Aesthetic Surgery Journal

Ventura, Carlo; Bondioli, Elena; de Vita, Roy; Rigotti, Gino; Morigi, Federico; Scarpellini, Francesca; Di Fede, Francesca; Nanni-Costa, Alessandro; Melandri, Davide

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae192pmid: 39302643

BackgroundUtilization of autologous adipose tissue transplantation in plastic and orthopedic surgery such as breast reconstruction and intra-articular injection has become an attractive surgical treatment with satisfactory clinical outcomes. Nevertheless, repeated liposuctions necessary to harvest fatty tissue, normally performed with sedation or general anesthesia, may represent a noteworthy concern.ObjectivesThe aim of this study was to demonstrate through an in vitro characterization the validity of the surgical option of cryopreserved autologous adipose tissue harvested in a single shot for repeated graft transfer in breast reconstruction without impairment of cell viability and sterility.MethodsAdipose tissue was collected by standard liposuction from patients who needed numerous fat grafting procedures for breast reconstruction. According to an innovative and patented cryopreservation method, autologous adipose tissue was subsequently fractioned in a sterile bag system and frozen at the RER Tissue Bank of the Emilia Romagna Region. Each graft was evaluated for sterility and cell viability immediately after harvesting, and 1, 3, 6, 12, and preliminarily 18 months after cryopreservation and thawing.ResultsIn vitro results showed that after processing, middle-term and long-term cryopreservation, and subsequent thawing, autologous cryopreserved adipose tissue retained absence of bacterial contamination, high cellular viability, and unmodified histomorphological properties, thereby ensuring maintenance of the stromal vascular niche and the filling properties in different multistep surgical procedures.ConclusionsIn vitro study and sterility assessment showed that autologous cryopreserved adipose tissue grafting is a safe procedure, making it possible to avoid multiple liposuction surgery. No impairment of sterility, cell viability, or morphology was observed over time.

Almadori, Aurora; Fung, Sze Ching; Denton, Christopher P; Butler, Peter E M

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae200pmid: 39325728

BackgroundOrofacial modifications occurring in systemic sclerosis are detrimental for patients, but the therapeutic options are limited.ObjectivesThis systematic review aimed to perform an up-to-date appraisal of the literature focusing on fat grafting and other adipose stem cell–based therapies for the treatment of facial systemic sclerosis, determining its efficacy and safety, and investigating the current practice for treatment optimization.MethodsThe review was prospectively registered in PROSPERO (CRD42021286268) and followed the PRISMA principles. Multiple databases were searched and only original studies were included.ResultsOver the 12 studies matching the inclusion criteria, 174 patients were treated. Of these, 87.3% (n = 152) were considered to have improved. The complications, graded with the Clavien-Dindo grading system, were Grade 1 (no treatment required) or Grade 2 (antibiotic required). Patients received a mean [standard deviation] of 2.5 [3.68] (median, 1.35; range, 1-14) lipotransfer procedures. Overall, an average volume of 14.60 [6.24] mL was injected in the facial area (median, 16 mL; range, 3-27 mL). The average interval between procedures was 5.30 [2.04] months (median, 6 months; range 3-6.91 months). At the time of inclusion, patients were diagnosed with scleroderma disease on average after 14.7 [7.35] years.ConclusionsFat grafting for facial systemic sclerosis is effective and safe. The definitive durability of the effect is still unclear, and the optimal number of treatments must be determined to define a precise evidence-based protocol. The body of evidence is highly fragmented, with disagreements over surgical techniques and outcome assessments, making results from different studies often not comparable. The level of evidence is overall low or very low, and the risk of bias of published studies is overall medium to high. Randomized controlled trials are urgently needed.Level of Evidence: 3 (Therapeutic)

Martin, Serena; Nugent, Nora; Pacifico, Marc D

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae169pmid: 39058328

Good communication with patients is essential in aesthetic surgery. In particular, the challenge of expectation management is crucial to optimizing patient satisfaction, which may be irrespective of objective outcomes. Experienced plastic surgeons inevitably refine their consultation process and hone their communication skills throughout years of practice. The invaluable “pearls” that expert surgeons develop would be beneficial to all surgeons, and particularly to those early in their practice. This prompted the authors to explore whether the communication skills acquired by a selected group of highly regarded plastic surgeons could be condensed and categorized in a way from which others could benefit. We seek to demonstrate that there are a select number of core messages that many plastic surgeons desire to communicate, particularly during the preoperative consultation process. Various phrases and aphorisms have been formulated within these subtopics that we hope will be positively incorporated into colleagues’ practices to improve the patient experience, and ultimately patients’ understanding of and satisfaction with their outcomes.

Gallo, Lucas; Churchill, Isabella F; Leveille, Cameron F; Coroneos, Christopher J

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae197pmid: 39312714

Aktar Ugurlu, Gulay; Ugurlu, Burak Numan; Yalcinkaya, Meryem

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae204pmid: 39365026

BackgroundBotulinum toxin type A (BoNT-A) injections are widely administered for facial rejuvenation, but their effects on facial expressions remain unclear.ObjectivesIn this study, we aimed to objectively measure the impact of BoNT-A injections on facial expressions with deep learning techniques.MethodsOne hundred eighty patients age 25 to 60 years who underwent BoNT-A application to the upper face were included. Patients were photographed with neutral, happy, surprised, and angry expressions before and 14 days after the procedure. A convolutional neural network (CNN)-based facial emotion recognition (FER) system analyzed 1440 photographs with a hybrid data set of clinical images and the Karolinska Directed Emotional Faces (KDEF) data set.ResultsThe CNN model accurately predicted 90.15% of the test images. Significant decreases in the recognition of angry and surprised expressions were observed postinjection (P < .05), with no significant changes in happy or neutral expressions (P > .05). Angry expressions were often misclassified as neutral or happy (P < .05), and surprised expressions were more likely to be perceived as neutral (P < .05).ConclusionsDeep learning can effectively assess the impact of BoNT-A injections on facial expressions, providing more standardized data than traditional surveys. BoNT-A may reduce the expression of anger and surprise, potentially leading to a more positive facial appearance and emotional state. Further studies are needed to understand the broader implications of these changes.Level of Evidence: 4 (Therapeutic)

Rams, Daniel J; Koziej, Mateusz; Green, Jeremy B; Biesman, Brian S; Szczepanek, Elżbieta; Popiela, Tadeusz J; Ostrogórska, Monika; Gleń, Agnieszka; Rohrich, Rod J; Alfertshofer, Michael; Cotofana, Sebastian

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae202pmid: 39351911

BackgroundGlabellar contraction patterns were introduced to the scientific literature to help guide glabellar neuromodulator injection algorithms. However, the relationship between the underlying musculature and its influence on these glabellar contraction patterns is unclear.ObjectivesThe aim of this study was to identify by magnetic resonance imaging (MRI) glabellar muscle parameters that display an influence on the distribution of individual glabellar contraction patterns.MethodsThirty-four healthy young individuals of Caucasian Polish descent were investigated (17 females, 17 males) with a mean age of 23.6 years and a mean BMI of 22.8 kg/m2. MRI-based measurements of length, thickness, width, and surface area of procerus, corrugator supercilii, orbicularis oculi, and frontalis muscles were conducted.ResultsUnadjusted models revealed that there was no statistically significant difference between the 5 glabellar contraction types and the investigated muscle parameters, indicating that, independent of the skin rhytid pattern, the underlying musculature was not different between the investigated groups in this sample, with all P ≥ .102. Adjusted models revealed that sex was the most influential factor, with males generally displaying higher values for the investigated parameters than females.ConclusionsThe results of this study reveal that, based on the MRI parameters investigated and the investigated cohort, there does not appear to be a strong relationship between glabellar contraction patterns and underlying glabella muscle anatomy. Utilizing glabellar contraction patterns to design neuromodulator treatment algorithms may be of variable clinical merit.Level of Evidence: 3 (Therapeutic)

Tang, Wei-Zhen; Chen, Xue-Bing; Liu, Tai-Hang

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae194pmid: 39277178

Park, Hyun Jin; Paulsen, Friedrich; Kim, Hongtae; Hur, Mi-Sun

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae176pmid: 39116358

BackgroundUnderstanding the attachment patterns of the corrugator supercilii (CS) muscle is vital for treatments designed to improve facial symmetry and functionality.ObjectivesThe aim of this research was to elucidate the anatomical trajectory and intricate relationships of the CS within the upper face and midface, specifically focusing on its connections with the frontalis (FT) and orbicularis oculi (OOc) muscles.MethodsThe CS was examined in 41 specimens of embalmed adult Korean cadavers with microdissection, histological analyses, and microcomputed tomography, performing an in-depth exploration of its anatomical positioning and the intricate interactions with adjacent muscles.ResultsSome lower fibers of the CS extended to the upper orbital part of the OOc in 59.5% of cases, while the CS interdigitated or blended exclusively with the FT in 40.5% of cases. The fibers of the CS demonstrated diverse extensions toward the upper face and midface, exhibiting varied trajectories and lengths. Additionally, lower fibers of the CS extended to significant anatomical landmarks such as the OOc, malaris muscle, and the superficial musculoaponeurotic system (SMAS).ConclusionsIn this study, we demonstrate that precise understanding of the CS and its relationship with the FT and OOc is crucial for optimizing invasive or noninvasive treatment like botulinum toxin injection, SMAS lifting, and browplasty surgery. The extension of lower fibers of the CS to significant anatomical landmarks indicates complex interactions with adjacent facial structures, highlighting the necessity of detailed anatomical knowledge for clinical applications.

Abi-Rafeh, Jad; Bassiri-Tehrani, Brian; Arezki, Adel; Schafer, Charles; Baker, Nusaiba; Nahai, Foad

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae181pmid: 39163270

BackgroundAlthough there exists ample evidence on the impact of perioperative blood pressure on hematoma incidence following facelift, the association of elevated or labile intraoperative blood pressure with postoperative hematoma remains to be explored.ObjectivesThe authors evaluated the association of elevated or labile intraoperative systolic blood pressure (SBP) with postoperative hematoma, based on the senior author's single surgeon experience of 118 consecutive facelifts.MethodsA multivariate logistic regression was conducted using complete demographic, procedure-related, blood pressure–related, and outcomes-related data, with the outcome of interest representing postoperative hematoma. One-way analysis of variance and linear regression analyses were performed to assess for significant associations between a preoperative history of hypertension and a tendency to demonstrate elevated or labile intraoperative SBP. A Fisher's exact test was subsequently applied to assess for specific intraoperative SBP measurement cutoffs significantly associated with postoperative hematoma, including maximum recorded intraoperative SBP, and the specific degree of intraoperative SBP fluctuation.ResultsMultivariate logistic regression demonstrated no statistically significant patient- or procedure-related demographic predictors of postoperative hematoma. With aggressive treatment of preoperative hypertension, high preoperative SBP was not found to be a significant predictor of postoperative hematoma following facelift, although this approached statistical significance (P = .05). In contrast, labile intraoperative SBP (maximum recorded intraoperative SBP minus minimum recorded intraoperative SBP; P = .026) and high immediate postoperative SBP (P = .002) were both independent and statistically significant predictors of postoperative hematoma. Patients with a preoperative history of hypertension, and more specifically those with elevated SBP measurements in the preoperative clinic, were more likely to demonstrate labile (P = .007) or elevated (P = .005) intraoperative SBP during facelift surgery. Specifically, maximum recorded intraoperative SBP ≥155 mmHg (P = .045) and maximum intraoperative SBP fluctuations ≥80 mmHg (P = .036) were found to be significantly associated with hematoma.ConclusionsA multimodal approach is necessary to control perioperative systolic blood pressure within the strict <120 mmHg target demonstrated to significantly decrease hematoma incidence. The senior author's preference is for intraoperative SBP to remain within a strict 90 to 100 mmHg range. In contrast to hypertension that is aggressively treated and successfully controlled, hypertension that is difficult to control intraoperatively may be a predictor of systolic blood pressure that is difficult to control postoperatively, and therefore a significant risk factor for postoperative hematoma following facelift.Level of Evidence: 4 (Therapeutic)

Swanson, Marco; DeLeonibus, Anthony; Ku, Ying; Guyuron, Bahman

2024 Aesthetic Surgery Journal

doi: 10.1093/asj/sjae153pmid: 39012964

BackgroundFor an optimal aesthetic plan for correction of nasal tip disharmony, it is crucial to note lip and tip disproportions.ObjectivesIn this study we sought to investigate the incidence of preoperative upper lip malposition in primary rhinoplasty patients.MethodsIn total, 150 consecutive primary rhinoplasty patients were included. The position of the upper lip was measured during smiling relative to the incisors and gum line, and categorized as ideal, inadequate incisor show, or excessive gum show. Nasal length was categorized based on soft tissue cephalometic analysis of life-size photographs as long, ideal, or short. Tip projection was categorized as overprojected, ideal, or underprojected. The columella was categorized as hanging, ideal, or retracted.ResultsStandardized photographs of 139 primary rhinoplasty patients met inclusion criteria. Forty-seven (34%) patients had an ideal upper lip position, 83 (61%) inadequate incisor show, and 7 (5%) excessive gum show. Sixteen (12%) had a short nose, 45 (33%) ideal length, and 76 (55%) a long nose. Fourteen (10%) had an underprojected tip, 38 (28%) had an ideal tip projection and 85 (62%) an overprojected tip. None of the nasal parameters were predictive of upper lip position. Tip overprojection (odds ratio [OR] 3.03, P = .02) and hanging columella (OR 2.97, P = .001) were predictive of a long nose. Tip underprojection was predictive of short length (OR 35, P < .0001).ConclusionsThere is a high incidence of upper lip malposition in patients undergoing primary rhinoplasty. It is vital for the rhinoplasty surgeon to identify it preoperatively and plan the surgical maneuvers accordingly to prevent exacerbating an insufficient incisor show or excessive gum show.Level of Evidence: 4