The mandibular condyle is a common site of facial fractures in children; however, it remains a clinical challenge due to its unique remodeling capacity and the ongoing debate over optimal treatment strategies. This study presents the clinical experience of a tertiary trauma center in Istanbul, Turkey, according to the Plastic and Reconstructive Surgery Clinic's treatment guidelines. A retrospective analysis was conducted on patients treated between 2010 and 2020. Condylar fractures were evaluated in terms of clinical presentation, Helkimo index scores and radiological subtypes. A total of 60 patients (mean age: 9.55 years) with 75 mandibular condyle fractures were managed using closed treatment methods. All fractures healed with restitutional remodeling, with only a few complications affecting quality of life and 20% of patients experiencing minor complications. The capacity for restitutional remodeling declined with age, particularly after around age 12. With increasing age, irregular healing patterns and higher complication rates became more common. Conservative management in this cohort resulted in favorable long-term functional and radiological outcomes across non-displaced, minimally displaced, and selected displaced fractures. These findings reflect the results achievable with conservative treatment in the pediatric population represented in this study. Further comparative studies are required to clarify treatment indications across different fracture types and age groups.

Dental caries and periodontitis are the most frequently diagnosed dental diseases worldwide. Their occurrence is age-dependent and, due to their widespread prevalence, they represent a major public health challenge. Further research is essential to identify factors that can be used to develop more effective prevention strategies. Potential factors contributing to the development of caries and periodontitis may be identified at the molecular level. Aquaporins (AQPs) are interesting candidate molecules in this context. Among them, AQP9, known for its role as a permeable channel for water, glycerol and other small molecules, has attracted considerable scientific interest in recent years. In this study we examined if AQP9 could serve as a biomarker for caries and periodontitis. The OKAPI study, a prospective observational study, enrolled patients in a dental practice and an oral and maxillofacial plastic surgery clinic. Clinical data like PSI-index and DMFT-Index were recorded and documented. Saliva samples were collected and RNA was isolated from saliva. cDNA was synthesized from the samples and qRT-PCR was performed using specific primers for AQP9 and ACTB (n = 159; 40.9% male). 39.4% of probands had severe caries and 15.3% had periodontitis. AQP9 mRNA expression was increased in patients with severe caries compared to milder forms (p = 0.0120), and increased AQP9 expression was also detected in patients with periodontitis compared to unaffected individuals (p = 0.0364). An AQP9 cut-off value was calculated to discriminate patients with and without severe caries. The groups below and above the cut-off differed only in the variables presence of severe caries or periodontitis and age: a binary logistic regression model was used to identify risk factors for caries (p = 0.009) and periodontitis (p = 0.023) and led to the conclusion that the AQP9 cut-off was most relevant. AQP9 mRNA expression is associated with the prevalence of caries or periodontitis and could represent a novel biomarker.

Telehealth has emerged as a transformative tool in healthcare delivery, particularly during and after the COVID-19 pandemic. In the field of plastic and reconstructive surgery, telehealth facilitates patient consultations, follow-up visits, and postoperative care, especially for those in remote areas. However, evaluating its usability and patient satisfaction remains essential to guide future implementation. This study aimed to assess the usability of telehealth services and measure patient perceptions in plastic surgery clinics at a tertiary healthcare center in Riyadh, Saudi Arabia. A cross-sectional study was conducted between September 2024 and May 2025 at King Abdulaziz Medical City. After receiving ethical approval (IRB: NRC23R/515/09), eligible patients who had attended at least one online plastic surgery clinic consultation were contacted by phone and invited to participate. A self-administered questionnaire was distributed via Google Forms. The survey included demographic questions and the validated Telehealth Usability Questionnaire (TUQ), which covers seven domains. Responses were rated on a 7-point Likert scale. Data were analyzed using RStudio; nonparametric tests and multivariable linear regression were performed to identify predictors of usability. A total of 93 participants completed the survey. Most respondents were female (67.7%), aged between 29-39 and 51-61 years. Overall, TUQ scores indicated high usability, with the highest medians in usefulness, ease of use, and interface quality (median = 7.0). Lower scores were observed in the reliability subscale (median = 6.0). Educational level significantly influenced ease-of-use and reliability scores, while visit type (e.g., craniofacial vs. breast reconstruction) impacted interaction quality. No significant predictors were identified for the overall TUQ score. Telehealth services in plastic surgery were perceived positively across all domains of usability. While demographic factors such as education influenced specific subscales, the overall experience was favorable. Telehealth presents a viable, efficient, and patient-satisfying alternative for surgical follow-up, with potential for broader integration in clinical practice.

Although occult breast carcinomas and lesions with uncertain malignant potential are rare, their incidental discovery during symmetrizing mammoplasty can significantly alter the treatment approaches and cancer staging. In the context of oncoplastic surgery, the systematic evaluation of the contralateral breast is a clinical priority that has been underexplored in Eastern Europe. Background/Objectives: This study aimed to assess the incidence and histological characteristics of incidental carcinomas and B 3 lesions detected during contralateral symmetry mammoplasty in patients with breast cancer. Methods: This retrospective study was conducted at the Plastic and Reconstructive Surgery Clinic of the “Pius Brînzeu” County Emergency Clinical Hospital in Timisoara, Romania, over six years (2018–2024), and included 180 of 256 patients who underwent contralateral breast symmetrization. Results: Among the 180 patients, 21 (11.66%) had incidental findings: eight (4.44%) had contralateral carcinomas, and 13 (7.22%) had B3 lesions. The histopathological types identified were invasive ductal carcinoma NST (one case), ductal carcinoma in situ (one case), invasive lobular carcinoma (five cases), and mucinous/papillary carcinoma (one case). Compared to the reported international range of 2–10%, our observed incidence of 11.66% reflects the unique aspects of our patient cohort and the thoroughness of our histological analyses. Conclusions: Detection of contralateral carcinomas and B3 lesions during symmetry mammoplasties underscores the importance of a multidisciplinary approach, comprehensive bilateral screening, and detailed histopathological examination of specimens.

Hand fractures are a common complaint in pediatric patients. The association between pediatric hand fractures and subsequent engagement with mental health and addictions (MHA) services remains unstudied. This study investigated the relationship between hand injury mechanisms and future presentation to MHA services. A retrospective cohort study was conducted off all patients presenting to a pediatric plastic surgery clinic from 2012 to 2017. Data collected included demographics, fracture mechanism and location, and subsequent presentation to MHA services. Stepwise logistic regression models were employed to assess risk factors for future presentation to MHA and diagnosis of psychiatric illnesses. A total of 1184 patients presented with pediatric hand fractures. Most injuries were accidental (87.9%), with sports being the most common cause (52.4%). Intentional injuries accounted for 12.2% of cases, primarily due to punching a solid object (53.5%) or another individual (45.1%). Patients with intentional injuries were significantly older (14.1 vs 11.8 years, p<0.001) and predominantly male (93.1% vs 66.2%, p <0.001) compared to patients with accidental injuries. Overall, 12.2% of patients were assessed by MHA services, with a relative risk of 5.59 for those with intentional injuries. The most diagnosed psychiatric illness was ADHD (56.7%). Intentional injury mechanism was significantly associated with a future diagnosis of ADHD (p<0.001), generalized anxiety disorder (p=0.022), major depressive disorder (p=0.012), and substance use disorder (p<0.001). Intentional hand fractures in the pediatric population are strongly associated with future MHA assessment. These findings support early screening and referral to MHA services when intentional injury mechanism is identified.

Abstract Introduction Small fiber neuropathy (SFN) is a neurological condition characterized by selective damage to small unmyelinated Aδ and C nerve fibers, which regulate pain and autonomic function. Despite increasing recognition of SFN in chronic pelvic pain, its impact on sexual function has not been well characterized. Objective We assessed differences in sexual and pelvic function at presentation among patients with and without known SFN. Methods Patients presenting to our Urogynecology and Reconstructive Pelvic Surgery (URPS) and Multidisciplinary Pelvic Pain Clinics completed an intake form consisting of history, validated measures of sexual function (PISQ-IR), pelvic pain (GUPI QOL q9), and prolapse (POPDI-6). SFN was confirmed via skin biopsy after a comprehensive neurological evaluation. We compared patients with and without SFN across 1) the full cohort, 2) a subgroup of patients with pelvic symptoms, and 3) a subgroup of patients with pelvic pain. Results 22 of 600 patients (3.7%) reported SFN at presentation. 74 patients were male, of whom 3 had SFN. The average age with SFN was 46 ± 15 years vs 54 ± 18 years without SFN. Patients with SFN reported significantly lower orgasm intensity within the full cohort (1.9 ± 0.5 vs 2.6 ± 1.0, p = 0.003), in the subgroup of patients with pelvic symptoms (2.0 ± 0.5 vs. 2.5 ± 1.0, p = 0.009), and in the subgroup of patients with pelvic pain (2.0 ± 0.5 vs. 2.4 ± 1.0, p = 0.036). The presence of sexual activity was not significantly different between those with and without SFN across all groups. Sexual satisfaction was also preserved in patients with SFN across all groups. In the full cohort, patients with SFN had higher prolapse symptoms (POPDI-6 40.5 ± 12.5 vs. 31.1 ± 19.1, p = 0.014), higher impact of genitourinary pain on quality of life (GUPI QOL q9, 4.8 ± 1.2 vs. 4.3 ± 1.5, p = 0.038), and pelvic pain sites localized to the pelvis (12.4 ± 6.1 vs. 5.6 ± 5.9, p &amp;lt; 0.001). Among patients with pelvic symptoms, concurrent presence of SFN was associated with higher POPDI-6 (40.5 ± 12.5 vs. 31.2 ± 19.1, p = 0.014) and more localized pelvic pain sites (13.0 ± 5.7 vs. 7.1 ± 5.8, p &amp;lt; 0.001). Among patients with pelvic pain, those with SFN had more localized pelvic pain sites (13.7 ± 5.5 vs. 10.9 ± 5.1, p = 0.043). Conclusions SFN is associated with reduced orgasm intensity and increased pelvic symptom burden. These findings emphasize the importance of including neurologic assessment in pelvic health evaluations and clinical awareness of SFN, which impacts both pain and autonomic nerve function. Despite worsened physiologic pelvic symptoms, sexual satisfaction and presence of sexual activity were preserved among patients with SFN. This may reflect compensatory adaptations and redefinition of sexual fulfillment beyond specific physical components of sexual activity. A limitation is that many patients had autonomic symptoms and were likely presenting with undiagnosed SFN, which may have diluted observed group differences. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Flume catheters, Luca Biologics, Alight Online 2nd Opinion

Abstract Introduction Trauma history is a significant modifier of sexual health, yet its clinical impact remains under-characterized in pelvic health settings. This study aimed to evaluate sexual function and quality of life in patients presenting with pelvic floor complaints, stratified by self-reported trauma history at intake. Objective We sought to explore whether trauma disclosure correlates with differences in sexual satisfaction and orgasmic response, despite a higher burden of comorbid symptomatology. Methods Comprehensive prospective electronic multidisciplinary intake data were collected sequentially on 600 new patients (526 female, 63 male, 11 transgender) presenting to a single institution’s Urogynecology and Reconstructive Pelvic Surgery and Multidisciplinary Pelvic Pain clinics. Presence of trauma history was determined from the following open-ended question on the intake questionnaire: “Is there a history of trauma/abuse you would like the team to be aware of?” Outcome measures included sexual satisfaction and orgasm intensity (measured on a scale of 1 -lowest to 5 -highest), Patient Health Questionnaire (PHQ-4), American Urological Association (AUA) QOL score, autonomic and neurologic symptom burden, and pelvic pain. Sexual outcomes were compared between trauma and non-trauma cohorts using unpaired t-tests and chi-square analysis. Open-ended patient perspectives on trauma-informed physician care were also collected. Results 54/600 (9%) of patients highlighted a trauma history (41 women (8%), 2 men (3%), 11 (100%) transgender) in response to the open-ended question. Of these, 38/54 (71%) reported pelvic pain, compared to 42% of patients without reported trauma (p&amp;lt;0.001). Depression and anxiety, measured by the PHQ4 (mean 2.2 ± 2.1 versus 1.0 ± 1.6, p&amp;lt;0.001, were significantly higher in those with a history of trauma), and worse AUA QOL scores (mean 4.17 ± 1.85 versus mean 3.21 ± 2.19, p&amp;lt;0.001). The presence of sexual activity was not significantly different between those with and without trauma. In those who were sexually active and willing to answer questions about sexual history, satisfaction was significantly higher in those with a trauma history compared to those without (mean 3.41 ± 1.40, N=49 versus mean 2.90 ± 1.48, N = 354, p = 0.020) (Figure 1). Orgasm intensity (mean 2.79 ± 1.32, N=28 versus mean 2.49 ± 0.95, N=250, p=0.260) was not clinically significantly different between the 2 groups. Conclusions In this multidisciplinary pelvic health cohort, patients with a trauma history demonstrated increased psychological and somatic symptomatology but reported preserved orgasmic response and greater sexual satisfaction among those engaged in sexual activity. These findings highlight possible therapeutic resilience, post-traumatic growth, or self-selection in patients willing to disclose trauma. Clinicians should consider integrating trauma-informed sexual health care to support this complex and potentially resilient patient population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant - Flume catheters, Luca Biologics. Infinite MD / Consumer Medical/ Alight Online 2nd Opinion Stockholder - ERYP Doximity

Background and Objectives: There is a worldwide increase in the demand for gender-affirming surgical treatments among transgender and gender-diverse (TGD) adults and adolescents. In Poland, transgender people generally lack trust in healthcare providers, which makes it more difficult for them to begin their transition process. This patient population is not well understood by many of the specialists who may potentially be involved in their care, in some way, reinforcing their concerns. The aim of this study is to present the sociodemographic characteristics of a group of female-to-male transgender patients who were admitted to a privately based plastic surgery center to undergo chest wall reconstruction. Materials and Methods: This study comprises a statistical analysis of data retrospectively obtained from the medical records of 100 patients from across the country undergoing female-to-male transition, who were operated on between 2021 and 2025 at a specialized private clinic in Poland. All individuals had already started gender-affirming medical treatment with testosterone at the time of first consultation. Results: The results show a trend toward a decreasing age at the time of the decision to undergo gender-affirming surgery. In the study group, 100% of patients were already undergoing hormone therapy. In our group of transgender individuals, we did not observe a correlation between cultural or social background, religion, and gender dysphoria. It is encouraging that more than half of the patients reported no longer needing psychiatric support, and that those who were still under specialist supervision stated that they experienced a significant improvement in their overall well-being. Conclusions: The rising demand for transgender healthcare highlights the need for studying and analyzing this group of patients in order to provide the best patient-centered care throughout the gender transition process by all specialists involved. Gender-affirming mastectomy, when combined with testosterone therapy, has a positive mental health impact on transgender individuals.

Introduction. The incidence of oropharyngeal cancer is steadily increasing, mainly due to an increase in the number of cases of HPV (human papillomavirus) infection. This is an important trend from a clinical point of view, since HPV-positive oropharyngeal cancer is associated with a better prognosis and treatment results. Despite its visually accessible location, the diagnosis of oropharyngeal cancer can be challenging due to the complexity of its anatomical structure. The active development of minimally invasive transoral microsurgery, combined with fluorescent technologies, demonstrates the effectiveness of early diagnosis of oropharyngeal tumors. Aim. To improve the diagnosis of oropharyngeal tumors, introduction into clinical practice of transoral microsurgical resections with double contrasting. Materials and methods. In the clinic of plastic surgery of the First Moscow Medical University named after I.M. Sechenov, a method for early diagnosis of oropharyngeal cancer was developed. The method consisted in intraoperative sequential double contrasting of the mucous of the oropharynx with indocyanine green and methylene blue, followed by autofluorescent videopharyngoscopy, transoral microsurgical, video-assisted resection based on the use of an operating microscope and rigid end-point optics (endoscope). Eleven surgeries were performed successfully. Results. The postoperative period was smooth and uncomplicated in all patients. According to the data presented, local recurrence was confirmed in 18 % (2 patients out of 11) after special treatment for oropharyngeal cancer using our method. Conclusion. Modern treatment of cancer patients requires not only cure, but also careful monitoring of the disease. The use of transoral video-assisted and microsurgical resection based on double contrasting is an alternative method for early diagnosis of both primary oropharyngeal cancer and its recurrence.

Between the scroll and the scalpel: Exploring body dysmorphic disorder and social media's role in cosmetic surgery seekers.

This study aims to evaluate parental knowledge and attitudes toward genetic counseling and testing in the context of pediatric plastic surgery in Qatar. It assesses baseline knowledge to identify educational gaps and factors that may contribute to fear or reluctance in managing children with congenital anomalies. Parents of children with congenital anomalies visiting the pediatric plastic surgery clinic at Sidra Medicine participated in an online questionnaire from October 2022 to February 2023. The 37‐question survey covered demographics, knowledge, and attitudes toward genetic counseling and testing, with knowledge scores ranging from 1 to 12 (scores above 9 indicating high knowledge). Responses were collected from 160 parents, representing various regions: Asia (26.6%), North Africa 25.3%, the Middle East 20.3%, America/Europe 5.7%, and Qatar 22.2%. Among them, 22.9% reported consanguinity, and 37% had children who underwent genetic testing. American/European parents (p = 0.016) and those with higher education (p = 0.006) showed greater genetic knowledge. Qatari parents had high knowledge 45.7% but lower perceived benefits and higher barriers. Consanguineous parents (p = 0.003) and those referred by medical providers (p < 0.001) had more positive attitudes toward genetic testing, while those with no prior testing experience or without another child with a genetic disorder displayed negative attitudes. This study highlights the need for culturally appropriate education on genetic counseling and testing for parents of children with congenital anomalies. Genetic counselors should consider education levels and consanguinity when discussing genetic testing to empower parents in making informed decisions.

ABSTRACTObjectivesSaddle nose deformity (SND) can be associated with nasal septal perforation (NSP). Both SND and NSP are observed in granulomatosis with polyangiitis (GPA) patients. This study aimed to compare the prevalence and severity of SND in GPA vs. non‐GPA patients with NSP.MethodologyNSP patients who visited tertiary rhinology or facial plastic surgery clinics from January 2010 through December 2023 were grouped into GPA and non‐GPA cohorts. The area of NSP, SND incidence, and SND severity (Daniel and Brenner's classification) were compared between the cohorts.ResultsOf 168 patients identified with NSP, 18 had GPA and 150 had non‐GPA diagnoses. Twelve GPA patients and 10 non‐GPA patients had SND. The odds ratio for SND association in GPA patients with NSP vs. non‐GPA patients was 31.3 (95% CI: 9.5–102.9), and 19.4 (95% CI: 4.3–87.7) after controlling for the NSP area. GPA patients with SND had a larger NSP area (median 670 mm2, IQR: 315.5–1061.3) compared to non‐GPA patients with SND (175.3 mm2, 113.1–204.1; p < 0.001). The severity of SND was similar between GPA and the non‐GPA group (p = 0.09). The area of NSP did not predict the severity of SND (p = 0.17).ConclusionGPA diagnosis was associated with larger NSPs and a higher risk of SND compared to non‐GPA etiologies; however, the severity of saddling did not differ between GPA and non‐GPA etiologies. GPA is an independent risk factor associated with SND irrespective of the size of septal perforation. The NSP area did not predict the severity of SND.Level of Evidence: 4.

The management of anorectal carcinomas necessitates a multimodal therapeutic approach. Advances in modern medicine have reduced the incidence of complete rectal extirpations and permanent colostomies to below 10%. Despite these improvements, the reconstruction of anorectal defects, particularly following abdominoperineal extirpation (APE) or pelvic exenteration, remains a significant challenge. Deep tissue defects, the impact of neo- or adjuvant radiotherapy, and bacterial contamination contribute to compromised wound healing, with reported complication rates reaching up to 60%.This retrospective study analysed all patients presenting with anorectal defects following oncological surgery in 2024 at a university-based plastic surgery clinic providing maximum-care services. The study assessed various influencing factors, including radiochemotherapy, cachexia, diabetes mellitus, nicotine consumption, vascular diseases, and corticosteroid therapies. Additionally, the evaluation covered the effect of surgical defect coverage using pedicled gracilis flap reconstruction on the number of required interventions and the time to complete wound healing and patient mobilisation.Prolonged intensive care treatment and prior radiochemotherapy were identified as primary contributors to disorders in postoperative wound healing. Moreover, factors such as cachexia, diabetes mellitus, and nicotine consumption had a detrimental impact on wound healing. Plastic-surgical defect reconstruction utilising a pedicled gracilis flap significantly reduced the number of required interventions and expedited recovery time.The interdisciplinary management of patients with anorectal defects post-oncological surgery can be optimised through targeted reconstructive plastic surgery. Pedicled gracilis flap reconstruction has proven to be an effective technique for defect coverage and should be integrated into treatment protocols at an early stage. Further studies are warranted to standardise guidelines, particularly regarding the optimal timing of reconstructive interventions.

Sebaceous carcinoma is a rare and aggressive malignant tumor that originates from sebaceous glands, most commonly in the periocular region. Extraocular manifestations, particularly on the nose, are exceptionally uncommon. A 91-year-old female patient presented to the plastic surgery clinic with a painless nodular mass on the nose. A punch biopsy confirmed sebaceous carcinoma, prompting a full-thickness lateral alar resection with immediate reconstruction using a superiorly based folded nasolabial flap. The surgical wound healed without complications, achieving favorable functional and aesthetic outcomes. This case underscores the need to consider sebaceous carcinoma among the differential diagnoses for nasal tumors to enable timely identification and treatment.

Body contouring surgery (BCS) can be applied to reduce the physical and mental burden of excess skin after massive weight loss. Self-reported outcomes of patients are used to assess this burden and to evaluate the effectiveness of BCS. The aim of this study is to clarify what is reflected in self-reports of excess skin after bariatric surgery. We hypothesise that the self-reported burden of excess skin is associated with both objectively assessed excess skin and the disposition to experience negative emotions. This cross-sectional study will include 68 outpatients presenting at a plastic surgery clinic with a request for BCS. Patients fill out two questionnaires (the BODY-Q and the Sahlgrenska Excess Skin Questionnaire (SESQ)) to measure the size and burden of excess skin as well as the Big Five Inventory (BFI) to measure the disposition towards negative emotionality. Anonymised photographs of excess skin will be rated independently by four plastic surgeons using the Pittsburgh Rating Scale (PRS) Rainbow Classification to establish the objective amount of excess skin. Multiple linear regression analyses will be performed to identify the association of BODY-Q and SESQ scores with objective appraisals of excess skin by plastic surgeons, negative emotionality and demographics. Interobserver agreement for PRS Rainbow Classification will be established by Fleiss' kappa. Ethical approval was obtained from the regional medical ethics committee (METC; W20.258) and the institutional review board (Lokale Toetsing, St. Antonius Hospital in Nieuwegein, no. Z23.035). Informed consent of participants will be obtained. The results of this study will be submitted for publication in a peer-reviewed journal.

Flexor tendon injuries of the hand are a common yet complex clinical challenge in reconstructive surgery, predominantly affecting young, working-age individuals and often resulting in significant functional impairment. Successful management requires a precise surgical approach combined with a structured, zone-specific rehabilitation protocol to restore optimal hand function. A one-year retrospective study was conducted in the Clinic of Plastic Surgery and Reconstructive Microsurgery at the Clinical Emergency Hospital Bucharest, reviewing the medical records of all patients admitted with traumatic flexor tendon injuries of the upper limb. A total of 58 patients with surgically confirmed flexor tendon injuries were included. Collected data encompassed demographic information, injury mechanism and anatomical location, zone classification, associated neurovascular injuries, timing and type of surgical intervention, and the rehabilitation protocols applied. All patients underwent operative treatment, followed by individualized rehabilitation programs tailored to the anatomical zone and severity of the injury. The data were analysed to identify patterns in injury aetiology, characteristics, and treatment strategies. These findings were compared with current literature and formed the basis for the development of a comprehensive, standardized rehabilitation protocol for flexor tendon injuries of the upper limb.

In this case, we describe a 52-year-old man who was switched to long-acting cabotegravir/rilpivirine (CAB/RPV LA) injectable antiretroviral therapy (ART) on a background of well-controlled HIV. He subsequently developed a painful and swollen area on his right ventrogluteal region 10days after his first CAB/RPV LA injections when he injected alternatively sourced testosterone in the same region. Examination findings showed a firm and defined lump with ecchymosis noted on the skin overlying. His initial blood results did not show any gross abnormalities and an ultrasound of the area was equivocal. After being reviewed in ambulatory care, the emergency department and an outpatient plastic surgery clinic settings over the course of 3weeks, the swelling and skin changes gradually resolved. He was then switched back to oral ART on subsequent review.

Multiple botulinum toxin A formulations were approved by the US Food and Drug Administration for treating the glabellar rhytids. A comparative quantitative evaluation of their effects on the glabella has not been conducted. To provide an objective quantitative assessment of the effect of 4 botulinum toxin A formulations on glabellar strain across using dynamic 3-dimensional photogrammetry. This single-center, double-blind clinical trial, conducted at the University of Pennsylvania Division of Plastic Surgery clinic, randomized 143 female individuals aged 30 to 65 years into 4 arms receiving different botulinum toxin A formulations on day 0 and with follow-up at days 3, 30, 90, and 180. Dynamic 3-dimensional photogrammetry and surveys were collected from March 2022 to June 2023 and analyzed from July 2023 to April 2024. Participants were randomized 1:1:1:1 into 4 treatment arms: 1 dose of 20 units of onabotulinum toxin A (OBoNT/A); 1 dose of 60 units of abobotulinum toxin A (ABoNT/A); 1 dose of 20 units of prabotulinum toxin A (PBoNT/A); or 1 dose of 20 units of incobotulinum toxin A (IBoNT/A) into the glabellar region (GR). The primary outcome was change in GR dynamic strain after injection over time. Secondary outcomes included changes in patient-reported satisfaction, the relationship between baseline strain severity and postinjection improvement in strain, and the effect on the strain of the untreated lateral canthal region. This study recruited 143 female individuals with a mean (SD) age of 43.5 (9.8) years. ABoNT/A and PBoNT/A had the fastest onset at day 3. PBoNT/A and IBoNT/A retained efficacy at day 180 compared with their baseline. Increasing baseline glabellar strain severity resulted in increased improvement with treatment. Lateral canthal region strain increased with decreasing GR strain. PBoNT/A was significantly more effective at day 180 than OBoNT/A. All arms experienced improvement in related FACE-Q module scores up to 90 days. This randomized clinical trial found that ABoNT/A and PBoNT/A displayed the most rapid onset of effect. The peak effect is similar across all toxins. When measuring strain at approximately 6 months, some toxins remain significant relative to their own baseline or compared with other specific toxins. ClinicalTrials.gov Identifier: NCT05167864.

Plastic surgery is emerging as a prime target for private equity (PE) investments, driven by its increasing demand, scalability, and opportunities for insurance-independent revenue streams. This review synthesizes current literature to evaluate the effects of PE investments on plastic surgery practices. Following Preferred Reporting Items for Systematic Reviews with Meta-Analyses Extension for Scoping Reviews guidelines, a search was conducted across PubMed, Cochrane Library, and Web of Science databases in November of 2024. English-language studies discussing equity-based investments in plastic surgery companies were included. Data on investment trends and operational and clinical effects were extracted and analyzed. Eight studies met the inclusion criteria after screening and full-text review, comprising 5 editorials and 3 quantitative analyses. The quantitative studies relied on PitchBook, a web-scraping investment database; however, limited methodologic transparency in these studies hindered comparability. Across the articles, key benefits included operational improvements (discussed in 6 of the 8 articles), reduced administrative burdens (3 articles), enhanced technology access (6 articles), practice expansion (4 articles), expanded services (3 articles), increased profitability (3 articles), financial stability (2 articles), and retirement benefits (2 articles). Challenges included misaligned objectives between PE firms and physicians (4 articles), aggressive cost-cutting (2 articles), compromised care quality (3 articles), increased patient costs (2 articles), loss of physician autonomy (3 articles), equity dilution (1 article), and declining morale (1 article). Although PE investments offer financial and operational advantages to plastic surgery practices, they may also threaten care quality and physician autonomy. This review underscores the ongoing expansion of PE investments in plastic surgery, highlighting the importance of standardized methodologies and longitudinal studies to evaluate and optimize the outcomes of PE investments for both patients and physicians.

To evaluate the impact of spreader grafts in reduction septorhinoplasty on quality of life (QOL) outcomes. Randomized clinical trial (RCT). Individuals over 15 years old with nasal obstruction were evaluated for functional and aesthetic septorhinoplasty from October 2018 to October 2022 at a facial plastic surgery clinic of a tertiary university hospital in Brazil. Participants were randomly allocated to subjects with or without spreader grafts. Relative changes in specific Nasal Obstruction Symptom Evaluation in the Portuguese language (NOSE-p). Outcomes were assessed at least 6 and 12 months postoperatively (PO ≥ 6 and PO ≥ 12 m). The participants and those assessing the outcomes were blinded to group assignment. A 50 patients were included, 25 randomized to each group, mainly Caucasians with moderate/severe allergic rhinitis symptoms. Mean age was 32.89 ± 13.36 years and 68% were female. Septorhinoplasty improved specific quality-of-life scores irrespective of using spreader grafts (p < 0.001). There was no difference between subjects submitted or not to placement of spreader grafts in NOSE-p score in PO ≥ 6 m (-60.0 vs. -66.6%; p = 0.37); ROE in PO ≥ 6 m (71.83 vs. 79.56; p = 0.35), NO-VAS in PO ≥ 6 m (13.00 vs. 8.00; p = 0,35), NOSE p in PO ≥ 12 m (-53.14% vs. -68.33%; p = 0.28), ROE in PO ≥ 12 m (76.33 vs. 79.53; p = 0.645), NO-VAS in PO ≥ 12 m (13.00 vs. 11.50; p = 0.60). Reduction septorhinoplasty was associated with improvement in quality of life regarding nasal obstruction irrespective of using spreader grafts in a 7.88-month follow-up. ClinicalTrials.gov identifier: (NCT0449946).