Application of a Proposed Multi-Positional Circumferential Arm Liposuction Method and Quantification of its Clinical Efficacy Evaluation

Abstract Background Upper arm liposuction mainly focuses on the posterolateral region, which may lead to a lack of harmony between the aspirated and unaspirated areas. In addition, the treatment effect of arm liposuction is often evaluated only by preoperative and postoperative photograph comparison and simple measurement; quantitative research on this topic is still lacking. Methods The multi-positional circumferential arm liposuction (MCAL) technique was proposed and applied to a total of 34 females in our hospital from 2017 to 2019. Three-dimensional data of 12 patients before the operation and after 2–3 months were collected and processed by 3D imaging, and the volume reduction rate was evaluated quantitatively. Results The MCAL method was successfully applied in the clinic, and its surgical effect was quantitatively studied. The mean follow-up time of 12 patients was (75.2 ±13.1) days, and the postoperative volume was significantly reduced. The postoperative volume of patients with type I, type II and type III decreased by (10.79 ±2.55)%, (17.25 ±3.02)% and (22.76 ±3.51)%, respectively. Conclusion Our new MCAL technique was successful, maximizing the esthetic results in upper limb contour refinements in the superficial fascial layer. The clinical efficacy of this proposed MCAL method was evaluated by CT and 3D digital technology, which provided further accuracy in demonstrating its effect on the shape of the arm. 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 https://www.springer.com.

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A Novel Method of Outcome Assessment in Breast Reconstruction Surgery: Comparison of Autologous and Alloplastic Techniques Using Three-Dimensional Surface Imaging

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-01749-4 ◽

2020 ◽

Vol 44 (6) ◽

pp. 1980-1987 ◽

Cited By ~ 4

Author(s):

Robin Hartmann ◽

Maximilian Weiherer ◽

Daniel Schiltz ◽

Stephan Seitz ◽

Luisa Lotter ◽

...

Keyword(s):

Breast Reconstruction ◽

Three Dimensional ◽

Surgical Techniques ◽

Full Description ◽

Surface Imaging ◽

Level Of Evidence ◽

Reconstruction Surgery ◽

Present Trial ◽

Based Medicine ◽

Dimensional Surface

Abstract Background Breast reconstruction is an important coping tool for patients undergoing a mastectomy. There are numerous surgical techniques in breast reconstruction surgery (BRS). Regardless of the technique used, creating a symmetric outcome is crucial for patients and plastic surgeons. Three-dimensional surface imaging enables surgeons and patients to assess the outcome’s symmetry in BRS. To discriminate between autologous and alloplastic techniques, we analyzed both techniques using objective optical computerized symmetry analysis. Software was developed that enables clinicians to assess optical breast symmetry using three-dimensional surface imaging. Methods Twenty-seven patients who had undergone autologous (n = 12) or alloplastic (n = 15) BRS received three-dimensional surface imaging. Anthropomorphic data were collected digitally using semiautomatic measurements and automatic measurements. Automatic measurements were taken using the newly developed software. To quantify symmetry, a Symmetry Index is proposed. Results Statistical analysis revealed that there is no difference in the outcome symmetry between the two groups (t test for independent samples; p = 0.48, two-tailed). Conclusion This study’s findings provide a foundation for qualitative symmetry assessment in BRS using automatized digital anthropometry. In the present trial, no difference in the outcomes’ optical symmetry was detected between autologous and alloplastic approaches. Level of evidence Level IV. 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.

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Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02479-x ◽

2021 ◽

Author(s):

Nabil Fakih-Gomez ◽

Jonathan Kadouch

Keyword(s):

Hyaluronic Acid ◽

Adverse Events ◽

Retrospective Chart Review ◽

Full Description ◽

Limited Data ◽

Level Of Evidence ◽

Hybrid Filler ◽

Calcium Hydroxylapatite ◽

Study Support ◽

Based Medicine

Abstract Background Limited data are available describing effectiveness of combining the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA). Methods The authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA (CaHA:CPM-HA ) in the authors’ aesthetic practices. The midface and lower face were injected. Patients’ records were evaluated, and treatment results were scored using the Merz Aesthetics Scale for the jawline® (clinician rated, CR-MASJ). Adverse events were recorded. Results A total of 41 patients were included, all females with a mean age of 47.5 years (range 21–63 years). The mean CR-MASJ score improved from 2.12 at baseline to 0.68 at t = 3 months (SD = 0.69, 95% CI 1.28–1.60) and 1.27 at t = 12 months (SD = 0.74, 95% CI 0.43–0.74). 100% of the subjects had experienced a ≥1-point improvement in CR-MASJ score at t = 3 months, versus 85% at t = 12 months. No adverse events were reported. Conclusion The results of this study support the volumizing and lifting potential of the hybrid mix CaHA:CPM-HA for treatment of cheeks and jawline. 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.

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Reproducibility of Novel Soft-Tissue Landmarks on Three-Dimensional Human Facial Scan Images in Caucasian and Asian

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02642-4 ◽

2021 ◽

Author(s):

Zhouxiao Li ◽

Riccardo Enzo Giunta ◽

Konstantin Frank ◽

Thilo Ludwig Schenck ◽

Konstantin Christoph Koban

Keyword(s):

Soft Tissue ◽

Three Dimensional ◽

Reference Points ◽

Full Description ◽

Surface Imaging ◽

Facial Soft Tissue ◽

Level Of Evidence ◽

Race And Gender ◽

Facial Region ◽

And Gender

Abstract Background Three-dimensional surface imaging is established in many disciplines for objective facial acquisition regarding anthropometry. Former studies addressed the validation of landmark-based measurements for single race. In order to distinguish racial difference, the reproducibility of the landmark measurements must first be validated. Objectives Our purpose is to validate the reproducibility of 46 facial soft-tissue landmarks on x, y, z axes to prove their reliability as 3D reference points. Methods The study included 80 European Caucasian and 80 Chinese volunteers. Standardized 3D surface imaging was performed using Vectra 3D system. Two raters identified and defined 46 landmarks (138 coordinates), then repeatedly 3D-imaged volunteers' facial region in separate sessions. Coordinates' reproducibility of landmarks is divided into three categories (< 0.5 mm, < 1 mm, and >1 mm) for intra- and inter-rater reproducibility assessments. Results Coordinates' reproducibility of 160 samples was distributed as follows: Intra-rater: < 0.5 mm (45%), < 1 mm (42%), >1 mm (13%); inter-rater: < 0.5 mm (31.2%), < 1 mm (42%), > 1 mm (26.8%). The reproducibility of landmarks in nasal tip region differs slightly between Caucasians and Asians. Compared to females, males typically have higher landmark reproducibility in lip and chin region. However, there were no differences in the reproducibility ranking of landmarks by gender. Conclusion The majority of the 46 landmarks in the 3D plane are reproducible to 1 mm, which is clinically acceptable. All selected landmarks showed strong consistency across race and gender, suggesting their potential use as reference points in prospective clinical 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.

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Predictors of Acceptance of Cosmetic Surgery: Instagram Images-Based Activities, Appearance Comparison and Body Dissatisfaction Among Women

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02546-3 ◽

2021 ◽

Cited By ~ 1

Author(s):

Cristian Di Gesto ◽

Amanda Nerini ◽

Giulia Rosa Policardo ◽

Camilla Matera

Keyword(s):

Body Dissatisfaction ◽

Cosmetic Surgery ◽

The Body ◽

Sociocultural Factors ◽

Full Description ◽

Level Of Evidence ◽

Appearance Comparison ◽

Italian Women ◽

Study Participants ◽

Based Medicine

Abstract Background This study aimed to test a model in which Instagram images-based activities related to self, friends, and celebrities were associated with acceptance of cosmetic surgery via Instagram appearance comparison and body dissatisfaction. We predicted that Instagram use for images-related activities involving celebrities and self (but not friends) was associated with acceptance of cosmetic surgery both directly and indirectly. Methods The study participants were 305 Italian women (mean age, 23 years). They completed a questionnaire containing the Instagram Image Activity Scale, the Instagram Appearance Comparison Scale, the Body Shape Questionnaire-14, the Acceptance of Cosmetic Surgery Scale. A path analysis was performed in which the Instagram images-based activities were posited as predictors of the Instagram appearance comparison, body dissatisfaction and acceptance of cosmetic surgery, respectively. Results We found that only image-based activities related to celebrities and self were significantly related to acceptance of cosmetic surgery, whereas friends’ Instagram-related activities were not significantly related to this criterion variable. Moreover, the indirect effect of both Instagram self- and celebrities-images activities on acceptance of cosmetic surgery through Instagram appearance comparison and body dissatisfaction was significant. Friends’ Instagram images-related activities were not associated with acceptance of cosmetic surgery. Conclusions Overall, these findings provide information about the role that activities carried out on Instagram, appearance comparison and body dissatisfaction, play on the acceptance of surgery for aesthetic reasons among women. The study highlighted the importance for surgeons to consider some psychological aspects and the influence of sociocultural factors on the interest for cosmetic surgery. 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.

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Injection of Aquafilling® for Breast Augmentation Causes Inflammatory Responses Independent of Visible Symptoms

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-01949-y ◽

2020 ◽

Author(s):

Michał Chalcarz ◽

Jakub Żurawski

Keyword(s):

Immune Response ◽

Inflammatory Responses ◽

Full Description ◽

Neoplastic Progression ◽

Immunohistochemical Examination ◽

Level Of Evidence ◽

Immunohistochemical Reaction ◽

History Of ◽

Tissue Antigens ◽

Based Medicine

Abstract Background A major concern related to modern surgery is to evaluate and address the complications associated with breast enlargement using Aquafilling® injection. This study aimed to assess the effect of Aquafilling® injection on immune response in such patients. Methods For four patients who consulted a surgeon after receiving Aquafilling® injection, medical history of the patients was taken; based on imaging examinations, Aquafilling® was removed. Samples were processed for histopathological and immunohistochemical examination. For detecting tissue antigens in histopathological samples, monoclonal antibodies against CD3 (lymphocytes T), CD 20 (lymphocytes B), and CD68 (macrophages) were used. By analyzing the images, the number of immune cells (lymphocytes T, lymphocytes B, and macrophages) and immunohistochemical reaction area were semiquantitatively evaluated. Results Different clinical features were observed in each patient after receiving Aquafilling® injection. In samples obtained from four patients, lymphocytes T (CD3), lymphocytes B (CD20), and macrophages (CD68) tissue expressions were observed. Statistically significant variations in the number of lymphocytes B (CD20) and macrophages (CD68), and differentiation of immunohistochemical reaction area for lymphocytes T (CD3) and lymphocytes B (CD20) were observed. Conclusions Inflammation is elevated in patients who received Aquafilling® injection. Medical imaging should be carried out in all such patients even if there are no visible symptoms. Removal of Aquafilling® can reduce the inflammation and risk of neoplastic progression in the patients. The influence of time elapsed since Aquafilling® injection and intensity of immune response requires further validation. 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.

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Reliability of Stereophotogrammetry for Area Measurement in the Periocular Region

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02091-5 ◽

2021 ◽

Author(s):

Jinhua Liu ◽

Alexander C. Rokohl ◽

Yongwei Guo ◽

Senmao Li ◽

Xiaoyi Hou ◽

...

Keyword(s):

High Reliability ◽

Intraclass Correlation ◽

Three Dimensional ◽

Correlation Coefficients ◽

Area Measurement ◽

Full Description ◽

Level Of Evidence ◽

Technical Errors ◽

Periocular Region ◽

Relative Errors

AbstractThree-dimensional (3D) stereophotography area measurements are essential for describing morphology in the periocular region. However, its reliability has not yet been sufficiently validated. The objective of this study was to evaluate the reliability of 3D stereophotogrammetric area measurements in the periocular region. Forty healthy volunteers had five flat paper objects placed at each of the seven periocular positions including the endocanthion and the upper medial, upper middle, upper lateral, lower medial, lower middle, and the lower lateral eyelid. Two series of photographic images were captured twice by the same investigator. Each image of the first series was measured twice by the same rater, while images of both series were measured once by a second rater. Differences between these measurements were calculated, and the intrarater, interrater, and intramethod reliability was evaluated for intraclass correlation coefficients (ICCs), mean absolute differences (MADs), technical errors of measurements (TEMs), relative errors of measurements (REMs), and relative TEM (rTEM). Our results showed that 21.2% of all ICCs were considered as excellent, 45.5% were good, 27.3% were moderate, and 6.1% were poor. The interrater ICC for the endocanthion location was 0.4% on a low level. MAD values for all objects were less than 0.3 mm2, all TEM were less than 1 mm2, the REM and rTEM were less than 2% for all objects, showing high reliability. 3D stereophotogrammetry is a highly reliable system for periocular area measurements and may be used in the clinical routine for planning oculoplastic surgeries and for evaluating changes in periocular morphology.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.

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Clinical Efficacy and Safety of Non-Cross-Linked Hyaluronic Acid Combined with L-carnosine for Horizontal Neck Wrinkles Treatment

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02307-2 ◽

2021 ◽

Author(s):

Shiwei Wang ◽

Huanyun Niu ◽

Yao Liu ◽

Yawen Tan ◽

He Gao ◽

...

Keyword(s):

Hyaluronic Acid ◽

Adverse Events ◽

Treatment Plan ◽

Treatment Options ◽

Critical Role ◽

Full Description ◽

Efficacy And Safety ◽

Level Of Evidence ◽

Filler Injection ◽

Based Medicine

AbstractBackground Horizontal neck wrinkle formation is gaining more attention among cosmetic practitioners and clients. To date, hyaluronic acid products are one of the most common treatment options for this aesthetic concern. However, different therapeutic strategies should be given to solve the problem due to multiple etiological reasons. Given that oxidative damage plays a critical role in neck wrinkle formation, anti-oxidative compounds are now considered by physicians when making a treatment plan. Aims To evaluate the efficacy and safety of a non-cross-linked hyaluronic acid filler in combination with L-carnosine in treating horizontal neck wrinkles. Methods Thirteen patients with a Wrinkle Assessment Scale (WAS) of 2–5 for horizontal neck wrinkles were treated with L-carnosine-containing non-cross-linked hyaluronic acid. Participants were followed-up for 3 months after treatment. The post-treated WAS scores evaluated by physicians were collected when patient satisfaction was surveyed. Any post-treatment adverse events were recorded. Results With a single injection of the above filler, the physician-evaluated WAS scores improved by at least one score at one month and the improvement kept consistent as far as three months after injection. According to the last follow-up visit, 11/13 patients were satisfied with the treatment effect of their neck wrinkle. Moreover, adverse events were rare after filler injection, except for local complications that were considered common reactions to the filler injection procedure. Conclusion The non-cross-linked hyaluronic acid filler containing L-carnosine is safe and effective for treating horizontal neck wrinkles.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.

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The Influence of Different Light Angles During Standardized Patient Photographic Assessment on the Aesthetic Perception of the Face

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02314-3 ◽

2021 ◽

Author(s):

Claudia A. Hernandez ◽

John Mario Espinal ◽

David Uribe Zapata ◽

Daniel Coimbra ◽

Michael Alfertshofer ◽

...

Keyword(s):

Facial Attractiveness ◽

Threshold Value ◽

Full Description ◽

Aesthetic Perception ◽

Level Of Evidence ◽

Clinical Images ◽

Facial Perception ◽

The Face ◽

The Aesthetic ◽

Based Medicine

Abstract Background 2D baseline and follow-up clinical images are potentially subject to inconsistency due to alteration of imaging parameters. However, no study to date has attempted to quantify the magnitude by which such images can be influenced. Objective The objective of the present study is to identify the magnitude by which images can be influenced by changing the imaging light angle. Methods This study is based on the evaluation of 2D frontal images of the face and included a total of 51 subjects of which n = 14 were males and n = 37 were females. Faces were photographed at 0°, 30°, and 60° light angle under identical and standardized conditions. Images were randomized and rated by 27 blinded raters for age, facial attractiveness, body mass index (BMI), temporal hollowing, lower cheek fullness, nasolabial sulcus severity, and jawline contour. Results Facial attractiveness decreased, facial unattractiveness increased and the evaluated BMI (based on facial assessment) increased statistically significantly at 60°. The assessment of regional facial scores, i.e., temporal hollowing, lower cheek fullness, and jawline contour, showed no statistically meaningful changes both at 30° and at 60° light angle. Conclusion The results indicate that there might be an observed blind range in light angle (0°–30°) which does not influence facial assessment. Increasing the light angle past the threshold value to 60° might result in a statistically significant impact on facial perception which should be accounted for when documenting and/or presenting facial 2D images. 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.

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Hyaluronic Acid Fillers Enriched with Glycine and Proline in Eyebrow Augmentation Procedure

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02412-2 ◽

2021 ◽

Author(s):

Antonio Scarano ◽

Biagio Rapone ◽

Domenico Amuso ◽

Francesco Inchingolo ◽

Felice Lorusso

Keyword(s):

Hyaluronic Acid ◽

Full Description ◽

Evidence Based ◽

Level Of Evidence ◽

Aesthetic Result ◽

Study Results ◽

High Level ◽

Based Medicine ◽

Augmentation Procedure

Abstract Background The eyebrow area is a clinically critical district due to the anatomical complexity and the propensity to aging-related atrophy. Hyaluronic acid fillers have been proposed to recover the dermal volume of the facial and lips regions. Aim The aim of the present investigation was to evaluate hyaluronic acid fillers enriched with glycine and proline for the treatment of eyebrow augmentation. Methods A total of 15 healthy patients were treated with eyebrow augmentation procedure. The distance between mid-bipupil to lateral eyebrow and mid-eyebrow to the medial eyebrow was measured before, immediately after treatment and at follow-up of 6 months. Results The healing period was uneventful, and no evidence of inflammation or swelling associated with the treatment was reported. No macroscopical alteration was reported in the surrounding tissues with no evidences of visible wheals or lumps in the treated sites at the follow-up. Before treatment, the angle was equal to 9.32 ± 0.2°, while after treatment it was 11.21 ± 0.4° (p < 0.01); after three and 6 weeks, it was, respectively, 10.66 ± 0.2° (p<0.05) and 10.02 ± 0.3°(p > 0.05). Conclusions The study results suggest that the hyaluronic acid fillers enriched with glycine and proline treatment resulted as being a useful procedure for augmentation, contour and volume definition and elevation of the eyebrow region with a high-level aesthetic result. 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.

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Standardized Three-Dimensional Lateral Distraction Test: Its Reliability to Assess Medial Canthal Tendon Laxity

Aesthetic Plastic Surgery ◽

10.1007/s00266-021-02440-y ◽

2021 ◽

Author(s):

Xiaoyi Hou ◽

Alexander C. Rokohl ◽

Marius M. Meinke ◽

Jinhua Liu ◽

Senmao Li ◽

...

Keyword(s):

High Reliability ◽

Intraclass Correlation ◽

Three Dimensional ◽

Absolute Difference ◽

Full Description ◽

Horizontal Line ◽

Neutral Position ◽

Technical Error ◽

Level Of Evidence ◽

Medial Canthal Tendon

Abstract Background Assessment of MCT laxity is critical to the surgery options. Our study aimed to analyze the reliability of measuring medial canthal tendon (MCT) laxity by using a novel standardized three-dimensional lateral distraction test (3D-LDT). Methods Forty-eight Caucasian volunteers (25 males and 23 females, 96 eyes) between 22 and 84 years of age (55.6 ± 18.6 years old) were included in our study. From a neutral position, the lower eyelid was gently pulled laterally along a horizontal line to define the most distracted position of the lower punctum. Both in the neutral and distracted position, standardized 3D images were acquired for each subject by two observers, and each image were measured twice by two raters. Four landmarks and six corresponding linear measurements were evaluated for intra-rater, inter-rater, and inter-method reliability. Results Intra-rater, inter-rater and inter-method reliability analyses of 3D-LDT revealed an intraclass correlation of more than 95%, a mean absolute difference of less than 1 mm, and a technical error of measurement of less than 1 mm. Measurements of relative error (2.59–12.04%) and relative technical error (1.83–16.05%) for the inter-landmarks distance from pupil center to the lower punctum were higher than those from limbus nasal center to the lower punctum (6.13–30.39 and 4.34–26.85%, respectively). Conclusions This study provided high reliability of the three-dimensional lateral distraction test (3D-LDT) for assessing medial canthal tendon (MCT) laxity, which were never evaluated by digital imaging system. 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.

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