BACKGROUND:Preservation breast augmentation (PBA) is an intralamellar technique preserving the pectoralis major muscle, circummammary ligament, and Cooper's suspensory ligaments. Its perioperative pain profile and the value of regional anesthesia adjuncts remain uncharacterized. OBJECTIVES:To characterize the perioperative pain profile of PBA under local anesthesia and sedation, and to determine whether a preoperative deep SAP block reduces intraoperative analgesic requirements and early postoperative pain. METHODS:This prospective, randomized, single-blind trial enrolled 40 women undergoing PBA. Patients were randomized 1:1 to a preoperative deep SAP block (20 mL of 0.25% bupivacaine bilaterally) or standard care; all procedures used tumescent local anesthesia and propofol sedation. Endpoints included 24-hour NRS score, rescue propofol and fentanyl consumption, hemodynamic response, and postoperative analgesic use. RESULTS:Baseline characteristics were comparable. The SAP group required less rescue propofol (45 ± 3 vs. 55 ± 4 mg; p < 0.001; d = 2.83) and fentanyl (12 ± 5 vs. 22 ± 9 µg; p < 0.001; d = 1.37). NRS scores favored the SAP group at 60 min (3.4 vs. 4.5; p = 0.011) and 6 h (3.8 vs. 4.7; p = 0.035), converging by 24 h (3.4 vs. 3.2; p = 0.377); both groups remained within a low pain range (NRS ≤ 3.5). No major complications occurred. CONCLUSIONS:PBA under local anesthesia and sedation is associated with a consistently low perioperative pain profile. The SAP block provides a clinically meaningful intraoperative analgesic advantage and improves early postoperative comfort, supporting selective rather than routine use.
Autologous fat grafting (AFG) is increasingly used for aesthetic breast augmentation and remodeling because it provides natural tissue augmentation without permanent implants. This systematic review and meta-analysis evaluated complications, radiologic outcomes, graft retention, and patient satisfaction following AFG. A PRISMA 2020-compliant search identified 40 primary clinical studies including 5,684 patients. The risk of bias was assessed using the RoB2, ROBINS-I, and Newcastle-Ottawa Scale. Random-effects meta-analysis used restricted maximum likelihood estimation as the primary model, with Hartung-Knapp adjustment and DerSimonian-Laird and Paule-Mandel estimators in sensitivity analyses. Mean follow-up exceeded 6 months. The pooled complication rate was 25.9% (95% CI, 22.4-29.6), mainly consisting of minor radiologic or palpable findings; fat necrosis was the most common adverse event. Benign radiologic findings included fat necrosis (8.8%) and calcifications (1.1%), without evidence of impaired cancer detection. Mean injected fat volume was 310 mL per breast. Twelve-month volume retention was 61.3% (95% CI, 57.1-65.4), with higher retention in SVF/PRP-enriched grafts (68.9% vs 56.1%; p<0.01), although evidence remained heterogeneous. Patient satisfaction was 93.1% (95% CI, 90.4-95.8), despite heterogeneous PROMs. Heterogeneity was substantial for complications (I2=78%; τ2=0.021; Q=177.6; p<0.001) and volume retention (I2=82%; τ2=0.067; Q=216.4; p<0.001), and moderate for radiologic outcomes (I2=52%; τ2=0.008; Q=81.3; p<0.001), reflecting variability in techniques, imaging, processing, enrichment, assessment methods, and follow-up. Current observational evidence supports favorable safety profiles; however, oncologic outcomes were not quantitatively pooled, and prospective comparative studies with standardized reporting are required.
BACKGROUND:Breast implants remain the cornerstone of aesthetic and reconstructive breast surgery, yet surgeon device selection is frequently driven by manufacturer marketing, social media, and brand loyalty rather than objective scientific data. OBJECTIVES:To provide a comprehensive, side-by-side qualitative and quantitative comparison of current-generation silicone gel breast implants from the four major United States manufacturers, characterizing each device's gel, shell, and gel-shell interface properties. METHODS:Two unopened, current-generation implants were obtained from each of Allergan (Inspira Responsive, Inspira SoftTouch), Mentor (MemoryGel BOOST, MemoryGel Xtra), Motiva (Ergonomix, Round), and Sientra (106/HSC, 107/HSC+). Eight assessment methods were applied: still-photo tilt-table analysis, time-in-motion video analysis, gel-shell pinch-roll testing, BTC 2000 biomechanical gel evaluation, tensiometer gel-shell peel testing, in vivo high-resolution ultrasound imaging, blinded patient tactile assessment, and matrix usability scoring. RESULTS:Mentor MemoryGel BOOST demonstrated the most form-stable gel across all five BTC 2000 parameters, the longest pinch-roll endpoint, and the longest tensiometer peel time with significant retained gel, indicating the strongest gel-shell interaction. Despite this form stability, BOOST was the third-highest-rated implant on blinded patient tactile assessment, with MemoryGel Xtra ranked first. Sientra 106 was consistently the least form-stable. Allergan implants demonstrated the highest ultrasound shell visualization clarity. Allergan also achieved the highest matrix usability score, reflecting broad profile diversity across aesthetic and reconstructive applications. CONCLUSIONS:Current silicone gel breast implants demonstrate measurable, manufacturer-specific differences in gel behavior, shell properties, gel-shell interaction, sonographic appearance, and clinical applicability. These findings support a paradigm shift toward science-driven implant selection and provide objective data to guide surgeon decision-making.
BACKGROUND:Random-pattern skin flaps are prone to distal necrosis, a major challenge in reconstructive surgery. Tranexamic acid (TXA) reduces perioperative bleeding, but its impact on flap viability remains controversial. OBJECTIVES:To investigate the concentration-dependent effects of local TXA application on random-pattern flap survival, with and without surgical delay, in the McFarlane dorsal rat flap model. METHODS:Sixty-four female Wistar albino rats were randomized into eight groups (n=8): control, TXA 10, 30, and 100 mg/mL, delayed control, and delayed TXA at the same concentrations. A 3×9 cm caudal-based dorsal flap was elevated and 1 mL of saline or TXA was administered locally before closure. Flap necrosis was quantified using ImageJ software. Two-way ANOVA assessed the independent effects of delay and TXA concentration; subgroup analyses used one-way ANOVA with Tukey HSD (non-delayed) and Kruskal-Wallis with Dunn's test (delayed). RESULTS:High-concentration TXA (100 mg/mL) significantly increased necrosis in non-delayed flaps (40.39% ± 7.41%, p = 0.016 vs. control). Delayed flaps showed markedly reduced necrosis across all groups (delayed control: 1.00% ± 1.45%, p < 0.001). No significant differences were observed among delayed subgroups regardless of TXA concentration. Two-way ANOVA identified the delay procedure as the dominant main effect (F(1,56) = 665.97, p < 0.001, partial η2 = 0.922). CONCLUSIONS:High-concentration local TXA impairs random-pattern flap survival, while low-concentration TXA (10 mg/mL) appears well tolerated. The surgical delay procedure markedly reduces TXA-associated necrosis risk across all concentrations. Careful concentration selection is recommended when TXA is used in cutaneous flap surgery.
BACKGROUND:Poly-L-lactic acid (PLLA) dermal fillers induce neocollagenesis through a bioinductive mechanism rather than facial tissue volumization. The next-generation PLLA-LASYNPRO formulation (LASYNPRO, Lactic Acid Induced Synthesis of Collagen Protein), a biomaterial-microsphere technology developed for regenerative aesthetic biostimulation, composed of uniform, non-porous microspheres, has been proposed as an evolution of earlier PLLA products, offering a more controlled, lower-inflammatory regenerative pathway. Efficacy data for nasolabial fold (NLF) correction are emerging, but patient-reported outcomes remain underreported. OBJECTIVES:To evaluate patient-reported outcomes, aesthetic self-perception, and treatment satisfaction over 12 months following JULÄINE (PLLA-LASYNPRO) treatment for NLF correction. METHODS:Prospective, single-arm, multicenter post-market clinical follow-up (PMCF) investigation enrolling 60 subjects. Subjects received up to 3 bilateral NLF injections of JULÄINE™ at 2- to 4-week intervals. Patient-reported outcomes included FACE-Q Appraisal of Lines (Nasolabial Folds), FACE-Q Satisfaction with Outcome, the Global Aesthetic Improvement Scale (GAIS), and a 12-item subject satisfaction questionnaire, assessed at 6 and 12 months after the final injection. RESULTS:At 12 months, the FACE-Q Appraisal of Lines score improved by a mean of 20.7 points (P<.0001; d=1.14), a large effect that continued to grow between 6 and 12 months. Subject GAIS responder rate was 83.3% at both timepoints. More than 90% of subjects reported natural-looking results; 83%-85% would repeat the treatment; 90%-94% would recommend it. Overall satisfaction was 88.9% at 6 months and 77.8% at 12 months. No serious adverse events or device deficiencies were reported. CONCLUSIONS:JULÄINE produced sustained, clinically meaningful improvements in patient-perceived aesthetic outcomes with high treatment satisfaction over 12 months. The consistent perception of natural-looking results is in line with the progressive, collagen-building mechanism of PLLA-LASYNPRO.
BACKGROUND:Androgenetic alopecia (AGA) is the most common cause of progressive hair loss in men and women and is associated with significant psychosocial distress. Platelet-rich plasma (PRP) is a regenerative therapy that stimulates follicular activity, angiogenesis, and dermal papilla activation through growth factor release. OBJECTIVES:This prospective randomized evaluator-blinded clinical trial evaluated the long-term efficacy and safety of autologous non-activated PRP (A-PRP) delivered through a standardized mechanical and controlled infiltration protocol. METHODS:Between January 2015 and January 2025, 234 patients with AGA were enrolled, including 135 men (Norwood-Hamilton I-IV) and 99 women (Ludwig I-II); 25 patients had previous confirmed COVID-19 infection. Patients received three A-PRP sessions at 30-day intervals with intradermal administration of 0.2 mL/cm2. Hair density (HD), hair thickness (HT), and total hair count (HC) were assessed by computerized trichoscopy and phototrichogram analysis at baseline, 12, 36, 60, and 120 months. RESULTS:At 12 months, HD increased by 31.4%, HT by 26.8%, and HC by 29.7% compared with baseline (p < 0.001). HD remained above baseline at 36 months (+24.1%) and 60 months (+17.3%). At 120 months, patients receiving maintenance treatment showed an 11.2% improvement. Female patients demonstrated greater preservation of hair shaft diameter. No significant differences were observed according to previous COVID-19 infection, and no severe adverse events occurred. CONCLUSIONS:Standardized A-PRP infiltration provides a safe and effective regenerative approach for AGA, with maintained clinical improvement during long-term follow-up. These findings support the role of standardized delivery protocols in improving reproducibility and therapeutic consistency in regenerative hair restoration.
BACKGROUND:Live clinical demonstrations at aesthetic medicine conferences is common, yet concerns regarding patient safety, commercial influence, and ethical governance. This study established a consensus-based governance framework for live injecting and compared expert and attendee perspectives. METHODS:A two-stage modified Delphi process involved an international expert panel (n=31) alongside a cross-sectional attendee survey of conference (n=218). Round 1 included 46 statements addressing clinical safety, ethics, educational value, commercial influence, and governance, with consensus predefined as ≥70% agreement. Unresolved statements were refined in Round 2. A 23-item modified survey assessed attendee views on live injecting and alternative educational formats. RESULTS:Experts demonstrated strong consensus on key governance requirements. A voluntary code of conduct was supported by 96.6% of experts and that formal tripartite agreements between injector, host clinician, and organiser be required (93.1%) and that the practitioner assuming medico-legal responsibility must be physically present during demonstrations (89.7%). Experts identified performance pressure (95.7%) and unsafe modelling for less experienced practitioners (91.3%) as significant risks. Attendees favoured alternatives: 74% preferred small-group teaching over auditorium demonstrations, and 82% would still attend conferences if live injecting were replaced by high-quality recorded demonstrations. CONCLUSION:Live injecting demonstrations retain conditional support but require stronger clinical governance to ensure patient safety and ethical practice. Findings support standardised oversight mechanisms, including in-person clinical supervision, defined medico-legal accountability, and a formal code of conduct. Small-group teaching and high-definition recorded demonstrations, may offer safer, equally effective alternatives for procedural education.
BACKGROUND:Evaluation of aesthetic rhinoplasty increasingly relies on patient-reported outcome measures (PROMs). However, the absence of population-based normative data limits accurate interpretation of these outcomes. OBJECTIVES:This study aimed to establish population-based normative scores for aesthetic rhinoplasty PROMs in a representative Dutch sample, thereby enhancing their interpretability. A secondary objective was to evaluate the influence of demographic factors on nasal appearance satisfaction. METHODS:A sample representative of the Dutch general population was obtained via an online panel. Participants completed 4 frequently used aesthetic rhinoplasty PROMs: the Utrecht Questionnaire (UQ), the SCHNOS cosmetic subscale, the FACE-Q rhinoplasty module, and the Numeric Rating Scale (NRS). Average scores were calculated for each PROM, and ordinal regression was employed to evaluate associations between nasal satisfaction and demographic variables, including age, gender, migration background, education, income, and residence. RESULTS:The weighted sample (n=1,134) showed high overall satisfaction with nasal appearance (mean UQ=6.28, SCHNOS-C=11.38, FQnose=75.2, FQnostrils=80.09, NRS=7.67). Aesthetic satisfaction significantly increased with age for all PROMs, with this shift occurring more rapidly in males. Individuals with a non-Western background reported significantly lower satisfaction in FQnose (OR 1.819, p=0.004), FQnostrils (OR 1.586, p=0.031), and SCHNOS-C (OR 0.417, p<0.001). Gender, education, income, and residence did not significantly affect satisfaction. CONCLUSIONS:This study provides normative benchmarks for aesthetic rhinoplasty PROMs, filling a critical literature gap. The general population exhibits high nasal appearance satisfaction. The significant influence of age and migration background highlights the complexity of aesthetic perception and underlines the necessity of patient-centered benchmarks to interpret aesthetic rhinoplasty outcomes.
Injectable fillers are increasingly used in aesthetic medicine, yet the medicolegal factors driving liability remain poorly defined. We conducted a retrospective review of U.S. civil litigation involving aesthetic injectable fillers using Westlaw and LexisNexis (1967-2025), extracting variables including filler type, anatomical site, provider credentials, practice setting, complication severity, FDA approval status, informed consent, and legal outcomes. Of 325 screened records, 46 met inclusion criteria. Claims were filed a mean of 2.4 years after the incident, with a mean of 2.5 years from filing to final decision. Plaintiff and defense outcomes were nearly evenly split (51% vs. 49%). The most implicated fillers were autologous fat (n=13, 28.3%), hyaluronic acid (n=12, 26.1%), and biostimulatory agents (n=12, 26.1%). The most common anatomical sites were the face, head, or neck (n=31, 67.4%), followed by breast (n=5, 10.9%) and buttock or body contouring (n=4, 8.7%). Neither physician credentialing, filler type, nor complication severity was significantly associated with legal outcome. Med-spa procedures had a 100% plaintiff verdict rate versus 47% in private clinic or hospital settings (p=0.024), and unapproved fillers had a 100% plaintiff verdict rate versus 44% for FDA-approved products (p=0.021). Documented informed consent was strongly protective, with substantially lower plaintiff verdict rates (8% vs. 65%, p=0.001). Liability was most strongly associated with regulatory and practice context rather than complication severity, filler type, or provider credentials, highlighting the importance of using FDA-approved products, ensuring thorough informed consent documentation, and maintaining appropriate oversight in medical spa settings.
BACKGROUND:Intraoral approaches to the buccal fat pad, deep midface, and temporal fascia are increasingly used in aesthetic surgery. However, the buccal nerve (BN) remains incompletely defined from this perspective, limiting understanding of procedure-related complications. OBJECTIVES:To investigate the course and morphometry of BN using an intraoral approach relevant to contemporary facial surgery. METHODS:Sixteen hemi-faces from eight embalmed adult body donors were dissected via a medial intraoral approach. BN was traced from its emergence between the heads of the lateral pterygoid muscle through the pterygomandibular and buccal spaces. Relationships to the temporalis tendon, buccal fat pad (BFP), buccinator, parotid duct papilla, and pterygoid lamina were documented. Five clinically relevant distances were measured with digital calipers. Interobserver reliability was assessed using intraclass correlation coefficients. RESULTS:BN consistently descended along the anterior temporalis tendon, with a tendon-piercing variant in 12.5% of hemi-faces. It coursed lateral to the pterygoid extension of the BFP and medial to the anterior lobe of BFP, forming a distinct corridor. Within the buccal space, BN followed a uniform anteroinferior course inferior to the linea alba. Mean distances were 14.1 ± 1.2 mm to the lateral pterygoid lamina and 18.9 ± 2.4 mm (horizontal) and 16.6 ± 2.4 mm (vertical) to the parotid duct papilla. Reliability was excellent (ICC: 0.970-0.998). CONCLUSIONS:This study defines the intraoral anatomy of BN and provides practical landmarks that may enhance surgical safety and reduce sensory complications in buccal, midface, and temporal procedures.
Breast tissue-preservation surgery relies on the identification of anatomical dissection planes that allow surgical access while minimizing disruption of glandular and fascial structures. Although a plane between the mammary gland and the pectoralis major fascia is increasingly utilized in aesthetic procedures, its anatomical basis remains incompletely defined. The aim of this study was to describe the anatomical and histological foundations of a posterior intralamellar dissection plane located between the corpus mammae and the pectoralis major fascia and to characterize its relevance for breast tissue-preservation surgery. Eight bilateral dissections (n = 16 breasts) were performed on fresh cadavers at 2 academic anatomy centers between 2024 and 2025. Conventional breast augmentation approaches (subglandular, subfascial, and dual-plane) and breast tissue-preserving techniques were sequentially performed. Specimens underwent layer-by-layer anatomical dissection or sagittal sectioning. Macroscopic, endoscopic, and histological analyses were conducted at standardized anatomical locations using hematoxylin and eosin, Masson's trichrome, and Sirius Red/Fast Green staining. A consistent posterior lamella composed of laminated adipose and fascial layers was identified in all specimens, regardless of the surgical approach. This posterior intralamellar plane separated the corpus mammae from the pectoralis major fascia and demonstrated variable thickness but reproducible continuity. Atraumatic tunneling and balloon-assisted expansion preferentially propagated within this plane, creating a reproducible dissection space while preserving glandular, fascial, and adjacent neurovascular structures. Histological analysis confirmed a distinct laminated fascial architecture, clearly differentiated from both glandular parenchyma and underlying muscular fascia. The posterior intralamellar plane represents a consistent anatomical and histological dissection plane suitable for breast tissue-preservation surgery. Recognition of this plane provides an anatomical rationale for conservative surgical strategies that preserve glandular integrity and may facilitate posterior access aligned with native breast tissue architecture. Level of Evidence: 4 (Therapeutic) For image description, please refer to the figure legend and surrounding text.
BACKGROUND:Breast augmentation has traditionally focused on implant volume and pocket selection, often overlooking the variability of native breast anatomy. OBJECTIVES:Breast tissue preservation (BTP) emphasizes preservation of fascial planes and tissue integrity, enabling prepectoral implant placement within a preserved tissue envelope. When combined with 3-dimensional (3D) imaging and ultrasound-based geometric analysis, BTP supports selective implant positioning tailored to regional deficiencies, potentially improving stability and natural aesthetic outcomes while reducing reliance on larger implant volumes and the need for scaffold support. METHODS:A single center retrospective study analyzed 111 patients undergoing primary breast augmentation or augmentation-mastopexy using tissue preservation techniques, including transaxillary and inframammary approaches. Pre- and 12-month postoperative assessments incorporated 3D imaging and high-resolution ultrasound to evaluate breast geometry, tissue distribution, volumetric and angular changes, and stability. Safety outcomes and patient satisfaction were evaluated over 12 months. RESULTS:Among 111 patients, complication rates were low (4.5%), with no Baker III-IV capsular contracture, no implant ruptures and high satisfaction scores. Geometric analysis demonstrated consistent increases in upper, medial, and lateral angles, procedure specific inferior angle changes, preserved nipple alignment with maximal projection, and improved breast stability, supporting controlled and reproducible volume redistribution. These changes were achieved through targeted regional volume placement. CONCLUSIONS:This study highlights the clinical value of a comprehensive native breast assessment in real-world practice. Integrating volumetric, topographic, and angular analysis enables individualized planning, precise implant positioning, with minimally invasive BTP techniques. This approach supports biomechanical stability, demonstrates a favorable safety profile, and promotes natural outcomes in everyday surgical practice. Level of Evidence: 4 (Therapeutic).
Breast implant surface topography plays a critical role in modulating host immune responses and long-term clinical outcomes. Although traditional classifications dichotomize implant surfaces as smooth or textured, emerging evidence demonstrates that specific architectural parameters differentially regulate macrophage polarization, T cell recruitment, and fibrotic capsule formation. This narrative review synthesizes preclinical, translational, and clinical evidence evaluating immune modulation associated with a specific 4 µm surface architecture and discusses its implications for capsular contracture, chronic inflammation, biointegration, and the corresponding consequences for conservative surgical techniques. Across animal models, capsule histology, proteomic analyses, and gene expression studies, this specific 4 µm surface consistently demonstrates reduced proinflammatory macrophage infiltration, enhanced FoxP3 + regulatory T cell recruitment, and decreased profibrotic signaling with thinner yet elastic structured capsules compared with both conventional smooth and high roughness surfaces, favoring immune regulation rather than chronic inflammation. Capsule behavior is governed not by thickness alone but by structural organization, elasticity, and immune profile. Clinically, these findings translate into low rates of capsular contracture without increased risks of implant instability, when appropriately managed. Collectively, these converging data support a broader conceptual framework in which foreign body response is a biologically modifiable process. Modulating this response through surface topography enables the development of an optimized implant-tissue interface that promotes physiologic healing, minimizes adverse outcomes, and supports natural breast biomechanics. Within this framework, coupling this specific architecture with breast tissue-preserving techniques, this biologic profile provides a foundation for stable, low-inflammatory implant integration without reliance on complex maneuvers, additional structural support or excessive fibrotic adhesion. Level of Evidence: 5 (Therapeutic) For image description, please refer to the figure legend and surrounding text.
LEVEL OF EVIDENCE:5 (Therapeutic) For image description, please refer to the figure legend and surrounding text.
BACKGROUND:Breast augmentation rates have remained relatively stagnant due to ongoing concerns regarding implant safety, fear of an oversized aesthetic, and trepidation surrounding general anesthesia. Advances in understanding breast anatomy have enabled innovative techniques that enhance breast volume while preserving surrounding soft tissues. This study presents the initial US experience with a minimally invasive, tissue-preserving breast augmentation (MI-BA) technique utilizing atraumatic tunneling, balloon-assisted pocket creation, and sixth-generation silicone implants. OBJECTIVES:The aim of this study was to describe the authors' early experience with an inframammary-based MI-BA, including its anatomical rationale, surgical technique, learning curve, early outcomes, satisfaction, and practical insights to guide broader adoption. METHODS:A prospective multicenter analysis was performed across 5 surgical centers over a 6-month period. Patient demographics, implant characteristics, anesthesia modality, early complications, patient-reported recovery, and satisfaction scores were prospectively collected. 161 consecutive patients were enrolled across five sites, but 2 were removed from the analysis due to age, as they were implanted off-label. Of note, the 2 patients removed were highly satisfied and had no complications. RESULTS:In total, 159 consecutive female patients underwent MI-BA, with 13% undergoing concomitant fat transfer and/or mastopexy. All patients received tumescent infiltration, 95% of procedures utilized a bolus anesthesia technique, with 58% performed under local anesthesia with sedation. No early postoperative hematomas, loss of breast sensation, sensory disturbances, or abnormal pain were reported. Surgeon satisfaction was high (96%), and most patients reported being satisfied or extremely satisfied (94%). CONCLUSIONS:This early US experience demonstrates a minimally invasive, tissue-preserving approach to breast augmentation that leverages implant-specific technologies to enable procedures under local anesthesia, minimize soft-tissue trauma, and facilitate rapid recovery. Although early outcomes are favorable, continued long-term follow-up is underway and will be reported in future studies. LEVEL OF EVIDENCE: 4 (THERAPEUTIC):For image description, please refer to the figure legend and surrounding text.
BACKGROUND:Patients' preoperative fears and expectations may help explain why lipoabdominoplasty is overwhelmingly performed under general anesthesia rather than sedation. OBJECTIVES:The aim of this study was to evaluate concordance between preoperative expectations and early postoperative recovery and to assess whether fear of intraoperative pain may explain a preference for general anesthesia over a sedation-based regimen. METHODS:Single-center, prospective cohort of consecutive outpatients undergoing lipoabdominoplasty (December 2020-June 2025). All procedures used intravenous sedation, tumescent local anesthesia, and a transversus abdominis plane (TAP) block. Demographic data were collected, surgical outcomes were assessed using the BODY-Q questionnaire, and patient-reported anxiety and anesthetic expectations before and after surgery were evaluated with the International Pain Outcomes (IPO) questionnaire. In addition, patient expectations regarding the resumption of daily activities were systematically compared with the actual timelines of their achievement. RESULTS:Thirty-nine patients were included (87% female; mean age 37 ± 11 years; BMI 26.0 ± 3.7 kg/m2). Preoperatively, 56% anticipated intraoperative pain, 28% nausea, and 26% loss of control under anesthesia. Postoperatively, all anesthesia-related concerns were significantly reduced from a median of 3 (4-2) to 1 (1-1) on a scale of 1 to 5. Within 72 h after abdominoplasty, patients typically resume indoor ambulation and stair climbing by Day 1, independent dressing and showering by Day 2, and a brief outdoor walk and preparing a small meal by Day 3. CONCLUSIONS:Intravenous sedation with tumescent anesthesia and TAP block met or exceeded preoperative expectations for intraoperative comfort. The median time to resume activities was slightly shorter than anticipated, and anesthesia-related fears-especially intraoperative pain-proved largely unfounded. LEVEL OF EVIDENCE: 4 (THERAPEUTIC):
Meta-analyses are the highest level of evidence within academic health literature. However, they vary significantly in quality and bias. Existing methodological assessment tools for meta-analyses are often time-consuming and difficult for clinicians to use. The "Meta-Analysis Critique" (MAC) Tool, was developed as a simple three-question screening instrument designed to quickly appraise study quality. We analyzed for temporal trends and correlations between the MAC Tool and the gold standard AMSTAR 2. MEDLINE and EMBASE were searched for plastic surgery meta-analyses published between 2011 and 2023, identifying 283 studies. These were independently assessed by two reviewers using both the gold-standard AMSTAR 2 and the novel MAC Tool. While the volume of meta-analyses in plastic surgery significantly increased in the latter half of the decade (n=68 [24%] vs n=215 [76%]), the proportion of high-quality studies did not improve. When compared to AMSTAR 2 score, our novel MAC Tool obtained high specificities when assessing the research question (100.00%, CI: 90.97%-100.00%), appropriateness of the statistical analysis (96.23%, CI: 87.02%-99.54%), and risk of bias (98.97%, CI: 94.39-99.97%), respectively. Taken together, we present a novel tool that simplifies assessment of plastic surgery literature and identifies poor quality meta-analyses but is not intended as a confirmatory quality assessment instrument. It has a high correlation with the gold-standard AMSTAR 2. Future studies should aim to validate this tool and determine its broader reliability in other specialties.
Background: A patient-reported outcome measure is needed to study facial appearance in the context of rapid weight loss following use of antiobesity medications. Such treatments can cause sunken cheeks, hollow eyes, saggy skin, and an aged appearance (eg, Ozempic face). The FACE-Q Aesthetics item library can be used to create short-form fit-for-purpose scales. Objectives: The goal was to create a short-form FACE-Q scale and to examine its psychometric performance in the context of antiobesity medication use. Methods: An international sample (Prolific Academic) was surveyed 3 times (initial, test-retest, 3-month follow-up). The sample included individuals who wanted to have, were having, or previously had a glucagon-like peptide-1 (GLP-1) or glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist to lose weight. Participants completed the FACE-Q item library that measures satisfaction with facial appearance. Rasch Measurement Theory analysis was used to item-reduce and produce a short-form scale. Psychometric properties were examined, including hypothesis-based construct validity, responsiveness, and test-retest reliability. Distribution-based and anchor-based minimally important differences (MIDs) were computed. Results: The sample included 632 individuals who wanted to have (30.9%), were having (50.6%), or previously had (18.5%) a GLP-1 or GIP/GLP-1 receptor agonist to lose weight. Data for a 15-item short-form scale fit the Rasch model (chi(2) = 130.1, df = 135, P = .60). Reliability was > 0.83 for 3 reliability coefficients. Hypothesis-based construct validity was supported with 14/14 (100%) and 7/9 (77.8%) of initial and change score hypotheses confirmed, respectively. The MIDs for the new scale for improvements were 6 (distribution-based) and 10 (anchor-based) points. Conclusions: This FACE-Q Aesthetics short-form scale demonstrated strong measurement properties in the context of GLP-1 and GIP/GLP-1 receptor agonist use for weight loss.
