Cancers doi: 10.20517/2347-9264.2026.17

Authors: Zhengyang Li,Tianyu Xiong,Wencan Li,Muhammad Naveed Ul Haq Chishti,Li Zeng,Yan Chen,Tianjing Yu,Li Li,Junlin Liao

Preoperative psychological screening in plastic surgery faces inconsistent implementation due to time constraints and patients’ reluctance to disclose distress. This narrative review explores the emerging roles of generative artificial intelligence (AI), particularly large language models (LLMs), in supporting preoperative psychological assessment and patient empowerment. This review synthesizes literature across four key domains: (1) psychological risk constructs; (2) conversational screening and language-based signal detection; (3) patient-facing psychoeducation and expectation management; and (4) system design, governance, and limitations. Current evidence suggests that LLM-enabled conversational agents can facilitate structured history-taking, elicit expectation-related cues, and deliver tailored psychoeducation in a low-stigma format. Hybrid approaches, combining validated psychometric instruments with free-text dialogue, may further improve contextualization for clinician review. Despite these potential benefits, key risks persist. These include hallucinations, demographic and aesthetic bias, privacy concerns, and a lack of standardized clinical validation. While generative AI can augment preoperative care by expanding access to screening-like interactions and expectation calibration, its deployment must be strictly bounded by a clearly defined scope, human oversight, and safety-by-design governance.To enable safer risk stratification and real-world implementation, future research should prioritize prospective clinical validation, robust escalation protocols, and multimodal approaches.

Cancers doi: 10.20517/2347-9264.2026.13

Authors: Renpeng Zhou,Ruoshui Liu,Yimin Liang,Chen Wang,Danru Wang

Aim: To evaluate the feasibility and preliminary educational impact of integrating case-based learning (CBL) with three-dimensional (3D) reconstruction in teaching nasal base depression to plastic and reconstructive surgery trainees, focusing on spatial anatomical cognition and clinical decision-making.

Methods: Eighty trainees from a tertiary academic hospital were randomly assigned to a traditional case-based instruction group or a 3D reconstruction-integrated CBL group. Both groups were instructed using a standardized nasal base depression case. The control group was taught using physical examination findings and two-dimensional images, whereas the experimental group additionally received a layered 3D reconstruction of skin-skeletal anatomy. Learning outcomes and satisfaction were assessed using self-assessment questionnaires and a structured in-class case-based assessment. Effect sizes were calculated to quantify between-group differences.

Results: Compared with the control group, the experimental group achieved significantly higher scores in understanding disease mechanisms, interpreting bone-soft tissue spatial relationships, and demonstrating proficiency in filler placement. Overall performance in the case-based diagnostic and treatment planning assessment was also superior in the experimental group, with large between-group effect sizes. In addition, satisfaction and perceived clinical relevance were higher in the experimental group.

Conclusion: The integration of CBL with 3D reconstruction was associated with improved spatial anatomical understanding and enhanced clinical decision-making within a standardized nasal base depression case model. These findings support the feasibility of this instructional approach and provide preliminary evidence for its application in anatomically complex domains of plastic and reconstructive surgery training.

Cancers doi: 10.20517/2347-9264.2026.01

Authors: Yanqi Wang,Ruyue Qiang,Dan Gan,Hui Miao,Jie Gao

Orthodontic therapy is an important component of a phased periodontal treatment plan. Clear aligners are becoming increasingly used in orthodontics. This case report describes the combined orthodontic-periodontal treatment performed on a 25-year-old female diagnosed with an Angle class II division 2 malocclusion with deep overbite and severe chronic periodontitis (stage III/grade C). The patient received a combination of periodontal therapy and orthodontic treatment with clear aligners. Basic periodontal treatment was used to control plaque and eliminate inflammation, and periodontal surgery was conducted to restore gingival esthetics. For this patient, the combined treatment achieved an ideal occlusal relationship with no progression of periodontal inflammation. Active treatment was completed within 45 months, and the patient was satisfied with both the functional and esthetic outcomes. During the 22-month follow-up, the treatment results remained stable. This case demonstrates that combining clear aligners with periodontal therapy and early relief of occlusal trauma is feasible in patients with periodontal inflammation that is effectively controlled. For selected patients with periodontitis, clear aligners may be a valuable option for improving soft- and hard-tissue esthetics, although this will need confirmation in larger-scale studies.

Cancers doi: 10.20517/2347-9264.2025.114

Authors: Pia Flender,Justus P. Beier,Tim Leypold

According to the German Association of Aesthetic Plastic Surgeons (VDÄPC, 2024), breast reduction surgery is among the most frequently performed plastic surgical procedures on the female breast. The primary goal of this operation is to reduce the volume of glandular and adipose tissue and to reposition the nipple-areola complex, for example, in cases of hypertrophic breasts. Indications include both functional impairments - such as chronic pain in the upper spine or recurrent intertriginous dermatitis in the inframammary fold - and aesthetic concerns. The first documented breast reduction procedures date back to the mid-19th century and have since undergone continuous evolution. To this day, there is no standardized protocol for preoperative marking, resulting in significant variability among clinics and surgeons. In recent years, artificial intelligence (AI) has gained increasing relevance in clinical practice, especially in enhancing diagnostic processes, surgical planning, and outcome prediction. This narrative review examines the current literature on the integration of digital solutions and AI into breast reduction surgery. The objective is to identify current applications, explore the potential of AI-assisted technologies in preoperative planning and assessment, and provide a perspective on future developments. By doing so, this article aims to contribute to the structured evaluation of the interdisciplinary interface between plastic surgery and digital innovation. It highlights the potential of AI to enable standardized, personalized, and precise surgical planning in breast reduction procedures, ultimately improving clinical outcomes and patient satisfaction.

Cancers doi: 10.20517/2347-9264.2025.115

Authors: Takamasa Nakai,Kazushi Sasaki

Thin-skinned Asian rhinoplasty is frequently complicated by cartilage visibility and oversharpening of the nasal tip. We introduce the fascial ball graft as a tunable on-lay technique for nasal tip augmentation and camouflage. A retrospective review was conducted of 227 patients (43 males, 184 females) who underwent fascial ball graft placement between 2020 and 2025 at a single rhinoplasty center. Patients were divided into two groups: Group A (n = 84), in which the fascial ball served as the sole on-lay augmentation graft; and Group B (n = 143), in which the fascial ball was placed over an auricular cartilage cap for layered augmentation. The fascial ball was constructed from autologous fascia (posterior auricular, temporalis, or costal perichondrium) using a 5-0 polydioxanone (PDS) purse-string suture, allowing intraoperative adjustment of thickness (3-6 mm) and firmness. Shine-through (0-3 scale), tip curvature radius, and FACE-Q (a validated patient-reported outcome measure for facial aesthetic procedures) “Satisfaction With Nose” scores were evaluated. Mean follow-up was 18.2 months (range 6-24 months). Shine-through was grade 0-1 in 87% of cases. Tip curvature radius significantly increased from 7.4 ± 0.8 mm preoperatively to 10.3 ± 1.0 mm at 12 months (P < 0.001), indicating improved roundness while avoiding bulbosity. FACE-Q scores increased from 52 ± 12 to 92 ± 8 (P < 0.001). No major complications were noted. The fascial ball on-lay graft provides tunable augmentation and non-translucent soft-tissue coverage, effectively achieving desired tip projection while preventing cartilage visibility in both primary and revision Asian rhinoplasty.

Cancers doi: 10.20517/2347-9264.2025.55

Authors: Katherine A. Gossett,Candace M. Waters

Full-thickness nasal defects pose significant reconstructive challenges due to the complex anatomical and functional requirements of nasal lining reconstruction. The lining is crucial for maintaining nasal patency, humidification, and overall structural integrity. This review explores the existing literature on nasal lining reconstruction, highlighting common etiologies, reconstructive principles, techniques, outcomes, and complications associated with various approaches. Techniques discussed range from simple local mucosal flaps suitable for small defects to more complex regional flaps, such as septal mucosal flaps and inferior turbinate flaps, ideal for moderate defects. Additionally, advanced approaches, including microvascular free tissue transfer - such as the radial forearm free flap - are evaluated for their effectiveness in larger or composite defects. Emerging strategies involving tissue engineering, biomaterials, and prefabricated composite grafts are explored as potential advancements that could mitigate current limitations. Critical appraisal of the advantages, complications, and limitations of each method highlights the importance of tailored reconstruction based on defect size, location, and patient-specific factors such as prior radiation therapy or surgical history. This review underscores the necessity for meticulous surgical planning, adherence to reconstructive principles, and consideration of innovative technologies to improve patient satisfaction and functional outcomes. By summarizing current evidence and identifying critical gaps, this paper aims to guide future research toward refining nasal lining reconstruction practices.

Cancers doi: 10.20517/2347-9264.2025.91

Authors: Xiaohui Liu,Kun Chen,Xitong Zhao,Zhaohan Zhuang,Xin Ni

A wound is a disruption in the integrity of the skin or other body tissues. The application of laser therapy can facilitate microscopic debridement by utilizing photothermal action to remove necrotic tissue and employing photobiological regulation to expedite epithelial growth while reducing the duration of acute inflammation. Laser therapy can regulate Heat Shock Proteins, Matrix Metalloproteinases, and inflammatory factors in wound tissues. This promotes wound re-epithelialization and organizes collagen fibers, helping to reduce scar formation. Additionally, laser therapy utilizes photochemical action for sterilization and photomechanical action to disrupt bacterial biofilms, thereby facilitating drug delivery and absorption. Numerous studies have substantiated the efficacy of laser therapy in promoting chronic wound re-epithelialization, diminishing scarring in acute wounds, and enhancing both the speed and quality of overall wound healing. However, further large-scale studies are required to explore the optimal parameter range for laser wound therapy. Consequently, laser therapy represents a promising option for managing various types of wounds, offering prospects for further reduction in scar formation.

Cancers doi: 10.20517/2347-9264.2025.123

Authors: Shi Xiong,Jiayin Ji,Wenjie Cheng,Qianqian Pang,Cuiling Lin,Peng Wei

Skin photoaging is a form of premature cutaneous aging caused by chronic ultraviolet (UV) exposure, manifesting as wrinkling, laxity, and pigmentary disturbances. UV radiation generates reactive oxygen species and upregulates matrix metalloproteinases, leading to extracellular matrix degradation. Emerging evidence implicates ferroptosis - an iron-dependent form of regulated cell death characterized by lipid peroxidation - in ultraviolet B (UVB)-induced photodamage. Studies show that glutathione peroxidase 4 (GPX4)-dependent antioxidant defenses are compromised in UV-exposed skin cells, and ferroptosis inhibitors can partially attenuate UV-induced cellular damage. Exosomes derived from adipose-derived stem cells (ADSC-Exos) have emerged as a promising cell-free regenerative strategy for skin rejuvenation. These 30-150 nm extracellular vesicles offer advantages over whole-cell therapy, including low immunogenicity, reduced tumorigenic concerns compared with replicating cells, and easier standardization. Through paracrine signaling, ADSC-Exos deliver bioactive proteins and non-coding RNAs that promote collagen synthesis, angiogenesis, and anti-inflammatory effects. Circular RNAs (circRNAs) are highly enriched and stable in exosomes due to their covalently closed structure. Notably, hypoxic-preconditioned ADSC-Exos deliver circ-Ash1l into UVB-damaged skin cells, where it sequesters miR-700-5p and upregulates GPX4. This circ-Ash1l/miR-700-5p/GPX4 axis inhibits ferroptotic cell death, reduces oxidative damage, and attenuates UVB-induced photoaging phenotypes in vitro and in vivo. This review summarizes the mechanisms of UVB-mediated photoaging and ferroptosis, the therapeutic potential of adipose-derived stem cell-derived exosomes, the role of exosomal circRNAs, and engineering strategies to enhance exosome therapy. We also discuss clinical translation challenges, including manufacturing, quality control, and regulatory considerations.

Cancers doi: 10.20517/2347-9264.2025.97

Authors: Nandita Melati Putri,Narottama Tunjung,Indira Saraswati Sanjaya,Sheila Oklia

Aim: This systematic review and meta-analysis aims to evaluate the efficacy and safety of postoperative radiotherapy following surgical excision, with or without reconstruction by flap, for patients with ear keloids.

Methods: A comprehensive literature search was performed in PubMed, Cochrane Library, ScienceDirect, and EBSCOHost through August 2025. We included randomized controlled trials, cohort studies, and case series involving patients with ear keloids treated with surgical excision and postoperative radiotherapy, with or without flap reconstruction. Data of recurrence, complications, aesthetic outcomes, and patient satisfaction were abstracted and analyzed.

Results: Fourteen studies were included based on the criteria, with 735 treated keloids in total. Pooled recurrence proportions were 7.8% [95% confidence interval (CI): 0.0%-16.0%] in studies reporting excision with flap reconstruction plus postoperative radiotherapy and 20.0% (95%CI: 5.2%-34.8%) in studies reporting excision plus postoperative radiotherapy without flap reconstruction. Reported adverse effects were generally mild, most commonly pigmentary change and hypertrophic scarring; flap-related events were uncommon. However, long-term oncologic risk could not be reliably assessed, as most included studies had limited follow-up and were not designed to detect rare late events. Cosmetic outcomes and patient satisfaction were frequently reported as favorable across the subset of studies that assessed these outcomes.

Conclusion: Postoperative radiotherapy is commonly reported as an effective adjuvant after excision of auricular keloids, with relatively low recurrence and generally mild short-term adverse effects. Cosmetic outcomes and patient satisfaction were frequently favorable, although interpretation is limited by substantial heterogeneity and predominantly non-comparative observational evidence, underscoring the need for well-designed comparative studies with standardized outcome reporting.

Cancers doi: 10.20517/2347-9264.2025.75

Authors: Anne Y. Feng,Kristen A. Echanique

Nasal septum reconstruction is an essential component of a successful rhinoplasty for both nasal cosmesis and function. In this review, we provide both historical strategies and contemporary updates in nasal septum surgery. Conventional septoplasty involves removal of deformed septal cartilage, with care taken to maintain the integrity of the dorsal and caudal cartilaginous L-strut and avoid opposing mucoperichondrial flap perforations that can cause septal perforations after the healing period. When these conditions cannot be met, advanced septal reconstruction techniques may be required to address caudal septal deviation, dorsal septal deviation, and septal perforations, including extracorporeal structural reconstruction in particularly severe cases. Recent refinements of these more extensive techniques also include subtotal and anterior modifications to total septal reconstruction to better preserve the keystone area and dorsal preservation techniques to minimize disruption of aesthetically desirable aspects of the native nose. We conclude with an algorithmic pathway containing major considerations that highlight advantages of each technique described in this review to guide the rhinoplasty surgeon toward appropriate maneuvers to achieve the desired cosmetic and functional result in septal reconstruction.

Cancers doi: 10.20517/2347-9264.2025.77

Authors: Sarena Maistry,Julia Toman

Reconstructive rhinoplasty, beyond its aesthetic role, is vital for the restoration of form and function in low-resource settings. Low- and middle-income countries (LMICs), especially in sub-Saharan Africa, remain critically under-resourced, with fewer than one plastic surgeon per 100,000 population and pronounced rural-urban disparities. Traditional outreach vertical models provide short-term relief but often lack continuity. Diagonal models, with integrated training and outcome monitoring, have demonstrated greater sustainability. Additional consideration is required for rhinoplasty procedures that account for cultural aesthetic norms and regional anatomical variations, as these are associated with higher patient satisfaction and better community uptake, highlighting the importance of culturally appropriate care in global surgical outreach. This narrative review aims to (1) highlight LMIC-specific challenges, particularly in sub-Saharan Africa; (2) compare surgical outreach models; (3) propose sustainable capacity building strategies, and (4) review culturally specific rhinoplasty techniques. As culturally specific rhinoplasty grows on a global scale, the result of locally empowered rhinoplasty surgeons in LMICs through diagonal partnership models and long-term skills transfer will result in improved patient care access. Investment in training, tele-mentorship, and metric-driven follow-up is essential to improving surgical equity and outcomes.

Cancers doi: 10.20517/2347-9264.2025.127

Authors: Maurizio Cavallini,Emanuele Chittano Congedo,Barbara Claysset,George Christopoulos,Ting Song Lim,Josè Ramon Saucillo Gibert,Hema Sundaram,Francesca Arrigoni,Valentina Merenda

Regenerative aesthetic medicine has rapidly evolved from a primarily corrective discipline into a biologically oriented field focused on restoring tissue function, quality, and homeostasis. This narrative review examines the conceptual foundations of “regeneration” in aesthetic practice and critically discusses the biological rationale and clinical evidence supporting the main injectable modalities currently described as regenerative, including platelet-rich plasma (PRP), polynucleotides, exosomes, stromal vascular fraction (SVF)-based approaches, poly-L-lactic acid (PLLA), and calcium hydroxylapatite (CaHA). These interventions act through distinct yet partially overlapping mechanisms, involving modulation of inflammation, fibroblast activation, extracellular matrix remodeling, angiogenesis, and immunobiological signaling. PRP provides concentrated growth factors with context-dependent effects on tissue repair; polynucleotides enhance fibroblast activity and dermal hydration through nucleotide-mediated pathways; exosomes function as intercellular signaling mediators influencing inflammatory cascades and tissue remodeling; SVF-based therapies combine volumetric support with paracrine and cellular effects; while PLLA and CaHA act as long-term biostimulatory fillers, promoting sustained neocollagenesis and dermal reorganization through controlled inflammatory and macrophage-mediated responses. Although clinical studies report improvements in skin quality parameters, dermal architecture, elasticity, and hair density, the available evidence is heterogeneous and often limited by variability in preparation methods, product characteristics, injection protocols, and outcome measures. Issues related to standardization, reproducibility, and regulatory classification remain particularly relevant for biologically derived products such as PRP, exosomes, and SVF. Overall, regenerative aesthetics represents a paradigm shift from transient correction toward biologically driven tissue renewal; however, consolidation within evidence-based aesthetic medicine will require higher-quality comparative trials, standardized methodologies, and clearer regulatory frameworks.

Cancers doi: 10.20517/2347-9264.2025.84

Authors: Jessica D. Kant,Kirsten M. Kuhn-Kutteh,Frances W. Grimstad,Elizabeth R. Boskey

As gender-affirming surgery becomes more widely available, the demand for such procedures has increased accordingly. Where once genital reconstructive surgeries, such as vulvovaginoplasty, metoidioplasty, and phalloplasty, were accessible only to a select few individuals in a limited number of facilities, they are now offered to a broader cross-section of prospective patients. The life experiences, social environments, and support available to these patients vary widely, and many can benefit from the support of behavioral health professionals. While this is true for many types of reconstructive surgery, gender-affirming genital surgeries have the potential to dramatically reshape how individuals relate to their bodies across numerous domains - affecting not just gender congruence, but also sexuality and daily activities such as toileting. Behavioral health providers play a crucial role in supporting patients through the preparation and recovery processes for these surgeries. This includes helping to identify areas of a patient’s life that may complicate recovery and working with them to develop appropriate healing strategies. While the role of behavioral health providers is sometimes complicated by their parallel responsibilities in regulating access to care through the letter-writing process, they are well-positioned to support patients across the perioperative period when their expertise is used to facilitate patient readiness and recovery. This review article explores how behavioral health professionals can support the well-being of individuals undergoing gender-affirming genital surgery, from the presurgical period through long-term recovery. It is also intended to raise surgeons’ awareness of the impact of mental health and social determinants of health on the perioperative experience and to facilitate the provision of trauma-informed care and support.

Cancers doi: 10.20517/2347-9264.2025.93

Authors: Elijah R. Hart,Finn Gornick,Jae Downing,Emile Latour,Solange Bassale, Daniel D. Dugi III,Amy Penkin,Geolani W. Dy

Aim: The process of seeking genital gender-affirming surgery (GGAS) can be mentally and emotionally taxing. Robust social support and effective coping strategies are essential for individuals pursuing GGAS, particularly during the perioperative period, when the complex demands of the healthcare system may exacerbate the adverse mental health effects of stigma, discrimination, and isolation experienced by transgender and gender diverse (TGD) people. To inform interventions aimed at enhancing the mental health of TGD individuals during the perioperative period, we assessed the relationships among coping, mental health, and perceived social support in TGD patients seeking GGAS (vaginoplasty and vulvoplasty) at an academic medical center.

Methods: Patients aged 18 years and older who attended a consultation visit for GGAS completed a one-time questionnaire (N = 118). Depression, anxiety, coping skills, and perceived social support were assessed using the Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder 7-Item scale (GAD-7), Coping Self-Efficacy Scale (CSES), and Multidimensional Scale of Perceived Social Support (MSPSS), respectively.

Results: Among respondents, greater depression symptoms (PHQ-2 ≥ 3) were associated with lower coping self-efficacy. Lower coping self-efficacy was associated with higher symptoms of anxiety. Higher coping self-efficacy was associated with higher perceived level of social support.

Conclusions: These findings identify an opportunity for perioperative interventions that address coping self-efficacy and social support for TGD individuals pursuing GGAS.

Cancers doi: 10.20517/2347-9264.2025.78

Authors: Nicole Senderovich,Schubin Chon,Benjamin Brownlee,Samuel Oyer

Aim: Gender-affirming rhinoplasty is a key component of facial gender-affirming surgery, aiming to align nasal aesthetics and function with a patient’s gender identity. While there has been a strong emphasis on the cosmetic outcomes of this procedure, rhinoplasty is also intended to improve nasal function. Few studies have assessed functional outcomes in this population using validated, patient-reported measures. This study aims to evaluate changes in nasal function and cosmetic satisfaction using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) in patients undergoing gender-affirming rhinoplasty.

Methods: A retrospective cohort of 20 patients (all facial feminization) who underwent gender-affirming rhinoplasty at a tertiary academic center was analyzed. SCHNOS-Obstruction (SCHNOS-O) and SCHNOS-Cosmesis (SCHNOS-C) scores were collected preoperatively and at approximately 3, 6, and 12 months postoperatively. Paired t-tests or Wilcoxon signed rank tests were used to compare pre- and postoperative scores, with subgroup analyses performed using analysis of variance. Statistical significance was set at P < 0.05.

Results: Statistically significant and clinically meaningful improvements in SCHNOS-C scores were observed at 3, 6, and 12 months post-operatively, compared to pre-operatively (P < 0.05). Among the subgroup of patients with baseline nasal obstruction, a statistically and clinically significant reduction in score was seen at 6 months post-operatively compared to baseline (P < 0.05). Patients without nasal obstruction at presentation did not show a worsening SCHNOS-O score at any post-operative timepoint.

Conclusion: Gender-affirming rhinoplasty is associated with significant improvements in aesthetic satisfaction as measured by SCHNOS-C scores, with significant improvements in nasal function seen among those patients with nasal obstruction on presentation. These findings support the use of validated, patient-centered tools in outcome assessment and highlight the need for further research to optimize both functional and cosmetic results in gender-affirming rhinoplasty.