Biosensors: An Upcoming Wave of Innovation.

SUMMARY: A biosensor uses a biological molecule to measure a chemical reaction. Wearable biosensors that attach to the body externally, including tooth enamel biosensors, contact lens biosensors, sweat biosensors, and skin tattoo biosensors, are in development. Nanoparticle-based biosensors are being developed to allow for the early detection of cancerous biomarkers. Applications relevant to plastic surgery include the development of biosensors that can detect metastatic breast cancer cells, bioimpedance spectroscopy, and intraoperative point-of-care diagnostics.

Ultrasonographic Identification of Shell Surface Types in Commercially Available Silicone Gel-Filled Breast Implants.

BACKGROUND: Breast implant safety issues have resulted in the need for global product recalls and medical device tracing. Conventional methods of breast implant tracing, have to date proven to be unsuccessful. This study aims to evaluate the effectiveness of high-resolution ultrasound (HRUS) screening in identifying implanted breast devices. METHODS: Data from 113 female patients undergoing preoperative ultrasound screening for secondary breast surgery between 2019 and 2022 was prospectively reviewed to evaluate the effectiveness of HRUS imaging with the aid of a sonographic surface catalog to identify the surface and brand type of implanted breast devices. To corroborate the findings and assess the reproducibility of the approach, further evaluations were replicated in New Zealand white rabbits and compared with the results found in humans. RESULTS: In the human recipients, implant surface and brand types were correctly identified by ultrasound imaging in 99% (112 of 113) and 96% (69 of 72) of the cases, either consultation-only or revision, respectively. This constituted an overall success rate of 98% (181 of 185). Furthermore, in a corroborating New Zealand white rabbit model where full-scale commercial implants were introduced and monitored over many months, from the total 28 analyzed, the surface was accurately identified in a total of 27 cases (the one failure being before generation of a sonograph surface catalogue), demonstrating an overall success rate of 96.4%. CONCLUSION: HRUS is, therefore, a valid and first-hand tool for breast implant imaging that can correctly evaluate both surface type and brand type alongside other variables such as implant placement, positioning, flipping, or rupture. CLINICAL RELEVANCE STATEMENT: HRUS is a valid and first-hand tool for the identification and traceability of breast implants that evaluates surface type and brand type. This low-cost, accessible, and reproducible practice provides patients with peace of mind and surgeons with a promising diagnostic tool.

Artificial Intelligence: Singularity Approaches.

SUMMARY: Artificial intelligence (AI) has been a disruptive technology within health care, from the development of simple care algorithms to complex deep-learning models. AI has the potential to reduce the burden of administrative tasks, advance clinical decision-making, and improve patient outcomes. Unlocking the full potential of AI requires the analysis of vast quantities of clinical information. Although AI holds tremendous promise, widespread adoption within plastic surgery remains limited. Understanding the basics is essential for plastic surgeons to evaluate the potential uses of AI. This review provides an introduction of AI, including the history of AI, key concepts, applications of AI in plastic surgery, and future implications.

Accurate Plane Fat Grafting in Gluteal Augmentation: An Anatomic Study.

BACKGROUND: The safety of gluteal fat grafting is a global concern in plastic surgery. OBJECTIVE: The goal of this study was to test whether fat grafting to the buttocks with Auto Stop Reach (ASR) technology prevents penetration from the subcutaneous space into the fascia and muscle layers of the buttocks. METHODS: Fat transfer simulation was performed with blue dye on 8 fresh tissue cadaver buttocks by 3 board-certified plastic surgeons (S.S.K., S.C., B.W.). An open control was utilized to visualize the process in the different anatomic layers, and all of the other procedures were performed blindly, akin to live surgery. After blue dye transfer reached maximum capacity (ranging from 400-800 mL per buttock), dissection of the anatomical layers of the buttocks was performed to determine the plane(s) of injection. RESULTS: Blue dye fat transfer injection to the buttocks did not penetrate the gluteal fascia or muscle layers from the subcutaneous space while using ASR. CONCLUSIONS: Auto Stop Reach technology supports the safety of gluteal fat transfer in the subcutaneous space by board-certified plastic surgeons.

Technology Innovation and Disruption in Plastic Surgery: Intelligence Quotient, Emotional Quotient, and Technology Quotient.

SUMMARY: This article is an introduction to the new PRS Tech Disruptor Series, the culmination of work originating from the Technology Innovation and Disruption Presidential Task Force. Our technology quotient is important to our success as individuals and as a specialty society. The goal of this new series is to address the broader concepts in technology as they relate to plastic surgery and thus enhance the technology quotient of readers and, in turn, of the specialty and specialty society. Critical topics related to technology, their current and future impact on plastic surgery, and the opportunities and barriers in research, education, and advocacy will be addressed. The intent is for readers to engage in dialogue and think outside the box about the current and future impact of technology.

Robotics in Plastic Surgery: It's Here.

SUMMARY: Although robotic surgery has been routinely established in other surgical disciplines, robotic technologies have been less readily adopted in plastic surgery. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, most reconstructive procedures, including microsurgery, have continued to necessitate an open approach. Recent advances in robotics and artificial intelligence, however, are gaining momentum and have shown significant promise to improve patient care in plastic surgery. These next-generation surgical robots have the potential to enable surgeons to perform complex procedures with greater precision, flexibility, and control than previously possible with conventional techniques. Successful integration of robotic technologies into clinical practice in plastic surgery requires achieving key milestones, including implementing appropriate surgical education and garnering patient trust.

Cybersecurity and Technical Patient Privacy Protection.

Plastic surgery offices are subject to a wide variety of cybersecurity threats, including ransomware attacks that encrypt the plastic surgeon's information and make it unusable, as well as data theft and disclosure attacks that threaten to disclose confidential patient information. Cloud-based office systems increase the attack surface and do not mitigate the effects of breaches that can result in theft of credentials. Although employee education is often recommended to avoid the threats, a single error by a single employee has often led to security breaches, and it is not reasonable to expect that no employee will ever make an error. A recognition of the two most common vectors of these breaches, compromised email attachments and surfing to compromised websites, allows the use of technical networking tools to both prevent email attachments from being received and to prevent employee use of unsanctioned and potentially compromised websites. Further, once compromised code is allowed to run within the office network, that code must necessarily make outbound connections to exploit the breach. Preventing that outbound traffic can mitigate the effects of a breach. However, most small office network consultants design firewalls to only limit incoming network traffic and fail to implement technical measures to stop the unauthorized outbound traffic that is necessary for most network attacks. Detailed techniques are provided which can be used to direct IT consultants to properly limit outbound network traffic as well as incoming email attachments, with more information at https://officenetworksecurity.com.

Novel Technology for Facial Muscle Stimulation Combined With Synchronized Radiofrequency Induces Structural Changes in Muscle Tissue: Porcine Histology Study.

BACKGROUND: With age, facial muscles lose the ability to complete contractions properly, resulting in limitation of facial expressions and fat shifting, and leading to skin creases and wrinkling. OBJECTIVES: The aim of this study was to determine the effects of the novel high intensity facial electromagnetic stimulation (HIFES) technology combined with synchronized radiofrequency on delicate facial muscles, using an animal porcine model. METHODS: Eight (n = 8, 60-80 kg) sows were divided into the active group (n = 6) and the control group (n = 2). The active group underwent four 20-minute treatments with radiofrequency (RF) and HIFES energies. The control group was not treated. Histology samples of muscle tissue were collected by a punch biopsy (6 mm in diameter) from the treatment area of each animal at baseline, 1-month, and 2-month follow-up. The evaluation included staining of the obtained tissue slices with hematoxylin and eosin and Masson's trichrome to determine the changes in muscle mass density, number of myonuclei, and muscle fibers. RESULTS: The active group showed muscle mass density increase (by 19.2%, P < .001), together with elevated numbers of myonuclei (by 21.2%, P < .05) and individual muscle fibers, which increased from 56.8 ± 7.1 to 68.0 ± 8.6 (P < .001). In the control group, no significant changes were seen in any of the studied parameters throughout the study (P > .05). Finally, no adverse events or side effects were observed in the treated animals. CONCLUSIONS: The results document favorable changes after the HIFES + RF procedure at the level of the muscle tissue, which may be of great importance in terms of maintenance of facial appearance in human patients.

Blockchain, Information Security, Control, and Integrity: Who Is in Charge?

SUMMARY: Blockchain technology has attracted substantial interest in recent years, most notably for its effect on global economics through the advent of cryptocurrency. Within the health care domain, blockchain technology has been actively explored as a tool for improving personal health data management, medical device security, and clinical trial management. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, integration of blockchain technologies within plastic surgery is in its infancy. Recent advances and mainstream adoption of blockchain are gaining momentum and have shown significant promise for improving patient care and information management. In this article, the authors explain what defines a blockchain and discuss its history and potential applications in plastic surgery. Existing evidence suggests that blockchain can enable patient-centered data management, improve privacy, and provide additional safeguards against human error. Integration of blockchain technology into clinical practice requires further research and development to demonstrate its safety and efficacy for patients and providers.

Spot Reduction of Localized Fat Deposits on the Lateral Thighs by Simultaneous Emission of Synchronized Radiofrequency and High-Intensity Focused Electromagnetic Energy: Magnetic Resonance Multicenter Study.

BACKGROUND: Unwanted lateral fat most prominently affects the female population and may cause self-esteem issues. OBJECTIVE: To investigate the effectiveness and safety of synchronized high-intensity focused electromagnetic (HIFEM) + radiofrequency (RF) for the treatment of lateral thigh adipose tissue. MATERIALS AND METHODS: Ninety-three subjects (21-70 year old) received 4, 30-minute HIFEM + RF treatments of the lateral thighs. Magnetic resonance imaging (MRI) of the treated area was obtained at baseline, 1, 3, and 6 months post-treatment to document the changes in fat layer thickness. Furthermore, digital photographs, circumference measurements of the lateral thighs, subjects' satisfaction questionnaires, and therapy safety and comfort were documented. RESULTS: Magnetic resonance imaging revealed a significant reduction of fat tissue in the saddlebag region peaking at 3 months (-18 ± 5.5 mm; N = 51). The thigh circumference measured at 3 predefined levels decreased on average by 2.3 cm, with the greatest change at the level of 10 cm below the infragluteal fold (-3.5 cm, 3-month follow-up). Results were maintained at 6 months. No adverse events were recorded. The therapy was found comfortable with a high satisfaction rate. CONCLUSION: High-intensity focused electromagnetic + RF treatment to the lateral thigh area demonstrated effectiveness in long-term fat thickness reduction by MRI imaging. Secondary endpoint showed simultaneous effectiveness and safety.

The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans.

Silicone is widely used in chronic implants and is generally perceived to be safe. However, textured breast implants have been associated with immune-related complications, including malignancies. Here, by examining for up to one year the foreign body response and capsular fibrosis triggered by miniaturized or full-scale clinically approved breast implants with different surface topography (average roughness, 0-90 µm) placed in the mammary fat pads of mice or rabbits, respectively, we show that surface topography mediates immune responses to the implants. We also show that the surface surrounding human breast implants collected during revision surgeries also differentially alters the individual's immune responses to the implant. Moreover, miniaturized implants with an average roughness of 4 µm can largely suppress the foreign body response and fibrosis (but not in T-cell-deficient mice), and that tissue surrounding these implants displayed higher levels of immunosuppressive FOXP3+ regulatory T cells. Our findings suggest that, amongst the topographies investigated, implants with an average roughness of 4 µm provoke the least amount of inflammation and foreign body response.

A multi-center, open-label, pilot study of allograft adipose matrix for the correction of atrophic temples.

BACKGROUND: Autologous fat grafting (AFG) and synthetic fillers are currently used in esthetic and reconstructive surgery. Challenges in AFG include inconsistent graft retention, donor site morbidities, insufficient harvest, and excessive harvesting times. An allograft adipose matrix (AAM) has been developed as an off-the-shelf alternative to AFG and synthetic fillers. AIMS: To evaluate the clinical safety and retention of an AAM over 24 weeks after treatment of bilateral atrophic temples. PATIENTS/METHODS: Ten subjects (nine females, one male, aged 47-69 years) with temple atrophy were enrolled in the IRB-approved study. AAM (Renuva® , MTF Biologics, Edison, NJ) was injected (<3 mL) bilaterally into the atrophic temples of each subject. Volume retention, global improvement, and safety were evaluated at 1, 4, 8, 12, 16, 20, and 24 weeks. Biopsy specimens were obtained for adipogenic and angiogenic histological evaluation. RESULTS: The mean temple volume improved over the baseline and was retained throughout the study period. Fullness (measure of volume) increased immediately from 0 pretreatment to 2.8 post-treatment (scale 0-4 = none-maximum). Fullness varied from 0.8 to 2.2 from weeks 1 through 12 and was 2.7-3.0 from weeks 16-24, around 75% increase from baseline. Furthermore, skin tone, smoothness, texture, and overall appearance also improved with 71% of subjects being satisfied to very satisfied with the results. Adverse events were minimal and histology revealed native tissue incorporation and remodeling. CONCLUSION: AAM is safe and well tolerated, provides at least 6-month volume retention, improves skin quality, and supports adipose tissue remodeling after treatment into temples.

MRI and CT Assessment of Abdominal Tissue Composition in Patients After High-Intensity Focused Electromagnetic Therapy Treatments: One-Year Follow-Up.

BACKGROUND: Several studies investigating high-intensity focused electromagnetic (HIFEM) treatments have recently been published. However, due to the novelty of the procedure, long-term data are still missing. OBJECTIVES: The aim of this study was to evaluate changes in abdominal tissues on average 1 year after a series of HIFEM treatments, to determine the long-term durability of patients' original body responses. METHODS: Magnetic resonance imaging (MRI) or computed tomography (CT) scanning were performed on 21 patients a mean of 332.6 [88.5] days after their original HIFEM treatment series. The scans were evaluated by a blinded radiologist for abdominal muscle thickness, subcutaneous fat changes, and abdominal separation. The results were compared with the MRI/CT-assisted measurements taken at baseline and 6-week follow-up. Correlations between collected data sets were calculated and tested. The incidence of any adverse events related to earlier treatments was monitored. RESULTS: When comparing the 1-year follow-up measurements with the baseline, the MRI/CT-assisted calculations revealed mean reductions of 14.63% (2.97 [2.11] mm) in fat, 19.05% (1.89 [0.88] mm) in muscle thickening, and 10.46% (1.96 [1.71] mm) in diastasis recti. All changes were significant (P < 0.05) and not related to weight fluctuations (P > 0.05). The baseline width of diastasis positively correlated with the degree of improvement at follow-up. No adverse events were reported. CONCLUSION: The HIFEM-induced muscle hypertrophy, fat reduction, and reduction in abdominal separation were maintained 1-year posttreatment. This suggests long-term durability of the original bodily response, which needs to be verified by continuing follow-up of this group and by further studies.

Expert Consensus on the Use of a New Bioengineered, Cell-Friendly, Smooth Surface Breast Implant.

BACKGROUND: Although general guidelines are available for established silicone gel breast implants, the unique characteristics of the latest Motiva implants warrant specific guidelines. OBJECTIVES: This study aimed to generate consensus recommendations and summarize expert-based advice to better understand current surgical practices and to establish guidelines for surgeons transitioning from other implant devices to the Motiva implants. METHODS: A survey was compiled by 12 plastic surgeon experts in aesthetic and reconstructive breast surgery and 1 biotechnology scientist, and distributed to 36 plastic surgeons to establish a consensus on the use of these devices. Surgical techniques, complication rates, and implant selection were among the topics discussed. RESULTS: The experts agreed on 3 core principles regarding the use of Motiva Round and Ergonomix implants. Firstly, the dissected pocket needs to be close fitting and steps must be taken to prevent expansion of the pocket. Secondly, implant selection must be individualized. Finally, surgical planning and technique must be carefully considered. When questioned about problems they had ecountered, 84.6% of the experts agreed that they experienced fewer overall complications and 76.9% confirmed reduced capsular contracture rates with these devices. Overall, 84.6% of the experts favored selecting Motiva Ergonomix implants over Round implants to achieve a more natural look. In addition, 92.3% of the experts agreed that Motiva implants, due to their innovative technology, reduce the risk of anaplastic large-cell lymphoma. CONCLUSIONS: This international consensus of leading practitioners will assist plastic surgeons with patient selection, preoperative planning, and surgical technique. These recommendations are designed to optimize surgical outcomes, resulting in lower overall complication rates, more natural-looking breasts, and highly satisfied patients.