Clinical evaluation of the safety and efficacy of a 1064 nm diode laser, and vacuum assisted pulsed electromagnetic fields and multipolar radio frequency for noninvasive fat reduction of the abdomen and flanks.

BACKGROUND: Noninvasive cosmetic body contouring techniques are growing rapidly, and noninvasive lipolysis has been shown to have low pain, little downtime and produce consistent long-term results. The objective of this study was to evaluate the safety and efficacy of a 1064 nm diode laser combined with vacuum assisted PEMF and RF energies for noninvasive fat reduction of the abdomen and flanks. METHODS: Subjects received a series of three treatments 8 weeks apart, each consisting of a diode laser session, followed by vacuum assisted PEMF and RF. Before and after photographs were graded for overall fat reduction by three blinded evaluators. Ultrasound was used to measure changes in the thickness of adipose tissue. Subject satisfaction was assessed using the 5-Point Likert Subject Satisfaction Scale and a subject questionnaire at 16 and 24-week follow-up visits. Throughout each treatment, the subjects were given the Wong-Baker Faces Pain Rating Scale (WBFS) to assess discomfort and pain of the treatment. RESULTS: Thirty-nine subjects (average age 48.6 years) from four clinical sites were enrolled. Evaluators identified the correct before and after images 73.1% of the time and images were graded an average score of 1.12 (SE 0.1) correlating to more than a "slight change." Adipose tissue was reduced by 31.9% based on ultrasound measurements (p < 0.001). Subject satisfaction was high with an average satisfaction score of 7.8 ("satisfied") out of 10. The overall pain over time on average was rated "hurts little bit." Ninety percent of subjects reported either a mild, moderate, or significant improvement in their fat reduction and skin surface appearance. Almost 77% (76.7%) of subjects reported that they would recommend the treatment to a friend. There were six reports of adverse events related to the device during the study that were all transient and resolved rapidly. CONCLUSION: A significant reduction of subcutaneous adipose tissue was measured after treatment with a combination of diode laser and vacuum assisted PEMF and RF. Treatment pain was low and tolerable, and subjects had high levels of satisfaction with the results.

Opioid Prescribing Practices Among Plastic Surgeons: Results of the 2019 American Society of Plastic Surgeons Opioid Survey.

BACKGROUND: Health care providers play an important role in the national opioid crisis with 40% of opioid-related deaths being attributed to prescription medications (Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. 2018) and as many as half of the opioid pills prescribed after outpatient plastic surgery may go unused (Plast Reconstr Surg 2019;143:929-938). The purpose of this study was to provide broad foundational data regarding postoperative analgesic prescribing patterns among members of the American Society of Plastic Surgeons (ASPS) to facilitate inclusion of opioid data fields in the ASPS Tracking Operations and Outcomes for Plastic Surgeons database for longitudinal evaluation. METHODS: A survey regarding opioid prescribing practices was electronically distributed to a representative cohort of 2555 ASPS members. Two hundred seventy-nine responses (11% response rate) were received. RESULTS: The majority of respondents reported prescribing opioids following 1 or more types of cosmetic and reconstructive procedures (90.2% and 81.7%, respectively; p = 0.0057), most commonly oxycodone and hydrocodone. Most (61.9%) reported less than 5% of patients request an opioid refill. Nonopioid medications, most commonly acetaminophen and ibuprofen/naproxen, were also prescribed but less commonly so for cosmetic (80.7-85.8%) than reconstructive (86.3-91.5%) procedures. Local anesthetic was less commonly used for mastopexy (83.7%) than augmentation (91.8%, p = 0.02). CONCLUSIONS: Based on survey responses, potential areas of improvement to reduce opioid prescribing and use include provider education on the use of multimodal pain regimens including nonopioid medication and "as needed" rather than scheduled dosing, use of local anesthetic blocks, as well as patient education on opioid safety and proper disposal of unused medication.

Reduced Seroma Risk in Drainless Abdominoplasty Using Running Barbed Sutures: A 10-Year, Multicenter Retrospective Analysis.

BACKGROUND: Drains are still commonly inserted during abdominoplasties despite extensive evidence documenting the benefits of drainless procedures. Continued improvements in progressive tension suturing (PTS) techniques and suture technologies have consistently shown a reduced seroma risk profile that outperforms procedures involving surgical drains. OBJECTIVES: The aim of this report was to assess the authors' combined patient series, which represents the largest and longest-running, retrospective, multicenter set of abdominoplasty patients treated with a PTS technique involving running barbed sutures. METHODS: Two surgical groups, each at different surgical centers, have for the past decade performed drainless abdominoplasties in which running barbed sutures were used. The results for all 445 patients in this series are reported by surgical center and pooled across centers. RESULTS: The majority of the 445 patients underwent drainless abdominoplasty alone (n = 368; 82.7%); most of the remaining patients did so as part of a circumferential body lift (n = 55; 12.4%). Overall, 33 (7.4%) patients experienced a postoperative complication. The overall seroma rate was 4.7% (21 of 445 patients), but this dropped to 2.3% after surgical technique modifications were made to decrease upper abdominal dead space. The seroma incidence in this series is markedly lower than the 13% seroma rate with drains reported during the same time period and comparable to those seen in drainless abdominoplasties with interrupted suture techniques. CONCLUSIONS: Drainless abdominoplasty involving PTS with running barbed sutures shows long-term reproducibility in lowering seroma risk compared to techniques in which drains are inserted, supporting results from published series of drainless abdominoplasty procedures that use interrupted suture techniques.

Rates and Predictors of Readmission Following Body Contouring Procedures: An Analysis of 5100 Patients From The National Surgical Quality Improvement Program Database.

BACKGROUND: Hospital readmissions can be a major contributor to increased healthcare costs and are a salient current topic in healthcare. There is a paucity of large, prospective studies that evaluate rates and risk factors of readmission within the aesthetic subset of plastic surgery. OBJECTIVES: The authors propose to determine the rates of unplanned readmission following body contouring procedures and to analyze the predictors associated with it. METHODS: The 2011 and 2012 National Surgical Quality Improvement Program Database was queried for body contouring procedures using the appropriate Current Procedural Terminology codes. The rate of unplanned readmission, preoperative risk factors, comorbidities, and medical and surgical postoperative complications data were analyzed using multivariate regression models to determine predictors of readmission after these procedures. RESULTS: We identified 5100 patients who underwent body contouring procedures, of which 142 (2.8%) experienced an unplanned readmission. Forty-eight per cent of readmitted patients experienced at least one surgical complication, and 23.9% experienced at least one medical complication. Multivariate regression analyses identified several independent predictors of unplanned readmission: increasing age (odds ratio [OR] 1.018 per year, P = 0.039), bleeding disorders (OR 3.674, P = 0.039), increased operative time (each additional hour conferring a 20% increased risk), surgical complications (OR 19.179, P < 0.001), and medical complications (OR 10.240, P < 0.001). CONCLUSIONS: The unplanned readmission rate for body contouring procedures is low overall (2.8%). We identified age, bleeding disorders, operative duration, and postoperative complication as independent risk factors for unplanned readmission. These data can help guide preoperative risk stratification and future interventions in high-risk patient populations. LEVEL OF EVIDENCE: 2.

Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction.

BACKGROUND: Although some surgeons prescribe prolonged postoperative antibiotics after autologous breast reconstruction, evidence is lacking to support this practice. We used the Tracking Operations and Outcomes for Plastic Surgeons database to evaluate the association between postoperative antibiotic duration and the rate of surgical site infection (SSI) in autologous breast reconstruction. STUDY DESIGN: The intervention of interest for this study was postoperative duration of antibiotic prophylaxis: either discontinued 24 hours after surgery or continued beyond 24 hours. The primary outcome variable of interest for this study was the presence of SSI within 30 days of autologous breast reconstruction. Cohort characteristics and 30-day outcomes were compared using χ² and Fischer exact tests for categorical variables and Student t tests for continuous variables. Multivariate logistic regression was used to control for confounders. RESULTS: A total of 1036 patients met inclusion criteria for our study. Six hundred fifty-nine patients (63.6%) received antibiotics for 24 hours postoperatively, and 377 patients (36.4%) received antibiotics for greater than 24 hours. The rate of SSI did not differ significantly between patients given antibiotics for only 24 hours and those continued on antibiotics beyond the 24-hour postoperative time period (5.01% vs 2.92%, P = 0.109). Furthermore, antibiotic duration was not predictive of SSI in multivariate regression modeling. CONCLUSIONS: We did not find a statistically significant difference in the rate of SSI in patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours. These findings held for both purely autologous reconstruction as well as latissimus dorsi reconstruction in conjunction with an implant. Thus, our study does not support continuation of postoperative antibiotics beyond 24 hours after autologous breast reconstruction.

Assessing Outcomes and Safety of Inpatient Versus Outpatient Tissue Expander Immediate Breast Reconstruction.

BACKGROUND: With the rising cost of healthcare delivery and bundled payments for episodes of care, there has been impetus to minimize hospitalization and increase utilization of outpatient surgery mechanisms. Given the increase in outpatient mastectomy and immediate tissue expander (TE)-based reconstruction and the paucity of data on its comparative safety to inpatient procedures, we sought to understand the risk for early postoperative complications in an outpatient model compared with more traditional inpatient status using the National Surgical Quality Improvement Program database. METHODS: NSQIP data files from 2005 to 2012 were queried to identify patients undergoing immediate TE-based breast reconstruction after mastectomy. Patients were stratified by whether they received outpatient or inpatient care and then propensity score matched based on preoperative baseline characteristics to produce matched cohorts. Multivariate regression analysis was used to determine whether outpatient versus inpatient status conferred differing risk for 30-days complications. RESULTS: Of the 2014 patients who met criteria, 1:1 propensity matching yielded 634 patients in each of the matched cohorts. Overall complications (5.2 vs. 5.4 %), overall surgical complications (4.3 vs. 3.9 %), overall medical complications (1.3 vs. 2.1 %), and return to the operating room (6.6 vs. 7.3 %) were similar between outpatient and inpatients cohorts (p > .2), respectively. There was a small, but significant increased risk of organ/space SSI in outpatients (1.9 vs. 0.5 %, p = .02) and trend for increased risk for pulmonary embolus (PE) and urinary tract infection (UTI) in inpatients (0.3 vs. 0 %, p = .16; 0.3 vs. 0 %, p = .16). CONCLUSIONS: Our studies suggest that outpatient TE confers similar safety profiles to inpatient TE with regards to 30-day postoperative overall complications, medical and surgical morbidity, and return to the operating room. A slightly increased risk for surgical site infection must be balanced against potential risk for known inpatient-related complications such as UTI and PE.

The use of patient registries in breast surgery: a comparison of the tracking operations and outcomes for plastic surgeons and national surgical quality improvement program data sets.

BACKGROUND: The National Surgical Quality Improvement Program (NSQIP) and the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) registries gather outcomes for plastic surgery procedures. The NSQIP collects hospital data using trained nurses, and the TOPS relies on self-reported data. We endeavored to compare the TOPS and NSQIP data sets with respect to cohort characteristics and outcomes to better understand the strengths and weakness of each registry as afforded by their distinct data collection methods. STUDY DESIGN: The 2008 to 2011 TOPS and NSQIP databases were queried for breast reductions and breast reconstructions. Propensity score matching identified similar cohorts from the TOPS and NSQIP databases. Shared 30-day surgical and medical complications rates were compared across matched cohorts. RESULTS: The TOPS captured a significantly greater number of wound dehiscence occurrences (4.77%-5.47% vs 0.69%-1.17%, all P<0.001), as well as more reconstructive failures after prosthetic reconstruction (2.82% vs 0.26%, P<0.001). Medical complications were greater in NSQIP (P<0.05). Other complication rates did not differ across any procedure (all P>0.05). CONCLUSIONS: The TOPS and NSQIP capture significantly different patient populations, with TOPS' self-reported data allowing for the inclusion of private practices. This self-reporting limits TOPS' ability to identify medical complications; surgical complications and readmissions, however, were not underreported. Many surgical complications are captured by TOPS at a higher rate due to its broader definitions, and others are not captured by NSQIP at all. The TOPS and NSQIP provide complementary information with different strengths and weakness that together can guide evidence-based decision making in plastic surgery.

Validation of Clinical Criteria for Obtaining Maxillofacial Computed Tomography in Patients With Trauma.

BACKGROUND: More than 180,000 patients present annually with facial trauma to emergency rooms in the United States. Maxillofacial computed tomography is the gold standard in identifying facial fractures. Providers must evaluate patients quickly; therefore, they use decision instruments to determine which patients need imaging. We previously developed a decision instrument that identified patients with trauma at low risk for facial fracture who could avoid imaging. The present study aims to perform an internal validation of that tool. METHODS: The decision instrument used 5 criteria: bony step-off or instability, periorbital swelling or contusion, Glasgow Coma Scale <14, malocclusion, and tooth absence. The presence of any 1 finding placed the patient at high risk for fracture. In the present study, a retrospective review was conducted on all of the patients with trauma evaluated at a Level I trauma center for >1 year. Inclusion criteria were maxillofacial physical examination, head and maxillofacial computed tomography at presentation. Physical examination findings were collected and imaging reviewed to determine whether the decision tool could accurately detect the presence of a facial fracture in a different patient population from which it was derived. RESULTS: One hundred seventy-nine patients met enrollment criteria. Facial fractures occurred in 81% of patients (n = 145). The decision instrument was 97.4% sensitive (95% confidence interval, 93.8-99.3) for the presence of facial fracture. The negative predictive value was 81.3% (95% confidence interval, 55.0-95.0). Application of the instrument resulted in a missed injury rate of 2.6% (n = 3). All of the missed fractures were nondisplaced and managed nonoperatively. CONCLUSIONS: The proposed decision tool identifies patients with trauma at low risk for facial fracture who can avoid maxillofacial imaging. Validation in a prospective study is warranted.

Lipoabdominoplasty without drains or progressive tension sutures: an analysis of 100 consecutive patients.

BACKGROUND: Subcutaneous surgical drains are commonly used in abdominoplasties to prevent seromas but are not tolerated well by patients and add additional discomfort after the procedure. The lipoabdominoplasty modification may create a more favorable surgical field to reduce the need for surgical drains without increasing seroma formation. OBJECTIVES: The goal of this review was to determine if surgical drains can be completely eliminated in lipoabdominoplasty procedures without an increased risk of seromas. METHODS: The authors conducted a retrospective chart review of 100 consecutive standard, extended, and circumferential lipoabdominoplasty patients done by a single surgeon with at least a 3-month follow-up period. RESULTS: Seroma was identified in 5% of patients, hematoma and abscess each in 2% of patients, and granuloma, cellulitis, and delayed wound healing each in 1% of patients. CONCLUSIONS: The use of discontinuous undermining with liposuction, limited direct undermining in the midline, preservation of a thin layer of fibrofatty tissue on the superficial abdominal wall fascia, and targeted surgical site compression can eliminate the need for surgical drains without increasing seroma rates.

Combining abdominal and cosmetic breast surgery does not increase short-term complication rates: a comparison of each individual procedure and pretreatment risk stratification tool.

BACKGROUND: Combined abdominal and breast surgery presents a convenient and relatively cost-effective approach for accomplishing both procedures. OBJECTIVES: This study is the largest to date assessing the safety of combined procedures, and it aims to develop a simple pretreatment risk stratification method for patients who desire a combined procedure. METHODS: All women undergoing abdominoplasty, panniculectomy, augmentation mammaplasty, and/or mastopexy in the TOPS database were identified. Demographics and outcomes for combined procedures were compared to individual procedures using χ(2) and Student's t-tests. Multiple logistic regression provided adjusted odds ratios for the effect of a combined procedure on 30-day complications. Among combined procedures, a logistic regression model determined point values for pretreatment risk factors including diabetes (1 point), age over 53 (1), obesity (2), and 3+ ASA status (3), creating a 7-point pretreatment risk stratification tool. RESULTS: A total of 58,756 cases met inclusion criteria. Complication rates among combined procedures (9.40%) were greater than those of aesthetic breast surgery (2.66%; P < .001) but did not significantly differ from abdominal procedures (9.75%; P = .530). Nearly 77% of combined cases were classified as low-risk (0 points total) with a 9.78% complication rates. Medium-risk patients (1 to 3 points) had a 16.63% complication rate, and high-risk (4 to 7 points) 38.46%. CONCLUSIONS: Combining abdominal and breast procedures is safe in the majority of patients and does not increase 30-day complications rates. The risk stratification tool can continue to ensure favorable outcomes for patients who may desire a combined surgery. LEVEL OF EVIDENCE: 4 Risk.

Aesthetically Ideal Breasts Created With Artificial Intelligence: Validating the Literature, Racial Differences, and Deep Fakes.

Background: A female's breasts are integrally tied to her identity and sense of femininity. Despite extensive study of breast aesthetics, there is no discrete formula for the "ideal breast" to guide the aesthetic surgeon. Racial and cultural differences heavily influence preferences in breast morphology. Artificial intelligence (AI) is ubiquitous in modern culture and may aid in further understanding ideal breast aesthetics. Objectives: This study analyzed AI-generated images of aesthetically ideal breasts, evaluated for morphologic differences based on race, and compared findings to the literature. Methods: An openly accessible AI image-generator platform was used to generate images of aesthetically ideal Caucasian, African American, and Asian breasts in 3-quarter profile and frontal views using simple text prompts. Breast measurements were obtained and compared between each racial cohort and to that of previously described ideal breast parameters. Results: Twenty-five images were analyzed per racial cohort, per pose (150 total). Caucasian breasts were observed to fit nicely into previously described ideal breast templates. However, upper-to-lower pole ratios, nipple angles, upper pole slope contours, nipple-areolar complex positions, and areolar size were observed to have statistically significant differences between racial cohorts. Conclusions: Defining the aesthetically ideal breast remains a complex and multifaceted challenge, requiring consideration of racial and cultural differences. The AI-generated breasts in this study were found to have significant differences between racial groups, support several previously described breast ideals, and provide insight into current and future ethical issues related to AI in aesthetic surgery.

Incorporating barbed sutures in abdominoplasty.

Barbed sutures can be used in body contouring procedures to close long incisions better than conventional sutures. The results of a literature review focusing on the use of barbed sutures in abdominal contouring procedures suggest that they are safe and effective in wound closure with complication rates similar to conventional sutures but with possibly faster incision-closure times. An update on one author's (K.A.G.) personal experience with barbed progressive tension sutures in abdominoplasty procedures is presented, along with practical technique recommendations for barbed suture use.

ACR Appropriateness Criteria® Imaging of Facial Trauma Following Primary Survey.

Maxillofacial trauma patients comprise a significant subset of patients presenting to emergency departments. Before evaluating for facial trauma, an emergency or trauma physician must perform a primary survey to ensure patient stabilization. Following this primary survey, this document discusses the following clinical scenarios for facial trauma: tenderness to palpation or contusion or edema over frontal bone (suspected frontal bone injury); pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia (suspected midface injury); visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis (suspected nasal bone injury); and trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth (suspected mandibular injury). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Incision Location Predicts 30-Day Major Adverse Events after Cosmetic Breast Augmentation: An Analysis of the Tracking Outcomes and Operations for Plastic Surgeons Database.

BACKGROUND: Enhanced understanding of early postoperative adverse events will improve patient counseling and preoperative risk modification to decrease complications in implant-based breast augmentation. This study seeks to evaluate the early major adverse events following cosmetic breast augmentation. METHODS: A retrospective cohort analysis of the Tracking Outcomes and Operations for Plastic Surgeons database was performed to identify any women undergoing augmentation mammaplasty with an implant between 2008 and 2016. RESULTS: A total of 84,296 patients were studied. Major adverse events were identified in 0.37 percent. Seroma requiring drainage was observed in 0.08 percent, hematoma requiring drainage was observed in 0.15 percent, deep wound disruption was observed in 0.09 percent, and implant loss was observed in 0.11 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m2 (relative risk, 2.05; p < 0.001), tobacco use (relative risk, 2.25; p < 0.001), and diabetes mellitus (relative risk, 1.8; p < 0.05). Use of a periareolar incision significantly increased the risk of developing an early postoperative complication (relative risk, 1.77; p < 0.001). CONCLUSIONS: The findings of this study indicate an early major adverse event rate following cosmetic breast augmentation with implants of 0.37 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m2, tobacco use, and diabetes mellitus. In addition, when controlling for other factors, periareolar incision significantly increased the risk for major adverse events, when compared to an inframammary incision. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Cosmetic use of botulinum toxin-a affects processing of emotional language.

How does language reliably evoke emotion, as it does when people read a favorite novel or listen to a skilled orator? Recent evidence suggests that comprehension involves a mental simulation of sentence content that calls on the same neural systems used in literal action, perception, and emotion. In this study, we demonstrated that involuntary facial expression plays a causal role in the processing of emotional language. Subcutaneous injections of botulinum toxin-A (BTX) were used to temporarily paralyze the facial muscle used in frowning. We found that BTX selectively slowed the reading of sentences that described situations that normally require the paralyzed muscle for expressing the emotions evoked by the sentences. This finding demonstrates that peripheral feedback plays a role in language processing, supports facial-feedback theories of emotional cognition, and raises questions about the effects of BTX on cognition and emotional reactivity. We account for the role of facial feedback in language processing by considering neurophysiological mechanisms and reinforcement-learning theory.

International interdisciplinary rhytidectomy survey.

Facial rhytidectomy is a complex and multi-faceted operation performed by different methodologies between practitioners. This study elucidates current international trends in facelift surgery, including patient selection, operative technique, and postoperative care. A 43-item questionnaire was sent electronically to 7247 members of the following societies: ASPS, ISAPS, CSPS, IFFPS, and the AAFPRS. The survey focused on 3 main areas: (a) background information, (b) intraoperative technique, and (c) postoperative care. The response rate was 11.4%. The majority of our population was from the United States (US) (73%). Most (85%) of the respondents have practices where over 50% of their procedures are considered aesthetic surgery. Statistical differences between the uses of minimally invasive adjuvant treatments (thread lifts, endotine mid-face devices, superficial and deep skin resurfacing procedures) were found between plastic surgeons (PS) and facial plastic surgeons (FPS), as well as between US, Canadian, and international surgeons. Suture imbrication (42%) was the most common way of handling the submuscular aponeurotic system. International surgeons were more likely (49.6% vs. 37.7%, P < 0.05) to use this technique than US or Canadian surgeons. Difference in handling patients who smoke and postoperative management differences were also found between the groups queried. No differences were found between FPS and PS in the handling of the submuscular aponeurotic system, treatment of platysmal bands, treatment of ptotic submandibular glands, or treatment of submental fat deposits (P > 0.05). Differences exist between FPS and PS, and between US, Canadian, and international surgeons with regard to facelift techniques and perioperative management. These differences need to be addressed in order to measure outcomes across specialties and between techniques. This data will additionally be helpful for less experienced and younger surgeons who wish to define best practice patterns.

Clinical applications of mesenchymal stem cells in soft tissue augmentation.

Based on a variety of preclinical studies showing that mesenchymal stem cells (MSC) play a significant role in tissue repair and homeostasis, MSC have rapidly moved into a phase of clinical trials investigating their efficacy as a cell-based therapeutic modality for a diverse group of applications. An emerging body of evidence shows that in addition to being a progenitor cell population with self-renewing and multipotent differentiation capabilities, MSC have unique immunomodulatory properties, making them even more attractive for regenerative medicine. Emerging discoveries in stem cell biology have revealed a multitude of mechanisms through which MSC could potentially augment the current techniques in aesthetic surgery. In this article, the authors review the clinical advances in cell-based therapies relevant to aesthetic surgery, including tissue augmentation, rejuvenation, and regeneration.

A Comprehensive Review of Surgical Treatment of Migraine Surgery Safety and Efficacy.

BACKGROUND: Recent clinical experience with migraine surgery has demonstrated both the safety and the efficacy of operative decompression of the peripheral nerves in the face, head, and neck for the alleviation of migraine symptoms. Because of the perceived novelty of these procedures, and the paranoia surrounding a theoretical loss of clinical territory, neurologists have condemned the field of migraine surgery. The Patient Safety Subcommittee of the American Society of Plastic Surgeons ventured to investigate the published safety track record of migraine surgery in the existing body of literature. METHODS: A comprehensive review of the relevant published literature was performed. The relevant databases and literature libraries were reviewed from the date of their inception through early 2018. These articles were reviewed and their findings analyzed. RESULTS: Thirty-nine published articles were found that demonstrated a substantial, extensively replicated body of data that demonstrate a significant reduction in migraine headache symptoms and frequency (even complete elimination of headache pain) following trigger-site surgery. CONCLUSIONS: Migraine surgery is a valid method of treatment for migraine sufferers when performed by experienced plastic surgeons following a methodical protocol. These operations are associated with a high level of safety. The safety and efficacy of migraine surgery should be recognized by plastic surgeons, insurance companies, and the neurology societies.