Journal of Aesthetic Medicine

Acellular dermal matrix (ADM) is commonly used for breast reconstruction with the proposed benefit of stabilizing the implant pocket and enhancing breast shape. However, some reports highlight safety concerns regarding ADM use. This study evaluates short and long-term unplanned return to the operating room (OR) for immediate implant-based reconstruction with or without ADM. Females who underwent primary mastectomy with direct to implant reconstruction for breast cancer or risk reduction (2010–2020) were identified using an integrated healthcare system’s EHR. Multivariable Poisson regression was conducted to evaluate return to OR outcomes at early (<1 year), intermediate (1–2 years), and long term (≥2 years) periods for ADM versus without. The cohort included 2886 patients, 69.8% with ADM. Overall, no differences were observed for OR returns for ADM compared to none. For unilateral procedures, a lower rate of return to OR was observed at 0–1 year (IRR = 0.74, 95% CI = 0.58–0.95) and >2 years (IRR = 0.52, 95% CI = 0.29–0.94). The lack of overall difference suggests ADM usage did not impact risk of complications nor improve surgical outcomes. For unilateral cases, ADM is associated with lower rates of return to OR at a higher cost to the healthcare system. Surgeons may use their discretion whether ADM is appropriate for breast reconstruction. Full article

Facial aging involves progressive changes to the skin, soft tissue, and skeletal framework, driven by genetic, social, and environmental factors. Rhytidectomy, or facelift surgery, has developed from simple skin excision to anatomically based techniques that reposition deeper tissues, restore volume, and enhance natural contours. The purpose of this review is to discuss the history of rhytidectomy, key anatomical foundations, and surgical techniques. Surgical approaches covered include subcutaneous, superficial musculoaponeurotic system (SMAS) manipulation, and deep plane procedures. Rhytidectomy remains a cornerstone of facial rejuvenation, with continuous refinements aimed at improving durability, minimizing risk, and achieving natural, patient-specific outcomes. Full article

Facial gender-affirming surgery (FGAS) is a transformative step for transgender individuals in their gender care journey. Even so, the way outcomes are measured and reported is highly inconsistent and unstudied. This limits the ability to compare studies or develop clear, patient-centered benchmarks for success. We systematically assess how current research defines FGAS outcomes and lay the groundwork for a unified Core Outcome Set (COS). A systematic review was conducted following the PRISMA 2020 guidelines. PubMed was searched up to 15 March 2025; we identified 334 studies, and four reviewers independently screened the studies. After screening, 207 studies met the inclusion criteria, encompassing 30,937 patients. Data on study characteristics, surgical procedures, outcome domains, measurement tools, and follow-up duration were extracted. Descriptive statistics and chi-square analyses were used to evaluate reporting trends. Most studies emphasized aesthetic outcomes (60.56%) and complications (62.44%); fewer addressed psychosocial well-being (43.19%), quality of life (35.21%), or reoperation rates (21.60%). Only 26 of the 207 studies used validated outcome instruments, such as FACE-Q or PROMIS (p < 0.001). Among studies that reported satisfaction, only 41.2% provided numerical or stratified scores. Outcome reporting in FGAS research is fragmented and dominated by subjective or unvalidated assessments. A standardized COS is needed to unify research practices, facilitate meaningful comparisons, and ensure that outcomes align with patient-defined measures of surgical success. Full article

Background: Breast surgery, both aesthetic and reconstructive, has evolved significantly over the years. Postoperative care is vital for patient recovery, with surgical dressings playing a crucial role in minimizing complications, including infections and bleeding. This review aims to evaluate the safety, comfort, and effectiveness of different durations for wearing surgical dressings after breast surgery. It also explores the use of negative pressure wound dressings and postoperative bras to enhance surgical outcomes. Methods: A comprehensive review of literature published from 2003 to 2024. Studies focusing on breast dressing techniques after mammary reconstruction and aesthetic surgery in plastic surgery were included. Results: Of 1503 initially identified articles, 12 were deemed relevant and included in this review. The findings suggest that prolonged dressing wear, up to 6 days postsurgery, may reduce cutaneous colonization without affecting infection rates in aesthetic breast surgery. Additionally, negative pressure wound therapy demonstrates promise in reducing overall wound complications and mastectomy flap necrosis. The utilization of specific postoperative bras is shown to improve patient comfort, mobility, and security, contributing to pain reduction and aesthetic outcomes. Conclusions: The lack of consensus on dressing selection and duration calls for further research in breast surgery postoperative care. Extended dressing wear, negative pressure therapy, and customized postoperative bras show potential in reducing complications, providing new avenues to enhance patient outcomes in the field of plastic surgery. Addressing these issues can lead to improved patient satisfaction and surgical results. Full article

Facial aging is not a singular phenomenon but a cascade of anatomical and biological transformations unfolding across the skeleton, fat, ligaments, muscles, dermis, and epidermis. Its clinical expression-volume loss, sagging, wrinkling, and surface irregularities-cannot be adequately explained by simplistic metaphors of “filling” or “lifting.” This article is a narrative review synthesizing current anatomical, physiological, and clinical evidence relevant to multimodal facial rejuvenation. Traditional monotherapies, while sometimes effective in isolation, are increasingly inadequate for contemporary patients who demand outcomes that are natural, harmonious, and durable. Modern esthetic practice has therefore shifted toward multimodal approaches that address aging across multiple planes. Hyaluronic acid (HA) fillers provide volumetric scaffolding and hydration; collagen stimulators such as poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) induce neocollagenesis and long-term dermal remodeling; botulinum toxin restores balance to muscular vectors and improves expression dynamics; while energy-based devices (EBDs), including fractional lasers, radiofrequency microneedling, and high-intensity focused ultrasound (HIFU), enhance skin texture, tone, and elasticity. When applied in a sequenced and evidence-based manner, these modalities act synergistically to deliver results unattainable by any single intervention. In addition to established modalities, the field has recently witnessed aggressive promotion of “regenerative” therapies-growth factors, exosomes, platelet-rich plasma (PRP), and platelet-rich fibrin (PRF). While biologically plausible, their efficacy and safety remain uncertain due to the absence of robust, randomized clinical trials and the heterogeneity of current data. This raises a critical question: is aesthetic medicine advancing through science, or being driven by novelty and marketing? This review synthesizes current anatomical and physiological knowledge of aging, evaluates the mechanisms, clinical applications, and safety considerations of major treatment modalities, and proposes practical sequencing strategies. It also emphasizes the ethical imperative that aesthetic medicine, while innovative and fast-evolving, must remain anchored in scientific evidence and patient safety—because aesthetic medicine is, fundamentally, still medicine. Full article

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings. Full article

Objective: Tranexamic acid (TXA) is widely used in rhinoplasty to minimize intraoperative bleeding and improve visualization; however, its effect on postoperative bleeding remains unclear. This study aimed to evaluate whether intravenous TXA reduces postoperative bleeding in patients undergoing primary or secondary rhinoplasty. Methods: A retrospective cohort study was performed using the TriNetX national research database to identify patients who underwent primary (CPT 30400, 30410, 30420) or secondary (CPT 30430, 30435, 30450) rhinoplasty from 2010 to 2023. Patients were grouped based on perioperative usage of intravenous TXA. Propensity score matching adjusted for demographics and coagulation disorders (ICD-10 D65–D69). The primary outcome was postoperative bleeding, including epistaxis, within one month of surgery. Results: Among 2586 patients who met inclusion criteria, 1293 (50%) received TXA. TXA recipients had a higher prevalence of bleeding risk factors, including prior use of antihemorrhagic medications (5.9% vs. 1.8%, p < 0.0001) and prolonged prothrombin time (20% vs. 16.1%, p = 0.032). TXA patients more frequently underwent concurrent septoplasty (29.7% vs. 21%, p < 0.0001). There were no significant differences observed in postoperative epistaxis or bleeding between cohorts. Similar postoperative bleeding rates despite these higher-risk characteristics suggest that TXA may have benefit in the mitigation of elevated bleeding risk in the treated cohort. Conclusions: TXA is preferentially administered to patients at higher risk of bleeding and during more complex, vascular procedures prone to increased blood loss. Prospective studies are needed to directly test whether TXA normalizes bleeding risk in higher-risk rhinoplasty patients. Full article

Background: Large-volume ptotic breasts are associated with incision complication rates in single-stage direct-to-implant pre-pectoral breast reconstruction. The aim is to propose an updated surgical approach for this patient population. Methods: A small retrospective case series of patients who underwent direct-to-implant breast reconstruction without a wise-pattern incision from 2019 to 2024 at a single academic institution. Results: Eight breasts from five patients fulfilled the inclusion criteria. One patient had minimal superior nipple–areolar complex ischemia with no additional postoperative complications identified. Conclusions: Refinement to a popular direct-to-implant breast reconstruction technique has the potential to decrease complication rates and improve aesthetic outcomes in large-volume ptotic breasts. Full article

Cellulite, or edematous-fibro-sclerotic panniculopathy (EFSP), is a multifactorial condition affecting most postpubertal women, characterized by surface irregularities with significant psychosocial impact. Its pathogenesis involves adipocyte metabolism, fibrous septa, microvascular dysfunction, extracellular matrix (ECM) remodeling, oxidative stress, and low-grade inflammation. Topical therapies remain among the most accessible approaches, acting on specific biological pathways. Osmotic and vSSasomodulatory formulations reduce edema and improve microcirculation, while methylxanthines such as caffeine and aminophylline promote lipolysis and enhance cutaneous blood flow. Retinoids mainly target the ECM, stimulating neocollagenesis and dermal thickening, with greater efficacy in early EFSP. Botanicals, including Centella asiatica, Rosmarinus officinalis, and Ginkgo biloba, provide antioxidant, anti-inflammatory, and venotonic effects. Randomized controlled trials consistently report modest but reproducible benefits: localized circumference reductions and improved elasticity, echogenicity, and orange-peel scores, all with excellent tolerability. Recent innovations, such as lipid nanoparticles, ultradeformable vesicles, and microneedle-assisted delivery, aim to enhance penetration, stability, and sustained bioactivity of established actives. Nonetheless, most studies are small, short-term, and heterogeneous, with limited ability to isolate the role of individual components or control for massage-related effects. Artificial intelligence offers opportunities to standardize outcome measures, optimize formulations, and personalize protocols. Overall, topical therapies are best positioned as safe, biologically active adjuncts within multimodal cellulite management. Full article

This narrative literature review is an evaluation of the cosmetic, perioperative, and clinical outcomes of alternative approaches to submandibular gland excision, including conventional and robotic transoral excision, as well as endoscopic and robotic retroauricular excision, in comparison with the traditional transcervical approach. We intend to compare the cosmetic impact of each procedure based on the type of scar and location. PubMed and Google Scholar identified studies published between January 2000 and May 2025 which reported the outcomes of submandibular gland excisions performed using a transcervical, transoral, or retroauricular technique. Our analysis showed that the transcervical approach provides reliable access but carries risks of marginal mandibular nerve injury (18.7%) and visible cervical scarring. Conventional transoral excision avoids external scars and reduces the risk to the marginal mandibular branch and hypoglossal nerves but increases the risk of lingual nerve neuropraxia, with transient sensory deficits reported in 25–43% of patients. Robotic transoral excision preserves the sublingual gland and may improve completeness of resection, but operative times remain prolonged (<190 min). Endoscopic and robotic retroauricular excision can hide scars in the hairline and provide improved cosmetic satisfaction scores, with limitations including longer operative times and learning curves. Alternative approaches to submandibular gland excision provide improved cosmetic outcomes with comparable safety profiles to the transcervical approach. Full article

Facial aesthetic surgery has evolved from early reconstructive efforts to highly refined, technology-driven practice. This educational review explores the historical development of key procedures, including rhinoplasty, blepharoplasty, and facelifts, and connects these milestones to modern innovations including artificial intelligence, virtual reality, and three-dimensional planning. By linking past techniques to current approaches, this work highlights how foundational surgical principles continue to guide safe, precise, and patient-centered aesthetic care. Full article

Body image dissatisfaction, particularly related to breast appearance, plays an important role in cosmetic breast surgery (CBS) decisions and psychological wellbeing. However, existing measures are often lengthy, overlook healthy women considering CBS, and fail to adequately address the nipple–areola complex (NAC), a critical component of breast satisfaction. This study introduces the 12-item Breast Appearance Concerns Scale (BACS), a brief screening tool developed to address existing gaps and to document breast-specific body image concerns among women considering CBS. Data were collected from a diverse sample of 589 young adult women who completed the BACS along with measures of related constructs such as self-esteem and anxiety. Exploratory and confirmatory factor analyses supported a two-subscale structure: NAC Satisfaction and General Breast Satisfaction. The BACS total score demonstrated strong internal consistency (α = 0.785) and test–retest reliability (r = 0.741). Predictive validity analyses revealed that the General Breast Satisfaction subscale effectively distinguished women who had considered CBS from those who had not (classification accuracy = 72.1%). Receiver Operating Characteristic (ROC) analysis was conducted with the General Breast Satisfaction subscale to establish a preliminary cutoff score. This cutoff provides initial support for use of this subscale as a screening tool to help classify individuals based on their consideration of CBS. Although clinically important, the NAC subscale is still in an early stage of development and requires additional research before cutoff scores can be established to inform surgical decision-making and evaluate patient-reported satisfaction outcomes. Both subscales require further investigation in older populations and clinical settings to support their use as screening tools. These findings position the BACS as a promising screening tool for assessing breast-specific body image concerns, particularly general breast satisfaction, with potential applications in clinical, pre-surgical settings. Full article

Background: Androgenetic alopecia (AGA) is the most prevalent form of hair loss in humans. Oral minoxidil and dutasteride are widely used treatments, while intradermal dutasteride mesotherapy has recently gained interest as a complementary approach. However, comparative studies in real-world settings are lacking. Objective: The aim was to compare the effectiveness and safety of four AGA therapies: oral minoxidil alone (OM), OM plus oral dutasteride (OM + OD), OM plus mesotherapy (OM + MD), and a combination of all three (CT). Methods: A retrospective study was conducted, including 280 adult patients (mean age 35 ± 9.4 years) with AGA, excluding those with recent treatment (last 3 months) or other hair loss disorders. The therapeutic response was assessed by comparing treatment outcomes from standardized clinical images at 6 and 12 months using a four-point improvement scale. Patient satisfaction was also assessed using a four-point subjective scale. Results: Participants were divided into four treatment groups. In total, 74 patients (26.4%) were treated with OM, 65 patients (23.2%) with OM + OD, 61 patients (21.8%) with OM + MD, and 80 patients (28.6%) with CT. At 12 months, group 4 treated with CT showed significantly better results in both frontal and vertex areas (p < 0.001), while group 3 (OM + MD) performed best at 6 months in the vertex. Side effects were mild and infrequent, with hypertrichosis being the most common. Erectile dysfunction was reported with a lower incidence than reported in the literature: two patients (3.1%) in group 2 (OM + OD) and three (3.8%) patients in CT. Overall, no serious adverse events were detected. Conclusions: Combining oral minoxidil, oral dutasteride, and mesotherapy with dutasteride yields the most effective results for AGA with a favorable safety profile. Full article

Recent decades have seen a rapid advancement in nonsurgical facial rejuvenation techniques due to technological advances and growing patient preference for minimally invasive aesthetic procedures. Laser resurfacing and chemical peels are two popular modalities that address aging skin, improve skin texture, and reduce signs of photodamage. In this work, we examine the historical evolution of these modalities, review current trends, and analyze their comparative efficacy in the context of facial rejuvenation. We discuss each modalities’ mechanisms, clinical indications, efficacy, and safety profiles. We additionally explore the impact of emerging technologies, such as fractional lasers, picosecond lasers, and novel chemical peel formulations, on patient outcomes, recovery times, and novel indications. Furthermore, we consider how recent advances have enabled safer and more effective treatment across diverse skin types, focusing primarily on higher Fitzpatrick skin. Additionally, a scoping review including adjunctive and non-surgical modalities is discussed and synthesized to highlight current evidence, clinical guidelines, and technological advances. This review aims to guide clinicians in optimizing procedure choice and patient outcomes in nonsurgical facial rejuvenation. Full article

The integration of artificial intelligence (AI) and advanced digital workflows is revolutionising full-arch implant dentistry, particularly for geriatric patients with edentulous and atrophic arches, for whom achieving both prosthetic passivity and optimal aesthetic outcomes is critical. This narrative review evaluates current challenges in intraoral scanning accuracy—such as scan distortion, angular deviation, and cross-arch misalignment—and presents how innovations like the Medit SmartX AI-guided workflow and the Scan Ladder system can significantly enhance precision in implant position registration. These technologies mitigate stitching errors by using real-time scan body recognition and auxiliary geometric references, yielding mean RMS trueness values as low as 11–13 µm, comparable to dedicated photogrammetry systems. AI-driven prosthetic design further aligns implant-supported restorations with facial symmetry and smile aesthetics, prioritising predictable midline and occlusal plane control. Early clinical data indicate that such tools can reduce prosthetic misfits to under 20 µm and lower complication rates related to passive fit, while shortening scan times by up to 30% compared to conventional workflows. This is especially valuable for elderly individuals who may not tolerate multiple lengthy adjustments. Additionally, emerging AI applications in design automation, scan validation, and patient-specific workflow adaptation continue to evolve, supporting more efficient and personalised digital prosthodontics. In summary, AI-enhanced scanning and prosthetic workflows do not merely meet functional demands but also elevate aesthetic standards in complex full-arch rehabilitations. The synergy of AI and digital dentistry presents a transformative opportunity to consistently deliver superior precision, passivity, and facial harmony for edentulous implant patients. Full article

This study evaluates a novel high-density polyethylene (HDPE) browlift peg for brow fixation in endoscopic forehead lifting, assessing its safety, effectiveness, and aesthetic outcomes while contextualizing its use through a narrative review of existing techniques. Twenty-nine consecutive female patients underwent bilateral endoscopic brow lifts using a custom-shaped HDPE peg inserted into the frontal bone via a small paramedian incision. Outcomes included postoperative brow symmetry, defined as ≤2 mm asymmetry, and documentation of complications. The mean patient age was 62.1 years, with an average follow-up of 12.3 months. All patients achieved symmetric brow positioning within 2 mm. No cases of implant extrusion, wound dehiscence, or permanent nerve injury occurred. Minor complications included one case each of transient paresthesia, localized incision infection not involving the implant, and a palpable implant removed in-office under local anesthesia. A parallel narrative review highlighted common limitations in brow fixation strategies—namely, implant palpability, risk of relapse, cost, and invasiveness. These findings suggest that the HDPE peg is a safe, customizable, and cost-effective alternative for brow fixation, offering durable aesthetic results with minimal complications and potential value in aesthetic and oculoplastic surgery. Full article

As acne scars remain challenging to treat, this study compared the safety and efficacy of two laser modalities for acne scar treatment. Between 2022 and 2024, 88 patients were treated for acne scars using either the Hybrid platform with the ProScan applicator, which delivers fractional ablative carbon dioxide (CO₂) 10,600 nm and non-ablative 1570 nm wavelengths in a dual mode, or the Pixel CO₂ laser with the LiteScan applicator, which delivers a fractional ablative CO₂ 10,600 nm wavelength alone. Clinical efficacy was assessed using the Echelle d’Evaluation Clinique des Cicatrices D’Acne (ECCA) scale. Both groups showed significant improvements in ECCA scores post-treatment (p < 0.001, Wilcoxon signed-rank test). However, the percentage change in scores from baseline to post-treatment did not differ significantly between the groups (p > 0.05, Wilcoxon rank-sum test). Adverse effects were mild and transient, resolving within a few days, with no significant differences between the groups (p > 0.05, chi-squared test). Both laser modalities demonstrated high efficacy and safety in treating acne scars, with significant post-treatment improvement in scar severity. Full article