A recent Plastic Surgery digest,
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Study Type: Systematic review and meta-analysis of placebo-controlled RCTs

Key Question: Does BoNT-A improve patient-reported aesthetic self-perception and related outcomes compared with placebo?

Key Findings:

• 65 unique RCTs (18,581 participants) contributed direct evidence; four homogeneous responder subsets were pooled, all favouring BoNT-A (RR 5.53-14.74, I² = 0% in each).
• Consistent improvement in satisfaction, patient-rated facial-line severity/bother, and perceived age/youthfulness (GRADE moderate); appearance-related psychological well-being low certainty; general quality of life/self-esteem very low.
• RoB 2: low risk in 60% of trials, some concerns in 40%.

Clinical Relevance: Provides moderate-certainty, placebo-controlled support for patient-perceived aesthetic benefit of BoNT-A, though claims of broader psychological or quality-of-life benefit (relevant to counselling and any commissioning discussions) remain poorly supported.

Limitations: Pooling was restricted to responder subsets, and the abstract does not report pooled continuous outcomes or durations, so effect size and duration of benefit remain unclear.

Study Type: Descriptive cross-sectional survey study (n = 360 women), with correlation and mediation analysis.

Key Question: Is genital self-image associated with psychological resilience, and does happiness mediate this relationship?

Key Findings:

• Genital self-image (FGSIS) correlated positively with happiness (r = 0.252) and resilience (r = 0.231); happiness correlated with resilience (r = 0.434) (all p < .001).
• Happiness partially mediated the FGSIS–resilience association: direct effect β = 0.152, indirect effect β = 0.119, total effect β = 0.271.
• Parity correlated negatively with genital self-image (r = -0.409) and happiness (r = -0.344).

Clinical Relevance: This offers limited context for psychological assessment in women presenting for genital aesthetic procedures (e.g. labiaplasty), though it does not assess surgical outcomes or inform NHS commissioning thresholds.

Limitations: The cross-sectional design precludes causal inference, and the abstract does not state whether participants were surgical patients or the general population, nor does it report the logistic regression findings on surgical attitudes suggested by the title.

Study Type: Systematic review and meta-analysis (19 predominantly small case series; random-effects model)

Key Question: Is single-stage nipple-sparing mastectomy with concurrent mastopexy and implant-based reconstruction safe in patients with ptosis or macromastia?

Key Findings:

• Pooled 1,076 breasts (mean age 48.1 years, BMI 27.2, specimen weight ~701 g); most used Wise-pattern skin resection (70%), with heterogeneous dermal pedicle designs.
• Pooled complication rates: partial NAC necrosis 5.9% (95% CI 3.0–9.5%), total NAC necrosis 0.9% (0.0–2.4%), mastectomy flap necrosis 3.1% (0.7–6.6%).
• Authors conclude the approach is safe in favourable, highly selected patients.

Clinical Relevance: Supports considering NSM with simultaneous mastopexy, rather than staged procedures or NAC sacrifice, for selected ptotic patients, which may reduce operations and NHS theatre use.

Limitations: Evidence derives from small, heterogeneous, likely selection-biased case series, with no aesthetic or patient-reported outcomes and no objective selection criteria (e.g. BMI, specimen weight thresholds) defined.

Study Type: Phase 3, double-blind, randomised (3:1), placebo-controlled trial (industry-sponsored pivotal study; sponsorship not stated in abstract).

Key Question: Is trenibotulinumtoxinE (botulinum neurotoxin serotype E, 700 U) effective and safe for moderate-to-severe glabellar lines in toxin-naive and toxin-experienced adults?

Key Findings:

• Day 7 composite responder rate (FWS grade 0/1 with ≥2-grade improvement, investigator and participant rated): 60.0% vs 0.6% placebo (P < .0001).
• Onset from Hour 8; peak effect at Day 7; return to moderate-to-severe severity by Day 21.
• Satisfaction with natural-looking results at Day 7: 78.5% vs 9.0% placebo. Most adverse events were mild, non-serious and unrelated to treatment.

Clinical Relevance: A rapid-onset, short-duration serotype E toxin may suit patients wanting a "trial" of toxin or fast results, but it is not licensed in the UK, and the ~3-week duration limits its practical value compared with serotype A agents.

Limitations: Placebo-only comparison with short follow-up (effect resolved by Day 21), so there is no head-to-head comparison with licensed serotype A toxins and no long-term or repeat-dose safety data.

Study Type: Scoping review of original empirical studies (26 included, 2019–2026).

Key Question: How has AI been applied to social media, online reviews and other public digital data to study patient and public perceptions in plastic surgery?

Key Findings:

• Research output is accelerating: 19/26 studies (73%) were published since 2024. Facial aesthetic surgery (35%) and RealSelf (31%) dominated; 69% analysed a single platform and 69% text only.
• Sentiment/emotion analysis was the commonest method (50%); 62% used pretrained models or lexicons without training on study data.
• Validation was weak: a human comparator was reported in 38% and external validation in only one study (4%). None linked digital data to a validated PROM or assessed surgical education.

Clinical Relevance: Patient expectations are increasingly shaped by online content, including AI-generated material, so UK clinicians should treat current AI-derived "patient perception" findings as hypothesis-generating rather than practice-informing.

Limitations: The abstract does not describe search strategy or quality appraisal, and the included literature is largely descriptive, single-platform and unvalidated.

Study Type: Retrospective single-practice case series (consecutive cases, Level 4 evidence)

Key Question: Can extended abdominoplasty (with flank excision and circumferential liposuction) be performed safely as a drainless, outpatient procedure?

Key Findings:

• 164 patients (mean BMI 28.4; 43.3% post-bariatric) had a mean operative time of 210 min; 26.2% had combined procedures, mostly breast surgery.
• Overall complication rate was 15.9% (26/164): 25 surgical-site complications managed as outpatients; one systemic complication (Ogilvie syndrome) needed admission.
• Greater weight loss (P = .045) and higher excised tissue weight (P = .040) were associated with complications; no demographic or operative variables were.

Clinical Relevance: Supports day-case pathways for circumferential body contouring, which may help NHS post-bariatric services facing limited inpatient capacity, though NHS funding and patient selection criteria differ.

Limitations: Retrospective single-surgeon-practice design without a comparator group, and likely private-practice case selection, limits generalisability and causal inference.

Study Type: Retrospective case series (39 patients, 2010–2021; Level IV evidence).

Key Question: Can bilateral horizontally advanced "∏" flaps, pedicled on the palpebral marginal arterial arch, reliably reconstruct full-thickness eyelid defects with marginal loss?

Key Findings:

• All 39 flaps survived, with satisfactory functional and aesthetic outcomes reported.
• One minor complication (dry eye, n=1), improved by 6 months.
• The authors propose applicability to defects involving 1/6 to 1/2 of the upper or lower eyelid, extending no higher than the upper tarsal border.

Clinical Relevance: This offers a single-stage, local-tissue option for moderate-to-large full-thickness eyelid defects (e.g. post-tumour excision) that could reduce reliance on staged flaps or grafts in oculoplastic and skin cancer reconstruction.

Limitations: Uncontrolled single-centre series with no comparator, and the abstract gives no objective outcome measures, follow-up duration or defect aetiology breakdown, so the "satisfactory" outcomes cannot be independently judged.

Study Type: Preclinical experimental study (in vitro cell assays plus in vivo streptozotocin-induced diabetic mouse model).

Key Question: Does a photocrosslinkable porcine dermal dECM hydrogel loaded with Schwann cell conditioned medium (dECMMA@RC) improve healing of full-thickness diabetic wounds?

Key Findings:

• In vitro, dECMMA@RC increased fibroblast (L929) proliferation and migration and HUVEC tube formation versus control and unloaded dECMMA, with no obvious cytotoxicity.
• In diabetic mice, it accelerated wound closure, improved re-epithelialisation, and increased regenerated hair follicles and sebaceous glands. Quantitative effect sizes were not reported in the abstract.
• Tissue qPCR showed reduced IL-6 and TNF-α, and increased CD31, VEGF-A, GAP43 and NGF expression.

Clinical Relevance: Early-stage work on a bioactive dressing that targets the neuropathic and angiogenic deficits of diabetic wounds, relevant to NHS diabetic foot burden, but it has no current clinical applicability.

Limitations: Findings are limited to a murine type 1 diabetes model and an immortalised rat Schwann cell line, with no human data, and the abstract gives no effect sizes or safety and immunogenicity data.