Scientific Abstract Presentations: Aesthetic 3 Saturday, October 28 Sat, Oct 28 5:00-6:00 p.m. CDT

We started with two experimental, comparative, prospective, cross-sectional studies. Wounds on the back, and another flap on the back of the rats. 6 groups of 4 rats each study, euthanasia at 2 and 10 days. The following were evaluated: wound contraction area, inflammatory infiltrate, fibroblast proliferation, angiogenesis, NfKB by immunohistochemistry and HIF-1 and VEGF by Western Blot. Significant Mann-Whitney U test p=<0.05, thus progressing to body contouring surgery applying it rectally, hemotransfusion, ozonophoresis, transcutaneous, ointments, oral, dividing the total doses into pre, trans and postoperative therapy.

Ozone therapy group area contraction wound greater compared to control day 2 (p=0.008), 5 (p=0.005), 7 (p=0.005) and 10 (p=0.005). Greater number of fibroblasts in ozone therapy, sacrificed on day 2 (p=0.008). Greater blood vessels in ozone therapy, sacrificed on day 2 (p=0.003) and day 10. (p=0.032). Densitometry increase in VEGF control group day 2 (p=0.005) and day 10 (p=0.003) and increase in HIF-1 experimental group day 2 (p=0.004) and decrease in expression in the same group day 10 (p=0.001) in the groups of ozone Vs control in body contouring surgery, faster and better healing quality was observed, promoting angiogenesis, shortening post-surgery recovery times.

Conclusion: Ozone therapy modulates wound healing by decreasing the inflammatory infiltrate, fibroblast proliferation, increases blood vessel formation, HIF-1 and VEGF expression. Ozone therapy better and faster healing, being the two best routes of rectal administration and autotransfusion, it can be complemented in all routes of administration by dividing the pre, trans and postoperative dose.

1.-Curtiellas, V., & Gómez, M., & Ledea, O., & Fernández, I., & Sánchez, E. (2005). Actividad antimicrobiana del OLEOZON® sobre Staphylococcus aureus y Pseudomonas aeruginosa. Revista CENIC. Ciencias Biológicas, 36

2.-Curtiellas. V, Ledea. O, Rodríguez, (16 noviembre de 2007). El OLEOZON® sobre la viabilidad, la permeabilidad celular y la ultraestructura de Staphylococcus aureus. Revista CENIC Ciencias Biológicas, 39, 128-131.

3.-Zanardi . I, Burgassi. S ,Paccagnini. E (12 de abril de 2013). What Is the Best Strategy for Enhancing the Effects of Topically Applied Ozonated Oils in Cutaneous Infections?. BioMed Research International, Volume 2013, Article ID 702949, 1-6.

4.-Costanzo. M, Cisterna. B, Vella. A,. (4 de Abril de 2015). Low ozone concentrations stimulate cytoskeletal organization, mitochondrial activity and nuclear transcription. European Journal of Histochemistry, 59:2515, 129-136.

5.-Travagli.V ,Zanardi.I ,Valacchi.G ,. (23 de Marzo de 2010). Ozone and Ozonated Oils in Skin Diseases: A Review. Hindawi Publishing Corporation Mediators of Inflammation, 2010, ID 610418, 1-9.

Dyslipidemia, a public health problem; it is associated with the progression of chronic diseases of clinical importance. It is accompanied by systemic inflammation and subsequent infiltration of monocytes into adipose tissue, to differentiate into macrophages. In this regard, a new population of macrophages called "metabolically activated" or MMe has been described, which are characterized by expressing markers associated with lipid processing; We can use this as one of the prognostic factors in body contour. MMe produce proinflammatory cytokines in adipose tissue of obese mice, however, the mechanisms involved in the activation of this macrophage population and its functional consequences in humans are still unknown. Thirty-two body contouring surgery patients were included, collecting their serum biochemical parameters. Adipose tissue samples were obtained that were processed to isolate mononuclear cells and stain them with different monoclonal antibodies coupled to fluorochromes; De novo adipogenesis was determined by PPARγ expression and lipid droplet staining with oily red dye. Co-cultures were performed with the human preadipocyte cell line PCS-210-010. We show that the MMe population is increased in patients with dyslipidemia (2.74% vs 1.43%), which favors the differentiation of preadipocytes to white adipocytes. These results show the presence of MMe in humans and its possible pathogenic role in the mechanisms underlying the metabolic syndrome; as well as a greater risk of a poor result in body contour, maintenance of long-term results, since they would be more susceptible to overweight and obesity.

1. Williams JW, Giannarelli C, Rahman A, Randolph GJ, et al. Macrophage biology, classification, and phenotype in cardiovascular disease. Journal of the American College of Cardiology. 2018;72(18):2166-80.
2. Ginhoux F, Guilliams M. Tissue-resident macrophage ontogeny and homeostasis. Immunity. 2016;44(3):439-49.
3. Okabe Y, Medzhitov R. Tissue biology perspective on macrophages. Nature Immunology. 2015;17(1):9-17.
4. Saeed S, Quintin J, Kerstens HH, Rao NA, et al. Epigenetic programming of monocyte- to-macrophage differentiation and trained innate immunity. Science. 2014;345(6204):1251086.
5. Netea MG, Domínguez-Andrés J, Barreiro LB, Chavakis T, et al. Defining trained immunity and its role in health and disease. Nature Reviews Immunology. 2020;20(6):375- 88.

Purpose: To describe the technique and outcome of combining helium plasma radiofrequency (Renuvion) sub-dermal treatment and minimal access face and neck lift. Methods: All patients treated with helium plasma radiofrequency technology and minimal access face and neck lift were reviewed between April 2022- to November 2022. Total energy and power setting were reviewed. Post-op outcome including complications, post-op residual concerns, and overall patient's satisfactions were analyzed. Results: A total of 7 patients were identified. Average procedure time were 4 hours and 57 minutes under local anesthesia. Average total energy used was 4.3 Kilo Joules. Follow up ranges from 3-9 months. 1/7 had resurfacing using the same technology (not at the same setting). All patients returned to normal activity within 1-2 week (median 10 days). There were no associated perioperative complications. All patients were satisfied with their results. Conclusions: Combining full face and neck subdermal treatment with helium plasma radiofrequency technology and minimal access face and neck lift is a safe and effective method in facial rejuvenation with minimal downtime.

Purpose: Rectus sheath plication during abdominoplasty is the standard treatment for diastasis of the rectus muscles to improve abdominal contour. Essential to this repair is a lasting correction of this diastasis using sutures to reapproximate the rectus muscles along the midline. There is currently a debate as to whether absorbable versus non-absorbable rectus plication accomplishes the lowest rate of recurrence. This study reviews a single surgeon's experience with absorbable suture rectus plication.

Methods and Materials: This is a retrospective study from the senior author's own cohort of female patients that underwent abdominoplasty from 2018 to 2022. Only patients that followed up longer than 6 months were included in this analysis to assess long term correction of diastasis. Plication of the rectus muscles was performed with a combination of interrupted, buried, figure of eight #0 PDS (Ethicon, Somerville, New Jersey) and running #0 Maxon (Covidien, Mansfield, Massachusetts). Outcomes were assessed by physical examination at post-operative visits. Via chart review, an analysis was also performed on patient factors such as number of pregnancies and the types of deliveries, history of prior abdominal surgeries before abdominoplasty, and whether a concurrent hernia repair was performed.

Results: From 2018 to 2022, 71 patients had follow up data >6 months. Average values are as follows: Age, 43 ; BMI, 27 kg/m2. The average number of follow up visits in the first 6 months post-operatively was 5. 43 patients (61%) had previous abdominal surgery. The most common previous abdominal surgery was a caesarean section (41%, n=29), with the average number of previous pregnancies being 2. 1 patient had a prior abdominoplasty performed and presented for revision. 20 patients (28%) had a hernia repair at the time of abdominoplasty. 50 patients had follow up data >9 months. Average values are as follows: Age, 44 ; BMI, 27 kg/m2. The average follow up time post-operatively was 18 months. 31 patients (62%) had previous abdominal surgery. The most common previous abdominal surgery was a caesarean section (46%, n=23), with the average number of previous pregnancies being 2. 12 patients (24%) had a hernia repair at the time of abdominoplasty. Correction of rectus diastasis was performed in all patients in both groups with a recurrence rate of 0 percent

Conclusion: Abdominal wall plication using a double-layered, absorbable suture closure is a safe, reliable, and long-lasting method to address rectus diastasis during abdominoplasty. Our technique achieved a 0 percent recurrence rate with no major complications and was unaffected by patient factors including prior pregnancies, abdominal surgeries, or concurrent umbilical hernia repairs.

Background: Facial skin rejuvenation, prior to facelifting is a key component to achieving a balanced and harmonious facial appearance. Modern surgical correction of facial aging typically addresses both the structural and volumetric deficiencies, but often overlooks rejuvenating the face and neck skin prior to facelifting. Normal physiologic skin aging as well as photoaging, is a complex process that is determined by many variables, including, but not limited to genetics, long term sun exposure, smoking, dermatologic as well as systemic disease processes. We present a single surgeon's stepwise approach to skin rejuvenation prior to performing a facelift.

Methods: 60 patients from 2018 to 2022 were evaluated for facelift. Patients were all prescribed topical Tretinoin at the time of their initial aesthetic consultation, if not already using it. All patients underwent at least one session of full-face hybrid broadband light/Erb:YAG fractional laser therapy no less than 6 weeks prior to their surgical procedure.

Results: From 2018 to 2022, 60 patients were treated with our facial pre-juvenation protocol at least 6 weeks prior to facelift. The same aesthetician, registered nurses, and surgeon were involved in the preoperative and postoperative management of our patients. Follow up ranged from 6 months to 3 years. There were no major long-term complications associated with the facial pre-juvenation process prior to facelifting, identifiable skin issues or vascular compromise noted post-operatively. Patients were noted to have a more even skin tone with improved quality of overlying skin (decreased rhytids, vascular defects, texture) after facial pre-juvenation combined with subsequent facelift.

Conclusions: Neck and facial skin analyses should be an integral part of the initial face lift consultation, and the treatment plan should be offered and instituted prior to surgical intervention. This can eliminate the concerns of unacceptably prolonged facial edema, hyperemia and skin flap viability with simultaneous laser therapy with facelifting.1,2 The use of topical skin care agents along with laser and light-based therapies prior to facelifting can be a valuable adjunct. These modalities have been proven to improve the effectiveness of surgical results by greatly reducing facial rhytids, pigment changes and vascular defects, as well as improving the overall texture and tone of the skin.

References

1. III JFS, Costa CR, Dauwe PB, Ramanadham SR, Rohrich RJ. Laser Resurfacing at the Time of Rhytidectomy. Plastic and Reconstructive Surgery. 2015;136(1):27-38.
2. Jackson IT, Yavuzer R, Beal B. Simultaneous Facelift and Carbon Dioxide Laser Resurfacing: A Safe Technique? Aesthetic Plastic Surgery. 2000;24:1-10.

Purpose: Tranexamic Acid (TXA), an antifibrinolytic agent, has gained increasing recognition as a valuable pharmacologic agent within plastic and reconstructive surgery. This study reviews the scientific evidence regarding the use of TXA in the full range of plastic and reconstructive surgery within the past two decades to provide clinical recommendations regarding for its safe and effective use in various plastic surgical procedures.

Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. Study design, Procedure types, dosing regimen, time and mode of administration, outcomes and complications for each study were recorded. Outcome data collected in the meta-analysis included blood loss, transfusion requirements and hematoma rates.

Results: Forty-two studies (2003-2023) describing the use of TXA in plastic surgery were included. TXA administration was significantly associated with reduced blood-loss in craniofacial surgery with a mean difference of -13.71 (95% CI -19.43 to -8.00) mL/kg in total blood loss. A reduction in transfusion was also demonstrated with TXA administration with an MD of -10.27 (95% CI -16.34, -4.19 mL/kg). TXA administration was significantly associated with a reduction in blood-loss and hematoma rates in cosmetic surgery, demonstrating a mean difference of -26.10 (95% CI -39.48, -12.73 mL/kg) and an odds ratio (OR) of 0.31 (95% CI 0.1, 0.64), respectively.

Conclusions: This is the largest study to date on the use of TXA in the full range of plastic surgery, summarizing two decades of experience. The literature highlights TXA's favorable safety profile and promising role in the fields of craniofacial surgery, face-lift surgery, rhinoplasty, and breast-related surgery and relatively limited use in microsurgery and burn care within the past two decades.

Background Women's bodies undergo many changes and challenges after pregnancy and during the postpartum period. After childbirth, regaining the strength of core muscles is important in preventing incontinence, pelvic floor disorders, and back pain issues.

Objective This study investigated the effect of abdominal HIFEM and synchronized RF with consecutive pelvic (standalone HIFEM) treatments for core muscle strengthening and improving quality of life.

Materials and Methods Thirty-six female subjects (27-44 years, BMI 19.4 – 34.5 kg/m2) were enrolled in this multicentre, single-arm, open-label, interventional study. The treatment schedule consisted of seven visits, four HIFEM+RF abdominal procedures spaced 5-10 days apart, and six standalone HIFEM pelvic floor procedures spaced 2-4 days apart. Both procedures were used consecutively at the first, third, and fifth treatment visits, the HIFEM+RF was applied prior to HIFEM-only treatment. The follow-up visits were scheduled 1 month and 3 months after the treatments. The primary evaluation included measuring the core strength by with a pressure biofeedback device and waist circumference. 5-point Likert scale questionnaires documenting patients' satisfaction and comfort were used, including a 10-point visual analog pain scale (VAS).

Results N=32 patients completed the 3-months follow-up evaluation. The core muscle strength showed a 22.8% (+24.07±22.14 mmHg, p<0.05) increase at 1-month follow-up, with a 25.2% (+26.58±28.45 mmHg, p<0.05) increase at 3-month follow-up. The waist circumference was reduced by 3.12±2.99 cm and 4.61±3.48 cm (both p-value<0.001) at 1-month and 3-months follow-up, respectively. Patients found the combined treatment comfortable and painless (VAS=2.6). According to 5-point Likert-scale satisfaction questionnaires evaluated 3 months post-treatment, 97.1.% of patients reported stronger core muscles (average score 4.3±0.6), 94.1% of subjects felt a stronger pelvic floor (average score 4.20.6), and 88.2% of subjects had improved physical performance during exercise (average score 4.1±0.6). Furthermore, 91.2% of patients reported being more comfortable in their clothes (average score 3.7±0.5), while all patients stated they were able to perform daily routine/activities without issue and spend quality time with their children (average score 4.5±0.5). No adverse events or side effects were observed.

Conclusion 3-month data analysis outcomes indicated that the treatment regimen of consecutive HIFEM+RF and HIFEM-only effectively improves core and pelvic floor strength, and function, through stimulation of abdominal and pelvic floor muscles. This resulted in improved patients' quality of life along with high satisfaction.

Introduction Extended deep plane face lift leads to the repositioning of tissues in an appropriate and natural feature, providing volume to the mid face and jawline, and a natural redraping of the flap through the mobilization of the medial mobile SMAS, and the release of the retention ligaments. Despite the benefits, the dissection below the SMAS exposes the surgeon to a high risk of injury to noble structures and a steep and longer learning curve. This study aims to analyze the impact caused by the new technique adopted on the variables and surgical outcomes of the facelift.

Methods: A retrospective analysis of the medical records of patients submitted to rhytidectomy performed between July 2019 and 2022, at the Dr Jerônimo Clinic in Ibitinga, São Paulo, Brazil. We divided the patients into two groups. In group A, patients were from July 2019 to February 2021, who were submitted to the SMAS plication technique, which will be used as a control group. In Group B, the period analyzed was between March 2021 and May 2022, where the technique performed for facelift was extended deep plane. The variables and outcomes analyzed were age, gender, comorbidities, body mass index (BMI), surgery time, length of hospital stay and complications. Statistical analyses were performed using the T-Student and Chi-square variables, with values lower than p<0.05 considered with statistical significance.

Results: A total of 160 medical records were analyzed, 80 of which were submitted to SMAS plication and 80 the Deep Plane technique. 150 (93.7%) were female, with not statistically different between groups (p 0.11). The mean age was 54.8 years, without significance . The mean BMI was 24.5; 78 patients had comorbidity, the most frequent being arterial hypertension in 43 individuals, and hypothyroidism in 27. There was no statistical difference when we compared these variables in both groups (p0.06; p 0.52). There were 5 active smokers patients. Regarding the surgical time, in the plication group it was 326.8 minutes and in the Deep Plane group the mean was 348.3 minutes (p 0.07). The length of hospital stay was 2.2 days in group A, and 2.3 days in B (p 0.57). Complications occurred in 2 (2.5%) patients in the control group and in 9 (11.2%) in the group submitted to Deep Plane (p 0.02). In group A, complications were 2 seromas and 1 neuropraxia, while in B there were 6 neuropraxia, 2 seromas, 1 infection, 1 sialoma and 1 late hematoma. There was no statistical difference when comparing each complication. Reapproach was necessary in one case, in group B, to treat the late hematoma. Among the neuropraxias, group A had 1 neuropraxia at Zygomatic branch, and in the extended deep plane group 3 affected the buccal branch, 3 the zygomatic branch and 1 the temporal branch (p0.43). All the neuropraxias had a spontaneous resolution in 3 to 4 months.

Conclusion Despite the significant increase in complications, most were treated conservatively. The technique did not impact in the LOS and in the surgical time.

Intro: The optimal surgical protocol for abdominoplasties remains a nebulous and contested domain. Classically, closed suction drains have been employed putatively to reduce seroma formation rates, which are estimated to be around 10%, in the absence of strong supporting evidence. This can potentially increase the risk of infection and worsen patient discomfort. Outcomes from progressive tension suturing (PTS) versus drainage (D) in abdominoplasty, have previously been reported in meta-analyses that have been hindered by poor methodology and limited sample sizes. We aimed to conduct the first methodologically robust systematic review to evaluate the outcomes for PTS versus D in abdominoplasty.

Methods: This study was registered a priori on PROSPERO: CRD42022346106. MEDLINE, EMBASE, CENTRAL, Google Scholar and Web of Science were searched between September 2022 and February 2023. Data were pooled by a random-effects Mantel-Haenszel model. Risk of bias was assessed using Cochrane's Risk of Bias Tool and Cochrane ROBINS-I tool, for randomized controlled trials and observational studies respectively. GRADE was used to assess the methodological quality of the studies.

Results: Progressive tension suturing, compared to drains alone, was superior with respect to post-operative seroma and haematoma rates, with no synergistic benefit to combining PTS and D. The studies were of moderate-low quality.

Discussion Abdominoplasty using PTS without drain was effective in reducing seroma rates. However, there is a need for larger, level I studies to evaluate the safety and effectiveness of the drainless abdominoplasty technique using PTS versus drainage. Additionally, further delineation of larger seroma volumes (>80 mL) that may be indicative of negative patient prognoses would facilitate a more systematic classification of complications.

BACKGROUND: The aesthetics standards for the male and female body fluctuate among different populations, hence Aesthetic Body Sculpting has to adjust accordingly to suit the patient preferences and expectations . One of the pillars in which Dynamic Definition Liposculpture (HD2) stands on is Fat Grafting, which nowadays include the concepts of power muscles and definition muscles. The latter are subject to demarcation and careful carving during surgery, while the former benefit as well from Fat Grafting in order to improve their volume and projection, and as a consequence, the anatomic, athletic, and youthful contour , . We carried out a retrospective cohort including patients who underwent fat grafting of different muscles during HD2 including: The trapezius, the latissimus dorsi, the erector spinae, the pectorals, the breasts, the rectus abdominis muscle, the gluteus medius, above the gluteus major (SQ), the deltoids, the biceps, the triceps, the vastus medialis/lateralis, the biceps femoris, and/or the calves.

METHODS: We performed cadaveric dissections for each anatomical region in order find the main pedicle for each muscle and as a result design a safe and reproducible fat grafting technique. Furthermore, we looked into our records for patients who underwent fat grafting in addition to HD2 from January 2017 to February 2022. Criteria for inclusion were any patient undergoing fat grafting of any/multiple muscles as part of HD2 procedures.

RESULTS: A total of 1192 patients consecutive patients met the inclusion criteria. About 1020 (85%) were women and 172 (15%) were men. Anatomic regions subject to fat grafting included the posterior torso (5%), the upper limbs (14%), the anterior torso (37%), the gluteal region (94%) and the lower limbs (10%). Adipose graft volumes ranged from 40 to 650 cc (Avg = 250 cc). Only three cases of cellulitis were reported (0.3%), they were treated with oral antibiotics and physical means. Hematoma was reported in 5 cases (0.4%), which solved with conservative measures. No other complications were reported related to fat grafting. Almost all patients were satisfied with the procedure (95%). Follow up period ranged from 2 to 48 months.

CONCLUSION: Liposuction might not be enough to achieve either the ideal muscularization of the male's body or the voluptuous/slim figure of the female anatomy. In such cases, fat grafting has become the cornerstone to achieve the desired body contour. The proper recognition of the main neurovascular pedicle from each muscle subject to fat grafting, the accurate preoperative markings and a meticulous surgical technique ensure both the safety and the reproducibility of our techniques . The high satisfaction index and the low rate of complications support our findings and encourage future studies to broaden the targeted population with a multicenter approach.

LEVEL OF EVIDENCE: IV. Type of Study: Therapeutic – Retrospective Cohort.

KEYWORDS: Anatomic dissection; liposculpture; high definition; body contouring surgery; fat grafting; intramuscular lipoinjection; subcutaneous lipoinjection; multilayer lipoinjection.

REFERENCES 1. Hoyos AE, Perez ME, Domínguez-Millán R. Variable Sculpting in Dynamic Definition Body Contouring: Procedure Selection and Management Algorithm. Aesthet Surg J. 2021;41(3):318-332. doi:10.1093/asj/sjaa133 2. Hoyos AE, Prendergast PM. The Human Form as Art: Contours, Proportions, and Aesthetic Ideals. In: High-Definition Body Sculpting. Springer Berlin Heidelberg; 2014:3-18. 3. Vyas KS, Vasconez HC, Morrison S, et al. Fat Graft Enrichment Strategies: A Systematic Review. Plast Reconstr Surg. 2020;145(3):827-841. doi:10.1097/PRS.0000000000006557. 4. Shim YH, Zhang RH. Literature Review to Optimize the Autologous Fat Transplantation Procedure and Recent Technologies to Improve Graft Viability and Overall Outcome: A Systematic and Retrospective Analytic Approach. Aesthetic Plast Surg. 2017;41(4):815-831. doi:10.1007/s00266-017-0793-3