Daily Cosmetic Research Analysis
Analyzed 10 papers and selected 3 impactful papers.
Summary
Across cosmetic and minimally invasive interventions, a systematic review finds current evidence insufficient to establish the safety of onabotulinumtoxinA in pregnancy despite no clear signal of harm. A large retrospective comparison links specific oncoplastic breast techniques after neoadjuvant therapy to higher postoperative morbidity, while a functionally screened cohort supports radiofrequency ablation as a mid-term alternative to surgery for indeterminate thyroid nodules with symptom and cosmetic improvement.
Research Themes
- Safety of aesthetic neuromodulators in pregnancy
- Technique-specific risk in oncoplastic breast surgery after neoadjuvant therapy
- Minimally invasive ablation as an alternative to surgery for indeterminate thyroid nodules
Selected Articles
1. Safety and Efficacy of OnabotulinumtoxinA in Pregnancy: A Systematic Review.
This first systematic review of BoNT-A exposure during pregnancy aggregates 18 studies covering 486 pregnancies and finds 77.7% healthy births, 20.1% fetal losses, and 2.3% birth defects. No direct causal link to adverse outcomes is evident, but heterogeneity and limited data preclude a definitive safety conclusion.
Impact: BoNT-A is widely used for cosmetic and medical indications in women of reproductive age; safety data in pregnancy directly inform counseling and clinical decision-making.
Clinical Implications: Elective aesthetic BoNT-A should generally be deferred during pregnancy; if inadvertent exposure occurs, clinicians can provide cautious reassurance while emphasizing the current evidence gaps and the need for routine obstetric follow-up.
Key Findings
- Included 18 studies covering 486 pregnancies (488 fetuses) exposed to BoNT-A, mostly in the first trimester.
- Outcomes: 77.7% healthy births, 20.1% fetal losses (elective/therapeutic/spontaneous), and 2.3% birth defects.
- No direct association between BoNT-A exposure and fetal harm could be inferred due to heterogeneity and limited data.
- Authors call for larger, well-designed studies to detect rare or delayed outcomes.
Methodological Strengths
- Systematic multi-database search (PubMed, Scopus, Web of Science) with structured data extraction.
- Synthesis across cosmetic and medical indications reporting maternal and neonatal outcomes.
Limitations
- Significant heterogeneity across studies with limited sample sizes and variable exposure timing.
- Predominantly observational evidence without appropriate control groups, raising risk of bias and confounding.
Future Directions: Prospective registries and controlled cohort studies with standardized exposure documentation and long-term child follow-up are needed to define the safety profile and detect rare adverse outcomes.
BACKGROUND: OnabotulinumtoxinA (BoNT-A) is used widely for medical and aesthetic purposes in women of childbearing age. With the increasing number of approved indications, it is essential to assess BoNT-A safety and efficacy in pregnant women. METHODS: We conducted a systematic review of the studies reporting maternal and neonatal outcomes following BoNT-A treatment during pregnancy. PubMed, Scopus, and Web of Science were searched to retrieve relevant studies. Data were synthesized into summary tables outlining maternal characteristics, treatment regimens, and neonatal outcomes. RESULTS: A total of eighteen studies with 486 pregnancies were included. Maternal indications for treatment included cosmetic purposes, neurological disorders, and pain management. Most patients received BoNT-A in the first trimester. Pregnancy outcomes were available for 488 fetuses. 379 (77.7%) were healthy, 98 (20.1%) fetuses were lost (elective, therapeutic, and spontaneous abortions), and 11 (2.3%) had cases of birth defects. CONCLUSIONS: This is the first systematic review to synthesize the published clinical outcomes of BoNT-A use during pregnancy. The current evidence remains insufficient to establish safety due to significant heterogeneity and insufficient data. Although no direct association between fetal harm or losses and BoNT-A treatment could be inferred, the evidence remains limited. Larger, well-designed studies are needed to establish the safety profile and identify potentially rare or delayed outcomes. LEVEL OF EVIDENCE IV: 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. Mid-Term Outcomes and Outcome Predictors after Radiofrequency Ablation for Indeterminate Thyroid Nodules Following Functional Imaging Screening: A Retrospective Cohort Study.
In 109 functionally screened Bethesda III/IV nodules treated with RFA, mid-term local control was acceptable (3-year LTF-free 85.4%) with significant reductions in volume, symptom, and cosmetic scores. Larger initial nodule diameter independently predicted local treatment failure.
Impact: Provides pragmatic mid-term outcomes and a size-based predictor in a controversial indication where minimally invasive alternatives may enhance cosmetic and functional quality of life.
Clinical Implications: RFA (radiofrequency ablation) can be considered for functionally favorable indeterminate nodules, particularly <3 cm, to improve symptoms and cosmetic concerns, with counseling that larger nodules carry higher regrowth risk and require structured follow-up.
Key Findings
- Among 109 patients, local treatment failure occurred in 13.8% with a 3-year LTF-free probability of 85.4%.
- Complete disappearance occurred in 8.3% (3-year cumulative incidence 6.5%).
- Significant reductions in nodule volume, symptom scores, cosmetic scores, free T4, and thyroglobulin were observed.
- Initial maximum nodule diameter predicted failure (HR per 1-cm increase 2.35; 95% CI 1.23–4.48).
Methodological Strengths
- Functional imaging-based selection (99mTc-MIBI and 18F-FDG PET) prior to RFA.
- Time-to-event endpoints with hazard modeling for predictors.
Limitations
- Retrospective single-arm design without a surgical or surveillance comparator.
- Mid-term follow-up (median 2.2 years) limits assessment of long-term oncologic safety.
Future Directions: Prospective controlled trials against diagnostic lobectomy or surveillance, standardized imaging selection criteria, and longer follow-up are needed to define indications and durability.
OBJECTIVE: Current guidelines recommend surveillance or diagnostic lobectomy for indeterminate thyroid nodules. Although radiofrequency ablation (RFA) has emerged as a potential alternative, its role remains controversial. Functional imaging modalities, including 99mTc-methoxyisobutylisonitrile scintigraphy and ¹⁸F-fluorodeoxyglucose positron emission tomography, have been used to support risk stratification. This study evaluated the mid-term outcomes of RFA and their predictors in a functionally screened cohort of patients with indeterminate thyroid nodules. MATERIALS AND METHODS: This retrospective cohort study included 109 patients with Bethesda category III or IV thyroid nodules who underwent RFA after functional imaging-based evaluation between January 2018 and November 2024. The primary outcome was local treatment failure (LTF), defined as the first occurrence of nodule regrowth, an increase in vital volume, or repeated indeterminate cytology. The secondary outcome was complete disappearance of the nodule. Supplementary outcomes included the volume reduction rate, symptom and cosmetic scores, and biochemical markers. RESULTS: During a median follow-up of 2.2 years (range, 0.7-6.8 years), LTF occurred in 15 of 109 patients (13.8%), whereas complete disappearance was observed in 9 (8.3%) patients. The 3-year LTF-free probability and cumulative incidence of complete disappearance were 85.4% and 6.5%, respectively. Significant reductions were observed in the nodule volume, symptom scores, cosmetic scores, and free T4 and thyroglobulin levels. A greater initial maximum nodule diameter was independently associated with a higher likelihood of LTF (hazard ratio [HR] per 1-cm increase, 2.35; 95% confidence interval [CI], 1.23-4.48; CONCLUSION: In this functionally screened cohort of patients with indeterminate thyroid nodules, RFA demonstrated acceptable outcomes with volume reduction and symptom relief, particularly in patients with nodules <3 cm.
3. Postoperative Complications Following Neoadjuvant Therapy Across Different Oncoplastic Breast Surgery Techniques: A Retrospective Comparative Study in Breast Cancer Patients.
In 556 NAT-treated breast cancer patients undergoing level II OBS, racquet and vertical mammoplasties had significantly higher overall and major complication rates and higher Clavien-Dindo and CCI scores, likely reflecting larger resections and altered perfusion. Reoperation rates were similar across techniques.
Impact: Identifies technique-specific morbidity after NAT in a large comparative cohort, directly informing surgical planning to balance oncologic safety with cosmetic outcomes.
Clinical Implications: When planning level II OBS after NAT, consider the higher morbidity with racquet and vertical techniques—especially in large resections or compromised perfusion—optimize patient selection, and employ strategies to reduce wound complications (e.g., perfusion assessment, careful flap handling).
Key Findings
- Across 556 cases, racquet and vertical mammoplasties had significantly larger resection volumes.
- These techniques showed higher overall and major complication rates, including wound dehiscence, surgical site infection, and seroma (p<0.05).
- Clavien-Dindo grades and Comprehensive Complication Index scores were significantly higher for racquet and vertical groups.
- Reoperation rates did not differ significantly across techniques.
Methodological Strengths
- Large retrospective comparative cohort with standardized complication grading (Clavien-Dindo) and CCI.
- Technique-stratified analysis enabling procedure-specific risk estimation.
Limitations
- Retrospective design with potential selection bias and unmeasured confounding between techniques.
- Limited detail on adjuvant therapy timing and perfusion assessment may affect complication risk attribution.
Future Directions: Prospective multicenter studies with risk adjustment and incorporation of intraoperative perfusion imaging (e.g., ICG angiography) could refine technique selection algorithms after NAT.
BACKGROUND: Neoadjuvant therapy (NAT) is increasingly used in breast cancer to downstage tumors and expand eligibility for breast-conserving approaches. NAT may also influence tissue vascularity and wound healing capacity, potentially affecting postoperative morbidity. Oncoplastic breast surgery (OBS) improves cosmetic outcomes while maintaining oncological safety; however, the impact of specific OBS techniques on postoperative complications after NAT remains unclear. In this context, postoperative complications are clinically important as they may lead to delayed initiation of adjuvant therapy, increased hospital stay, higher morbidity, and impaired cosmetic and quality-of-life outcomes. This study aimed to evaluate the associations between different OBS techniques and postoperative complications in patients undergoing surgery after NAT. METHODS: This retrospective study included patients who underwent level II OBS after NAT between 2019 and 2025. Patients were categorized into five groups according to the surgical technique: racquet; vertical; radial fusiform incision; batwing-donut-Grisotti; and J-, L-, or V-shaped mammoplasties. The primary endpoint was comparison of complication rates among techniques. Secondary endpoints included identification of factors associated with complications. Complications were graded using the Clavien-Dindo classification, and overall morbidity was assessed using the Comprehensive Complication Index (CCI). RESULTS: A total of 556 patients were analyzed. Racquet and vertical mammoplasties were associated with significantly larger resection volumes than the other techniques. These two techniques demonstrated significantly higher rates of overall and major complications, as well as wound dehiscence, surgical site infection, and seroma (p<0.05). Clavien-Dindo grades and CCI scores were also significantly higher in the racquet and vertical mammoplasty groups. Despite these differences, reoperation rates did not differ significantly between techniques. CONCLUSION: Postoperative complication rates were significantly influenced by the OBS technique chosen following NAT. Racquet and vertical mammoplasties were associated with higher morbidity, likely due to larger resection volumes, altered tissue perfusion, and more extensive tissue dissection. Individualized technique selection based on tumor characteristics, breast anatomy, and patient risk factors is essential to minimize complications while preserving oncological safety and aesthetic outcomes.