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American Journal of Cosmetic Surgery
Number of Followers: 7 Hybrid journal (It can contain Open Access articles) ISSN (Print) 0748-8068 - ISSN (Online) 2374-7722 Published by Sage Publications [1176 journals] |
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Pages: 136 - 136
Abstract: The American Journal of Cosmetic Surgery, Volume 41, Issue 2, Page 136-136, June 2024.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-05-14T06:05:49Z
DOI: 10.1177/07488068241237043
Issue No: Vol. 41, No. 2 (2024)
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- Crescent Mastopexy With Augmentation and Hemi-Interlocking Circumareolar
Mersilene Suture: An Innovative Approach-
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Authors: Hatem Elfieshawy
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Introduction:Safety and patient satisfaction of crescent mastopexy and concurrent primary or revisional augmentation mammoplasty is controversial owing to secondary asymmetry and potential complications involving breast tissue and the nipple-areolar complex (NAC). The primary objective of this case series was to present a new technique that can achieve anatomic integrity and natural morphology of the NAC, while avoiding complications and minimizing scarring and hypertrophic alterations.Materials and Methods:Using white nonabsorbable 3-0 polyester mersilene suture for tension-free closure, the procedure was completed via intradermal insertion of the needleless end of the suture into the circumareolar NAC-skin junction at the inferior segment and an interlocking purse-string or spoke-wheel configuration in the superior segment, juxtaposing the NAC and cutaneous margin, thereby redistributing the tension line from the crescent scar to a circumareolar, cranially repositioned site. Patients were followed at 24 hours, 1, 3, 6, and 12 weeks, and 6 and 12 months. Postoperative pain was patient-measured using the Visual Analog Scale (possible scores ranged from 0 to 10), and esthetic satisfaction was determined by patient surveys (scores 0-5). Follow-up visits involved evaluation of scars, nipple sensation, nipple-areolar perfusion by capillary refill, asymmetry, and hypertrophic and pigmentation changes.Results:Six patients (ages 32-46) underwent 2 primary procedures and 4 revisions between January 2020 and March 2023 and were chosen retrospectively based on inclusion and exclusion criteria. One revision was completed using the traditional method while the rest were completed with the new technique. Surgical times ranged from 15:34 to 17:35 minutes, with patients reporting minimal initial and postoperative pain, high patient satisfaction, and reduced scar visibility. All patients reported postoperative pain assessments as negligible initial pain on days 0 to 3 (0) and 1 to 2 on days 4 to 7, with 1 patient scoring pain as 2 to 3. Scar visibility was minimal (
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-07-31T12:19:26Z
DOI: 10.1177/07488068241264174
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- Buccal Fat Pad Excision for Cheek Contouring: A Systematic Review
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Authors: Noah Pierzchajlo, William Clifton, Chandler Hinson, Catherine Kemeness, Toni Rogers, Victoria N. Bouillon, Ronald M. Brooks
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Introduction:Buccal fat pad (BFP) excision (bichectomy) or lipolysis by injectable deoxycholic acid (brand name, Kybella) is increasingly used procedures for cheek contouring and facial slimming. However, the literature on their effectiveness and safety is inconsistent. The most recent review was published over 5 years ago; however, the study was limited, did not include injectable lipolysis, and available literature has doubled since its publication. Thus, an updated systematic review is needed to provide a comprehensive evaluation of these procedures.Methods:Aligned with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, a literature review with pre-determined search terms was conducted with 5 major medical journal databases from 1975 to March 2023. We were unable to conduct a meta-analysis due to limited reporting.Results:Our initial search yielded 590 results, with 13 studies meeting criteria for inclusion with a total of 883 patients. All studies performed surgical BFP excision with no studies performing injectable lipolysis. Seven (53%, n = 181) studies reported mean excised volume at 4.01 ± 1.19 grams per side. Two (15%, n = 61) studies assessed mouth opening, noting a combined mean decrease of 28.0 ± 1.93 mm 4 days post-operative and mean decrease of 1.36 ± 4.96 mm 1-month post-operative. Three studies (23%, n = 115) reported a combined mean increase in pain of 2.62 ± 1.63 on a 10-point scale at 72 hours post-operative. Eleven (85%, n = 883) studies reported complications following BFP excision showing complications in 6.8% of patients with 75% of those complications being swelling that resolved spontaneously.Discussion:This review suggests initial patient satisfaction with BFP excision, with only a 6.8% complication rate, primarily consisting of edema that spontaneously resolves. However, concerns regarding bias were raised in 2 of the clinical trials included in this review. Although the original aim was to compare surgical excision to a dissolution technique using deoxycholic acid (DCA), no studies on the DCA were identified that met inclusion criteria. Some authors compared alternative techniques to standard excision, such as hydrodissection and laser-assisted techniques, noting benefits including faster procedures, less pain, and reduced inflammation. Patient age and BFP volume are crucial considerations for appropriate candidate selection, with over excision cautioned against due to natural aging effects.Conclusion:As BFP contouring continues to gain popularity, it is important to continue to monitor outcomes of BFP reduction and its associated complications. It is apparent that more studies are needed in both surgical excision and injectable dissolution to accurately assess this novel procedure.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-07-29T01:52:04Z
DOI: 10.1177/07488068241257732
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- Comparative Сharacteristic of Complications in Smooth and Textured
Implants for Breast Modification Surgeries Performed in Women-
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Authors: Yusufov Stiven Ranbomovich, Yusufova Eteri Ranbomovna, Filimonov Dmitry Alekseevich, Ishchenko Roman Viktorovich
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Introduction:The aim of this study is to comprehensively compare breast modification surgeries using smooth and textured implants in terms of a complication profile.Materials and methods:PubMed, ScienceDirect, Embase, and Cochrane databases were searched for relevant studies reporting complication rates and quality of life on the BREAST-Q questionnaire in groups of patients with smooth and textured implants. The odds ratios of the following complications between the groups were calculated: capsular contracture, hematoma, infection, malposition, seroma, breast rippling, implant rupture, and reoperation rates. And mean differences for BREAST-Q scores were also calculated.Results:A meta-analysis of 14 studies was performed in this article. No significant differences were found in the odds of capsular contracture, malposition, seroma, breast rippling, implant rupture, and reoperation rates between groups. The chance of developing infection was statistically significantly lower with smooth implants. The chance of hematoma development was statistically significantly lower with textured implants. Comparison of BREAST-Q results showed no difference between the groups.Conclusion:Our results suggest that using smooth implants is associated with a lower chance of infection and a higher chance of hematoma development.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-07-28T11:47:11Z
DOI: 10.1177/07488068241253470
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- A Systemic Review of the “Informed Consent” Process for Aesthetic
Cosmetic Surgery Procedures-
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Authors: Jacqueline Maroon, Syeda Zakia Hossain, Lynette Mackenzie
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Informed consent is a foundational component of ethical patient care and may be effectively provided when a competent patient is given pertinent information to make well-informed decisions on their health care. Various studies have considered patients’ experiences with surgery for aesthetic reasons, rather than plastic surgery procedures which are medically warranted for reasons such as restoring form and function. Current empirical discourse on the consenting process, and ultimately how informed patients undergoing cosmetic surgical procedures are, is scant, particularly in Australia. The key aim of this review was to synthesize qualitative and quantitative research which considers the consenting process and the factors which impact on the patient’s decision-making process to undergo invasive cosmetic procedures. Eligible studies were identified via systematic searching across the PubMed and Medline databases; and hand searches were conducted of gray literature databases including university databases and Google Scholar. Reference lists of included studies were also examined for relevant studies. Eligible studies had to meet specific participant criteria including an age requirement of 19 to 64 years and discuss factors or present discussion surrounding the “informed consent” process for invasive cosmetic procedures. The characteristics and findings of each study were extracted. The studies were analyzed and presented under question categories. The Mixed Methods Appraisal Tool was used to assess the quality of evidence. Thirty-one studies were eligible for inclusion. Most studies were quantitative (90.3%). The highest proportion of these studies were focused on the United States (51.6%), followed by the United Kingdom (12.9%). The dominant methodology utilized by these studies was questionnaires/surveys (37.5%). The literature identified was classed into one of the 5 groups based on their overall concepts and objective. These 5 categories included (1) articles focusing on the types of information which should be communicated to a patient before they undergo their procedure or provide consent; (2) legal claims and cases based on a lacking informed consent; (3) sources of information patients access to become “informed” on their procedure; (4) studies exploring the readability of online information on certain invasive cosmetic procedures; and (5) studies focusing on the most effective methods of obtaining patient consent for cosmetic surgery procedures. These categories were reformulated into research questions and addressed in the section “Results of the Findings.” Most of the studies included in this review were quantitative (90.3%). Most studies (where gender was mentioned) had a higher population of female participants or respondents. Women have a greater tendency to have cosmetic surgery opposed to men. There are few studies (particularly qualitative studies) exploring the pre-operative patient experience in Australia for those having or seeking cosmetic surgery. A key stage in this process is obtaining and providing informed consent. A “lack of informed consent” is one of the more dominant factors identified consistently throughout these studies which focus on legal case reviews and claims. A significant source of information patients use to become informed of their procedure is through the Internet. This may be problematic as the readability of online materials is most commonly above the recommended reading level in multiple jurisdictions; and some online materials may have questionable accuracy or validity. Whether or not patients verify the information they access through external sources such as this, is of concern. There have been minimal studies identified exploring the patient experience pre-operatively including during their consultations and decision to provide consent.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-06-18T05:05:53Z
DOI: 10.1177/07488068241260771
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- Patient Advisory on Medical Tourism for Brazilian Butt Lift
Procedure—Ensuring Patient Safety in Cosmetic Surgery: The Importance of
Training and Expertise-
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Authors: Allison N. Laffoon, Wilbur Hah, Alton E. Ingram
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-06-06T06:12:52Z
DOI: 10.1177/07488068241259133
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- Staged Periorbital Reconstruction for Cicatricial Lagophthalmos
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Authors: Scott Bueno, Timothy Neal, Randy Sanovich
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Introduction:Eyelid trauma can present reconstructive challenges for facial surgeons. The authors postulated that treating cicatricial lagophthalmos with protective ptosis in the acute setting prior to definitive grafting could help limit scar contraction.Material and Methods:This is an observation of a patient who benefited from a staged approach to periorbital reconstruction after suffering extensive facial trauma. Informed consent was appropriately obtained from the patient.Results:After treating the periorbital injury in staged fashion, an aesthetically acceptable result was achieved and was well-tolerated by the patient.Discussion:Disruption of the periorbital region, particularly the eyelids, can have severe functional and aesthetic consequences. One such disruption is lagophthalmos. Neurotoxin-induced protective ptosis is a well-known strategy that can be used as the initial treatment in a staged approach to cicatricial lagophthalmos.Conclusion:Treating lagophthalmos with protective ptosis in the acute setting prior to definitive grafting is not only a means of avoiding tarsorrhaphy but also it can allow time for the wound to declare itself and limit scar contraction. In addition, the contralateral eyelid represents both a complimentary skin graft harvest site as well as an opportunity to create a symmetrical repair.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-06-03T06:34:18Z
DOI: 10.1177/07488068241254158
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- Current Advances in Artificial Intelligence in the Field of Aesthetic
Surgery and Breast Augmentation: Short Review-
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Authors: Senthil Kumar Supramaniam
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Study design:This review is structured as a systematic analysis of the literature to evaluate the impacts of artificial intelligence (AI) on the field of plastic surgery, with a focus on breast augmentation and aesthetic surgical procedures. Key areas of exploration include advancements in machine-learning techniques relevant to plastic surgery, the integration of AI into preoperative planning processes, and the historical evolution of AI in aesthetic surgery. The review also systematically assesses current AI tools specifically developed for breast augmentation, such as 3D imaging and predictive analytics, to understand their efficacy and role in clinical practice.Objective:This article explores the current state and future prospects of AI in plastic surgery, with a focus on breast augmentation and aesthetic procedures. Emphasis is placed on the benefits, challenges, and the imperative for collaborative efforts in the integration of AI technologies.Methods:Advancements in machine-learning algorithms and AI technologies are examined for their potential in automating the assessment and enhancement of surgical skills. The role of AI in facilitating objective evaluations in aesthetic surgery is discussed, addressing challenges such as the lack of standardized training datasets and integration issues. The importance of mitigating potential biases introduced by AI to ensure objectivity in patient assessments is highlighted.Results:The article discusses the historical evolution of AI, from Alan Turing’s conceptualization to contemporary applications in aesthetic surgery. Artificial intelligence’s ability to analyze vast patient datasets is explored, showcasing its potential for offering personalized treatment recommendations and improving accuracy over time. Specific AI tools for breast augmentation, including Canfield Mirror, QuantifiCare LifeViz Infinity Pro, Crisalix, BreastGAN, Arbrea Breast Software (ABS), and Deep Surface AI, are examined in detail, emphasizing their advantages and drawbacks.Conclusions:Evaluation of clinical photography techniques, relying on specific hardware, is presented, with consideration given to the potential of AI-based illumination systems to enhance consistency in preoperative images. The review concludes by envisioning the transformative future of AI in aesthetic surgery, considering its untapped potential in diagnostic imaging, personalized treatment plans, and enhanced surgical precision through integration with virtual and augmented reality. Despite challenges, the promises of AI in personalized treatments, precise patient care, and improved surgical assistance suggest a transformative future for plastic surgery, contingent on addressing current concerns. Collaborative efforts are deemed essential for the successful implementation of AI technologies in the field.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-05-07T10:54:14Z
DOI: 10.1177/07488068241245520
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- The “Angel-Wing” Combined Labia Minoraplasty/Majoraplasty
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Authors: Michael P. Goodman
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Background:Reduction of prominent/hypertrophic/ptotic vulvar labia minora and/or labia majora is an increasingly common surgical procedure in the hands of plastic and cosmetic surgeons and female genital cosmetic and reconstructive surgeons. While several techniques for these reductions are described in the literature and are individually modified by experienced practitioners, 2 procedures for the minora (linear and wedge-type reductions), and the vertically-aligned reduction of redundant majora are the most utilized techniques. It is not unusual for a woman to present to her potential surgeon requesting “work” on both minora and majora. Historically, this has necessitated two separate incision lines (minora and majora) bilaterally, often resulting in a long case, difficult recovery, and a significant potential for visible incision lines and gaping of the vaginal introitus.Objective:To introduce a novel single-incision-line technique for combining labia minoraplasty and labia majoraplasty.Methods:A modification of a classic central V-Wedge technique is affected by “shifting” the wedge incision line across the interlabial fold to encompass a portion of the medial labum majorum, both reducing redundancy and “lifting” the lowermost portion of the majora to correct ptosis. This is accomplished in one incision line with “en-bloc” closure of both minora and majora, placing the incision line mostly within the interlabial fold.Results:The author has completed eight wedge-type combined labia minora-majoraplasties without complication and with 2.5-36 months of follow-up.Discussion:This modification in Wedge design converts two separate procedures into one, making the surgery both less time-consuming, easier to recover from, and more visually esthetic for those patients who are capable of the more rigorous recovery protocol that wedge procedures mandate.Conclusion:The “Angel-Wing combined labia minoraplasty + labia majoraplasty appears to be a relevant option for combined labia minor hypertrophy and labia majora deflation and redundancy.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-04-23T12:57:49Z
DOI: 10.1177/07488068241243263
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- Footprint Elevation and Fullness of the Upper Pole of the Breast in
Free-Style Reduction Mammaplasty Procedures-
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Authors: Nader Elmelegy
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Background:Despite the significant advances in the reduction mammaplasty fields, they all have drawbacks. A persistent lack of fullness in the upper pole was observed after 6 to 8 months in most of the instances given by the pioneers. The author’s goal was to enhance the cosmetic aspect of the breast and to achieve this goal; they searched for a superior approach that could provide upper pole fullness over the long term.Patients and methods:The project aimed to achieve all the other objectives of breast reduction while also enhancing the footprint elevation and fullness of the upper pole in free-style reduction mammaplasty surgeries. This study was carried out on 117 patients between February 2015 and July 2021.Results:In this study, the upper breast border produced an esthetically acceptable upper border in 114 (97.4%) cases for 2 to 7 years, whereas the outcomes were unsatisfactory for 4 patients (2.6%).Conclusions:The second rib, the second intercostal space, the third rib, the third intercostal space, or more are the possible starting levels of the upper border of the breast footprint. By severing the superior breast ligament and attaching the medial and lateral pillars to the pectoral fascia at the level of the second rib, the upper border of the breast can be stably elevated.Level of Evidence:IV therapeutic
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-04-23T09:04:29Z
DOI: 10.1177/07488068241246392
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- Patient Satisfaction After Cosmetic Breast Surgery Utilizing the Free
Nipple Graft Technique-
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Authors: Yagnik Pandya, Alberico Sessa, Arya Doshi, Aileen Caceres, Dan Garner
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Introduction:Breast surgery using the free nipple areolar graft (FNG) technique is a less frequently utilized technique; however, a very safe alternative to other available dermoglandular pedicles when nipple areola vascularity is of concern. One of the drawbacks with FNG technique is the loss of tactile sensation and the overall postoperative esthetic appearance of the nipple areola complex (NAC).Objective:Our aim was to study patient satisfaction, specifically in regard to NAC sensation and esthetic appearance of the NAC in patients who underwent breast surgery utilizing the FNG technique.Study Design:This study is a case series of patients undergoing cosmetic breast procedures utilizing the FNG technique. Postoperative outcomes were evaluated both by the clinician and the patient by completing a survey questionnaire.Methods:We conducted a 3 month postoperative patient satisfaction survey utilizing a questionnaire in 74 patients who underwent various cosmetic surgical procedures on the breast using the FNG technique. Patients were also objectively evaluated by a physician during the same visit. Patients rated their NAC sensation and esthetic appearance on a scale of 1 to 5 and 1 to 10, respectively, and the physician rated the NAC loss on a scale of 1 to 5. Results were reported as percentages of total patients in each group.Results:Our results indicated that over 85% of patients in our study had more than 50% tactile sensation to the NAC at 3 months. We also found that over 75% of patients were very satisfied with the esthetics of the NAC after these procedures.Conclusions:We conclude that the risk of sensation loss to the NAC and patient satisfaction in regard to esthetic appearance of the NAC is better than what is believed to be and that the FNG technique may possibly be an underutilized tool in the surgeon’s toolbox.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-04-22T09:09:47Z
DOI: 10.1177/07488068241241118
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- Quality Improvement Versus Research: When Do You Need an Institution
Review-
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Authors: Michael T. Goupil, Elie M. Ferneini
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-04-16T06:01:20Z
DOI: 10.1177/07488068241245494
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- Quantification of Gravitational Effects on Nasal Tip Geometry
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Authors: Victor B. Hsue, Wasiq Nadeem, Ariel Azhdam, Gene Liu, Henry Chen, Matthew K. Lee
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Introduction:It is widely accepted in plastic surgery that patient positioning can affect the geometry of the nasal tip due to downward gravitational forces. However, empirical data supporting this principle is lacking. The primary objective of this study is to quantify gravitational effects on nasal tip geometry by calculating changes in tip rotation and projection between the supine and upright positions. This analysis will help further assess whether gravity affects the actual positional rotation of the nasal tip or if its impact is solely relative to neighboring landmarks.Methods:This study is a prospective case series that obtains upright and supine nasal measurements in 20 subjects. The nasolabial, nasofrontal, and columellar-facial angles, as well as the Goode, Crumley, Simon, and Powell ratios are used to calculate nasal tip rotation and projection changes.Results:Mean nasolabial angle demonstrated a statistically significant tip derotation of 3.2° in the upright position relative to supine. Mean nasofrontal angle and mean columellar-facial angle did not significantly differ between positions. The nasal tip appeared relatively less projected in the upright position using the Simon and Crumley methods, whereas no significant difference was seen with the Powell and Goode methods.Conclusion:Gravity can influence the apparent nasal tip geometry by altering lip position and length, but it does not impact the true nasal tip geometry when the upper lip is excluded as a reference point.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-04-16T05:59:41Z
DOI: 10.1177/07488068241245389
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- High-Definition Liposuction Contouring of the Arms in Males and Females
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Authors: Sarah Young, Chris Lowery
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Liposuction is one of the most common esthetic procedures performed in both males and females. High-definition liposuction has become more sought after recently, especially to define the arms and abdominal musculature. This is a case report of high-definition liposuction of the arms to create markings and techniques to obtain a muscular and sculpted appearance of the arms. Between July 2022 and October 2023, 6 patients were selected for high-definition liposuction to bilateral arms. Specific pre-operative markings were made to outline the deltoid, biceps, and triceps. Traditional liposuction with focus on liposculpture of these markings was done to define the muscles of the arms. Results showed that with proper selection, pre-operative markings, and adequate technique of liposculpture, the muscles of the arms can be defined to meet patient expectations and give a more athletic appearance.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-04-11T06:10:06Z
DOI: 10.1177/07488068241244955
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- Periareolar Mastopexy: A Historical Appraisal of Technique and Further
Technical Refinements Toward Reliable, Lasting, and Reproducible Results-
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Authors: Kwok Hao Lie, Darryl J. Hodgkinson
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Introduction:Since its first description in 1976, periareolar mastopexy has attained a negative perception due to perceived high rates of unsatisfactory outcomes. The 2 main reported problems are (1) periareolar scar widening and (2) poor breast shaping. It is the author’s experience that with appropriate refinements in surgical technique based on sound anatomical and surgical underpinnings, good breast shaping and areolar aesthetics can be reliably achieved. This article describes innovations in the technique to improve outcomes, followed by a description of our own technique and refinements over the senior author’s 40-year journey.Materials and methods:A literature review of technical refinements in periareolar mastopexy surgical technique was undertaken. Suggested refinements from various authors were then placed in the context of the senior author’s own clinical experience and evolution of technique over 40 years. Representative case studies from the author’s personal series are then presented to illustrate technical pearls and results.Results:Four illustrative cases are discussed, along with a comprehensive description of the senior author’s technique and underlying principles.Discussion:Early techniques of periareolar mastopexy were plagued by poor breast shaping and areolar distortion. Progressive refinements in technique over the last 50 years have steadily improved surgical outcomes.Conclusion:By combining various published refinements into a single operation, it is now possible to reliably achieve good aesthetic outcomes and avoid previous problems, as shown by the author’s own case series.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-03-01T04:54:34Z
DOI: 10.1177/07488068241228732
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- Gluteal Fat Grafting Technique and Mortality Update Among Surveyed ABCS
Surgeons-
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Authors: A. Cuzalina, P. Mostofi, W. Hah
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Background:The demand for gluteal fat grafting (colloquially known as Brazilian butt lift [BBL]) has seen a dramatic increase in the past decade. Brazilian butt lift has been the fastest-growing cosmetic procedure in the United States for several years. During this time, the incidence of pulmonary fat embolisms (PFEs) associated with this procedure has raised safety concerns. Several professional organizations have responded to these concerns with investigational reports to identify the causes and provide recommendations to decrease the mortality associated with this popular cosmetic procedure. Awareness and implementation of these safety recommendations have been a cornerstone to decreasing the mortality rate associated with gluteal fat grafting.Objectives:To provide a comparison of current technical approaches and a mortality update on gluteal fat grafting among surgical members from the American Board of Cosmetic Surgeons (ABCS) within the last 6 years. Also, to determine if specific technical changes in the manner this procedure is performed are improving safety.Methods:An online (emailed) survey regarding perioperative gluteal fat grafting techniques and postoperative outcomes performed by ABCS surgeons within the previous 3 years was collected in 2 different 3-year time frames. Initial data were collected in 2019 for the preceding 3 years 2016-2019. The survey was again repeated in 2022 to collect similar data as before from ABCS member years 2019-2021. The data, which included the total # of BBLs performed, incidence of major infection or fat emboli, cannula size, and injection methods details was compared for each 3-year period. Both sequential studies provided a comparison of the techniques employed as well as morbidity and mortality outcomes.Results:Sixty-four ABCS surgeons who reported performing BBLs responded to the survey in 2019 and reported performing a total of 22 800 (BBLs) gluteal fat grafting cases in a previous 3-year window from 2016 to 2018. More surgeons used a closed system peristaltic pump in the second part of the study as compared to the first (51% vs 22%) (P < .01). Two cases required in-hospital treatment of infection in the first survey while zero cases were reported for the second survey period (P = .07). Twenty-five of 64 (39%) reported injecting fat at least into superficial gluteal muscle during this earlier time frame. In this earliest study, there were 3 total cases of PFE reported (2 fatal PFEs and 1 nonfatal PFEs). In 2022, 85 ABCS surgeons who reported performing BBLs responded to the survey. Around 12 172 gluteal fat grafting cases were reported in the second 3-year study from 2019 to 2021 compared to 22 800 in the first study (P < .01). There was a total of 34 972 BBLs during the entire 6-year study. Most surgeons (82 of the 85) in the second-phase 3-year study reported injecting fat “exclusively” above the muscle (P < .01). There were no fatal and non-fatal PFEs reported in the follow-up 3-year study in 2022 of ABCS member data from 2019 to 2021 (P = .03).Conclusions:The mortality report associated with gluteal fat grafting from this survey among surgical members of the ABCS suggests using the current safety recommendations proposed, including injection of fat in the subcutaneous layer only, have led to a decreased risk of PFEs associated with gluteal fat grafting. The mortality rate was zero (0 out of 12 800) when 96% were injecting above muscle only compared to a mortality rate of 1:11 400 (2 of 22 800 cases) when 39% of 22 800 BBLs performed had fat injected into muscle. While there were more BBLs performed during the earlier 3-year study (P = .07). The mortality rate significantly decreased in the years when only a small minority of cases had fat injected into the muscle. This study adds to other existing literature from professional organizations’ reports on the safety of gluteal fat grafting using the proper safety measure and recommendations.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-02-16T08:21:22Z
DOI: 10.1177/07488068231215113
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- Standarized Protocols for Hybrid Filler Application in Aesthetic Medicine
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Authors: Nabil Fakih-Gomez, Cristina Muñoz-Gonzalez, Carmen Alejandra Porcar Plana, Alba Verano Garcia, Jonathan Kadouch
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Introduction:This study introduces protocols for using hybrid fillers (mixing calcium hydroxylapatite and hyaluronic acid) in facial, jaw, neck, and hand aesthetic treatments. The goal is to establish clear, standardized procedures to enhance effectiveness and safety.Methods:The study outlines detailed protocols for using hybrid fillers in aesthetic treatments, covering patient selection, injection techniques, and posttreatment care for face, jaw, neck, and hands.Results:The detailed descriptions empower clinicians with insights to implement standardized approaches using hybrid fillers. They aim to optimize procedural accuracy and effectiveness while reducing the risk of complications.Conclusions:The hybrid filler protocols standardize aesthetic treatments, aiding in optimal outcomes and guiding clinicians in enhancing their practice. In addition, these protocols serve as a valuable reference, offering comprehensive guidelines for future research in the realm of hybrid filler utilization in aesthetic medicine.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-01-22T09:32:41Z
DOI: 10.1177/07488068241227278
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- Modified Posterior Triple Scoring as a Refinement Technique in Creating
Aesthetic Antihelical Fold in Otoplasty-
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Authors: Kenneth Brito, Michael Zacharia
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Objective:To develop a precise and reliable technique in addressing underdevelopment of antihelical fold in patients with prominent ears.Background:Prominent ears remain to be a common presentation in aesthetic surgery. Multiple otoplasty techniques addressing the antihelical fold have been developed, but no standard technique is globally adopted. Creating a uniformly even, defined and smooth-edged antihelical fold without retropulsion of helix can be at times challenging and difficult to achieve. This study describes a modified way of refining a desirable antihelical fold by posterior triple scoring technique.Methods:A posterior approach was developed to access the posterior surface of antihelix and apply strategic triple linear scoring in conjunction with conchal repositioning. Ten patients underwent this procedure and followed up in 1-month and 1-year periods.Results:All patients were satisfied with the procedure. None of the patients developed complication or require secondary otoplasty.Conclusion:This novel technique provides a simple yet reliable and precise technique in conjunction with conchal setback or as a standalone procedure in selected patients to achieve the aesthetic curves of the external ear. We suggest this technique as an option to address the underdevelopment of antihelical fold in patients with prominent ears.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-01-19T12:01:48Z
DOI: 10.1177/07488068231225058
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- Artificial Intelligence and Deep Learning in Preservation Rhinoplasty: A
Review-
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Authors: Shohreh Ghasemi, Mahmood Dashti
Abstract: The American Journal of Cosmetic Surgery, Ahead of Print.
Study Design:This review explores the potential applications of artificial intelligence (AI) and deep learning in preservation rhinoplasty. Preservation rhinoplasty is a surgical technique that aims to enhance the aesthetic appearance of the nose while preserving its natural structures and functions. Artificial intelligence and deep learning offer new avenues for improving surgical planning, intraoperative guidance, and postoperative analysis in this specialized field.Objective:The objective of this review is to examine how AI and deep learning can enhance preservation rhinoplasty by providing tools for precise surgical planning, real-time guidance during surgery, and comprehensive postoperative analysis.Methods:The review synthesizes information from relevant studies and articles in the field of rhinoplasty, AI, and deep learning. It discusses the potential benefits and challenges associated with the integration of AI into preservation rhinoplasty, drawing from the literature and expert insights.Results:The review highlights several key findings:Surgical Planning:Artificial intelligence can analyze preoperative imaging data to assist surgeons in planning the procedure accurately. It can predict postoperative outcomes and enhance discussions with patients.Intraoperative Guidance:Artificial intelligence can provide real-time guidance to surgeons, ensuring the preservation of natural nasal structures during surgery.Postoperative Analysis:Artificial intelligence can automate the analysis of postoperative images and patient-reported outcomes, aiding in assessing surgical success and patient satisfaction.Challenges and Ethical Considerations:The integration of AI in preservation rhinoplasty should prioritize patient safety, ethical considerations, and validation to ensure its effectiveness.Conclusions:Artificial intelligence has the potential to greatly impact the field of preservation rhinoplasty. Using advanced algorithms and machine learning techniques, AI can assist surgeons in analyzing patient data, predicting outcomes, and optimizing surgical techniques. This technology can help improve surgical precision, reduce complications, and enhance patient satisfaction. However, it is important to note that AI should be seen as a tool to support and enhance the surgeon’s expertise rather than replacing human judgment and experience. As AI continues to evolve, it is crucial for surgeons to stay updated with the latest advancements and incorporate them judiciously into their practice to achieve the best possible outcomes for their patients.
Citation: The American Journal of Cosmetic Surgery
PubDate: 2024-01-09T11:37:28Z
DOI: 10.1177/07488068231224133
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