Publications

INTRODUCTION: Hernia repairs are the most common surgical procedures in the United States, with a significant financial burden primarily attributed to emergent presentations and postsurgery complications. This study aimed to examine race differences on postoperative outcomes.

METHODS: American College of Surgeons National Surgical Quality Improvement Program database was queried to identify ventral hernia repair (VHR) cases from 2016 to 2021, with a subgroup of patients undergoing component separation (CS). Statistical analysis utilized multinomial regression to compare outcomes across racial groups, generating weighted cohorts with balanced covariates to assess differences between groups.

RESULTS: 288,515 patients were initially identified. Of these, 120,017 underwent VHR and 8732 VHR with CS. After weighting for the different groups, there were no differences in demographics or comorbidities between the racial groups for both cohorts. When evaluating postoperative complications after VHR, others (American Indian or Alaskan Native, Asian, Native Hawaiian, or Pacific Islander) had the highest rate of organ or space surgical site infection (SSI) (P < 0.001). Hospitalization >30 d was the lowest in Whites (0%), compared to Blacks (1%, P = 0.003) and others (1%, P < 0.001). For patients in the VHR with CS group, significant differences were noted in organ or space SSI (others 8%, P = 0.005), return to the operating room (others 13%, P = 0.015), hospitalizations >30 d (others 4% P = 0.002), and total LOS (others 5 [IQR 3,8], P = 0.004).

CONCLUSIONS: Despite advancements in surgical techniques, racial differences in VHR outcomes persist. These include higher rates of complications such as SSIs, higher rates of return to the operating room, and extended hospital stays among racial groups.

BACKGROUND: The literature on patient-reported outcomes (PROs) discussing dorsal preservation rhinoplasty (DPR) and component dorsal hump reduction (CDHR) is scarce. This study aims to fill the gap in PROs between these techniques.

METHODS: A systematic review was conducted to investigate PROs of DPR and CDHR. A proportion meta-analysis was conducted using Stata statistical software.

RESULTS: A total of 25 studies met our inclusion criteria, pooling 1706 participants, with 13 studies on CDHP and 12 studies on DPR. Overall satisfaction rates were high, varying from 84% to 100% across studies. A subgroup analysis revealed that both techniques exhibited equally high satisfaction with no statistical differences (P = 0.18). A random-effects model revealed that about two of 100 treated patients underwent revisions across our cohort (95% interquartile range: 0-4). Notably, the CDHR technique was associated with a significant 53.7-point reduction in the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS)-cosmetic domain [95% confidence interval (CI): -62.7 to -44.8, P < 0.001], along with a meaningful improvement in SCHNOS-obstructive scores by -27.3 points (95% CI: -50.5 to -4.04, P = 0.02). Conversely, the DPR was linked to a 55.3-point reduction in the SCHNOS-cosmetic domain (95% CI: -60.7 to -49.9, P < 0.001), and a -19.5 point change in the SCHNOS-obstructive domain (95% CI: -27.9 to -11.1, P < 0.001).

CONCLUSION: Although PROs are comparable, the literature suggests that CDHR outcomes may be better than DPR in alleviating obstructive symptoms, potentially offering an evidence-based choice for addressing functional concerns in rhinoplasty.

Introduction: The purpose of this study was to understand the perceptions of potential complications and motivations among patients willing to travel internationally for cosmetic surgery and to gain insight into public perceptions of cosmetic surgery tourism by surveying a large, cross-sectional sample of the general public. Methods: A cross-sectional survey was performed through Amazon Mechanical Turk regarding cosmetic surgery tourism in adults 18 years and older and currently residing in the United States (US). Results: A total of 484 responses were analyzed. Of those, 45.2% of participants would consider having plastic surgery. Among these participants, 67.1% would consider traveling outside of the US to receive cosmetic surgery. Participants who reported Hispanic or Latino ethnicity had increased odds of considering surgery abroad (OR 3.1, 95% CI 1.1-8.7, P = .030). Participants reported that the top advantages of traveling outside of the US for surgery were the price of surgery internationally, a shorter waiting list for surgery, and privacy during recovery. The top disadvantages were the risk of complications, lack of follow-up or continuity care after surgery, and distance from home. Although the risk of complications was acknowledged as the top disadvantage, the perceived safety of receiving plastic surgery abroad was not related to willingness to consider having surgery abroad (P = .268). Conclusion: These findings support the need for continued awareness of patients considering international travel for cosmetic surgery and increased education of the general public regarding the safety of cosmetic surgery tourism and the importance of selecting board-certified plastic surgeons and accredited facilities.

BACKGROUND: The popularity of cosmetic tourism may increase unnecessary risks for patients as postoperative care is variable. However, little is known about the current trends and public perception of this growing phenomenon. This study compares interest in cosmetic tourism in popular medical tourism destinations relative to the US.

METHODS: Google Trends was queried from October 2017 to September 2023, examining trends over the full period and dissecting changes between 2017-2020 and 2020-2023. Search volume data were retrieved for the top international countries and the US for each of the top five cosmetic procedures, according to the ISAPS 2022 Global Survey. A p value < 0.05 was used for statistical significance.

RESULTS: Searches for liposuction, blepharoplasty, breast augmentation, mastopexy, and abdominoplasty were compared between the US, Mexico, Turkey, Thailand, and Colombia. Google Trends data mirrored the prevalence of the two most common procedures, liposuction, and breast augmentation. Differences in interest regarding liposuction were greatest in Mexico, Thailand, and Turkey compared to the US (p < 0.05). Medical tourism for blepharoplasty had the highest search interest scores for Turkey and Thailand from 2017 to 2023 (p < 0.05). Significant differences were also consistent across all time intervals for breast augmentation, mastopexy, and abdominoplasty, with higher interest in Mexico and Turkey (p < 0.05).

CONCLUSIONS: Google Trends analysis serves as an insightful tool for understanding cosmetic tourism. Changing trends bring the potential to assess worldwide versus country-specific procedure interest. These observed trends may foreshadow future international aesthetic procedure trends.

NO LEVEL ASSIGNED: 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.

BACKGROUND: Before and after (B&A) photographs are a sensitive part of patients' medical records, and the use of smartphones may pose risks to confidentiality and comfort. The purpose of this study was to assess patient comfort depending on the circumstances under which these photographs being taken.

METHODS: Amazon's Mechanical Turk crowdsourcing service and REDCap's survey manager were used to recruit survey participants. An anonymous survey was distributed to ascertain demographics and comfort in various B&A scenarios using a five-point Likert scale. T tests and ANOVA testing were used to compare groups.

RESULTS: There were 411 respondents with an average age of 36.1 years old. Of them, 46% were female and the majority were White (90%) and non-Hispanic (64%). Nearly one-third had previously undergone plastic surgery, with 80% receiving B&A photography. Surgeons took these photographs 51% of the time with similar rates of smartphone cameras use (47%) versus professional cameras (52%). The public had similar levels of comfort when a nurse or a surgeon took the clinical photographs (p = 0.08). Patients were significantly less comfortable when non-medically trained office staff captured their photographs (p = 0.0041). The public had similar comfort levels with the use of smartphones and professional cameras when dressed but were significantly less comfortable with the use of a smartphone when unclothed (p = < 0.001).

CONCLUSION: To ensure the best patient experience, B&A photography should be taken by a medical professional. If photographs are to be taken when the patient is unclothed, the use of a professional-grade camera may help ease patient discomfort.

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 .

BACKGROUND: The creation of postoperative rhinoplasty results that appear natural and proportional to the face are crucial for patient satisfaction. The purpose of this study was to assess the public's ability to detect a post-rhinoplasty result and preference of preoperative and postoperative rhinoplasty outcomes.

METHODS: A survey was distributed using the Amazon Mechanical Turk online platform showing nine preoperative and postoperative rhinoplasty patients. Participants rated aesthetic appearance, identified areas of abnormality, and stated whether they believed the patient had undergone prior rhinoplasty.

RESULTS: A total of 456 responses were included. On a scale of 1-5 with 5 being the most aesthetically pleasing, the highest rated nose was a postoperative patient without visible deformities (3.95, SD 1.07) followed by the postoperative patient with a resultant bulbous tip (3.48, SD 0.96). The lowest ranking noses were the prior rhinoplasty with resultant saddle nose deformity (3.02, SD 1.19) and the prior rhinoplasty with nasal trapezoid deformity (2.95, SD 1.04). The public was able to correctly determine if patients had prior rhinoplasty surgery only if there were resultant defects. When respondents believed that the patient had undergone prior rhinoplasty, their average rating was lower than those who believed they had not undergone surgery (3.74/5 vs. 4.15/5, p < 0.0001).

CONCLUSIONS: The belief that someone had previously undergone rhinoplasty led the public to rate the aesthetic appearance of the nose lower. To provide optimal results following rhinoplasty, surgeons may therefore seek to provide a natural, "un-operated" look.

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 . Differences for nasal aesthetic preferences exist and vary based on geographic region The public is unable to discern if a patient previously underwent rhinoplasty if the result does not show a postoperative defect, such as a dorsal hump, over-rotated tip, or mid-vault collapse Oppositely, the public can generally tell if patients have undergone rhinoplasty surgery if a postoperative deformity is present The belief that someone had rhinoplasty surgery negatively impacts the attractiveness ranking of the nose, even without any postoperative defects present.

BACKGROUND: As social attitudes toward plastic surgery continue to evolve, the prevalence of men seeking plastic surgery has been increasing. By delving into the factors that encourage male patients to seek plastic surgery and the obstacles they encounter, this study aims to facilitate the development of more inclusive and effective approaches for this population.

METHOD: An anonymous 41-question survey was conducted among adult men in the USA via the Amazon Mechanical Turk crowdsourcing platform. Questions assessed demographic information and identified factors that influenced males to seek plastic surgery care, the barriers they experienced while seeking care, and their preferences. Multivariate logistic regression was used to assess relationships between demographic variables and likelihood of undergoing cosmetic surgery.

RESULTS: Four hundred and eleven complete responses were analyzed. The median (IQR) age of respondents was 32 (30, 40) years old. Of the respondents, 60% had undergone cosmetic surgery. Functional improvement (40%), personal aspiration (32%), and partners' opinions (22%) were the most commonly cited reasons for undergoing procedures. The most common barriers faced by this population were recovery time following a procedure (52%), perceived risk of complications (48%), cost (43%), fear of being identified as having had plastic surgery (32%), and surgeons not being able to meet expectations (31%). Eighty-nine percent of respondents who underwent plastic surgery procedures reported facing at least one barrier. Multivariate regression demonstrated that higher education levels were strongly associated with a likelihood of undergoing cosmetic surgery (p < 0.001). Income (p = 0.44) and region (p = 0.23) did not significantly affect the likelihood of undergoing plastic surgery.

CONCLUSION: Despite improving societal stigma, many male patients continue to face barriers when obtaining plastic surgery care. Efforts may be made to alleviate these barriers and surgeons looking to expand their practice may benefit from increased outreach to male patients. This may be compounded with improved education targeting stigma and risks of procedures, increasing male-specific marketing communications to make them feel welcome in an industry predominantly focused on female patients, and offering male-tailored procedures.

NO LEVEL ASSIGNED: 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 .

BACKGROUND: The Plastic Surgery Central Application (PSCA), designed to provide an equitable and streamlined application for both applicants and programs, was first designed in 2019, piloted in the 2020-21 application cycle, and is now in its fourth cycle in 2023-24. It has included preference signaling since the 2022-23 cycle, a feature in which applicants can send five "signals" to programs to express interest. We surveyed both program directors (PDs) and applicants following the 2023 match on their perceptions of PSCA versus Electronic Residency Application Service (ERAS).

METHODS: Surveys were deployed to applicants from three integrated plastic surgery programs during the 2022-23 cycle and all PDs. Respondents were asked basic demographic information, which application system they preferred: PSCA or ERAS, how well they were able to highlight/evaluate different areas of the application, and about their experiences specifically with preference signaling.

RESULTS: Forty-two (48%) PDs and 93 (29%) applicants responded. Most PDs (72%) and applicants (59%) preferred PSCA, with only 18% and 27% preferring ERAS. The remainder had no preference. Ninety-three percent of applicants reported that the cost savings of the PSCA were important. Most applicants (78%) and PDs (80%) were in favor or strongly in favor of the preference signaling program.

CONCLUSIONS: Most applicants and PDs prefer PSCA over ERAS. These data, in conjunction with the cost savings, suggest that the PSCA may be a better alternative for the integrated plastic surgery match. Future analyses of these application systems will help provide the best application for prospective residents.

PURPOSE: The choice of pedicle in reduction mammaplasty is highly variable with prior studies demonstrating high patient satisfaction in most cases. This study aimed to examine the impact of pedicle type on clinical and patient-reported outcomes in patients undergoing reduction mammaplasty.

METHODS: A total of 588 patients underwent bilateral reduction mammaplasty with Wise pattern or modified Robertson incision by 13 surgeons at a single institution. Clinical outcomes were compared according to the pedicle type in all patients and BREAST-Q responders (32% response rate). Survey respondents were sub-grouped by resection volume, and the BREAST-Q satisfaction scores were compared.

RESULTS: Among all included reduction mammoplasties, 439 (75%) were performed using inferior pedicles, and 149 (25%) using superior or superomedial pedicles. Responders and non-responders were similar in preoperative characteristics including age, body measurements, and comorbidities. Although a higher incidence of infection occurred among the responders, clinical outcomes were comparable across all pedicle types. A total of 187 patients completed the BREAST-Q. Compared to the superior pedicle group, respondents in the inferior pedicle group reported higher nipple satisfaction, even when adjusted for resection weight over 500 g. In contrast, the superior pedicle group had better sexual well-being scores, which persisted in resection weight less than 500 g (all p values <0.05).

CONCLUSION: Inferior pedicles were associated with greater nipple satisfaction and superior pedicles were associated with greater sexual satisfaction. Our findings suggest that those with resections less than 500 g were more satisfied with superior pedicles whereas those with greater resections were more satisfied with inferior pedicles.