TerKonda, Sarvam P.

Background/Objectives: Immortality and anti-aging research is accelerating, with implications across medicine. This narrative review explores the biological principles, translational innovations, and ethical considerations at the intersection of aging and plastic surgery, reframed for a broad clinical audience. Methods: A narrative review of the literature from PubMed, clinical trials, and translational studies was conducted, with emphasis on regenerative medicine, stem cells, tissue engineering, gene editing, and longevity pharmacologics within the field of plastic and reconstructive surgery. Results: Key themes include (1) the biology of aging and epigenetic reprogramming, (2) esthetic and regenerative innovations with broader clinical significance, (3) emerging genetic and pharmacologic longevity strategies, (4) ethical and regulatory challenges, and (5) future directions such as nanotechnology, artificial intelligence, and digital immortality. Conclusions: Immortality remains an aspirational frontier, but innovations in regenerative science and longevity research offer opportunities for improving healthspans. Medicine as a whole must balance innovation with ethics, equity, and safety in translating these discoveries to patient care.

Introduction The Care Hotel is a virtual medicine hybrid model of care implemented at the Mayo Clinic to increase use of enhanced recovery protocols, address hospital capacity and reduce medical costs. This voluntary accommodation offers patients a comfortable environment to receive nursing care postoperatively with in-person daytime monitoring and 24-hour virtual telemonitoring in a hotel setting. This study aims to evaluate postoperative outcomes in patients admitted to the Care Hotel after mastectomy with immediate tissue expander reconstruction compared to standard overnight admission. Methods A retrospective review of the electronic medical record was conducted for patients who underwent mastectomy with immediate tissue expander reconstruction prior to (1/2019–1/2020) and after (7/2021–7/2023) the implementation of the Care Hotel. Postoperative outcomes, including 48-hour ED visit, 48-hour readmission, and 30-day infection, hematoma, seroma, admission, and return to operating room were collected. Results There were 61 patients with 108 tissue expander reconstructions in the hospital admission group and 122 patients with 212 tissue expander reconstructions in the Care Hotel group. The average length of hospital stay was 1.2 days while the average Care Hotel stay was 1.4 days. There were four 48-hour ED visits with 1 admission for 12 hours of observation in the Care Hotel group. There was no statistically significant difference in 30-day infection, seroma, hematoma, readmission, need for IR drain procedure or return to operating room between the groups. Conclusions This investigation demonstrates the safety of postoperative virtual telemonitoring and should encourage providers to utilize virtual visit technology in the immediate postoperative time-period.

Abstract Goals/Purpose To address the complex problems arising from contemporary aesthetic procedures, specifically focusing on the occurrence of antibiotic-resistant non-tuberculosis mycobacterium (NTM) infections following autologous fat grafting and the development of full-thickness burns due to the use of Renuvion for skin tightening. The study underscores the critical need for stringent aseptic techniques, updated sterilization practices, and thorough understanding of new cosmetic technologies to prevent severe complications. Methods/Technique A 45-year-old otherwise healthy female underwent autologous fat grafting to the face and neck tightening with Renuvion in 2023 at an outside aesthetic clinic to address premature facial and cervical ageing. Post-operatively, her course was complicated by multiple midface abscesses from fat grafting and third-degree burns to the neck from Renuvion. She initially sought treatment at a local community hospital, where aspiration was performed which revealed a Mycobacterium fortuitum infection. Despite debridement and antibiotics for the abscesses and xenograft application for her cervical burns, her symptoms persisted, prompting presentation to our tertiary care center. On arrival to our facility, the patient exhibited multiple dermal and subcutaneous abscesses in the premaxillary soft tissues. Broad-spectrum antibiotics were initiated, and she underwent surgical incision and drainage. Cultures identified a multiple resistant Mycobacterium fortuitum complex. Following infectious disease consultation, she commenced a 10-month course of IV antibiotic therapy involving three drugs. Despite this, in 2024, she experienced on-going facial drainage, necessitating further debridement and antibiotic therapy. Results/Complications The patient’s condition was complicated by the discovery of a multiply resistant Mycobacterium fortuitum complex. The infection's resistance to standard antibiotics required an extended and rigorous 10-month treatment regimen involving a combination of macrolide, aminoglycoside, and other antibiotics as well as surgical debridement. Despite aggressive treatment, persistent facial drainage necessitated further surgical intervention. The chronic and recurring nature of the infection significantly increased morbidity and highlighted the need for a multidisciplinary approach to optimize patient outcomes. Additionally, the use of Renuvion led to full-thickness burns, a complication not previously reported in the literature per extensive review. Conclusion This case report and literature review highlights the increasing complexities and potential complications associated with modern aesthetic procedures, specifically antibiotic resistant NTM infections following autologous fat grafting and full thickness burns in the setting of liposuction and Renuvion skin tightening. It underscores the necessity for meticulous aseptic technique, thorough knowledge of equipment, and adherence to modern sterilization protocols to mitigate the risk of infection. Additionally, the development of thermal injuries with Renuvion emphasizes the need for increased reporting to enable proper training and caution with its application. This case report is limited by the inability to definitively identify the source or etiology of the mycobacterium infection and the specific method that led to the full thickness burn, which highlights the need for further investigation and reporting in these areas. This case report is intended to stimulate discussion, investing, and reporting to ultimately improve safety standards in cosmetic surgery and stresses the importance for patients to seek out board-certified and qualified plastic surgeons, as their expertise and adherence to the highest safety standards can significantly reduce the risk of complications such as these.

Background: In this systematic review, we assessed the therapeutic efficacy and safety of Clostridium histolyticum collagenase (CCH) and tissue subcision (TS) for treating cellulite, which ranges from subtle to pronounced lesions. Methods: A systematic review was performed following PRISMA guidelines for CCH and TS treatment to the thigh and gluteal regions. A proportion meta-analysis was then conducted using Stata statistical software. Results: A total of 14 studies were incorporated into the final analysis. Nine focused on TS and five on CCH injection, collectively reporting outcomes for 1254 patients. Of these, 465 received CCH injection and 789 underwent subcision. For bruising, rates were 89% [95% confidence interval (CI), 71%–96%] with CCH injection and 99% (95% CI, 85%–99%) for subcision; pain requiring analgesic was reported at 74% (95% CI, 55%–87%) for CCH and 60% (95% CI, 43%–76%) for subcision; both showed induration at 7% (95% CI, 5%–11% for CCH, 95% CI, 2%–25% for subcision), whereas skin discoloration was higher post-CCH injection at 16% (95% CI, 10%–26%) compared with 7% (95% CI, 5%–10%) postsubcision. Conclusions: Both CCH and TS seem effective treatments for cellulite. However, upon evaluating the adverse outcomes between the two modalities, subcision demonstrated a higher incidence of bruising, albeit similar rates of induration compared with CCH injection. Conversely, the CCH injection group manifested a higher propensity for pain requiring analgesia and notably exhibited increased instances of skin discoloration compared with their subcision patient group. Further standardized research is crucial for more informed cellulite treatment decisions and for comparing efficacy, safety, and cost-effectiveness between TS and CCH.

OBJECTIVE The COVID-19 pandemic led to many changes across medical organizations and graduate medical education programs nationwide including the rapid implementation of telemedicine as a modality for delivering health care. The purpose of this study was to investigate the telemedicine experiences of residents and fellows with their self-reported level of preparedness, impact on their education including precepting, skill development, and patient-physician relationships, and perceptions of telehealth platforms and curricula in the future. METHODS A total of 365 Mayo Clinic residents and fellows across three sites (Florida, Arizona, and Minnesota) were identified as trainees who conducted at least one telemedicine encounter from January 1, 2020 to June 30, 2020 and were sent an electronic survey by e-mail. RESULTS There was a total of 103 completed surveys across various specialties with 58.3% female respondents, 63.1% residents, 35.0% fellows and 77.7% of respondents who attended medical school in the United States. Most trainees reported having very little to no exposure to telemedicine in their medical careers before the pandemic. The majority were satisfied with their first telemedicine encounter and found precepting comparable to in-person visits. The trainees in this study had a favorable view with 98.1% believing telemedicine will play a more prevalent role in the future and most agreed this should be included in medical school and residency training. CONCLUSION Our survey found that after the implementation of telemedicine during the COVID-19 pandemic, the experiences of trainees at a multi-site academic center were overall positive. More research is needed on the perceptions of skill development (physical exam and history taking) during a telemedicine encounter and outlining an optimal telemedicine curriculum that can improve confidence in trainees.

Summary: Although robotic surgery has been routinely established in other surgical disciplines, robotic technologies have been less readily adopted in plastic surgery. Despite a strong demand for innovation and cutting-edge technology in plastic surgery, most reconstructive procedures, including microsurgery, have continued to necessitate an open approach. Recent advances in robotics and artificial intelligence, however, are gaining momentum and have shown significant promise to improve patient care in plastic surgery. These next-generation surgical robots have the potential to enable surgeons to perform complex procedures with greater precision, flexibility, and control than previously possible with conventional techniques. Successful integration of robotic technologies into clinical practice in plastic surgery requires achieving key milestones, including implementing appropriate surgical education and garnering patient trust.