Daily Cosmetic Research Analysis
A triple-blind RCT in rhinoplasty demonstrates desmopressin and tranexamic acid reduce bleeding and improve surgical field quality versus control, with phenylephrine showing shorter-lived benefits. Complementing this, a preliminary FACE-Q study supports nonsurgical lower-face feminization in transwomen via masseter botulinum toxin, and a two-case series shows eyelid/conjunctiva-sparing exenteration with microvascular free flap can preserve periocular esthetics after orbital exenteration.
Summary
A triple-blind RCT in rhinoplasty demonstrates desmopressin and tranexamic acid reduce bleeding and improve surgical field quality versus control, with phenylephrine showing shorter-lived benefits. Complementing this, a preliminary FACE-Q study supports nonsurgical lower-face feminization in transwomen via masseter botulinum toxin, and a two-case series shows eyelid/conjunctiva-sparing exenteration with microvascular free flap can preserve periocular esthetics after orbital exenteration.
Research Themes
- Perioperative bleeding control strategies in cosmetic surgery
- Nonsurgical gender-affirming facial feminization
- Reconstructive oncology techniques preserving periocular esthetics
Selected Articles
1. Comparative Efficacy of Desmopressin, Tranexamic Acid, and Phenylephrine in Reducing Bleeding and Improving Surgical Field Quality during Rhinoplasty: A Triple-Blind Randomized Controlled Trial.
In a triple-blind, four-arm RCT (n=80), desmopressin and tranexamic acid significantly reduced bleeding and improved Boezaart surgical field scores at all measured time points versus control, while phenylephrine showed benefits only early. All three drugs shortened operative time compared with control, with desmopressin and tranexamic acid showing the most consistent effects.
Impact: Head-to-head, triple-blind evidence clarifies optimal pharmacologic strategies to control intraoperative bleeding in a common cosmetic procedure. The findings are immediately actionable for anesthetic and surgical protocols.
Clinical Implications: Consider desmopressin or tranexamic acid as first-line adjuncts for bleeding control and surgical field optimization in rhinoplasty, with phenylephrine reserved for short-duration benefit. Protocols should incorporate dosing and monitoring for safety.
Key Findings
- Desmopressin and tranexamic acid reduced bleeding and improved Boezaart surgical field scores at 30, 45, and 90 minutes versus control (p<0.05).
- Phenylephrine improved bleeding and field quality only at early time points (15–30 or 30–45 minutes).
- All intervention groups had shorter operative times compared with control (p<0.05), with no baseline imbalances.
Methodological Strengths
- Triple-blind randomized design with four arms and trial registration.
- Standardized measurements: Boezaart scale for field quality and objective bleeding quantification by gauze weight and suction volume.
Limitations
- Single-center, modest sample size (n=80) limits generalizability.
- Short-term endpoints; no postoperative ecchymosis/edema or bleeding complications reported beyond intraoperative period.
Future Directions: Define optimal dosing and timing, evaluate combination regimens, and test postoperative outcomes (ecchymosis, edema, transfusion, revision) across procedure complexity in multicenter trials.
BACKGROUND: Rhinoplasty, a popular cosmetic surgery, often faces intraoperative bleeding, which reduces surgical visibility and increases postoperative periorbital edema and ecchymosis. This study compared the effects of desmopressin, tranexamic acid, and phenylephrine on reducing bleeding and improving surgical field quality in rhinoplasty. METHODS: In this triple-blind clinical trial, 80 patients aged 18-50 undergoing rhinoplasty were randomly divided into four groups: tranexamic acid, phenylephrine, desmopressin, and control. Surgical field quality was assessed using the Boezaart scale, and bleeding volume was measured by weighing blood-soaked gauze and suction fluid. Data were recorded at 15, 30, 45, and 90-minute intervals and analyzed using SPSS 24. RESULTS: There were no significant differences in demographic or laboratory characteristics among the groups (p > 0.05). The desmopressin and tranexamic acid groups had less bleeding than the control group at 30, 45, and 90 min (p < 0.05), while phenylephrine was effective only at 30 and 45 min (p < 0.05). The quality of the surgical field was better in the desmopressin and tranexamic acid groups at all time points (p < 0.05), but phenylephrine showed improvement only at 15 and 30 min (p < 0.05). Additionally, all intervention groups had a shorter operative time duration compared to the control group (p < 0.05). CONCLUSION: Desmopressin, tranexamic acid, and phenylephrine, in that order, were the most effective in reducing bleeding and improving surgical field quality. Additionally, these drugs reduced operative time, highlighting their potential to benefit patients and facilitate surgical procedures for surgeons. TRIAL REGISTRATION: IRCT20240712062409N1 LEVEL OF EVIDENCE I: 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 .
2. Transwomen satisfaction after nonsurgical management of large lower face with botulinum toxin injection of the masseter: A preliminary FACE-Q study.
Using FACE-Q before, after, and at 3 months post-procedure, masseter botulinum toxin injections significantly improved lower-face appearance satisfaction in transwomen. The study highlights a scalable, nonsurgical approach to facial feminization with measurable patient-reported outcome gains.
Impact: Addresses a critical need for accessible, nonsurgical gender-affirming options with validated patient-reported outcomes. Highlights patient-centered metrics in cosmetic care.
Clinical Implications: Masseter botulinum toxin can be offered as a low-risk, outpatient option for lower-face feminization, with counseling on durability and retreatment intervals (e.g., 3–6 months) and potential need for adjunctive procedures.
Key Findings
- Significant improvement in lower-face appearance satisfaction post-masseter botulinum toxin injection (P<0.001).
- FACE-Q was administered pre-procedure, post-procedure, and at 3-month follow-up, showing sustained benefit at 3 months.
- Demonstrates a nonsurgical, gender-affirming approach for lower-face transverse reduction.
Methodological Strengths
- Use of a validated, procedure-specific patient-reported outcome measure (FACE-Q).
- Prospective repeated-measures assessment including a 3-month follow-up.
Limitations
- Sample size and demographics not specified in abstract; likely single-center.
- No control group and lack of objective morphometric data (e.g., 3D facial scans or caliper measurements).
Future Directions: Controlled trials with objective morphometrics, dose–response optimization, EMG-guided injection strategies, and longer-term satisfaction/retreatment trajectories in diverse trans populations.
Facial feminization can be considered as an essential element of gender-affirming care and overall well-being of transgender women. This study explores a nonsurgical approach to facial gender-affirming procedures (FGAP) by assessing the efficacy of botulinum toxin (BT) injection for lower face transversal reduction. This cosmetic procedure was evaluated by administering the FACE-Q survey to participants, both pre- and post-procedure and at the three-month follow-up visit. A significant improvement in satisfaction was observed concerning the lower face appearance after BT injection in the masseter (P<0.001). These findings raise awareness towards alternative nonsurgical options in achieving lower facial feminization.
3. Eyelid and conjunctiva sparing exenteration followed by microvascular free flap reconstruction - report of two cases.
Two patients with deep orbital disease extending intracranially underwent extended eyelid- and conjunctiva-sparing exenteration followed by microvascular free flap reconstruction, providing an esthetic alternative to traditional approaches. This combined technique maintains eyelid architecture while enabling oncologic extirpation and robust reconstruction.
Impact: Introduces a reconstructive strategy that preserves eyelid anatomy in exenteration, a setting where esthetic outcomes are typically poor. Offers a feasible pathway to improve quality of life in select orbital oncology cases.
Clinical Implications: In cases requiring exenteration for deep orbital pathology, ECSE combined with microvascular free flap reconstruction can be considered to preserve eyelid form and potentially improve prosthetic retention and cosmesis, with careful patient selection and multidisciplinary planning.
Key Findings
- Describes extended eyelid- and conjunctiva-sparing exenteration in two patients with intracranially extending orbital disease.
- Microvascular free flap reconstruction was successfully used following ECSE in both cases.
- The combined approach may offer improved esthetic outcomes compared with traditional exenteration and reconstruction techniques.
Methodological Strengths
- Detailed surgical description of a novel combined oncologic–reconstructive approach.
- Demonstrates feasibility across two complex cases with intracranial extension.
Limitations
- Two-case series without long-term functional or quality-of-life outcomes.
- No comparative cohort to quantify esthetic or complication benefits versus standard techniques.
Future Directions: Develop prospective registries comparing ECSE plus free flap versus standard exenteration approaches, with standardized esthetic, prosthetic, and patient-reported outcomes and complication profiles.
Eyelid and conjunctiva sparing exenteration (ECSE) allows for the extirpation of pathologies that lie deep within the orbit without disrupting the anatomy of the eyelids. Despite the cosmetic benefits of maintaining the eyelids, few cases of ECSE have been reported, and reconstruction following the procedure has only been detailed in the form of primary closure or a temporalis muscle transfer. The authors present two patients with deep orbital pathologies that extended into the intracranial space. Each patient underwent an extended ECSE followed by reconstruction with a microvascular free flap. The combination of ECSE plus microvascular free flap reconstruction offers an alternative approach to previously published techniques and may improve esthetic outcomes when exenteration is required for deep orbital pathologies.