Search Results (69)

Background: The philosophy of preservation rhinoplasty (PR) is gaining popularity as an alternative to structural rhinoplasty (SR), prompting comparison of their effectiveness, patient satisfaction, and impact on quality of life. Methods: This study evaluated the outcomes of rhinoplasty performed using PR and SR, supported by the SCHNOS, ROE, NOSE, and WHOQOL-BREF questionnaires. Seventy-five patients were included (N = 47 (63%) female and N = 28 (37%) male), of whom 39 underwent SR. Surveys were completed preoperatively and at one and three months postoperatively. A single surgeon performed all procedures, and the results were subjected to statistical analysis. Results: Baseline ROE scores were identical in both groups (1.2 vs. 1.2; p > 0.05). At three months, PR demonstrated significantly higher ROE scores (3.8 vs. 3.7; p < 0.05). In the SCHNOS-Obstruction domain, PR showed better outcomes at one month (0.8 vs. 1.3; p < 0.01), whereas three-month scores were equal (0.5 vs. 0.5; p > 0.05). SCHNOS-Cosmesis and NOSE outcomes did not differ significantly at any point. WHOQOL-BREF results indicated significant postoperative improvement across all domains in both groups (p < 0.001). Conclusions: PR provides higher early satisfaction, but both PR and SR yield progressive improvement and comparable longer-term outcomes. Quality of life and self-esteem improved regardless of surgical technique. 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

Introduction: The da Vinci Single-Port (SP) robotic system represents a newer minimally invasive surgical development with greater articulation and reduced surgical footprint through the use of a single incision. While originally applied in urology and otolaryngology, its application in general surgery is on the rise. This review aims to delineate the current applications, outcomes, and limitations of the SP platform in general surgical procedures. Methods: A descriptive literature search of PubMed, Scopus, and Embase databases was conducted to identify relevant peer-reviewed studies up to September 2025. The included studies reported SP robotic surgeries in various fields of general surgery. Results: A growing body of literature was found that reports the safety and feasibility of SP robotic surgery within general surgery. Advantages reported include improved cosmesis, decreased postoperative pain, and shorter recovery time. The present evidence is largely made up of small case series and initial feasibility studies. Technical drawbacks, such as crowding of instruments and a learning curve, remain issues. Conclusions: The da Vinci SP system shows promising potential for application in general surgery, particularly for certain procedures. Additional prospective studies and larger case series need to outline its long-term results, cost-effectiveness, and optimal indications. Full article

Background/Objectives: Comparative studies examining postoperative pain and cosmetic outcomes following single-port laparoscopic appendectomy (SLA) and three-port laparoscopic appendectomy (TLA) in pediatric patients with appendicitis have produced inconsistent results. We aimed to determine whether SLA offers practical benefits over TLA in terms of recovery-phase pain relief and long-term cosmetic satisfaction in pediatric patients. Methods: This prospective comparative study included children aged 15 years or younger who underwent laparoscopic appendectomy for uncomplicated acute appendicitis. The degree of pain reduction was compared between the SLA and TLA groups on postoperative days (PODs) 1, 2, and 7, both at rest and during coughing and ambulation, using the Visual Analog Scale for Pain (VASP). Global cosmetic satisfaction was assessed at 1 month and 3 years postoperatively using the Visual Analog Scale for Cosmesis (VASC). Scar perception was evaluated with the Patient and Parental Scar Assessment Scale (PSAS). The primary outcome was the degree of pain reduction during ambulation on POD7. The secondary outcome was global cosmetic satisfaction at 3 years. Propensity score matching (PSM) was used as a sensitivity analysis to control for baseline differences. Continuous variables were assessed for normality using the Shapiro–Wilk test. Results: Baseline characteristics were similar among 238 patients (127 SLA and 111 TLA). SLA resulted in significantly greater pain reduction during ambulation on POD7 (deltaVASP7_walk: −6.22 ± 2.60 vs. −5.06 ± 3.23, p < 0.01, mean difference = −1.16, Cohen’s d = 0.39). However, this difference did not reach the minimal clinically important difference (MCID) threshold of 1.3. PSM analysis with 82 matched pairs confirmed the results, with even larger effect sizes. At 3 years, the SLA group reported significantly higher cosmetic satisfaction (VASC: median 10 [9–10] vs. 8 [6–9], p < 0.001, r = 0.44), surpassing the MCID of 1.5. The TLA group scored worse in scar perception regarding color, stiffness, thickness, and irregularity. Mediation analysis indicated that 66% of the overall effect on cosmetic satisfaction was mediated by scar perception. Conclusions: Although SLA offers statistically significant yet clinically marginal benefits in early postoperative pain reduction, it provides substantial benefits in long-term cosmetic satisfaction compared with TLA in pediatric patients. Full article

Cutaneous malignancies represent the most common cancers worldwide and pose a growing public health burden. While surgical excision remains the primary curative modality, radiotherapy offers an effective adjuvant therapy for high-risk histopathologic features and an established, organ-preserving alternative for patients with inoperable disease or lesions in cosmetically or functionally sensitive sites. Advances in radiotherapeutic techniques, including brachytherapy and proton therapy, have expanded the therapeutic armamentarium, allowing tailored treatment based on tumor depth, extent, and anatomical location. Contemporary evidence highlights favorable local control and toxicity outcomes with modern radiation therapy approaches, yet data remain fragmented, with most studies limited by small cohorts, heterogeneous methodologies, and limited follow-up durations. Furthermore, the role of radiotherapy in complex scenarios, such as perineural invasion, recurrent disease, and previously irradiated fields, continues to evolve. This review synthesizes the current literature on radiotherapeutic management of skin cancer, critically evaluates dosimetric and clinical outcomes across modalities, and identifies key gaps in evidence. Emphasis is placed on the need for prospective, multicenter investigations to better define comparative effectiveness, optimize dose-fractionation regimens, and integrate emerging technologies into clinical practice. Radiotherapy remains an indispensable modality in dermatological oncology, offering curative potential with preservation of cosmesis and function, yet its optimal utilization demands further high-quality research to refine patient selection and therapeutic strategies. Full article

Laparoscopic urological surgery has become a cornerstone in the management of diverse urological pathologies, offering substantial advantages over traditional open approaches. These benefits include minimized incisions, reduced tissue trauma, decreased intraoperative blood loss, lower postoperative pain, shorter hospital stays, superior cosmesis, and accelerated recovery. Despite these advantages, laparoscopic surgery carries inherent risks, with major vascular injury (MVI) representing one of the most severe and potentially life-threatening complications. This review examines the incidence, etiologies, and management strategies for MVI in laparoscopic urological surgery, emphasizing the critical role of early recognition, standardized protocols, and surgical expertise in optimizing patient outcomes. Full article

Background/Objectives: To evaluate the clinical and histological efficacy, safety, and cosmetic outcomes of 5% imiquimod (IMQ) cream, used in monotherapy or in combination, for periocular superficial and nodular basal cell carcinoma (BCC). Methods: A systematic search of MEDLINE, PubMed, and Google Scholar (inception—12 June 2025) identified studies reporting IMQ treatment of eyelid/periocular BCC. Randomized, nonrandomized and observational designs were eligible. Risk of bias was assessed with Cochrane RoB 2 or ROBINS-I, and certainty of evidence graded with GRADE. Results: Seven studies (n = 152 lesions) met the inclusion criteria. The pooled clinical-plus-histological clearance across case series was 82% (95% CI 72–90%). The single RCT (n = 27) reported 100% histological clearance for both IMQ and radiotherapy at 3 months, but IMQ produced superior cosmetic results. Combination immunocryosurgery (IMQ + cryotherapy) achieved 87.5% sustained remission at ≤5 years. Local adverse events—erythema, crusting, or conjunctivitis—occurred in ≥70% (85/122) of treated cases but were mild-to-moderate and self-limiting; systemic reactions were not reported. Forty-seven additional patients in a dedicated safety cohort showed only transient ocular irritation. The certainty of evidence was moderate for short-term clearance and low for long-term control because of small samples and heterogeneous follow-up. Conclusions: IMQ 5% is a useful, tissue-sparing option for selected (superficial and nodular subtypes) periocular BCCs where surgery is contraindicated or cosmesis is paramount. Overall clearance is slightly lower than Mohs surgery but comparable to radiotherapy, and cosmetic outcomes are favorable. Larger, standardized RCTs with ≥3-year follow-up are needed to confirm durability, optimize dosing schedules, and validate patient-reported outcome measures. Full article

Minimally invasive coronary artery bypass grafting (MI-CABG) has emerged as a transformative approach to coronary revascularization, offering reduced morbidity, faster recovery and improved cosmesis compared to conventional coronary artery bypass grafting (CABG). Performed without full sternotomy and commonly without cardiopulmonary bypass (CPB), MI-CABG encompasses a variety of techniques. These procedures present unique challenges for the anesthesiologist, necessitating a tailored perioperative strategy. This review explores the anesthetic management of MI-CABG, focusing on preoperative assessment, intraoperative techniques, and postoperative care. Preoperative evaluation emphasizes cardiac, respiratory, and vascular considerations, including suitability for one-lung ventilation (OLV) and the impact of comorbidities. Intraoperatively, anesthesiologists must manage hemodynamic instability, ensure effective OLV, and maintain normothermia. Postoperative strategies prioritize multimodal analgesia, early extubation, and rapid mobilization to leverage the benefits of a minimally invasive approach. By integrating surgical and anesthetic perspectives, this review underscores the anesthesiologist’s pivotal role in navigating the physiological demands of MI-CABG. As techniques evolve and experience grows, a comprehensive understanding of these principles will enhance the safety and efficacy of MI-CABG, making it a viable option for an expanding patient population. Full article

Cultured epidermal autografts (CEAs) serve as an alternative permanent skin replacement, though high costs often limit their use in resource-constrained settings and to life-saving cases. This case report presents the first documented cosmetic application of a modified CEA technique in a bodybuilder, demonstrating favorable aesthetic outcomes. A 28-year-old Black male with a 20% total body surface area burn sustained in a domestic fire exhibited superficial and deep partial-thickness burns to the face, arms, torso, and feet. Refusing grafts from visible donor sites, treatment using a low-cost modified CEA approach was employed to minimize donor site morbidity. Keratinocytes harvested from a groin biopsy were cultured on Cutimed Sorbact^® (Essity AB, BSN Medical (Pty) Ltd., Pinetown, RSA) dressings with autogenous plasma and hydrogel supplementation and incubated at 37 °C for two weeks. Xenografts provided temporary coverage before CEA transplantation. Graft take was 85%, with minor (15%) loss at 21 days, requiring small autograft coverage. At two months, the Vancouver Scar Scale score was 4, indicating optimal pigmentation, smoother texture, and minimal scarring. These findings align with limited studies on CEAs for cosmetic applications, suggesting this cost-effective technique may broaden the scope of CEAs beyond life-saving interventions to include aesthetic reconstruction, reducing both donor site morbidity and scarring. Full article

Objective: Trauma is a leading cause of enophthalmos, typically resulting from an increase in the volume of the bony orbit. The general consensus is that post-traumatic primary deformity repair should aim to restore the premorbid volume, shape, and cosmesis of the orbitozygomatic complex (OZC). This study aims to utilise novel three-dimensional (3D) printed patient-specific moulds to intraoperatively fabricate enophthalmos wedges and onlays using polymethylmethacrylate (PMMA) bone cement to reconstruct the OZC. Methods: A total of seven patients underwent digital surgical planning using Freeform software to virtually correct orbitozygomatic complex deformities guided by a design algorithm. Three-dimensionally printed nylon patient-specific moulds were used intraoperatively to fabricate enophthalmos wedges and/or onlays using an industry-standard PMMA bone cement. Clinical examination and application of the proposed design algorithm determined that enophthalmos wedges were indicated for four patients, with one also requiring an onlay; and periorbital onlays were required for the three remaining patients. Results: Hertel exophthalmometry at a mean follow-up of 19.1 months demonstrated good outcomes in the correction of post-traumatic enophthalmos and hypoglobus and with patients reporting good subjective cosmetic results. Patients 5 and 7 had follow-up three-dimensional computed tomography (3D-CT) to confirm correct placement. Conclusion: The use of patient-specific PMMA wedges and onlays, fabricated intraoperatively with the aid of 3D-printed moulds, offers a reliable and effective approach for correcting post-traumatic enophthalmos and hypoglobus. This method allows for the restoration of orbital volume and anatomical contours, addressing both functional and aesthetic concerns. Our results demonstrate that this technique yields favourable outcomes. Full article

(1) Background: The management of ipsilateral breast cancer recurrence depends on the extent of the tumor, and staging results, and mastectomy is currently the standard of care for previously irradiated patients. Studies are increasingly investigating suitable candidates for the repeated use of breast-conserving approaches as an alternative to mastectomy. But this includes the crucial necessity for curative reirradiation (Re-RT). The therapeutic challenge in reirradiation involves finding a balance between tumor control and the risk of severe toxicity from cumulative radiation doses in previously irradiated organs. Re-RT options include the use of brachytherapy, intraoperative radiotherapy, or external beam RT with photons or electrons. The application of particle therapy using proton beam therapy represents an innovative radiotherapeutic technique for breast cancer patients that might offer advantageous physical properties, a superior dose reduction to adjacent organs-at-risk, and effective target volume coverage with lower integral doses to the patient’s whole body. In addition, this technique could potentially offer higher radiobiological effects and tumor responses. (2) Methods: The BREAST trial (NCT06954623) will be conducted as a prospective, single-arm, phase II study in 20 patients with histologically proven invasive breast cancer recurrences after repeat breast-conserving surgery and with an indication for local reirradiation. The patients will receive partial-breast re-RT with proton beam therapy in 15 once-daily fractions up to a total dose of 40.05 Gy(RBE), delivered with active raster scanning. The required time interval will be 1 year after previous RT to the ipsilateral breast. (3) Results: The following results will be reported: The primary endpoint is defined as the cumulative overall occurrence of (sub)acute skin toxicity of grade ≥ 3 within 6 months after the start of re-RT. Secondary outcome includes an analysis of the local, regional, and distant control, progression-free and overall survival, quality of life, and cosmesis. The explorative and translational objectives of this study include planning comparisons to other RT techniques and irradiation types, dosimetric evaluations, analyses of radiological imaging features, and translational assessments of cardiac toxicity biomarkers and tumor markers. (4) Conclusions: Overall, the aim of this study is to evaluate the potential of proton beam therapy for partial breast reirradiation and to establish the underlying data for a randomized trial. Full article

Background/Objectives: Surgical Site Infections (SSIs) rank among the most common complications following stoma takedown and lead to increased morbidity, increased Length of Hospital Stay (LOS), and higher healthcare costs. Negative Pressure Wound Therapy (NPWT) systems have emerged as a promising option for optimizing wound management and minimizing SSI rates. This systematic review and meta-analysis compares postoperative outcomes of NPWT and conventional Non-Pressure Dressings following stoma reversal. Methods: A search of the literature published up to 1 September 2024 was conducted across MEDLINE/PubMed, and the Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus, as well as ClinicalTrials.gov. Only Randomized Controlled Trials (RCTs) were included. The primary outcome was SSI rate, while secondary outcomes included time to complete wound healing, LOS, and patient-reported wound cosmesis. Quality assessment was performed using the Cochrane Risk of Bias 2 (RoB 2) tool. The results were synthesized using means and Standard Deviations for continuous variables, counts and percentages for categorical variables, and presented as Odds Ratios (OR) or Mean Differences (MD) with 95% Confidence Intervals, using random or fixed effects models based on heterogeneity (I²). Results: Six RCTs, including 328 patients, were ultimately eligible for inclusion. No significant difference was revealed in SSI rates between the NPWT and conventional dressing groups (OR = 0.95; 95% CI: 0.27–3.29; p = 0.94; I² = 38%). Time to complete wound healing was significantly lower in the NPWT group compared to conventional dressings (MD = −3.78 days; 95% CI: −6.29 to −1.27; p = 0.003). Two studies reported a lower rate of wound healing complications other than SSIs in the NPWT group (OR = 0.22; 95% CI: 0.05–1.09; p = 0.06). No substantial differences were observed in terms of LOS (MD = −0.02 days; 95% CI: −1.22 to 1.17; p = 0.97) and patient-reported wound cosmesis (SMD = 0.31; 95% CI: −0.49 to 1.11; p = 0.44). The review’s limitations include potential risk of bias, variability in study designs, and heterogeneity between studies. Conclusions: NPWT contributes to improved wound management through reducing wound healing time compared to Non-Pressure Dressings after stoma reversal, although it does not appear to substantially impact SSI rates, LOS, or patient-assessed wound cosmesis. Further large-scale, multicenter RCTs are necessary to validate these results and identify patient populations most likely to benefit from NPWT application. Full article

Background: Syndactyly of the toes is a common congenital malformation, yet there are few reports of long-term outcomes after toe syndactyly repair and its effect on well-being. In this study, we surveyed patients and parents of patients who underwent toe syndactyly repair to investigate the functional and psychological outcomes of their surgery. Methods: Wereviewed the medical records of all of the patients who underwent toe syndactyly repair using a plantar flap technique between January 1, 2010, and January 1, 2021. Parents or patients completed a survey assessing their opinion regarding cosmesis, function, and overall satisfaction. Independent observers used a modified Vancouver Scar Scale to evaluate surgical scars. Results: A plantar flap technique was used for 19 syndactylous webs in nine patients. Complications included one instance of mild cellulitis and one instance of web creep requiring revision. Average follow-up time was 5.5 years. Overall, 88% of survey respondents were very or moderately satisfied with the surgical outcome. No patients had unwanted hair growth or a bothersome groin site scar. Average modified Vancouver Scar Scale score was 3.2. There was a perceived improvement in toe range of motion and hygiene after surgery. Patients who underwent first web space release could wear flip-flops. All of the respondents would recommend surgery for another child with toe syndactyly. Conclusions: Toe syndactyly repair can be performed with minimal complications and high parent/patient satisfaction. Survey results indicate that there may be functional and psychological benefits to undergoing toe syndactyly repair. Full article

Background: A crooked nose is a challenge for a surgeon performing rhinoplasty. When performed correctly, rhinoseptoplasty aligns the nasal framework, restores nasal patency, and achieves facial symmetry. The key to this procedure is to dissect all the structures of the nasal framework, mobilize, reposition, and stabilize them. Aim: This study aims to discuss the quality of life after the rhinoseptoplasty and principles of treating a post-traumatic crooked nose with a view to improving the predictability and reliability of rhinoplasty procedures involving this challenging problem. Methods: The study compared the results of the Rhinoplasty Outcome Evaluation (ROE) and the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) through statistical analysis. Results: Considering the structural deformities that lead to a crooked nose, the open approach seems to be preferred during a rhinoseptoplasty of a post-traumatic, crooked nose. When reconstructing the nasal septum, it is always necessary to leave the required amount of cartilage to provide nasal support and to secure the septum to the nasal spine. Osteotomies are important for fixing a crooked nose. The preoperative values for ROE were significantly lower before surgery than after surgery (8.7 vs. 20.2), while for SCHNOS, the postoperative values were statistically significantly lower compared to the preoperative values (46.0 vs. 9.1). Conclusions: Properly planned and performed surgery improves the functional and aesthetic outcomes in patients after rhinoseptoplasty. Full article

(1) Background: The emergence of microneedle patch technology and its development as a transdermal drug delivery platform have shown proven results in improving skin texture and appearance. This study was conducted to determine the efficacy of the microneedle patch (MNP)-only cosmesis of undereye skin texture and wrinkles against patch cosmesis with diluted botulinum toxin-A. (2) Methods: A total of 23 Thai females volunteered for this prospective clinical trial. Each participant was treated according to a split-face design, with the application of diluted botulinum toxin-A through MNP technology to the right undereye and a normal saline MNP application to the left undereye. Test areas were recorded at baseline and 2, 4, 8, 12, and 16 weeks after the initial treatment. (3) Results: Botulinum toxin-A was successfully delivered to the skin by MNP technology. After the initial treatment, these novel transdermal drug delivery patches significantly improved infraorbital hollowness at week 8 and wrinkles at week 16. In addition, the skin surface was markedly enhanced, with no adverse effects observed during the trial. (4) Conclusions: Novel MNPs are an effective and safe technology for use in the management of undereye skin aging. Combination treatment with botulinum toxin-A-impregnated devices gave a higher patient satisfaction than MNPs alone. Full article