A systematic review of generative adversarial networks (GANs) in plastic surgery.

INTRODUCTION: Generative adversarial networks (GANs) are a form of deep learning architecture based on the zero-sum game theory, which uses real data to generate realistic fake data. GANs use two opposing neural networks working: a generator and a discriminator. They represent a powerful tool for generating realistic synthetic patient data sets and can potentially revolutionize research. This systematic literature review evaluated the scale and scope of GANs within plastic surgery, constructing a framework for its use and evaluation within subspecialties. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review was performed for applications of GANs in plastic surgery from 2014 to 2022. Three independent reviewers screened from databases: PubMed, Embase, PsychInfo, Scopus, and Google Scholar. RESULTS: A total of 70 studies were captured by the search, of which seven studies met our criteria. The most common subspecialty was craniofacial (n = 4). Proposed uses of GANs included facial recognition, burn estimation, scar prediction, and post-breast cancer reconstruction anomaly scoring. GANs were conditional, trained on data sets averaging 54,652 ± 112,180 samples, with some sourced publicly and others being primary. CONCLUSION: GANs hold promise for advancing plastic surgery, backed by diverse applications in the literature. Studies should follow a standardized reporting structure for consistency and transparency, as outlined, especially regarding the data sets used to ensure appropriate representation from an ethnic and cultural diversity perspective. Although GANs require specialist computational expertise to create, surgeons need to understand their development by leveraging the full potential of GANs within the emerging field of computational plastic surgery and beyond.

Perceptions, awareness and influences of medical students towards plastic surgery: A systematic review.

Introduction: Plastic, reconstructive and aesthetic surgery (PRAS) is a significant yet often overlooked specialty in medical school curricula. The impact of social media and unregulated information sources can distort the perceptions of medical specialties, including PRAS, leading to a decline in student interest, inappropriate referrals and strain on healthcare services. This systematic review aimed to understand the perceptions of medical students towards PRAS, identify influencing factors and explore strategies to address these influences. Methods: The review followed the PRISMA 2020 guidelines. Four databases were searched, and the inclusion and exclusion criteria were applied. Data from 17 relevant studies were analysed in Microsoft Excel using descriptive statistics. The risk of bias was assessed using a modified Newcastle-Ottawa Scale. Results: Medical students generally held positive perceptions about PRAS, particularly regarding career opportunities, specialised skills and the nature of the specialty. However, their awareness of the full scope of plastic surgery is limited, with a focus on cosmetic and aesthetic procedures. Social media and the internet significantly influenced the students' perceptions, whereas personal experiences had a minor impact. Education and training in plastic surgery positively affected the students' perceptions. Nevertheless, there is a need for improved representation of PRAS in medical school curricula and promotion of accurate information through reliable sources. Conclusion: Students exhibited a favourable attitude towards plastic surgery, but their knowledge of the specialty can be enhanced. Strengthening PRAS teaching in medical schools and ensuring accurate information dissemination can foster a deeper understanding and interest in this field. Large-scale studies with standardised protocols should be conducted in different countries to gain comprehensive insights tailored to specific educational contexts.

TikTok in Plastic Surgery: A Systematic Review of Its Uses.

TikTok (San Jose, CA) is a popular and rapidly growing social media platform. With beauty and skincare among the top 5 most popular categories, TikTok represents an important platform for plastic surgery education and communication. However, given the vast array of content shared daily, regulating content for veracity is challenging. It may also be an important and potentially overlooked avenue for the dissemination of inaccurate information pertaining to plastic surgery. This systematic review evaluates TikTok's impact on plastic surgery. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines, a systematic literature review was performed of the use of TikTok within the plastic surgery field. The following databases were queried: PubMed (National Institutes of Health; Bethesda, MD), EMBASE (Elsevier; Amsterdam, the Netherlands), and PsychInfo (American Psychological Association; Washington, DC). The search captured 31 studies of which 7 were included in the final analysis. The studies examined the following areas: gender-affirming surgery (n = 1), breast reconstruction (n = 1), aesthetic surgical procedures (n = 1), plastic surgeon profiles (n = 1), and profiles of videos relating to plastic surgery hashtags (n = 3). The videos' quality was assessed using the DISCERN scale. Physician videos scored notably higher than nonphysician videos. The mean DISCERN score across all the videos (n = 386) was 1.91 (range: 1.44-3.00), indicating poor quality. TikTok is a popular medium for sharing plastic surgery content. The existing literature has demonstrated overall poor-quality information on plastic surgery, and further study is needed to evaluate its impact in terms of perceptions of the specialty and healthcare behaviors. Future work should focus on promoting accurate, high-quality videos, potentially including a peer-review function for healthcare content. This can leverage TikTok's potential for disseminating content while upholding patient safety.

Quantitative and qualitative analysis of individual experiences post botulinum toxin injection - United Kingdom Survey.

Introduction: In the United Kingdom (UK), complications that arise following the administration of Botulinum Toxin are reported to the Medicines and Health Regulatory Agency (MHRA) via the Yellow Card Reporting Scheme. Over the past decade, there has been a significant increase in the number of non-surgical aesthetic procedures. Concerns have been raised that the MHRA is not fully capturing complications in terms of volume and impact on patients. Aim: This novel study explores the lived experiences of individuals who have experienced an adverse event following administration of Botulinum Toxin for aesthetic purposes. Using a combination of qualitative and quantitative methodologies, this analysis evaluates data relating to long-lasting physical, psychological, emotional, and financial sequelae of complications arising from cosmetic Botulinum Toxin injections in the UK. Methods: A mixed method, qualitative and quantitative approach was adopted to gain comprehensive insights into patients' experiences. A focus group which comprised patient representatives, psychologists, and researchers reached a consensus on a 17-question survey which was disseminated via social media channels. Deductive thematic analysis was used to analyse coded themes. Furthermore, for secondary analysis, sentiment analysis was used computationally as an innovative approach to identify and categorise free text responses associated with sentiments using natural language processing (NLP). Results: In the study, 655 responses were received, with 287 (44%) of respondents completing all questions. The mean age of respondents was 42.6 years old. 94.1% of respondents identified as female. In the sample, 79% of respondents reported an adverse event following their procedure, with the most common event being reported as 'anxiety'. Findings revealed that 69% of respondents reported long-lasting adverse effects. From the responses, 68.4% reported not having recovered physically, 63.5% of respondents stated that they had not recovered emotionally from complications, and 61.7% said that they have not recovered psychologically. In addition, 84% of respondents stated that they do not know who regulates the aesthetics industry. Furthermore, 92% of participants reported that their clinic or practitioner did not inform them about the Yellow Card Reporting Scheme. The sentiment analysis using the AFINN Lexicon yielded adjusted scores ranging from -3 to +2, with a mean value of -1.58. Conclusion: This is the largest survey in the UK completed by patients who experienced an adverse outcome following the aesthetic administration of Botulinum Toxin. Our study highlights the extent of the challenges faced by patients who experience an adverse event from physical, emotional, psychological, and financial perspectives. The lack of awareness of MHRA reporting structures and the lack of regulation within the UK's cosmetic injectables sector represent a significant public health challenge.

Emergency burn education: Evaluating a surgical simulation-based intervention.

INTRODUCTION: Medical simulation has provided favorable outcomes in the improvement of clinical competence at both the undergraduate and postgraduate levels. The recall of information demonstrably increases when it has been taught in environments similar to the workplace. This study aimed to evaluate the role of a one-day burn simulation session in improving students' knowledge of burn management and interest in plastic surgery as a specialty. METHOD: A one-day course was designed to deliver multiple lectures covering surgical topics such as the classification and management of burns, followed by a series of practical workshops. Participants were instructed to undergo a pre-course knowledge assessment and a survey focusing on interest in plastic surgery. Students were subsequently instructed to complete a post-course assessment and a survey of knowledge and confidence in managing burns as well as interest in plastic surgery both immediately and 6 weeks post-course. RESULTS: The students' knowledge demonstrated a 54.2% increase in the post-course assessment (p < 0.01). 27% of participants (n = 14) participated in a 6-week post-course quiz. The knowledge assessment of these participants at 6 weeks post-course also demonstrated a sustained increase of 61.0% (p < 0.01). Interest in plastic surgery was increased by 31.4% post-course (p < 0.01). At 6 weeks post-course, a sustained increase of 14.7% was demonstrated in comparison to pre-course data (p = 0.03). CONCLUSION: Simulation teaching provides good outcomes in both information retention and interest in plastic surgery as a specialty. Therefore, medical school curriculums may benefit from including burn simulations.

Cosmetic business mechanics in London: A cross-sectional analysis and audit of ASA compliance.

INTRODUCTION: The proliferation of providers and practitioners of cosmetic botulinum toxin and dermal filler has profound public health implications. The Advertising Standards Authority (ASA) regulates the use of advertising materials in the United Kingdom and prohibits the promotion of prescription-only medicines. AIMS: We aim to perform a cross-sectional analysis of the practitioners in London, UK to evaluate the distribution of clinics within Greater London, prices advertised for interventions, and compliance with the ASA code. We also aim to identify whether there are any differences in cost of botulinum toxin or dermal filler between the boroughs. METHODS: Between December 2021 and January 2022, we performed a systematic search using the internet search engine Google. Five searches were performed (1) [london] botox, (2) [london] botulinum toxin, (3) [london] anti wrinkle injection, (4) [london] filler, (5) [london] dermal filler. One hundred websites per search string were systematically reviewed and those which met the inclusion/exclusion criteria of each search string were included and analyzed. Each clinic's product/service range compliance with the ASA/CAP code was assessed. Any reference to Botulinum Toxin or anti-wrinkle injections was noted and analyzed. Further analysis would look to calculate price per milliliter (mL) of botulinum toxin and dermal filler per borough and to calculate whether there were any statistical differences between the 32 different London boroughs. RESULTS: A total of 500 websites were visited and evaluated. After removal of duplicates, a total of 233 independent clinics was identified. A total of 206 out of the 233 clinics sampled (88%) were in direct infringement of the enforcement notice through advertising a prescription medicine. The overall average cost per mL of dermal filler was £330.89 and there was a statistically significant variance across London boroughs (p < 0.05). The overall average cost per mL of Botulinum Toxin was £284.45 and the variance across London boroughs was close to significant (p = 0.058). CONCLUSION: This paper demonstrates poor compliance with the ASA/CAP guidelines and further provides an insight into the industry mechanics associated with aesthetic injectables in a major UK city, identifying regional variance in price and clinic density. The advertising of prescription-only medication may pose a potential risk to patients and will be an important consideration in proposed legislation to introduce licensing to the industry.

Assessment of an Articulating Laparoscopic Needle Holder (FlexDex™) Compared to a Conventional Rigid Needle Holder in 2-Dimension Vision Amongst Novices: A Randomised Controlled Study.

AIM: This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation. METHODS: In this prospective randomised trial, novices (n = 40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves. RESULTS: The intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 s versus 267 s taken for the first three attempts and 283 s versus 187 s taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.3 versus 6.2 errors per individual). CONCLUSION: When compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors. KEY STATEMENT: Traditional rigid needle holder leads to faster task completion times and lower error rates when compared with an articulating laparoscopic needle holder in 2D vision.

Evaluation of Advanced Bimanual Skills in Novices Using the Wrist-Like FlexDex™ Articulating Laparoscopic Needle Holder in 2D and 3D Vision: A Randomised Trial.

AIM: The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDexTM laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems. METHODS: In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDexTM and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves. RESULTS: The intervention group that used FlexDexTM and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDexTM with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). CONCLUSION: Combination of 3D visual systems and the FlexDexTM laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance. KEY STATEMENT: 3D visual systems lead to faster task completion times when combined with an articulating laparoscopic needle holder compared to 2D vision. This effect however is not seen in error rates.