Ethical Considerations and Outcomes in Body Contouring Surgeries Among Adolescents: A Comprehensive Narrative Review.

BACKGROUND: Body contouring surgery (BCS) in adolescents, particularly following bariatric surgery, involves a complex array of ethical, psychological, and medical factors. This review focuses on adolescents who have experienced significant weight loss, often due to bariatric surgery, and subsequently require body contouring to address excess skin and soft tissue. METHODS: A literature narrative review was conducted using PubMed and Google Scholar databases. Relevant articles were screened and selected based on their discussion of post-bariatric and massive weight loss body contouring surgeries in adolescents, focusing on prevalence, outcomes, and ethical considerations. RESULTS: The prevalence of BCS among adolescents is rising, influenced by social media and societal perceptions of beauty. However, the percentage of adolescents receiving BCS after bariatric surgery remains low. Adolescents undergoing BCS experience improvements in physical functioning, body image, and psychological well-being. Complications, although common, are mostly minor. Ethical considerations include ensuring informed consent, assessing emotional maturity, managing patient expectations, and involving adolescents in decision-making. Comparative analysis reveals similar outcomes in adults and adolescents, but adolescents face unique ethical challenges related to autonomy, long-term effects, and ongoing physical and emotional development. CONCLUSION: BCS in adolescents following bariatric surgery can lead to improved physical and psychological outcomes. However, the decision to undergo BCS must be carefully considered, taking into account the adolescent's maturity, expectations, and long-term well-being. Ethical considerations are paramount, emphasizing the need for informed consent, realistic expectations, and a multidisciplinary approach. Further research is needed to assess long-term outcomes and the specific ethical implications of BCS in adolescents compared to adults. LEVEL OF EVIDENCE V: 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 rare case of mucormycosis in a diabetic patient: diagnostic challenges and clinical management of mucormycosis hand infection.

Mucormycosis hand infection in poorly controlled diabetic presented as rapidly progressive swelling, redness, pain, and necrosis unresponsive to antibiotics. Prompt diagnosis and aggressive surgery, antifungals, and diabetes management were critical, highlighting the need for early recognition and treatment of mucormycosis in diabetics.

Does tranexamic acid effectively minimise blood loss in cleft palate repair? A rigorous assessment through comprehensive systematic review and meta-analysis.

Cleft palate repair is a common reconstructive procedure that can involve significant blood loss. Tranexamic acid (TXA) has been proposed to minimise blood loss during various surgical procedures, but its effectiveness in cleft palate repair remains unclear. This systematic review and meta-analysis aimed to assess the effectiveness of TXA to reduce postoperative blood loss. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive search across multiple databases, including PubMed, Cochrane, and Web of Science, to identify relevant studies published up to September 2023. Only randomised controlled trials (RCTs) were included. Primary outcomes measured were total blood loss, transfusion rates, and postoperative complications. We identified four relevant RCTs, which included 275 cleft palate patients with a mean (range) age of 28.7 (6-65) months. The pooled analysis found no significant difference in duration of surgery (MD -18.40 minutes, p = 0.09), preoperative haemoglobin (MD 0.46 g/dl, p = 0.27), or postoperative haemoglobin (MD 0.07 g/dl, p = 0.86) between TXA and control groups. Intraoperative blood loss was lower with TXA, but with TXA, the difference was not statistically significant (MD -16.63 ml, p = 0.15). TXA significantly improved surgical field visibility (p = 0.004). No adverse events occurred with its use. While no significant differences were found in surgical outcomes with TXA, surgical field visibility significantly improved, and TXA showed a promising safety profile. Larger and higher-quality RCTs are still needed to validate these preliminary findings before TXA can be considered as a standard treatment.

Efficacy and Safety of Triamcinolone Acetonide Injections Following Rhinoplasty: A Systematic Review of Recommended Doses, Complications, and Outcomes.

BACKGROUND: Triamcinolone acetonide injections (TAIs) have been suggested to decrease complications following rhinoplasty. This systematic review aimed to assess the efficacy and safety of TAIs following rhinoplasty. METHODS: We performed a systematic literature search on Medline, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials from inception to May 2023, without any timeframe limitations. The following terms were used: (Triamcinolone OR steroid injections OR triamcinolone acetonide) AND (Skin thickness OR supratip edema OR supratip deformity OR Pollybeak deformity) AND (rhinoplasty OR external rhinoplasty). We included randomized controlled trials and observational studies (prospective, retrospective, and case series). RESULTS: In total, six of the 1604 articles met our inclusion criteria. A total of 1524 patients were included in this study. Our results included patient demographics, type of rhinoplasty, post-injection follow-up period, site of injection, type of syringe used, timing of the first dose, volume and concentration used, time interval between doses, response to the injection, and complications of injection. CONCLUSION: To our knowledge, this is the first systematic review to address this issue. Our results demonstrate the ease and safety of TAIs as a first-line treatment, with positive outcomes and limited complications. TAIs can be used early postoperatively to minimize the need for revision surgery. Despite the limited number of studies on TAIs, this study provides the best available evidence that can help surgeons decide when to use the injection, the intervals between doses, and the duration of use. Further randomized controlled trials are required to confirm our findings. LEVEL OF EVIDENCE II: 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 .

Impact of Body-contouring Surgery Post Bariatric Surgery on Patient Well-being, Quality of Life, and Body Image: Saudi Arabia-based Cross-sectional Study.

Background: Body-contouring surgery is commonly performed to address functional and aesthetic issues that can arise following bariatric surgery. However, there is limited understanding of the psychological impact of this procedure on Saudi Arabian patients who have undergone bariatric surgery. This study aimed to explore the effects of body-contouring surgery on the psychological well-being, quality of life, and body image of individuals who have undergone bariatric surgery. Methods: This cross-sectional study assessed the psychological impact of body-contouring surgery by measuring levels of depression and generalized anxiety disorder using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scale, respectively. Results: The study included a total of 227 participants, with 112 (49.3%) undergoing body-contouring surgery. Among the entire sample, 77.5% experienced excess skin folds following bariatric surgery. The prevalence of depression was 6% in the body-contouring group, lower than the 8% observed in the non-body-contouring group (P = 0.073). Notably, anxiety was significantly lower in the body-contouring group, with a prevalence of 4% compared with 6% in the non-body-contouring group (P = 0.006). Additionally, patients who had undergone body-contouring surgery reported higher scores for emotional well-being when compared with those who had not undergone body-contouring (P = 0.011). Conclusions: The study suggests that body-contouring surgery improves the physical appearance of bariatric-surgery patients and reduces anxiety and depression, leading to improved psychological well-being. Further research, including larger and more diverse populations, such as multicenter studies at a regional or international level, is needed to validate these findings.

Modified McKissock's Breast Reduction Technique: A Case Series and Description of Our Technique Modification.

Background: The modified McKissock breast reduction technique uses upper and lower vascular pedicles to reduce breast size and reshape the breasts. This technique has gained significant interest in recent years because of its potential to minimize surgical complications. The current study aims to report our experience and results with our refined version of the McKissock technique. Methods: We conducted a prospective cohort study on patients with breast hypertrophy between 2022 and 2023 to evaluate the modified McKissock breast reduction technique. Two main alterations were made to the original McKissock technique. First, the superior pedicle was modified to create a superomedial pedicle. Second, the inferior pedicle was thinned to form a dermoseptal pedicle with a 4 cm wide base. Results: A total of 13 patients underwent surgery using the modified McKissock breast reduction technique. The average age of the patients was 37.2 years. For the right breast, the weight of tissue resected during reduction ranged from 189 g to 695 g (average 379 g). For the left breast, the resection weight range was 160 g to 608 g (average 370 g). There were no complications except one patient who developed partial nipple necrosis on the left side. All patients expressed satisfaction with the outcomes. Conclusion: Our modified McKissock breast reduction technique shows promise as a method for reducing breast size. It offers several potential advantages, including improved preservation of the nipple and areola complex, more precise breast shaping, contouring capabilities, and reduced risk of complications. Although the early results of this technique are encouraging, further research is required to evaluate its long-term benefits and risks fully.

Evolution of Superficial Muscular Aponeurotic System Facelift Techniques: A Comprehensive Systematic Review of Complications and Outcomes.

Background: Facelift procedures are a popular method of facial rejuvenation. The most common technique is superficial muscular aponeurotic system (SMAS) plication, with several variations. However, the optimal approach remains unclear. This review analyzed previous studies to compare SMAS facelift techniques, their outcomes, and complication rates. Methods: A systematic search was conducted using the MEDLINE, Cochrane, Embase, and Google Scholar electronic databases in September 2022. The search included studies published from January 2000 to September 2022 using keywords such as "facelift," "complications," and "outcomes." Results: This review examined 27 selected studies that evaluated 6 SMAS facelift techniques. The studies involved 6086 patients in total, over 85% of who were satisfied with the outcome of their surgery. The complication rates varied depending on the technique used, with the SMAS flap and composite SMAS technique having the highest (5.75%) and lowest (0.05%) complication rates, respectively. The most common complications were temporary facial nerve injury (0.85%) and skin necrosis (0.41%). To date, only one case of permanent facial nerve injury has been reported. Conclusions: On the basis of our findings, SMAS facelift techniques achieve high patient satisfaction rates, with complication rates that vary by technique. The composite SMAS technique showed the lowest complication rates, whereas the SMAS flap showed the highest rate. However, some studies have not reported all complications, making it difficult to determine the best approach. Therefore, future studies are required to identify the most aesthetically pleasing technique with the lowest complication risk.

The Use of Hyaluronic Acid in Non-surgical Rhinoplasty: A Systematic Review of Complications, Clinical, and Patient-Reported Outcomes.

INTRODUCTION: In cosmetic practices, non-surgical rhinoplasty using filler injections has become increasingly common. Nevertheless, the outcome and overall complications have not been studied as a systematic review in the literature. This study provides a high-quality systematic review of studies reporting clinical and patient-reported outcomes following non-surgical rhinoplasty with hyaluronic acid (HA) to further guide practitioners. METHODS: This systematic review was conducted in accordance with PRISMA guidelines and was registered in PROSPERO. The search was conducted using MEDLINE, EMBASE, and Cochrane. The literature retrieval was conducted by three independent reviewers, and the remaining articles were screened by two independent reviewers. The quality of included articles was assessed using the MINORS and methodological quality and synthesis of case series and case reports tools. RESULTS: A total of 874 publications were found based on the search criteria. A total of 3928 patients were reviewed for this systematic review from 23 full-text articles. For non-surgical rhinoplasty, Juvéderm ultra was the most commonly used HA filler. The nasal tip was most commonly injected (13 studies), followed by the columella (12 studies). Nasal hump deformities are the most common reason for non-surgical rhinoplasty. All studies showed high patient satisfaction. Among all patients reviewed, eight developed major complications. CONCLUSION: Non-surgical rhinoplasty performed with HA has minimal side effects and a short recovery period. Furthermore, non-surgical rhinoplasty with HA results in high satisfaction. To strengthen the presently available evidence, further well-designed RCTs are needed. 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 https://www.springer.com/00266.

Top 50 Highly Cited Publications in Facelift Surgery: A 50-Year Bibliometric Analysis Review.

INTRODUCTION: Facelift surgery, also known as rhytidectomy, is a commonly performed procedure to address aging-related changes in the face and neck. Over the years, its techniques and methodologies have evolved. This study aimed to provide a bibliometric analysis of the top 50 most cited publications related to facelift surgery over a fifty-year period (1973-2023). METHODS: The authors obtained data from the Web of Science Core Collection on July 15, 2023. Using a predefined search strategy, the most cited articles from 1973 to 2023 on facelift surgery were identified. The publications were analyzed for their type of study, journal of publication, geographic origin, and primary outcomes. Furthermore, the authorship gender distribution was assessed. RESULTS: The majority of the publications (34 out of 50) were published in the "Plastic and Reconstructive Surgery" journal. The USA contributed to 72% of the research, followed by the UK, Mexico, Australia, and Germany. The primary outcomes varied from surgical techniques, anatomical studies, risk factors, patient-specific outcomes, and facial rejuvenation techniques, to comparative and historical progression of techniques. Notably, male authors dominated the field with 47 out of 50 papers having both a first and senior male author. CONCLUSION: Facelift surgery has seen substantial research development over the past fifty years. The USA has been at the forefront of this research, with a predominant focus on surgical techniques and anatomical studies. Male dominance in authorship indicates potential scope for increased gender diversity in this specialty. Annual updates are recommended for continued insights. 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 .

Preventing and Managing Operating Room Fires in Plastic Surgery: A Review of Incidence, Risk Factors, and Recommendations with Case Experiences.

Fires in operating rooms are rare yet devastating incidents. There are guidelines for the prevention and management of surgical fires; however, these recommendations are based on expert opinion and case reports. Almost all surgical procedures have an oxidizer (oxygen, nitrous oxide), an ignition source (such as a laser or "Bovie"), and a fuel, which together make up the three elements of an operating room fire. Our review analyzes each fire component to decide on the most effective clinical approach for reducing the risk of fire. We investigate the incidence, risk factors, legal repercussions, preventive strategies, and the precise management of fires in the operating room, with a particular focus on plastic surgery procedures. In addition, we share insights from our own experiences and propose guidelines based on our findings to enhance safety and response measures in surgical settings. Fires most commonly occur around the head, neck, and upper chest. High-risk procedures include tonsillectomies, tracheostomies, laryngoscopies, and facial/neck surgeries. Checklists help ensure proper precautions are taken, like using moist towels and lowering oxygen concentration. If a fire erupts, prompt removal of the oxygen source and irrigation are critical. From our experience, fires spread rapidly and can cause severe burns and inhalation injuries. We share illustrative cases of surgical fires at our institution over the past decade. Our review underscores the importance of fire prevention and preparedness through safety protocols, equipment maintenance, staff training, and maintaining situational awareness. More research is needed to quantify risk factors and determine optimal management strategies when fires do occur.

Factors and barriers influencing the decision to undergo body contouring surgery after bariatric surgery: A cross-sectional study.

OBJECTIVES: To identify the factors and predictors that play a role in shaping the decision-making process of post-bariatric patients when considering aesthetic surgery. METHODS: This cross-sectional study was carried out at the Specialized Medical Center Hospital in Riyadh, Saudi Arabia. Data collection for the study occurred between January and March 2023. To gather the necessary data, a self-administered questionnaire was distributed to participants through the messaging platform WhatsApp. RESULTS: Among the 445 responses analyzed, 71.2% reported having excess skin folds. A total of 62 (13.9%) participants underwent body contouring surgery, most of which was carried out in the trunk region (67.7%). Being female was associated with statistically significantly higher rates of body contouring surgery (82.3%, p=0.002), as was achieving one's best weight after 2 years (37.1%, p=0.003) or more than 2 years (14.5%, p=0.003). Among those who did not consider body contouring surgery, the most important reason reported was the belief that such surgeries were not needed, accounting for 41.1% of responses. CONCLUSION: This study found that female gender, achieving optimum weight within 2 or more years post-bariatric surgery, and a smaller median change in body mass index were significant predictors of future body contouring surgery. These findings are important for advising and educating post-bariatric patients regarding their options for body-contouring procedures.

Utilization of ChatGPT-4 in Plastic and Reconstructive Surgery: A Narrative Review.

Background: ChatGPT-4 (Chat Generative Pre-Trained Transformer) has demonstrated remarkable capabilities in natural language processing and understanding, making it a promising tool for various medical domains. This article presents a comprehensive overview of the potential applications of ChatGPT-4, a cutting-edge language model developed by OpenAI, in the field of plastic and reconstructive surgery. Methods: After conducting a thorough literature review, we discovered pertinent articles that explore the application of ChatGPT-4 in plastic surgery. By examining these findings and integrating the information with our personal experience using ChatGPT-4 in the field of plastic surgery, we have produced an all-encompassing narrative review. Results: The narrative review focuses on three main areas: clinical applications, research applications, and medical education. In the clinical realm, ChatGPT-4 has the potential to streamline documentation processes, improve communication, and enhance personalized patient care. It can assist in generating accurate and comprehensive progress notes, operative notes, surgical consent forms, on-call schedules, and consultation reports. However, it is important to note that ChatGPT-4 should be used as a supportive tool and should not replace human doctors. Conclusions: The potential applications of ChatGPT-4 in plastic and reconstructive surgery are vast and promising. This technology has the potential to revolutionize documentation, research, and medical education in the field. However, it is crucial to integrate this tool responsibly, considering its limitations and ensuring that human expertise remains paramount.

Complications of Silicone Fillers in Gluteal Augmentation: An Unusual Case of Filler Migration and Granuloma Formation.

Silicone liquid (polydimethylsiloxane) is an inert material commonly used for cosmetic purposes. A combination of both systematic and local devastating complications can cause end-organ toxicity and multi-organ dysfunction. In this article, we examine the literature and present a case of a patient who presented with lower extremity filler migration and granuloma formation 11 years post gluteal silicone injection. A 31-year-old woman who had received a gluteal silicone injection 11 years ago was experiencing painful erythema, progressive fibrosis, and swelling as the result of the injection. The patient was diagnosed with postfiller autoimmune syndrome. Multiple surgical interventions were conducted to remove the permanent filler from her left knee. As a result of multiple surgical sessions, the patient has been managed successfully with no relapses. This case demonstrated complications of an unusual silicone injection technique for gluteal augmentation. Despite silicone being considered inert, complications can arise years after injection, necessitating extensive medical intervention. This case also raises questions regarding the systemic effects of silicone fillers, warranting further research. Through this report, we aimed to enhance awareness and management of similar future cases.

Antiseptic Techniques in Breast Implant Surgery: Insights From Plastic Surgeons in Saudi Arabia.

Background: Breast implant surgery is a popular procedure worldwide, and the same holds true for Saudi Arabia. Ensuring a sterile surgical environment is crucial to avert postoperative infections. This study explores the various antiseptic techniques adopted by Saudi plastic surgeons during breast implant procedures. Objectives: This study aims to assess Saudi plastic surgeons' adherence to antiseptic measures in breast implant surgery, and determine what types of antiseptic measures are most commonly used among Saudi plastic surgeons. Methods: The authors conducted a cross-sectional survey among board-certified plastic surgeons in Saudi Arabia, collecting data through a self-administered online questionnaire. This questionnaire, which covered their demographic information and their antiseptic practices during breast implant surgery, was disseminated via a WhatsApp (Menlo Park, CA) broadcast message from May 15 to June 27, 2023. Results: Of the 52 Saudi plastic surgeons who completed the questionnaire, all reported employing preoperative antibiotics and skin disinfection. Other measures included pocket irrigation (86.5%), implant irrigation (92.3%), sleeve/funnel usage (65.4%), nipple shield usage (51.9%), and glove change during the procedure (96.2%). Nearly, all respondents used only a surgical cap for head cover (96.2%) and postoperative antibiotics as prophylaxis (98.1%). However, more than half of them did not minimize door movement during the procedure (51.9%). Conclusions: This study offers a valuable insight into the antiseptic practices during breast implant surgery in Saudi Arabia. The findings underline the need for further research to establish evidence-based guidelines for antiseptic practices in this field.

Use of Tranexamic Acid in Aesthetic Surgery: A Retrospective Comparative Study of Outcomes and Complications.

Background: Bleeding is a potential complication of aesthetic surgery. Surgeons have adhered to the principle of minimizing blood loss. Tranexamic acid (TXA) is an antifibrinolytic medication capable of reducing bleeding. This study aimed to investigate TXA and its effect on complications and overall outcomes in aesthetic surgery patients. Methods: This retrospective chart review of patients undergoing various aesthetic procedures between 2019 and 2022 was conducted in Riyadh, Saudi Arabia. Preoperative and postoperative hemoglobin levels, blood transfusions, and complications were the primary outcomes. Furthermore, the predictors of giving TXA were studied. Results: In total, 435 patients were included in the study. TXA was administered to 181 patients (41.6%). Significantly higher proportions of patients who received TXA underwent trunk aesthetic surgery (P < 0.001), and those who received TXA underwent combined procedures more frequently than non-users (P < 0.001). The mean operative time and length of hospital stay were significantly longer among patients who did not receive TXA (P < 0.001, and P < 0.001, respectively). Most predictors for using TXA were significantly associated with performing liposuction (OR = 5.5), trunk aesthetic surgery (OR = 4.9), and undergoing combined procedures (OR = 2.7). No significant difference was noted in the rate of complications between the two cohorts. Conclusions: Although our data show improvement in patient outcomes in multiple aspects, the heterogeneity of our cohort makes us unable to draw definite conclusions to recommend the use of TXA in aesthetic surgery. Thus, a randomized controlled trial is necessary to support the findings of this study.