Daily Cosmetic Research Analysis
Three studies advance aesthetic and reconstructive practice: a randomized trial shows barbed sutures improve scar satisfaction after total knee arthroplasty and correlate with better PROMs; a systematic review suggests immediate contralateral symmetrisation in therapeutic mammoplasty yields better cosmetic and cost outcomes without added complications; and a triple-blinded RCT finds ready-to-use abobotulinumtoxinA matches powder formulations for glabellar lines, with slightly higher injection pa
Summary
Three studies advance aesthetic and reconstructive practice: a randomized trial shows barbed sutures improve scar satisfaction after total knee arthroplasty and correlate with better PROMs; a systematic review suggests immediate contralateral symmetrisation in therapeutic mammoplasty yields better cosmetic and cost outcomes without added complications; and a triple-blinded RCT finds ready-to-use abobotulinumtoxinA matches powder formulations for glabellar lines, with slightly higher injection pain.
Research Themes
- Scar aesthetics and patient-reported outcomes after surgery
- Optimization of botulinum toxin formulations in aesthetic dermatology
- Timing strategies in oncoplastic breast surgery and cost implications
Selected Articles
1. Skin Closure Using Barbed Sutures Improves Patient Satisfaction With Wound Healing Compared to Interrupted Sutures in Total Knee Arthroplasty: A Prospective Single-Blind Randomized Controlled Trial.
In a single-blind randomized trial of 83 knees, barbed sutures produced superior Patient Scar Assessment Scale scores at 1 year versus interrupted sutures without increasing wound complications. Better scar scores correlated with improved Knee Society Score 2011 domains and Forgotten Joint Score-12, linking cosmetic wound healing to functional PROMs.
Impact: Demonstrates that suture selection can measurably improve cosmetic outcomes and patient satisfaction after TKA without added risk, providing actionable guidance for routine practice.
Clinical Implications: Consider barbed sutures for TKA skin closure to enhance scar satisfaction and potentially improve overall PROMs, with no observed increase in wound complications at 1 year.
Key Findings
- Barbed sutures yielded better PSAS total scores at 1 year than interrupted sutures (14.9 ± 7.7 vs 20.0 ± 13.7; P = 0.038).
- No difference in wound complication rates between groups (0/44 vs 2/39; P = 0.42).
- PSAS scores negatively correlated with KSS 2011 symptoms (r = -0.39, P < 0.001), satisfaction (r = -0.26, P = 0.022), expectations (r = -0.37, P < 0.001), and FJS-12 total (r = -0.25, P = 0.027).
Methodological Strengths
- Prospective single-blind randomized controlled design with 1-year follow-up.
- Use of validated measures (PSAS, KSS 2011, FJS-12) and predefined outcomes.
Limitations
- Modest sample size from a single trial.
- Single-blind design may introduce assessment bias versus double-blind.
Future Directions: Larger multicenter RCTs comparing closure techniques with standardized scar scales, cost analyses, and longer follow-up to assess durability and rare complications.
2. Immediate or delayed contralateral symmetrisation in therapeutic mammoplasty-A systematic review.
Across 35 studies (2297 patients), immediate contralateral symmetrisation after therapeutic mammoplasty was associated with higher patient satisfaction and better cosmetic assessments, without increased complications, and lower costs than delayed procedures. Direct head-to-head comparative evidence is limited, highlighting a need for standardized prospective comparisons.
Impact: Synthesizes outcomes, complications, and costs to inform timing of symmetrisation in oncoplastic surgery, with consistent signals favoring immediate procedures.
Clinical Implications: When feasible, discuss immediate contralateral symmetrisation with patients as it may improve cosmetic outcomes and reduce costs without increasing complications, while acknowledging the paucity of direct comparative trials.
Key Findings
- Immediate symmetrisation studies reported high satisfaction with breasts (68.6–81.5%).
- Delayed symmetrisation was associated with inferior cosmetic ratings (50% "unfair"), whereas immediate procedures reported 89% "fair/good/excellent" outcomes.
- Complication rates were similar between immediate and delayed symmetrisation across 34 studies.
- One study found significantly higher costs for delayed procedures (median €9368 vs €4696 for immediate).
Methodological Strengths
- Comprehensive search across four databases with clearly defined outcomes.
- Large aggregate sample (2297 patients) including PROMs, cosmesis, complications, and cost.
Limitations
- Only two studies directly compared immediate versus delayed symmetrisation.
- Heterogeneity in outcome measures and limited cost-effectiveness data.
Future Directions: Prospective, standardized comparative studies (ideally randomized) assessing PROMs, aesthetic ratings, oncologic safety, and economic outcomes for immediate vs delayed symmetrisation.
3. Comparing Ready-to-Use and Powder AbobotulinumtoxinA for Glabellar Lines: A Randomized, Controlled, Triple-Blinded Clinical Trial.
In 38 male participants, ready-to-use abobotulinumtoxinA performed equivalently to powder abobotulinumtoxinA for glabellar lines across EMG, wrinkle severity, and satisfaction outcomes up to 4 months. Injection pain was higher with the ready-to-use formulation.
Impact: Directly informs product selection in aesthetic practice by showing non-inferiority of a ready-to-use formulation with a minor tolerability trade-off.
Clinical Implications: Clinicians can choose ready-to-use abobotulinumtoxinA for glabellar lines with expectations of similar efficacy and durability to powder formulations; counsel patients about slightly higher injection pain.
Key Findings
- No significant inter-group differences in EMG for corrugator (p = 0.11) or procerus (p = 0.93) across all time points.
- No significant differences in glabellar line severity at rest (p = 0.737) or contraction (p = 0.390) through 4 months.
- Patient satisfaction did not differ between groups; injection pain was higher with ready-to-use abobotulinumtoxinA (p = 0.01).
Methodological Strengths
- Randomized, triple-blinded design with predefined dosing and multiple validated outcome measures (EMG, Merz scale, FACE-Q).
- Repeated assessments up to 4 months with appropriate statistical analyses (RM-ANOVA, Bonferroni, chi-squared).
Limitations
- Small sample size and inclusion of only male participants limits generalizability.
- Single-study, short follow-up (4 months) without registration or multicenter validation reported.
Future Directions: Larger, mixed-sex RCTs with longer follow-up to evaluate duration, onset, and patient-reported aesthetic outcomes, plus head-to-head comparisons across BoNT-A brands and reconstitution practices.