The Role of Blood Pressure Control in Prevention of Hematoma After Blepharoplasty.

INTRODUCTION: Hematoma formation after blepharoplasty is serious and potentially vision-threatening, with hypertension being the primary risk factor. The aim of this paper is to assess perioperative blood pressure trends and rates of complication in patients undergoing a strict blood pressure protocol designed to keep perioperative systolic blood pressure below 120 mmHg. METHODS: A retrospective chart review was performed of 32 patients undergoing face lift with conomitant blepharoplasty from January 2015 to July 2018. For each patient blood pressure readings obtained before, during, and after surgery were reviewed. Two-sample one-tail T-tests were performed, and p values less than 0.05 were considered statistically significant. RESULTS: The mean systolic blood pressure (SBP) for all patients was highest intraoperatively. Patients with known hypertension had higher mean SBPs than patients without hypertension across all phases of care, with a statistically significant difference in immediate preoperative SBP (p=0.05). Males had a higher average blood pressure immediately postoperatively (p=0.05). A previous diagnosis of hypertension in females was associated with a higher immediate preoperative SBP (p=0.07) as well as age over 65 (p=0.07). The overall rate of complications was 37.5%. No patients experienced hematoma. CONCLUSION: This study demonstrated that keeping blood pressure below 120 mmHg after surgery was an effective method of preventing hematoma after blepharoplasty, even in patients concurrently on anti-coagulative medications. Special attention to blood pressure control should be shown to patients with known risk factors such as a previous diagnosis of hypertension, male sex, or age greater than 65. LEVEL OF EVIDENCE III: 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 .

Utility and Comparative Performance of Current Artificial Intelligence Large Language Models as Postoperative Medical Support Chatbots in Aesthetic Surgery.

BACKGROUND: Large Language Models (LLMs) have revolutionized the way plastic surgeons and their patients may access and leverage artificial Intelligence (AI). OBJECTIVES: The present study aims to comparatively assess the performance of two current publically-available and patient-accessible LLMs in the potential application of AI as postoperative medical support chatbots in an aesthetic surgeon's practice. METHODS: Twenty-two simulated postoperative patient presentations following aesthetic breast plastic surgery were devised and expert-validated. Complications varied in their latency within the postoperative period, as well as urgency of required medical attention. In response to each patient-reported presentation, Open AI's ChatGPT and Google's Bard, in their unmodified and freely available versions, were objectively assessed for their comparative accuracy in generating an appropriate differential diagnosis, most likely diagnosis, suggested medical disposition, treatments or interventions to begin from home, and/or red flag signs/symptoms indicating deterioration. RESULTS: ChatGPT cumulatively and significantly outperformed Bard across all objective assessement metrics examined (66% vs. 55%, respectively; p < 0.05). Accuracy in generating an appropriate differential diagnosis were 61% for ChatGPT, and 57% for Bard (p = 0.45). ChatGPT asked an average of 9.2 questions on history, relative to 6.8 questions by Bard (p < 0.001), following which, accuracies of 91% vs. 68% at arriving at the most-likely diagnosis were noted, respectively (p < 0.01). Appropriate medical dispositions were suggested with an accuracy of 50% by ChatGPT, and 41% by Bard (p = 0.40); relevant home interventions/treatments with an accuracy of 59% and 55% (p = 0.94), and red flag signs/symptoms with accuracies of 79% and 54% (p < 0.01), respectively. Detailed and comparative performance breakdowns according to complication latency and urgency are presented herein. CONCLUSIONS: ChatGPT represents the superior LLM for the potential application of AI technology in postoperative medical support chatbots. Imperfect performance and limitations identified herein may guide the necessary refinement to facilitate adoption.

Artificial Intelligence-Generated Social Media Content Creation and Management Strategies for Plastic Surgeons.

BACKGROUND: Social media platforms have come to represent integral components of the professional marketing and advertising strategy for plastic surgeons. Effective and consistent content development, however, remains technically demanding and time consuming, prompting most to employ, at non-negligible costs, social media marketing specialists for content planning and development. OBJECTIVES: The present study aims to investigate the ability of presently available artificial intelligence (AI) models to assist plastic surgeons in their social media content development and sharing plans. METHODS: An AI Large Language Model was prompted on the study's objectives through a series of standardized user interactions; social media platforms of interest, on which the AI model was prompted, included Instagram, TikTok, and X (formerly Twitter). RESULTS: A one-year, entirely AI-generated social media plan, comprising a total of 1091 posts for the three aforementioned social media platforms, is presented herein. Themes of the AI-generated content proposed for each platform were classified into 6 categories, including patient-related, practice-related, educational, "uplifting", interactive, and promotional posts. Overall, 91 publicly recognized holidays, observant, and awareness days were incorporated into the content calendars. The AI model demonstrated an ability to differentiate between the distinct formats of each of the three social media platforms investigated, generating unique ideas for each, and providing detailed content development and posting instructions, scripts, and post captions, leveraging features specific to each platform. CONCLUSIONS: By providing detailed and actionable social media content creation and posting plans to plastic surgeons, presently available AI models can be readily leveraged to assist in and significantly alleviate the burden associated with social media account management, content generation, and potentially patient conversion.

Complications Following Body Contouring: Performance Validation of Bard, a Novel AI Large Language Model, in Triaging and Managing Postoperative Patient Concerns.

INTRODUCTION: Large language models (LLM) have revolutionized the way humans interact with artificial intelligence (AI) technology, with marked potential for applications in esthetic surgery. The present study evaluates the performance of Bard, a novel LLM, in identifying and managing postoperative patient concerns for complications following body contouring surgery. METHODS: The American Society of Plastic Surgeons' website was queried to identify and simulate all potential postoperative complications following body contouring across different acuities and severity. Bard's accuracy was assessed in providing a differential diagnosis, soliciting a history, suggesting a most-likely diagnosis, appropriate disposition, treatments/interventions to begin from home, and red-flag signs/symptoms indicating deterioration, or requiring urgent emergency department (ED) presentation. RESULTS: Twenty-two simulated body contouring complications were examined. Overall, Bard demonstrated a 59% accuracy in listing relevant diagnoses on its differentials, with a 52% incidence of incorrect or misleading diagnoses. Following history-taking, Bard demonstrated an overall accuracy of 44% in identifying the most-likely diagnosis, and a 55% accuracy in suggesting the indicated medical dispositions. Helpful treatments/interventions to begin from home were suggested with a 40% accuracy, whereas red-flag signs/symptoms, indicating deterioration, were shared with a 48% accuracy. A detailed analysis of performance, stratified according to latency of postoperative presentation (<48hours, 48hours-1month, or >1month postoperatively), and according to acuity and indicated medical disposition, is presented herein. CONCLUSIONS: Despite promising potential of LLMs and AI in healthcare-related applications, Bard's performance in the present study significantly falls short of accepted clinical standards, thus indicating a need for further research and development prior to adoption. 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 .

Evidence of Hematoma Prevention After Facelift.

Hematoma is a common complication after facelift procedures. Multiple factors have been shown to increase the risk of hematoma formation, such as male gender, anticoagulant medication use, perioperative hypertension, increased intrathoracic pressure, and operative technique. The purpose of this manuscript is to provide an overview of existing literature to provide surgeons with evidence-based recommendations on how to minimize hematoma risk during facelift surgery. A literature search for hematoma and facelift surgery was performed that identified 478 unique manuscripts. Abstracts were reviewed, excluding articles not describing facelift surgery, those written before 1970, studies with a sample size of fewer than 5 patients, non-English studies, and those that did not provide postoperative hematoma rates. Forty-five articles were included in this text, with their recommendations. Measures such as the prophylactic management of pain, nausea, and hypertension, the use of fibrin glue tissue sealants, the use of local anesthesia rather than general anesthesia, and strict blood pressure control of at least <140 mmHg were found to significantly reduce hematoma formation. Quilting sutures has shown benefit in some high-risk patients. Measures such as drains, compression dressings, perioperative use of selective serotonin reuptake inhibitors, and perioperative steroids had no significant effect on hematoma formation. In addition to appropriate patient selection and careful intraoperative hemostasis, many adjunct measures have been shown to reduce postoperative hematoma formation in facelift procedures.

A Bibliometric Analysis of the Highest Cited Rhytidectomy Literature.

In this bibliometric analysis, we investigated the top 100 most cited articles on rhytidectomy, a prevalent cosmetic surgical procedure in the United States of America. Using data from Web of Science spanning from 1900 to 2021, we found these papers collectively cited 7737 times, with individual citation counts ranging from 277 to 37 (mean 77). Notably, the majority of these papers (58 out of 100) were categorized as Level of Evidence 5, indicating a prevalence of expert opinions, anatomical studies, and narrative reviews. Interestingly, none of the papers achieved Level 1 status, underscoring a lack of high-quality research in the field. The primary focus of these papers was on operative techniques (48 papers) and surgical anatomy of the face (20 papers). Only 10 articles incorporated patient-reported outcome measures (PROMs), but none utilized validated scales. This analysis highlights the urgent need for improved research methodologies in rhytidectomy studies, emphasizing the necessity for rigorous, high-quality research, and the implementation of validated rhytidectomy-specific PROMs.

Developing Consensus-Based Guidelines for Case Reporting in Aesthetic Medicine: Enhancing Transparency and Standardization.

Clinical case reporting plays a vital role in sharing detailed patient narratives, providing insights into rare conditions, innovative treatments, and unexpected outcomes. However, existing reporting guidelines in aesthetic medicine fail to capture the specific nuances of procedures and outcomes in this field. The authors' objectives were to develop comprehensive guidelines for Case REporting in Aesthetic Medicine (CREAM). The study employed a 3-phase consensus process, including a literature review, expert interviews, and a consensus meeting. A diverse group of 10 expert participants (plastic surgeons, dermatologists, noncore specialists, evidence-based medicine expert, and research scientist) in Phase I and 30 experienced aesthetic practitioners in Phase II contributed to the research. Statistical analysis was conducted to assess agreement levels among participants and explore associations and variations within the data. The participants represented various specialties, genders, LGBTQ+ identities, and ethnic backgrounds. The research resulted in the development of the CREAM guidelines, consisting of a 16-item checklist. The guidelines covered essential aspects of case reporting, such as patient and practice information, procedure details, clinical assessment and outcomes, adverse events, and ethical considerations. Statistical analysis indicated a high level of consensus among participants, as well as significant associations between checklist items. CREAM guidelines represent a step toward enhancing transparency and standardization in case reporting in aesthetic medicine. Adhering to these guidelines will allow authors to contribute to a robust evidence base, prioritize patient safety, and drive advancements aesthetic medicine.

Complications Following Facelift and Neck Lift: Implementation and Assessment of Large Language Model and Artificial Intelligence (ChatGPT) Performance Across 16 Simulated Patient Presentations.

INTRODUCTION: ChatGPT represents a potential resource for patient guidance and education, with the possibility for quality improvement in healthcare delivery. The present study evaluates the role of ChatGPT as an interactive patient resource, and assesses its performance in identifying, triaging, and guiding patients with concerns of postoperative complications following facelift and neck lift surgery. METHODS: Sixteen patient profiles were generated to simulate postoperative patient presentations, with complications of varying acuity and severity. ChatGPT was assessed for its accuracy in generating a differential diagnosis, soliciting a history, providing the most-likely diagnosis, the appropriate disposition, treatments/interventions to begin from home, and red-flag symptoms necessitating an urgent presentation to the emergency department. RESULTS: Overall accuracy in providing a complete differential diagnosis in response to simulated presentations was 85%, with an accuracy of 88% in identifying the most-likely diagnosis after history-taking. However, appropriate patient dispositions were suggested in only 56% of cases. Relevant home treatments/interventions were suggested with an 82% accuracy, and red-flag symptoms with a 73% accuracy. A detailed analysis, stratified according to latency of postoperative presentation (<48 h, 48 h-1 week, or >1 week), and according to acuity of complications, is presented herein. CONCLUSIONS: ChatGPT overestimated the urgency of indicated patient dispositions in 44% of cases, concerning for potential unnecessary increase in healthcare resource utilization. Imperfect performance, and the tool's tendency for overinclusion in its responses, risk increasing patient anxiety and straining physician-patient relationships. While artificial intelligence has great potential in triaging postoperative patient concerns, and improving efficiency and resource utilization, ChatGPT's performance, in its current form, demonstrates a need for further refinement before its safe and effective implementation in facial aesthetic surgical practice. 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 .

An Overview of Surgical Approaches for Lower Eyelid Blepharoplasty.

Age-related changes in the lower eyelid are noticed by patients as bags or circles under the eye, a tired look, and a flattened face. Lower eyelid blepharoplasty, in which the excess skin and/or orbital fat is excised and repositioned, is mainly performed for aesthetic reasons rather than the correction of functional abnormalities. Favorable outcomes for the combination of these approaches have been reported, but the most suitable surgical technique is still debated. This systematic narrative review deals with the indications, preoperative considerations, operative techniques, and complications of several different surgical approaches to lower eyelid blepharoplasty.

A Systematic Review of the Efficacy and Safety of Tranexamic Acid in Facelift Surgery.

Tranexamic acid (TXA) has become widely utilized in different specialities including facelift surgery. The aim of this review was to robustly evaluate the quality of available evidence on the efficacy and safety of TXA use in facelift surgery. We searched the MEDLINE (National Institutes of Health, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), CINAHL (EBSCO Information Services, Ipswich, MA), Cochrane Central Register of Controlled Trials (CENTRAL; Wiley, Hoboken, NJ), Google Scholar (Alphabet Inc. Mountain View, CA), Science Citation Index (Clarivate, London, UK), and Latin American and Caribbean Center on Health Sciences Information (LILACS; São Paulo, Brazil) databases for randomized controlled trials (RCTs) and observational studies. Primary outcomes were blood loss, postoperative hematoma, ecchymosis, and swelling, in addition to technical considerations and complications. We assessed review quality with the AMSTAR 2 tool, study quality with Grading of Recommendations, Assessment, Development, and Evaluations approach (GRADE) tool, and the risk of bias with Cochrane's RoB 2.0 tool for RCTs and ROBINS-I for nonrandomized studies. Of the 368 articles, a total of 3 studies including 150 patients met the inclusion criteria. The RCT reported a significant reduction in postoperative serosanguineous collections in the TXA group (P < .01), and in surgeon-rated postoperative ecchymosis and bruising. The prospective cohort study reported reduced drainage output in first 24 hours in the TXA group (P < .01). The retrospective cohort study reported lower intraoperative blood loss, mean postoperative day 1 drain output, percentage of drain removal on postoperative day 1, and number of days to drain removal in the TXA group (all P < .01). The quality of studies was moderate, and this review was the highest rated compared to previous reviews, as per the AMSTAR 2 tool. Based on limited literature, TXA improves clinical outcomes regardless of the route of administration. Topical TXA is an emerging route, expediting drain removal and reducing blood loss. Future Level I high-quality studies are required.

Systolic Blood Pressure Less Than 120 mmHg is a Safe and Effective Method to Minimize Bleeding After Facelift Surgery: A Review of 502 Consecutive Cases.

BACKGROUND: Hematoma is the most common complication after facelift surgery. Hypertension is the major risk factor for hematoma following facelift. Measures taken to reduce systolic blood pressure perioperatively significantly reduce the risk of hematoma. There is evidence that treating systolic blood pressure of 140 mmHg or above reduces hematoma; there were no studies to date in which systolic blood pressures below 120 mmHg had been evaluated. OBJECTIVES: To assess the safety and efficacy of maintaining systolic blood pressures of 120 mmHg or less postoperatively to reduce hematoma after facelift. METHODS: A retrospective chart review of a single surgeon's series of facelift procedures from January 2004 to July 2018 was undertaken. Implementation of a more stringent perioperative blood pressure protocol (maintaining a systolic blood pressure of less than 120 mmHg postoperatively) was initiated in January of 2013, dividing patients into 2 groups. RESULTS: A total of 502 consecutive patients who underwent a facelift by F.N. were included in the study. A total of 319 patients underwent a facelift before 2013, and a total of 183 patients underwent a facelift in 2013 or later. Overall, a total of 13 hematomas occurred during the entire 15-year study period (2.59%), of which 12 occurred before the implementation of a strict blood pressure regimen (3.76%), and only 1 occurred after the new protocol (0.5%). There were no adverse events related to the lower blood pressure. CONCLUSIONS: Treating systolic blood pressure greater than 120 mmHg postoperatively is a safe and effective method for reducing the risk of hematoma after facelift.