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Publication timelines in plastic surgery vary across journals and study types, impacting the timely dissemination of research. This study aimed to evaluate the publication timelines and patterns of plastic surgery journals. A bibliometric analysis of all original articles published in the 7 plastic surgery journals with the highest impact factors in 2024 was conducted. A total of 2033 plastic surgery articles were analyzed. The median total time to publication (TT) was 8.0 months, with significant variation across journals (P < 0.001). Plastic and Reconstructive Surgery (PRS) had the longest TT (20.1 mo), whereas Plastic and Reconstructive Surgery - Global Open had the shortest (5.2 mo). Regarding study category, hand and peripheral nerve surgery had the longest TT (12.9 mo), and cosmetic surgery had the shortest (7.6 mo) (P < 0.001). North American articles had the longest TT (8.7 mo), whereas African articles had the shortest (6.5 mo) (P < 0.001). Studies by nonplastic surgeons, from multiple institutions, or with medical student coauthors had longer TTs (all P < 0.05). Multivariable analysis identified journal, study category, and author continent as independent predictors of a shorter TT (≤8 mo). Articles in Plastic and Reconstructive Surgery - Global Open (odds ratio = 5.7) or Journal of Plastic, Reconstructive, and Aesthetic Surgery (odds ratio = 4.5) were more likely to be published quickly, whereas those on breast surgery or from Africa or Asia were less likely to be published quickly. Publication timelines in plastic surgery journals improved overall from 2018 to 2024, but unevenly across journals. Study category, author continent, and affiliation significantly influenced publication speed.
Tranexamic acid (TXA) has gained increasing popularity in plastic and reconstructive surgery for minimizing perioperative bleeding and improving postoperative outcomes. However, standardized guidelines on its use remain lacking. Methods: An anonymous international survey was distributed to over 400 plastic surgeons worldwide to evaluate current TXA usage patterns, including dosage, timing, route of administration as well as perceived efficacy and safety. Sixty-nine fully completed responses from 17 countries were analyzed. Overall, 86.9% of respondents reported TXA use, primarily to reduce blood loss and postoperative bruising. Intravenous administration was preferred by 55.9%, topical by 15.3%, and 28.8% used both. The most common intravenous dose was 10-14 mg/kg BW, usually given intraoperatively or within 30 min before incision. Topical TXA was typically applied during hemostasis or wound closure, most frequently undiluted (100 mg/mL) or in diluted solutions (10-50 mg/mL). Use was highest in aesthetic bodycontouring and breast procedures but remained low in microvascular and burn surgery. Almost all respondents (98%) reported no TXA-related complications. No thromboembolic or neurological adverse events occurred. TXA is widely and safely implemented in plastic surgery, particularly in aesthetic procedures, but substantial heterogeneity exists regarding dosage, timing, and route of application. These findings underscore the need for procedure-specific, evidence-based protocols and prospective multicenter trials to standardize TXA use in plastic and reconstructive surgery.
The integration of residents and physician assistants (PAs) into cosmetic plastic surgery has become increasingly common to address workforce shortages and maintain educational opportunities. However, questions remain about their impact on operative efficiency and outcomes. A retrospective review was conducted of 78 cosmetic surgery cases performed at an academic medical center between October 2022 and October 2024. Cases included abdominoplasty, breast augmentation/mastopexy, abdominoplasty combined with breast augmentation/mastopexy, breast augmentation mammaplasty, and reduction mammaplasty. Patients were stratified by team composition: attending surgeon alone, attending surgeon with a resident, attending surgeon with a PA, and attending surgeon with both a resident and a PA. Operative time, estimated blood loss (EBL), and complications were compared using analysis of variance and descriptive statistics. No significant differences in overall operative time or EBL were observed across team compositions (P > 0.05). However, when analyzed by procedure type, significant findings emerged. In abdominoplasty combined with breast augmentation/mastopexy, solo cases had significantly longer operative times compared with assisted groups (P = 0.017). In breast augmentation mammaplasty, resident participation was associated with the lowest mean EBL (P = 0.026). Only 2 complications occurred in the entire cohort (2.6%), with no difference across groups. Resident and PA participation in cosmetic plastic surgery does not compromise patient safety or outcomes. These findings support the inclusion of residents and PAs in aesthetic procedures as both feasible and beneficial, balancing education with high-quality patient care.
Telemedicine revolutionized healthcare post-COVID-19 by expanding virtual care across consultations, post-operative care, and inter-physician collaboration. However, its impact on adoption and effectiveness in plastic surgery remains underexplored. This study systematically compares pre- and post-pandemic telemedicine in plastic surgery, focusing on outcomes, accessibility, and patient satisfaction to inform best practices. A systematic review was conducted using PubMed, Medline, and Web of Science, following PRISMA guidelines, for articles published through November 2024. Extracted data included author, year, country, subspecialty, pandemic classification, sample size, demographics, utilization, barriers, travel time/distance, satisfaction, complications, and appointment duration. Meta-analyses calculated pooled estimates with 95% confidence intervals. Meta-regression and Welch's t-test assessed pre- versus post-pandemic differences. Analyses were performed in R 4.4.1. Of 450 identified publications, 72 met inclusion criteria, encompassing 9435 subjects (mean age: 47.99). 89.3% (95% CI 59.3-96.2%) of patients reported willingness to reuse telemedicine, and the pooled satisfaction rate was 83.9% (95% CI 79.4-88.5; p < 0.05). Meta-analysis showed significant reductions in travel time (120 min; p < 0.05) and distance (187.1 km; p < 0.05). Five studies reported a mean appointment duration of 16.07 min. Complications were rare (7.7%; 95% CI 2.9-18.6%; p < 0.05). Post-pandemic satisfaction score was lower (81.1 vs. 91.2; p = 0.0315), likely reflecting increased utilization and technological barriers. Other outcomes, including complication rates and willingness to reuse telemedicine, showed no significant difference (p > 0.05). Telemedicine plays an evolving role in plastic surgery, reducing travel burden and maintaining safety. However, lower post-pandemic satisfaction highlights the need to improve accessibility and technology to optimize outcomes. 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 .
As demand for aesthetic procedures continues to grow in the UK, alongside presentations of aesthetic-related complications, understanding current training provision and clinician preparedness is essential to inform educational curriculum development and regulatory policy. A cross-sectional online survey was conducted across UK medical schools and postgraduate medical education regions to evaluate UK medical students' and resident doctors' exposure to, knowledge of, and perceptions of aesthetic practice. A total of 2369 participants completed the survey (1757 students; 612 residents). Formal aesthetic teaching was uncommon: 10.9% of students (n = 191) and 10.5% of resident doctors (n = 64) received undergraduate teaching, and 11.9% of residents (n = 73) had postgraduate exposure. Self-reported knowledge scores ranged from 1.72 to 2.65/5 for surgical procedures and 2.32-2.99/5 for non-surgical procedures. However, 40.7% of residents (n = 249) had already managed at least one aesthetic complication, with 78.3% (n = 195) arising from procedures performed abroad. Career interest was substantial (38.2% overall), with participants identifying consent principles (4.08 ± 1.02) and procedure overview (4.00 ± 1.00) as priority curriculum additions. Social media was the most influential source shaping perceptions (residents 3.64 ± 1.17; students 3.51 ± 1.30), while formal education had minimal impact. Strong consensus emerged on regulatory needs: 86.4% of residents and 78.6% of students identified lack of regulation in the non-surgical sector as a significant concern, with 88.2% and 86.0% respectively supporting restriction of invasive non-surgical procedures to medically trained professionals. These findings provide an evidence base for developing structured aesthetic curricula and strengthening regulatory frameworks to better prepare clinicians for this expanding area of practice.
Cosmetic surgery refers to procedures aimed at changing and enhancing external body appearance. This study aims to investigate the correlation between the dark triad personality traits and the acceptance of cosmetic surgery among university students in the Kurdistan region of Iraq. This quantitative cross-sectional study was conducted between October and November 2024 using random sampling and self-report questionnaires. The dark triad and acceptance of cosmetic surgery were assessed by using the Dark Triad Dirty Dozen and the Acceptance of Cosmetic Surgery Scale, respectively. Data were analyzed using t tests, Pearson correlations, and multiple regressions in SPSS software. A sample of 1321 participants-984 females and 337 males-participated in the study. Descriptive statistics of gender differences revealed that narcissism, psychopathy, and Machiavellianism were significantly higher in males than females, whereas consider the sub-scale of acceptance of cosmetic surgery, which was higher in females. The correlational analysis illustrates that all variables are correlated regarding dark traits and acceptance of cosmetic surgery sub-scales. Narcissism was found to be the most predictable dark triad among applicants who seek cosmetic surgery. Individuals with high levels of narcissism are more likely to consider cosmetic surgery. Health professionals should be aware of the effects of the dark triad on cosmetic surgery decisions, and the study recommends further research. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 www.springer.com/00266 .
Instagram has emerged as a prominent platform for professional engagement in plastic surgery, enabling surgeons to educate, network, and promote their services. The aim of this study is to determine how widespread the professional use of Instagram is among German plastic surgeons and to describe the level of engagement on this platform. The professional Instagram use of all 1281 members of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) was analyzed in March 2022. Publicly identifiable Instagram accounts were assessed for activity metrics, such as the number of posts, followers, accounts followed, and types of content. Instagram use was analyzed in relation to clinical position, work setting, sex, and geographic location using descriptive statistics and χ2 tests. A total of 407 (31.8%) DGPRÄC members used Instagram to post professional content. Instagram use was significantly higher among practicing physicians (47.7%) compared with hospital-based surgeons (8.6%-20.8%, P < 0.001). The median number of posts was 65, with a median posting frequency of 1.8 posts per month. The median follower count was 653. Surgeons in city-states and those in private practice were significantly more active on Instagram. Nearly half of all accounts contained both professional and private content. Instagram is a common professional tool for plastic surgeons, particularly those in private practices and urban areas. Although professional engagement was evident, overall activity remained moderate in terms of post frequency and audience reach.
Botulinum toxin and fillers are among the most effective antiaging treatments in aesthetic medicine and modern plastic surgery. They serve to contour, model, and rejuvenate the face. The relatively long duration of action of these treatments, as well as the long-term positive impact of these materials, allows us to characterize them as helpful tools for aesthetic facial optimization. These substances complement each other and can be combined. The focus of such attractiveness-enhancing treatment concepts is the optimization of age-related changes while taking into account the three-dimensional proportions of the aging structures as well as the dynamics of the facial muscles and also respecting individual beauty. Botulinumtoxin und Filler zählen zu den effektivsten Anti-Aging-Verfahren in der ästhetischen Medizin und modernen plastischen Chirurgie. Sie dienen der Konturierung, Modellierung und Verjüngung des Gesichts. Die relativ lange Wirkungsdauer dieser Behandlungen sowie der langfristig positive „impact“ dieser Materialien erlauben uns, sie als hilfreiche „tools“ für die ästhetische Gesichtsoptimierung zu charakterisieren. Beide Substanzen ergänzen sich und können miteinander kombiniert werden. Im Fokus solcher attraktivitätssteigernden Therapiekonzepte steht die Optimierung altersbedingter Veränderungen, jedoch sowohl unter Berücksichtigung der dreidimensionalen Proportionalität der alternden Strukturen sowie der Dynamik der mimischen Muskulatur als auch unter Respektierung der individuellen Schönheit.
Lip augmentation using hyaluronic acid fillers is a popular cosmetic procedure; however, vascular complications remain a concern. The 11-point injection technique (11-PIT), combined with sonographic vascular mapping, enhances safety by guiding precise filler placement while achieving optimal aesthetic outcomes. A prospective study was conducted on 25 female patients (21-65 y) undergoing lip augmentation with Cleviel Volume hyaluronic acid filler. High-frequency ultrasound (Aplio-i700, Canon Medical Systems) was used to measure the depth of superior and inferior labial arteries at 6 key points before injection. The 11-PIT was performed to enhance specific lip landmarks while minimizing vascular risks. Postprocedure assessments included 3-dimensional imaging for volume changes, sonographic analysis for lip thickness and projection, and Global Aesthetic Improvement Scale surveys at 1, 3, and 6 months. The mean arterial depth at the midline of the upper and lower lips was 2.54 ± 1.89 and 1.91 ± 1.58 mm, respectively, increasing laterally. Lip volume increased immediately postinjection (0.96 ± 0.24 mL) and gradually declined to 0.58 ± 0.17 mL at 6 months. Upper lip thickness increased from 8.94 ± 1.16 to 10.98 ± 1.03 mm at 1 month before regressing. Lip corner elevation was measured at 1.21 ± 0.35 mm at 1 month. Global Aesthetic Improvement Scale scores remained favorable (3.28 ± 0.75 at 6 mo). No major complications occurred. The 11-PIT, combined with sonographic vascular mapping, provides a safe and effective approach for lip augmentation. This method minimizes vascular risks, enhances aesthetic outcomes, and offers reproducible results, supporting its adoption for safer lip enhancement procedures.
Nasal septal deviation is a common cause of nasal obstruction, and septorhinoplasty addresses both functional and aesthetic concerns. The role of endoscopic assistance in closed septorhinoplasty remains incompletely characterized. To compare conventional closed and endoscopic-assisted septorhinoplasty regarding functional and aesthetic outcomes, postoperative morbidity, and operative time. This prospective, randomized, single-blinded clinical trial included 50 patients randomized to conventional closed (group A) or endoscopic-assisted septorhinoplasty (group B). Outcomes included Nasal Obstruction Symptom Evaluation (NOSE) scores, FACE-Q Rhinoplasty Module, operative time, and postoperative morbidity (edema, ecchymosis, pain). Operative time was longer in group B (116.68 ± 7.02 vs. 90.96 ± 7.07 min; p < 0.001). Group B showed significantly greater NOSE score improvement at 1 and 6 months (p < 0.001). Aesthetic satisfaction was higher in group B at 1 month (p < 0.001) but comparable at 6 months. Postoperative edema, ecchymosis, and day-7 pain scores were significantly lower in group B (p < 0.05). Endoscopic-assisted septorhinoplasty offers superior early functional outcomes and reduced postoperative morbidity despite longer operative time, with comparable long-term aesthetic results. These findings support endoscopic assistance as a valuable adjunct for enhancing surgical precision and early recovery in septorhinoplasty.
Facelift surgery is increasingly performed in older adults, yet data on age-stratified risk remain limited. This study updates a prior 2011 single-surgeon series and evaluates whether advancing age, including age greater than 75 years, is associated with complications after facelift surgery. We retrospectively reviewed 10 years of consecutive primary or secondary facelifts by a single surgeon using extended SMAS or SMAS plication. Demographics, comorbidities, and operative details were recorded. Complications were classified as major (unplanned admission, reoperation, persistent motor nerve injury) or minor (outpatient-managed). Age was analyzed in five strata (less than 60, 60-65, 66-70, 71-75, and 76 or older) and at dichotomous cutoffs (66 years or greater, 71 years or greater, 76 years or greater). Multivariable logistic regression evaluated age-complication associations. 541 patients underwent facelift: less than 60 years (28%), 60-65 (24%), 66-70 (24%), 71-75 (17%), and 76 or older (7%). Major complications were rare (0.4%) and did not differ by age (p=0.08). Minor complications occurred in 7.6% of patients and were not associated with age on univariate (p=0.4) or multivariable analysis. On subanalysis, age was not associated with any complication (major or minor) after adjustment, including among patients older than 75 (OR 1.82 [0.51-5.19], p=0.3). In this single-surgeon cohort with strict preoperative screening and standardized management, facelift surgery remained safe across all age groups, including age greater than 75 years. Chronological age alone is therefore not an independent predictor of adverse events after rhytidectomy.
Dorsal preservation rhinoplasty aims to maintain the native dorsal roof while achieving aesthetic and functional goals comparable to structural dorsal hump reduction. This systematic review evaluates comparative outcomes, patient-reported measures, and complication patterns across techniques. A systematic search of PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL was performed from inception to November 1, 2025. Eligible studies included randomized trials, comparative cohorts, and case series with ≥ 10 patients and ≥ 6 months of follow-up. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2 and ROBINS-I. Outcomes included validated PROs, objective airway metrics, aesthetic assessments, and complications. From 487 records identified, 20 studies met inclusion criteria. Across randomized and nonrandomized comparative studies, dorsal preservation demonstrated aesthetic and functional results equivalent to structural dorsal hump reduction at 6-12 months. Patient-reported improvement (ROE, NOSE, SCHNOS) was consistently favorable in both groups. The only comparative objective airway study showed no significant differences in cross-sectional area or nasal volume. Complication and revision rates were low overall, with pooled recurrence and revision typically between 2-4%. Current evidence indicates that dorsal preservation rhinoplasty provides outcomes comparable to structural reduction in appropriately selected patients. Standardized reporting and more objective physiologic evaluations are needed.
Pulmonary fat embolism (PFE) is a serious complication of liposuction surgery, characterized by atypical clinical presentation and considerable diagnostic difficulty. Morphological examination of Bronchoalveolar Lavage Fluid (BALF) can provide critical evidence for diagnosis. This article reports a rare delayed-onset case, highlighting the diagnostic value of this examination and the importance of risk prevention and management in plastic surgery. A 25-year-old female was admitted with a 4-day history of chest tightness, which worsened after eating and at night. The patient had undergone liposuction surgery half a month prior. Laboratory findings revealed elevated D-dimer levels and decreased total protein and albumin. Chest Computed Tomography (CT) suggested chronic inflammation with fibroproliferative changes in the left lower lobe. Bronchiectasis was initially diagnosed; however, anti-infective therapy was ineffective. Microscopic examination of BALF revealed fat droplets and macrophages phagocytosing fat particles, with positive Sudan III staining. In conjunction with contrast-enhanced pulmonary CTA, the patient was ultimately diagnosed with pulmonary fat embolism secondary to liposuction. After receiving symptomatic and supportive treatment, the patient's symptoms resolved, and she was discharged. This case indicates that pulmonary fat embolism following liposuction is prone to being misdiagnosed. BALF morphological examination can effectively assist in early diagnosis and gain valuable time for treatment. Meanwhile, this case also reminds us of the significance of risk assessment in aesthetic and plastic surgery. Clinicians should remain vigilant regarding atypical postoperative symptoms to prevent missed diagnoses and misdiagnoses.
This study evaluates anthropometric outcomes of a modified Onizuka technique for unilateral cleft lip (CL) repair using 3-dimensional (3D) photogrammetry, with emphasis on anatomic subunit reconstruction without preoperative numerical measurements. A prospective cohort study was conducted at a tertiary craniofacial center. Sixty-one patients with unilateral CL and/or palate who underwent CL repair using the modified Onizuka technique were enrolled. The technique relocates key landmarks to the footplate of the medial crus, preserves an 80° angular design at the peak of Cupid's bow, and uses a V-Y advancement flap for frenulum reconstruction. Concurrent primary rhinoplasty and gingivoplasty were performed. Anthropometric symmetry was assessed via 3D imaging at ≥1-year follow-up, including nostril width, columellar height, central and medial lip height, lateral lip height and length, and hemi-Cupid's bow width. The cohort comprised 60.7% males, with 70.5% having left-sided clefts and 67.2% having complete clefts. Median age at surgery was 5.0 months. All intraclass correlation coefficient values exceeded 0.75, indicating good to excellent reliability. No statistically significant differences were observed between cleft and noncleft sides (all P>0.05). Mean differences were <0.2 mm, below the threshold of human visual perception. The modified Onizuka technique achieves symmetric outcomes in unilateral CL repair, validated by objective 3D metrics. Its emphasis on anatomic subunit reconstruction without preoperative numerical marking offers a versatile, reproducible approach for diverse cleft phenotypes.
The femme fatale has traditionally been examined as a visual archetype characterized by beauty intertwined with danger. Previous craniofacial analyses of Western portraiture demonstrated that depictions of femme fatales emphasize gaze intensity, orbital shadow, and structural contour rather than soft symmetry or luminosity. However, Western culture encodes archetypes not only visually but also acoustically. In 19th-century opera, central seductive and destructive female figures-such as Carmen, Dalila, and Amneris-are frequently written for mezzo-soprano rather than soprano. The mezzo-soprano voice is characterized by lower tessitura, greater chest resonance, and reduced overtone brilliance, producing a timbre perceived as mature, grounded, and authoritative. This editorial proposes that the femme fatale is consistently encoded across visual and acoustic domains through sensory depth rather than brightness. Chiaroscuro modeling in portraiture and timbral density in opera represent parallel strategies of archetypal construction. Recognizing such cross-modal structural patterns may broaden the scope of aesthetic medicine beyond brightness-centered youthfulness toward a more nuanced understanding of contour, maturity, and cultural symbolism. Beauty may be associated with luminosity, but power often resides in depth.
The optimal timing for surgical intervention in single-suture craniosynostosis (SSC) remains debated, despite advances in minimally invasive and open reconstructive approaches. This work integrates Children's National Medical Center (CNMC) institutional data with current literature to clarify age-related outcomes and guide timing recommendations. Published series from CMNC were analyzed and outcomes included perioperative morbidity, morphometric correction, intracranial pressure, and revision rates. Findings were contextualized with recent systematic reviews and multicenter data. Early endoscopic repair (≤ 4 months) yielded superior morphometric gains, lower blood loss, and shorter hospital stays. O'Brien et al. demonstrated a 2-4-month "sweet spot" for sagittal synostosis1, while Lajthia et al. confirmed excellent outcomes for metopic deformities in the same age range2. Open reconstruction at 9-12 months achieved durable aesthetic correction with low complication rates3. Delayed presentations were associated with elevated intracranial pressure but benefited from surgical decompression4. Meta-analyses corroborate these trends. CNMC's experience and global evidence converge on an early-infancy window (2-4 months) as optimal for endoscopic repair. Open cranial vault reconstruction remains effective for older infants or complex anatomy. Surgical timing should balance biological potential, institutional resources, and neurodevelopmental opportunity.
Free nipple-areola grafting (FNAG) is the most common approach for nipple-areola complex (NAC) reconstruction in transgender patients and is often performed in conjunction with double incision mastectomy for chest masculinization. Unwanted consequences of FNAG include graft failure, hypopigmentation as well as circular scarring around the areola. We developed a novel technique for NAC reconstruction using nipple punch grafts in conjunction with 3D areola tattooing (NPAT). Patient demographics and postoperative complications were reviewed. To compare aesthetic outcomes of NPAT with FNAG, postoperative images of both groups were distributed among public raters using the crowdsourcing platform Amazon MTurk. Raters were asked to rank the aesthetic appearance of each NAC on a 1-7 Likert scale. Eighteen patients (mean age 30 ± 10.74, mean BMI 27 ± 7.36) underwent double incision mastectomy together with NPAT for NAC reconstruction. Mean follow-up was 100 days after surgery. Postoperative complications such as graft loss, partial graft necrosis, hypertrophic/distended scarring were not observed. One patient demonstrated a loss of graft projection, and one patient developed partial graft depigmentation. Across the full sample of 895 public raters, NPAT received significantly higher aesthetic ratings than FNAG (NPAT 5.0 ± 1.5 vs FNAG 4.5 ± 1.8, p < 0.001), a pattern that persisted across different genders and age groups. The NPAT technique is a simple and effective approach to NAC reconstruction in transgender patients, combining the advantages of traditional FNAG and 3D tattooing. Our findings suggest that NPAT may provide an aesthetically superior NAC and potentially reduce complications associated with traditional FNAG.
Cleft lip and palate are frequently associated with disturbances in maxillary growth, and many patients require orthognathic surgery at skeletal maturity. This study aimed to characterize baseline craniofacial morphology and determine factors influencing the magnitude of planned orthognathic surgical movements in a Singaporean cleft cohort managed using virtual surgical planning (VSP). A retrospective cohort study was conducted, including non-syndromic cleft patients who underwent orthognathic surgery between 2020 and 2025 at a tertiary cleft center in Singapore. All procedures were planned using VSP and performed with customized cutting guides and fixation plates. Demographic variables, preoperative cephalometric parameters (SNA, SNB), and planned skeletal and dental movements were extracted from surgical planning records. Forty-four patients were included (20 males, 24 females). The median age at surgery was 20.24 years (IQR 19.67-22.46). Male patients underwent surgery at a significantly older age than females (22.21 versus 19.87 y, P < 0.001) and demonstrated greater baseline maxillary retrusion (median SNA 73.05 degrees versus 77.50 degrees, P = 0.007). Planned maxillary advancement was significantly greater in males for both A-point (8.18 ± 2.19 mm versus 5.88 ± 2.05 mm; P < 0.001) and maxillary incisor tip movement (7.55 ± 1.94 mm versus 5.25 ± 2.24 mm, P < 0.001). SNB differed significantly across cleft subtypes (P = 0.005), although the magnitude of planned surgical movements did not differ significantly between cleft phenotypes. These findings suggest that while sex and cleft phenotype influence baseline craniofacial morphology, planned orthognathic surgical movements remain broadly comparable across cleft subtypes within contemporary VSP workflows.
Breast-conserving therapy (BCT), consisting of lumpectomy followed by adjuvant radiation, provides oncologic outcomes equivalent to mastectomy for many patients with breast cancer. As survivorship increases, the demand for aesthetic restoration after BCT has grown; however, reconstructive strategies in this setting remain less standardized than those following mastectomy. Reconstruction after BCT presents distinct challenges due to partial tissue loss, nonuniform radiation injury, progressive fibrosis, and wide variability in patient expectations and tolerance for revision surgery. Consequently, mastectomy-based reconstructive algorithms are often insufficient for guiding care in this population. This review synthesizes contemporary reconstructive options following BCT through a personalized medicine framework, emphasizing patient-specific risk factors that influence technique selection, timing, and long-term outcomes. Key determinants include radiation exposure, breast morphology, comorbid conditions, prior breast surgery, and psychosocial preferences. Oncoplastic volume displacement, implant-based augmentation, fat grafting, and autologous reconstruction each demonstrate distinct risk profiles in the post-BCT tissue environment and require individualized application. Timing of reconstruction and willingness to undergo staged procedures play a central role in outcome durability and patient satisfaction. Across reconstructive strategies, revision burden emerges as a clinically meaningful, patient-centered outcome that is not adequately captured by traditional short-term complication metrics. A risk-informed approach that integrates individualized risk assessment with transparent counseling and shared decision-making may improve alignment between reconstructive planning and patient goals. Personalized reconstruction after BCT requires moving beyond technique-driven paradigms toward flexible, longitudinal care pathways. Future efforts should focus on developing BCT-specific predictive models and incorporating patient-reported outcomes to advance personalized reconstructive care.