Publications by Type: Journal Article

BACKGROUND: Filler injections are one of the most common minimally invasive cosmetic procedures. Some of the related adverse effects remain unexplored, such as kidney-related complications. This systematic review aims to summarize the cases of patients who developed kidney disease after filler injections.

METHODS: The study protocol followed the PRISMA guidelines. Multiple online databases were used in this review. Eligible studies included cases of patients who developed any kidney-related complication after filler injections. A two-stage screening process was conducted for study selection. Data extraction focused primarily on kidney complications.

RESULTS: Twenty-nine patients were identified, from 18 case reports and 4 case series. The most frequently injected anatomical site was the buttocks (72.41%, n=21). The three most identified fillers included silicone (51.72%, n=15), methacrylate (31.03%, n=9), and oil (17.24%, n=5). Notably, the status of the practitioner who administered the injections was reported as a non-medical professional in six articles. The most common reported kidney-related complication was chronic kidney disease (CKD), affecting 55.17% (n=16) of patients. Most patients received treatment through hydration (68.97%, n=20) and steroids (68.97%, n=20), while surgery was performed in 20.69% (n=6) of cases. After the renal complication, 37.93% (n=11) patients achieved remission, 20.69% (n=6) patients developed CKD, and 10.34% (n=3) patients died.

CONCLUSIONS: This study described 29 patients who developed renal complications after filler injections. The prevalence of unlicensed or unidentified practitioners performing these procedures could increase the risk of severe outcomes. This underscores the need for stringent regulations and education.

NO LEVEL ASSIGNED: 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: Many patients seek body contouring surgery (BCS) to address excess skin following significant weight loss (WL), including from GLP-1 receptor agonists such as semaglutide. Optimal BCS timing is crucial, as postoperative weight fluctuations can distort outcomes. While weight stabilizes 12-18 months after bariatric surgery, the timeline for semaglutide-associated WL is less clear, particularly with weight recurrence (WR) after drug discontinuation METHODS: A systematic review of MEDLINE, Embase, Web of Science, and PubMed was performed. Randomized controlled trials (RCTs) and prospective observational studies measuring weight change over time with semaglutide use were included. Time to weight loss plateau (WLP), defined as ≥1 month with WL <3%, was calculated. WR, defined as ≥25% WL regained, was calculated for studies including drug discontinuation, and meta-analysis was performed RESULTS: Of 555 studies, 12 met inclusion criteria (n=13,947 patients). WLP occurred at 53.0±8.2 weeks at 16% (±3.1%) WL, deviating from greatest on-treatment WL by 2% (±0.7%) and end-of-treatment WL by 1% (±1.2%). Two studies assessed WR following drug discontinuation. WR occurred at 12 weeks and 24 weeks post-discontinuation. By the end of the observation period, participants regained 62.7 and 74.3% of greatest on-treatment WL, respectively CONCLUSION: This systematic review and meta-analysis suggests weight stabilizes after 8-12 months of semaglutide use, at which time BCS may be appropriate. This timeline is slightly earlier than post-bariatric surgery. However, given initial data indicating weight recurrence exceeding 50% after drug discontinuation, surgeons should approach BCS cautiously until further research clarifies the impact of WR on surgical outcomes.

NO LEVEL ASSIGNED: 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: Most deaths after outpatient plastic surgery are because of thromboembolic events, particularly pulmonary embolism (PE). The effectiveness of QUAD A deep vein thrombosis (DVT) safety measures after recent policy changes remains undocumented.

OBJECTIVES: The aim of the authors of the study is to assess how adherence to DVT prophylaxis guidelines affects complications and mortality in QUAD A facilities.

METHODS: Using the Patient Safety Data Reporting database, we retrospectively assessed DVT, PE, and mortality rates in adult patients at QUAD A facilities from 2019 to 2023, with subgroup analysis of plastic surgery centers. The authors analyzed demographics and complications relative to facility protocol compliance using descriptive statistics and regression analyses.

RESULTS: The authors identified 3,338,519 surgeries and 247 DVT/PE events. Facility-level deficiencies in DVT/PE prophylaxis ranged from 7.4% to 14.17%; peak deficiencies coincided with the highest complications and mortality. Among DVT/PE patients, 67 underwent plastic surgery (mean age 47.7 years, standard deviation [SD: 11.8]; mean BMI 29.2 kg/m2, [SD: 7.7]); 94% were women. The mean operative time was 220.4 min (SD: 115.9), with 98.5% of procedures under general anesthesia and nearly half of patients (49.3%) hospitalized postoperatively. Liposuction was most commonly associated with complications (38.8%), followed by multiple procedures (23.9%). Within plastic surgery, cosmetic procedures accounted for 73.1% of complications. Statistical analysis showed an association between liposuction and DVT/PE occurrence, with more favorable outcomes for cosmetic procedures (P = .038).

CONCLUSIONS: Following a QUAD A policy change, DVT/PE rates peaked alongside DVT/PE prophylaxis deficiencies. Based on the findings of this study, the authors suggest considering a standardized prophylaxis and preoperative evaluation to reduce morbidity and mortality. Liposuction patients may be at higher risk for these complications.

BACKGROUND: Microneedling (MN) has risen in popularity as a non-surgical treatment option for facial skin aging. We aimed to evaluate patient-reported outcomes (PROMs) and safety profiles associated with MN.

METHODS: A systematic review was conducted adhering to PRISMA guidelines. Articles were screened for relevance in a two-stage process. Descriptive statistics and a proportion meta-analysis was utilized for patient satisfaction using Stata statistical software.

RESULTS: Of 346 studies identified, a total of 21 articles reporting outcomes of 723 patients undergoing MN for facial rejuvenation were included for review and meta-analysis. The patient cohort was majority female (72%), and the average age was 48 years. The most common esthetic study endpoints were wrinkling (71%, 15/21), skin texture (33%, 7/21), photoaging (29%, 6/21), and skin laxity (14%, 3/21). The majority of trials (90%, 19/21) treated patients with multiple MN sessions, and these studies' treatment schedules also varied by number and timing of sessions. Pooled meta-analysis revealed that 83% of patients reported satisfaction with their treatment (95% CI [0.76; 0.88]). The most common reported adverse effects were transient erythema (6.8%), scaling (1.7%), burning sensation (1.5%), and pruritus (0.4%).

CONCLUSION: Our meta-analysis revealed that MN is associated with high patient satisfaction and low rates of adverse events. High patient satisfaction coupled with a low incidence of adverse events supports MN as a viable non-surgical treatment option for facial rejuvenation. However, the lack of standardized measures for esthetic outcomes warrants continued research to better determine its efficacy in treating signs of facial aging.

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.

OBJECTIVES: Deep Inferior Epigastric Perforator (DIEP) flaps are a preferred type of autologous breast reconstruction because of their relatively low rate of donor site complications. Comorbidities, such as cardiovascular disease (CVD) and hypertension (HTN), influence the rate of post-operative complications, leading to increased length of stay (LOS). The Nationwide Readmission Database (NRD) compiles readmission and LOS data in the USA. We aim to investigate the relationship between CVD and cardiovascular risk factors and the LOS after DIEP flap.

METHODS: The NRD was queried from 2016 to 2020 using ICD-10 codes for DIEP flaps. The resulting dataset was analyzed for congestive heart failure (CHF), hypertension, obesity and diabetes. Multivariate regression analyses were performed to evaluate the influence of CVD on LOS.

RESULTS: A total of 23,319 cases were identified; the average LOS without comorbidities was 4.15 days. Complicated HTN increased LOS by 1.17 days while uncomplicated HTN, CHF, complicated diabetes, morbid- and moderate obesity all significantly increased the length of stay by 0.09, 0.64, 0.40, 0.29 and 0.24 days, respectively (P<0.05). Out of 20,423 patients, 872 were readmitted within 90 days (4.3%). Main reasons for readmission were infection (83.8%), vascular complications (12.7%) and seroma (8.3%). Flap failure occurred 6 times.

CONCLUSION: Results show that CVD increased the LOS after DIEP flap, with complicated HTN increasing LOS most by 1.17 days. This is clinically relevant due to the rising cost of healthcare and the shortage of healthcare workers.