Plastic Surgery Procedures Research Articles

Aqua Breast Augmentation (ABA): Hydrodissection Breast Augmentation Technique.

Breast augmentation is a prevalent procedure in plastic surgery. In this article we present the Aqua Breast Technique (ABA), an approach aimed at enhancing patient satisfaction and reducing downtime. This technique leverages tumescent anesthesia and a small incision in the inframammary fold, avoiding electrocautery and surgical drains, to fulfill the growing demand for painless procedures with minimal recovery periods. The study retrospectively analyzed 238 patients who underwent breast augmentation using the ABA technique at Instituto Rubi between 2021 and 2024. The ABA protocol involves detailed preoperative design, local anesthesia, a precise 3-centimeter incision, careful dissection, and specific postoperative care, emphasizing hydrodissection for tissue separation and the use of smooth round silicone implants through a Keller funnel. The application of the ABA technique to 238 patients, with a mean follow-up time 14months. Ten patients required surgical intervention due to complications. Hematoma and infection rates were 0.42%, while capsulectomies were required in 2.1% of cases. Aqua Breast Augmentation technique has been successfully applied as ahydrodissection-based breast augmentation technique method, with low complication rates, short downtime, and reduced postoperative pain. Level V, therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Novel Approach to Incision Marking in Abdominoplasty Using 3D Printing Technology: A Description of Technique.

Abdominoplasty is one of the most common plastic surgery procedures used to improve the appearance and contour of the abdominal region. Despite advances in surgical techniques, achieving optimal aesthetic results with minimal scarring remains a challenge. In this study, we describe a feasible approach to incision marking in abdominoplasty using a three-dimensional-printed incision marking tool. This technique with open source nature has the potential to revolutionize the field of plastic surgery and enhance patient satisfaction. Further studies are needed to confirm our findings and explore the potential applications of three-dimensional printing technology in other aesthetic procedures.

Reduction Mammoplasties: Risk Factors and Early Complications-About 1442 Cases.

Breast reduction surgery is a widely performed plastic surgery procedure. The incidence of such complications has been steadily decreasing in recent years but is still nonetheless 5.6%. The primary aim of this study was to analyze the incidence of the main postoperative complications of breast reduction surgery. In addition, we identified cause-and-effect links between complications and characteristics of the patients, such as smoking, age, weight resection, BMI, and wound drainage. This retrospective study was performed on a population of 1442 women who underwent breast reduction surgery between January 2016 and October 2022 in the plastic surgery unit at Saint-Louis Hospital, Paris, France. At the follow-up examination, we evaluated the patients for complications. The average resection weight was 1297.7 g in a population for which the average BMI was 28.9. We found 19.9% rate of total complications, of which 3.5% were major complications. We found that only the resection weight was a risk factor for complications. The main strength of our study is the size of our sample. The large number of patients allowed us to conduct numerous analyses and obtain significant results despite the rarity of certain events. This large cohort was also responsible for the high statistical power of our results. The risk of developing a postoperative infection was 7.5% for resections of less than 2.4 kg, increasing to 13.9 % when greater than that. Thus, the administration of prophylactic antibiotic therapy to affected women to reduce the risk of infection is a distinct consideration. For the other factors, while none of them appeared to promote the occurrence of adverse events and, therefore, do not formally contraindicate breast reduction surgery, some preventive measures still strike us as being relevant, such as blade drainage, weight loss, diabetes control, and smoking cessation. 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 .

Therapeutic Aspects of Lipofilling, Abdominoplasty in Combination with Body Liposuction and Bariatric Surgery

This review article is dedicated to the therapeutic aspects of various plastic surgery procedures. Nowadays, improving appearance and quality of life through plastic surgery is becoming increasingly popular. Managing patients after lipofilling and abdominoplasty combined with liposuction is an interdisciplinary challenge. Intraoperative risks in plastic surgery are associated with anesthesia and comorbidities. The immediate response of the cardiovascular and respiratory systems to the administration of anesthetic agents and the anesthesiologist's qualifications determines the immediate success of the operations. The duration of the surgery, volumetric disturbances, reduction of body surface area, and changes in metabolic and immunological status after mechanical impact on adipose tissue significantly alter the rate of compensatory-adaptive reactions of the body. In the long-term period after lipofilling, abdominoplasty, liposuction, and augmentation mammoplasty, systemic complications are often observed. These include insomnia, chronic kidney disease, protein-energy malnutrition, arthropathies, nonspecific interstitial lung lesions, unverified hepatitis, lupus-like syndrome, antibodies to transplanted fats and silicone materials, idiopathic limb edema, as well as autoinflammatory syndromes. The presented work also provides data on propofol infusion syndrome and the clinical-prognostic significance of vascular endothelial growth factor in plastic surgery. The authors’ team also presents their own clinical data on obesity and associated diseases. To maintain the aesthetic effect and prevent long-term complications after lipofilling, liposuction, augmentation mammoplasty, blepharoplasty, and rhinoplasty, it is recommended to follow a hypoallergenic and low-calorie diet for the next 3-6 months, avoid night work, excessive physical exertion, simultaneous intake of antibiotics and anti-inflammatory drugs, sun exposure, trips to mountainous areas, and long flights.

Periodontal management during orthodontic-surgical treatment of maxillary impacted incisors: Acase report

The treatment of impacted teeth is a multidisciplinary process requiring close collaboration between periodontics and orthodontics. Impaction can have several causes, including physical obstructions in the eruption pathway, arch length discrepancies, or dental deformity. The management of these cases lies in the diagnosis established after an appropriate clinical and radiological examination. The age, position, etiology, and amount of space in the dental arch of an unerupted tooth determine how it should be treated. In several cases, orthodontic creating space, removing physical obstructions, and exposing the patient surgically with or without traction are general guidelines for treatment. In addition, ensuring adequate access to the tooth and the possibility of attaching an orthodontic anchor, the periodontal plastic surgery procedures associated with surgical clearance must preserve the integrity of the periodontium of the impacted tooth, as well as that of adjacent teeth, and above all promote the long-term maintenance of their periodontal health.

Patient Weight and Chemoprophylaxis in Abdominoplasty: Does It Result in More Bleeding Events?

Bariatric surgery has gained popularity in recent decades as an effective treatment for obesity. Abdominoplasty is one of the most often performed aesthetic procedures all over the world. In post-bariatric patients undergoing abdominoplasty, the diameter size and number of the abdominal wall perforators increase proportionally with increased body weight. Postoperative complications that may occur are haematoma, and venous thromboembolism (VTE). In plastic surgery procedures VTE prophylaxis grades vary due to the lack of consensus and clear guidelines. The aim of this study was to explore the frequency of postoperative bleeding and VTE in patients undergoing abdominoplasty and to explore the risk factors associated with major bleeding. A retrospective single-centre study of adult patients who were operated on by abdominoplasty between 2011 and 2020. Chemoprophylaxis including low molecular weight heparin (LMHW) was recommended when the operating time exceeded 2h. A total of 102 patients were included. There were no patients with VTE. Eight patients were re-operated for major haematoma. The weight loss (peak weight to weight before the abdominoplasty) was 14.4kg larger in the re-operation group (p = 0.03). Eighty-eight percent in the re-operation group and 67% in the other group were treated with LMWH (p = 0.43). Multivariable logistic regression showed that with each decrease from the peak in BMIkg/m2 the risk of re-operation for major haematoma was increased by 22% (p = 0.02). Abdominoplasty in patients after massive weight loss has a higher risk of postoperative bleeding. Having a clear protocol for chemoprophylaxis should be considered. 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 .

Acute and chronic mammary periprosthetic histological changes of the muscle

Augmentation mammoplasty with subpectoral prosthesis implantation is a frequent performed procedure in plastic surgery for reconstructive and aesthetic purposes. Although prosthesis implantation in a pocket under the major pectoralis muscle has been related to volumetric and functional alterations, there is not much information about the associated short- and long-term histological changes. Therefore, the aim of our study was to describe the acute and chronic histological muscle alterations associated with subpectoral prosthesis implantation. We collected samples from patients with breast tissue expander (<6 months after implantation) and prosthesis (>1 year after implantation) and from patients without implantation as a control group. The samples were processed for assessing their histological, histochemical and immunohistochemical properties. In the control group, no relevant histological findings were identified. Additionally, in the patients with expander, we observed mild augmentation of the internalised nuclei, normal morphology, significant muscle atrophy and fibrosis, whereas in the patients with prosthesis considerable augmentation of internalised nuclei, significant muscle atrophy, fibrosis and alteration of normal muscle morphology were observed. Prosthesis implantation induces histological changes in the periprosthetic striated muscle. Chronic fibrosis and inflammation play key roles in this process, which should be characterised in more detail from the histological and molecular biological perspective.

Effects of Optimal Temperature Control in Body Contouring Surgery: A Nonrandomized Controlled Clinical Trial.

Perioperative hypothermia in plastic surgery has underestimated risks, including increased risk of infection, cardiac events, blood loss, prolonged recovery time, and increased nausea, pain, and opioid usage. Inadequate preventive measures can result in up to 4 hours of normothermia restoration. The aim was to compare the impact of different strategies for normothermia during plastic surgery procedures and their relationship with clinical outcomes. A nonrandomized clinical trial was conducted in a single center in Bogota, Colombia. We enrolled adult patients undergoing body contouring surgery and divided them into 4 intervention groups with different measures to control body temperature. Univariate and bivariate analyses were performed, comparing several clinical symptoms to evaluate outcomes. A total of 197 patients were analyzed. Most of them were females (84.3%). Mean age was 38.6 years, and the median procedure duration was 260 minutes. Demographic and clinical characteristics did not exhibit significant differences between the groups. There were notable variations in temperature measurements at crucial moments during the surgical procedure among the groups, attributed to the implementation of distinct thermal protective strategies. Group comparisons showed a relationship between hypothermia and increased nausea, vomiting, shivering, pain, and additional analgesia requirements. Incorporation of active thermal protective measures, such as Blanketrol or HotDog, during body contouring procedures, markedly diminishes the risk of hypothermia and enhances overall clinical outcomes. Implementing these active measures to maintain the patient in a state of normothermia not only improves operating room efficiency but also leads to a reduction in recovery room duration.

Vaginal Hysterectomy and Pelvic Organ Prolapse: History and Recent Developments.

Vaginal hysterectomy (VH) was described as far back as 120 CE. However, it was not till the mid-1900s when reconstructive procedures were introduced to mitigate the risk of, or treat, pelvic organ prolapse in relation to VH. Furthermore, routine hysterectomy, particularly VH, has long been advocated in prolapse surgery. However, this indication is now questionable. Literature review to provide an overview of current evidence and experts' opinion regarding the relationship between VH and pelvic organ prolapse. The review presents a historical perspective on the role of VH in the management of pelvic organ prolapse, the current debate on the usefulness of the procedure in this context, a practical guide on operative techniques used during VH and the impact of recent surgical developments on its use. Vaginal hysterectomy is a well-established technique that is still superior to laparoscopic hysterectomy for benign gynecological disease, although more surgically challenging. However, it is possible that some contemporary techniques, such as vaginal natural orifice transluminal endoscopic surgery, may overcome some of these challenges, and hence increase the number of hysterectomies performed via the vaginal route. Although patients should be counselled about uterine-sparing reconstructive surgery, vaginal hysterectomy continues to be a major surgical procedure in reconstructive pelvic floor surgery. Therefore, it is prudent to continue to train residents in vaginal surgical skills to ensure that they continue to provide safe, cost-effective, and comprehensive patient care.

Disparities in pathways to reduction mammaplasty: A single institution review of 425 women with macromastia

BackgroundReduction mammaplasty improves the quality of life by providing functional and aesthetic benefits to women with macromastia. This study contributes to the existing literature on socioeconomic and clinical barriers to referral for plastic surgery procedures by focusing specifically on reduction mammaplasty. MethodsPatients with macromastia were identified via a chart review in a single institution from 2021–2022. The treatment pathway for each patient was characterized by reception of referral, completion of plastic surgery consultation, and eventual reception of surgery. After controlling for clinical covariates, multivariate logistic regression was applied to quantify the independent impact of race, insurance, and language status on the completion of surgery (p < 0.05). ResultsThe final patient cohort included 425 women with macromastia. Among the 151 patients who were first seen by a primary care physician, 64 (42%) completed an initial plastic surgery consultation. Among all patients, 160 (38%) eventually underwent reduction mammaplasty. Multivariate regression predictions indicated a lower likelihood of completing breast reduction surgery in patients with current smoking history (OR: 0.08, 95% CI: 0.01–0.59) and higher body mass index (BMI) (OR: 0.94, 95% CI: 0.90–0.97) (p < 0.05). Minority race and ethnicity, private insurance status, and primary language status were not significant predictors of this outcome (p > 0.05). ConclusionsIn this study, the socioeconomic variables were not independent predictors of breast reduction surgery completion. However, the association of minority race and ethnicity and nonprivate insurance status with the most common reasons for breast reduction deferral suggest an indirect influence of socioeconomic status on the treatment pathway.

A clinical case of secondary breast augmentation after previous implants removal

The patient underwent primary breast augmentation at a different clinic. Two years later, the implants were replaced with larger breast implants (500 ml each). Three months after the procedure, inflammation of the right and left mammary glands occurred, which led to the removal of both implants. The patient was 24 years old when the surgery took place. She underwent a preoperative examination in accordance with the standards set by the Ministry of Health of Ukraine. The patient came to us for breast augmentation, correction of mammary gland contour imperfections, and management of postoperative scars. Round‑shaped and moderate‑profile implants were selected. Implant parameters: width 13 cm, projection 4.4 cm, implant texture — microtexture, volume 400 ml. We placed the implants in the retropectoral space, and used the dual‑plane method for cavity formation. The surgical procedure lasted for a total of 140 minutes. The duration of the patient’s hospitalisation was one day. No drains were used. The scars on the abdomen were also corrected and fixed in the projection of the inframammary fold. No complications occurred in the postoperative period. The patient received antibiotic therapy and took nonsteroidal anti‑inflammatory drugs. Postoperative wound management was carried out. We prescribed compression underwear for the patient to wear for two months after surgery. Mammoplasty is a commonly performed procedure in plastic surgery. It aims to produce predictable and agreed‑upon aesthetic outcomes for the patient while maintaining a low rate of complications by adhering to modern surgical standards. The patient experienced complications that led to a significant scarring process. The pectoralis major muscle had a significant deformity, and the tissue showed scarring. The lack of muscle elasticity complicated the implant placement, leading to specific challenges throughout the operation. The occurence of complications following mammoplasty invariably has a lasting impact on the capsule’s formation and increases the risk of developing both early and late postoperative issues.

Preconditioning Strategies for Improving the Outcome of Fat Grafting.

Autologous fat grafting is a common procedure in plastic, reconstructive, and aesthetic surgery. However, it is frequently associated with an unpredictable resorption rate of the graft depending on the engraftment kinetics. This, in turn, is determined by the interaction of the grafted adipose tissue with the tissue at the recipient site. Accordingly, preconditioning strategies have been developed following the principle of exposing these tissues in the pretransplantation phase to stimuli inducing endogenous protective and regenerative cellular adaptations, such as the upregulation of stress-response genes or the release of cytokines and growth factors. As summarized in the present review, these stimuli include hypoxia, dietary restriction, local mechanical stress, heat, and exposure to fractional carbon dioxide laser. Preclinical studies show that they promote cell viability, adipogenesis, and angiogenesis, while reducing inflammation, fibrosis, and cyst formation, resulting in a higher survival rate and quality of fat grafts in different experimental settings. Hence, preconditioning represents a promising approach to improve the outcome of fat grafting in future clinical practice. For this purpose, it is necessary to establish standardized preconditioning protocols for specific clinical applications that are efficient, safe, and easy to implement into routine procedures.

Palatal Graft Harvesting Site Healing and Pain Management: What Is the Best Choice? An Umbrella Review

The use of free gingival graft (FGG) and connective tissue graft (CTG) from the palate are among the most predictable periodontal and peri-implant plastic surgery procedures. However, palatal harvesting causes severe discomfort in the palatal area in patients undergoing harvesting. The aim of this umbrella review is to evaluate which products or techniques can result in fewer side effects and less morbidity in patients. Systematic reviews, with meta-analysis or not, about postoperative pain and wound healing in patients undergoing surgery to remove a free gingival graft or connective tissue graft from the palatal region, published only in the English language, were electronically searched for on BioMed Central, Scopus, MEDLINE/PubMed, the Cochrane library databases, and PROSPERO register. Of 1153 titles, only 7 articles were included in this review. The reviews included suggest that the more effective interventions for patient-reported outcomes, particularly for pain management, are cyanoacrylate adhesives, platelet-rich fibrin, hyaluronic acid, and the use of palatal stents. Low-level laser therapy also demonstrated good results in palatal wound healing speed after FGG procedures. Also, topical agents were also described. Future studies and more high-quality randomized clinical trials are needed to provide clear descriptions and standardized procedures of interventions to obtain clear results.

The landscape of current trends and procedures in plastic surgery practices across the D-A-CH region: An in-depth analysis of 511 websites

BackgroundRecent data shows a 139.9% global increase in aesthetic procedures since 2011, with a notable 190.5% rise in Germany. This study analyzes the current landscape of plastic surgery in German-speaking European countries, focusing on the range of procedures offered in plastic surgery practices in Germany, Austria and Switzerland.We aimed to provide an overview of the current trends and procedures of plastic surgery in the practice setting in Germany, Austria, and Switzerland.MethodsThe information sampled from the websites of n = 511 plastic surgery practices (314 German, 113 Austrian, 84 Swiss) were analyzed with regards to general information, as well as procedures offered on the websites. A set of different procedures, belonging to each pillar of plastic surgery (i.e., Aesthetic, Reconstructive, Hand, Burn surgery) as well as non-surgical aesthetic procedures was analyzed.ResultsAesthetic surgical procedures were offered most often with 98.8% (506) of all websites analyzed, followed by Hand surgery at 29.7% (152), Reconstructive surgery at 27.8% (142) and Burn surgery at 5.7% (29). Reconstructive and Hand surgery were statistically significantly most commonly offered on Austrian plastic surgery websites, with p = 0.011 and p < 0.001, respectively. Among aesthetic surgical procedures, statistically significant regional differences were found for head and neck, body and breast procedures most commonly offered on Swiss plastic surgery with p = 0.041, p = 0.010 and p = 0.003, respectively, while the procedures of the intimate region were most commonly offered on German websites with p = 0.007.ConclusionsPlastic surgery websites in German-speaking European countries predominantly advertise aesthetic surgical procedures, with other domains of plastic surgery such as reconstructive, hand, and burn surgery being less prominent, suggesting an underrepresentation. Regional differences between the countries investigated are evident, underscoring the need for a more balanced approach in plastic surgery care in the practice setting. Level of Evidence: Not gradable

Is Piezosurgery Associated with Improved Patient Outcomes Compared to Conventional Osteotomy in Rhinoplasty? A Systematic Review and Meta-Analysis of RCTs.

Background: Rhinoplasty is a common plastic surgery procedure with evolving surgical techniques. This systematic review and meta-analysis compares the outcomes of piezosurgery versus conventional osteotomy in rhinoplasty. Methods: A comprehensive search of six databases yielded 12 randomized controlled trials (RCTs) comparing piezosurgery (292 cases) to conventional osteotomy (338 cases) in rhinoplasty patients. The examined outcomes included postoperative edema, ecchymosis, complications, pain (using the Visual Analogue Scale-VAS), and operative time. Subgroup analyses were conducted based on the assessment timepoint, surgical approach, and outcome grade. The risk of bias was evaluated using the revised Cochrane tool. Results: Piezosurgery showed a significant reduction in the degree of postoperative edema (second and seventh postoperative days) and ecchymosis (second, fourth, and seventh postoperative days). The external approach in piezosurgery demonstrated greater benefits for both outcomes. Piezosurgery was associated with a significant reduction in overall complications, especially mucosal injuries, compared to conventional osteotomy, with no significant difference regarding postoperative hemorrhage. A significant reduction in pain scores and the need for analgesia was observed with piezosurgery. No significant difference was found in operative time. Conclusions: Piezosurgery offers significant benefits in patient outcomes, with similar operative time between both techniques. However, long-term investigations are still needed.

A Systemic Review of the “Informed Consent” Process for Aesthetic Cosmetic Surgery Procedures

Informed consent is a foundational component of ethical patient care and may be effectively provided when a competent patient is given pertinent information to make well-informed decisions on their health care. Various studies have considered patients’ experiences with surgery for aesthetic reasons, rather than plastic surgery procedures which are medically warranted for reasons such as restoring form and function. Current empirical discourse on the consenting process, and ultimately how informed patients undergoing cosmetic surgical procedures are, is scant, particularly in Australia. The key aim of this review was to synthesize qualitative and quantitative research which considers the consenting process and the factors which impact on the patient’s decision-making process to undergo invasive cosmetic procedures. Eligible studies were identified via systematic searching across the PubMed and Medline databases; and hand searches were conducted of gray literature databases including university databases and Google Scholar. Reference lists of included studies were also examined for relevant studies. Eligible studies had to meet specific participant criteria including an age requirement of 19 to 64 years and discuss factors or present discussion surrounding the “informed consent” process for invasive cosmetic procedures. The characteristics and findings of each study were extracted. The studies were analyzed and presented under question categories. The Mixed Methods Appraisal Tool was used to assess the quality of evidence. Thirty-one studies were eligible for inclusion. Most studies were quantitative (90.3%). The highest proportion of these studies were focused on the United States (51.6%), followed by the United Kingdom (12.9%). The dominant methodology utilized by these studies was questionnaires/surveys (37.5%). The literature identified was classed into one of the 5 groups based on their overall concepts and objective. These 5 categories included (1) articles focusing on the types of information which should be communicated to a patient before they undergo their procedure or provide consent; (2) legal claims and cases based on a lacking informed consent; (3) sources of information patients access to become “informed” on their procedure; (4) studies exploring the readability of online information on certain invasive cosmetic procedures; and (5) studies focusing on the most effective methods of obtaining patient consent for cosmetic surgery procedures. These categories were reformulated into research questions and addressed in the section “Results of the Findings.” Most of the studies included in this review were quantitative (90.3%). Most studies (where gender was mentioned) had a higher population of female participants or respondents. Women have a greater tendency to have cosmetic surgery opposed to men. There are few studies (particularly qualitative studies) exploring the pre-operative patient experience in Australia for those having or seeking cosmetic surgery. A key stage in this process is obtaining and providing informed consent. A “lack of informed consent” is one of the more dominant factors identified consistently throughout these studies which focus on legal case reviews and claims. A significant source of information patients use to become informed of their procedure is through the Internet. This may be problematic as the readability of online materials is most commonly above the recommended reading level in multiple jurisdictions; and some online materials may have questionable accuracy or validity. Whether or not patients verify the information they access through external sources such as this, is of concern. There have been minimal studies identified exploring the patient experience pre-operatively including during their consultations and decision to provide consent.

Use of Intravenous Tranexamic Acid in Patients Undergoing Plastic Surgery: Implications and Recommendations per a Systematic Review and Meta-Analysis.

With increasing interest in aesthetic plastic procedures, the event of blood loss has compromised patients' safety and satisfaction. Tranexamic acid (TXA) is a drug used for the reduction of blood loss during surgical procedures. This systematic review aims to evaluate the clinical efficacy and safety of TXA in aesthetic plastic surgery for the reduction of bleeding and related complications. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. The medical subject headings (MeSH) keywords used for data extraction were ("TXA," OR "tranexamic acid,") AND ("plastic surgery," OR "aesthetic surgery," OR "rhinoplasty," OR "blepharoplasty,") AND ("blood loss" OR "bleeding" OR "TBL") AND ("Edema" OR "ecchymosis"). A combination of these MeSH terms was used in the literature search. The timeline of research was set from 2015 to January 2024. A total of 7380 research articles were identified from the above-mentioned databases, and only 13 research articles met the inclusion criteria. There was a significant difference in total blood loss (TBL) among patients who had undergone plastic surgery procedures while on TXA as compared to a placebo (mean difference = -6.02; Cl: -1.07 to -0.16; p > 0.00001), and heterogeneity was found (degrees of freedom (df) = 9; I2 = 97%). Only two studies reported the average ecchymosis scores after TXA among interventions in comparison to the placebo group. This review provides evidence that TXA lowers TBL, ecchymosis, edema, and anemia during cosmetic surgery without significantly increasing thromboembolic consequences.

Surgical instruments for plastic surgery operations in Ancient Greek and Byzantine times

Background-Objective: Even though the term “plastic surgery” was first introduced in the 19th century, the study of ancient Greek and Byzantine medical manuscripts reveals a significant number of plastic surgery operations performed during these periods. The aim of this work is to present the surgical instruments that were used to conduct such operations.Material-Method: The original manuscripts of ancient Greek and Byzantine physicians, including Hippocrates, Galen, Oribasius, Aetius, Paul of Aegina and Alexander of Tralles, were studied and analysed. The references concerning plastic surgery instruments were marked and are presented.Results-Discussion: Ancient Greek and Byzantine physicians performed several plastic surgery procedures, i.e. reconstructions of defects in the nose, ears, eyelids, lips, cheeks, and forehead, while surgical restoration of female breasts, hypospadias, elderly loose jawbone, penile tumours, syndactyly, and polydactyly was also described in detail. Several surgical instruments with various functions were used for these procedures, such as tools for tissue cutting (scalpels, chisels), for tissue grasping (forceps), tissue preparation, haemostasis (cauteries), as well as tissue suturing. Many of these tools had a wide range of uses, while others appear to have been specifically designed for plastic surgery procedures.Conclusion: Ancient Greek and Byzantine physicians possessed a comprehensive set of surgical instruments that effectively supported a wide range of plastic surgery procedures.

Large Language Models for Intraoperative Decision Support in Plastic Surgery: A Comparison between ChatGPT-4 and Gemini.

Background and Objectives: Large language models (LLMs) are emerging as valuable tools in plastic surgery, potentially reducing surgeons' cognitive loads and improving patients' outcomes. This study aimed to assess and compare the current state of the two most common and readily available LLMs, Open AI's ChatGPT-4 and Google's Gemini Pro (1.0 Pro), in providing intraoperative decision support in plastic and reconstructive surgery procedures. Materials and Methods: We presented each LLM with 32 independent intraoperative scenarios spanning 5 procedures. We utilized a 5-point and a 3-point Likert scale for medical accuracy and relevance, respectively. We determined the readability of the responses using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) score. Additionally, we measured the models' response time. We compared the performance using the Mann-Whitney U test and Student's t-test. Results: ChatGPT-4 significantly outperformed Gemini in providing accurate (3.59 ± 0.84 vs. 3.13 ± 0.83, p-value = 0.022) and relevant (2.28 ± 0.77 vs. 1.88 ± 0.83, p-value = 0.032) responses. Alternatively, Gemini provided more concise and readable responses, with an average FKGL (12.80 ± 1.56) significantly lower than ChatGPT-4's (15.00 ± 1.89) (p < 0.0001). However, there was no difference in the FRE scores (p = 0.174). Moreover, Gemini's average response time was significantly faster (8.15 ± 1.42 s) than ChatGPT'-4's (13.70 ± 2.87 s) (p < 0.0001). Conclusions: Although ChatGPT-4 provided more accurate and relevant responses, both models demonstrated potential as intraoperative tools. Nevertheless, their performance inconsistency across the different procedures underscores the need for further training and optimization to ensure their reliability as intraoperative decision-support tools.

A Novel Treatment for Convex Lateral Crura: The Inverted Spanning Suture.

Rhinoplasty is one of the most complex and challenging procedures in plastic surgery, even for experienced surgeons. Among the steps leading to an aesthetic and functional nose, there is the nasal tip improvement. Today's approach to nasal tip is the product of different techniques shifting through time, mainly from a resection tendency, to preservation and suture use to reshape cartilages. Addressing the lateral crura is vital to an aesthetic nasal tip and it is frequently obtained by adequate suture techniques. The alar-spanning suture described by Perkins is one of such. Regardless of its importance, it was not able to improve convex crura in some cases. The inverted alar-spanning suture (ISS) is an adaptation designed to treat those cases with the suture alone. ISS is a novel technique that can lead to better results treating the convex lateral crura by distributing the force vector in a more effective way. New techniques in rhinoplasty have multiplied, bringing this procedure to a new level and keeping up with the updated notion of restoration instead of excision the ISS is a new, precise, approach to an old problem.