Daily Cosmetic Research Analysis
Analyzed 10 papers and selected 3 impactful papers.
Summary
Analyzed 10 papers and selected 3 impactful articles.
Selected Articles
1. Safety and Efficacy of OnabotulinumtoxinA in Pregnancy: A Systematic Review.
This first systematic review pooling 18 studies (486 pregnancies) reports no clear causal link between onabotulinumtoxinA exposure during pregnancy and adverse fetal outcomes, though 20.1% fetal losses and 2.3% birth defects were observed across heterogeneous datasets. Evidence is insufficient to confirm safety, underscoring the need for larger, well-designed studies and registries.
Impact: It consolidates the dispersed clinical experience on BoNT-A exposure in pregnancy, informing risk–benefit counseling for aesthetic and therapeutic uses in reproductive-age women.
Clinical Implications: Counsel pregnant or potentially pregnant patients that definitive safety cannot be assured; defer elective cosmetic BoNT-A and restrict use to compelling medical indications with shared decision-making. Encourage reporting to pregnancy registries.
Key Findings
- Synthesized outcomes from 18 studies encompassing 486 pregnancies exposed to onabotulinumtoxinA.
- Observed 77.7% healthy outcomes, 20.1% fetal losses (elective, therapeutic, spontaneous), and 2.3% birth defects.
- No direct causal association between BoNT-A exposure and adverse outcomes could be inferred due to heterogeneity and limited data.
Methodological Strengths
- Systematic multi-database search with structured data extraction and synthesis.
- First comprehensive aggregation focused specifically on BoNT-A exposure during pregnancy.
Limitations
- Marked heterogeneity in indications, dosing, timing of exposure, and outcome reporting across included studies.
- Predominance of observational designs and small samples for rare outcomes limit causal inference and power.
Future Directions: Establish prospective pregnancy registries, standardize exposure/outcome reporting, and perform adequately powered studies to detect rare malformations and long-term neurodevelopmental effects.
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. Postoperative Complications Following Neoadjuvant Therapy Across Different Oncoplastic Breast Surgery Techniques: A Retrospective Comparative Study in Breast Cancer Patients.
In 556 patients undergoing level II oncoplastic breast surgery after neoadjuvant therapy, racquet and vertical mammoplasties had larger resections and significantly higher overall and major complication rates, including wound dehiscence, infection, and seroma, with higher Clavien-Dindo grades and CCI. Reoperation rates were similar across techniques.
Impact: Technique-specific complication profiles after NAT directly inform surgical planning to balance oncologic safety with cosmetic and quality-of-life outcomes.
Clinical Implications: Consider avoiding racquet and vertical mammoplasties in high-risk settings post-NAT or mitigate risks (optimize perfusion, minimize resection volume) to prevent delays to adjuvant therapy and protect cosmetic results.
Key Findings
- Among 556 NAT-treated patients, racquet and vertical mammoplasties involved larger resections and had higher overall and major complication rates (p<0.05).
- Higher Clavien-Dindo grades and Comprehensive Complication Index scores were observed with racquet and vertical techniques.
- Reoperation rates did not significantly differ across the five oncoplastic techniques.
Methodological Strengths
- Large comparative cohort with technique stratification after standardized context (post-neoadjuvant therapy).
- Use of validated complication grading (Clavien-Dindo) and aggregate morbidity (CCI).
Limitations
- Retrospective design with potential selection bias in technique choice and confounding by resection volume and perfusion.
- Timeframe and standardized follow-up for complications not detailed; generalizability may vary by center expertise.
Future Directions: Prospective, multicenter, propensity-matched studies integrating intraoperative perfusion assessment (e.g., ICG angiography) to refine technique selection and reduce morbidity post-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.
3. Mid-Term Outcomes and Outcome Predictors after Radiofrequency Ablation for Indeterminate Thyroid Nodules Following Functional Imaging Screening: A Retrospective Cohort Study.
In 109 Bethesda III/IV nodules selected by functional imaging, radiofrequency ablation achieved acceptable mid-term control (3-year LTF-free 85.4%), significant volume reductions, and improved symptom and cosmetic scores. Larger initial nodule diameter independently predicted local treatment failure.
Impact: Provides real-world evidence supporting RFA as a minimally invasive alternative to surgery in selected indeterminate thyroid nodules, with patient-centered outcomes including cosmetic benefit.
Clinical Implications: For Bethesda III/IV nodules with favorable functional imaging, RFA can be discussed as an alternative to lobectomy, especially for nodules <3 cm, balancing oncologic safety with cosmetic priorities.
Key Findings
- Among 109 patients, local treatment failure occurred in 13.8% over a median 2.2-year follow-up; 3-year LTF-free probability was 85.4%.
- RFA led to significant reductions in nodule volume, symptom scores, cosmetic scores, and free T4 and thyroglobulin levels.
- Larger initial maximum nodule diameter independently increased the hazard of local treatment failure (HR 2.35 per 1 cm; 95% CI 1.23–4.48).
Methodological Strengths
- Defined primary endpoint (LTF) with survival analysis and multivariable hazard modeling.
- Comprehensive outcomes including imaging volumetrics, patient-reported symptom/cosmetic scores, and biochemical markers.
Limitations
- Retrospective, single-cohort design without a surgical or surveillance control group; selection bias possible.
- Heterogeneity in functional imaging modalities and modest sample size limit generalizability.
Future Directions: Prospective comparative trials against lobectomy and active surveillance, standardized functional imaging criteria, and longer-term oncologic outcomes are needed.
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.