University Hospital Lewisham (formerly known as Lewisham Hospital) is an acute district general hospital run by Lewisham and Greenwich NHS Trust and serving the London Borough of Lewisham. It is now affiliated with King's College London and forms part of the King's Health Partners academic health science centre. It is situated on Lewisham High Street between Lewisham and Catford.
Nasal aesthetics are central to rhinoplasty outcomes, yet ideals of beauty vary considerably across cultures, ethnicities, and generations. Current evidence is fragmented, often Eurocentric, and lacks a comprehensive synthesis. This systematic review aimed to evaluate nasal aesthetic preferences and their implications for clinical practice. The protocol was prospectively registered on PROSPERO (CRD420251009102). Systematic searches of PubMed, Embase, Web of Science, and PsycINFO were conducted from inception to June 2025. Eligible studies assessed nasal aesthetic preferences in adult (≥18 years) populations. The Newcastle-Ottawa Scale (NOS), NOS-xs, Grading of Recommendations, Assessment, Development and Evaluations, and Appraisal tool for Cross-Sectional Studies tools were used to guide critical appraisal, and findings were synthesized narratively. A total of 2881 records were screened, yielding 31 studies with 25,382 respondents. Preferences demonstrated marked regional variation: North American Caucasians favored a slight dorsal scoop with mild underprojection, whereas East Asian/Middle Eastern groups preferred a straight dorsum with more obtuse nasolabial angles. Chinese cohorts most frequently selected radix positions at the pupil, Japanese studies reported stable nasofacial angles of 30° to 33°, and Syrian findings converged around ∼31°. Generational trends indicated Millennials and Generation Z favored longer, straighter noses with augmented radix and reduced rotation. Across populations, overall facial harmony was consistently prioritized over isolated measurements. Notable contradictions and the underrepresentation of Black populations highlighted key limitations. Nasal aesthetic preferences are dynamic and context dependent. Surgeons should adopt a personalized, culturally sensitive approach to rhinoplasty, prioritizing timeless harmony over transient fashions. Future research must expand inclusivity, employ standardized measurement tools, and leverage emerging technologies to track evolving ideals and assess psychosocial outcomes. Level of Evidence: 3 (Therapeutic).
Background Prophylactic gonadectomy has been historically recommended postpubertally for individuals with complete androgen insensitivity syndrome (CAIS) to mitigate gonadal malignancy risk. It is recognized that a proportion of individuals with CAIS choose to live with the risk of malignancy rather than undergo gonadectomy and subsequent long-term hormone treatment. Methods This retrospective study included all new postpubertal patients with CAIS seen between 2000 and 2025 at a single UK differences of sex development center. Demographic characteristics, presentation, histopathology, gonadal surveillance, and psychological data were reviewed. Descriptive statistics were used, with temporal trends analyzed using linear and logistic regression. Results This study included 187 patients diagnosed with CAIS, of whom 89/187 (47.6%) had genetic testing identifying a mutation affecting their androgen receptor gene. At review, 28/187 (15.0%) retained their gonads, with a significant increase in gonadal retention over time (P = .002). In the last 5 years, 76.5% opted for retention.Among the 28 individuals who chose to retain their gonads, 24/28 (85%) had a psychological review, with themes explored including identity, secrecy, repression of CAIS, health-related anxiety, and negative health care experiences. Of the group who had undergone gonadectomy (159/187, 85%), the median age at surgery was 17 years (IQR = 6-19), with a temporal trend toward increasing age at time of gonadectomy over time (P < .001). Of those with a confirmed androgen receptor mutation (n = 89) who underwent gonadectomy (40/89, 44.9%), histopathology was available in 40/89 (44.9%): malignancy was found in 1 (4.0%), precursor lesions in 4 (10.0%), and benign gonadal lesions in 22 (55%), most commonly Sertoli adenoma (18/40, 45%). Conclusion An increasing proportion of individuals with CAIS are choosing to retain their gonads rather than have postpubertal gonadectomy. Malignancy incidence in this cohort was low, consistent with recent literature. Further work should explore decision-making factors and how gonadal function and malignancy risk in CAIS change through adulthood.
Introduction:Hyperbaric oxygen therapy (HBOT) involves the administration of 100% oxygen at pressures greater than atmospheric pressure, leading to increased tissue oxygenation and enhanced wound healing. Its role in surgical practice has expanded due to its potential to improve tissue viability and manage a myriad of complications. Objective and Hypothesis:To evaluate the clinical indications, therapeutic benefits, and treatment protocols of HBOT in facial plastic and aesthetic surgery. Study Design:Literature review. Methods:A literature search of electronic databases including PubMed, the Cochrane Library, and Google Scholar was performed to identify studies evaluating HBOT in facial plastic surgery, including its use in rhytidectomy, rhinoplasty, vascular ischemia following dermal filler injections, and keloid management. Conclusion:HBOT serves as a valuable adjunct, improving tissue oxygenation, promoting wound healing, and potentially reducing complications. Early utilization may enhance surgical outcomes and recovery.
