Scientific Abstract Presentations: Aesthetic Session 1 Thursday, October 9 Thu, Oct 9 1:30-3:00 p.m. CDT

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Background: Smoking has been demonstrated as a significant risk factor for patients undergoing breast reduction [1]. Within the past decade, tobacco-free e-cigarettes and nicotine pouches have become popular alternative methods to smoking, as these products are perceived to be safer options [2-3]. Nevertheless, the impact of non–tobacco nicotine dependence (NTND) on breast reduction remains less explored. The present study sought to assess the effect of preoperative NTND on postoperative complications and revision rates in patients undergoing breast reduction.

Methods: The Research Network on TriNetX, a federated national database aggregating anonymized electronic health records from 103 healthcare organizations, was queried on February 18, 2025. Patients who underwent breast reduction from January 2012 to February 2025 were included, while those with history of breast cancer, tobacco product usage, and cigarette smoking were excluded. Patients were categorized into two cohorts: those with preoperative NTND use before undergoing breast reduction and those with no documented history of nicotine dependence. A 1:1 propensity score–matching was conducted for age, sex, ethnicity, race, body mass index, and comorbidities (chronic kidney disease, liver disease, diabetes, hypertension, obesity, chronic obstructive pulmonary disease, and cerebrovascular disease). Primary outcomes evaluated surgical site infection, hematoma, acute postoperative pain, and any surgical site complications at 30-days and 90-days. Secondary analysis measured rates of postoperative breast deformity and surgical revision at 2-years. Multivariate regression was performed for outcomes, with statistical significance set at p<0.05.

Results: An unmatched total of 45,581 adult patients were included. The NTND and control cohorts comprised 1,432 and 44,149 patients, respectively. Following 1:1 matching, 1,424 comparable patients remained in both cohorts. At 30-days following surgery, the NTND cohort presented with significantly elevated risk for surgical site infection, hematoma, acute postoperative pain, and any surgical site complications compared to the control cohort (all p<0.05). After 90-days post-op, patients with preoperative NTND status continued to have significantly elevated risks of surgical site infection, hematoma, and any surgical site complications (all p<0.05). However, no significant differences were observed for postoperative breast deformity and surgical revision at 2-years following breast reduction.

Conclusion: This present study highlighted the association between NTND and significantly higher risks of immediate postoperative complications in breast reduction. While NTND is not linked to increased rates of deformity and surgical revision of breasts, nicotine–whether from tobacco or non-tobacco sources–can adversely impact short-term outcomes. Therefore, these findings contribute to the growing literature regarding operative risks associated with NTND, underscoring the need for cessation guidelines for non-tobacco nicotine users before undergoing breast reduction.

References: 1. Hillam JS, Borsting EA, Chim JH, Thaller SR. Smoking as a risk factor for breast reduction: An analysis of 13,503 cases. J Plast Reconstr Aesthet Surg. 2017;70(6):734-740. doi:10.1016/j.bjps.2016.12.012 2. Davis DR, Rajesh Kumar L, Morean ME, et al. Why young adults use tobacco-free nicotine E-cigarettes: An analysis of qualitative data. Addict Behav. 2024;150:107925. doi:10.1016/j.addbeh.2023.107925 3. Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat. 2023;9:19. Published 2023 Jun 7. doi:10.18332/tpc/163243

Since its inception in 1992, the endoscopic brow lift has gained popularity as a minimally invasive solution for treating age-related brow ptosis. (1) Over time, various fixation techniques have been developed, including cortical tunnel bone fixations, resorbable devices like Endotine, adhesives, and simple sutures. (2,3,4) Despite these various methods, there is paucity in the literature evaluating patient satisfaction and outcomes between techniques. (5) This scoping review aims to evaluate the existing literature on endoscopic brow lifts, focused on reporting outcomes and methods of reporting patient satisfaction. By synthesizing this information, we hope to provide clinicians with a clearer understanding of how different techniques impact patient experiences, and surgical results. Our goal is to enhance clinical practice and inform future research.

A licensed librarian conducted a computerized search using PubMed, Scopus, and Embase databases to identify papers including terms such as "endoscopic brow lifts," "endoscope," or "brow rejuvenation" from inception to June 2024. After analysis, 27 papers were included in this study. Studies were included if they examined endoscopic brow lifts using a single fixation technique and reported surgical outcome data. Due to heterogeneity in complication reporting, complications were categorized into aesthetic, neurological, wound-related, and other.

This review analyzed 2519 patients across 11 fixation methods. Bone tunnel (649 patients), Endotine (333), suture (906), and screw fixation (216) were the most common. Other methods were reported in one study each. Among studies reporting gender, 85.9% were female. Ages ranged from 38.8 to 72 years, with follow-up ranging from 5.1 months to 4 years. While 74% of studies addressed patient satisfaction only 22% quantified it. Bone tunnel fixation had the lowest complication profile across all four categories. Screw fixations had the highest rate of complications across all categories. Overall, neurological complications (11.69%) were the most common followed by aesthetic (6.27%), other (4.94%), and wound-related (1.19%).

The longevity of the endoscopic approach to address brow ptosis has driven the development of various fixation methods. Despite this, there is not a clear distinction of the best approach due to the heterogeneity of the literature in reporting both surgical outcomes and patient satisfaction. Our review suggests bone tunnel fixation appears to have a favorable safety profile, while screw fixation is associated with higher rates of complications. Notably, our findings indicate that minimal complications were seen across all studies, supporting the efficacy of the endoscopic brow lift technique. There is a significant gap in the consistent reporting of complications across the literature that if addressed could lead to improved patient outcomes. Additionally, the role of muscle tone and physiological adaptation in long-term brow positioning remains unexplored and should be a focus of future investigation. Future research should focus on long-term outcomes, standardizing complication definitions, and utilizing universal patient satisfaction instruments. This effort would enhance the comparability of studies, improve surgical techniques, and ultimately elevate patient care.

References: 1. Swiftjr R, Nolan W, Aston S, Basner A. Endoscopic brow lift: objective results after 1 year. Aesthetic Surgery Journal. 1999 Jul;19(4):287–92. 2. Berkowitz RL, Jacobs DI, Gorman PJ. Brow fixation with the Endotine Forehead device in endoscopic brow lift. Plast Reconstr Surg. 2005 Nov;116(6):1761–7; discussion 1768. 3. Foustanos A. Suture fixation technique for endoscopic brow lift. Semin Plast Surg. 2008 Feb;22(1):43–9. 4. Drolet BC, Phillips BZ, Hoy EA, Chang J, Sullivan PK. Finesse in forehead and brow rejuvenation: modern concepts, including endoscopic methods. Plast Reconstr Surg. 2014 Dec;134(6):1141–50. 5. Karimi N, Kashkouli MB, Sianati H, Khademi B. Techniques of eyebrow lifting: A narrative review. J Ophthalmic Vis Res. 2020 Jun;15(2):218–35.

Introduction: Soft tissue fillers are widely used in plastic surgery for cosmetic enhancement, particularly in addressing age-related volume loss and skin laxity. Similarly, the hands are a key indicator of aging, prompting interest in rejuvenation techniques to restore volume and minimize vasculature prominence. While fat grafting is the gold standard for hand rejuvenation, it is not suitable for all patients, such as those with a history of radiation or coagulopathies. Injectable fillers provide a nonsurgical alternative for volumization and aesthetic improvement. The purpose of this study is to evaluate various filler options for hand rejuvenation to analyze aesthetic outcomes and complications.

Methods A systemic literature review was conducted according to PRISMA guidelines. The PubMed and Embase databases were searched for studies from October 2014 to October 2024. The following keywords were used: filler, hyaluronic acid, dermal filler, calcium hydroxyapatite, L-lactic acid, Restylane Lyft, Radiesse, hand rejuvenation, volume, aging, and veins. Two reviewers independently performed title-abstract and full-text screening for inclusion. Studies with combination therapies, fat grafting, or chemical peels were excluded. Review papers, letters, and articles not in English were excluded. The included studies were reviewed for risk of bias using the Cochrane Risk of Bias, Newcastle Ottawa Risk of Bias, and Joanna Briggs Institute critical appraisal tools for randomized trials, cohort studies, and case series, respectively. Patient demographics and treatment protocol were extracted. Clinical outcomes were identified using the Merz Hand Grading Scale (MGHS), Global Aesthetic Improvement Scale (GAIS), patient satisfaction, and complications.

Results/Complications Of 474 search results, 27 unique articles met the inclusion criteria. Among these, 7/9 randomized trials, 3/3 cohort studies, and 13/15 case series demonstrated a low risk of bias. There were 981 patients across the studies: 511 patients received Calcium Hydroxyapatite, 441 received Hyaluronic Acid, and 80 received other fillers such as poly-L-lactic acid, polymethylmethacrylate, or polycaprolactone. The patients were predominantly female (98%). Various filler volumes were utilized, ranging from 0.5mL to 3mL per treatment, with 96.3% of studies providing 1-3 treatments (range: 1-13 treatments). In 85.2% of the studies, patients received treatment on both hands. Follow-up time ranged from 4 weeks to 15 months. The incidence of complications per study had a mean of 7.2 complications across multiple injections (range: 0-79). Among the 173 total complications, common complications included difficulty performing activities (32.4%), swelling (12.9%), and loss of sensation or sensitivity (11%). Of 14 studies (494 patients) reporting the GAIS, a range of 72% to 100% of patients reported aesthetic improvement. Of the scores reporting MHGS, 4 studies (140 patients) showed an improvement from 0.8 to 1.8 points, and 5 other studies (112 patients) reported a final score between 1.1-2.1 (mean: 1.48).

Conclusions: Using fillers for hand rejuvenation is an effective approach, with high patient satisfaction as per GAIS and low complication rates. Improvements in the MGHS suggest fillers successfully restore hand volume and provide aesthetic outcomes at long-term follow-up.

PURPOSE Non-invasive fat reduction techniques, such as injection lipolysis, cryolipolysis, and high-frequency ultrasound, have been widely used by plastic surgeons for contouring the body and face. These non-invasive procedures offer benefits over more invasive techniques including little to no anesthesia and quicker recovery periods. The biomedical industry is heavily involved in the production of these innovative products and techniques. However, due to the possible conflicts that may arise with plastic surgeons' collaboration with the industry, it seems inherent that plastic surgeons need to disclose their conflict of interests (COI) to reduce the risk of bias when reporting outcomes in the literature. In this study, we aim to explore the relationship between corporate payments received and the outcomes of the reported non-invasive fat reduction techniques.

METHODS A systematic review using PRISMA guidelines included studies on non-invasive fat reduction techniques published through July 2022. The Open Payments database (openpaymentsdata.cms.gov) was used to access compensation data from companies disclosed in COI statements and those received specifically from companies manufacturing the device used in the study. Study outcomes were analyzed using descriptive statistics and uni- and multi-variate analyses.

RESULTS Of the 86 studies, 72.1% had a COI disclosure statement. Positive outcomes were reported in 56 (65.1%), negative outcomes in 8 (9.30%), and neutral outcomes in 22 (25.6%) studies. Interventions included injection lipolysis (n = 34), cryolipolysis (n = 15), radiofrequency energy (n = 25), ultrasound-based (n = 21) and laser-based fat reduction techniques (n = 14). Eleven authors failed to disclose COI despite receiving compensation. Positive outcomes were more frequent in studies where the first authors disclosed COI (84.2%) versus those without (59.7%) (p = 0.048). No significant differences were observed in study outcomes for the last authors with COI versus those without. However, the last authors who received compensation from companies manufacturing the device used in the study reported higher rates of positive outcomes (91.7%) versus those who did not (60.8%) (p = 0.037). This trend was not seen for first authors receiving compensation from the device-specific companies.

Receiver Operating Characteristic curve analysis showed a weak association between first-author compensation and study outcomes (AUC = 0.597). Similarly, weak associations were observed between the compensation amounts received by both first authors (AUC = 0.525) and last authors (AUC = 0.592) from the device-specific companies and study outcomes.

CONCLUSION Our study found inconsistency and gaps in COI reporting and highlighted that the presence of a COI disclosure is associated with more positive outcomes than negative or neutral outcomes in non-invasive fat reduction-related studies. Additionally, we observed higher average compensation amounts among first and last authors with positive outcomes compared to those with negative or neutral outcomes. These findings underscore the importance of establishing consistent COI reporting guidelines across journals and in Open Payments database to increase transparency and mitigate bias in biomedical research, ultimately enhancing patient trust. COI reporting needs to be clearer and of higher quality to help the journal and the reader better understand the purity of the scientific literature.

INTRODUCTION: Cosmetic surgery aims to correct or improve body imperfections and is generally elective in nature.(1) Among those with psychiatric disorders that pursue cosmetic surgeries, those with depression and anxiety are most often encountered and body dysmorphic disorder is the greatest predictor of poor outcome from a cosmetic procedure.(2) This study aims to further clarify the connection between psychiatric disorders and the pursuit of cosmetic procedures with additional analysis of complication rates. METHODS: De-identified patient records utilizing the PearlDiver Database were accessed from 2012 to 2024 with unrestricted patient age. Records were selected based on pre-determined list of diagnosis codes categorized in the following groups: Mental Disorders with a Physiologic Cause, Psychotic Disorders, Mood Affective Disorders, Anxiety and Related Disorders, Behavioral Syndromes, Personality Disorders, Intellectual Disabilities, Attention Deficit Hyperactivity Disorder and Unspecified. Cosmetic procedures were categorized as Body Contour, Facial Aesthetics and Breast Surgery. The comparison groups consisted of patients with a psychiatric diagnosis and subsequent cosmetic procedure. We analyzed these comparison groups against 3 control groups of patients who received a cosmetic procedure (either body contour, facial aesthetic or breast surgery) but never a psychiatric diagnosis. Complication rates within each group were also analyzed. De-identified descriptive statistics for comparison and control groups were performed. Additional analysis included logistic regressions determining odds ratios of patients within psychiatric diagnosis groups and the likelihood of having a cosmetic procedure. RESULTS: A total of 65,581,380 psychiatric claims were analyzed from 2016-2020. The majority were female (63%) with the most common diagnosis being Anxiety and Related Disorders (43%). Logistic regression of our Anxiety and Related Disorders group against the likelihood of having a cosmetic procedure classified as Body Contour (BC) or Breast Surgery (BS) resulted in the greatest odds ratio compared to the other categorized diagnosis, (BC OR: 1.65, 95% [CI]: 1.63, 1.67, BS OR: 1.79, 95% [CI]: 1.76, 1.82). Additionally, the Mood Affective group which includes diagnosis codes such as Major Depressive Disorder, resulted in an increased odds ratio for Body Contour procedure (BC OR: 1.42, 95% [CI] 1.40, 1.43). The lowest odds ratio came from a regression between the Pervasive Disorders group, which includes diagnoses such as Autism and Asperger's syndrome, and Breast Surgery cosmetic procedures (BS OR: 0.046 95% [CI]: 0.04, 0.05). CONCLUSION: The results of our data analysis supported findings from our literature review, revealing that patients with depression and anxiety have an increased likelihood of pursuing a cosmetic procedure based off a large sample of deidentified data. Our findings stress the importance of standardized psychological screening protocols and ethical considerations for individuals seeking cosmetic procedures. Future investigations should explore whether psychiatric illnesses impact postoperative complication rates and overall patient satisfaction.

References: 1. Barone M, Cogliandro A, Persichetti P. Ethics and plastic surgery/What is plastic surgery? Arch Plast Surg. 2017;44(1):90-92. doi:10.5999/aps.2017.44.1.90.
2. Jang B, Bhavsar DR. The prevalence of psychiatric disorders among elective plastic surgery patients. Eplasty. 2019;19:e6. PMID: 30949279; PMCID: PMC6432998.

Purpose: After massive weight loss (MWL), patients often experience skin excess and laxity, which can lead to persistent functional, psychological, and health issues. Body contouring procedures like brachioplasty and thighplasty can address these concerns and enhance patient well-being. These procedures may be performed either in a staged manner (separate surgeries) or together in a combined approach (referred to as the "mummy procedure"), requiring post-operative wrapping of both the upper and lower extremities. While staged procedures present scheduling and financial challenges, there is a lack of long-term studies comparing the outcomes of combined versus staged procedures. This study aims to explore the post-operative outcomes of these two approaches, contributing to a patient-centered approach to body contouring.

Methods: A retrospective review was conducted for MWL patients who underwent both brachioplasty and thighplasty at UPMC Department of Plastic Surgery between July 2003 and October 2023. Demographic, intra-operative, and post-operative complication data were collected. Statistical analysis included Fisher's Exact, Wilcoxon Rank-Sum, and two-sample T-tests for demographic data, and Fisher's Exact tests for complication data. Non-normally distributed continuous variables were analyzed with non-parametric tests, reporting median (IQR).

Results: Of 343 patients, 36 underwent the mummy procedure, and 28 had staged procedures. The majority of patients in both groups were female (94% vs. 93%, p = 0.729). The median age of the mummy cohort was 59 (IQR: 17), and for the staged cohort, 43 (IQR: 17) (p = 0.3343). Median follow-up was 139 (IQR: 155.5) days for the mummy group and 126 (IQR: 132) days for the staged group (p = 0.3673). Median BMI at the time of body contouring was 29.02 (IQR: 5.28) kg/m² for the mummy group and 28.97 (IQR: 3.92) kg/m² for the staged group (p = 0.3759). The most common complications were wound dehiscence (28% vs. 25%), seroma (21% vs. 27%), and cellulitis (10% vs. 7%) (p = 0.841, p = 0.529, p = 0.755, respectively). No significant differences were found between the mummy and staged cohorts for other complications: hematoma (3% vs. 2%), abscess (4% vs. 2%), suture extrusion (10% vs. 9%), fat necrosis (1% vs. 2%), and contour deformity (8% vs. 4%).

Conclusion: Patients who opt for the mummy procedure or staged procedures exhibit similar demographic characteristics and post-operative outcomes. The mummy procedure does not result in a higher rate of complications compared to staged procedures. Future research should focus on patient-reported outcomes, particularly satisfaction levels with combined versus staged procedures.

Introduction: Blepharoplasty is a common procedure that removes excess upper eyelid skin, improving function and appearance. A primary indication for blepharoplasty is dermatochalasis, a condition characterized by redundant eyelid skin that can obstruct vision and cause ocular discomfort. The risks of blepharoplasty include corneal abrasions, retrobulbar hemorrhage, eyelid malposition, and persistent dry eye syndrome. Despite its widespread use, large-scale data on patient demographics and complication risks remain limited. This study leverages the TriNetX database-a multi-institutional health network-to analyze demographic trends and postoperative complications across different timeframes, highlighting factors that may influence surgical risk and long-term outcomes.

Purpose: To synthesize large-scale demographic and complication data from TriNetX to assess the influence of preoperative dermatochalasis on postoperative outcomes in blepharoplasty patients.

Methods: A retrospective cohort study was conducted using de-identified patient records from 69 U.S. health centers in the TriNetX database. Patients who underwent blepharoplasty (n = 59,777) were identified using CPT codes and stratified into two cohorts based on preoperative dermatochalasis: those with (n = 47,007, 78.6%) and those without (n = 12,770, 21.4%). Postoperative complications were categorized into acute (≤1 month: corneal abrasions, retrobulbar hemorrhage), intermediate (1-3 months: eyelid malposition, exposure keratitis, epiphora), and chronic (1 month-3 years: scarring, persistent edema, dry eye syndrome, ptosis). Statistical analysis was performed within TriNetX, with complication rates compared between cohorts, and significance set at p < 0.05.

Results: Among 59,777 blepharoplasty patients, the mean age was 72, with 69.5% female, 77.3% White/Caucasian, and 76.7% non-Hispanic/Latino. A majority (78.6%) had a preoperative diagnosis of dermatochalasis. Acute complications were rare, with corneal abrasions occurring in 0.24% and retrobulbar hemorrhage in 0.03%, with no significant difference between dermatochalasis and non-dermatochalasis patients (p = 0.148). Intermediate complications were more frequent, with eyelid malpositions (ectropion/entropion) occurring in 1.53% of all patients and 1.56% in those with dermatochalasis (p = 0.0056). Chronic complications were significantly more prevalent in patients with dermatochalasis (41.24%) compared to those without (36.23%, p = 0.0001). Postoperative ptosis was twice as common in dermatochalasis patients (17.1% vs. 8.5%, p < 0.001, RR = 2.01). Persistent dry eye syndrome was also twice as likely (21.2%) vs. 10.4%, p < 0.001, RR = 2.04). Overall, patients with dermatochalasis had a significantly higher risk of developing any postoperative complication (39.86% vs. 20.43%, p < 0.001).

Conclusion: Preoperative dermatochalasis is strongly associated with an increased risk of postoperative complications after blepharoplasty, with risk ratios above 2.0. Patients with dermatochalasis face nearly double the overall complication burden compared to those without, highlighting the impact of eyelid laxity on surgical outcomes. These findings underscore the need for thorough preoperative assessment, patient counseling, and targeted postoperative care to minimize long-term complications. Optimizing surgical techniques, such as conservative tissue excision or modified closure, may improve both functional and aesthetic results. Future research should focus on refining risk models and enhancing postoperative care to guide best practices in eyelid surgery.

Purpose:

While tailored injection patterns are common in aesthetic practices, objective data on the effects of anatomical differences on neurotoxin efficacy remains limited. Existing literature relies on subjective assessments based on rhytids, which often does not reflect underlying muscle activity. A classification system for glabellar contracture patterns (U, V, Omega (O), Inverted Omega (IO), and Converging Arrows (CA)) based on muscle activity was previously proposed (1), but the impact of various patterns on neurotoxin efficacy has not been objectively evaluated. This study is the first to assess the influence of glabellar anatomy on neurotoxin efficacy using 3D imaging to quantify strain reduction.

Methods  Women aged 30–65 received standardized five-point injections. Dynamic strain data were collected using Vectra M3 (Canfield Scientific), a 3D imaging system that calculates precise facial strain. Strain data was captured at baseline and at follow-ups (3, 30, 90 and 180 days). Strain was defined as the percent change in the short axis of generated mesh points during furrowing. Participants were categorized into five glabellar contracture patterns based on muscle recruitment. U and V patterns involve the procerus and corrugator supercilii, with V showing additional medial orbicularis oculi activation. O engages the corrugator, orbicularis, and frontalis, causing glabellar elevation. IO includes the procerus, corrugator, internal orbicularis oculi, and nasalis, leading to depression without approximation. CA reflects balanced activation of the procerus and frontalis. Classification was performed by an expert injector.

Results  A total of 142 neurotoxin-naïve women were enrolled, with an average age of 43.5 years (SD 9.82). The distribution of contracture patterns was: CA (30.28%), V (33.80%), U (16.20%), IO (8.45%), and O (9.15%). At baseline, strain differed significantly across contracture patterns (p = 0.0293), with U exhibiting the highest mean strain at 16.54% (SD 4.71). O (16.21%, SD 4.36) and V (16.11%, SD 5.21) showed intermediate strain, while IO had the lowest baseline strain (12.01% SD 4.73). All groups showed significant reductions in strain by day 90. At 180 days, reductions diminished and were no longer statistically significant in O, V, and IO groups, but remained significant in patients with U and CA (p<0.05) patterns. Maximum efficacy was observed at day 30, with differences in strain persisting (p = 0.0393). The U, V and O groups maintained greater strains (6.19%, 6.18%, and 6.08%, respectively), while the IO group recorded the lowest strain at 3.02% (SD 2.29). However, IO showed the lowest reduction in strain compared to baseline (8.37% p=0.002).

Conclusion These findings indicate that contracture patterns significantly impact baseline glabellar activity as well as neurotoxin efficacy, with O and IO showing limited and shorter-lived responses due to additional muscle involvement. Tailored injection strategies incorporating additional toxin placement in the frontalis and orbicularis (for O) and nasalis and orbicularis pars palpebralis (for IO) may enhance outcomes. By integrating dynamic strain analysis, this study provides objective evidence supporting personalized neurotoxin treatment approaches.

(1) de Almeida AR, Marques EM, Kadunc BV. Glabellar wrinkles: a pilot study of contraction patterns. Surg Cosmet Dermatol 2010;2:23–8

Introduction: The global market for hyaluronic acid (HA) fillers, valued at $4.08 billion in 2023, is continually growing and driven by increasing accessibility of injectable procedures (1). However, major ischemic complications such as vascular occlusion, tissue necrosis, and blindness are also more prevalent. Management of these complications relies on the immediate availability of hyaluronidase (HYAL), yet discrepancies in accessibility and provider training persist. Given the expanding landscape of injectors-including non-core aesthetic practitioners such as registered nurses, dentists, and other non-surgical specialists-there is a concern about the preparedness of providers to manage filler-related complications. This study aims to assess the availability of HYAL and the presence of standardized protocols across different healthcare settings.

Methods: A telephone-based survey was conducted across 574 medical facilities in North Carolina, including emergency departments, urgent care centers, private practices, MedSpas, and hospital-affiliated Plastic Surgery & Dermatology clinics. Two distinct survey instruments were designed to account for variations in training, emergency resources, and institutional policies between emergency and elective aesthetic providers. Responses were collected on HYAL availability, provider familiarity, training in vascular occlusion management, and presence of formalized treatment protocols. Data were securely stored in REDCap and analyzed for trends in accessibility and preparedness.

Results: Respondents included a diverse range of practitioners, including physicians, PAs, nurse practitioners, medical assistants, and registered nurses (RNs, BSNs), reflecting the broad spectrum of providers performing dermal filler injections. Among surveyed facilities, 54% reported administering fillers daily, 38% weekly, and 8% monthly, with nearly all offering HA-based fillers. Despite the well-documented role of hyaluronidase in managing vascular complications, only 67% of respondents reported familiarity with HYAL, leaving 33% unaware of its use or application. Furthermore, only 54% of surveyed facilities stocked HYAL consistently, with on-hand supply ranging from two to twenty vials. Private practices reported the highest rates of managing filler complications (63%), whereas urgent care centers and emergency departments exhibited limited familiarity with both the presentation and treatment of vascular occlusions. Among all surveyed facilities, only 44% had a formalized protocol for managing filler-related complications, with common strategies including ophthalmology referral, emergency department transfer, or informal team discussions. A minority of sites reported utilizing ultrasound guidance or Delorenzi's protocol for vascular occlusion management, and several locations noted that hyaluronidase was primarily used for patient-requested filler dissolution rather than emergency intervention.

Conclusion: These findings underscore a significant gap in emergency preparedness, particularly among non-specialist settings where delayed intervention may lead to poorer patient outcomes across different healthcare settings. The limited access to hyaluronidase, lack of formalized treatment protocols, and variability in practitioner training pose significant risks to patient safety. Given the increasing number of aesthetic injectors from diverse backgrounds, standardized training programs, improved accessibility to hyaluronidase, and clear emergency management protocols are essential to mitigate the risks associated with dermal filler complications.

References: 1. Grand View Research. (2024). Hyaluronic acid-based dermal fillers market report, 2030. Hyaluronic Acid-based Dermal Fillers Market Report. https://www.grandviewresearch.com/industry-analysis/hyaluronic-acid-based-dermal-fillers-market

BACKGROUND - The umbilicus is a central aesthetic feature of the abdomen, and its appearance significantly influences patient satisfaction following cosmetic abdominoplasty. In the era of social media, achieving a natural-looking belly button with minimal visible scarring has become increasingly important. While numerous umbilicoplasty techniques have been described, no standardized algorithm exists to ensure reproducible, aesthetically pleasing results. This study introduces a novel algorithmic approach to umbilicoplasty, incorporating key factors such as native umbilical tissue quality, midline positioning, abdominal flap thickness, and patient preferences for umbilical shape. By employing a systematic, stepwise method, this algorithm aims to enhance the predictability and consistency of natural, aesthetically optimized umbilical outcomes with minimal scarring.

METHODS - A structured algorithm was developed based on four key considerations: (1) native umbilical tissue quality (e.g., hernias, depth), (2) umbilical midline alignment (e.g., scoliosis, abdominal asymmetry), (3) abdominal flap thickness, and (4) patient preference for the final umbilical shape. This algorithm was implemented in a consecutive case series of 525 patients who underwent elective cosmetic abdominoplasty over a five-year period (January 2020 – December 2024) performed by a single surgeon. Included procedures comprised abdominoplasty, panniculectomy with umbilical transposition, and fleur-de-lys abdominoplasty. Outcomes were assessed based on symmetry, natural appearance, and patient satisfaction. Postoperative umbilicoplasty management included prolene suture removal at seven days, umbilical training at six weeks for select patients, initiation of SkinMedica scar gel at three weeks, and adjunctive laser treatments or 5-FU + TXA injections as needed.

RESULTS - The umbilicoplasty algorithm was successfully applied in all cases, yielding consistent, aesthetically favorable outcomes with well-concealed scars in the majority of patients. Among 525 patients, complications were minimal, with no cases of complete umbilical stalk loss, no unplanned return to surgery, no umbilical stalk infections requiring additional procedures, and no recurrent hernias necessitating further surgical intervention. This systematic approach minimized complications and reduced the need for revision surgery while optimizing final aesthetic outcomes.

CONCLUSION - This algorithmic approach to umbilicoplasty standardizes surgical decision-making, enhances predictability, and may improve overall patient satisfaction in cosmetic abdominoplasty. By addressing key anatomical and aesthetic factors in a structured manner, this technique provides a reproducible method for optimizing umbilical outcomes. Future studies should further validate this approach in larger patient cohorts to assess long-term aesthetic and functional results.

Purpose: Facial attractiveness significantly influences social perception. While prior studies have identified the eyes and mouth as primary focal points of attention, the specific role of nasal aesthetics in overall facial attractiveness remains poorly understood. This study investigates the relationship between nose shape, perceived attractiveness, and visual attention using eye-tracking technology and anthropometric analyses. We hypothesize that the most attractive noses are noticed least, contributing to facial harmony by blending into their surroundings.

Methods: A total of 34 models (mean age 38) and 31 observers (mean age 33) participated. Models underwent standardized 2D and 3D facial imaging, and 17 anthropometric facial measurements were recorded. Observers viewed these images on an eye-tracker to record visual attention data from areas of interest (AOIs), including fixation and visit durations, revisit counts, and time to first fixation. Observers then used a 10-point visual analog scale to rate the attractiveness of the models' faces, then of their noses using both full face photos and isolated nose photos. Photos were separated based on nose attractiveness ratings, and the corresponding gaze patterns and anthropometrics were compared across attractiveness group.

Results: Unattractive noses received significantly longer fixation durations (0.81±0.14s vs. 0.72±0.12s, P=0.03), more revisits (3.09±0.35 vs. 2.76±0.32, P=0.03), and had longer first fixation durations (0.48±0.08s vs. 0.42±0.05s, P=0.03) than attractive noses. Conversely, models with attractive noses received greater fixation on their eyes (1.92±0.15s vs. 1.69±0.27s, P=0.02). Observers also spent significantly more time fixating on the mouth of models with unattractive noses (0.65±0.13s vs. 0.54±0.07s, P=0.03). Nasal tip deviation significantly correlated with lower nasal attractiveness ratings in nose-only images (P=0.01), but lost significance when evaluated within the full face (P>0.05). Longer upper lips also predicted lower attractiveness ratings (Subnasale-to-Cheilion, 27mm vs. 24mm, P=0.05). However, traditionally emphasized proportions, including the neoclassical canons and nasal width, had limited impact (P>0.05). Interrater reliability was higher for overall facial attractiveness ratings (ICC=0.348, 95% CI: 0.243–0.490) than for nasal attractiveness ratings (ICC=0.117–0.156), indicating greater subjectivity in nasal aesthetic assessments.

Conclusions: Our results support our hypothesis, suggesting that an attractive nose enhances facial harmony by drawing minimal attention to itself, allowing gaze to focus on dominant features like the eyes. The increased mouth fixation associated with unattractive noses suggests a compensatory gaze mechanism. These findings reinforce the importance of nasal aesthetics in overall facial perception, while highlighting the need for holistic facial evaluations during rhinoplasty consults. The lack of significant correlation between tip deviation and nasal attractiveness in full face photos may help reassure patients that minor imperfections are less noticeable during normal social interactions. Eye-tracking provides an objective means of assessing nasal aesthetics by serving as a proxy for attention, and it can be integrated into surgical planning to predict how postoperative changes influence facial harmony. Future studies should incorporate dynamic facial stimuli and diverse observer populations to refine our understanding of how nasal aesthetics influence social perception.

Introduction. Utilization of GLP-1 receptor agonists (GLP-1ras) has increased dramatically in recent years. While GLP-1ras appear safe to use overall, it remains unclear if pre-operative GLP-1ra use impacts body contouring surgery outcomes. This study evaluated the post-operative course of patients receiving body contouring procedures by GLP-1ra use.

Methods. A retrospective cohort study was conducted on all patients who received panniculectomies, abdominoplasties, brachioplasties, and thighplasties at a large academic institution between November 2014 and November 2024. These procedures were selected as common body contouring surgeries following significant weight loss with similar indications and complication rates.[1] GLP-1ra users were defined as patients who used any FDA-approved GLP-1ra within two years prior to their body contouring procedure. Propensity score matched analysis paired cohorts by age, smoking status, and body mass index and hemoglobin A1c at the time of surgery. Univariate analyses and multivariable logistic regression were performed.

Results. In total, 590 patients were included in this study. 100 patients (16.9%) utilized GLP-1ras prior to body contouring surgery, of whom 60 patients (60%) used GLP-1ras for obesity and 40 patients (40%) used GLP-1ras for diabetes. Compared to patients who used GLP-1ras for obesity, patients who used GLP-1ras for diabetes were older (59.1 years vs 50.5 years, p < 0.001), had higher hemoglobin A1c levels at the time of surgery (6.40% vs 5.23%, p < 0.001), and had a longer duration of GLP-1ra use (40.0 months vs 17.4 months, p < 0.001). Mean BMI and the number of weeks of GLP-1ra discontinuation prior to surgery did not differ between cohorts. Propensity score matched analysis paired 72 GLP-1ra and 143 non-GLP-1ra patients. In both matched and unmatched cohorts, readmission rates and emergency department encounters at 30, 60, and 90 days following body contouring surgery did not differ by GLP-1ra use (all p > 0.05). Similarly, rates of seroma, hematoma, and wound dehiscence did not significantly differ by GLP-1ra use in both matched and unmatched cohorts (all p > 0.05). Post-operative cellulitis occurred less frequently among GLP-1ra users in matched cohorts (p = 0.008); however, GLP-1ra use did not predict decreased cellulitis on multivariable logistic regression. Duration of GLP-1ra use and timing of discontinuation prior to surgery did not predict the incidence of wound dehiscence, seromas, or hematomas (all p > 0.05). Patients using GLP-1ras for obesity had lower rates of wound dehiscence than patients using GLP-1ras for diabetes (p = 0.028).

Conclusions. Compared to non-GLP-1ra controls, GLP-1ra users have similar post-operative outcomes following body contouring surgery. The use of GLP-1ras prior to body contouring surgery is safe overall. Wound dehiscence is more prevalent among patients taking GLP-1ras for diabetes compared to weight loss, potentially due to worse glycemic control or associated comorbidities.

REFERENCES (1) Vieira, B. L.; Dorfman, R.; Turin, S.; Gutowski, K. A. Rates and Predictors of Readmission Following Body Contouring Procedures: An Analysis of 5100 Patients From The National Surgical Quality Improvement Program Database. Aesthet. Surg. J. 2017, 37 (8), 917–926. https://doi.org/10.1093/asj/sjx012.

Purpose: Hematoma prevention in outpatient plastic surgery is crucial for enhancing patient safety and surgical outcomes. With the rise in outpatient plastic surgery, implementing a targeted hematoma prevention protocol is essential. This study evaluates the impact of a 5-step Hematoma Prevention Protocol on hematoma rates over three decades of outpatient cosmetic procedures.

Methods: All cases were performed by board-certified plastic surgeons at an accredited outpatient facility between 1995 and 2024. Patient demographics, procedural data, and hematoma rates were recorded. Hematoma rates were compared before and after implementing a 5-Step Hematoma Prevention Protocol consisting of 1) thorough preoperative patient optimization, 2) normotensive anesthesia, and perioperative blood pressure management, 3) Intraoperative meticulous hemostasis, 4) Intraoperative Tranexamic Acid (TXA) administration, and 5) postoperative drain placement. TXA was utilized in facelifts and breast procedures, but not in abdominoplasties. Additionally, each protocol component was graded per the American Society of Plastic Surgeons' Evidence Rating and Grading Scales.

Results: A total of 44,133 consecutive cases were analyzed, with an overall hematoma rate of 0.46% (n=203). Hematoma rates were highest in abdominoplasty (0.8%, n=35), followed by breast procedures (0.76%, n=115) and face procedures (0.53%, n=51). The introduction of the 5-Step Hematoma Prevention Protocol corresponded with a downward trend in hematoma rates, with a 68.8% decrease from 0.64% (n=166, 26,032 patients) during 1995-2017 to 0.2% (n=37, 18,101 patients) during 2017-2024 (p<0.0001). Procedure-specific trends showed a 49.4% reduction in hematoma rates for breast procedures (0.96% vs. 0.49%; p=0.0009) and a 91.03% reduction for face procedures (0.74% vs. 0.06%; p<0.0001). In abdominoplasties, where TXA was not administered in either cohort, hematoma rates showed only a modest decline of 6.7% (0.82% vs. 0.77%; p=0.8655).

Conclusion: This study represents the largest single-center analysis to date, encompassing 44,133 cases performed over three decades, with a focus on hematoma prevention strategies. We present a comprehensive 5-Step Hematoma Prevention Protocol that integrates evidence-based measures, significantly enhancing patient safety in outpatient plastic surgery.

Introduction: Hypertrophic and keloid scars can present significant aesthetic and functional concerns in pediatric patients. While traditional treatments such as steroid creams, silicone gels, and oral steroids have demonstrated varying degrees of success, there remains a need for effective, non-invasive therapies with minimal side effects. Steroid tape has emerged as a promising treatment option in Japan, but has not been widely accepted in the United States. Furthermore, data on its efficacy in pediatric populations remain limited. We aim to evaluate the effectiveness and safety of steroid tape in managing hypertrophic and keloid scars in pediatric patients.

Methods: A cohort of pediatric patients who underwent scar treatment with steroid tape were identified from clinical records. Data on patient demographics, scar characteristics, and prior treatments were collected. Scar improvement was assessed using the Vancouver Scar Scale (VSS) and Japanese Scar Scale (JSS), both pre- and post-treatment. Statistical analysis was performed to determine the significance of changes in scar index scores, which are based on scar pigmentation, vascularity, pliability, height, and overall severity. Additionally, patient charts were reviewed for adverse effects (ie skin irritation, dermatitis, breakdown) and symptom relief.

Results: A total of 25 patients (36% female, 64% male) with a mean age of 73.1 months (SD: 67.0) were included. The average scar age at treatment initiation was 2.1 months (SD: 1.8), with 80% of scars resulting from surgery and 20% from trauma. Prior treatments included steroid creams (36%), oral steroids (4%), and silicone creams (8%), while 52% of patients had received no prior therapy.

Post-treatment assessments demonstrated significant improvements across multiple scar characteristics. The Vancouver Scar Scale scores showed reductions in pigmentation (1.04 to 0.36, p=0.001), vascularity (1.28 to 0.64, p=0.003), pliability (2.44 to 0.96, p<0.001), and height/thickness (1.0 to 0.6, p=0.042), with an overall reduction in total VSS score from 5.76 to 2.56 (p<0.001). Similarly, Japanese Scar Scale scores improved significantly, with classification scores decreasing from 8.76 to 4.76 (p<0.001) and evaluation scores from 4.08 to 1.84 (p<0.001). Adverse effects were minimal, with only 2 patients (8%) reporting mild side effects of skin irritation, while the remaining 92% experienced no complications. Symptom relief was noted in a majority of cases, with reduced itching and discomfort following treatment.

Conclusion: Our data demonstrates that steroid tape therapy significantly improves scar appearance and symptomatology of scars in pediatric patients with a favorable safety profile and easy application. While injection therapy is the most common delivery method for steroid treatment, steroid tape is a patient-friendly alternative, where its occlusive nature offers a more sustained, concentrated, and localized delivery of the medication to the scar, without the risk of systemic side effects. Patient compliance may be increased as steroid tape is less painful and more tolerable compared to repeated injections. Further studies will compare outcomes of steroid tape treatment to untreated patients and those receiving other forms of scar therapy to further evaluate its relative effectiveness.