Daily Cosmetic Research Analysis
Three studies advance cosmetic outcomes across oncology and periodontal surgery. PB-IORT maintains high patient-rated cosmesis but reveals poor interrater reliability, a meta-analysis finds tissue adhesives comparable to sutures after periodontal flap surgery, and ultrasound guidance in breast-conserving surgery substantially reduces resection volumes while preserving oncologic safety.
Summary
Three studies advance cosmetic outcomes across oncology and periodontal surgery. PB-IORT maintains high patient-rated cosmesis but reveals poor interrater reliability, a meta-analysis finds tissue adhesives comparable to sutures after periodontal flap surgery, and ultrasound guidance in breast-conserving surgery substantially reduces resection volumes while preserving oncologic safety.
Research Themes
- Patient-centered cosmetic outcome assessment in breast cancer therapy
- Wound closure materials and cosmetics in periodontal surgery
- Imaging-guided tissue preservation metrics in oncologic surgery
Selected Articles
1. Beauty Is in the Eye of the Beholder: Cosmetic Outcomes After Precision Breast Intraoperative Radiation Therapy.
In a phase II cohort of 357 PB-IORT patients with up to 24 months follow-up, 88.7% of patients rated cosmesis as good/excellent, with clinicians and a plastic surgeon rating 93.7% and 80.3% similarly. Interrater agreement was low (Kappa <0.40), emphasizing the primacy of patient-reported outcomes for cosmetic assessment.
Impact: Demonstrates that PB-IORT maintains favorable cosmetic outcomes while revealing poor interrater reliability, reshaping how cosmetic endpoints should be measured in breast surgery.
Clinical Implications: PB-IORT can deliver a single high-dose treatment without compromising cosmesis; cosmetic assessment should prioritize patient-reported outcomes. Clinicians should counsel patients on likely cosmetic results and incorporate standardized PRO measures.
Key Findings
- At 24 months, 88.7% of patients rated cosmesis as excellent/good; clinicians and a plastic surgeon rated 93.7% and 80.3%, respectively.
- Interrater reliability across patients, clinicians, and the plastic surgeon was minimal (Kappa <0.40).
- PB-IORT delivers a single high dose of radiation without compromising cosmetic outcomes.
Methodological Strengths
- Prospective data collection within a phase II clinical trial
- Multiple independent raters using a validated cosmesis scale with interrater analysis
Limitations
- No randomized comparator; lack of direct comparison with standard whole-breast irradiation
- Follow-up limited to 24 months; long-term cosmetic durability unknown
Future Directions: Include PROs as primary endpoints in comparative trials versus standard radiotherapy, extend follow-up beyond 5 years, and evaluate predictors of cosmetic outcomes.
2. Comparison of clinical effectiveness between tissue adhesives and sutures for wound closure in periodontal flap surgery: a systematic review and meta-analysis.
Registered (PROSPERO) PRISMA-compliant synthesis of prospective trials found no significant difference in wound healing between tissue adhesives and sutures after periodontal flap surgery, amid high heterogeneity. Tissue adhesives may offer comparable or better cosmetic outcomes and patient satisfaction.
Impact: Establishes evidence-based parity of tissue adhesives with sutures for periodontal flap closure, informing practice where cosmetic outcomes and efficiency matter.
Clinical Implications: Tissue adhesives are a reasonable alternative to sutures for periodontal flap closure, potentially reducing procedure time and pain while maintaining healing and cosmetic outcomes. Clinicians should consider patient preference and surgical context.
Key Findings
- Meta-analysis found no significant mean difference in wound healing between tissue adhesives and sutures, despite high heterogeneity.
- Most included studies had a low risk of bias, supporting reliability of findings.
- Conclusions suggest tissue adhesives may match or surpass sutures in cosmetic outcomes and patient satisfaction.
Methodological Strengths
- PROSPERO-registered, PRISMA 2020-compliant methodology
- Comprehensive multi-database search with qualitative and quantitative synthesis
Limitations
- High heterogeneity limits pooled estimates and generalizability
- Variable study designs and follow-up periods across included trials
Future Directions: Conduct large, standardized randomized trials directly comparing adhesives versus sutures with harmonized endpoints, including cosmetic outcomes and patient-reported measures.
3. Standardizing Tissue Preservation in Breast-Conserving Surgery: Ultrasound Guidance Reduces Resection Volumes by 40% Compared to Palpation.
In a retrospective cohort (n=114), ultrasound-guided BCS significantly reduced positive margins (2.2% vs 9.0%), re-excisions (2.6% vs 14.0%), and improved resection efficiency by 40% (CRR 1.8 vs 3.0). Nonpalpable tumors achieved the lowest CRR, supporting US guidance for tissue preservation and cosmesis.
Impact: Quantifies large gains in tissue preservation and oncologic safety with a reproducible metric (CRR), strengthening the case for ultrasound-guided BCS to enhance cosmetic outcomes.
Clinical Implications: Where expertise exists, adopt intraoperative ultrasound guidance to reduce resection volumes and re-excisions, potentially improving cosmetic outcomes. Training and workflow integration are needed; consider nonpalpable tumors as prime candidates.
Key Findings
- Positive margin rate reduced from 9.0% to 2.2% and re-excisions from 14.0% to 2.6% with ultrasound guidance.
- Median calculated resection ratio (CRR) improved from 3.0 to 1.8 (p < 0.001), with 1.6 in nonpalpable tumors.
- For a representative 2 cm tumor, total resection volume reduced by 78% with ultrasound guidance.
Methodological Strengths
- Introduces and applies a quantitative surgical quality metric (CRR)
- Includes both palpable and nonpalpable tumors with multivariate analyses
Limitations
- Retrospective, nonrandomized design with potential selection bias
- Single-center study; multivariate results were nonsignificant
Future Directions: Prospective randomized trials to validate CRR improvements, assess learning curves, and quantify long-term cosmetic outcomes and quality of life.