Traditionally, esophageal oncological resections have been performed via open approaches with well-documented levels of morbidity and mortality complicating the postoperative course. In contemporary terms, minimally invasive approaches have garnered sustained support in all areas of surgery, and there has been an exponential adaptation of this technology in upper GI surgery with the advent of laparoscopic and robotic techniques. The current literature, while growing, is inconsistent in reporting on the benefits of minimally invasive esophagectomies (MIEs) and this makes it difficult to ascertain best practice. The objective of this review was to critically appraise the current evidence addressing the safety, efficacy, and cost-effectiveness of MIEs versus open esophagectomies. A systematic review of the literature was performed by searching nine electronic databases to identify any systematic reviews published on this topic and recommended Joanna Briggs Institute approach to critical appraisal, study selection, data extraction and data synthesis was used to report the findings. A total of 13 systematic reviews of moderate to good quality encompassing 143 primary trials and 36,763 patients were included in the final synthesis. Eleven reviews examined safety parameters and found a generalized benefit of MIE. Efficacy was evaluated by eight systematic reviews and found each method to be equivalent. There were limited data to judiciously appraise cost-effectiveness as this was only evaluated in one review involving a single trial. There is improved safety and equivalent efficacy associated with MIE when compared with open esophagectomy. Cost-effectiveness of MIE cannot be sufficiently supported at this point in time. Further studies, especially those focused on cost-effectiveness are needed to strengthen the existing evidence to inform policy makers on feasibility of increased assimilation of this technology into clinical practice.

Emmaline Ashley, MBBChBAO (Hons), MCh (Hons), BA (st), PgDipAes, ProfCertDerm, Anika Parmar, BDS, BSc, Shonnelly Novintan, MBBS, BSc, MRCS (Eng), Lara Watson, BM, BSc (Hons), BMedSci, MRCS (Eng), BDS (Hons), Priyanka Chadha, MBBS (Lond), BSc (Hons), DPMSA (Lond), MRCS (Eng), MSc (Lond). J Cosmet Med 2024;8:34-40. https://doi.org/10.25056/JCM.2024.8.1.34

The multilayer injection technique for dermal fillers has emerged as a promising strategy in facial rejuvenation, aiming to restore volume, enhance contours, and achieve a more natural and youthful appearance by strategically placing fillers of varying rheology in multiple facial planes. This contrasts with more traditional, single-layer injection techniques. This scoping review aims to critically evaluate evidence around the feasibility, procedural approaches, outcomes, and complications associated with the multilayer approach. A review of the literature was conducted across multiple databases, including Medline, Web of Science, and Embase, for studies published between January 1, 2010, and June 4, 2024. The search included keywords related to dermal fillers, facial rejuvenation, and multilayer injection techniques. Experimental studies, including randomized control trials (RCTs), observational studies, retrospective studies, case series, and cadaver studies were considered eligible for review. The search yielded 6 studies that met the inclusion criteria: 2 cadaver studies with associated prospective studies and 4 retrospective reviews. The studies collectively involved 464 patients and 15 human cadavers. The cadaver studies focused on establishing the anatomical justification for the multilayer technique, while the clinical studies reported high patient and physician satisfaction with few complications. The multilayer injection technique is a promising approach to facial rejuvenation, offering natural-looking results with a sound anatomical basis and low risk of complications. However, the existing literature is limited by methodological shortcomings, including variations in study designs, lack of control groups, and reliance on subjective assessments. Further rigorous research is needed to validate the efficacy and safety of this technique in live patient settings.

Background: Injectable hyaluronic acid (HA) fillers, particularly the Restylane (Galderma Laboratories, LP) range, are widely used in cosmetic treatments, yet comprehensive data on adverse events in training academy settings remain sparse. This retrospective study aims to evaluate the incidence and nature of adverse events associated with Restylane fillers across 2227 treatments of 1052 patients conducted at a leading U.K. training academy. Methods: We conducted a detailed analysis of treatment records from August 2020 to July 2023, examining the frequency and types of adverse events in relation to different Restylane products and treatment areas. Results: Among the 2227 treatments, a total of 6 adverse events were documented, yielding an adverse event rate of 0.269%. The most common adverse events included bruising and asymmetry, with the tear trough and lips being the most frequently affected areas. No serious adverse events were reported. Conclusion: This study demonstrates a relatively low incidence of adverse events in HA filler treatments within a training academy setting, reporting a low complication rate. Further studies are recommended to expand upon these findings and explore long-term outcomes.