Daily Cosmetic Research Analysis
A meta-analysis of 11 randomized trials shows periauricular incision outperforms modified Blair incision in benign superficial parotidectomy with fewer complications and superior cosmetic outcomes. A single-center cohort supports the oncologic safety and cosmetic advantages of TOETVA for pT1b papillary thyroid carcinoma. An NHANES analysis links body dissatisfaction to higher benzophenone-3 exposures among minority women, highlighting equity and personal care product safety concerns.
Summary
A meta-analysis of 11 randomized trials shows periauricular incision outperforms modified Blair incision in benign superficial parotidectomy with fewer complications and superior cosmetic outcomes. A single-center cohort supports the oncologic safety and cosmetic advantages of TOETVA for pT1b papillary thyroid carcinoma. An NHANES analysis links body dissatisfaction to higher benzophenone-3 exposures among minority women, highlighting equity and personal care product safety concerns.
Research Themes
- Cosmetic and functional optimization in head and neck surgery
- Scarless/remote-access endocrine surgery (TOETVA)
- Health equity and chemical exposures from personal care products
Selected Articles
1. Periauricular incision vs. Modified blair incision in parotidectomy: A systematic review and meta-analysis of randomized controlled trials.
Across 11 RCTs (n=804), periauricular incision reduced transient facial palsy, Frey’s syndrome, earlobe numbness, and facial deformity versus modified Blair incision, with higher patient satisfaction. No differences were found in salivary fistula or operative time; some perioperative metrics favored PI but with high heterogeneity.
Impact: This synthesis of RCTs provides moderate-to-high certainty evidence that PI improves both safety and cosmetic outcomes in superficial benign parotidectomy, informing incision choice. It may standardize practice toward less visible scarring and fewer complications.
Clinical Implications: For small-to-medium benign superficial parotid tumors, consider adopting periauricular incision to reduce facial nerve-related morbidity and improve aesthetic satisfaction. Surgeons should be trained in PI planning to minimize facial contour deformity without increasing fistula risk or operative time.
Key Findings
- Periauricular incision reduced transient facial palsy (RR 0.60, 95% CI 0.39–0.93).
- Frey’s syndrome risk was substantially lower with PI (RR 0.27, 95% CI 0.13–0.55).
- Earlobe numbness (RR 0.53) and facial deformity (RR 0.19) were reduced, and patient satisfaction was higher (RR 1.24).
- No significant differences in salivary fistula (RR 0.70) or operative time; some perioperative parameters favored PI but with high heterogeneity.
Methodological Strengths
- PROSPERO-registered protocol with comprehensive multi-database search.
- Included only randomized controlled trials; risk of bias assessed by RoB 2 and certainty graded by GRADE.
Limitations
- High heterogeneity for several perioperative outcomes (I² 72–97%).
- Applicability limited to small-to-medium benign superficial tumors; long-term outcomes variably reported.
Future Directions: Conduct multicenter RCTs with standardized PI techniques, longer follow-up, and patient-reported scar assessments; evaluate applicability to larger tumors and different pathology.
2. Transoral endoscopic thyroidectomy vestibular approach for pT1b papillary thyroid carcinoma: surgical and oncological outcomes.
In 50 consecutive pT1b PTC patients undergoing TOETVA by a single experienced surgeon, no recurrences occurred over a mean 29.6 months. Temporary mental nerve injury and recurrent laryngeal nerve palsy occurred in 4% each, resolving by 3 months, with high cosmetic satisfaction.
Impact: These data support the oncologic safety and cosmetic advantages of a scarless approach (TOETVA) for pT1b PTC in experienced hands. It informs patient counseling and center selection for remote-access thyroidectomy.
Clinical Implications: TOETVA can be offered to selected pT1b PTC patients at experienced centers, with counseling regarding transient mental nerve dysesthesia and RLN palsy risks. Early oncologic outcomes appear favorable, supporting its use for patients prioritizing cosmesis.
Key Findings
- No recurrences during mean 29.6 months follow-up (range 2.4–64.4 months).
- Temporary mental nerve injury 4% and temporary recurrent laryngeal nerve palsy 4%, all resolved within 3 months; no permanent complications.
- Occult central lymph node metastases in 30% with a mean central node yield of 4.2.
- High cosmetic satisfaction reported by all patients.
Methodological Strengths
- Consecutive series with standardized technique by a single experienced endoscopic surgeon.
- Clear reporting of complications, node yield, and follow-up duration with patient-reported cosmetic outcomes.
Limitations
- Single-center, single-surgeon cohort without a comparator arm; potential selection bias.
- Moderate follow-up with predominantly young female patients limits generalizability and long-term oncologic assessment.
Future Directions: Prospective multicenter comparative studies versus open or other remote-access approaches with long-term recurrence, quality of life, and cost-effectiveness endpoints.
3. Body dissatisfaction widens the racial disparities of Benzophenone-3, a chemical biomarker of personal care and consumer product usage.
In NHANES data on 3,072 women, non-Hispanic Black women had the lowest BP3 levels, while several other racial/ethnic groups had higher levels, which further increased with body dissatisfaction. The moderating effect persisted after adjusting for sunscreen use, suggesting other personal care/consumer products drive exposure.
Impact: This study reveals a psychosocial driver (body dissatisfaction) that amplifies racial disparities in chemical exposures from personal care products. It informs exposure risk assessment and equity-focused regulatory strategies.
Clinical Implications: Clinicians should consider counseling on safer product choices and exposure reduction, particularly for minority women with body dissatisfaction. Public health initiatives can target non-sunscreen personal care products containing BP3 as potential exposure sources.
Key Findings
- Compared to non-Hispanic Black women, BP3 levels were higher in Mexican American (59%), Other Hispanic (56%), Other Race (33%), non-Hispanic White (16%), and non-Hispanic Asian (9%) women.
- Body dissatisfaction amplified racial disparities; e.g., Other Hispanic women perceiving themselves as overweight had 69% higher BP3 vs non-Hispanic Black women (p=0.01).
- Within-group effects: Other Hispanic women with overweight perception had 73% higher BP3 than those without (p=0.03); differences were minimal in non-Hispanic White women (-0.5%, p=0.98).
- Associations persisted after adjusting for sunscreen use, suggesting other personal care/consumer products contribute to exposure.
Methodological Strengths
- Large, nationally representative NHANES sample with multi-cycle data.
- Adjusted models for key confounders and stratified analyses by race/ethnicity.
Limitations
- Cross-sectional design limits causal inference; body dissatisfaction measured by self-reported weight perception.
- Single spot urine for BP3 with temporal variability; detailed product use data not captured.
Future Directions: Prospective studies integrating product diaries and biomonitoring to test interventions that reduce BP3 and other EDC exposures among high-risk groups.