Social media and the widespread use of selfie filters have reshaped beauty expectations and intensified appearance-related pressures among women. In Jordan, where the popularity of aesthetic procedures is rising, little is known about how filtered images influence body image perception and satisfaction after aesthetic procedures. To examine the association between selfie filter use and social media engagement on body image perception, and satisfaction after aesthetic procedures among Jordanian women. A cross sectional study was conducted among 390 women aged 18–50 years attending public and private aesthetic clinics in Jordan. Participants completed a structured questionnaire covering demographics, cosmetic history, social media habits, and validated psychological measures (BIDQ, FACE-Q, and PsychFilt). Statistical analyses involved group comparisons, correlations, and multivariable regression. Participants had a mean age of 33 years. Selfie filters were used by 80.5 www.springer.com/00266 .
To identify independent risk factors for keloid infection and explore optimal therapeutic strategies for infected keloids. A retrospective study included 131 keloid patients (26 infected, 105 non-infected) from two hospitals (July 2021–January 2025). Univariate and multivariate logistic regression analyses screened infection-related risk factors. Efficacy was compared among infected patients treated with complete surgical excision + radiotherapy (n= 12), intralesional injection + radiotherapy (n= 10), and local resection of infectious focus + injection + radiotherapy (n= 4). Outcomes included Patient and Observer Scar Assessment Scale (POSAS), infection recurrence, keloid recurrence, and complications. Multivariate logistic regression analysis identified maximum lesion diameter, disease duration and family history of keloids as independent risk factors for keloid infection (all P< 0.05). For infected keloids, the injection group had significantly higher 6-month/12-month POSAS scores, infection recurrence rate (50.0 www.springer.com/00266 .
Botulinum toxin type A (BoNT-A) is increasingly recognized for tissue-level effects beyond neuromuscular blockade, but its impact on dermal collagen composition remains incompletely characterized. Acetyl hexapeptide-8 (Argireline) is a SNAP-25 mimetic cosmeceutical peptide whose biological activity at the tissue level is unclear. This study evaluated the effects of BoNT-A, Argireline, and their combination on dermal collagen type I/III and Substance P (SP) expression in a flap model. Forty female Wistar rats were allocated to four groups (n = 10): saline control, BoNT-A, Argireline, and BoNT-A + Argireline. Subdermal injections were administered at six points one week before elevation of a 9 × 3 cm caudally based McFarlane flap. Flap survival was quantified on day 10 using planimetric analysis. Collagen type I/III was assessed using picrosirius red staining under polarized light, and SP expression was evaluated immunohistochemically. Flap survival did not differ significantly among groups (p = 0.327). Collagen composition differed significantly: BoNT-A-containing groups demonstrated lower type I and higher type III collagen compared with control and Argireline groups (p < 0.001). Argireline alone produced a collagen profile indistinguishable from control. SP expression was significantly elevated in the combination group compared with control and Argireline (p = 0.002). BoNT-A shifted dermal collagen toward a less mature profile without improving flap survival. Injectable Argireline produced no detectable tissue-level effect under the tested conditions. Increased Substance P expression in the BoNT-A-containing groups represents an exploratory, predominantly BoNT-A-associated neurogenic signal warranting dedicated study. These findings highlight a dissociation between macroscopic tissue viability and dermal remodeling responses. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
In recent years, with the increasing prevalence of cervical spondylosis, neck-shoulder syndrome, and scapulohumeral periarthritis, dorsocervical fat pad (DCFP) has become more commonly observed and is no longer considered exclusively a rare disease entity. Consequently, there is a growing need for safer, more effective, and minimally invasive therapeutic strategies to manage the rising number of patients presenting with DCFP. A total of 42 patients diagnosed with DCFP in our hospital between December 2023 and January 2025 were enrolled in this study. The cohort comprised 23 male and 19 female patients, with a mean age of 37.69 years, a mean height of 164.42 cm, and a mean body weight of 58.64 kg. Among these patients, 17 had a history of hypertension, four had diabetes mellitus, 27 were diagnosed with neck-shoulder myofascial pain syndrome, and 31 presented with cervical spondylosis. Following four sessions of combined cupping and acupuncture therapy, therapeutic efficacy was evaluated by assessing changes in DCFP volume, head-and-neck range of motion, neck disability index (NDI) scores, body mass index, and the occurrence of adverse reactions After four treatment sessions, significant overall differences were observed in DCFP length, width, and thickness across the three time points (P < 0.001), with the most pronounced improvement noted in thickness. Additionally, NDI scores decreased significantly compared to baseline (P < 0.001). Following treatment, flexion range of motion (FF-ROM), extension range of motion (E-ROM), left lateral flexion range of motion (LLF-ROM), and right lateral flexion range of motion (RLF-ROM), all showed significant increases relative to pretreatment values (all P < 0.001). No significant change in BMI was detected before and after treatment (P = 0.598). The combination of acupuncture and cupping therapy demonstrates significant efficacy in reducing the volume parameters of DCFP, particularly in decreasing thickness. Furthermore, this therapeutic approach improves head-and-neck range of motion and enhances cervical function and esthetic appearance in affected patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Tranexamic acid (TXA) reduces perioperative blood loss in several surgical fields; however, its role in breast reduction surgery remains unclear. This study aimed to evaluate the effect of combined TXA therapy (intravenous and local infiltration) on postoperative outcomes of patients who underwent modified Liacyr Ribeiro breast reduction. We conducted a controlled, non-randomized pilot study of patients who underwent bilateral reduction mammoplasty by the same surgeon. The intervention group received 1 g of intravenous TXA at anesthesia induction and local infiltration with a 1-mg/mL TXA vasoconstrictive solution containing epinephrine. The control group received local infiltration with an identical vasoconstrictive solution that did not contain TXA. Primary outcomes were total and daily drain output. Secondary outcomes included length of hospital stay, time to drain removal, and postoperative complications. Fifty-seven patients were included (31 in the control group and 26 in the intervention group). TXA significantly reduced the total postoperative drain volume (p<0.001) by an estimated 79 www.springer.com/00266 .
This retrospective study assessed the outcomes of combined orthodontic-surgical treatment in skeletal Class III patients by comparing results achieved with clear aligners to those achieved with conventional fixed appliances. This study involved 24 skeletal Class III malocclusion patients who were treated with non-extraction orthodontic using either fixed appliances or clear aligners (Invisalign), in conjunction with orthognathic surgery. All patients underwent mandibular surgery only. Lateral cephalometric radiographs were obtained and analysed for both groups at three stages: before orthodontic treatment (T0), one week before surgery (T1), and at least eight months after surgery (T2). All the statistical tests were performed in SPSS 30 and power calculations were done in G*Power. In this pilot study, significant skeletal and dentoalveolar changes occurred in both groups (p < 0.001). Between-group comparisons showed that during presurgical decompensation (T1–T0), fixed appliances produced greater lower incisor proclination (IMPA) (p < 0.05, Cohen’s d = -1.13 – 1.27). During postsurgical orthodontics (T2–T1), clear aligners resulted in less lower incisor labial tipping (L1-FH), less upper incisor intrusion (U1-PP), and less lower first molar intrusion (L6-MP) (p < 0.05, d = -1.03 – 1.1). At final follow-up (T2–T0), the clear aligner group continued to show less vertical intrusion of the lower incisor and first molar (L1-MP, L6-MP; p < 0.05, d = 1.11–1.17). After adjusting for genioplasty, clear aligners were associated with superior postsurgical vertical skeletal control, upper lip retraction, and facial convexity (p < 0.05). Within this pilot study, clear aligners showed signals of greater treatment efficiency, less unwanted labial tipping, and reduced vertical intrusion, whereas fixed appliances showed greater incisor and molar decompensation. These hypothesis-generating findings indicate that treatment individualization by biomechanical needs and patient preferences should be tested in future powered trials. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
The increasing demand for female genital cosmetic surgery (FGCS) raises serious concerns. Although psychosexual and physical concerns are frequently reported as key drivers, additional social and cultural influences have further fueled the demand for these surgeries. This study sought to examine the influence of media on this growing trend. A systematic literature review was conducted across multiple electronic databases—including PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library—to assess the media’s influence on women’s interest in FGCS. The search spanned publications from January 2000 to February 2025 and targeted original English-language studies evaluating this relationship. After removing duplicates, 545 articles were identified through keyword searches in titles and abstracts. This review incorporated a total of 14 eligible studies, encompassing a combined participant pool of 5,287 individuals. The researchers investigated the media's multifaceted role in driving demand for and influencing decisions regarding FGCS. Specifically, they analyzed its function as an information source, its impact on shaping perceptions of genital image, and its contribution to the consideration of FGCS across various media platforms. The media’s role in popularizing FGCS operates through three key mechanisms: serving as a primary channel of information, redefining norms about genital appearance, and normalizing consideration of the procedure across platforms. Recognizing this influence could help mitigate unrealistic body standards and reduce socially induced pressures on women’s surgical decision-making. However, it is crucial to note that these conclusions are tempered by methodological limitations that preclude causal inference and obscure the precise mechanisms and moderators of media's influence. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Facial localized scleroderma (LoS) often results in visible disfigurement and stigma, yet factors contributing to stigma in this population remain insufficiently characterized. To identify clinical, psychosocial, and socioeconomic factors associated with stigma in patients with facial LoS. A cross-sectional study was conducted between June 2023 and June 2025 at a tertiary dermatology and plastic surgery center in China. Patients aged ≥ 12 years with stable facial LoS completed validated questionnaires assessing appearance satisfaction (FACE-Q), social support (SSRS), and stigma (Stigma Scale for Chronic Illness). Clinical and socioeconomic data were collected, and multivariate regression was used to identify independent predictors of stigma. Of 159 eligible patients, 123 completed the survey (mean age, 24.3 years; 66.7 www.springer.com/00266
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Abdominoplasty is a common body contouring procedure. Optimization of surgical outcomes should be pursued. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated benefits in various surgical fields, presenting as a potential solution to address these challenges. This study evaluates the impact of combined TXA administration in patients undergoing abdominoplasty with Scarpa fascia preservation. A retrospective analysis of 141 patients undergoing full abdominoplasty was performed. Patients were divided into two groups: TXA Group (n = 61, receiving 1 g intravenous TXA at anesthesia induction and 50 mL of a 3 www.springer.com/00266 .
To present an integrated, evidence-based view of current rhinoplasty practices, emphasizing patient safety, functional preservation, and interdisciplinary collaboration. We reviewed the literature published between 2019 and 2025, including systematic reviews, meta-analyses, and official documents from the International Society of Aesthetic Plastic Surgery (ISAPS) covering functional, structural, and preservation approaches. Studies regarding the pre-, intra-, and postoperative phases were analyzed to identify associations with patient safety and satisfaction. A global shift from reductive techniques to structural and preservation approaches prioritizing anatomical respect and functional integrity was observed. Evidence supports team planning, psychological screening, and standardized protocols applied across the operative pathway to reduce complications. In addition, technological advances have improved predictability and surgical training. Despite advances, substantial variability in techniques and protocols persists, underscoring the need to strengthen a shared culture of safety through standardized perioperative workflows, structured documentation, and validated outcome assessment, rather than standardizing operative techniques. Rhinoplasty should combine esthetic precision with preservation of nasal function and ethical responsibility. Establishing a global culture of safety requires more than protocols; it demands empathy, collaboration, and the surgeon’s active role as a technical and ethical mediator at all stages of care. While not an official ISAPS guideline, this article offers a critical reflection on current evidence and discussions within the ISAPS Patient Safety Committee. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Facial aging involves deep structural changes and superficial skin texture alterations, single-energy treatments often fail to address both dermal remodeling and skin rejuvenation comprehensively, and combination regimens may enhance outcomes by targeting complementary layers. This study aimed to evaluate the efficacy and safety of microfocused ultrasound (MFU) combined with 1550-nm non-ablative fractional laser (NAFL) in facial rejuvenation for Asian patients with Fitzpatrick skin types III–IV. To assess the efficacy and safety of MFU combined with 1550-nm NAFL in improving facial laxity, wrinkles, and pigmentation. A prospective, randomized, evaluator-blinded, split-face study was conducted with 22 participants (44 facial sides) with facial photoaging. MFU was applied to both sides, with one side followed by 1550-nm NAFL. Two therapy sessions with a 6-week interval were held. Evaluations were conducted at baseline, 6, 12, and 24 weeks, using biometric and ultrasound measurements to assess treatment efficacy. Safety was assessed based on adverse events (AEs). All enrolled participants presented with Fitzpatrick skin types III–IV, and 22 participants completed the 24-week follow-up. Compared to baseline, both sides showed significant improvements in IASLSS, FWS, PIS, dermal thickness, skin relaxation time, MI, and EI (all P < 0.05). Between-side analysis demonstrated that the combined side had greater benefits than the MFU side in improving FWS, PIS, dermal thickness, skin relaxation time, and MI (all P < 0.05), with no significant difference in IASLSS and EI (both P > 0.05). MFU combined with 1550-nm NAFL is effective and safe for facial rejuvenation. The combined therapy provides superior improvement in facial wrinkles, pigmentation, and patient satisfaction rates. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Gynecomastia is the most common benign breast condition in men. Although multiple surgical options exist, the optimal technique that minimizes complications while maximizing patient satisfaction remains debated. We retrospectively reviewed 128 patients (239 breasts) who underwent gynecomastia surgery between 2013 and 2023 at a university hospital. Techniques included glandular excision alone, liposuction alone, combined excision with liposuction, and mastectomy with free nipple–areola grafting. Primary endpoints were postoperative complications, while secondary endpoints included patient-reported satisfaction and pain scores (telephone survey, 0–10 scale). The mean age was 27.3 years. Procedures were distributed as excision 39.8 www.springer.com/00266 .
The deep plane facelift first described by Dr. Sam Hamra in 1990 is a well-established approach to addressing facial aging however despite being widely adopted and adapted since its introduction concerns regarding the complications associated with the technique persist, with permanent injury to the facial nerve being the most feared. As a result, many surgeons may opt for alternative approaches such as the SMAS facelift, which may not provide as effective results. This systematic review and meta-analysis aimed to evaluate the complication rates of deep plane facelifts, and the aesthetic outcomes compared with subcutaneous and SMAS facelift techniques. A systematic review and meta-analysis was performed according to PRISMA standards. Randomised controlled trial, cohort studies, case controls, and case series describing deep plane facelifts were included. Primary outcomes were overall complications including temporary or permanent facial nerve injury, haematoma, infection, seroma, skin necrosis, hypertrophic scarring and epidermolysis. Secondary outcomes were aesthetic outcomes compared to subcutaneous and SMAS facelifts. A random effects model was used for data analysis and results were reported in forest plots with 95 www.springer.com/00266 .
Facial feminization surgery (FFS) encompasses a broad range of procedures that aim to provide gender affirmation for male-to-female transgender individuals. Historically, these surgeries have been performed in tertiary care centers and have required overnight stay in the hospital. We reviewed our experience performing FFS at an ambulatory surgery center. Patients undergoing FFS at an ambulatory surgery center between July 2018 and January 2022 were included in this retrospective study. Postoperative transfer to hospital and emergency department visits were the primary outcome measures. Procedures performed and case duration were also recorded. A total of 304 FFS cases were performed at an ambulatory surgery facility between July 2018 and January 2022. The average number of procedures performed per case was 3.5, and the average case duration was 3 hours and 13 minutes (with a range of 20 minutes to 8.5 hours). A total of 3 cases (0.99 www.springer.com/00266 .
Hairline lowering (HALO) surgery is commonly performed using either a single anterior incision (AI) placed along the hairline or an anterior incision combined with bilateral extensions (BE) oriented anteroposteriorly along the superior temporal lines. The biomechanical implications of these incision designs remain insufficiently defined. Cadaveric dissections were performed on five heads. After placement of an AI and subgaleal release, maximal scalp advancement was measured in the midline and along both mid-pupillary lines. Subsequently, bilateral extensions were added, together with additional posterior subgaleal dissection and one additional galeotomy, and measurements were repeated. Statistical analysis compared advancement achieved with each incision design. The BE design demonstrated greater scalp advancement at all measurement points compared with the AI design. Midline advancement increased by 21 www.springer.com/00266 .
This article aims to evaluate the application value of augmented reality (AR)-assisted surgical navigation in perpendicular plate of ethmoid bone (PPE) resection teaching, assessing the extent to which AR improves medical trainees’ mastery of PPE anatomical localization and surgical navigation, and providing a standardized training method. PPE osteotomy lines were designed and integrated into an AR navigation system that superimposes virtual guidance onto the surgical field using HoloLens 2 AR glasses. Ten participants (five clinical medical students and five non-clinical students) were instructed to localize five anatomical points on the PPE of eight cranial models, both manually and with AR guidance. Teaching effect was evaluated via statistical analysis of localization accuracy and operation time. AR-assisted navigation significantly improved the accuracy of the safety harvesting area points of PPE localization in both groups. Clinical group trainees demonstrated higher accuracy than non-clinical group trainees, both when using AR and not using AR. However, AR guidance prolonged annotation time due to participants reassessing anatomical landmarks. Point E consistently exhibited the greatest deviation, suggesting that it is a critical anatomical landmark during PPE harvest. Integrating AR technology into simulated PPE resection training may enhance trainees’ spatial positioning accuracy and reduce experience-related variability. While current limitations exist in projection alignment and system fidelity, AR serves as a feasible auxiliary educational tool for PPE resection. As a preliminary simulation study, it provides a technical foundation for trainees to master complex landmarks prior to clinical practice. Experimental simulation study: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
Treating periorbital static wrinkles in patients with pigmented skin is challenging due to the risk of post-inflammatory hyperpigmentation. This study aimed to evaluate a safe and effective laser modality for this underrepresented demographic. A prospective, single-center, split-controlled, evaluator-blinded trial was conducted, enrolling 27 Asian patients with Fitzpatrick skin types (FSTs) III–IV. Patients were treated with a non-ablative erbium-YAG 2940-nm fractional laser, undergoing three sessions at eight-week intervals. Treatment efficacy was assessed at six months using objective VISIA imaging, in vivo confocal microscopy, and standardized clinical scales (the Fitzpatrick wrinkle scale assessed by blinded evaluators, and the Global Aesthetic Improvement Scale assessed by patients). The results demonstrated significant wrinkle reduction (mean improvement: 0.9 points on the Fitzpatrick wrinkle scale), robust dermal collagen remodeling (confirmed via confocal microscopy), and high patient satisfaction (88.9 www.springer.com/00266 .
