American Society Of Plastic Surgeons Research Articles

Trends in American Plastic Surgery Procedures (2005-2019): Observing the Growth Rate of Maxillofacial Surgery and Cosmetic Minimally Invasive Procedures in ASPS Data.

This study explores the dynamic changes in plastic surgery practices, focusing on the growth rates across different subcategories, particularly highlighting the trends in the United States. To analyze evolving trends in plastic surgery using statistical methods, providing insights into the changes and growth patterns in various segments over time. Utilizing data from 2005 to 2019 from the American Society of Plastic Surgeons, the authors, conducted a comprehensive statistical analysis using the SPSS program to investigate trends in plastic surgery procedures. Our analysis revealed no significant differences in year-on-year growth rates between cosmetic and reconstructive surgery. However, in reconstructive surgery subcategories, maxillofacial surgery showed the highest mean growth rate at 11.61%, though this was not statistically significant. In cosmetic minimally invasive procedures, soft tissue filler injections and botulinum toxin A injections experienced notably higher growth trends compared with microdermabrasion. The findings suggest that practitioners considering a career in plastic surgery should not focus solely on choosing between reconstructive and cosmetic surgery. Recognizing substantial growth in cosmetic minimally invasive procedures, especially botulinum toxin A injections and fillers, is vital for making informed career decisions.

Abstract PO1-20-08: Primary breast implant-associated squamous cell carcinoma with subsequent TEMPUS testing and failure of immunotherapy

Abstract Primary squamous cell carcinoma of the breast is a rare entity, and there are a limited number of cases in the literature describing squamous cell carcinoma arising from breast implants. It has been hypothesized that these implant-associated cancers may arise from epithelialization of the implant capsule followed by chronic inflammation. None of the cases in the literature were treated with immunotherapy. We present a case of an aggressive, primary sarcomatoid squamous cell carcinoma of the breast arising from a breast implant that was treated unsuccessfully with simultaneous chemotherapy and immunotherapy following TEMPUS testing. Introduction: Breast augmentation is the most common plastic surgery procedure performed worldwide, with more than 300,000 done in the United States every year. While breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is extensively discussed in recent literature, other breast implant-associated cancers are rarer and less studied. Breast implant-associated squamous cell carcinoma (BIA-SCC) specifically is an extremely rare complication of breast augmentation and no guidelines for treatment exist. The American Society of Plastic Surgeons (ASPS) released a statement on BIA-SCC on 9/2022 following a safety communication from the FDA, and it is recommended health care providers submit case reports of BIA-SCC to a patient registry. Case study: We present the case of a female patient who underwent bilateral breast augmentation in 2006 with Mcghan textured, pre-pectoral, areolar saline implants. In 2022, she presented with swelling and a lump in her breast and underwent bilateral breast implant removal with capsulectomy. Pathology showed triple negative sarcomatoid squamous cell carcinoma of the right breast capsule. TEMPUS testing on the breast biopsy revealed a PIK3CA mutation and PD-L1 negative status. Her case was discussed with a multi-disciplinary team including plastic surgery, multiple oncologists, and radiation oncology and her clinical picture was determined to be most consistent with BIA-SCC. Based on the KEYNOTE-522 study, she was determined to be a candidate for neoadjuvant therapy with pembrolizumab and chemotherapy as she was newly diagnosed, previously untreated, nonmetastatic, and had a triple negative tumor. She received two cycles of carboplatin, paclitaxel, and pembrolizumab but unfortunately rapidly progressed with chest wall extension, multiple new pulmonary nodules, worsening lymphadenopathy, right ventricular tumor thrombus, and new malignant pleural effusion and was transitioned to hospice. Discussion: Seven cases of BIA-SCC, one case of squamous cell carcinoma (SCC) after liquid silicone injection augmentation, one case of squamous metaplasia on the breast implant capsule, and one case of epithelization of the breast implant capsule have been previously described in the literature (Table 1). None of the available cases of BIA-SCC report TEMPUS testing, and none of the patients were treated with immunotherapy. The origin of BIA-SCC is unclear, but several theories have been described including chronic inflammation leading to conversion of epithelial tissue on the capsule to SCC. It is unknown how the breast implant capsule might become epithelialized to begin with – introduction of epithelium intraoperatively during augmentation, rupture of epidermal cysts, existence of epithelium in the area from a childhood injury or from birth, or epithelization from chronic shear forces from the augmentation or leakage of the implant are all possibilities. With the ongoing data gathering through the FDA patient registry, we will continue to learn more about these rare cancers and potentially get further insight into their origins. Table 1 An overview of cases of BIA-SCC in the literature Citation Format: Emily Podany, Katherine Clifton. Primary breast implant-associated squamous cell carcinoma with subsequent TEMPUS testing and failure of immunotherapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-20-08.

Plastic Surgeons' Perspective on the FDA Breast Implant Regulatory Mandates.

In 2021, the US Food and Drug Administration (FDA) issued a new checklist, labeling and rupture screening recommendations for breast implants to improve the decision-making process. This study aims to understand the plastic surgeon's perspective on these changes and their perceived impact on clinical practice. In September 2023, a 27 multiple-choice cross-sectional survey was distributed to 4,352 active members of the American Society of Plastic Surgeons to evaluate attitudes on the FDA's black box warning, informed decision checklist, and updated rupture screening recommendations. A total of 591 responses were collected (13.6%). The majority of respondents were between the ages of 45 to 64 (58%) and had been in practice for more than 20 years (52%). Surgeons felt like some additions were appropriate, however the majority (57%) stated that the informed decision checklist did not have a positive impact on workflow; 66% were also neutral or disagreed with the reported incidence rates related to complications and cancer. Nearly half of respondents (47%) did not feel the black box warning improved their patients' understanding of the risks and benefits. Additionally, 47% of respondents also believed these requirements, in combination, did not improve the overall patient experience with implants. Respondents had an overall positive response towards the addition of risk information provided by the FDA issued guidance and updates to rupture screening recommendations. However, they remain divided as to whether the black box warning and patient decision checklist had an overall positive impact on clinical practice patterns.

Performance of ChatGPT in Answering Clinical Questions on the Practical Guideline of Blepharoptosis.

ChatGPT is a free artificial intelligence (AI) language model developed and released by OpenAI in late 2022. This study aimed to evaluate the performance of ChatGPT to accurately answer clinical questions (CQs) on the Guideline for the Management of Blepharoptosis published by the American Society of Plastic Surgeons (ASPS) in 2022. CQs in the guideline were used as question sources in both English and Japanese. For each question, ChatGPT provided answers for CQs, evidence quality, recommendation strength, reference match, and answered word counts. We compared the performance of ChatGPT in each component between English and Japanese queries. A total of 11 questions were included in the final analysis, and ChatGPT answered 61.3% of these correctly. ChatGPT demonstrated a higher accuracy rate in English answers for CQs compared to Japanese answers for CQs (76.4% versus 46.4%; p = 0.004) and word counts (123 words versus 35.9 words; p = 0.004). No statistical differences were noted for evidence quality, recommendation strength, and reference match. A total of 697 references were proposed, but only 216 of them (31.0%) existed. ChatGPT demonstrates potential as an adjunctive tool in the management of blepharoptosis. However, it is crucial to recognize that the existing AI model has distinct limitations, and its primary role should be to complement the expertise of medical professionals. Observational study under respected authorities. 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 .

A 16-Year Analysis of Aesthetic Surgery Volume and Its Association with U.S. Economic Performance

Abstract Goals/Purpose Historically, demand for plastic surgery has been associated with the performance of the United States (US) economy. Over the past two decades, the US has weathered a recession, several presidential election cycles, and has seen a rise in the use and influence of social media. Each of these events has led to varying effects on the economy, which undoubtedly have had an impact on plastic surgery demand and expenditures. Thus, this study aims to evaluate the relationship between indicators of economic performance and the popularity and profitability of aesthetic surgery from 2006 to 2022. Methods/Technique Data from the Aesthetic Society’s (AS) Aesthetic Plastic Surgery National Databank and the American Society of Plastic Surgeons’ (ASPS) Plastic Surgery Statistics Report was collected from 2006 to 2022. Surgical procedures analyzed included the most commonly performed cosmetic surgeries: breast augmentation, breast reduction, mastopexy, abdominoplasty, liposuction, blepharoplasty, facelift, and rhinoplasty. The non-surgical botox injections and dermal fillers were also included. A total of 24 variables were examined, including the 10 procedures and two composite variables—total surgical procedures and total injectables; case change percent difference and patient expenditures percent difference were recorded for each of these. Within the corresponding period, economic indices were collected, including personal disposable income per capita (PDI), consumer price index (CPI), medical care services CPI, average gross domestic product per capita (GDP), and annual average closing prices of the NASDAQ, S&P 500, and the Dow Jones (DOW). Pearson correlation tests were used to analyze the strength of association between each financial indicator and case volumes and expenditures for each procedure included in the ASPS and AS reports. Results/Complications From 2006 to 2020 ASPS data demonstrated GDP year-over-year (YOY) change that was positively correlated with case volume and expenditures across 13 out of the 24 different procedure metrics (54.2%). From 2006 to 2016, AS data was positively correlated with the performance of NASDAQ, S&P500, and DOW in 12 of the 24 procedure metrics (50%). GDP YOY change closely followed suit with positive correlations to 11 variables (45.8%). YOY change of PDI, CPI, and medical care services CPI were less frequently associated amongst both data sets. For ASPS data, YOY medical services CPI change was negatively associated with five variables, indicating that as medical services CPI increased, volume of procedures and expenditures decreased. PDI YOY change was not significantly associated with any variables. In the AS dataset between 2006 and 2016, CPI YOY change was not found to be significantly associated with any variables. Across 2019–2022, CPI YOY and disposable YOY change were found to be significantly associated with three variables each. Conclusion Our study suggests that aesthetic plastic surgery procedures and expenditures are most positively correlated with GDP. Stock market indices are additional financial indicators which have significant positive correlations with plastic surgery case volume and expenditures. Inflation indicators were less frequently correlated. Over this timeframe, several important financial events have occurred including the Great Recession, a stock market selloff in 2015 and 2016, and the COVID-19 pandemic. Each of these events, along with several election cycles and the increasing influence of social media and popular culture, have had variable impacts on consumers and the demand for aesthetic plastic surgery. Plastic surgeons should be familiar with US and global financial markets as they fluctuate with current events. While plastic surgery prices and demand may be difficult to anticipate, this study elucidates several factors that may be used by plastic surgeons as a bellwether for their practice.

Blepharoptosis Consultation with Artificial Intelligence: Aesthetic Surgery Advice and Counseling from Chat Generative Pre-Trained Transformer (ChatGPT).

Chat generative pre-trained transformer (ChatGPT) is a publicly available extensive artificial intelligence (AI) language model that leverages deep learning to generate text that mimics human conversations. In this study, the performance of ChatGPT was assessed by offering insightful and precise answers to a series of fictional questions and emulating a preliminary consultation on blepharoplasty. ChatGPT was posed with questions derived from a blepharoplasty checklist provided by the American Society of Plastic Surgeons. Board-certified plastic surgeons and non-medical staff members evaluated the responses for accuracy, informativeness, and accessibility. Nine questions were used in this study. Regarding informativeness, the average score given by board-certified plastic surgeons was significantly lower than that given by non-medical staff members (2.89 ±  0.72 vs 4.41 ± 0.71; p = 0.042). No statistically significant differences were observed in accuracy (p = 0.56) or accessibility (p = 0.11). Our results emphasize the effectiveness of ChatGPT in simulating doctor-patient conversations during blepharoplasty. Non-medical individuals found its responses more informative compared with the surgeons. Although limited in terms of specialized guidance, ChatGPT offers foundational surgical information. Further exploration is warranted to elucidate the broader role of AI in esthetic surgical consultations. Observational study under respected authorities. 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 .

Racial Diversity of Patient Population Represented on United States Plastic Surgeons' Webpages.

Current literature demonstrates a lack of racial diversity in plastic surgery media. However, to our knowledge, no study has yet examined the racial diversity of Webpage content as if from a patient-search perspective. The objective of this study is to determine if there is a racial discrepancy between the US Census, American Society of Plastic Surgeons (ASPS) statistics, and the media featuring implied patients on US plastic surgeons' Webpages from a patient-focused approach. A Google search was completed using the term "(state) plastic surgeon." The first 10 relevant Web sites were collected for each state, and homepages were analyzed. In line with previous studies, the implied patients in media were classified into 1 of 6 skin tone categories: I, ivory; II, beige; III, light brown; IV, olive; V, brown; and VI, dark brown. These correlate to Fitzpatrick phototypes; however, the Fitzpatrick scale measures skin's response to UV exposure. Skin tone was used as a guide to measure racial representation in the media, with the caveat that skin tone does not absolutely correlate to racial identity. Categories I-III were further classified as "white" and IV-VI as "nonwhite." These data were compared with the 2020 ASPS demographics report and US Census. Four thousand eighty individuals were analyzed from 504 Webpages, the majority of which were those of private practice physicians. A total of 91.62% of individuals were classified as "white" and 8.38% "nonwhite." The distribution by category was as follows: I = 265, II = 847, III = 2626, IV = 266, V = 71, and VI = 5. Using χ2 analyses, a statistically significant difference was found between the racial representation within this sample and that of the 2020 US Census nationally (P < 0.001), regionally (P < 0.001), and subregionally (P < 0.001); the 2020 ASPS Cosmetic Summary Data (P < 0.001); and the 2020 ASPS Reconstructive Summary Data (P < 0.001). This study highlights the significant difference between racial representation on plastic surgeons' Webpages and the demographics of patients they serve. Further analyses should identify the impact of these representational disparities on patient care and clinical outcomes, as well as examine how best to measure racial diversity and disparities in patient-oriented media.

A 16-Year Analysis of Aesthetic Surgery Volume and Its Association With US Economic Performance.

Abstract Background Historically, demand for plastic surgery has been associated with the performance of the United States (U.S.) economy. Objectives This study evaluates the relationship between economic performance indicators and the popularity and profitability of aesthetic surgery from 2006 to 2022 considering several recessions and the rise of social media. Methods Data was collected from the Aesthetic Society's (AS) Aesthetic Plastic Surgery National Databank and the American Society of Plastic Surgeons’ (ASPS) Plastic Surgery Statistics Report from 2006 to 2022. Procedures analyzed included the most performed cosmetic surgeries, as well as neuromodulator injections and dermal fillers. Pearson correlation tests were used to analyze the strength of association between eight financial indicators and case volumes and expenditures for each procedure. Results From 2006 to 2020, ASPS data demonstrated gross domestic product (GDP) per capita year-over-year (YOY) change that was positively correlated with case volume and expenditures across 13 out of the 24 different procedure metrics (54.2%). From 2006 to 2016, AS data was positively correlated with the YOY change of the NASDAQ, S&amp;P500, and Dow Jones in 12 of the 24 variables (50%). This was followed by GDP YOY change, with positive correlations to 11 variables (45.8%). YOY change of consumer-level finances and inflation indicators were less frequently associated amongst both data sets. Conclusion Our study shows that aesthetic plastic surgery procedures and expenditures correlate with GDP. While aesthetic surgery demand may be difficult to anticipate, this study elucidates several factors plastic surgeons may use as a bellwether for their practices.

Coverage of Congenital Anomalies: Ensuring Lasting Smiles Act (ELSA) in Legislation.

The Ensuring Lasting Smiles Act (ELSA) is a federal bill which would require all health federally regulated insurance products to cover the full treatment of a congenital anomaly or birth defect until complete restoration of normal function or appearance. ELSA has been a key federal priority for the Legislative Advocacy Committee of the American Society of Plastic Surgeons (ASPS) since the 115 th Congress in 2018. Although it has gained momentum, particularly in the 117 th Congress, the bill remains stalled. Congressional Budget Office review, conducted in March 2022, appears to have overestimated this bill's cost for the private sector, secondary to an alleged lack of data on the prevalence of the conditions, extent of treatments and their costs, and the current extent of private sector coverage. The present review highlights the progress of the ELSA bill and serves to illustrate the hurdles involved in passing significant healthcare bills. This review emphasizes the need for healthcare professionals to provide their congressional representatives with accurate information on realistic cost of currently covered treatments of congenital defects, the necessary treatments not currently covered by insurance, and additional out-of-pocket costs covered by patients. A concerted effort by plastic surgeons should provide tools for ELSA legislative champions to re-introduce and pass the bill during the 118th Congress. This process highlights the essential role of organized medicine in advocating for the successful passage of healthcare legislation.

Beyond Dollars and Scars: The Influence of Wealth Inequality on Total Expenditure on Cosmetic Procedures in the United States.

The present study delves into the "beauty paradox," a multifaceted phenomenon influenced by wealth inequality, societal norms, and consumer behaviors, specifically regarding spending on cosmetic procedures. Relying on data from the United States Census Bureau and the American Society of Plastic Surgeons, the research primarily focuses on the Gini coefficient, Mean Logarithmic Deviation (MLD), and income data for the lowest and top 5% quintiles of mean household income over a 15-year span. The analysis uncovers a significant correlation between Total Expenditures on Cosmetic Surgery and minimally invasive procedures and the wealth of the top 5% income quintile. The "Cosmetic Enhancement Cycle (CEC)" is proposed, indicating a symbiotic growth between wealth accumulation among the affluent and the plastic surgery industry. As such, the "beauty paradox" lays bare the multifaceted consequences of wealth inequality, necessitating a comprehensive approach that addresses socioeconomic dynamics, accessibility of cosmetic procedures, societal norms, and perceptions. This investigation underscores the imperative for further exploration into the myriad ways that wealth inequality sculpts societies and influences behaviors, including within the context of the CEC.

Complications Following Body Contouring: Performance Validation of Bard, a Novel AI Large Language Model, in Triaging and Managing Postoperative Patient Concerns.

Large language models (LLM) have revolutionized the way humans interact with artificial intelligence (AI) technology, with marked potential for applications in esthetic surgery. The present study evaluates the performance of Bard, a novel LLM, in identifying and managing postoperative patient concerns for complications following body contouring surgery. The American Society of Plastic Surgeons' website was queried to identify and simulate all potential postoperative complications following body contouring across different acuities and severity. Bard's accuracy was assessed in providing a differential diagnosis, soliciting a history, suggesting a most-likely diagnosis, appropriate disposition, treatments/interventions to begin from home, and red-flag signs/symptoms indicating deterioration, or requiring urgent emergency department (ED) presentation. Twenty-two simulated body contouring complications were examined. Overall, Bard demonstrated a 59% accuracy in listing relevant diagnoses on its differentials, with a 52% incidence of incorrect or misleading diagnoses. Following history-taking, Bard demonstrated an overall accuracy of 44% in identifying the most-likely diagnosis, and a 55% accuracy in suggesting the indicated medical dispositions. Helpful treatments/interventions to begin from home were suggested with a 40% accuracy, whereas red-flag signs/symptoms, indicating deterioration, were shared with a 48% accuracy. A detailed analysis of performance, stratified according to latency of postoperative presentation (<48hours, 48hours-1month, or >1month postoperatively), and according to acuity and indicated medical disposition, is presented herein. Despite promising potential of LLMs and AI in healthcare-related applications, Bard's performance in the present study significantly falls short of accepted clinical standards, thus indicating a need for further research and development prior to adoption. 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 .

Evidence-Based Performance Measures for Reconstruction after Skin Cancer Resection: A Multidisciplinary Performance Measure Set.

The American Society of Plastic Surgeons commissioned the multidisciplinary Performance Measure Development Work Group on Reconstruction after Skin Cancer Resection to identify and draft quality measures for the care of patients undergoing skin cancer reconstruction. Included stakeholders were the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Dermatology, the American Society of Dermatologic Surgery, the American College of Mohs Surgery, the American Society for Mohs Surgery, and a patient representative. Two outcome measures and five process measures were identified. The outcome measures included the following: (1) patient satisfaction with information provided by their surgeon before their facial procedure, and (2) postprocedural urgent care or emergency room use. The process measures focus on antibiotic stewardship, anticoagulation continuation and/or coordination of care, opioid avoidance, and verification of clear margins. All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the stakeholder societies. The work group recommends the use of these measures for quality initiatives, Continuing Medical Education, Continuous Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.

Assessing the Readability of Online English and Spanish Language Patient Education Resources Provided by the American Society of Plastic Surgeons, American Society of Aesthetic Plastic Surgeons, and American Society of Reconstructive Microsurgeons.

The National Institutes of Health recommends that patient education materials (PEMs) be written at the sixth grade level. However, PEMs online are still generally difficult to read. The usefulness of online PEMs depends on their comprehensibility. This study assessed the readability of PEMs from national Plastic and Reconstructive Surgery (PRS) organization websites. Patient education materials were collected from 3 prominent PRS organizations-the American Society of Plastic Surgeons (ASPS), American Society of Aesthetic Plastic Surgeons (ASAPS), and the American Society of Reconstructive Microsurgeons (ASRM). ASPS PEMs were organized into reconstructive and cosmetic groups, and then further subdivided into English and Spanish subgroups. ASAPS and ASRM PEMs provided cosmetic and reconstructive comparison groups to ASPS, respectively. Readability scores were generated using the Simple Measure of Gobbledygook (SMOG) and the Spanish SMOG scales. Overall, all PEMs failed to meet readability guidelines. Within ASPS, Spanish PEMs were easier to read than English PEMs ( P < 0.001), and cosmetic PEMs were easier to read than reconstructive PEMs ( P < 0.05). There was no significant difference between ASPS cosmetic and ASAPS PEMs ( P = 0.36), nor between ASPS reconstructive and ASRM PEMs ( P = 0.65). ASAPS and ASRM did not have any Spanish PEMs, and 92% of all ASPS PEMs were in English. Although PRS societies strive to better educate the public on the scope of PRS, PRS ranks lowly in public understanding of its role in patient care. In addition, Spanish language PEMs from the 3 PRS organizations are severely lacking. Addressing these concerns will make online patient resources more equitable for various patient populations.

Surgical Written Consent in Aesthetic Plastic Surgery: A Plastic Center Audit of Surgical Consent Standards.

Background Informed consent is a fundamental aspect of modern medical practice that requires effective communication and an ample understanding of medical ethics, patient autonomy, and the legal obligations of healthcare professionals. Maintaining high-quality surgical informed consent is a crucial step in the healthcare process. Thus, we aimed to obtain surgical written consent on abdominoplasty, suction-assisted abdominal dermo lipectomy, and lower body lifting from our hospital database over three months (January to March, 2023) to assess our level across the American Society of Plastic Surgeons (ASPS) system. Results A total of 45 surgical written consents were obtained and 37 consents remained after exclusion. Bleeding, infection, and hematoma were mentioned in more than 80% of our consents. However, important complications such as ileus and umbilical malposition were never mentioned. Overall, the completion rate of written complications ranged from 14% to 56% in comparison to data from the ASPS. Conclusions Our results show a measurable inconsistency in surgical written consents at our center. Thus, establishing a comprehensive and accurate surgical written consent will aid in protecting our center against deficient surgical written consent accusations, improve the experience of patients, and enhance the quality of service provided by our center.

Evaluation of Liposuction as a Part of Abdominoplasty and Simultaneous Hernioabdominoplasty

Introduction. According to the estimates of many countries, liposuction comprises a sought-after aesthetic surgery, achieving a leading position among popular surgical interventions in recent decades. For instance, the records of the American Society of Plastic Surgeons show, that liposuction occupied the 4th place in 2020, 3rd — in 2019, and 2nd — in 2000. Liposuction is frequently included in other aesthetic surgeries. In 2019–2023 the Plastic Surgery Unit of the Mother and Child Clinical Hospital, Ufa, performed this surgical intervention an isolated operation, and as part of abdominoplasty, mammoplasty, brachioplasty, and face-lifting. Aim. To analyze the clinical data of the Plastic Surgery Unit of the Mother and Child Clinical Hospital, Ufa, on the experience of performing liposuction as a stage of the anterior abdominal wall correction in isolated abdominoplasty and simultaneous hernioabdominoplasty. Materials and methods. The study involved 56 patients: women with overweight or obesity, suffering from aesthetic and functional problems in the anterior abdominal wall associated with pregnancy and childbirth. Surgical treatment and outpatient follow-up were performed in the Plastic Surgery Unit of the Mother and Child Clinical Hospital, Ufa from 2019 to 2023. Group 1 of patients included 33 people who underwent abdominoplasty combined with liposuction, group 2 comprised 23 patients, who had hernioabdominoplasty with liposuction. Results and discussion. Liposuction refers to a technique for removing excess fat deposits and improving the contours of the anterior abdominal wall. Liposuction stands as the main component of surgical intervention on the anterior abdominal wall, simplifying the stages of detachment of the anterior abdominal wall and redistribution of the skin-fat flap. The complication rates in abdominoplasty with liposuction and hernioabdominoplasty with liposuction differ insignificantly. Conclusion. Liposuction as a part of abdominoplasty or hernioabdominoplasty contributes to the improvement of surgical treatment outcomes.

Pearls for Starting a Headache Surgery Practice in Academic and Private Practice

There has been a growing body of evidence indicative of the effectiveness of headache surgery in treating patients with refractory headache disorders. The American Society of Plastic Surgeons issued a Policy Statement in 2018 stating that peripheral nerve decompression surgery for the treatment of refractory chronic headache disorders in select patients is considered a standard of care treatment. This endorsement sparked the interest of numerous plastic surgeons into initiating their own headache surgery practices. However, establishing a headache surgery clinic introduces challenges and considerations. This report outlines the key pillars for launching a successful headache surgery practice in academic and private practice environments.

Can Large Language Models Generate Outpatient Clinic Letters at First Consultation That Incorporate Complication Profiles From UK and USA Aesthetic Plastic Surgery Associations?

Abstract   The importance of written communication between clinicians and patients, especially in the wake of the Supreme Court case of Montgomery vs Lanarkshire, has led to a shift toward patient-centric care in the United Kingdom. This study investigates the use of large language models (LLMs) like ChatGPT and Google Bard in enhancing clinic letters with gold-standard complication profiles, aiming to improve patients’ understanding and save clinicians’ time in aesthetic plastic surgery. The aim of this study is to assess the effectiveness of LLMs in integrating complication profiles from authoritative sources into clinic letters, thus enhancing patient comprehension and clinician efficiency in aesthetic plastic surgery. Seven widely performed aesthetic procedures were chosen, and complication profiles were sourced from the British Association of Aesthetic Plastic Surgeons (BAAPS) and the American Society of Plastic Surgeons (ASPS). We evaluated the proficiency of the ChatGPT4, ChatGPT3.5, and Google Bard in generating clinic letters which incorporated complication profiles from online resources. These letters were assessed for readability using an online tool, targeting a recommended sixth-grade reading level. ChatGPT4 achieved the highest compliance in integrating complication profiles from BAAPS and ASPS websites, with average readability grades between eighth and ninth. ChatGPT3.5 and Google Bard showed lower compliance, particularly when accessing paywalled content like the ASPS Informed Consent Bundle. In conclusion, LLMs, particularly ChatGPT4, show promise in enhancing patient communications in aesthetic plastic surgery by effectively incorporating standard complication profiles into clinic letters. This aids in informed decision making and time saving for clinicians. However, the study underscores the need for improvements in data accessibility, search capabilities, and ethical considerations for optimal LLM integration into healthcare communications. Future enhancements should focus on better interpretation of inaccessible formats and a Human in the Loop approach to combine Artifical Intelligence capabilities with clinician expertise. Level of Evidence: 3

Recent trends in hand surgery fellowship applicants and programs

BackgroundHand surgery is a competitive fellowship that draws applicants from orthopedic, plastic, and general surgery. In 2010, recommendations from the American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Match Oversight Committee and the American Society of Plastic Surgeons (ASPS) Plastic Surgery Workforce Task Force led to significant reforms to their respective workforces and training. This study characterizes trends in hand fellowship applicants and programs since these recommendations (2010–2023). Materials and methodsWe queried hand fellowship applicant and program data from the American Society for Surgery of the Hand (ASSH), the National Resident Matching Program (NRMP), and the Accreditation Council for Graduate Medical Education (ACGME). Results, discussion and conclusionsFrom 2010 to 2023, the number of ACGME-accredited hand fellowship programs increased across specialties (orthopedic surgery, 58 to 74 (27.6 % increase, R = 0.97, p < 0.001); plastic surgery, 14 to 19 (35.7 % increase, R = 0.91, p < 0.001); general surgery, 1 to 2 (50 % increase, R = 0.71, p = 0.004). The number of available fellowship positions commensurately increased by 38.8 % over the same time period. The number of applicants did not significantly change between 2010 (155 applicants) and 2023 (198 applicants) (R = 0.32, p = 0.27). The ratio of applicants-to-positions significantly decreased from 2010 (1.12 applicants per position) to 2023 (1.04 applicants per position) (R = -0.74, p = 0.003). Yet, applicants ranked nearly twice as many programs in 2023 (14.9 programs per applicant) compared to in 2010 (7.5 programs per applicant) (R = 0.98, p < 0.001). In light of the American Orthopaedic Association endorsing signal preferencing in the 2022–2023 residency Match, strategies to optimize rank lists in the fellowship application process should be further explored.

A SWOT Analysis of Hot Topics in Plastic Surgery Resident Education: Consensus From the ACAPS 10th Annual Winter Meeting.

With the aim of facilitating a critical self-reflection on how to align plastic surgery education with making excellent plastic surgeons, a rotating small-group session followed by live interactive audience polling was used to perform a SWOT (strengths, weaknesses, opportunities, and threats) analysis at the 10th Annual American Council of Academic Plastic Surgeons Winter Meeting. The final day of the conference included a 3-hour session of rotating small groups followed by live interactive audience polls discussing the following six relevant educational topics: the Plastic Surgery Common Application and resident selection, aesthetic surgery education, leadership development and business education, embedded fellowships and focused training, mentorship, and faculty retention. A total of 60 individuals participated in the activity. A SWOT analysis was successfully performed for each educational topic, and a minimum of four opportunities were identified per topic to help guide future endeavors. Examples of opportunities include releasing recommendations for the implementation of holistic review; developing formal guidelines for aesthetic surgery education in residency via collaboration between ACAPS, American Society of Plastic Surgeons, and The Aesthetic Society; creating extended focused elective rotations; integrating business education into formal curricula for all training levels; enforcing transparency regarding position expectations and offerings including salary, call schedule, and current challenges; and more. The results of this study will help guide future initiatives by the ACAPS to improve resident education and academic retention.

Visual representation of diversity in online patient education materials for reduction mammaplasty

Online patient education materials play an important role in plastic surgery, and surgeons should ensure that materials accurately reflect their patient population. This study compared the skin tone of images in online materials from the American Society of Plastic Surgeons (ASPS), academic plastic surgery programs, and private groups to the demographics of the United States (US) reduction mammaplasty population. Images within patient education materials and embedded photo galleries were assessed and skin tones were categorized using the Fitzpatrick Skin Scale (FSS). Two reviewers evaluated 616 images. Scores of 1-3 were categorized as White, while scores of 4-6 were classified as non-White. The proportion of images categorized as White and non-White were compared to the demographics of the reduction mammaplasty population in the US. Of 616 images, 82% were classified as White, while 18% were non-White. This distribution differed significantly from the racial demographic distribution of patients undergoing reduction mammaplasty in the US in 2020, where 48% identified as White and 52% as non-White (p<0.001). There was also a statistically significant difference in the distribution of FSS scores between the materials from the ASPS, academic programs, and private surgeon groups, with private groups having a lower percentage of non-White images (p=0.028). These findings suggest that implicit bias may impact the creation of patient education materials for reduction mammaplasty and highlights the need for improvement in distributing patient education materials that accurately represent the diverse reduction mammaplasty population.