Daily Cosmetic Research Analysis

BACKGROUND: Laparoscopic repair of congenital inguinal hernia (CIH) has evolved with techniques to minimize invasiveness while ensuring efficacy. This study compares percutaneous internal ring suturing (PIRS) with laparoscopic disconnection of the hernial sac and internal ring narrowing regarding feasibility, safety, operative time, cosmetic outcome, and recurrence rate. METHODS: A prospective randomized study was conducted on 109 male patients with 120 CIHs. Patients were allocated into two groups: Group A (laparoscopic disconnection and internal ring narrowing) and Group B (PIRS). Perioperative parameters, postoperative complications, recurrence rates, and parental satisfaction with cosmetic results were assessed. RESULTS: The mean operative time was significantly shorter in group B (8.5 ± 3.9 min for unilateral cases) compared to group A (40.8 ± 9.9 min) (p < 0.001). Postoperative spermatic cord edema occurred in 19.6% of Group A and 1.9% of Group B (p < 0.05). Recurrence rates were 5.4% in Group A and 1.9% in Group B (p > 0.05). Parental satisfaction with scarring was significantly higher in group B (p < 0.05). CONCLUSION: In this randomized trial, PIRS resulted in shorter operative time, lower incidence of spermatic cord edema, and higher parental satisfaction compared with conventional laparoscopic repair in pediatric patients with congenital inguinal hernia. LEVEL OF EVIDENCE: II (Prospective randomized study).

Graves' orbitopathy (GO) is a clinically significant extrathyroidal manifestation of Graves' disease (GD), often resulting in functional and cosmetic morbidity. Preventive strategies remain limited. Statins, widely prescribed for cardiovascular disease, possess anti-inflammatory and immunomodulatory properties that may also mitigate the risk of GO. This systematic review and meta-analysis aimed to evaluate the association between statin use and GO risk in GD, with subgroup analyses by geographic region and sex to capture potential differential effects. This study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, the Excerpta Medica database (Embase), and the Cochrane Library were systematically searched from database inception through May 2025 using a predetermined strategy. Eligible observational studies (cohort or case-control) assessing the effect of statin use on incident GO were included. Where feasible, pooled hazard ratios (HRs) or odds ratios (ORs) were estimated using random-effects models (Western cohorts). For Asian populations, effect estimates were synthesized narratively due to heterogeneity in effect measures. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the ROBINS-I tool. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD420251032246). Five studies (n = 156,926) met the inclusion criteria. In Asian populations (n = 113,628), statin use was associated with a significantly reduced risk of GO (HR = 0.56; 95% CI: 0.46-0.68; p < 0.001). In Western populations (n = 43,298), pooled analysis suggested a non-significant trend toward risk reduction (HR = 0.76; 95% CI: 0.53-1.10; p = 0.14), with substantial heterogeneity (I² = 60.8%). Among Asian females (n = 83,997), statin use consistently demonstrated protective associations (HRs 0.37-0.66), while male subgroup estimates, derived from a single study, were not statistically significant. Across all studies, risk of bias was rated as moderate, primarily due to confounding and variability in outcome measurement. Statin use appears to reduce the risk of GO among patients with GD, with the strongest protective effect observed in Asian women. Although Western data suggested a protective trend, findings did not reach statistical significance and were limited by heterogeneity. These results highlight the importance of region- and sex-specific investigations. Large-scale prospective cohort studies and randomized controlled trials (RCTs) are warranted to confirm the potential preventive role of statins in GO and to clarify dose-response relationships.

BACKGROUND: Rhinoplasty is one of the most commonly performed facial plastic surgeries worldwide. Despite its frequency, there is significant heterogeneity in perioperative management, particularly regarding the choice of anesthesia-local, local with sedation, or general-and the postoperative use of nasal packing. A clear, evidence-based consensus on safety and outcomes is lacking. OBJECTIVE: To systematically review the literature comparing anesthesia techniques used in rhinoplasty and their associated complication rates, and to assess the indications, benefits, risks, and duration of nasal packing postoperatively. The aim is to identify whether current evidence supports standardized safety protocols or guidelines. METHODS: A systematic search of PubMed and Scopus databases was conducted for studies published from January 2000 to May 2025. Inclusion criteria were clinical studies reporting outcomes of rhinoplasty under local, sedation, or general anesthesia, and studies comparing the use vs. nonuse of nasal packing post-surgery. Outcomes evaluated included intraoperative and postoperative complications, patient-reported discomfort, and mean duration of nasal pack placement. RESULTS: Forty-three studies were included. General anesthesia remains the most frequently used method (72%), with local anesthesia with sedation favored in selected secondary or minor procedures. Complication rates were not significantly different across anesthesia modalities, although general anesthesia had a slightly higher incidence of nausea and vomiting (12%) compared to sedation (7%) and local (4%). Regarding nasal packing, the literature shows a progressive trend toward minimal or no packing, citing lower patient discomfort, quicker recovery, and no increase in postoperative bleeding. The average duration of packing ranged from 24 to 72 hours. CONCLUSIONS: Current literature supports the safe use of all anesthesia modalities in rhinoplasty when appropriately selected. Nasal packing appears increasingly avoidable in routine cases, without compromising safety. However, a lack of unified guidelines persists. The development of evidence-based perioperative protocols could standardize care and reduce variability in clinical practice. It should also be underlined that certain packing materials, such as carboxymethylcellulose-based absorbable sponges or silicone splints, can in fact reduce the risk of synechiae formation by maintaining separation of mucosal surfaces during healing. Thus, the blanket statement that packing is a source of synechiae must be nuanced: The material, duration, and indication are critical determinants. LEVEL OF EVIDENCE II: 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 .