Southern medical journalEmmanuel Giannas, Barite Gutama, Vignesh Chennupati, Franklin Gergoudis, William C Lineaweaver, Jordi Puente Espel
OBJECTIVE: Access to surgical specialists often is influenced by the geographic distribution of the workforce. Limited data describing the plastic surgery workforce in Tennessee exist. This study aimed to describe the county- and region-level distribution of the plastic surgery workforce in Tennessee. METHODS: A cross-sectional descriptive study was conducted. State- and county-level population estimates were obtained from US Census data. The names and practice locations of board-certified plastic surgeons were obtained from the American Medical Association physician directory and validated via the American Board of Plastic Surgery online database. Descriptive statistics were used to summarize surgeon counts and county-level and regional densities. RESULTS: The number of plastic surgeons practicing in Tennessee was 137. Sixty plastic surgeons (43.8%) practiced in the Nashville metropolitan area, and 36% of the state population lived in counties without direct access to plastic surgery services. The statewide plastic surgery workforce density was 1.98 plastic surgeons per 100,000 population. Washington County had the highest surgeon density at 4.29 plastic surgeons per 100,000 followed by Knox County, with 4.14 plastic surgeons per 100,000 population. CONCLUSIONS: Plastic surgeons in Tennessee are concentrated in metropolitan regions, with limited availability across the state. More than one-third of the state's population lives in counties without direct access to plastic surgery services. The results of this study highlight potential disparities in access to plastic surgery care for residents of rural counties in the state of Tennessee, which account for the majority of the state's territory.
The Journal of international medical researchAyse Konac
ObjectiveGenital aesthetic surgery, within the broader domain of female genital cosmetic surgery, has become increasingly visible in clinical practice. However, descriptive data on patient characteristics and self-reported motivations remain limited. This study describes the demographic profile, psychosocial context, motivations, and procedural patterns among women undergoing genital aesthetic surgery in Turkey.MethodsThis descriptive cohort included 927 consecutive women who underwent genital aesthetic surgery between 2017 and 2024. Data were collected during clinical evaluation using a structured questionnaire and medical records, including lifestyle factors, partner-related decision context, psychiatric history markers, motivations, procedure type, and post-treatment status. Analyses were purely descriptive, with continuous variables reported as mean ± SD and median.ResultsThe mean age was 42.0 ± 12.4 years, and 62.4% were married. Educational attainment most commonly reflected an associate degree (45.5%). Current smoking was reported by 629 of 927 participants (67.9%), alcohol use by 32.4%, and a history of prior cosmetic surgery by 33.1%. A psychiatric diagnosis was documented in 10.0%, and psychiatric medication use in 11.4%. Partner involvement was frequent: 64.2% presented at their spouse's request; decisions were self-driven in 53.0%, partner-driven in 32.6%, and joint in 14.5%. The most commonly endorsed motivations were personal aesthetic concern (63.0%) and relationship anxiety/relationship repair (38.0%). The most frequent procedures were perineoplasty + vaginoplasty (24.3%). Recorded post-treatment status was categorized as successful in 76.9%, with wound-healing problems (9.8%) and unrealistic expectations (6.0%) among the most common nonsuccess categories.ConclusionIn this large descriptive cohort, genital aesthetic surgery was commonly pursued in mid-adulthood and often occurred within partner-related decision-making contexts, with motivations frequently spanning aesthetic, relational, and functional domains. These findings support the clinical importance of autonomy-sensitive counseling, expectation management, and structured psychosocial documentation in routine genital aesthetic surgery care.
Three-dimensional (3D) bioprinting is an evolving biofabrication approach in regenerative medicine with the potential to overcome many limitations of conventional reconstructive techniques, including donor-site morbidity, limited tissue availability, and suboptimal restoration of form and function. Recent advances in biofabrication have accelerated the development of patient-specific living constructs for reconstructive applications. This narrative review synthesizes contemporary evidence on the use of 3D bioprinting in reconstructive surgery, emphasizing developments most relevant to plastic surgery. The current literature on bioprinting technologies, bioinks, tissue-specific applications, translational studies, and regulatory considerations was critically reviewed. Significant progress has been achieved in the bioprinting of skin, cartilage, bone, osteochondral tissues, vascularized constructs, and composite craniofacial tissues. Advances in extrusion-, inkjet-, laser-, and stereolithography-based printing, together with increasingly sophisticated natural and synthetic bioinks, have improved construct fidelity, cellular viability, and tissue-specific functionality. In situ bioprinting, patient-specific computer-aided design, and hybrid biomaterial strategies have further expanded the clinical potential of bioprinted tissues. Despite these advances, major barriers remain, including inadequate vascularization of large constructs, limited mechanical maturation of load-bearing tissues, manufacturing standardization, regulatory uncertainty, and the absence of robust long-term clinical outcomes. Three-dimensional bioprinting is enabling increasingly personalized tissue fabrication, although most applications remain preclinical. Clinical translation will require further advances in biomaterials, vascular engineering, manufacturing standardization, and regulatory science.
Facial plastic surgery clinics of North AmericaRyan C Kelm, Cameron Chesnut
The traditional "rest and wait" approach to surgical recovery is being replaced by proactive biohacking strategies designed to optimize patient biology. This paper explores "pre-covery" and postoperative protocols that modulate systemic stress responses and facilitate repair. By integrating modalities such as hyperbaric oxygen therapy, pulsed electromagnetic field therapy, and photobiomodulation, surgeons can actively accelerate tissue repair and improve aesthetic outcomes. Coupled with supplementation and emerging regenerative peptides, these strategies represent a paradigm shift toward a more thoughtfully planned perioperative recovery approach in facial plastic surgery.
BACKGROUND: Algorithm-driven social media platforms such as TikTok are increasingly creating stratified layers in the cosmetic medical market, thereby influencing patient decisions and safety. In Taiwan, TikTok has 2 parallel markets: one is a formal tier promoting "cosmetic surgery tourism" to the public and the other is an underground tier targeting Southeast Asian migrant workers, providing informal, high-risk services. OBJECTIVE: In this study, we quantified the clinical risks embedded within these hierarchical markets and demonstrated how digital platforms exacerbate health inequalities through algorithm-driven social media content delivery. METHODS: We conducted a dual-track content analysis of 60 TikTok videos (n=30 per group). A panel of 6 specialist physicians independently evaluated the videos using the newly developed Clinical Legitimacy and Risk Scoring (CLRS) scale. This scale assesses videos across 4 dimensions: depicted environment, operator identity, risk communication, and communication channels. Interrater reliability was evaluated using Fleiss κ. RESULTS: The CLRS was used by 6 specialist physicians and showed a significant safety difference between the two groups. The medical tourism group (model A) had an average video score of 3.2 (SD 0.7), with the primary content type of short-form videos being "surgery experience vlogs" (9/30, 30%). Concomitantly, although professionalism was apparent in these videos, underlying risks were regularly obscured. In contrast, the migrant worker group (model B) had an extremely low average score of 1.1 (SD 0.3), indicating a complete deviation from medical standards (P<.001) and thus posing a higher risk to patient safety. The videos in model B were mainly "home surgery demonstrations" (15/30, 50%). The interrater reliability among physicians was high (Fleiss κ=0.85; P<.001). The primary coding team compiled the baseline descriptive data, whereas the board-certified physician panel independently evaluated the specific CLRS metrics. CONCLUSIONS: The algorithmic architecture of TikTok creates a stratified marketplace, reinforcing socioeconomic stratification and health inequities. Specifically, regarding the informal aesthetic medical tier for migrant workers, the risk of infection has become a serious and urgent public health threat. Results of this study indicate that responsible public health interventions are urgently needed for the informal aesthetic medical tier targeting migrant workers and that there is a need to reassess TikTok's social responsibility in reviewing high-risk medical content in short-form videos.
Journal of robotic surgeryTina Moon, Ellen Deng, Erin Taylor
Robotic-assisted surgery has risen exponentially across surgical sub-specialties, with increasing adoption within plastic surgery. Robotics can offer enhanced accuracy and dexterity for technically demanding procedures such as microsurgery. This study aims to characterize global research trends in robotic applications within plastic surgery through a bibliometric analysis. Robotic surgery studies in the plastic surgery literature were identified using PubMed and Web of Science using MeSH terms and keywords. Extracted variables included study type, sub-specialty, number of authors, country, journal and journal impact factor, institution type, and type of robot. Analysis was performed using Bibliometrix. A total of 492 studies met criteria for final analysis. The majority of studies (63%) focused on microsurgery. The number of publications has increased annually since 1997 (n = 1/yr) to 2025 (n = 94/yr) with an average annual growth over the past 5 years of 29% year over year. The most common articles types were technical articles (23%), literature reviews (20%), and cohort studies (16%). The Da Vinci® system was the most commonly cited robotics platform (52%), followed by Symani® (22%) and MUSA® (4%). Institutions with the highest proportion of authors included University Hospital Zurich (5.6%), Shanghai Jiao Tong University (5.6%), and New York University (4.6%). Plastic & Reconstructive Surgery published the highest number of articles (9%). This bibliometric analysis demonstrates the emerging role of robotic surgery and increasing global presence within plastic surgery. Ongoing innovation and rigorous clinical evaluation will be paramount as this technology continues to evolve and improve our specialty.
Frontiers in public healthAbdullah A Alharbi, Mohammed A Muaddi, Anas E Ahmed, Ahmad Assiri, Amr Youssef Arkoubi, Taif I Alameer, Shahad M Alharbi, Afnan H Abuzawah, Renad A Madkhali, S…
BACKGROUND: Social media exposure may be associated with women's attitudes toward cosmetic surgery, yet data from Saudi Arabia's Jazan region are lacking. OBJECTIVES: To evaluate acceptance of cosmetic surgery and its association with social media exposure among adult women in Jazan. METHODS: This cross-sectional study recruited 1,206 women aged ≥18 years via WhatsApp and Snapchat between 1 and 30 January 2025. An Arabic Google Forms questionnaire included the validated Acceptance of Cosmetic Surgery Scale (ACSS), sociodemographic items, and social media behaviors. Multivariable linear regression identified factors associated with ACSS score. RESULTS: Mean ACSS score was 58.90 (SD 25.07). Higher acceptance was observed among older participants (≥45 years: β = 11.62, 95% CI 5.32-17.92, p < 0.001), higher income (>10,000 SAR: β = 4.39, p = 0.038), and each additional hour of daily social media use (β = 0.38, p = 0.035). Following beauty experts showed the strongest effect (β = 11.85, 95% CI 8.43-15.27, p < 0.001), followed by using photo-editing apps (β = 5.33, p < 0.001), comparing appearance with influencers (β = 3.81, p = 0.017), and posting selfies (β = 3.70, p = 0.012). CONCLUSIONS: Social media engagement and demographic factors were associated with cosmetic surgery acceptance among women in Jazan. These associations may have implications for media-literacy interventions, transparent content regulation, and ethical pre-procedure counseling. However, as recruitment occurred via social media apps, results may not generalize to all women in the region.
Facial plastic surgery clinics of North AmericaDominic Bray, Mike Nayak
Social media has had a tremendous impact on the field of facial plastic surgery. This discussion summarizes some of the positive and negative impacts, and discusses how surgeons can best navigate them.
JMIR medical educationMarius Drysch, Sonja Verena Schmidt, Felix Reinkemeier, Flemming Puscz, Alexander Fiedler, Maria Fueth, Marcus Lehnhardt, Alexander Sogorski, Christoph Wallner
BACKGROUND: Surgical residency training faces mounting pressure from expanding subspecialty knowledge requirements alongside compressed learning opportunities. Microlearning, defined as brief, focused educational episodes, offers a pedagogically sound approach suited to fragmented clinical schedules, while large language models present capabilities for scalable content generation. However, the feasibility, quality, and educational value of large language model-generated microlearning in surgical training remain unexplored. OBJECTIVE: This study aimed to assess the feasibility and acceptability of artificial intelligence (AI)-generated microlearning modules among plastic surgery residents, evaluate content quality through systematic faculty evaluation, and generate preliminary effect size estimates for self-perceived knowledge and confidence changes. METHODS: A single-arm pilot feasibility study with a pre-post design was conducted at an academic plastic surgery residency program (N=11 residents) over 12 weeks. Six modules covering core subspecialties were developed using Google Gemini 2.5 Pro. From 60 AI-generated multiple-choice questions, 42 were selected following independent evaluation by 2 board-certified plastic surgeons using a 5-dimension rubric (accuracy, relevance, clarity, pedagogical value, and safety). Modules were released biweekly via Google Forms. Outcomes included retention, acceptability (7-point Likert scales), faculty evaluation ratings, item-level psychometrics, and pre-post changes in self-perceived knowledge and confidence. Composite scores were calculated as the mean change across all 6 subspecialty topics. Wilcoxon signed-rank tests served as the primary analysis for matched pairs (n=9). Analyses were conducted using Python 3.11. RESULTS: All 11 residents completed postassessments. Acceptability was high across all 6 subitems (all medians ≥5 out of 7). Faculty evaluation confirmed high content quality (mean quality index 4.68/5); interrater reliability was poor (intraclass correlation coefficient (3,1)=0.231). Among 9 matched pairs, composite confidence improved significantly (median change 0.33; d=0.65; P=.047), while composite knowledge showed a medium effect (d=0.71; P=.09). Topic-specific gains were largest where baseline was lowest: hand surgery knowledge (d=1.48; P=.02) and confidence (d=1.41; P=.02). Resource use and sense-of-community measures remained stable. CONCLUSIONS: AI-generated microlearning modules are feasible and acceptable for plastic surgery residency education. Faculty-evaluated content achieved high quality ratings (mean 4.68/5), and residents showed strong engagement with preliminary improvements in self-perceived confidence. The intervention was integrated into existing learning ecosystems without disrupting traditional resources or peer dynamics. These findings provide effect size estimates to support the design of adequately powered randomized trials.
ACS applied bio materialsCai Ling Yong, Alexander Shao-Rong Pang, Dinesh Kumar Srinivasan
Plastic and reconstructive surgery (PRS) aims to restore form and function, thereby improving patients' quality of life. In recent years, nanotechnology has emerged as a promising field, offering innovative solutions in tissue engineering, wound healing, implant design, and aesthetic applications. This scoping review evaluates recent advancements, clinical applications, and limitations of nanotechnology-based approaches in plastic surgery. A structured literature search was conducted in PubMed using combinations of keywords including "nanotechnology", "nanoparticles", "plastic surgery", "reconstructive surgery", "wound healing", "tissue engineering", and "aesthetic medicine", combined using Boolean operators (AND/OR). Example search string: ("nanotechnology" OR "nanoparticles" OR "nanomedicine") AND ("plastic surgery" OR "reconstructive surgery" OR "wound healing" OR "tissue engineering" OR "aesthetic medicine"). Inclusion criteria included English-language articles published within the past five years focusing on nanotechnology applications in PRS. Reviews, preclinical studies, and clinical studies were included. Editorials, conference abstracts, and studies not directly relevant were excluded. Key data were extracted, including nanomaterial types, methods of application, and reported therapeutic outcomes, and findings were synthesized through thematic analysis. This review identified diverse nanotechnology applications, including nanoskin development, nanoparticle-mediated drug delivery, nanoscaffolds for tissue regeneration, and improved biomaterials for reconstructive procedures such as breast reconstruction. Notable innovations included enhanced wound healing outcomes using clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR-associated protein 9 (Cas9)-based approaches, burn treatment using tilapia skin xenografts, and chitosan-based nanoparticles demonstrating antimicrobial activity and drug delivery potential. Despite promising preclinical and early clinical results, widespread clinical translation remains limited. Key barriers include insufficient long-term safety and toxicity data, challenges in large-scale production, and regulatory constraints. Nanotechnology in Plastic and Reconstructive Surgery. Created in BioRender. Yong, C.L. (2026) https://BioRender.com/l1pmh1n.
Surgical oncologyAmirmohsen Jaleefar, Mohammad Shirkhoda, Ata Garajei, Ali Arab Kheradmand, Arshia Zardoui, Seyedeh Zahra Mousavi, Amirsina Sharifi
BACKGROUND: Microvascular free flap reconstruction is central to contemporary head and neck cancer surgery. Although plastic surgeons have traditionally performed these reconstructions, evolving training pathways have enabled other surgical subspecialties to acquire advanced microsurgical expertise. Comparative data between plastic surgeons and surgical oncologists trained in microsurgical reconstruction remain limited. METHODS: We performed a retrospective cohort study of 300 patients who underwent head and neck reconstruction at the Cancer Institute of Iran between 2013 and 2022. Patients were stratified by operating surgeon specialty (surgical oncologist vs. plastic surgeon). Primary outcomes included operative duration, postoperative hemorrhage, flap failure, intensive care unit (ICU) stay, and mortality. Cumulative sum (CUSUM) analysis was used to assess performance trends and learning curves over time. RESULTS: Of 300 reconstructions, 192 (64.0%) were performed by surgical oncologists and 108 (36.0%) by plastic surgeons. Baseline demographics and comorbidities were comparable between groups. There were no significant differences in flap failure (9.4% vs. 9.3%), postoperative hemorrhage (7.3% vs. 3.7%), ICU stay, or mortality (4.2% vs. 3.7%). Operative duration was longer in the surgical oncology group on unadjusted analysis; however, surgeon specialty was not an independent predictor after multivariable adjustment. CUSUM analysis demonstrated stable outcomes over time for both groups, with no evidence of an active learning curve. CONCLUSION: In a high-volume center with structured microsurgical training, surgical oncologists achieve outcomes comparable to plastic surgeons in head and neck reconstruction. These findings support expansion of microsurgical reconstruction beyond traditional specialty boundaries when appropriate training and institutional support are present.
Plastic and reconstructive surgerySahand C Eftekari, Elizabeth P Wu, Emily E Zona, M Kristine Carbullido, Ellen C Via, Weifeng Zeng, Aaron M Dingle, Samuel O Poore
Microsurgery is a specialized field within plastic surgery constrained by the high cost and limited availability of surgical microscopes, particularly in resource-limited settings. This lack of access hinders trainees from developing essential microsurgical skills. Previous efforts have explored smartphone-based alternatives, but there remains a need for high-fidelity, accessible training microscopes. This study presents a novel, low-cost, travel-friendly surgical microscope designed for microsurgery training. Modified binocular objective lenses enable near-field stereoscopic viewing using a dual-mirror array. A 3D-printed chassis provides the correct top-down orientation, and an integrated light source operates on standard or battery power, ensuring usability in low-resource environments. Initial testing demonstrated a fixed 6.5× magnification, allowing trainees to perform end-to-end anastomoses on 2-mm vessels. Prototypes were deployed for microsurgery training in the United States, Rwanda, Ethiopia, and Vietnam through the SHARE (Surgeons in Humanitarian Alliance for Reconstruction, Research and Education) plastic surgery organization, Nuoy Reconstructive International, and the senior author's home institution. The authors' investigation continues to assess the effectiveness of the microscope compared with state-of-the-art surgical microscopes. By offering a low-cost, portable solution without compromising image quality, this innovation has begun to transform microsurgical education and operating room-based microscopy worldwide, increasing accessibility for trainees and patients in diverse settings.
Facial plastic surgery clinics of North AmericaSamuel E Lynch, Christopher K Hee, Rod Rohrich, David Weir, Tara Chadab, Aaron L Wiegmann
Goals in plastic surgery and aesthetic medicine include minimizing healing complications, optimize aesthetic outcomes and improve patient satisfaction. Platelet-derived growth factor BB (PDGF-BB) is among the most potent natural activators of healing. A pharmaceutical copy of natural PDGF-BB, (rhPDGF-BB or pure PDGF) is the active ingredient in four US Food and Drug Administration-approved therapies to stimulate healing of skin, mucosa, gingivae or bone. Here we describe the mechanism of action and clinical uses of off-the-shelf pure PDGF in plastic surgery and aesthetic medicine as a post-treatment adjunct to enhance patient satisfaction.
Facial plastic surgery & aesthetic medicineManuela von Sneidern, Arianna Winchester, Arman Saeedi, Lydia Pan, Eleni Varelas, Danielle F Eytan
BACKGROUND: Women have historically been underrepresented in surgical subspecialties like facial plastic surgery. Authorship is a key metric in career progression; hence, it is important to assay progress in this domain. STUDY OBJECTIVES: To identify trends in female authorship within facial plastic surgery over time. METHODS: Publications from three facial plastic surgery journals were reviewed for the gender of authors from 2007 to 2022. Female authorship across time was compared using chi-squared and Cochrane-Armitage trend tests. RESULTS: A total of 6,921 original research articles were identified; 2,419 articles (34.9%) had female authorship. Female authorship showed a significant increase over time for first/single authors (p = 0.028), last authors (p = 0.015), and all authors combined (p = 0.013). Male authorship was significantly higher across all years studied (p = 0.008). Facial Plastic Surgery and Aesthetic Medicine (FPSAM), Plastic and Reconstructive Surgery (PRS) had significant increases in overall female authorship from 2007 to 2022 (p = 0.003 and p = 0.03, respectively). FPSAM showed a significant increase in female first/single authorship (p = 0.001), while PRS showed a significant increase in female last authorship (p = 0.02). CONCLUSION: Female authorship in facial plastic surgery is increasing over time. First/single authorship is advancing more rapidly, possibly reflecting more female trainees advancing their careers. Further work is needed to support female representation in the facial plastic surgery literature.
Plastic and aesthetic nursingFarida Murtiani, Rahmat Saputra, Yeni Devita, Ba'da Febriani, Amelia Marisa, Fatimah Fatimah
Postoperative pain and anxiety are significant challenges that can hinder patient recovery after plastic surgery. Hypnotherapy as a nonpharmacological adjunctive therapy offers a potential solution, but its effectiveness requires systematic evaluation. This systematic review aimed to assess the role of hypnotherapy in managing pain and anxiety during plastic surgery recovery. We conducted literature searches in PubMed, Scopus, and the Cochrane Library for randomized controlled trials evaluating hypnotherapy in plastic surgery patients. Three trials, encompassing a total of 110 patients, met the inclusion criteria. Study quality was assessed using the Cochrane Risk of Bias (RoB 2.0) tool. Hypnotherapy reduced the incidence of postoperative nausea and vomiting (PONV) and significantly reduced postoperative pain intensity and intraoperative opioid consumption (e.g., remifentanil decreased from 761.4 mcg to 200 mcg, p = .034). Patient satisfaction was also higher in the hypnotherapy groups. However, the interventions did not produce significant differences in anxiety levels or surgical field quality. Overall, hypnotherapy appears to be a promising adjunct therapy for reducing pain, analgesic requirements, and postoperative PONV in plastic surgery patients. Nonetheless, the current evidence is preliminary and limited, underscoring the need for more rigorous research to confirm these findings and guide clinical application.