Background: Nontobacco nicotine use, including electronic cigarettes and vaping devices, has increased substantially in recent years. While the adverse effects of combustible tobacco on wound healing are well established, less is known about postoperative risks associated with nontobacco nicotine dependence (NTND). This study evaluated the association between NTND and postoperative complications following reconstructive and aesthetic breast surgery procedures. Methods: A retrospective cohort analysis was performed using the TriNetX research database. Patients undergoing reconstructive or aesthetic breast surgery were identified using Current Procedural Terminology codes and stratified by documented NTND within 1 year before surgery. Patients without nicotine dependence served as controls. Propensity score matching (1:1) was used to balance demographic and clinical covariates. Postoperative complications were assessed at 30 days, 90 days, and 1 year. Results: Among 227,098 patients, 4801 had NTND and 222,297 served as controls. After 1:1 matching, 4467 patients remained in each cohort. Across all timepoints, NTND was associated with higher rates of surgical site complications, wound-related complications, wound dehiscence or delayed healing, infection, and unplanned readmission (all P <0.01). Seroma, hematoma, and postoperative bleeding occurred less frequently among patients with NTND. Conclusions: Nontobacco nicotine dependence was associated with higher rates of wound complications, infection, and unplanned health care utilization following reconstructive and aesthetic breast surgery. These findings highlight the importance of assessing nicotine exposure during preoperative risk evaluation and counseling.

Background: Facial fracture repair is commonly performed following traumatic injury. Postoperative pain is frequently managed with opioid prescriptions. However, opioid exposure has been associated with impaired wound healing and increased postoperative complications in several surgical populations. This study aims to evaluate the association between perioperative opioid prescriptions and postoperative complications following facial fracture repair procedures. Methods: A retrospective cohort study using the TriNetX Research Network identified patients undergoing facial fracture repair between 2005 and 2025 using Current Procedural Terminology codes. Patients were stratified by documented opioid prescriptions within 2 weeks postoperatively. Individuals with prior opioid-related disorders or malignancy were excluded. Outcomes were assessed during early (1–30 d) and late (31–365 d) postoperative intervals. Results: A total of 207,750 patients undergoing facial fracture repair were identified. This included 162,449 patients with perioperative opioid exposure and 45,301 controls. After propensity score matching, 35,869 patients remained in each cohort. During the early postoperative period, opioid exposure was associated with higher rates of overall complications (OR: 1.75, P < 0.0001), surgical site complications (OR: 2.07, P < 0.0001), infection (OR: 3.00, P < 0.0001), wound disruption (OR: 2.35, P < 0.0001), and emergency department visits or readmissions (OR: 1.67, P < 0.0001). During late follow-up, opioid exposure remained associated with higher rates of surgical site complications (OR: 1.37, P < 0.0001), infection (OR: 2.05, P < 0.0001), and wound disruption (OR: 2.10, P < 0.0001). Conclusions: Perioperative opioid prescriptions were associated with increased postoperative complications following facial fracture repair. These findings support continued efforts to optimize opioid-sparing analgesic strategies in patients undergoing facial trauma reconstruction.

Chronic wounds account for a considerable burden on the overall US healthcare system, affecting an estimated 10.2 million people and costing as much as $148 billion dollars in 2022 alone. Elderly patients suffer disproportionately, as nearly 85% of the chronic wound population is over the age of 65 years old. Despite the burden chronic wounds place on elderly patients and the overall healthcare system, the full mechanism of wound healing changes as one ages has not been fully elucidated. The major deficits in wound healing in the elderly are a function of both skin structural changes and alterations in wound healing kinetics resulting from molecular shifts in gene profiles. Elderly individuals exhibit reduced skin integrity, characterized by a disorganized epidermis, thinned dermis and subcutaneous fat, and a less stable basement membrane, impairing protection from external insults. Simultaneously, wound healing is disrupted across all four stages, as low‐level persistent inflammation from increased fibroblast senescence delays the onset of the proliferative phase and limits overall healing capacity. We hope that this review can bridge the knowledge gap in this field and ultimately lead to future discoveries in aiding the prevention of aging skin and the improvement in wound healing outcomes.

Background: Rhinoplasty is one of the most commonly performed facial plastic surgery procedures. Postoperative pain management frequently includes opioid prescriptions, although opioid exposure has been associated with impaired wound healing and increased postoperative complications in several surgical populations. This study aims to evaluate the association between perioperative opioid prescriptions and postoperative complications following rhinoplasty procedures. Methods: A retrospective cohort study using the TriNetX Research Network identified patients undergoing rhinoplasty between 2005 and 2025 using Current Procedural Terminology codes. Patients were stratified by documented opioid prescriptions within 2 weeks postoperatively. Individuals with prior opioid-related disorders or malignancy were excluded. Outcomes were assessed during early (1–30 d) and late (31–365 d) postoperative intervals. Results: A total of 419,449 rhinoplasty patients were identified, including 312,053 with perioperative opioid exposure and 107,396 controls. After propensity score matching, 85,201 patients remained in each cohort. During the early postoperative period, opioid exposure was associated with higher rates of overall complications (RR 2.11, 95% CI 1.94–2.29, P <0.0001), surgical site complications (RR 1.60, P <0.0001), infection (RR 1.82, P <0.0001), wound disruption (RR 1.53, P =0.0008), emergency department visits or readmissions (RR 2.23, P <0.0001), and mortality (RR 2.08, P <0.0001). During late follow-up, opioid exposure remained associated with higher rates of surgical site complications (RR 1.14, P =0.0049), infection (RR 1.48, P =0.0003), and wound disruption (RR 1.36, P =0.0044). Conclusions: Perioperative opioid prescriptions were associated with increased postoperative complications following rhinoplasty. These findings support continued efforts to optimize opioid-sparing analgesic strategies in rhinoplasty-related procedures

Chronic wounds, including diabetic foot ulcers (DFUs), venous leg ulcers (VLUs), and pressure injuries, remain a major global health burden and contribute substantially to Medicare spending. Because traditional wound dressings fail to address the dynamic microenvironment of chronic wounds, bioactive materials that modulate inflammation and support tissue regeneration are needed. In this study, we evaluated the tissue response to our borate-based bioactive glass fiber matrix (BBGFM) designed to overcome limitations of existing fibrous wound dressings. Two Sus scrofa domesticus underwent creation of twelve 5 × 5 cm subcutaneous pockets each, which were treated with BBGFM at three thicknesses (25%, 50%, and 100%) or left untreated as controls. One animal was euthanized at three weeks and the other at six weeks for gross and histopathological evaluation of all wound sites. BBGFM-treated pockets demonstrated a dose-dependent increase in inflammation at three weeks that diminished by six weeks. Enhanced neovascularization and collagen matrix deposition were also seen at both time points. Collagen maturity increased across all groups by six weeks, and residual BBGFM correlated with initial implant thickness. These findings indicate that BBGFM promotes a controlled inflammatory response and supports neovascularization and matrix remodeling in a dose-dependent manner, suggesting its potential as an effective bioactive wound matrix.

Background: The neck is a visible marker of aging and a growing focus in aesthetic medicine. Compared to the face, neck skin quality has been underexplored, despite its aesthetic importance in the aging process. This study evaluated whether modifiable health-related risk factors better predict neck skin quality than chronological age. Methods: In a cross-sectional study, adults aged ≥ 55 years completed a survey on demographics, metabolic health, sun exposure, sunscreen use, tobacco/alcohol use, exercise, and stress, plus the FACE-Q™ Appraisal of the Neck. Neck skin elasticity parameters (Young’s modulus, viscoelasticity, retraction time) were objectively measured under standardized conditions. Univariate tests and multivariable linear regression (adjusted for age, gender, ethnicity) assessed associations between elasticity and risk factors. Results: Thirty-six participants (mean age 64.3 ± 7.8) were included. Young’s modulus was lower in males, in diabetes/metabolic syndrome, and with ≥ 3 sun-induced skin changes, and was inversely related to BMI. Viscoelasticity was lower in diabetes/metabolic syndrome, with ≥ 3 sun-induced changes, and without daily neck sunscreen use. Age was not significantly associated with any objective parameter. FACE-Q scores trended with higher viscoelasticity. In multivariable models, daily neck sunscreen predicted greater viscoelasticity, while obesity predicted the opposite. Conclusions: In older adults, neck skin viscoelasticity relates more to modifiable risk factors, particularly photoprotection and obesity, than to chronological age. Incorporating risk factor screenings into aesthetic consultations may help promote healthy behaviors that prolong the results of rhytidectomies, and objective tools like viscoelasticity can aid longitudinal monitoring. Level of evidence: Level III, prognostic study.