The American Journal of Cosmetic Surgery

This study introduces protocols for using hybrid fillers (mixing calcium hydroxylapatite and hyaluronic acid) in facial, jaw, neck, and hand aesthetic treatments. The goal is to establish clear, standardized procedures to enhance effectiveness and safety.

The study outlines detailed protocols for using hybrid fillers in aesthetic treatments, covering patient selection, injection techniques, and posttreatment care for face, jaw, neck, and hands.

The detailed descriptions empower clinicians with insights to implement standardized approaches using hybrid fillers. They aim to optimize procedural accuracy and effectiveness while reducing the risk of complications.

The hybrid filler protocols standardize aesthetic treatments, aiding in optimal outcomes and guiding clinicians in enhancing their practice. In addition, these protocols serve as a valuable reference, offering comprehensive guidelines for future research in the realm of hybrid filler utilization in aesthetic medicine.

Despite the significant advances in the reduction mammaplasty fields, they all have drawbacks. A persistent lack of fullness in the upper pole was observed after 6 to 8 months in most of the instances given by the pioneers. The author’s goal was to enhance the cosmetic aspect of the breast and to achieve this goal; they searched for a superior approach that could provide upper pole fullness over the long term.

The project aimed to achieve all the other objectives of breast reduction while also enhancing the footprint elevation and fullness of the upper pole in free-style reduction mammaplasty surgeries. This study was carried out on 117 patients between February 2015 and July 2021.

In this study, the upper breast border produced an esthetically acceptable upper border in 114 (97.4%) cases for 2 to 7 years, whereas the outcomes were unsatisfactory for 4 patients (2.6%).

The second rib, the second intercostal space, the third rib, the third intercostal space, or more are the possible starting levels of the upper border of the breast footprint. By severing the superior breast ligament and attaching the medial and lateral pillars to the pectoral fascia at the level of the second rib, the upper border of the breast can be stably elevated.

IV therapeutic

Since its first description in 1976, periareolar mastopexy has attained a negative perception due to perceived high rates of unsatisfactory outcomes. The 2 main reported problems are (1) periareolar scar widening and (2) poor breast shaping. It is the author’s experience that with appropriate refinements in surgical technique based on sound anatomical and surgical underpinnings, good breast shaping and areolar aesthetics can be reliably achieved. This article describes innovations in the technique to improve outcomes, followed by a description of our own technique and refinements over the senior author’s 40-year journey.

A literature review of technical refinements in periareolar mastopexy surgical technique was undertaken. Suggested refinements from various authors were then placed in the context of the senior author’s own clinical experience and evolution of technique over 40 years. Representative case studies from the author’s personal series are then presented to illustrate technical pearls and results.

Four illustrative cases are discussed, along with a comprehensive description of the senior author’s technique and underlying principles.

Early techniques of periareolar mastopexy were plagued by poor breast shaping and areolar distortion. Progressive refinements in technique over the last 50 years have steadily improved surgical outcomes.

By combining various published refinements into a single operation, it is now possible to reliably achieve good aesthetic outcomes and avoid previous problems, as shown by the author’s own case series.

Breast surgery using the free nipple areolar graft (FNG) technique is a less frequently utilized technique; however, a very safe alternative to other available dermoglandular pedicles when nipple areola vascularity is of concern. One of the drawbacks with FNG technique is the loss of tactile sensation and the overall postoperative esthetic appearance of the nipple areola complex (NAC).

Our aim was to study patient satisfaction, specifically in regard to NAC sensation and esthetic appearance of the NAC in patients who underwent breast surgery utilizing the FNG technique.

This study is a case series of patients undergoing cosmetic breast procedures utilizing the FNG technique. Postoperative outcomes were evaluated both by the clinician and the patient by completing a survey questionnaire.

We conducted a 3 month postoperative patient satisfaction survey utilizing a questionnaire in 74 patients who underwent various cosmetic surgical procedures on the breast using the FNG technique. Patients were also objectively evaluated by a physician during the same visit. Patients rated their NAC sensation and esthetic appearance on a scale of 1 to 5 and 1 to 10, respectively, and the physician rated the NAC loss on a scale of 1 to 5. Results were reported as percentages of total patients in each group.

Our results indicated that over 85% of patients in our study had more than 50% tactile sensation to the NAC at 3 months. We also found that over 75% of patients were very satisfied with the esthetics of the NAC after these procedures.

We conclude that the risk of sensation loss to the NAC and patient satisfaction in regard to esthetic appearance of the NAC is better than what is believed to be and that the FNG technique may possibly be an underutilized tool in the surgeon’s toolbox.

Reduction of prominent/hypertrophic/ptotic vulvar labia minora and/or labia majora is an increasingly common surgical procedure in the hands of plastic and cosmetic surgeons and female genital cosmetic and reconstructive surgeons. While several techniques for these reductions are described in the literature and are individually modified by experienced practitioners, 2 procedures for the minora (linear and wedge-type reductions), and the vertically-aligned reduction of redundant majora are the most utilized techniques. It is not unusual for a woman to present to her potential surgeon requesting “work” on both minora and majora. Historically, this has necessitated two separate incision lines (minora and majora) bilaterally, often resulting in a long case, difficult recovery, and a significant potential for visible incision lines and gaping of the vaginal introitus.

To introduce a novel single-incision-line technique for combining labia minoraplasty and labia majoraplasty.

A modification of a classic central V-Wedge technique is affected by “shifting” the wedge incision line across the interlabial fold to encompass a portion of the medial labum majorum, both reducing redundancy and “lifting” the lowermost portion of the majora to correct ptosis. This is accomplished in one incision line with “en-bloc” closure of both minora and majora, placing the incision line mostly within the interlabial fold.

The author has completed eight wedge-type combined labia minora-majoraplasties without complication and with 2.5-36 months of follow-up.

This modification in Wedge design converts two separate procedures into one, making the surgery both less time-consuming, easier to recover from, and more visually esthetic for those patients who are capable of the more rigorous recovery protocol that wedge procedures mandate.

The “Angel-Wing combined labia minoraplasty + labia majoraplasty appears to be a relevant option for combined labia minor hypertrophy and labia majora deflation and redundancy.

It is widely accepted in plastic surgery that patient positioning can affect the geometry of the nasal tip due to downward gravitational forces. However, empirical data supporting this principle is lacking. The primary objective of this study is to quantify gravitational effects on nasal tip geometry by calculating changes in tip rotation and projection between the supine and upright positions. This analysis will help further assess whether gravity affects the actual positional rotation of the nasal tip or if its impact is solely relative to neighboring landmarks.

This study is a prospective case series that obtains upright and supine nasal measurements in 20 subjects. The nasolabial, nasofrontal, and columellar-facial angles, as well as the Goode, Crumley, Simon, and Powell ratios are used to calculate nasal tip rotation and projection changes.

Mean nasolabial angle demonstrated a statistically significant tip derotation of 3.2° in the upright position relative to supine. Mean nasofrontal angle and mean columellar-facial angle did not significantly differ between positions. The nasal tip appeared relatively less projected in the upright position using the Simon and Crumley methods, whereas no significant difference was seen with the Powell and Goode methods.

Gravity can influence the apparent nasal tip geometry by altering lip position and length, but it does not impact the true nasal tip geometry when the upper lip is excluded as a reference point.

This review is structured as a systematic analysis of the literature to evaluate the impacts of artificial intelligence (AI) on the field of plastic surgery, with a focus on breast augmentation and aesthetic surgical procedures. Key areas of exploration include advancements in machine-learning techniques relevant to plastic surgery, the integration of AI into preoperative planning processes, and the historical evolution of AI in aesthetic surgery. The review also systematically assesses current AI tools specifically developed for breast augmentation, such as 3D imaging and predictive analytics, to understand their efficacy and role in clinical practice.

This article explores the current state and future prospects of AI in plastic surgery, with a focus on breast augmentation and aesthetic procedures. Emphasis is placed on the benefits, challenges, and the imperative for collaborative efforts in the integration of AI technologies.

Advancements in machine-learning algorithms and AI technologies are examined for their potential in automating the assessment and enhancement of surgical skills. The role of AI in facilitating objective evaluations in aesthetic surgery is discussed, addressing challenges such as the lack of standardized training datasets and integration issues. The importance of mitigating potential biases introduced by AI to ensure objectivity in patient assessments is highlighted.

The article discusses the historical evolution of AI, from Alan Turing’s conceptualization to contemporary applications in aesthetic surgery. Artificial intelligence’s ability to analyze vast patient datasets is explored, showcasing its potential for offering personalized treatment recommendations and improving accuracy over time. Specific AI tools for breast augmentation, including Canfield Mirror, QuantifiCare LifeViz Infinity Pro, Crisalix, BreastGAN, Arbrea Breast Software (ABS), and Deep Surface AI, are examined in detail, emphasizing their advantages and drawbacks.

Evaluation of clinical photography techniques, relying on specific hardware, is presented, with consideration given to the potential of AI-based illumination systems to enhance consistency in preoperative images. The review concludes by envisioning the transformative future of AI in aesthetic surgery, considering its untapped potential in diagnostic imaging, personalized treatment plans, and enhanced surgical precision through integration with virtual and augmented reality. Despite challenges, the promises of AI in personalized treatments, precise patient care, and improved surgical assistance suggest a transformative future for plastic surgery, contingent on addressing current concerns. Collaborative efforts are deemed essential for the successful implementation of AI technologies in the field.