Robotic and Plastic Surgery: actuality and prospects for the near future, a scoping review.

OBJECTIVE: This work aims to review the existing use of robotics in plastic surgery. METHODS: A meticulous selection process identified 22 articles relevant to this scoping review. RESULTS: The literature on the use of robotics in plastic surgery is sparse. Nonetheless, this review highlights emerging benefits in microsurgery, breast reconstruction, and transoral surgery. CONCLUSION: This scoping review identifies critical articles reporting the emerging use of robotics in plastic surgery. While the scientific medical community has yet to extensively document its use, the available evidence suggests a promising future for robotics in this field.

Analysis of modified ilib therapy in patients submitted to plastic surgery.

The sample comprised 44 volunteers who had undergone some surgical procedure and were equally divided into four groups. G1 started the therapy 24 h after the surgical procedure with the device off. G2 followed the same time pattern, 24 h, but with the device turned on. G3 and G4 started therapy three days after the surgical procedure; in G3, the device was turned off, and in G4, the device remained on during therapy; each session lasted 30 min, using 660 nm (red), energy 180 J. For all groups, the therapy started with daily use for seven days and followed the interval use of three times a week until completed 21 days. The revaluation was performed after 7 and 21 days. The results found show changes in HR at rest, systolic and diastolic BP, and in peripheral oxygen saturation, which showed a significant difference in the groups that used on-therapy (p < 0.05). In the MCGILL Scale evaluation, the mean total score showed a more accentuated drop in the groups that used ILIB, (p < 0.05). ILIB may have prevented a more significant evolution of firosis levels; however, no changes were observed in the evaluation of sleep and anxiety. The application of the ILIB in patients undergoing plastic surgery was supported in terms of hemodynamics and pain; in addition, starting the ILIB application 24 h after the procedure proved to be more advantageous.

Ninfoplastia o Labioplastia: Técnica quirúrgica y tratamiento de sus complicaciones / Nymphoplasty or Labioplasty: Surgical Technique and Treatment of its Complications

Se describe la técnica quirúrgica denominada ninfoplastia o labioplastia. Es la reducción del tamaño de los labios menores de la vulva hipertróficos, requerida además por razones estéticas. Se realiza una reseña de sus técnicas quirúrgicas y el detalle que nosotros realizamos en la resección, con el fin de respetar la zona clitoriana. Se señalan además las complicaciones presentadas y cómo resolverlas

The surgical technique called nymphoplasty or labiaplasty is described. It is the reduction in the size of the hypertrophic labia minora of the vulva, furthermore, required for aesthetic reasons. A review is made of their surgical techniques and the detail that we carry out in the resection, in order to respect the clitoral area. The complications presented and how to resolve them are also pointed out

Facial Gender-Affirming Surgery: Pitfalls, Complications, and How to Avoid Them.

Facial feminization is a complex undertaking requiring skill in both craniofacial and aesthetic plastic surgery. As in aesthetic procedures, understanding the patient's goals and setting realistic expectations in light of an individual's anatomy is critical. Both soft tissue and bone must be addressed to adequately soften masculine facial features. This article delves into specific anatomic areas and delineates some of the pathways to successful outcomes.

Colgajo nautilus y colgajo en muleta taurina para defectos quirúrgicos faciales periorificiales / Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face

Antecedentes La reconstrucción de defectos quirúrgicos en regiones anatómicas próximas a bordes palpebrales, fosas nasales o boca es un reto debido su tendencia a ser deformadas por la tensión del cierre directo o los colgajos cutáneos. El empleo de nuevas técnicas reconstructivas que eviten la retracción de estas zonas sensibles puede suponer un avance importante. Pacientes y métodos Se emplean 2 nuevos diseños, el colgajo nautilus y el colgajo en muleta taurina, para la reconstrucción de defectos quirúrgicos periorificiales, realizando una recolección retrospectiva de los mismos en las zonas periparpebral, perivestibular nasal y peribucal. El colgajo nautilus se empleó en 4 pacientes con defectos periparpebrales y 2 peribucales. El colgajo en muleta taurina se utilizó para la reconstrucción de 14 defectos en ala nasal. Resultados En los 20 pacientes se obtuvieron resultados muy satisfactorios tanto a nivel estético como funcional, sin la aparición de ectropión, colapso del vestíbulo nasal o asimetría de borde labial. No se observó necrosis en ningún caso. Conclusiones Proponemos el colgajo nautilus y el colgajo en muleta taurina como una excelente opción reconstructiva para defectos quirúrgicos localizados en zonas periorificiales (AU)

Background Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. Patients and methods Retrospective study of the use of 2 novel flap designs—the nautilus flap and the bullfighter crutch flap—to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects.Results Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. Conclusions The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas (AU)

[Translated article] Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face / Colgajo nautilus y colgajo en muleta taurina para defectos quirúrgicos faciales periorificiales

Background Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. Patients and methods Retrospective study of the use of 2 novel flap designs—the nautilus flap and the bullfighter crutch flap—to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects.Results Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. Conclusions The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas (AU)

Antecedentes La reconstrucción de defectos quirúrgicos en regiones anatómicas próximas a bordes palpebrales, fosas nasales o boca es un reto debido su tendencia a ser deformadas por la tensión del cierre directo o los colgajos cutáneos. El empleo de nuevas técnicas reconstructivas que eviten la retracción de estas zonas sensibles puede suponer un avance importante. Pacientes y métodos Se emplean 2 nuevos diseños, el colgajo nautilus y el colgajo en muleta taurina, para la reconstrucción de defectos quirúrgicos periorificiales, realizando una recolección retrospectiva de los mismos en las zonas periparpebral, perivestibular nasal y peribucal. El colgajo nautilus se empleó en 4 pacientes con defectos periparpebrales y 2 peribucales. El colgajo en muleta taurina se utilizó para la reconstrucción de 14 defectos en ala nasal. Resultados En los 20 pacientes se obtuvieron resultados muy satisfactorios tanto a nivel estético como funcional, sin la aparición de ectropión, colapso del vestíbulo nasal o asimetría de borde labial. No se observó necrosis en ningún caso. Conclusiones Proponemos el colgajo nautilus y el colgajo en muleta taurina como una excelente opción reconstructiva para defectos quirúrgicos localizados en zonas periorificiales (AU)

The Promise and Pitfalls of AI-Generated Anatomical Images: Evaluating Midjourney for Aesthetic Surgery Applications.

BACKGROUNDS: The rapid advancement of generative artificial intelligence (AI) systems, such as Midjourney, has paved the way for their use in medical training, producing computer-generated images. However, despite clear disclosures stating that these images are not intended for medical consultations, their accuracy and realism are yet to be thoroughly examined. METHODS: A series of requests were addressed to the Midjourney AI tool, a renowned generative artificial intelligence application, with a focus on depicting appropriate systemic anatomy and representing aesthetic surgery operations. Subsequently, a blinded panel of four experts, with years of experience in anatomy and aesthetic surgery, assessed the images based on three parameters: accuracy, anatomical correctness, and visual impact. Each parameter was scored on a scale of 1-5. RESULTS: All of images produced by Midjourney exhibited significant inaccuracies and lacked correct anatomical representation. While they displayed high visual impact, their unsuitability for medical training and scientific publications became evident. CONCLUSIONS: The implications of these findings are multifaceted. Primarily, the images' inaccuracies render them ineffective for training, leading to potential misconceptions. Additionally, their lack of anatomical correctness limits their applicability in scientific articles. Although the study focuses on a single AI tool, it underscores the need for collaboration between AI developers and medical professionals. The potential integration of accurate medical databases could refine the precision of such AI tools in the future. 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 .

The Results of Our Reader Survey Are In!

To become more acquainted with Plastic and Aesthetic Nursing (PAN) readers and help identify the strengths and weaknesses of the PAN journal, I worked collaboratively with representatives from Wolters Kluwer Health to conduct an online survey of plastic and aesthetic registered nurses who are members of the International Society of Plastic and Aesthetic Nurses. This article describes the methods and results of this reader survey.

Self-awareness and Social Influences as Predictors of Body Dissatisfaction and Acceptance of Cosmetic Surgery for Social Reasons Among Men.

BACKGROUND: Body dissatisfaction and the use of surgery for purely aesthetic reasons among men is steadily increasing. Nevertheless, compared to women, few studies have focused on specific sociocultural and individual factors predicting men's body dissatisfaction and interest in cosmetic surgery procedures. The present study investigated the role of media, significant others, public and private self-awareness in predicting men's body dissatisfaction and acceptance of cosmetic surgery for social reasons. METHODS: Participants were 203 men (mean-age 24 years), who completed a questionnaire containing the Sociocultural Attitudes Toward Appearance Questionnaire-4R, the Situational Self-Awareness Scale, the Muscular internalization subscale, the Male Body Attitudes Scale, and the Social subscale of the Acceptance of Cosmetic Surgery Scale. A path analysis was performed. RESULTS: The influence of significant others and public self-awareness predicted men's body dissatisfaction directly and indirectly, via muscularity internalization, while media was only directly associated with body dissatisfaction. A significant link between private self-awareness and body dissatisfaction was found. Moreover, media was not associated with cosmetic surgery either directly or indirectly and public self-awareness showed only a significant association with internalization. CONCLUSIONS: These findings provide information about the role that self-awareness and sociocultural factor play on body dissatisfaction and acceptance of surgery for social reasons among men. The study highlighted the importance of designing preventive programs aimed at enhancing men's ability to resist various forms of pressure regarding body image and its management. Moreover, the advantages of focusing one's attention on internal states and feelings can limit body dissatisfaction and can discourage consideration of cosmetic surgery for social benefits. 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 .

Clinical Practice Patterns in Abdominoplasty: 16-Year Analysis of Continuous Certification Data from the American Board of Plastic Surgery.

BACKGROUND: The authors evaluated trends in practice patterns for abdominoplasty based on a 16-year review of tracer data collected by the American Board of Plastic Surgery as part of the continuous certification process. METHODS: To facilitate comparison of an equal number of patients over time, tracer data from 2005 to 2021 were split into an early cohort (EC) (from 2005 to 2014) and a recent cohort (RC) (from 2015 to 2021). Fisher exact tests and two-sample t tests were used to compare patient demographics, surgical techniques, and complication rates. RESULTS: Data from 8990 abdominoplasties (EC, n = 4740; RC, n = 4250) were analyzed. RC abdominoplasties report a lower rate of complications (RC, 19%; EC, 22%; P < 0.001) and a lower rate of revision surgery (RC 8%; EC, 10%; P < 0.001). This has occurred despite the increased use of abdominal flap liposuction (RC, 25%; EC, 18%; P < 0.001). There has been a decline in the use of wide undermining (81% versus 75%; P < 0.001), vertical plication of the abdomen (89% versus 86%; P < 0.001), and surgical drains (93% versus 89%; P < 0.001). Abdominoplasty surgery is increasingly performed in an outpatient setting, with increased use of chemoprophylaxis for thrombosis prevention. CONCLUSIONS: Analysis of these American Board of Plastic Surgery tracer data highlights important trends in clinical practice over the past 16 years. Abdominoplasty continues to be a safe and effective procedure with similar complication and revision rates over the 16-year period.

Open Otoplasty Through Ventral Skin Incision and Abrasion of the Antihelix Under Vision.

BACKGROUND: Common otoplasties through incisions behind the ear with blind scoring or scratching the anterior perichondrium often leave an irregular surface of the antihelix. METHOD: To avoid these tiny side effects, a skin incision along the ventral antihelical fold (scapha) is used to thin and fold the flat antihelix under vision. After local anesthesia of the ventral ear skin, an incision along the scapha allows its blunt lifting toward the concha and to expose the cartilaginous antihelix. Its future shape is marked and the thickness of the cartilage is thinned with a dermabrader by approximately half or until one sees the gray of the inner cartilage. The now missing perichondrium causes the antihelix to fold by itself with an absolute smooth surface and is fixed with three absorbable mattress sutures. RESULTS: The technique has been developed in 1985 in Frankfurt and has since been performed on over 1000 patients with optimal results and a low complication rate. The skin flap is so well perfused that no skin necrosis and only 5.7% wound healing problems were experienced. CONCLUSION: This approach from ventral is safe, timesaving, and avoids contour irregularities of the antihelix often seen after traditional techniques. It can be left to beginners in plastic surgery without hesitation. The fear of hypertrophic scars or even keloids can be dispelled with the fact that ear keloids only occur after wound infection. 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.

Rhinofiller: Fat Grafting (Surgical) Versus Hyaluronic Acid (Non-surgical).

We conducted a thorough examination of the paper titled " Rhinofiller: Fat Grafting (Surgical) Versus Hyaluronic Acid (Non-surgical)" authored by Gentile et al. in Aesthetic Plastic Surgery with significant interest. The author shared their practical insights gained from employing "fat grafting" and "hyaluronic acid" methods for nasal remodeling in a randomized controlled trial. The research is notably captivating and executed with commendable proficiency. However, we do hold specific reservations concerning the methodologies employed. Precise understanding of the properties of the active substances utilized is fundamental for any medical intervention, and standardization stands as a pivotal element. It is essential to grasp the core characteristics of the administered HAs to potentially uncover links between these attributes, resulting outcomes, and possible complications. In the context of tissue volumization using fillers, rheology-an investigation into material flow and deformation under stress-holds particular importance. Gaining a comprehensive understanding of HA's rheological properties is imperative, especially when selecting an appropriate dermal filler for nasal applications. Among the critical properties of HA are viscosity, elasticity, and cohesiveness. While acknowledging the valuable contributions made by the authors, it is imperative that further analysis takes into account these influential factors during the course of their investigation. 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 .

Forehead Flap Practices: A Cross-Sectional Survey of Facial Plastic and Reconstructive Surgeons.

Background: The paramedian forehead flap (PMFF) is a well-established technique utilized for reconstruction of complex nasal defects. Objective: To identify the different techniques and management of patients undergoing PMFF reconstruction and compare these with current literature. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery were sent a practice survey highlighting various nuances in PMFF reconstruction. The survey included questions about flap design, operative techniques, and perioperative care. Results: In total, 172 responses were received (14% response rate). Mean years of practice after fellowship was 15.8 years with most respondents performing either 1-5 (33.1%) or 6-10 (27.3%) PMFFs per year. Common practices included the use of general anesthesia, elevation of PMFF in the subgaleal plane (59.6%), and pedicle division at 3 weeks (80%) (p < 0.001). Complication rates ranged between 1% and 5%. The nose was the most common site for revision (p < 0.001) and the average number of secondary procedures after forehead flap division was 1.1 (standard deviation 0.81). The most variability in responses was seen for methods of internal lining reconstruction. Conclusion: Reconstructive surgeons frequently divide the PMFF pedicle at 3 weeks or later and have variable approaches to reconstruction of the internal lining with low complication rates overall.