Hair Transplantation in the United States: A Population-based Survey of Female and Male Pattern Baldness

Background: Androgenetic alopecia, the most common type of hair loss, can impair the patient’s overall mental health. Although there are pharmaceutical and surgical treatments available, little is known about the public standpoint toward hair transplantation (HT). Methods: A sample of individuals living in the United States (n = 1000; male and female participants were equally distributed) was asked to fill out the questionnaire. The online survey was conducted in June 2022. Results: Most participants (42%; n = 416) were between 41 and 60 years of age. Study participants frequently reported that, with their hair loss progressing, they would not feel attractive anymore (n = 400; 40%), nor as confident as before (n = 330; 33%). Although women with minimal hair loss were willing to spend a median price of $4000 [interquartile range (IQ) IQR$1000–$5000], women with extensive hair loss were willing to spend significantly more (median =$5000; IQR $3600–$6375; P = 0.011). This was reproducible in men (P = 0.033). Although significantly fewer women considered undergoing HT (430 women versus 447 men; P < 0.001), female participants were willing to pay more for their HT compared with men (P = 0.039). Conclusions: Individuals living in the United States consider hair loss to impair their attractiveness and regard HT as a valuable therapeutic option. More affordable and gender-specific HT should be subject to future research work

Racial Disparities in Surgical Outcomes after Mastectomy in 223,000 Female Breast Cancer Patients - A Retrospective Cohort Study

BACKGROUND: Breast cancer mortality and treatment differ across racial groups. It remains unclear whether such disparities are also reflected in perioperative outcomes of breast cancer patients undergoing mastectomy. STUDY DESIGN: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2021) to identify female patients who underwent mastectomy for oncological purposes. The outcomes were stratified by five racial groups (white, Black/African American, Asian, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander) and included 30-day mortality, reoperation, readmission, surgical and medical complications, and non-home discharge. RESULTS: The study population included 222,947 patients, 68% (n=151,522) of whom were white, 11% (n=23,987) Black/African American, 5% (n=11,217) Asian, 0.5% (n=1,198) American Indian/Alaska Native, and 0.5% (n=1,018) Native Hawaiian/Pacific Islander. While 136,690 (61%) patients underwent partial mastectomy, 54,490 (24%) and 31,767 (14%) women received simple and radical mastectomy, respectively. Overall, adverse events occurred in 17, 222 (7.7%) patients, the largest portion of which were surgical complications (n=7,246; 3.3%). Multivariable analysis revealed that being of Asian race was protective against perioperative complications (OR=0.71; P<0.001), whereas American Indian/Alaska Native women were most vulnerable to the complication occurrence (OR=1.41; P<0.001). Black/African American patients had a significantly lower risk of medical (OR=0.59; P<0.001) and surgical complications (OR=0.60; P<0.001) after partial and radical mastectomy, respectively, their likelihood of readmission (OR=1.14; P=0.045) following partial mastectomy was significantly increased. CONCLUSION: We identified American Indian/Alaska Native women as particularly vulnerable to complications following mastectomy. Asian patients experienced the lowest rate of complications in the perioperative period. Our analyses revealed comparable confounder-adjusted outcomes following partial and complete mastectomy between Black and white races. Our findings call for care equalization in the field of breast cancer surgery

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Effect of primary admission to burn centers on the outcomes of severely burned patients

Objective: Burns represent a special form of severe trauma. Due to long hospitalization, rehabilitation, and extensive scar treatment, severe burn injuries rank among the most expensive traumatic injuries regarding associated health care costs. The presented single-burn-center experiences evaluated the effects of primary versus secondary burn intensive care unit (BICU) admissions on outcomes in severely burned patients. Methods: Within 30 months, 186 patients were admitted to the BICU. The cases were divided into two groups depending on their admission type: "primary" vs. "secondary". All patients were analyzed retrospectively regarding the need for surgery, encountered complications, time of hospitalization and overall survival. Results: The incidence of primary BICU-admissions was 65.1%. Both patient groups were comparable regarding demographics, comorbidities, % TBSA burn, associated inhalation injuries, ABSI scores and intubation rates (p>0.05). Both groups received similar numbers of operations and had overall comparable mortality rates (p>0.05). However, duration until first burn excision, length of ventilation, as well as BICU-and overall hospital length of stay were significantly shorter in the "primary"-compared to the "secondary" group (p<0.05). Conclusion: Several burn societies have published precise criteria of when a patient needs to be referred to a burn center. In the presented series, patients that were primarily treated at a BICU showed significantly better outcomes regarding several parameters. In order to further optimize treatment of burn patients it therefore appears that precise initial assessment and if appropriate respective primary transport to dedicated burn centers needs to be reemphasized, especially among first-and emergency care providers. (C) 2018 Elsevier Ltd and ISBI. All rights reserved

Impact of patients’ gender on microvascular lower extremity reconstruction

The physiological differences between genders have significant implications for health and disease. With regard to microsurgery, results remain elusive as to whether male or female gender is an independent risk factor for free flap reconstruction. This study evaluated the impact of gender on outcomes of lower-extremity free-flap reconstructions. Within 7 years, 358 patients received 393 microvascular lower limb free flap reconstructions. The cases were divided into two groups according to patients' gender: male vs. female. Retrospective data analysis evaluated patients' demographics, perioperative details, surgical complications and flap outcomes over a 3-month follow-up period. Major and minor surgical complications, including total and partial flap loss, showed no significant differences between the investigated groups (p>.05). In addition, there was no significant difference with regard to the rate of surgical revision surgery, or the incidence of arterial and venous thrombosis (p>.05). Comparison of different flap types (fasciocutaneous ALT vs. gracilis muscle flaps) and type of anastomosis (end-to-end vs. end-to-side) also revealed no difference in outcomes in respect to gender. In conclusion, gender cannot be regarded as an independent risk factor for free flap reconstructions in patients with lower-extremity defects

Impact of Prehospital Hypothermia on the Outcomes of Severely Burned Patients

When treating burn injuries, to date, there still remains significant disagreement whether presence of hypothermia (HT) on burn centers' intensive care unit (BICU) admission improves or worsens outcomes. The presented single burn center experiences set out to further evaluate the incidence, cause, and potential effects of HT on outcomes in severely burned patients. Between January 2015 and February 2017, 142 severely burned patients were admitted to a BICU. Temperature at BICU admission of = 36.0 degrees C as normothermia (NT). The cases were divided into two groups: HT vs NT. Fifty-four patients met inclusion criteria and were analyzed retrospectively regarding encountered complications, time of hospitalization, and overall survival. The overall incidence of HT on arrival was 62.9%. Mean duration from burn accident to BICU admission did not differ significantly, but the groups showed significant differences regarding total body surface area (TBSA; P .05). However, time until death was significantly shorter in the HT group. HT at admission remains a common problem following burn injury. Main risk factors include inappropriate temperature management after injury and during transport, extent of TBSA burn, and quantity of resuscitation. Given the high incidence, the involved health care and, especially, also prehospital providers should be further educated about existing recommendations and guidelines to prevent HT

The Role of Plastic Surgeons in Advancing Development Global

In September 2015, the international community came together to agree on the 2030 Agenda for Sustainable Development, a plan of action for people, the planet, and prosperity. Ambitious and far-reaching as they are, they are built on three keystones: the elimination of extreme poverty, fighting climate change, and a commitment to fighting injustice and inequality. Critical to the achievement of the Agenda is the global realization of access to safe, affordable surgical and anesthesia care when needed. The landmark report by the Lancet Commission on Global Surgery estimated that between 28 and 32 percent of the global burden of disease is amenable to surgical treatment. However, as many as five billion people lack access to safe, timely, and affordable surgical care, a burden felt most severely in low- and middle-income countries (LMICs). Surgery, and specifically plastic surgery, should be incorporated into the international development and humanitarian agenda. As a community of care providers dedicated to the restoration of the form and function of the human body, plastics surgeons have a collective opportunity to contribute to global development, making the world more equitable and helping to reduce extreme poverty. As surgical disease comprises a significant burden of disease and surgery can be delivered in a cost-effective manner, surgery must be considered a public health priority

Global aesthetic surgery statistics: a closer look

Introduction: Obtaining quality global statistics about surgical procedures remains an important yet challenging task. The International Society of Aesthetic Plastic Surgery (ISAPS) reports the total number of surgical and non-surgical procedures performed worldwide on a yearly basis. While providing valuable insight, ISAPS' statistics leave two important factors unaccounted for: (1) the underlying base population, and (2) the number of surgeons performing the procedures. Methods: Statistics of the published ISAPS' "International Survey on Aesthetic/Cosmetic Surgery' were analysed by country, taking into account the underlying national base population according to the official United Nations population estimates. Further, the number of surgeons per country was used to calculate the number of surgeries performed per surgeon. Results: In 2014, based on ISAPS statistics, national surgical procedures ranked in the following order: 1st USA, 2nd Brazil, 3rd South Korea, 4th Mexico, 5th Japan, 6th Germany, 7th Colombia, and 8th France. When considering the size of the underlying national populations, the demand for surgical procedures per 100,000 people changes the overall ranking substantially. It was also found that the rate of surgical procedures per surgeon shows great variation between the responding countries. Conclusion: While the US and Brazil are often quoted as the countries with the highest demand for plastic surgery, according to the presented analysis, other countries surpass these countries in surgical procedures per capita. While data acquisition and quality should be improved in the future, valuable insight regarding the demand for surgical procedures can be gained by taking specific demographic and geographic factors into consideration

Female eye attractiveness – Where beauty meets science

Introduction: While periorbital and -ocular surgery ranks amongst the most frequently performed plastic surgical procedures, only scarce information exists regarding the contributing factors of aging and its systematic anatomic assessment. The presented study, based on measuring distinct physical landmarks, aimed to gather data to provide a foundation of in-depth periorbital analysis in order to more clearly define female eye attractiveness. Methods: 80 probands (age range: 30-50 years, M = 38.4 +/- 6.5 years) were asked to judge 60 standardized high-resolution digital pictures of female eye regions in respect to the perceived age (in years) and attractiveness (7-point Likert scale). All photographs were objectively evaluated and measured utilizing a total of 38 distinct landmarks. The data was analyzed by calculating correlations between relevant measured eye area parameters and mean attractiveness ratings including age estimations. Results: Overall, it was found that several specific eye shape features correlate with attractiveness and perceived age. For instance, large visible height of the iris and large upward and lateral inclination of both eye axis and eyebrows correlated moderately to strongly with attractiveness (p < 0.05). Conclusion: Regarding the female eye, there exist distinct periorbital anatomic features and landmarks which contribute to a youthful appearance and attractiveness. Knowledge regarding these facts may serve as an important guideline for pre- and post-operative patient analysis. (C) 2018 Published by Elsevier Ltd on behalf of European Association for Cranio-Maxillo-Facial Surgery