Aesthetic Indications Research Articles

When to change needles during neuromodulator injections-An electron-microscopy investigation into needle tip deformation.

Neuromodulator injections are minimally invasive procedures performed across the globe. Despite their ubiquity, there is a dearth of information on whether and how needle tips used for neuromodulator procedures are deformed after repeated injections. We investigated the magnitude of needle tip deformation following sequential injection passes (3×, 5×, and 10×) during facial neuromodulator injections with three commonly used needle sizes (30G, 31G, and 32G). Neuromodulator was administered for four different aesthetic indications. Each collected needle was mounted and imaged in a Philips XL-30 Scanning electron microscope. Images were processed using ImageJ photo analysis software. Forty-five needle tips were investigated. When comparing the facial regions of interest, a statistically significant difference in deformation percentage was found when injecting 10× (p = 0.044) with greatest damage after injecting the glabella (38.4%), followed by lateral canthus (27.9%), forehead (27.5%), and midface (23.1%). Independent of facial region targeted, the mean percentage of needle deformation at 3× was 14.8%, at 5× 19.6%, and at 10× 29.2% with p < 0.001. Smaller needle size corresponded to smaller percentage of damage. Exchanging needles after more than five injection passes will minimize needle deformation and likely increase injection precision.

Breast implant-associated anaplastic large cell lymphoma in Romania: First case series of all documented cases

SummaryBreast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon malignancy linked to textured breast implants by moderate evidence in 2021. Documenting Romanian cases provides valuable insights into epidemiology, management, and outcomes, enhancing global understanding and informing clinical practices. Our objectives were to analyze BIA-ALCL cases in Romania, focusing on patient demographics, implant characteristics, clinical presentation, diagnostic methods, treatment, and outcomes.We conducted a retrospective review of all known BIA-ALCL cases in Romania, examining patient demographics, implant details, clinical presentation, diagnostic methods, and outcomes. Data sources included medical records, surgical reports, follow-up data, and implant characteristics like shape, texture, and manufacturer.The mean age at diagnosis was 44.4 years. All patients had textured implants and no replacements, 4 with aesthetic indication and 1 reconstruction. The mean time from implantation to diagnosis was 7.2 years. Clinical presentations were primarily late seromas, diagnosed through fine needle aspiration and immunohistochemistry. Treatments involved multidisciplinary teams, with bilateral en-bloc explantation and adjuvant therapies in two cases. One patient had immediate reconstruction with smooth implants and Acellular Dermal Matrix. No disease recurrence was observed post-treatment.The low BIA-ALCL prevalence in Romania estimated at 1:44,500 compared to the mean of 1:13,745 in Europe indicates the need for an increased awareness and tracking. Establishing mandatory national implant registries, pathology databases, and enhancing physician and patient education will help identify potential cases. All cases involved textured implants, highlighting the need for ongoing research to identify risk factors and guide surgeons consulting patients with these implants.

A simple method to identify implant sites in totally edentulous arches: a pilot study with thermo-printed templates used with cone beam computed tomography.

All dental implants must be placed following radiological, clinical and aesthetic indications in compliance with prosthetic principles avoiding iatrogenic damage to patients. In implantology, among the key choices, to obtain predictable results, it is essential to establish (by cone beam computed tomography [CBCT]) the sites where to insert the implants; these sites must be identified, during the surgical phase, in the oral cavity. Surgical guides represent a valid aid especially in complex cases that require multiple implants. For some clinical conditions, expert operators choose the free hand technique during which identifying the chosen implant sites on CBCT in the oral cavity is more difficult. This experimental study is based on the use of thermo-molded mask as an alternative to surgical guides when the freehand technique is adopted in totally edentulous patients. These innovative masks, containing radiopaque references, are initially worn by patients during the execution of the CBCT, and later during surgery to identify the implant sites in the oral cavity. The procedure described proved to be very useful and able to increase the precision of the freehand technique even if it does not provide information on the inclination of the implants. The metal references help clinical identification of the implant site. Our thermo-molded masks, in particular clinical conditions, could represent a valid and economical alternative to the classic surgical guide. The described procedure does not increase costs for the patient and significantly increases the precision in inserting the implants during free-hand techniques.

Efficacy and Safety of Poly-l-Lactic Acid in Facial Aesthetics: A Systematic Review.

The primary objective of this systematic review study was to investigate the effectiveness, durability, and adverse events of PLLA treatment for aesthetic indications. The search strategy was performed in MEDLINE (Ovid). The electronic literature search of five databases was performed, from the inception of the databases until the 12th of February 2024. This was to identify randomized clinical trials that assessed PLLA treatment in adult individuals exhibiting facial aging and/or facial lipoatrophy. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Eleven RCTs out of 1467 identified citations were included. Four studies showed increased dermal thickness, significant improvement in facial lipoatrophy severity and aesthetic clinical scores, after PLLA treatment with its effects sustained for at least 25 months. Two studies demonstrated the superiority of PLLA over injectable human collagen. Also, three studies showed positive results favoring PLLA when compared with PH gel in lipoatrophy severity, transepidermal water loss, skin quality, elasticity, and patient satisfaction. All adverse events were mild-to-moderate in intensity, and the main ones worth noting were bruising, hematoma, tenderness, nodules, and edema. Five out of eleven studies were considered having high risk of bias. The evidence on the effectiveness and safety of PLLA for facial rejuvenation is of low quality; thus, the reported high effectiveness, safety, and long-lasting effects for this purpose should be further investigated.

The Endo-lift Laser (Intralesional 1470 nm Diode Laser) for Dermatological Aesthetic Conditions: A Systematic Review.

The prominence of minimally invasive aesthetic approaches has become increasingly pivotal. The endo-lift laser method is an intralesional 1470nm diode laser connected to a fiber that serves both therapeutic and aesthetic properties. We sought to evaluate the efficacy and safety of the endo-lift laser method for dermatological aesthetic applications. PubMed, Ovid-Embase, and Web of Science were systematically searched up to November 5th, 2023. A citation search was also performed. The National Institute of Health (NIH) Quality Assessment Tool was used to evaluate the quality of the studies. Out of 339 articles, twenty-three relevant studies were included in the current review. Applying the endo-lift laser method for rejuvenation, including face and neck lifting, enhancing skin laxity, and disappearing wrinkles, folds, and lines, demonstrated favorable efficacy and safety profile. Moreover, most studies have shown that the endo-lift laser method is promising in eliminating the adipose tissue in the jowl, abdomen, thighs, and arms. The endo-lift laser technique was also efficacious in nose remodeling and blepharoplastic procedures, including treating eyelid and eyebrow ptosis, eye bag, eyebrow position, and eyelid laxity. Patients who suffer from several diseases, such as hidradenitis suppurativa, progressive lipodystrophy, acne vulgaris, scars, and keloids, benefit from procedural treatment with the endo-lift laser technique. Across all studies, the adverse events were mild and self-limiting. Investigating the endo-lift laser method in all aesthetic and therapeutic indications resulted in high patient satisfaction rates. The endo-lift laser technique has therapeutic effects and is recommended for various dermatological aesthetic indications. Further clinical studies with control groups and larger sample sizes are needed to acquire more reliable evidence. 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 .

Update on Non-Interchangeability of Botulinum Neurotoxin Products.

The growing use of botulinum neurotoxins (BoNTs) for medical and aesthetic purposes has led to the development and marketing of an increasing number of BoNT products. Given that BoNTs are biological medications, their characteristics are heavily influenced by their manufacturing methods, leading to unique products with distinct clinical characteristics. The manufacturing and formulation processes for each BoNT are proprietary, including the potency determination of reference standards and other features of the assays used to measure unit potency. As a result of these differences, units of BoNT products are not interchangeable or convertible using dose ratios. The intrinsic, product-level differences among BoNTs are compounded by differences in the injected tissues, which are innervated by different nerve fiber types (e.g., motor, sensory, and/or autonomic nerves) and require unique dosing and injection sites that are particularly evident when treating complex therapeutic and aesthetic conditions. It is also difficult to compare across studies due to inherent differences in patient populations and trial methods, necessitating attention to study details underlying each outcome reported. Ultimately, each BoNT possesses a unique clinical profile for which unit doses and injection paradigms must be determined individually for each indication. This practice will help minimize unexpected adverse events and maximize efficacy, duration, and patient satisfaction. With this approach, BoNT is poised to continue as a unique tool for achieving individual goals for an increasing number of medical and aesthetic indications.

Classification of Breast Implant Malposition.

Implant malposition is a well-recognized complication of prosthetic breast implants. However, to date, no objective classification system has been described. The aim of this study was to perform a prospective trial of an objective and reproducible classification system for implant malposition formulated by analyzing retrospective data from a large cohort of patients with implant malposition. The authors retrospectively analyzed the degree of medial/lateral and inferior/superior implant malposition relative to their optimal position within the breast footprint in a series of 189 breasts (n = 100 patients). An objective classification system for implant malposition was devised and then applied to a prospective cohort of 53 breasts in 28 patients with implant malposition. The degree of malposition in a single or combination of axes was categorized according to the distance (measured in centimeters) from the ideal breast footprint. The classification system incorporated the axis of malposition and distance to generate a treatment decision-making guide. Cases of Grade 1 malposition did not warrant surgical intervention, whereas surgical correction was warranted in all Grade 3 cases. In the combined patient cohort (n = 242 breasts, 128 patients), lateral, inferior, medial, and superior displacement ranged between Grades 1 and 3. There was no interobserver variability in the grades assigned to 9 out of 10 patients in the prospective group. A simple and reproducible classification system for implant malposition has been created that allows surgeons to objectively record the extent of malposition, guides surgical decision-making, and can be used to document the results of any intervention.

Aesthetic Surgery &amp; the Indications at A Sub-Urban Tertiary Hospital in Edo State, Nigeria

Background: Aesthetic surgery though growing at an exponential rate in developed countries is still not well developed in Nigeria. Though lately, there has been an increasing demand for cosmetic procedures in Nigeria but still, the practice is still slow growing. Objective: Few reports of the scope of aesthetic surgery are available from the sub region and Nigeria as a whole. In this study we seek to determine the aesthetic procedures and its indications in our centre, a sub urban teaching hospital in Irrua, Edo State, Southern Nigeria. Methods: A retrospective study of all aesthetic surgery cases carried out over a 5-year period – Jan 2019 to December 2023 at Irrua Specialist Teaching Hospital. Data from theatre records and case notes were analysed with respect to age, sex, procedure and indications for surgery done. Descriptive analysis of variables, means and percentages were considered. Results: In the period of study, 1,066 plastic surgery procedures were documented: 34 (3.19%) were for aesthetic indications. Sixteen of the patients (47.1%) were male and 18 (52.9%) female. Age range of patients that had aesthetic surgery was 1 - 60 years and the mean age was 24.1 + 18.08 years. The commonest aesthetic procedure was cleft repair 14 (41.17%) following cleft lip/palate, the rest were scar revisions 6 (17.65%) with the commonest indication being unsightly scar, otoplasties 5 (14.70%) following traumatic injury to the ear, liposuction 3 (8.82%) indicated by lipodystrophy, rhinoplasties 3 (8.82%) post traumatic injury to the nose, mammoplasties 2 (5.88%) which were done post mastectomy, and one (2.94%) cranioplasty following gun-shot orbital injury. Conclusion: There is paucity in the volume of cosmetic procedures in Irrua and the pattern of requests here differs in many respects from western centres. With the current reduced pool of aesthetic surgery, it is advisable to establish an aesthetic surgery sub-unit in most tertiary institutions. This sub-unit should be fully functional including special clinic days, as this could help attract future clients and develop this branch of Plastic Surgery.

Extra facial esthetic indications of botulinum toxin: A review

Harnessing of the most potent neurotoxin, botulinum toxin (BTX) has been one of the most significant developments in the field of esthetics. Ever since its approval by the Food and Drug Administration in 2002 for the temporary improvement in the appearance of moderate-to-severe glabellar lines, BTX has been used for numerous off-label esthetic indications, the majority being facial indications. In this review, we intend to discuss the extra facial esthetic indications of BTX which include neck rejuvenation, improving shoulder contours, calf slimming, ankle slimming, and androgenetic alopecia. We have included essential tips for each indication.

Influence of the initial state of the subcutaneous cell in overweight and obesity patients on the development of complications in the postoperative period

The World Obesity Federation published an atlas in 2023, which reports that if the current trend continues, in 2035 every second person in the World will be overweight or obese. Often, overweight or obese patients turn to a plastic surgeon for help, as the “easiest way” to solve this problem. Nevertheless, the initial state of the patient's health is fundamental to obtain a satisfying result for both the surgeon and the patient of the aesthetic intervention. Therefore, a thorough understanding of the pathomorphological processes occurring in the body of patients with overweight or obesity is necessary, which determines the relevance of this study.Purpose of the study: to study the morphological picture of the subcutaneous tissue in patients with overweight or obesity.Material and methods. A morphological and immunohistochemical assessment of the state of the subcutaneous tissue was carried out in 49 overweight women who, in the period from 2019 to 2020, underwent planned surgical interventions for aesthetic indications aimed at correcting body contours. After the operation, women were observed for 6 months, assessing the timing of wound healing, as well as the presence or absence of seromas, ligature fistulas, and wound infection. We carried out a comparative analysis of the morphological picture of the subcutaneous tissue in different course of the wound process, studied the prognostic significance of the identified subcutaneous tissue morphotypes in relation to the risk of delayed and complicated wound healing.Results. Histological examination revealed two morphological types of subcutaneous adipose tissue structure: adipocyte and adipocyte-fibrous. The adipocyte type of structure of the subcutaneous adipose tissue is represented by the adipose tissue itself from typical mature adipocytes with interadipocyte small capillaries, which has a lobular structure with thin layers of interlobular connective tissue. This morphological type of structure was observed mainly in the group with a standard postoperative period. The mixed adipocyte-fibrous type of subcutaneous adipose tissue structure was characterized by a different ratio of two tissue components - fatty and fibrous. This morphological type of structure is typical for a group of patients with a delayed and complicated wound process in the postoperative period. The established changes in the histological structure, cell infiltration with an increase in the number of CD68+ positive macrophages and HLA-DR+ positive immune cells, perivascular CD20+ B-lymphocytes in the subcutaneous fat indicates that patients with a complicated healing process have already been admitted to the clinic in a state of local chronic inflammation of the subcutaneous tissue.Conclusion. The morphological changes in the subcutaneous tissue revealed during our study can partially explain the prolongation of the wound process and the development of complications in the postoperative period in overweight and obese patients. However, in order to create a routine algorithm for the preoperative identification of patients at risk, it is necessary to identify correlations between biochemical changes in the blood and the development of changes in the subcutaneous tissue.

Combining Poly-Levo-Lactic Acid and a HA-Biorevitalizer for Aesthetic Indications. A Case Report for Facial Rejuvenation

Combining Poly-Levo-Lactic Acid and a HA-Biorevitalizer for Aesthetic Indications. A Case Report for Facial Rejuvenation

Assessment of Harms Reporting Quality in Randomized Controlled Trials of Aesthetic Rhinoplasty: A Systematic Review.

Rhinoplasty is one of the most common aesthetic plastic surgery procedures. Complications can lead to both aesthetic and functional impairments. The Consolidated Standards of Reporting Trials (CONSORT) Harms statement was developed to promote improved reporting of harm across randomized controlled trials (RCTs). The aim of this systematic review is to assess harms reporting quality across RCTs on aesthetic rhinoplasty. A literature search was conducted in Ovid MEDLINE and Embase databases (January 1, 2005 to August 4, 2023). RCTs which compared 2 or more interventions in rhinoplasty with primarily aesthetic indications and assessed patient-important outcomes were included. The reporting quality was assessed by following a 40-item checklist endorsed by the 2022 CONSORT Harms Extension update. A total of 58 RCTs met the inclusion criteria. Fifteen RCTs addressed harms of treatment in some capacity. Overall, the reporting quality across RCTs was poor, with a median CONSORT Harms score of 33% (range, 16%-83%). A reporting adherence of ≥50% was met by only 8 studies. There was no significant difference in reporting adherence between studies based on journal endorsement of CONSORT or industry vs nonindustry funding sources (P > .05). A high journal impact factor was significantly associated with a higher reporting quality (P = .044). CONSORT Harms reporting adherence was poor across the majority of included RCTs. Future trials on aesthetic rhinoplasty should aim to follow the reporting recommendations endorsed by the CONSORT Harms statement to increase transparency and minimize heterogeneity in harms reporting across studies.

Evaluation of the Hydrophilic, Cohesive, and Physical Properties of Eight Hyaluronic Acid Fillers: Clinical Implications of Gel Differentiation.

Hyaluronic acid (HA) fillers are used to treat an array of aesthetic indications. Proper filler selection is paramount for successful patient outcomes. However, many important physiochemical and physical properties that impact HA gel behavior remain undefined. To evaluate the hydrophilicity, cohesivity and particle size of eight commercial HA fillers manufactured by either Non-Animal Stabilized Hyaluronic Acid (NASHA) or Optimal Balance Technology (OBT) techniques. Three individual in vitro experiments were performed to assess HA swelling capacity, cohesion, and particle size. Image analyses, blinded evaluation using the Gavard-Sundaram Cohesivity Scale, and laser diffraction technology were utilized, respectively. Compared to fillers manufactured with NASHA technology, OBT products demonstrated greater swelling capacity, cohesion, and wider particle size distributions. Strong positive correlations between swelling factor, degree of cohesivity, and increasing widths of the particle size distributions were observed. The hydrophilicity, cohesivity and particle size distributions vary among HA fillers manufactured with different techniques. The creation of new labels identifying products based on their unique combination of physiochemical and physical characteristics may help guide appropriate selection of HA fillers to optimize patient outcomes.

A Scoping Review of the Role and Limitations of Surgical Versus Non-Surgical Management of Dentofacial Deformities

Objectives: The amount of dermal filler procedures is increasing. Some patients opt to undergo dermal fillers instead of orthognathic surgery to treat unesthetic complaints from dentofacial deformities. The aim of this work is to carry out a literature review with regard to a comparison of role and limitations between aesthetic indications of orthognathic surgery and dermal fillers. Methods: A scoping review was performed according to the PRISMA-ScR guidelines on Pubmed, Web of Science and Google Scholar. A second search was conducted to highlight topics very close subjects to the main subject: the importance of social media and measures to avoid litigation in facial aesthetics. Results: Literature on the subject is very rare. Clinical facial analysis is fundamental to both procedures. Although patients wishes are important issues, facial analysis cannot be neglected due to its objectivity. Body dysmorphic disorder is considered a contraindication for both procedures. Social media is important in patient decision-making, but should not influence treatment planning by experts. Preventing litigation or reducing financial and reputational damage can be accomplished with a few simple steps. Conclusions: A helpful list of indications and particularly contraindications for orthognathic surgery and dermal fillers was drawn up. Dermal fillers must not substitute orthognathic surgery. Further studies are urgently needed to discuss this contemporary issue.

A survey on the cosmetic use of injectable polynucleotide: The pattern of practice among Korean Dermatologists.

Skin boosters denote injectables that promote global improvement of the skin which includes skin texture, elasticity, hydration, and overall appearance. Polynucleotide (PN) products have become popular, but there is surprisingly little guidance on their use. We aimed to maximize the safety and efficacy of injectable PN by providing information on their pattern of practice among board-certified dermatologists. A total of 235 Korean board-certified dermatologists familiar with skin boosters participated in a survey which questioned the participant's years of practice, selection of skin boosters in one's clinic, and range of lasers and light sources as well as skin care devices that are available. For those who use PN, one was asked to check all its aesthetic indications, mode of delivery, injection depth, treatment interval as well as options for combined therapy. Seventy-one percent of the survey participants had at least 5 years of professional experience as a board-certified dermatologist, and among the different skin boosters, 88% replied that they practiced PN injection. The top six indications for PN were fine lines on the cheek followed by infraorbital fine lines, periorbital fine lines, uneven skin texture, dry skin, and fine lines on the forehead. Many opted for a 33G needle and the serial puncture technique targeting the dermis. A total of three sessions of PN injection spaced 4 weeks apart is most often recommended. 79 percent of PN users blended PN injection with lasers and light therapy with the most popular being radiofrequency (non-invasive, needle RF) and high-intensity focused ultrasound (HIFU). PN is a skin booster which is widely practiced among Korean dermatologists. According to our survey, the best indication of PN is facial fine lines, and as such PN injection is often repeated and combined with a variety of non-surgical rejuvenation procedures. We hope our data help dermatologists better understand and utilize PN injection.

Fat Grafting to the Breast for Aesthetic Indications: Techniques and Outcomes in 165 Consecutive Patients.

Fat grafting to the breast for aesthetic indications has become increasingly popular. Herein, methods, aesthetic outcomes, and complications are reviewed in a retrospective case series. Female patients (n=165) with an average age of 45years (range: 17-78years) who underwent fat grafting to breast were evaluated. Demographic parameters, the type of procedure, the amount of fat transferred, the site(s) of fat harvest, operative times, and the patient's postoperative recovery and outcomes were recorded. Of the 165 patients, 105 had breast augmentation with fat only. Of these 105 patients, 14(8%) had implant removal with and without capsulectomy, and 61(37%) had mastopexies. Composite augmentation was performed in the remaining 60 patients. The average amount of fat used was 208 cc (range: 10 to 945cc) per breast. Forty-five patients (27%) underwent a second procedure. Of the 165 patients, 37(22%) had adverse events unrelated to the fat graft, including suture abscesses, scarring, and minor incision cite skin breakdown. Four patients (2.4%) had a complication related to fat grafting including 'lump' formation between the breast, abnormal mammograms, and the need for simple aspiration of a lipid cyst. Autologous fat grafting should be considered for both primary and secondary aesthetic breast surgery to enhance outcomes. Complications related to fat grafting are uncommon. Revisional and secondary surgeries may be needed to achieve the desired outcome. Power-assisted liposuction, with vibratory infiltration of the tumescent solution, auto-infusion of fat, and Expansion Vibration Lipofilling using a closed system has become our preferred technique. Fat grafting to breast can be considered for both primary and secondary aesthetic breast surgery Complications related to fat grafting are uncommon There does not appear to be an overall increase in complications of associated mastopexy and composite augmentation LEVEL OF EVIDENCE V: 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 .

Addressing the Real-World Challenges of Immunoresistance to Botulinum Neurotoxin A in Aesthetic Practice: Insights and Recommendations from a Panel Discussion in Hong Kong

With increasing off-label aesthetic indications using higher botulinum neurotoxin A (BoNT-A) doses and individuals starting treatment at a younger age, particularly in Asia, there is a greater risk of developing immunoresistance to BoNT-A. This warrants more in-depth discussions by aesthetic practitioners to inform patients and guide shared decision-making. A panel comprising international experts and experienced aesthetic practitioners in Hong Kong discussed the implications and impact of immunoresistance to BoNT-A in contemporary aesthetic practice, along with practical strategies for risk management. Following discussions on a clinical case example and the results of an Asia-Pacific consumer study, the panel concurred that it is a priority to raise awareness of the possibility and long-term implications of secondary non-response due to immunoresistance to BoNT-A. Where efficacy and safety are comparable, a formulation with the lowest immunogenicity is preferred. The panel also strongly favored a thorough initial consultation to establish the patient’s treatment history, explain treatment side effects, including the causes and consequences of immunoresistance, and discuss treatment goals. Patients look to aesthetic practitioners for guidance, placing an important responsibility on practitioners to adopt risk-mitigating strategies and adequately communicate important risks to patients to support informed and prudent BoNT-A treatment decisions.

Neutralizing Antibody Formation with OnabotulinumtoxinA (BOTOX®) Treatment from Global Registration Studies across Multiple Indications: A Meta-Analysis.

Though the formation of neutralizing antibodies (NAbs) during treatment with botulinum neurotoxin is rare, their presence may nonetheless affect the biological activity of botulinum toxin and negatively impact clinical response. The goal of this updated meta-analysis was to evaluate and characterize the rate of NAb formation using an expanded dataset composed of 33 prospective placebo-controlled and open-label clinical trials with nearly 30,000 longitudinal subject records prior to and following onabotulinumtoxinA treatment in 10 therapeutic and aesthetic indications. Total onabotulinumtoxinA doses per treatment ranged from 10 U to 600 U administered in ≤15 treatment cycles. The NAb formation at baseline and post-treatment was tested and examined for impact on clinical safety and efficacy. Overall, 27 of the 5876 evaluable subjects (0.5%) developed NAbs after onabotulinumtoxinA treatment. At study exit, 16 of the 5876 subjects (0.3%) remained NAb positive. Due to the low incidence of NAb formation, no clear relationship was discernable between positive NAb results and gender, indication, dose level, dosing interval, treatment cycles, or the site of injection. Only five subjects who developed NAbs post-treatment were considered secondary nonresponders. Subjects who developed NAbs revealed no other evidence of immunological reactions or clinical disorders. This comprehensive meta-analysis confirms the low NAb formation rate following onabotulinumtoxinA treatment across multiple indications, and its limited clinical impact on treatment safety and efficacy.

Influence of changes in the human intestinal microbiota on slowing the wound process in overweight persons

Overweight and imbalance of the intestinal microbiota are risk factors for disruption of reparative processes during the healing of postoperative wounds. Given the scale of the obesity epidemic in the modern world, the number of overweight patients undergoing surgery for various reasons is also increasing. Potentiation of the risk of a delayed and complicated course of the wound process with a combination of obesity and disturbances in the composition of the intestinal microbiota determines the relevance of this study. Purpose of the study : to study the composition of the intestinal microbiota in patients with overweight and obesity, who have a slowdown in the course of the wound process and the development of complications in the postoperative period. Material and methods . The composition of the intestinal parietal microbiota was studied by microbial markers in the blood using gas chromatography in 49 overweight women who underwent planned surgical interventions for aesthetic indications aimed at correcting body contours from 2019 to 2020. After surgery, women were followed up for 6 months, assessing the timing of wound healing. A comparative analysis of the composition of the intestinal microbiota was carried out in different courses of the wound process, the prognostic significance of individual indicators of the intestinal microbiota was studied in relation to the risk of delayed and complicated wound healing. Results . In the postoperative period, three groups were formed: 1st − complicated wound process (n = 21), 2nd − slow wound process 16 (n = 16), 3rd − standard wound process (n = 12). There were statistically significant differences between the 1st and 2nd groups in terms of “ Peptostreptococcus anaerobius (Gr 1) ≥ 562.0 · 105 cells/g”, p = 0.025) and “ Propionibacterium ≥3.2 · 105 cells/g”, p = 0.0136). Differences were found between the 1st and 3rd groups in terms of “Endotoxin ≥0.7 nmol/ml”, p = 0.051). The highest risk of complicated and delayed postoperative wound healing is observed when the value of the indicators « Propionibacterium ≥32.0 · 105 cells/g”, “ Peptostreptococcus anaerobius (Gr 1) ≥7.0 · 105 cells/g” and “Endotoxin ≥0.7 nmol/ml”. On the basis of the decision tree method, 4 risk classes of a delayed and complicated course of the wound process were identified. The highest risk is in patients with a combination of factors “ Propionibacterium ≥ 3.2 · 105 cells/g” and “Endotoxin ≥ 0.7 nmol/ml”. Conclusion . A number of indicators of intestinal microbiota have a high prognostic value in relation to the risk of developing a complicated and delayed course of the wound process in overweight individuals. The data obtained can be used to predict unfavorable healing of surgical wounds.

Prediction of the Complicated Wound Process in Overweight Patients Depending on the Composition of the Intestinal Microbiota

Introduction. Overweight and imbalance of the intestinal microbiota are risk factors for disruption of reparative processes during the postoperative wound healing. Given the scale of the obesity epidemic in the modern world, the number of overweight patients undergoing surgery for various reasons is also increasing. The potentiation of the risk of a delayed and complicated course of the wound process combined with obesity and violated composition of the intestinal microbiota determines the relevance of this study.The aim of the study was to investigate the composition of the intestinal microbiota in patients with increased body weight, with long-term non-healing and complicated surgical wounds.Methods. The composition of the parietal intestinal microbiota was studied by microbial markers in the blood using gas chromatography in 49 overweight women who underwent planned surgical interventions for aesthetic indications in the period from 2019 to 2020, aimed at correcting body contours. After the operation, women were observed for 6 months, with assessment of the timing of wound healing. We carried out a comparative analysis of the composition of the intestinal microbiota in the different course of the wound process, studied the prognostic significance of individual parameters of the intestinal microbiota in relation to the risk of delayed and complicated wound healing.Results. In the postoperative period, all patients were divided into three groups: group 1 - complicated wound process (n=21), group 2 - delayed wound process 16 (n=16), group 3 - conventional wound process (n=12). Statistically significant differences were found between groups 1 and 2 in terms of "Peptostreptococcus anaerobius (Gr 1) 562.0" (621.76962.03 versus 101.75371.90, respectively, p=0.025) and "Propionibacterium 3.2" (77.57 48.57 vs. 40.44 38.15, respectively, p=0.014). Differences were found between groups 1 and 3 in terms of Endotoxin 0.7 (0.730.58 nmol/ml versus 0.860.48 nmol/ml, respectively, p=0.051). The most risk of the complicated and delayed postoperative wound healing is observed when the values of the parameters were "Propionibacterium 32.0", "Peptostreptococcus anaerobius (Gr 1) 7.0" and "Endotoxin 0.7". Based on the decision tree analysis, 4 risk classes of delayed and complicated course of the wound process were identified. Patients with a combination of Propionibacterium 3.2 and Endotoxin 0.7 had the highest risk.Conclusion. A number of parameters of the intestinal microbiota have a high prognostic value regarding the risk of developing a complicated and delayed course of the wound process in overweight individuals. The data obtained can be used to predict unfavorable healing of surgical wounds. Further research is needed in this area on a larger sample of patients, including males.