Outcomes of Surgical Treatment of Malar Mounds and Festoons.

BACKGROUND: Malar mounds (congenital) and festoons (acquired) are persistent puffiness in the prezygomatic space between the orbicularis retaining ligament (ORL) and zygomatico-cutaneous ligament (ZCL). Non-surgical treatments often yield unsatisfactory results. This paper aims to demonstrate a surgical approach for the treatment of malar bags by outlining the author's surgical technique of treating malar mounds and festoons and reviewing outcomes in 89 cases. METHODS: Correction of malar mounds and festoons was achieved with subciliary skin-muscle flap, release of the ORL and ZCL, midface lift, canthopexy, and muscle suspension. We performed a retrospective study of 89 patients, all of whom had surgical correction of malar mounds or festoons in the past 10 years and a follow-up period of at least 6 months. This study was conducted over the course of the past year and involved reviewing patient charts in the office. Specifically, patient data spanning 2012 to 2022 were analyzed. The predictor variable in this study is the specific class of malar bags the patient has, as determined by the underlying pathophysiology. Outcome variables include the presence or absence of prolonged lid or malar edema, necessary re-excision of excess orbicularis oculi of the subciliary area, lid malposition, permanent visual changes, the need for additional non-operative treatment, and recurrence requiring reoperation. RESULTS: The majority of patients presented with acquired festoons (81/89) with prior attempts of correction (49/89). The mean follow-up is 11.2 months. Persistent malar edema (> 6 weeks) was documented in 14 patients and mainly resolved with Medrol Dosepak (methylprednisolone) and hydrochlorothiazide. A two-proportion Z-test was conducted, comparing the proportion of patients with poor protoplasm who experienced postoperative malar edema to the proportion of those with excellent protoplasm who experienced postoperative malar edema. A p-value of 3.414e-7 was obtained, indicating a statistically significant difference of proportions between the two groups. Five patients received additional injections of deoxycholic acid and two needed fillers for smoother contour of the lower eyelids. Two patients with severe malar mounds required multiple reoperations including direct excision in one patient. One incidence of transient lid retraction was reported in a patient with previous facelift and facial nerve injury. CONCLUSION: Malar mounds and festoons present a unique challenge to plastic surgeons. They are persistent in nature and require close-interval, long-term follow-up as additional injections and reoperations are warranted. Our approach to malar mound and festoon correction is safe and effective and provides long-lasting results. LEVEL OF EVIDENCE IV: 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 machine learning analysis of patient concerns regarding mastopexy.

BACKGROUND: Social media plays an important role in connecting patients and plastic surgeons. We utilized patient inquiries regarding mastopexy from an online social media site to determine the most prevalent patient concerns, while employing a machine-learning algorithm to generate the questions representative of the dataset. OBJECTIVE: This data allow plastic surgeons to better tailor their preoperative consultations to address common concerns, set realistic expectations, and improve overall satisfaction. METHODS: A total of 2,011 inquiries from the mastopexy section of Realself.com were obtained using an open-source web crawler. Each inquiry was manually categorized as preoperative or postoperative and classified into subcategories based upon the free text entry. Lastly, questions were analyzed using machine learning to determine ten questions most representative of the inquiry pool. RESULTS: Of the 2,011 inquiries analyzed, 52.91% were preoperative and 47.09% were postoperative. Most preoperative questions asked about procedure eligibility (309, 29.04%), surgical techniques and logistics (260, 24.44%), and the best type of breast lift for the user (259, 24.34%). Among postoperative questions, questions regarding appearance were the most common (491, 51.85%), followed by symptoms after surgery (197, 19.75%) and behavior allowed/disallowed (145, 15.31%). Appearance was further subcategorized with the most common categories being appearance of the nipple (98, 19.86%), skin discoloration (88, 17.92%), and scarring (74, 15.07%). CONCLUSION: By utilizing the data that social media websites, like Realself.com, provide, plastic surgeons can better understand common patient concerns. This data aid in optimizing the preoperative consultation process to address the common concerns, recalibrate unrealistic expectations, and improve overall satisfaction.

The Relative Citation Ratio: A Modern Approach to Assessing Academic Productivity within Plastic Surgery.

The accurate assessment of physician academic productivity is paramount and is frequently included in decisions for promotion and tenure. Current metrics such as h-index have been criticized for being biased toward older researchers and misleading. The relative citation ratio (RCR) is a newer metric that has been demonstrated within other surgical subspecialties to be a superior means of measuring academic productivity. We sought to demonstrate that RCR is a valid means of assessing academic productivity among plastic surgeons, and to determine demographic factors that are associated with higher RCR values. Methods: All Accreditation Council for Graduate Medical Education-accredited plastic and reconstructive surgery residency programs and faculty throughout the United States were compiled from the American Council of Academic Plastic Surgeons website. Demographic information was obtained for each surgeon via the program's website, and RCR data were obtained utilizing iCite, a bibliometrics tool provided by the National Institutes of Health. Surgeons were excluded if any demographic or RCR data were unavailable. Results: A total of 785 academic plastic surgeons were included in this analysis. Surgeons who belonged to departments with more than six members had a higher median RCR (1.23). Increasing academic rank (assistant: 12.27, associate: 24.16, professor: 47.58), chief/chairperson status (47.58), male gender (25.59) and integrated model of residency training program (24.04) were all associated with higher median weighted RCR. Conclusions: RCR is a valid metric for assessing plastic surgeon academic productivity. Further research is warranted in assessing disparities among different demographics within academic plastic surgery.