The role of sexual partner in women's seeking for labiaplasty: a systematic review and meta-analysis.

BACKGROUND: The primary reasons for labiaplasty usually revolve around aesthetic, sexual, and functional concerns. Upon delving deeper into these issues, it becomes apparent that sexual partners play a controversial role in influencing women's decisions to undergo surgery. AIM: This study aimed to investigate the impact of sexual partners on women's choices to pursue labiaplasty. METHODS: A comprehensive search was conducted across electronic databases covering the period from January 2000 to February 2024. After removing duplicates, a total of 931 articles were retrieved by searching keywords in titles and abstracts. OUTCOMES: The meta-analysis revealed that 36.7% of women who sought labiaplasty cited their partners' negative comments as a factor influencing their decision. RESULTS: After applying the eligibility criteria and excluding irrelevant articles, a total of 12 articles involving 962 participants were included in the analysis. With the exception of 2 articles, the majority of the studies suggested a discernible influence of male partners on women's decisions to seek labiaplasty. Frequently, sexual partners are not the primary decision makers, nor do they exert significant pressure when it comes to seeking labiaplasty. In certain instances, women seeking labiaplasty acknowledged that their sexual partners did influence their decisions, either by making disparaging comments about their genitalia or by directly pressuring or requesting them to undergo labiaplasty. Additionally, women might opt for labiaplasty out of fear of their partner's negative remarks or to enhance sexual pleasure for their partners. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity. CLINICAL IMPLICATIONS: The findings of this study can be applied in prelabiaplasty counseling sessions to acknowledge and explore the role of the sexual partner in women's decision making. STRENGTHS AND LIMITATIONS: This study stands as the inaugural systematic review examining the impact of sexual partners on women seeking labiaplasty, encompassing all original studies exploring the role of the sexual partner. However, a notable limitation lies in the varied interpretations of the sexual partner's role, that the heterogeneous nature of these interpretations poses a challenge to providing a more precise answer through meta-analysis. CONCLUSION: Based on the findings of this systematic review, it is evident that sexual partners exert multifaceted influences on women's decisions to seek labiaplasty. While not serving as the primary decision makers, women opt for labiaplasty with the aim of enhancing attractiveness in sexual relationships and mitigating potential negative comments from their partners.

Validating the Revised Mating Effort Questionnaire.

The mating effort questionnaire (MEQ) is a multi-dimensional self-report instrument that captures factors reflecting individual effort in upgrading from a current partner, investment in a current partner, and mate seeking when not romantically paired. In the current studies, we sought to revise the MEQ so that it distinguishes among two facets of mate seeking-mate locating and mate attracting-to enable a more nuanced measurement and understanding of individual mating effort. Moreover, we developed additional items to better measure partner investment. In total, the number of items was increased from 12 to 26. In Study 1, exploratory factor analysis revealed that a four-factor solution, reflecting partner upgrading, mate locating, mate attracting, and partner investment, yielded the best fit. In Study 2, this structure was replicated using confirmatory factor analysis in an independent sample. Based on extant studies documenting the relationships between psychopathy, short-term mating effort, and sexual risk taking, a structural equation model (SEM) indicated that trait psychopathy positively predicted mate locating, mate attracting, and partner upgrading and negatively predicted partner investment. A separate SEM showed that partner upgrading positively predicted risky sexual behaviors, while partner upgrading and mate locating positively predicted acceptance of cosmetic surgery.

Labiaplasty Outcomes and Complications in Turkish Women: A Multicentric Study.

INTRODUCTION AND HYPOTHESIS: We aimed to evaluate the outcomes, complication rates, and complication types of different labiaplasty techniques. METHODS: In this cross-sectional retrospective study, a total of 2,594 patients who underwent surgery owing to hypertrophy or asymmetry of the labium minus were retrospectively analyzed. Data were collected by individual interviews with 43 experts from different centers. The patients were between 18 and 50 years of age. During the interview information about the presence and nature of complications, and about concomitant or revision surgeries, were gathered. The surgeons who performed these surgeries were also questioned about their training and surgical experience. RESULTS: The most frequently observed complication was complete dehiscence, accounting for 29% of all complications. Complete dehiscence was most commonly seen after wedge resection (16 cases). The second most common complication was labium majus hematoma, accounting for 12.5% of all cases. Among the labiaplasty techniques, wedge resection had the highest complication rate at 3% (26 cases out of 753 patients). This was followed by composite labiaplasty at 1.2% (5 cases out of 395 patients), Z-plasty at 0.8% (1 case out of 123 patients), and trimming labiaplasty at 0.5% (7 cases out of 1,323 patients). CONCLUSION: Considering the heterogeneity and low quality of the existing studies on this subject, this study provides valuable information for surgeons practicing in this field. However, further research is clearly warranted as female genital aesthetic procedures are being performed with a steadily increasing trend.

Pathological findings in enucleated eyes of patients with neurofibromatosis type 1: report of a case with 15-year follow-up and review of 14 patients in the literature.

BACKGROUNDS: Iris nodules are frequently noted as clinical manifestations of neurofibromatosis type 1 but the other intraocular manifestations are rare. The purpose of this study is to present a patient with a phthisic eye who underwent enucleation for a cosmetic reason after 15-year follow-up and also to review 14 patients with enucleation described in the literature. CASE PRESENTATION: A 17-year-old man with neurofibromatosis type 1 from infancy underwent the enucleation of phthisic left eye and also had the resection of eyelid subcutaneous mass lesions on the left side for a cosmetic reason. He had undergone four-time preceding surgeries for eyelid and orbital mass reduction on the left side in childhood and had developed total retinal detachment 10 years previously. Pathologically, the enucleated eye showed massive retinal gliosis positive for both S-100 and glial fibrillary acidic protein (GFAP) in the area with involvement of the detached retinal neuronal layer, together with a more fibrotic lesion along the choroid which were, in contrast, negative for both S-100 and GFAP. The choroid, ciliary body, and iris did not show apparent neurofibroma while episcleral neurofibroma was present. LITERATURE REVIEW: In review of enucleated eyes of 14 patients in the literature, buphthalmic eyes with early-onset glaucoma on the unilateral side was clinically diagnosed in 9 patients who frequently showed varying extent of hemifacial neurofibromatosis which involved the eyelid and orbit on the same side. Pathologically, neurofibromas in varying extent were found in the choroid of 12 patients. One patient showed choroidal malignant melanoma on the left side and fusiform enlargement of the optic nerve on the right side suspected of optic nerve glioma. The phthisic eye in another patient showed massive retinal gliosis similar to the present patient. CONCLUSIONS: In summary of the 15 patients with neurofibromatosis type 1, including the present patient, buphthalmic or phthisic eyes with no vision were enucleated for cosmetic reasons and showed choroidal neurofibroma in most patients and massive retinal gliosis in two patients including the present patient.

Female genital cosmetic surgery in Indonesia: a qualitative analysis of medical advertising on Instagram.

Research on female genital cosmetic surgery usually comes from Anglophone countries. We investigated female genital cosmetic surgery in the predominantly Muslim South-East Asian country of Indonesia, aiming to identify the procedures offered by medical clinics on Instagram, how they are justified, and what they claim to achieve; and to understand what this means for women and their bodies. The 184 eligible posts from 19 clinics between 1 January to 31 March 2021 offered vaginoplasty, labiaplasty, hymenoplasty, and other procedures. Reflexive thematic analysis yielded three themes: Why you should have female genital cosmetic surgery, Indications for female genital cosmetic surgery, and What you will gain from female genital cosmetic surgery. Posts were similar to those identified in other countries, revealing implicit vulvar aesthetics, expectations that women choose to 'improve' their genitals, the need to please men, and that female genital cosmetic surgery is straightforward. Two differences from Anglophone advertising were the use of euphemisms to describe the vulva and an emphasis on physical 'virginity'. Across countries, female genital cosmetic surgery advertising appears to arise from patriarchal constructs of women's bodies and determination to control them. We contend that Indonesia shares with other countries the need for education-of medical practitioners and the general public-about sexuality and the vulva, and that the advertising of female genital cosmetic surgery should be regulated and rigorously monitored.

The cost of cosmetic surgery tourism complications to the NHS: A retrospective analysis.

INTRODUCTION: Medical tourism refers to the process of patients travelling outside of their native country to undergo elective surgical procedures and is a rapidly expanding healthcare phenomenon [1-3]. Whilst a multitude of established Private Healthcare Providers (PHPs) offer cosmetic surgical procedures within the United Kingdom (UK), a growing number of patients are opting to travel outside of the UK to undergo cosmetic surgery. AIM: To assess the number of patients presenting to the Canniesburn Plastic Surgery Unit, with cosmetic surgery tourism complications, from outside of the UK, and the associated costs to NHS Scotland over a five-year period. METHODS: A retrospective case review of a prospectively maintained trauma database, which records all acute referrals, was undertaken analysing patients referred from January 1st 2019 to December 31st 2023 inclusive. RESULTS: 81 patients presented over five years with complications of cosmetic surgery tourism. The most common presenting complaints were wound dehiscence (49.4%) or wound infection (24.7%). The total cost to NHS Scotland was £755,559.68 with an average of £9327.90 per patient. CONCLUSION: This is the largest single centre cohort of cosmetic surgery tourism complications reported within the NHS to date; with rates on the rise, demand grows for increased patient information regarding healthcare tourism risks, a national consensus on the extent of NHS management and urgent international collaboration with policymakers is required to address this issue across borders.

Physical properties of Scarpa's fascia.

Preservation of Scarpa's fascia has improved clinical outcomes in abdominoplasty procedures and in other body contour surgeries. However, the physical properties of Scarpa's fascia have not yet been described, and grafts are still underexplored. Fresh surgical specimens from five female patients subjected to classical abdominoplasty were dissected and analyzed. A grid was drawn on the fascia surface, dividing it into equal upper and lower halves; four Scarpa's fascia samples (30 × 10 mm) were collected from each half, 40 mm apart. The thickness was measured with a caliper. A strain/stress universal testing machine was used for mechanical tests. Twenty-five samples were obtained (nine from the upper half, 16 from the lower). The average thickness was 0.56 ± 0.11 mm. The average values for stretch, stress, strain, and Young's Modulus were, respectively, 1.436, 4.198 MPa, 43.6%, and 23.14 MPa. The upper half showed significantly greater thickness and strain values (p = 0.020 and p = 0.048; Student's t-test). The physical and biomechanical properties of Scarpa's fascia can make it a donor area for fascial grafts as an alternative to fascia lata, as it is always available and has minimal donor-site morbidity. Further studies are needed to validate this statement. It seems advantageous to use the lower half of the abdomen instead of the upper part as a donor site.

Cosmetic Medical Tourists' Use of Online Support Communities: Sharing Information, Reciprocity, and Enduring Relationships.

Cosmetic procedures are amongst the most popular procedures sought after by medical tourists. Cosmetic medical tourists utilise numerous sources of information when planning their trips including, where available, discussing their decision with previous medical tourists. Current research on online support communities has investigated the interactions of patients with various health conditions with online support; however, limited research exists on cosmetic medical tourists' participation in online support communities. Here we report findings from our qualitative interview study of Australian cosmetic medical tourists. We found that many of our participants experienced stigma regarding their intention to receive cosmetic procedures and to travel overseas from within their local social networks. Participating in online communities (Facebook groups) enabled them to access information and support from other cosmetic medical tourists. Through using public posting and messaging functionality of the communities, they performed two distinct roles in the groups that parallel the temporal transitions of their journeys: they were information and support seekers pre-surgery and information and support providers post-surgery. The reciprocity they practiced in the provider role occurred due to their desire to 'pay forward' the support they had received from others pre-surgery. This role was performed as a collective, community-based reciprocity rather than a direct mutual exchange. Some participants also transitioned their online relationships into enduing offline friendships demonstrating how online interactions may become enmeshed with broader social networks.

A Decade of Lawsuits Against Surgeons Performing Female Genital Cosmetic Surgery (FGCS) in Tehran, Iran.

BACKGROUND: The objective of this study is to evaluate the legal proceedings that arise from Female Genital Cosmetic Surgeries (FGCS) and analyze the reasons why women file complaints against their surgeons. Additionally, we examined the outcomes of the legal decisions associated with these complaints. METHODS: This descriptive cross-sectional study was conducted in Tehran province, Iran, from 2012 to 2021. The primary data source for this study was forensic medical records, which were reviewed to gather relevant information. The collected data included the characteristics of the participants, the reasons for lawsuits, the procedure setting, and the outcomes of the legal decisions. RESULTS: A total of 121 patients were examined in the study, revealing that Labiaplasty was the most prevalent procedure (49.6%), followed by vaginoplasty (19.8%) and perineoplasty (13.2%). The most common complaints were related to cosmetic concerns (57%), lack of recovery (26.4%), and sexual dysfunctions (22.3%). Healthcare providers were found liable for malpractice in 52.1% of cases. Additionally, having the surgery performed by a gynecologist decreased the risk of malpractice (ß = 0.21, p= 0.034), while procedures in private clinics increased the risk (ß = 2.95, p = 0.040). CONCLUSION: The study's findings emphasized the importance of providing women with comprehensive education and consultations to ensure they are well-informed about the potential outcomes and risks of FGCS. Furthermore, the study highlighted the significance of having these surgical procedures performed by skilled and experienced surgeons. 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 .

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 .

Genital Cosmetic Surgery in Women of Different Generations: A Qualitative Study.

BACKGROUND: Individuals from different generations are interacting more and more today, and while each generation exists with its own characteristics, this situation causes intergenerational differences in every issue in social life. Considering the characteristics of different generations, it is predicted that individuals' views on genital cosmetic surgery may differ. OBJECTIVE: This study was conducted to examine the views of women of different generations on genital cosmetic surgery and to determine their perspectives on genital cosmetic surgery. METHODS: The population of the study consists of women from different generations. The sample of the study was formed using typical case sampling from purposive sampling methods. Data saturation was reached by conducting qualitative interviews with 15 women by selecting the snowball sampling method. Data were collected using a semi-structured individual interview form, and data analysis was performed using MAXQDA 2020. RESULTS: The opinions of women of different generations about genital cosmetic surgery were analysed under four themes and 13 categories as "Perception of Beauty", "Perception of Health", "Perception of Society" and "Perception of Need". The opinions of women of different generations about genital cosmetic surgery differ. It is thought that these differences may be caused by factors such as psychosocial, economic, environment, media, technological developments and culture. 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 .

Custom-Made Implant Fabrication for Chin Augmentation Using Piled-Up Expanded Polytetrafluoroethylene Sheets: An Innovative Surgical Technique and Literature Review.

BACKGROUND: Alloplastic chin augmentation is the most common esthetic surgical treatment to reshape the chin. However, factory-made chin implants are typically standardized rather than custom-made and have potential to cause complications. Although the fabrication of custom-made implants by using computer-assisted planning and 3D-printing technology has become widespread, the process has several disadvantages, including long preoperative prosthesis preparation times, high costs, and unsuitability for patients with asymmetric chins or those who undergo combined mandibuloplasty before implant placement. The present study developed an innovative chin augmentation technique involving stacked expanded polytetrafluoroethylene (e-PTFE) sheets that is suitable for most patients and has minimal side effects. MATERIALS AND METHODS: A retrospective review of a single surgeon's experience was performed over a 2 year period for patients who underwent a procedure involving piled-up e-PTFE sheets for alloplastic chin augmentation. This study analyzed the outcomes, complications (temporary nerve numbness, wound infection, hematoma formation, and implant displacement), and patient satisfaction during follow-up. RESULTS: Between January 2018 and December 2020, 38 patients underwent the procedure involving piled-up e-PTFE sheets for alloplastic chin augmentation. Six patients (15.8%) experienced nerve-related temporary numbness, and one (2.6%) experienced wound infection. None had developed major complications such as implant displacement or wound infection at follow-up. Moreover, the patients demonstrated a high level of satisfaction with the surgical results. CONCLUSION: Piled-up e-PTFE sheets can be used to produce custom-fit porous polyethylene chin implants that result in minimal complications and a very high satisfaction rate. 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 .

Combination Administration of Heparin and Nitroglycerin for the Treatment of Polycaprolactone-Induced Intravascular Embolism: A Preclinical Investigation.

BACKGROUND: As a new-generation collagen stimulator, polycaprolactone (PCL) containing filler has been extensively applied in facial dermal fillers and other medical aesthetic fields. However, inadvertent intravascular injection of PCL may result in complications such as tissue edema, flap necrosis, and even blindness. To date, there is no effective treatment for PCL-induced intravascular embolism. OBJECTIVES: The aim of this study was to identify a viable resolution for the embolism resulting from intravascular administration of PCL-containing fillers. METHODS: Two different animal experiments were performed: (1) PCL-induced rat inferior epigastric arteries embolism, followed by gross observation, histological evaluation, and cytokines analysis from serum; and (2) PCL-induced rabbit auricular artery embolism, immediately treated with heparin and nitroglycerin. The ears were then evaluated by gross observation, Laser speckle imaging, in vivo imaging system (IVIS) imaging, and histological evaluation. Saline and hyaluronic acids (HA) were used as controls, hyaluronidase was used as a positive drug. RESULTS: In a rat model of inferior epigastric arteries embolism, both intravascular injection of HA and PCL resulted in flap necrosis, indicating that the filler-induced intravascular embolism can lead to serious complications. In a rabbit model of auricular artery embolism, the combination treatment of heparin and nitroglycerin resulted in a relative blood reperfusion recovery of 80% in the ischemic area of the PCL group on day 7 post-operation, which was comparable to that of the HA group treated with hyaluronidase. Histological analysis revealed that the administration of heparin and nitroglycerin significantly attenuated intravascular thrombosis formation and inflammatory cell aggregation. CONCLUSIONS: The combination of heparin and nitroglycerin effectively restores blood flow reperfusion in the intravascular embolization caused by PCL filler injection, alleviates local tissue edema and flap necrosis. These findings offer a novel approach for future clinical management of intravascular embolization with PCL-containing filler injection. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Greater Risk Taking in Cosmetic Surgery Acceptance and History: An Experimental and Computational Study.

Cosmetic surgery is ever more affordable and accessible, but carries physical and psychological risks. Yet, no study to date has directly examined risk-taking behaviour under controlled conditions, beyond self-report and in relation to cosmetic surgery attitudes. We used the Balloon Analogue Risk Task and advanced computational modelling to measure decision-making behaviour and identify the latent parameters driving behaviour associated with cosmetic surgery attitudes in women with no cosmetic surgery history (N = 265) and a subsample of women with a cosmetic surgery history (N = 24). Risk taking was higher in women with greater acceptance and history of cosmetic surgery. Computational modelling revealed increased risk taking in women with greater acceptance of cosmetic surgery when decisions were made with greater knowledge of loss (risk) and not when the likelihood of loss was unknown (uncertainty). When women with greater acceptance of cosmetic surgery made decisions, they also placed less emphasis on possible losses (reduced loss aversion). Our findings suggest that women seeking cosmetic procedures may be less sensitive to losses and thus make more risky decisions. Greater emphasis should be placed on communicating potential losses rather than just the associated risks to women considering cosmetic procedures.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Ethics for AI in Plastic Surgery: Guidelines and Review.

INTRODUCTION: Artificial intelligence (AI) holds the potential to revolutionize medicine, offering vast improvements for plastic surgery. While human physicians are limited to one lifetime of experience, AI is poised to soon surpass human capabilities, as it draws on limitless information and continuous learning abilities. Nevertheless, as AI becomes increasingly prevalent in this domain, it gives rise to critical ethical considerations that must be addressed by professionals. MATERIALS AND METHODS: This work reviews the literature referring to the ethical challenges brought on by the ever-expanding use of AI in plastic surgery and offers guidelines for its application. RESULTS: Ethical challenges include the disclosure of use of AI by caregivers, validation of decision-making, data privacy, informed consent and autonomy, potential biases in AI systems, the opaque nature of AI models, questions of liability, and the need for regulations. CONCLUSIONS: There is a lack of consensus for the ethical use of AI in plastic surgery. Guidelines, such as those presented in this work, are needed within each discipline of medicine to respond to important ethical considerations for the safe use of AI. 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 .

Analysis of the Thigh Aesthetic Profiles: One of Physical Ideal Body Proportions.

BACKGROUND: The contour of the thigh is increasingly being recognized as crucial component of the ideal human physique, giving rise to heightened interest in attaining the perfect thigh profile. Notwithstanding, the contemporary landscape of cosmetic surgery appears to be bereft of efficient and precise objective methodologies to evaluate the outcomes of thigh contouring treatments. The present study is aimed to investigate the aesthetic appeal of varying thigh contours, employing specialized software as an indispensable instrument for quantitative and qualitative analysis. METHODS: Standardized photographs of the lower body were obtained from a sample of 200 healthy volunteers. A linear analysis was conducted, examining aspects such as the vertical length and transvers width of the thigh, as well as angular measurements including the posterior gluteal angle (PGA) and lateral angle thigh (LAT). Variables relating to thigh measurements and body mass index (BMI) were documented, with the relationships between them ascertained through Pearson's correlation and regression analysis. RESULTS: In males, the LAT was measured at 168 ± 3.9, and the PGA at 170 ± 3.4, while in females, these measurements were 166 ± 2.8 ve 166 ± 2.8, respectively. Linear analyses, including the vertical length of thigh (VLT), transverse width of thigh (TWT), lateral width (LW), and posterior width (PW), were conducted. Based on the LW inferior/LW superior ratio values, the most commonly observed thigh types were Type III (0.90) at 45% and Type II (0.85) at 24.75% while the least common was Type V at 4% (0.99). PW inferior/PW superior was 84.7%. The PWI/PWS ratio was highest for Type V, at 0.99, accounting for 84.70% of the total. Furthermore, an increase in the LWI/LWS ratio leads to an increase in the PWI/PWS ratio.  The frequency of the VLT/TW1 ratio 0.31-0.35 (Type 3) was found to be on the left side and Type 4 on the right side. A strong correlation was found between BMI and all thigh indexes, with a significant positive correlation between the index and factors tied to the buttocks and upper thigh. CONCLUSIONS: The concept of an ideal thigh may vary based on an individual's gender, race, country of residence, and self-esteem, aiming to achieve a more natural silhouette. Focusing on the different ratios of hip and thigh varieties in the study is quite intriguing. Further inquiry and rigorous exploration are warranted to delineate the optimal techniques and methodologies for attaining ideal thigh proportions. 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 .

Investigation of Appearance Anxiety Levels and Influencing Factors in Patients Undergoing Minimally Invasive Facial Cosmetic Procedures.

OBJECTIVE: This study aimed to investigate appearance anxiety and its influencing factors in patients undergoing minimally invasive facial cosmetic procedures. METHODS: A convenience sampling method was used to select 351 patients who attended the outpatient clinic of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January to August 2023. Patients completed self-administered and social appearance anxiety questionnaires before treatment. RESULTS: The mean appearance anxiety score was 2.49±0.85, indicating a moderate level of anxiety. Significant differences in appearance anxiety levels were observed based on age (p = 0.010), gender (p = 0.026), marital status (p = 0.032), number of children (p = 0.019), facial wrinkle removal procedures (p = 0.023), self-pleasure (p = 0.043), and special attention to the treatment area (p = 0.042). Multiple linear regression analysis identified facial wrinkle removal (p = 0.018), facial depression filling (p = 0.049), and special attention to the treatment area (p = 0.034) as significant factors. CONCLUSION: Younger populations are more likely to seek improved appearance for better opportunities. The uncertainty of treatment outcomes may also increase social appearance anxiety in patients. Patients can reduce this anxiety by increasing their self-efficacy and self-confidence. 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 .

Assessing the Effectiveness of a Short Form Screening Tool (COPs) for Body Dysmorphic Disorder in Cosmetic Surgery Patients: A Study of Pre- and Post-Operative Outcomes.

Recent regulatory changes in Australian cosmetic surgery necessitate preoperative screening for body dysmorphic disorder (BDD). This study, which focuses on patient outcomes, evaluates the COPs tool's efficacy and examines its implications on patients undergoing cosmetic procedures. A total of 189 patients were included: 78 underwent Medicare-classified "cosmetic" surgeries, and 111 underwent "medically necessary" procedures. Patients completed the COPs assessment pre- and post-operatively, with a score >40 indicating BDD susceptibility. Results show no significant pre- to post-operative change in COPs scores across different surgical procedures (body, breast, facial, and mixed) in both "cosmetic" (p = 0.2-0.4) and "itemised" groups (p = 0.15-0.33). However, overall, there was a marked reduction in COPs scores post-operatively (p < 0.001), indicating improved self-perception. Specifically, 91% of patients initially BDD-prone showed scores < 40 post-operatively. Conversely, 3.8% of initially low-scoring patients developed BDD-prone scores post-operatively. Comparison between cosmetic and itemised groups revealed higher preoperative COPs scores in the itemised group (p = 0.006), though post-operative scores did not differ significantly (p = 0.33). Incidences of post-operative BDD-prone scores or scores < 40 did not differ between groups (p = 0.61). Complication rates and the need for revision surgery were similar between groups. These findings suggest two plausible interpretations: First, preoperative screening with the COPs tool may positively influence self-perception related to BDD among cosmetic surgery patients, potentially serving as a therapeutic adjunct for those at risk. Second, while screening tools are beneficial, they may have limitations in predicting post-operative outcomes related to BDD development. Further research should explore these dynamics to refine screening practices and optimise patient outcomes in cosmetic surgery contexts. 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 .

Aqua Breast Augmentation (ABA): Hydrodissection Breast Augmentation Technique.

INTRODUCTION: Breast augmentation is a prevalent procedure in plastic surgery. In this article we present the Aqua Breast Technique (ABA), an approach aimed at enhancing patient satisfaction and reducing downtime. This technique leverages tumescent anesthesia and a small incision in the inframammary fold, avoiding electrocautery and surgical drains, to fulfill the growing demand for painless procedures with minimal recovery periods. MATERIALS AND METHODS: The study retrospectively analyzed 238 patients who underwent breast augmentation using the ABA technique at Instituto Rubi between 2021 and 2024. The ABA protocol involves detailed preoperative design, local anesthesia, a precise 3-centimeter incision, careful dissection, and specific postoperative care, emphasizing hydrodissection for tissue separation and the use of smooth round silicone implants through a Keller funnel. RESULTS: The application of the ABA technique to 238 patients, with a mean follow-up time 14 months. Ten patients required surgical intervention due to complications. Hematoma and infection rates were 0.42%, while capsulectomies were required in 2.1% of cases. CONCLUSIONS: Aqua Breast Augmentation technique has been successfully applied as a hydrodissection-based breast augmentation technique method, with low complication rates, short downtime, and reduced postoperative pain. Level V, therapeutic study. 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 .

Changing to Impress: Testing a Mediation Model from Instagram Self-presentation to Cosmetic Surgery.

BACKGROUND: This study examined the relationship between false self-presentation on Instagram and consideration of cosmetic surgery through the mediating role of body image control in photos (BICP), photo manipulation, and body shame. We predicted that false self-presentation on Instagram was indirectly associated with cosmetic surgery intentions through the aforementioned constructs. METHODS: A total of 504 young Italian adults (28.2% males, 18-30 years) completed an online survey. They completed a questionnaire containing the Self-presentation on Instagram Questionnaire, the Body Image Control in Photos Questionnaire-revised, the Photo Manipulation Scale, the Objectified Body Consciousness Scale, and the Acceptance of Cosmetic Surgery Scale. The pattern of associations between the constructs was analyzed via path analysis. RESULTS: The results show that false self-presentation on Instagram was associated with photo manipulation, both directly and indirectly, through BICP. Furthermore, photo manipulation was linked to body shame, but neither of them was associated with cosmetic surgery intentions. Finally, false self-presentation on Instagram was associated with the consideration of cosmetic surgery only through the mediation of BICP. CONCLUSION: Findings indicate that self-presentation styles might affect Instagram photo behaviors and individuals' cosmetic surgery intentions, suggesting that surgeons should fully examine patients' motivations before providing them with services. Furthermore, intervention programs encouraging users to present a more authentic version of themselves online might reduce the risk of self-objectification and reduce the consideration of procedures aimed at modifying one's body for purely aesthetic reasons. 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 .