To the researchers’ surprise, it was not without risk to omit the tube after this surgery. Illustration: Jakob Hedberg
In the largest Nordic study to date concerning oesophageal cancer surgery, the researchers found clear evidence that decompression with a nasogastric tube is associated with less serious complications. Their results challenge a trend of declining use of the nasogastric tube after major surgical procedures. The study was led from Uppsala University and has now been published in Lancet Regional Health Europe.
A number of small studies had previously suggested that it is safe to abandon the tradition of leaving in a decompressing – but for many patients unpleasant – nasogastric tube after surgery to remove oesophageal cancer (gullet cancer). The tube is plastic and runs from the nose down to the stomach, and its use in this particular context is to relieve and reduce pressure in this newly operated area. When the question was discussed in a Nordic research collaboration, it was concluded that these smaller studies lacked sufficient statistical power to justify a change in care. Subsequently, a randomised trial was carried out at 12 university hospitals across Sweden, Norway, Denmark and Finland, where patients were randomised to have or not have a decompressing nasogastric tube in their oesophagus following this type of surgery.
Patients without the tube experienced leakage
To the researchers’ surprise, it was not without risk to omit the tube after this surgery, as more patients without the tube experienced leakage in the anastomosis created during the operation. Leakage must be treated immediately, often with interventions under general anaesthesia, resulting in suffering for the patient and a longer length of hospital stay.
Although no differences in survival rates or other complications were found, this new knowledge may help to reduce suffering for patients in the future.
“Oesophageal cancer is an uncommon form of cancer, with only about 200 operations of this type being performed per year in Sweden. National and international cooperation is therefore absolutely necessary in order to conduct sufficiently large trials to answer the research questions we have. The fact that in just over two years, almost 450 patients have been recruited for the trial surpassed our expectations and represents a great success for this network,” says Jakob Hedberg, surgical oncologist, associate professor at Uppsala University and consultant surgeon at Uppsala University Hospital who is also principal investigator for the study.
“Strong interest has been shown at international conferences where our preliminary results have been presented, and the principle of building surgical care on solid evidence has allowed us to provide the best care to our patients. Another important effect of this successful collaboration is that we can build more clinical trials within the Nordic network which has now been consolidated. In fact, the next clinical trial is already under development,” says Jakob Hedberg.
In a study conducted in Uganda and published in JAMA Surgery, researchers from Karolinska Institutet evaluated a new surgical method for treating groin hernias in women. The method could become an alternative in resource-limited settings where laparoscopic techniques are not generally available.
Groin hernia repair is the most common general surgical procedure in the world. Groin hernias are more common in men, but women are more likely to experience complications due to this condition.
Many women in low- and middle-income countries who need surgery for groin hernias lack access to laparoscopy (keyhole surgery). To evaluate a new method using open surgery, the researchers conducted a randomised clinical trial at two publicly funded hospitals in Uganda. The study included 200 women who underwent groin hernia surgery and were followed up after two weeks and after one year.
There are two main types of groin hernias, called inguinal and femoral hernias. The evaluation showed that the new surgical method was effective for both femoral and inguinal groin hernias.
Its effectiveness for both types is particularly important as the study also showed that nearly 45% of the women had femoral hernias, which carry a higher risk of complications.
“The fact that so many of the women had femoral hernias was unexpected and highlights the need to develop effective, safe and accessible methods,” says Alphonsus Matovu, PhD at the Department of Molecular Medicine and Surgery, Karolinska Institutet and first author of the article.
Millions of women affected
The results are promising as the new method could be developed into a viable alternative where access to advanced laparoscopic surgery is limited.
“Women with groin hernias can suffer serious and even fatal complications and therefore need access to effective surgical methods,” says Jenny Löfgren, docent at the same department and last author of the article. “The new method could become a valuable tool to improve care for millions of women”.
The method needs further evaluation, and the researchers will also follow up with the study participants five years after surgery to ensure long-term results. To improve treatment, the new method will also be compared with other surgical methods, both open and laparoscopic.
Research from ICES, Sunnybrook Research Institute and U of T’s Temerty Faculty of Medicine highlights the potential of using team design to improve patient outcomes
Photo by Jafar Ahmed on Unsplash
The odds of patient complications following high-risk surgeries is lower when the surgeon and anaesthesiologists have prior experience working together, according to a new study by researchers at ICES, Sunnybrook Research Institute and the University of Toronto.
The findings come from an analysis of data from hundreds of thousands of high-risk surgeries in Ontario over a 10-year period, along with information on the surgeon and anesthesiologist for each procedure and how often the pair had worked together in the previous four years.
The study, which was recently published in JAMA Surgery, highlights the potential of using team design to improve patient outcomes.
“Team design is used in a lot of other fields like business and sports, but it’s overlooked in health care,” says lead author Julie Hallet, a scientist at Sunnybrook Research Institute and an associate professor of surgery at U of T’s Temerty Faculty of Medicine. “Health care is one of the only areas where we expect people who have never worked together – who sometime have never met before – to perform at peak levels in the most stressful circumstances.”
As a surgeon, Hallet knows first-hand how the environment in an operating room can change depending on team members’ familiarity with each other. It’s something that she and her colleagues have all observed but until recently, lacked the data to describe.
To study this question, Hallet and colleagues analysed population-based health-care data from 711 005 high-risk elective surgeries performed in Ontario between 2009 and 2019, and corresponding information on surgeon-anaesthesiologist teams.
They found that for surgeries related to the gastrointestinal tract, spine and gynaecological cancers, there was an association between surgeon-anaesthesiologist familiarity and the odds of severe complications in the 90 days after surgery – for each additional procedure performed by the same surgeon-anaesthesiologist pair, the likelihood of experiencing a severe complication decreased by three to eight per cent.
“Those are meaningful differences because severe post-operative complications can lead to additional surgeries, ICU stays or even death,” says Hallet.
The researchers also noted that for most procedures, the average surgeon-anaesthesiologist pair were in the operating room together three times a year or less. The exceptions were orthopaedic and cardiac surgery, where surgeons teamed up with the same anaesthesiologist for an average of eight and nine procedures each year, respectively.
These procedures had greater team stability because anaesthesiologists require specialized training to participate in cardiac surgeries and orthopaedic surgeries are often done at dedicated centres like Sunnybrook’s Holland Centre.
“In those particular procedures where they’ve achieved team stability, we do not see an association because the team already has a high degree of familiarity,” says Hallet.
The findings show that unlike expensive new technologies or drugs, optimising the makeup of surgical teams to foster consistency and familiarity could be a no-cost way to improve patient outcomes.
Hallet acknowledges that there are challenges and potential drawbacks to adopting a team design-centred approach to organising and scheduling surgeries. One possible consequence could be that anaesthesiologists, most of whom are currently considered generalists, become increasingly specialised and less comfortable stepping in to cover other procedures.
In the next phase of this project, the researchers are looking at this and other factors that can support the implementation of more stable teams in the operating room.
The team is currently interviewing anaesthesiologists and surgeons to understand their perspectives about the different models of care and what concerns need to be addressed to enable adoption of this new approach. They’re also doing a cost analysis to determine how much money hospitals and health systems could save by having more familiar surgical teams and fewer post-operative complications.
“You can’t put team stability or team familiarity in a bottle or replicate its effects through protocols or processes,” says Hallet.
“The only way that you can get that effect is by putting people together more often and having them work and succeed together.”
A major shift is underway in South Africa’s aesthetics industry, as cutting-edge platelet-rich fibrin (PRF) is quickly surpassing fillers or traditional platelet-rich plasma (PRP) therapy as the anti-ageing treatment of choice, delivering results that patients describe as “four times better” than its predecessor.
“Since introducing PRF into our practice, patients overwhelmingly choose it over PRP for skin rejuvenation and anti-ageing,” notes Dr Reza Mia, aesthetics expert at Anti-Aging Art in Johannesburg. “It means injecting a more potent concentrate with four times the cells to produce the results needed than previous alternatives, and subjectively, patients report it’s indeed four times better.”
A significant evolution from the once-popular “vampire facial”, PRF uses concentrated healing cells from the patient’s own blood to address an impressive range of concerns.
“When someone needs to improve their skin condition, stimulate hair growth, treat stretch marks and scarring, heal certain injuries or wounds, or even enhance intimate well-being with our P-shots and V-shots, PRF delivers some extraordinary results. For example, with our P-shots and V-shots, we’re seeing dramatic improvements in post-menopausal and post-pregnancy concerns among women, while men are achieving some enhancements in size, function, and performance,” he explains.
Turning platelets into a living filler
Through cutting-edge techniques, Dr Mia’s team turns the patient’s blood into a natural injectable filler with a blend of active cells and filler material, creating a gel-like substance. The filler is then injected back into the face or other areas where volume is needed, offering a compelling substitute for hyaluronic acid fillers, and a more powerful alternative to synthetic products.
PRP’s shorter lifespan comes from the use of anticoagulants that prevent clotting and keep the platelets inactive until they are injected. These additives thin the solution, causing it to spread quickly in the body. As a result, the treatment has less time to work and build momentum.
Because anticoagulants can interfere with the regenerative properties of platelets, they aren’t used in PRF. Instead, PRF works with the body’s natural fibrin clotting process, creating a rich concentration of platelets, healing proteins, and repair signals that trigger tissue regeneration and collagen production – helping the skin recover and appear more youthful for longer.
“These platelets stay active for roughly three weeks, instead of the 12-hour window we see with PRP. The release is gradual and the platelets have more time to work in the body, so collagen and fibronectin production is stimulated for longer. This translates into thicker skin, steadier hair-growth cycles, and a noticeably longer glow. Our clinic further uses an advanced centrifuge protocol that can achieve more than four times the platelet count from a session with PRF, packing each vial with far greater regenerative potential.”
In practice, Anti-Aging Art uses PRF to revitalise and restore wherever the skin or hair needs a boost. It’s become a go-to for smoothing fine lines, strengthening hair follicles to fill in patchy beards and thinning crowns, and refreshing postpartum skin. “Many patients who switched from PRP to PRF report they healed faster and need fewer follow-up visits, making it a preferred option.”
The recovery time is also notably shorter. “With standard microneedling, patients remain red for two to three days. With PRF, they’re red for just a day – the platelets actually accelerate their healing.”
A non-surgical breast enhancement alternative
One of the most groundbreaking applications has been for non-surgical breast enhancement. “For patients who’ve removed their implants and now have tissue laxity, or those seeking natural enhancement without surgical implants, PRF filler is a game-changer. For breast enhancement, there really isn’t an alternative, with results lasting as long as six to 12 months.”
Because PRF is taken from the patient’s own blood and then allowed to thicken into a soft gel before injection, it acts like a natural cushion inside the breast. Once placed, the gel holds its shape for a few weeks, giving an immediate subtle lift. The platelets inside also continue to release growth signals that tell the body to lay down fresh collagen and create tiny new blood vessels, so the early fullness slowly turns into real, living tissue instead of fading away like normal swelling.
“Patients like that the injected material is completely theirs, with no risk of immune rejection, hard capsules or implant leaks, while routine mammograms remain easy for radiologists to read. Most women feel only mild bruising and heaviness for a day or two, and they’re back to normal within the week.
“There is some swelling over the first few days, so patients should plan treatments well before any special events. If you choose a top-up after a year, the new PRF simply layers onto existing tissue, giving a gentle, cumulative boost without stretching the skin unnaturally.”
Treatments start around the cost of a mid-range smartphone and vary based on the extent of the area treated. Results become visible quickly but continue to improve over time, developing over three to six months as collagen rebuilds, delivering significant value compared to multiple syringes of traditional fillers or surgical options.
However, Dr Mia cautions that PRF is powerful but not magical. “Regeneration has a biological ceiling. We can thicken skin, soften scars, and enhance breasts naturally, but PRF doesn’t replace surgical intervention for augmentation. PRF also isn’t appropriate for everyone – especially anyone with active cancer in the treatment area, since the growth factors could stimulate those cells.
“But for most patients seeking a rejuvenated, youthful appearance with that coveted ‘juicy’ glow, PRF delivers results that synthetic alternatives simply can’t match,” he concludes.
Although postoperative complications, such as infections, can pose significant health risks to children after undergoing surgical procedures, timely detection following hospital discharge can prove challenging.
A new study from Northwestern University, along with other institutions, is the first to use consumer wearables to quickly and precisely predict postoperative complications in children and shows potential for facilitating faster treatment and care. The study appears in Science Advances.
“Today, consumer wearables are ubiquitous, with many of us relying on them to count our steps, measure our sleep and more,” said senior author Arun Jayaraman, professor at Northwestern University Feinberg School of Medicine and a scientist at Shirley Ryan AbilityLab. “Our study is the first to take this widely available technology and train the algorithm using new metrics that are more sensitive in detecting complications. Our results suggest great promise for better patient outcomes and have broad implications for paediatric health monitoring across various care settings.”
How the study worked
As part of the study, commercially available Fitbit devices were given to 103 children for 21 days immediately after appendectomy, the most common surgery in children, which results in complications up to 38% of the time. Rather than just using the metrics automatically captured by the Fitbit to identify signs of complications (eg, low activity, high heart rate, etc.), Shirley Ryan AbilityLab scientists trained the algorithm using new metrics related to the circadian rhythms of a child’s activity and heart rate patterns.
In the process, they found such metrics were more sensitive to picking up complications than the traditional metrics. In fact, in analysing the data, scientists were able to retrospectively predict postoperative complications up to three days before formal diagnosis with 91% sensitivity and 74% specificity.
“Historically, we have been reliant upon subjective reporting from children – who often have greater difficulty articulating their symptoms – and their caregivers following hospital discharge. As a result, complications are not always caught right away,” said study author Dr Fizan Abdullah, who at the time of the study was an attending physician of paediatric surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and a professor at Feinberg. “By using widely available wearables, coupled with this novel algorithm, we have an opportunity to change the paradigm of postoperative monitoring and care – and improve outcomes for kids in the process.”
What’s next?
This research is part of a four-year National Institutes of Health-funded project. As a next step, scientists plan to transition this approach into a real-time (vs retrospective) system that analyses data automatically and sends alerts to children’s clinical teams.
“This study reinforces wearables’ potential to complement clinical care for better patient recoveries,” said Hassan M.K. Ghomrawi, vice chair of research and innovation in the department of orthopaedic surgery at University of Alabama at Birmingham. “Our team is eager to enter the next phase of research exploration.”
A medical team at Erasmus University Medical Center in the Netherlands uses the new imaging probe with a Quest camera to get a better view of cancerous tumors during non-brain cancer surgery. Photo courtesy of Erasmus University Medical Center
In a significant leap forward for successful cancer surgery, researchers at the University of Missouri and collaborators have developed a new imaging probe to help surgeons more accurately identify and remove aggressive tumours during operations.
The tool is expected to be a critical advancement in the fight against glioblastoma, one of the most difficult-to-treat brain cancers. In the future, it is intended to be expanded for image-guided surgery of various other solid tumours.
Described in a new study in Nature Publishing Group Imaging, the innovation works by pairing a fluorescent dye with a fatty acid molecule that cancer cells readily absorb. When introduced into the body, the compound is taken up by tumour cells, causing them to glow under near-infrared light, revealing cancer that might otherwise remain hidden.
Glioblastoma is considered surgically incurable because the tumour doesn’t stay in one place – it spreads and invades healthy brain tissue in a diffuse, microscopic way. This makes it impossible to remove completely without risking serious damage to brain function.
“Surgery remains one of the primary treatments for many cancers,” Elena Goun, associate professor of chemistry in the College of Arts and Science and one of the lead authors of the study, said. “In breast or prostate cancer, surgeons can often remove the tumour along with surrounding tissue. In brain cancer, that’s simply not possible. You must preserve healthy brain tissue. But if even a few cancer cells are left behind, the disease will return.”
That dilemma is especially acute with glioblastoma, which doesn’t form a neatly contained mass. Instead, it sends out microscopic extensions — finger-like projections that blend into healthy brain tissue and are invisible to the naked eye.
Because of this, surgeons must walk a fine line: removing as much tumour as possible while avoiding harm to vital brain areas. The more thoroughly the tumour is removed, the more effective follow-up treatments like radiation and chemotherapy tend to be.
The new small-molecule probe, known as FA-ICG, is engineered to solve that problem. It links a natural long-chain fatty acid (FA) to indocyanine green (ICG), an FDA-approved near-infrared dye widely used in surgical imaging. This fatty acid-based approach means the probe is highly selective: glioblastoma cells, which thrive on fatty acids, absorb it more than normal brain cells. That makes the cancer stand out more clearly.
The result is a tool that takes advantage of cancer’s altered metabolism to highlight tumour cells from within.
“Surgeons would view a monitor during surgery showing where the probe is lighting up,” Goun explained. “If they still see fluorescent signals, it means cancer is still present and more tissue needs to be removed. When the light disappears, they would know they’ve cleared the area.”
In the operating room, surgeons already use a variety of tools to guide tumour removal – including microscopes, ultrasound and fluorescent dyes. Of those, fluorescent dyes are particularly useful because they make otherwise invisible tumour cells light up under special lighting.
Right now, the only approved imaging dye for glioblastoma surgery is 5-ALA, which fluoresces under blue light. But 5-ALA comes with major limitations: The operating room must be darkened in order to see it, tissue penetration is shallow and the fluorescent signal is often weak and non-specific.
It also comes with side effects, including photosensitivity, meaning patients must avoid bright light exposure after surgery due to the risk of skin and eye damage.
That’s where the FA-ICG probe shines – both literally and functionally.
Compared to 5-ALA, FA-ICG is brighter, works under normal surgical lighting, and offers real-time visualisation under the microscope – no need to turn the lights off mid-surgery. This saves time and makes procedures more efficient. The signal-to-background ratio is also higher, meaning it’s easier to distinguish tumour tissue from healthy brain.
The FA-ICG probe is not only easier to see, it’s also easier to use. Its longer half-life allows more flexibility in scheduling surgeries, and the logistics of administration are simpler than with current probes.
“The upside of fluorescence-guided surgery is that you can make little remnants much more visible using the light emitting properties of these tumour cells when you give them a dye,” said Rutger Balvers, a neurosurgeon at Erasmus University Medical Center in the Netherlands, who is expected to lead human clinical trials of the probe. “And we think that the upside of FA-ICG compared to what we have now is that it’s more select in targeting tumour cells. The visual properties of the probe are better than what we’ve used before.”
Michael Chicoine is a neurosurgeon at MU Health Care and chair of Mizzou’s School of Medicine’s Department of Neurosurgery. While he’s not directly involved in the research, Chicoine understands the potential benefits firsthand.
Currently, he said, MRIs are the gold standard for imaging tumours; however, they’re expensive and time-consuming, especially when required during an operation.
“This fluorescent metabolically linked tool gives you real-time imaging,” he said. “We could merge techniques, using the probe during surgery and saving the MRI for a sort of final exam. It’s definitely an exciting advancement.”
Researchers are also excited about other uses for the probe, including for other types of cancers and for use during follow-up treatments.
“After radiation or chemotherapy, it becomes very difficult to distinguish between scar tissue and active tumor,” Chicoine said. “This probe could give us a definitive answer – helping doctors know whether to continue treatment or adjust it, or consider another surgery. Eliminating the current uncertainty would be really helpful.”
Another promising use of the probe could be in photodynamic therapy either during or after surgery. Since the dye also has light-activated properties that can kill cancer cells, researchers are exploring whether it could double as a treatment tool, not just a diagnostic one.
Clinical trials for use in glioblastoma cases are expected to start in Europe, with strong interest already growing among neurosurgical teams.
The upcoming Phase 1 trial will focus on how patients tolerate the probe, whether there are any side effects at an effective dose and how its performance compares to existing tools. Ultimately, the goal is to make brain tumour surgery safer, helping surgeons remove all cancerous tissues while preserving as much healthy brain tissue as possible.
If results are positive, future studies could expand the use of FA-ICG beyond brain tumours to other cancers with high fatty acid metabolism, such as pancreatic cancer,according to fellow corresponding author Laura Mezzanotte from the Erasmus’ Department of Radiology and Nuclear Medicine.
Self-esteem scores more than doubled within one year of weight-loss surgery, according to a new study* presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2025 Annual Scientific Meeting.
Researchers from Geisinger Medical Center found that after bariatric surgery self-esteem scores rose to 77.5 from 33.6 – a more than 40-point increase. The higher the score on a scale from 0 to 100, the higher the level of self-esteem and quality of life. The amount of weight loss appears to fuel the increase in self-esteem — scores were highest among those who lost the most weight despite demographics differences including gender, age, and race or type of bariatric procedure.
Researchers used a prospectively maintained database to identify 5,749 patients aged 18 and older with body mass index (BMI) of 35 or more who had metabolic and bariatric surgery between 2006 and 2019. Patients completed the Impact of Weight Quality of Life (iwQOL) survey pre-operatively and 12 months after the operation to assess weight stigma and their quality of life.
“Understanding weight stigma and psychosocial factors associated with obesity is essential to offering holistic care. While these factors should not dictate the decision to have bariatric surgery, they should be an important part of the conversation,” said study co-author Justin Dhyani, MD, Geisinger Medical Center in Danville, PA.
Weight stigma is associated with adverse health outcomes including depression, anxiety, disordered eating, and low self-esteem. Among adults with obesity, the prevalence of weight discrimination is 19% to 42%, with higher rates reported among those with higher BMIs and women.
“Weight stigma is a serious issue that places an extra psychological burden on patients struggling with obesity and there is no excuse for it,” said Ann M. Rogers, MD, MD, FACS, FASMBS, President, ASMBS, who was not involved in the study. “This study shows we need to understand what patients are going through and be supportive and empowering of them as they navigate their health and make decisions about treatment.”
An international study published in the New England Journal of Medicine sheds light on acute normovolaemic haemodilution, also known as ANH, a blood conservation technique. ANH involves removing a patient’s blood before the patient goes on heart-lung bypass, and then reinfusing it toward the end of heart surgery. Long debated for its effectiveness, ANH does not appear to reduce the need for red blood cell transfusion, according to results of the global clinical trial.
Nevertheless, study co-author Kenichi Tanaka, MD, professor and chair of the Department of Anesthesiology at the University of Oklahoma College of Medicine, said the outcomes necessitate further scrutiny and may not be applicable to US patients.
More than 2 million patients worldwide undergo heart surgery annually, and about 35% require at least one unit of red blood cells. Blood transfusions can lead to complications, are costly, and are sometimes affected by shortages. Previous retrospective studies and meta-analyses have shown mixed results about whether ANH reduces the need for blood transfusions in heart surgery.
Although the study did not show that ANH decreased infusions, several factors should be taken into consideration, said Kenichi Tanaka, MD, who co-led the United States’ participation in the trial along with researchers from the University of Virginia. Altogether, the study recruited 2010 patients from 11 countries in Europe, Asia, South America and North America.
“This trial may reduce the interest in doing another large, randomised study, but I think it does not exclude the possibility that ANH could help some patients,” he said.
Tanaka pointed to several aspects that may make the study less applicable to the U.S., where about 20% of medical centers use ANH:
US centres did not begin enrolling patients in the study until at least half of all participants had been enrolled. He estimates that less than 5% of participants are from the United States.
US patients are typically larger than patients from other countries and, paradoxically, larger body size is protective against surgical bleeding and the need for transfusions.
Smaller patients have less blood to give during ANH. This means a smaller volume is available to treat anaemia and bleeding that can occur while the patient is on a heart-lung bypass machine.
There was no standardised protocol for ANH or transfusion in the trial. Countries like the United States are more likely to use special clotting factor concentrates in combination with ANH, which has been shown to reduce the need for transfusions.
In supplemental information not included in the study, patients receiving ANH showed a slight trend toward better overall survival rates compared to those who received transfusions only.
Tanaka is preparing to publish a retrospective study showing that ANH reduced the need for transfusions in a US population.
“I plan to continue practising ANH,” he said. “It is also an option for Jehovah’s Witness patients whose beliefs stipulate they cannot receive blood transfusions (from donor blood). At the least, the study proved that there is no downside for ANH. I believe ANH can be part of a multi-pronged blood conservation strategy in the US, where blood product costs are very high.”
Twenty years ago, cosmetic surgery was still a subject of taboo, whispered about behind closed doors. Today, that silence has been replaced by honest conversations about beauty, confidence, ageing, empowerment, and personal choice, as South Africans openly embrace a wide range of aesthetic enhancements. And what South Africans are choosing might surprise you.
Leading plastic and reconstructive surgeon Professor Chrysis Sofianos shares insights from his own practice, revealing how cosmetic surgery trends are evolving across age and race – and what that means for the future of beauty.
“Cosmetic surgery is no longer about fitting a single mould, but about choosing how we, as individuals, want to age, restore, or refine. Today’s patients are more informed, intentional, and unapologetic about their tastes, and wanting to feel good in their own skin,” he says.
Aesthetic choices by age
Gone are the days where cosmetic procedures were the exclusive domain of patients of a certain age. According to Professor Sofianos, the modern approach views aesthetics as a journey, although age still plays a major role in shaping the types of treatments individuals may seek:
20s: Patients in their twenties are often navigating early self-image issues, driven by social media influences. The most requested procedures include breast augmentations, lip fillers, and occasional rhinoplasties to address long-held insecurities.
30s: Often post-pregnancy or in the midst of career and family life, this group leans toward tummy tucks, mommy makeovers, and the start of anti-ageing injections, cosmetic fillers, and preventative treatments. Restoration without exaggeration is usually the goal.
40s: This is the decade of refinement. Liposuction, eyelid lifts, and more assertive facial rejuvenation procedures become common, as patients seek to stay ahead of midlife volume loss and skin laxity.
50s and beyond: For those who want long-term, natural results, the deep plane facelift, neck lifts, and biostimulators become top of mind. “Our approach is structural, not superficial,” he notes. “It’s about restoring facial harmony without compromising identity.”
“What fascinates me is how differently my patients may define beauty. A 22-year-old influencer and a 55-year-old executive might sit in the same waiting room, but their goals couldn’t be more different. We’re not selling a standard look – we’re facilitating personal choices, and sometimes, those choices may even challenge conventional aesthetic norms.”
Understanding patient preferences: A cultural lens
Perhaps the most significant change is how different communities and racial groups are approaching enhancement in South Africa, reflecting new trends in beauty ideals. For example, African women are increasingly choosing breast reductions, prioritising comfort and opting for a different aesthetic from more traditional beauty standards which often favour a fuller figure or more pronounced curves.
Indian patients are leading the way in tummy tucks and body contouring, while Caucasian patients tend to focus on breast augmentations and high-definition liposuction, particularly around the waistline and abdomen, to refine their silhouette and definition.
“What’s beautiful about this shift is how it reflects our diversity. We’re not seeing patients trying to look like someone else – they’re choosing procedures that enhance their natural features and fit their lifestyles,” says Sofianos. “Critically, there is no one-size-fits-all in aesthetic medicine. The more we understand the nuances of each patient’s background and goals, the better we can serve them.”
Why winter is the most strategic time for surgery
No matter your personal objectives, an insider tip could make a huge difference in your surgical recovery: while people mistakenly tend to plan procedures for December – unaware that most surgeons do not operate after November due to holiday closures and the necessity of post-operative care – smart patients are booking for winter.
Cooler temperatures help to reduce swelling, promote easier healing, and generally mean less downtime. Patients also benefit from increased coverage beneath bulkier clothing, allowing them to recover more discreetly while still going about their daily lives. With fewer social commitments and sunnier distractions, winter becomes the ideal window for surgical recovery.
“If you want to look and feel your best by summer, now is the time to plan,” he advises. “Winter is a strategic opportunity for recovery.”
As aesthetic surgery continues to evolve in South Africa, Professor Sofianos believes that education, access, and authenticity are key pillars moving forward.
“My role is to guide patients through their options, help them make informed choices, and deliver results that are both technically excellent and emotionally empowering. The most rewarding part of my practice isn’t about creating one particular look, but about helping people become more confident versions of themselves. Whether that means a subtle enhancement or a more significant change, the choice is truly personal.”
A UCLA Health surgical team has performed the first-in-human bladder transplant.
The surgery was successfully completed at Ronald Reagan UCLA Medical Center on May 4, 2025. The team was led by Dr Nima Nassiri, a urologic transplant surgeon and director of the UCLA Vascularized Composite Bladder Allograft Transplant Program, with assistance from Dr Inderbir Gill, founding executive director of USC Urology.
“Bladder transplantation has been Dr Nassiri’s principal academic focus since we recruited him to the UCLA faculty several years ago,” said Dr Mark Litwin, UCLA Urology Chair, “It is incredibly gratifying to see him take this work from the laboratory to human patients at UCLA, which operates the busiest and most successful solid-organ transplant program in the western United States.”
“This first attempt at bladder transplantation has been over four years in the making,” Nassiri said. “For the appropriately selected patient, it is exciting to be able to offer a new potential option.”
The patient had lost most of his bladder during a tumour removal, leaving the remainder too small and compromised to work. Both of his kidneys were also subsequently removed due to renal cancer in the setting of pre-existing end-stage kidney disease. As a result, he was on dialysis for seven years.
The biggest risks of organ transplantation are the body’s potential rejection of the organ and side-effects caused by the mandatory immune suppressing drugs given to prevent organ rejection.
“Because of the need for long-term immunosuppression, the best current candidates are those who are already either on immunosuppression or have an imminent need for it,” Nassiri said.
Nassiri and Gill collaborated for several years to develop the surgical technique. Numerous pre-clinical procedures were performed at USC and OneLegacy, Southern California’s organ procurement organisation, to prepare for the first human bladder transplant.
During the complex procedure, the surgeons transplanted the donated kidney, following that with the bladder. The new kidney was then connected to the new bladder using the technique that Nassiri and Gill pioneered. The entire procedure lasted approximately eight hours.
“The kidney immediately made a large volume of urine, and the patient’s kidney function improved immediately,” Nassiri said. “There was no need for any dialysis after surgery, and the urine drained properly into the new bladder.”
Current treatment for severe terminal cases of bladder dysfunction or a bladder that has been removed due to various conditions includes replacement or augmentation of the urinary reservoir. These surgeries use a portion of a patient’s intestine to create a new bladder or a pathway for the urine to exit the body.
While these surgeries can be effective, they come with many short-and long-term risks that compromise a patient’s health such as internal bleeding, bacterial infection and digestive issues.
“A bladder transplant, on the other hand, results in a more normal urinary reservoir, and may circumvent some short- and long-term issues associated with using the intestine,” Nassiri said.
As a first-in-human attempt, there are naturally many unknowns associated with the procedure, such as how well the transplanted bladder will function immediately and over time, and how much immunosuppression will ultimately be needed.
Bladder transplants have not been done previously, in part because of the complicated vascular structure of the pelvic area and the technical complexity of the procedure. As part of the research and development stage, Nassiri and Gill successfully completed numerous practice transplantation surgeries at Keck Medical Center of USC, including the first-ever robotic bladder retrievals and successful robotic transplantations in five recently deceased donors with cardiac function maintained on ventilator support.
The two surgeons also undertook several non-robotic trial runs of bladder recovery at OneLegacy, allowing them to perfect the technique while working closely with multi-disciplinary surgical teams.
The bladder is strictly within the domain of urologists. At UCLA, kidney transplantation is also housed within the department of urology. This is why the combined kidney and bladder transplant was ultimately performed at UCLA, which has the necessary infrastructure, clinical expertise, and multidisciplinary support to carry out the procedure and manage the patient from pre-transplant evaluation through post-transplant care, all within the one department.
The procedure was performed as part of a UCLA clinical trial. Nassiri hopes to perform more bladder transplants in the near future.
UCLA Urology has long been at the frontier of urologic transplantation, with pioneering research in kidney transplantation and now, bladder transplantation.
