondary outcome was 30-day postoperative morbidity among patients undergoing abdominal surgery who were sampled for reporting to the National Surgical Quality Improvement Program.

The study included 48 444 adults; mean [SD] age at surgery was 61 (17) years, and 51% were female. Using principal component analysis, 3 body composition scores were derived: body size, muscle quantity and quality, and distribution of adiposity. Higher muscle quantity and quality scores were inversely correlated (r = -0.42; 95% CI, -0.43 to -0.41) with the HFRS and associated with a reduced risk of 30-day readmission or mortality (quartile 4 vs quartile 1: relative risk, 0.61; 95% CI, 0.56-0.67) and 30-day postoperative morbidity (quartile 4 vs quartile 1: relative risk, 0.59; 95% CI, 0.52-0.67), independent of sex, age, comorbidities, body mass index, procedure characteristics, and the HFRS. In contrast to the muscle score, scores for body size and greater subcutaneous and intermuscular vs visceral adiposity had inconsistent associations with postsurgical outcomes and were attenuated and only associated with 30-day postoperative morbidity after adjustment for the HFRS.

In this study, higher muscle quantity and quality scores were correlated with frailty and associated with 30-day readmission and postoperative mortality and morbidity, whereas body size and adipose tissue distribution scores were not correlated with patient frailty and had inconsistent associations with surgical outcomes. The findings suggest that assessment of muscle quantity and quality on CT can provide an objective measure of patient frailty that would not otherwise be clinically apparent and that may complement existing risk stratification tools to identify patients at high risk of mortality, morbidity, and readmission.

Extracorporeal Shockwave for Intermittent Claudication and Quality of Life: A Randomized Clinical Trial.

JAMA Surgery

Intermittent lower limb claudication limits function and quality of life. Supervised exercise programs are not readily available, and a noninvasive alternative is needed.

To assess extracorporeal corporeal shockwave therapy in improving quality of life in patients with claudication.

In this double-blind, placebo-controlled randomized clinical trial, patients in the outpatient setting at a single tertiary center for vascular surgery were randomized in a 1:1 ratio to extracorporeal shockwave therapy or placebo therapy with no shockwaves delivered. Recruitment was between June 2015 and January 2020, with 12-week follow-up ending in March 2020. A convenience sample of patients with claudication and conservative treatment requirements who refused or were unable to participate in supervised exercise were eligible. Patients receiving anticoagulation therapy or with an active cancer were excluded. Of 522 patients screened, 389 were eligible, 138 were enrolled, and 110 completed follow-up and were included in the primary analysis. Statistical analysis was completed by May 2021.

In the intervention group, patients received 100 impulses of 0.1mJ/mm/cm2 in an area of the gastrocnemius muscle 3 times weekly for 3 weeks. The steps for treatment were replicated for the control group without delivering the treatment.

The primary outcome was the Physical Functioning domain of the 36-item Short-Form Quality of Life Questionnaire at 12-week follow-up. Secondary outcomes included walking distances, ankle brachial pressure index, and other quality-of-life measures.

Of 138 patients recruited and randomized, 92 (67%) were male, and the mean (SD) age of the study population was 67 (9.6) years. The intervention group had a significantly higher physical function score at 12 weeks (estimated median difference 3.8; 95% CI, 0.0-7.7; P = .03). However, this significance did not remain when adjusting for covariates. At 12 weeks, the intervention group had significantly longer pain-free and maximum walking distances (pain-free estimated median difference, 34.1, 95% CI, 11.4-56.8; P = .004; maximum estimated median difference, 51.4; 95% CI, 10.7-86.5; P = .01).

To our knowledge, this is the first double-blind, placebo-controlled, randomized clinical trial to consider extracorporeal shockwave therapy for the management of intermittent claudication. It demonstrated efficacy for walking distances, may have a positive effect on quality of life, and may provide a safe, noninvasive alternative therapy for patients with intermittent claudication.

ClinicalTrials.gov Identifier: NCT02652078.

Epidemiology and Healthcare Expenditure for Skin Disease in Emergency Departments in Alberta, Canada.

Journal of Cutaneous Pathology

There are limited data on the epidemiology and costs associated with managing dermatologic conditions in emergency departments (EDs).

To assess the incidence and mean cost per case of skin diseases in EDs in Alberta.

Alberta Health Services' Interactive Health Data Application was used to determine the epidemiology and costs associated with nonneoplastic dermatologic diseases in EDs in the province of Alberta, Canada, from 2018 to 2022. Skin conditions were identified using the International Classification of Disease 10th edition diagnostic groupings.

Skin disease represented 3.59% of all ED presentations in Alberta in 2022. The total costs associated with managing dermatologic conditions have remained stable over time at approximately 15 million Canadian Dollars (CAD) annually, but the mean cost per case has risen from 188.88 (SD 15.42) in 2018 to 246.25 CAD (SD 27.47) in 2022 (7.59%/year). Infections of skin and subcutaneous tissue were the most expensive diagnostic grouping. The most common dermatologic diagnostic groupings presenting to the ED were infections of skin and subcutaneous tissue [mean age-standardized incidence rate (ASIR) of 143.67 per 100,000 standard population (SD 241.99)], urticaria and erythema [mean ASIR 33.57 per 100,000 standard population (SD 59.13)], and dermatitis and eczema [mean ASIR 18.59 per 100,000 standard population (SD 23.65)]. Cellulitis was both the most common and the costliest individual diagnosis. The majority of patients were triaged as less urgent or nonurgent.

Skin disease represents a substantial public health burden in EDs. Further research into drivers of cost change and areas for cost savings is essential.

Aesthetic Potential and Safety Profile with Nanotextured Breast Implants With 1,000 Cases of Breast Augmentation as Evaluation of Single-Center Experience.

Aesthetic Surgery Journal

Nanotextured implants, an innovation in implant technology, are designed to enhance tissue interaction, reduce inflammation, and mitigate complications compared to traditional implants.

The aim of the study was to evaluate the aesthetic potential and safety profile of nanotextured breast implants in breast augmentation from a single-surgeon experience.

This prospective cohort study included 1,000 patients who underwent breast augmentation with nanotextured implants. Aesthetic outcomes were assessed using direct measurements and BCCT.core software, focusing on breast projection, symmetry, and upper pole fullness. Patient satisfaction was measured through BREAST-Q and overall satisfaction surveys. Safety profiles were evaluated based on the incidence of complications such as infection, hematoma, capsular contracture, and implant rupture. Statistical analyses were conducted to assess the outcomes.

The study found significant improvements in aesthetic outcomes, with 92.8% of cases achieving substantial aesthetic enhancements. Patient satisfaction was high, with 96.4% reporting enhanced self-esteem and contentment. The safety profile was favorable, with a low incidence of complications (0.7% requiring revision surgery) and no major complications reported. Long-term follow-up data indicated sustained aesthetic outcomes and a stable safety profile.

Insights into the synergistic relationship between nanotextured implants are defined by a significantly wider range of aesthetic options. The findings of this study underscore the positive impact of nanotextured breast implants on enhancing the aesthetic potential of breast augmentation. and contributing to a low incidence of complications.

Partner Satisfaction in Labiaplasty Patients.

Aesthetic Surgery Journal

Labiaplasty operation, which has become increasingly popular in recent years, is frequently preferred by women for cosmetic and functional reasons. It creates significant changes on female sexuality with high satsfaction rates. But there is limited data on its effects on male sexual response.

To investigate the effects of labiaplasty on partners.

Partners of 49 patients who underwent labiaplasty between January 2020 and May 2023 were included in the study. Male Sexual Health Questionnaire Ejaculatory Dysfunction (MSHQ-EjD), Golombok Rust Sexual Satisfaction Scale and New Sexual Satisfaction Scale (NSSS) questionnaires were administered to the partners preoperatively and 6 months postoperatively.

There was no significant difference between preoperative and postoperative results in the MSHQ-EjD questionnaire applied to the partners included in the study. The postoperative increase in the new sexual satisfaction scale compared to the preoperative sexual satisfaction score was statistically significant. In the Golombok Rust sexual satisfaction scale, statistically significant, positive changes were observed in the categories of frequency of intercourse, communication, satisfaction, and nature of sexual intercourse in postoperative results.

Labiaplasty operation had positive effects onmale sexual response, but had no effect on ejaculation function and difficulty.

A Multicenter, Randomized, Evaluator-Blinded Study to Examine the Safety and Effectiveness of Hyaluronic Acid Filler in the Correction of Infraorbital Hollows.

Aesthetic Surgery Journal

Hyaluronic acid injections are increasingly used for correction of infraorbital hollows (IOHs).

Examination of effectiveness (IOH correction) and safety of Restylane® EyelightTM hyaluronic acid (HAEYE, Galderma, Uppsala, Sweden) injections.

Subjects with moderate/severe IOHs, assessed using the Galderma infraorbital hollows scale (GIHS), were randomized to HAEYE injections (via needle/cannula) (Day 1+optional Month-1 touch up) or no-treatment control. Primary endpoint was blinded evaluator-reported Month-3 response, defined as ≥1-point GIHS improvement from baseline (both sides, concurrently). Other endpoints examined investigator-reported aesthetic improvement (GAIS), subject-reported satisfaction (FACE-Q™ satisfaction with outcome; satisfaction questionnaire), and adverse events.

Overall, 333 subjects were randomized. Month 3 GIHS responder rate was significantly higher with HA-EYE (87.4%) versus control (17.7%; p<0.001), and comparable between HA-EYE-needle and HA-EYE-cannula groups (p=0.967). HAEYE GAIS responder rate was 87.5-97.7% (Months 3-12). Mean FACE-Q Rasch-transformed scores were 64.3-73.5 (HAEYE) versus 14.1-16.2 (control) through Month 12. Subjects reported looking younger (≥71%) and less tired (≥79%) with reduced under-eye shadows (≥76%) and recovered within 3-5 hours, post-treatment. Efficacy was maintained through Month 12 (63.5% GIHS responders) and through Month 18, after Month-12 retreatment (80.3% GIHS responders; 99.4% GAIS responders; FACE-Q scores: 72.5-72.8). Forty subjects (12.7%) reported typically mild adverse events (4.9% HAEYE-needle; 20.9% HAEYE-cannula).

HAEYE treatment was effective in correcting moderate/severe IOHs at the primary endpoint (Month 3). Efficacy was sustained through Month 12 after first treatment for 63.5% and through Month 18 for 80.3% (after one retreatment) with needle or cannula administration. Safety outcomes were reassuring.

Paradoxical Adipose Hyperplasia Following Cryolipolysis.

Aesthetic Surgery Journal

Cryolipolysis (CL) is a noninvasive technique that uses applicators to cool tissue to temperatures that selectively destroy adipocytes. Since its i...

Disulfiram Improves Fat Graft Retention by Modulating Macrophage Polarization Via Inhibition of NLRP3 Inflammasome-Mediated Pyroptosis.

Aesthetic Surgery Journal

Macrophage-mediated inflammatory response in the early post-grafting period restricts fat graft retention. Pyroptosis is a novel type of programmed cell death that extensively participates in inflammatory pathologies.

This study sought to determine whether macrophage pyroptosis is activated during the inflammatory phase after fat grafting and to investigate the efficacy of a pyroptosis inhibitor, disulfiram (DSF) in fat graft retention.

We established a C57BL/6 mice fat grafting model and then analyzed macrophage pyroptosis. DSF (50 mg/kg, every other day) was intraperitoneally injected started from 1 h prior to fat grafting and continued for 14 days. An in vitro co-culture system was established in which mouse RAW264.7 macrophages were co-cultured with apoptotic adipocytes to further validate the findings of the in vivo studies and to explore the underlying mechanisms.

Here we reported that macrophage pyroptosis was activated in both fat grafts and in vitro co-culture models. DSF was found to be a potent pyroptosis inhibitor to promote M2 macrophage polarization. In addition, DSF was demonstrated to enhance vascularization and graft retention.

Our results suggested that pyroptosis plays a crucial role in the inflammatory cascade within fat grafts. DSF, being a clinically available drug could be translated into a clinically effective drug for improving fat graft survival via inhibiting macrophage pyroptosis, thereby inducing M2 macrophage polarization and promoting neovascularization.

Risks and Complications Rate in Liposuction: A Systematic Review and Meta-Analysis.

Aesthetic Surgery Journal

Liposuction is a surgical procedure used to remove localized excess adipose tissue. According to The Aesthetic Society's annual report, liposuction...

Biologics for Treatment of Pityriasis Rubra Pilaris: A Literature Review.

Journal of Cutaneous Pathology

To describe the published efficacy and adverse event rates associated with existing biologics for the treatment of pityriasis rubra pilaris (PRP).

A literature review using the PubMed database (January 1990-July 2023) was conducted. Multiple search combinations were conducted using "pityriasis rubra pilaris" and various biologics as keywords to identify relevant articles.

Inclusion criteria included all study types that were published within the past 30 years in English and mentioned at least one biologic and PRP. A preliminary search yielded a total of 499 results. After screening using inclusion and exclusion criteria, 77 relevant articles (69 case reports, 5 case series, 2 clinical trials, and 1 retrospective analysis) were analyzed.

TNF-α inhibitors have been evaluated and are effective in treating PRP. However, recent treatment with anti-interleukin (IL)-17 and anti-IL-23 therapies such as ustekinumab, secukinumab, and ixekizumab are emerging as new treatment options with a mean improvement in PRP Area and Severity Index scores, change in severity of erythema, scaling, and thickness of PRP lesions. From initial clinical trials, secukinumab and ixekizumab are promising treatment options for achieving remission.

This review compares the efficacy for numerous biologics and a discussion to guide clinicians on benefits and risks in choosing a biologic for PRP patients.

Biologics may be a favourable treatment option leading to greater patient adherence due to reduced dosing frequencies, improvement in quality of life, and reduction in frequency and severity of flares.