Daniel J. Gould

Platelet-rich plasma (PRP) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB) are both used in aesthetic medicine but have never been directly compared. They differ in origin, route of administration, and regulatory status, and neither is FDA approved for aesthetic use. This structured narrative review was reported in accordance with PRISMA 2020, PRISMA-S, and SWiM. PubMed was searched on May 5, 2026, using 4 strategies covering PRP/platelet-rich fibrin (PRF) in aesthetic, scar, and hair restoration applications; rhPDGF-BB/becaplermin in cutaneous wound healing; PRP preparation and reporting quality; and PDGF-related hair follicle biology. A total of 3667 records were identified, of which 36 met inclusion criteria. PRP had the broader aesthetic evidence base, with meta-analyses reporting hair density gains of ∼+25 to +40 hairs/cm2, but preparation and reporting were inconsistent, with only 12.1% of studies providing reproducible protocols and 26.6% reporting final product composition. Measured growth factor concentrations, including PDGF, did not consistently correlate with clinical outcomes. rhPDGF-BB provides defined dosing and benefit in diabetic wound closure (odds ratio, 1.53; 95% CI, 1.14-2.04), but aesthetic evidence is limited to controlled studies of 5 to 12 participants with follow-up of 6 months or less. No head-to-head aesthetic trials exist. PRP is supported by broader clinical experience, whereas rhPDGF-BB offers greater standardization whose aesthetic value remains unestablished. Because the agents are delivered by different routes to different populations, these findings describe parallel evidentiary paradigms rather than a comparison of interchangeable therapies. Standardization should not be interpreted as evidence of superior clinical efficacy. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.

Patients increasingly form expectations about plastic surgery from social media and other online sources, and artificial intelligence (AI) now functions both as a tool for analyzing that content and as a source of the content itself. This review maps original empirical studies that applied an AI or computational method beyond conventional statistical analysis to social media, online reviews, public digital images, surveys, or crowdsourced data in plastic surgery while reporting an outcome related to the perceptions, questions, experiences, or information exposure of patients or the public. Twenty-six studies published between 2019 and 2026 met inclusion criteria, 19 (73%) of them since 2024. Facial aesthetic surgery was the most represented domain (n = 9; 35%). RealSelf was the most common primary data source (n = 8; 31%), 18 studies (69%) analyzed a single platform, and 18 (69%) analyzed text alone. Sentiment or emotion analysis was the most common computational method (n = 13; 50%), and 16 studies (62%) applied pretrained models or lexicons as released, without training on study data. A human comparator was reported in 10 studies (38%) and external validation in 1 (4%). No study linked patient-generated digital data to a validated patient-reported outcome measure or evaluated these data for surgical education. Work at this intersection is expanding rapidly but remains descriptive, single-platform, and largely unvalidated.

Was not provided for this article.

Background: The beauty industry has seen a shift in standards, with patients increasingly favoring natural and subtle enhancements over dramatic cosmetic changes. In this evolving landscape, nanofat has emerged as a promising tool to plastic surgeons due to its regenerative potential and biocompatibility. Despite its growing popularity, hesitancy regarding its efficacy and side effects persists. Methods: A systematic literature review was conducted in December 2024 following PRISMA guidelines. Databases searched included PubMed, Embase, MEDLINE, Scopus, Web of Science, and Cochrane Library databases. Results: A total of 18 studies met the inclusion criteria, encompassing 768 patients. Nine studies (n = 512 patients) assessed patient satisfaction, with most patients reporting above-average satisfaction. Eight studies (n = 188) reported outcomes using the Vancouver Scar Scale and Patient and Observer Scar Assessment Scale, all showing significant improvements in scar characteristics. Additional outcomes included collagen synthesis and transforming growth factor beta 1 expression (n = 68), hair density and thickness (n = 9), and histological analysis of skin samples ( n = 24). Regarding safety, 12 studies reported no significant complications such as granulomas or cysts, whereas 8 studies noted mild side effects, including erythema, hyperpigmentation, and edema. Conclusions: Nanofat demonstrates significant potential as a cost-effective, well-tolerated regenerative therapy in both aesthetic and reconstructive contexts. Although preliminary findings are promising, further high-quality studies are necessary to establish standardized methodologies and optimize preparation techniques.

Submandibular gland prominence can undermine aesthetic outcomes in neck and lower face rejuvenation, even after deep-plane facelifts and platysmaplasty. In selected patients, gland reduction has emerged as an effective adjunct to improve cervicomental contour. In this systematic review, the authors analyze 51 studies involving 2971 patients undergoing submandibular gland reduction across 6 surgical approaches, including transcervical, necklift-integrated, intraoral, retroauricular, endoscopic, and robotic-assisted techniques. The overall complication rate was 15.1%, with marginal mandibular nerve injury being most common (9.8%). Minimally invasive methods, particularly endoscopic and intraoral, showed lower hematoma rates and faster recovery with high patient satisfaction. Retroauricular approaches yielded excellent aesthetic outcomes but had the highest nerve injury rates. LigaSure-assisted and partial reductions reduced bleeding and preserved function. Despite generally favorable results, variation in technique, outcome reporting, and patient selection limits broader adoption. Standardized protocols and prospective studies are needed to optimize safety, aesthetic benefit, and long-term results in submandibular gland contouring for facial rejuvenation. Level of Evidence: 3 (Therapeutic)

As the fields of plastic surgery and dermatology advance, regenerative medicine is positioned to play a transformative role in both aesthetic and reconstructive procedures. This narrative review examines current and emerging applications of biologic therapies, including exosomes, platelet-rich plasma (PRP), and adipose-derived stem cells (ASCs) with an emphasis on their mechanisms of action, clinical efficacy, and regulatory considerations. We also explore synergistic strategies, such as the combined use of biologics with laser-based technologies, which may enhance therapeutic outcomes. Looking forward, we highlight promising developments in mitochondrial-based therapies, microRNA-based therapies, synthetic exosome mimetics, and AI-assisted biologic design, offering a framework for personalized, precision-driven interventions. By synthesizing existing clinical data alongside scientific and ethical challenges, this narrative review provides a comprehensive perspective on how regenerative therapies are transforming the landscape of aesthetics. Ultimately, successful integration of these innovations will require rigorous validation, ethical responsibility, and a patient-centered approach by plastic surgeons and dermatologists to ensure both safety and accessibility in mainstream practice.

Background: Facial feminization surgery has become a key component of the male-to-female transition. Objectives: The authors of this study aim to determine which facial features are viewed as most masculine or feminine across biological sex and ethnicity. Methods: Four web-based survey instruments were used, displaying an image set of artificial intelligence–generated cis-male and cis-female facial photographs from the following ethnicities: Black, Asian, Oceanic, South Asian, and Caucasian. Faces were divided into 11 unique components and were thus rated on a scale from 1 (most masculine) to 11 (most feminine). Results: A total of 2566 respondents completed the survey instruments. Respondents identified the lips as the most feminine facial feature (range, 7.98-9.41, P < .0001). Female respondents found the lips to be the most feminine feature of all faces except those of the Black female and Caucasian male, in which the eyes were rated as the most feminine (8.09, 8.20, P < .0001). The most masculine facial features were the mandibular angle (4.67), laryngeal prominence (4.81), chin (4.94), and hairline (5.17), whereas the most feminine features were the lips (8.50), eyes (7.84), orbits (6.74), and cheeks (6.73), which were all statistically significant (P < .05). Conclusions: The authors of this study provide valuable insight into the public's perception of inherently masculine and feminine facial features across ethnicity and gender. Level of Evidence: 5 (Therapeutic):

Background: Glucagon-like peptide-1 (GLP-1) receptor agonists have gained popularity after clinical trials demonstrated their weight-loss potential. The term “Ozempic® face” has been coined to describe the exaggerated volume loss from semaglutide therapy, resulting in advanced facial aging. Objectives: The authors of this study aim to review plastic surgery publications discussing GLP-1 receptor agonists and characterize the public's perception of the effect of these medications on weight loss. Methods: A systematic review of the PubMed database was conducted to identify articles discussing GLP-1 receptor agonist use in plastic surgery. Articles in non-English languages or on nonhuman subjects were excluded. Bias assessment was completed using standardized checklists. Google Trends was used to track public interest in these medications and their effect on face and body morphology. Results: Twenty-three articles were identified, revealing that (1) several injectable drugs are available for weight loss, (2) GLP-1 receptor agonists cause morphological changes resembling advanced aging, (3) surgical and nonsurgical options exist to address these changes, (4) adverse effects of these medications help guide perioperative management, and (5) important contraindications exist to their use. Online searches for “Ozempic® face” were linked to rising searches for “face filler” and “plastic surgeons.” Conclusions: As the unintended morphological changes of GLP-1 receptor agonists become increasingly reported, so does the public interest in seeking rejuvenation procedures. Although limited by study biases, this systematic review can help the plastic surgery community prepare for the rising needs of this patient population by understanding the risk and benefit profile of GLP-1 receptor agonists and developing clear clinical practice guidelines. Level of Evidence: 4 (Therapeutic):

: The procedure with the highest rate of opioid prescription in plastic surgery is abdominoplasty. Additionally, plastic surgery patients are at a particularly elevated risk of becoming opioid-dependent. The main objective of this study was to perform a systematic review and create an algorithm for a multimodal pain regimen specific to patients undergoing abdominoplasty. A systematic search of the research literature was performed to summarize the prevailing understanding of multimodal pain control in the management of abdominoplasty. The initial search yielded 448 articles. Sixty-eight manuscripts were identified for full-text review. The effectiveness of current strategies was evaluated by way of pain scores, opioid usage, and length of stay, as well as other measures of physical function such as time to early mobilization. In 32 studies involving 2451 patients, the efficacy of different pain regimens during abdominoplasty was evaluated. Among nontraditional, opioid-sparing analgesia, efficacy of treatment interventions for improved pain and decreased opioid usage was found inall studies. Among local infusion studies, efficacy of treatment interventions for improved pain and decreased opioid usage was found in 78% of studies. Last, among regional block studies, efficacy of treatment interventions for improved pain was found in 87%, with 73% efficacy for decreased opioid usage. Multimodal pain regimens in abdominoplasty have the potential to play an important role in opioid-sparing practices in medicine by incorporating nonopioid pain adjuvants such as nonsteroidal anti-inflammatory drugs and transversus abdominis plane blocks in the preoperative, perioperative, and postoperative periods. Level of Evidence: 2: