Scientific Abstract Presentations: Aesthetic Session 3 Saturday, October 11 Sat, Oct 11 8:00-9:30 a.m. CDT

Introduction: Facial aging involves changes in skin, soft tissues, and bone structures, leading to wrinkles, skin laxity, and psychological effects such as social anxiety. Traditional facelifting techniques reposition soft tissues to achieve a youthful appearance, but they do not fully address skin aging signs such as fine wrinkles and photoaging. This study introduces the biplanar facelift, a novel technique combining facelifting with subdermal radiofrequency (RF) technology to enhance skin outcomes and reduce aging signs.

Methods: A retrospective cohort study was conducted on 256 patients who underwent facelifting combined with subdermal RF from 2018 to 2024. Patients with significant comorbidities or smoking habits were excluded. Data on medical history, surgical procedures, and satisfaction were analyzed, along with changes in five key skin aging signs: laxity, spots, nodules, telangiectasias, and scars. The study utilized descriptive statistics and student's t-test for significance testing.

Results: Biplanar facelift demonstrated a significant reduction in skin aging signs, with skin laxity reduced in 96.49% of cases and hyperpigmentation in 98.7%. The average additional surgical time for RF was 10–15 minutes. Minor complications, such as hematomas and dyschromia, occurred in 7.42% of patients, all resolving postoperatively. Patient satisfaction was high, with an increase in Face-Q scores from 11.6 to 92.7 out of 100.

Discussion: This technique effectively combines traditional facelifting benefits with the skin-tightening effects of RF, yielding superior results in facial rejuvenation. The biplanar facelift represents an innovative approach for treating both structural and skin-related aspects of facial aging.

RZL-012 (5-(3,6-dibromo-9H-carbazol-9-yl)-N,N,N-trimethylpentan-1-aminium chloride) is a novel injectable synthetic molecule which induces liponecrosis at the injection site, followed by a transient inflammatory response and finally by a healing process in which fibrotic tissue replaces previous fat tissue. RZL-012 safety and efficacy profiles were tested in two clinical trials for submental fat (SMF) reduction. The objective of a three-arm, randomized, double blind, placebo-controlled phase 2b study in SMF was to determine the efficacy of low and high dose RZL-012 versus placebo on SMF reduction as well as to determine safety and tolerability of RZL-012 following a single administration session. The objective of the open label phase 2 study was to determine the safety and efficacy of RZL-012 on SMF reduction following a second administration given to subjects previously dosed with RZL-012 and seeking further improvement in SMF appearance. Methods: In the SMF phase 2b blinded trial, male and female subjects (n = 151), aged 18-65 years with excess SMF, were enrolled in Twelve US clinics. At baseline visit, subjects received a single treatment session that consisted of multiple injections (32±4) of RZL-012 or placebo into the submental area under the chin, after which they were monitored for safety and efficacy over 84 days. In the SMF phase 2 second administration trial, subjects (N=15, aged 18-65 years) were enrolled in Two US clinics and injected with a 2nd SMF dose of RZL-012, 3-24 months after the first SMF dosing was given. Subjects were subsequently followed up for 84 days. In both studies, SMF was evaluated at baseline and after dosing using the Clinician Chin Assessment Tool (C-CAT) and Subject Chin Assessment Tool (S-CAT) as previously described. Adverse events (AEs) were recorded throughout the study.

Results: In the SMF P2b trial, the proportion of subjects who had at least a 1-grade improvement in Clinician Chin Assessment Tool (C-CAT) on Day 84 vs. baseline was significantly higher in the RZL-012 high dose versus placebo (86% vs. 56.3%, P = 0.0011). The difference between the RZL-012 high dose and placebo groups in the number of subjects with at least a 2-point improvement on both the C-CAT and S-CAT scales on Day 84 (34% vs 6.3% respectively) was also statistically significant (P = 0.0007). C-CAT and S-CAT scoring was well correlated with reductions in SMF volume as measured by MRI. In the open label second administration study, all subjects (15/15, 100%) demonstrated at least a one-grade improvement in both the C-CAT and S-CAT scales after the second dosing vs. initial baseline (prior to first dosing) and 7/15 (47%) had at least a two-grade reduction in both scales. This result demonstrated a significant improvement vs first dosing after which only 10/15 (67%) had a one-grade reduction in both C-CAT and S-CAT scales vs. initial baseline and 0/15 (0%) had a two-grade reduction. In both studies there were no SAEs nor any clinically significant changes in vital signs or laboratory tests over the course of the study. Local injection-site reactions were the most common AEs, all of which were reversible. Conclusions: Single administration of RZL-012 into SMF resulted in a significant fat reduction appearance and second administration of RZL-012 could further improve the SMF appearance and can be used as a complementary treatment.

Aim. This study explores the clinical outcomes and advancements of nanotextured ergonomic implants in aesthetic breast augmentation, highlighting their transformative potential in achieving natural contours, optimal safety, and long-term patient satisfaction. Methods. A synthesis of three prospective cohort studies conducted between 2017 and 2024 involving 1,100 patients who underwent breast augmentation with nanotextured ergonomic implants. The studies incorporated comprehensive preoperative planning, individualized implant selection, and advanced surgical techniques. Outcomes were assessed through standardized measurements, patient-reported outcomes (BREAST-Q), and elastography to evaluate implant dynamics and integration. The studies included patients with diverse anatomical and aesthetic goals. Follow-up durations ranged from 12 months to over 5 years. Novel metrics, including dynamic tissue interaction and implant pliability, were assessed using innovative imaging modalities. Results. Nanotextured ergonomic implants demonstrated superior biocompatibility and integration, leading to enhanced breast contour, symmetry, and upper pole fullness. Aesthetic results were stable over time, with a 95% satisfaction rate and significant improvement in BREAST-Q scores. The safety profile was exceptional, with a low complication rate (0.7% requiring revision). Elastographic analysis confirmed the implants' ability to mimic natural breast dynamics, contributing to improved patient satisfaction. Conclusions. This research establishes nanotextured ergonomic implants as a breakthrough in aesthetic breast surgery, blending naturalistic aesthetics with robust safety. The studies emphasize the importance of advanced preoperative planning and individualized surgical approaches to optimize outcomes. These findings redefine the potential of breast augmentation, offering a paradigm shift in harmonizing aesthetic and functional goals.

References: 1. Szychta P. Aesthetic Potential and Safety Profile of Nanotextured Breast Implants. Aesthetic Surgery Journal. 2024;44(1):1-11. 2. Szychta P. Advancements in Aesthetic Breast Augmentation: Evaluating Ergonomix2 Implants. Aesthetic Plast Surg. 2024;48(2):183-198. 3. Szychta P. Achieving Harmonious Feminine Proportions with Nanotextured Implants. Plast Reconstr Surg Glob Open. 2024;12:e5751.

Background We describe a safe technique for lip augmentation technique based in three numbers: 1. The well-known number (Φ) or golden ratio or 1,618 2. The 2.5mm which is the deepest point of injection 3. The 1ml which is the maximum quantity of hyaluronic acid injected per session. We call the technique Pheidias from the famous Greek sculptor who used the number Φ to build the Parthenon. Material + Methods We apply the number Φ 1.618 to identify the points for injection. We use a specific caliber (image 1). These points are varying from 12-18 (fig 1). Studying the anatomy of the labial vessels we concluded that in more than 99% of the cases the vessels are deeper than 2,5mm from the surface of the lip. So, we mark our 30G needle at 2,5mm and we do not inject deeper than this mark (image 2). The third point of our technique is that we never inject more than 1ml hyaluronic in each session. We may re-inject in 4-6 weeks follow up. Patients with very thin lips we may inject several times with one to three months in between the sessions (Fig 3). We applied the technique in 1500 cases during the last 10 years. The mean age of the patients was 32 years old. 1458 cases were women. We offered our patients a questionnaire that they evaluated their result from 0-5 scale (0: not satisfied and 5: excellent results). Results We never encountered any embolic episode. Redness and pain during injection as well as swelling the next 2 days were the most common side effects. 90% of the patients self-graded their result as excellent (image3)

Conclusion: We propose a technique based in certain mathematics measurements in order to achieve safe and ideal aesthetic results in lip enlargement while it is quite easy teaching to plastic surgery residents.

vPurpose: In Japan, a novel rhinoplasty concept known as the less presence aesthetic nose (LPAN) has emerged, emphasizing a subtle and harmonious nasal appearance that avoids creating a strong visual impression. However, LPAN remains loosely defined, leading to discrepancies between surgeons' interpretations and patient expectations. This study aims to clarify the specific nasal characteristics associated with LPAN, assess patient satisfaction, and underscore the importance of individualized surgical strategies.

Methods: We conducted a retrospective observational study of 102 patients (11 males, 91 females; median age 25.1 years, SD=7.22) who underwent LPAN-centric rhinoplasty by a single surgeon between April 2023 and August 2024. Postoperative data were collected at the three-month follow-up. Cases involving osteotomy were excluded to minimize the impact of residual swelling on measurement accuracy. Intraoperative nasal skin thickness was subjectively graded from "Thick" (5 points) to "Visible Cartilage" (1 point). Standardized preoperative and postoperative (≥3 months) photographs were taken at a fixed distance of 2 feet with a focal length of 50 mm. Four key parameters were measured: (I) Angle D, formed by lines connecting the nasal tip, infratip, and the lowest point of the alar base at a 45° lateral view; (II) N/N ratio, representing nasal tip highlight width relative to maximum alar base width; (III) Alar-Columellar Angle (ACR), measured as the angle between bilateral alar base attachments and the columella; and (IV) NW/ID ratio, indicating maximum alar base width relative to interpupillary distance. Postoperative satisfaction was scored as Great (3 points), Good (2 points), or Poor (1 point). Data were statistically analyzed using paired t-tests, independent t-tests, and one-way ANOVA.

Results: At the three-month follow-up, the mean postoperative values were Angle D of 13.1° (SE=0.246), N/N ratio of 44.81% (SE=0.5), ACR of 160.31° (SE=0.097), and NW/ID ratio of 58.22% (SE=0.43). The overall complication rate was low, with one infection and one hematoma resolving without deformity. Primary rhinoplasty cases displayed significantly greater changes in Angle D (p=0.027) and ACR (p=0.044) compared to revision cases. Patients who reported high satisfaction (Great, 67.6%) demonstrated ideal postoperative nasal parameters, with mean values of Angle D=13.17°, N/N ratio=44.3%, ACR=159.69°, and NW/ID ratio=58.82%. These values can serve as objective benchmarks for achieving the LPAN aesthetic. Remarkably, skin thickness was significantly associated with satisfaction (p=0.0078), with slightly thin-skinned patients reporting the highest scores.

Conclusion: This study establishes objective criteria for LPAN, providing clear benchmarks (Angle D, N/N, ACR, NW/ID) that correlate with patient satisfaction. Patients with slightly thin skin achieved the highest satisfaction, underscoring the importance of considering nasal skin thickness when planning rhinoplasty. By defining the ideal postoperative nasal parameters associated with high satisfaction for LPAN rhinoplasty, this study contributes a valuable framework for achieving consistent, aesthetically pleasing outcomes congruent with patient expectations.

Purpose: Asian individuals often exhibit a wide, flat facial contour with pronounced mandibular angles. Many patients seek an oval-shaped face, increasing the popularity of mandibuloplasty. This procedure reshapes the prominent mandibular angle and achieves a more defined lower facial profile. Accurately reproducing the osteotomy line is crucial to prevent inferior alveolar nerve injury. This study introduces a simple, cost-effective surgical guide made from dental condensation silicone, enabling accurate preoperative planning while reducing time and expenses compared to 3D-printed guides.

Methods: We retrospectively reviewed the medical records of 24 patients who underwent mandibuloplasty between April and December 2024. Patients requiring simultaneous sagittal split ramus osteotomy or bimaxillary surgery were excluded. Preoperative cone-beam computed tomography (CBCT) images were used to fabricate mandibular bone models. The surgeon drew an osteotomy line on each model, measuring four parameters. Distance A was the distance from the condylar process to the most posterior point of the osteotomy line, and distance B was the distance from the intersection of the osteotomy line and a perpendicular line between teeth 6 and 7 to the coronoid process. The angle between the osteotomy line and distance A was defined as angle C, while the angle between the osteotomy line and distance B was defined as angle D. Dental condensation silicone was mixed for 30 seconds and molded over the planned resection area on the model. After hardening, the silicone was trimmed to precisely match the osteotomy line, creating a custom surgical guide. Postoperative CBCT images were obtained one month after surgery to measure the same aforementioned distances, but these were labeled as A-post and B-post, and angles C-post and D-post, respectively. Statistical analyses used two-sample tests to compare continuous data.

Results: The average age was 32.13±6.31 years. Four male and 22 females were included. Two patients (6.67%) underwent secondary mandibuloplasty. There was 1 case of infection and 1 hematoma, both managed successfully. Intraclass correlation coefficients for repeated measurements exceeded 0.75, indicating good to excellent reliability. The mean left distance A (49.94±5.47) and left A-post were similar (49.72±5.62, p=0.058). The mean right distance A (49.81±5.43) and right A-post were comparable (49.86±5.27, p=0.809). The mean left distance B (67.33±6.83) and left B-post were comparable (67.04±5.62, p=0.089). The mean right B (68.21±6.24) and right B-post were similar (68.16±6.43, p=0.809). The mean left distance C (119.92±5.21) and left C-post were comparable (120.24±5.26, p=0.402). The mean right C (119.04±4.92) and right C-post were similar (123.27±16.21, p=0.218). The mean left distance D (52.4±3.23) and the left D-post were comparable (51.96±3.54, p=0.09). The mean right D (52.19±3.78) and right D-post were similar (51.87±3.56, p=0.193).

Conclusion: Dental condensation silicone provides a fast, safe, reliable, and economical approach to surgical guide fabrication for mandibuloplasty. Overall, comparisons of preoperative (A, B, C, D) and postoperative (A-pos, B-pos, C-pos, D-pos) measurements revealed no significant differences (all p>0.05), demonstrating that the silicone guide accurately reproduced the intended osteotomy.

Introduction and objective Midface volume deficit, a hallmark of facial aging, is characterized by the depletion or shrinkage of supportive tissue in the central facial region1. As such, in recent years, an increasing number of patients have sought facial rejuvenation through minimally invasive techniques, with Hyaluronic Acid (HA) dermal fillers being a popular choice2. RHA fillers manufactured using the Preserved Network Technology (PNT) and developed with varying HA concentrations and rheological properties enabled their customization for specific areas and depths, allowed multilayering techniques (MLT) and contouring3. RHA4 (23mg/mL) was designed to treat dynamic wrinkles and restore age related volume loss, thanks to the PNT which optimizes tissue integration, adaptability to dynamic facial areas while maintaining projection capacity3. Recent pre-clinical research has highlighted RHA4's adipose tissue lifting capacity and integration without fibroplasia, showing better tissue projection when injected both in superficial and deep layers (MLT)4. The aim of this work is to present outcomes of a recently completed prospective, randomized, blinded evaluator, multicenter clinical study on the safety and effectiveness of Resilient HA volumizer versus an FDA-approved active comparator for treating Midface Volume Deficiency (MVD) in the US population.

Methods The primary endpoint was to demonstrate non-inferiority of RHA4 vs active comparator 8 weeks after last treatment (initial or touch-up) for patients graded 3-4 on the Teoxane Midface Volume Deficit Scale (TMVDS)5, as assessed by the Blinded Live Evaluator (BLE) assigned at each study site. A total of 200 patients aged 22 years or older (randomization 3:1) were injected into the supraperiosteal to subcutaneous layers for cheek augmentation and correction of age-related mid-face volume deficiencies. Secondary endpoints included safety assessment, patient satisfaction, GAIS improvement, treatment volumes, optimal cosmetic result (OCR), subject satisfaction scale and midface naturalness.

Results After 8 weeks, RHA4 led to a clinically meaningful improvement of MVD (≥ 1 grade), as assessed by BLE using the TMVDS. 75% of patients were treated with RHA4 using the MLT Approach. To reach OCR, ≤3.5mL was injected on both sides and retreatment volumes were higher in active comparator vs RHA4 (2.3mL vs 1.3mL). RHA4 required fewer treatment sessions vs comparator to achieve equivalentOCR. Patient satisfaction with RHA4 remained high throughout the study and never decreased below 82%. 88% of patients reported natural looking results after 8 weeks in the midface subject naturalness questionnaire, increasing to nearly 100% after retreatment. RHA4 was well tolerated for MVD treatment. Reported adverse device effects and common treatment responses were mostly limited to injection site reactions, of mild severity and short duration (<14 days).

Conclusion RHA4 demonstrated comparable effectiveness to FDA-approved volumizer, achieving non-inferior aesthetic outcomes with fewer treatment sessions. Its safety profile remained favorable regardless of the injection technique used, including the MLT which was preferred by treating investigators. In addition, RHA 4 delivered natural-looking outcomes. These findings underline RHA4 as an effective solution for midface dynamic volume restoration.

References 1. Coleman SR, Grover R. The anatomy of the aging face: volume loss and changes in 3-dimensional topography. Aesthetic Surgery Journal. 2006;26(1s): S4-9. 2. Trévidic P et al. Injection Guidelines for Treating Midface Volume Deficiency With Hyaluronic Acid Fillers: The ATP Approach (Anatomy, Techniques, Products). Aesthet Surg J. 2022 Aug 1;42(8):920-934. 3. Faivre J, Pigweh AI, Iehl J, Maffert P, Goekjian P, Bourdon F. Crosslinking hyaluronic acid soft-tissue fillers: current status and perspectives from an industrial point of view. Expert Review of Medical Devices. 2021/12/02 2021;18(12):1175-1187 4. Flégeau K, Ballarini S, Brusini R, et al. Safety and performance of RHA®4 in the midface using the multilayering technique: preclinical and clinical evidence. Plast Reconstr Surg Global Open. 2025;13:e6560. DOI: 10.1097/GOX.0000000000006560. 5. Submitted article Bury A, et al. Creation and Validation of a Photonumeric Scale for Assessment of Midface Volume Deficit. Dermatol Surg, 2024.

DEEP PLASMA RESURFACING: ACCELERATED HEALING WITH HUMAN MSC EXOSOMES By Dr. Melinda Lacerna, MD FACS Bradenton, Florida USA Abstract Background: Deep facial skin resurfacing with plasma technology results in better correction of superficial and deep rhytids, photo-damage and more tissue contraction resulting in improved skin and soft tissue tightening, yet safe to perform at the same time as a face and necklift. While the outcome can be quite impressive, the recovery can be daunting. Re-epithelialization can take as long 21 days. Objective: This study describes how topical application of MSC exosomes immediately after deep plasma resurfacing procedures have decreased the rate to re-epithelialization, decreased pain scores, improved the rate of healing and improved the overall outcomes. Methods: A retrospective review of one surgeon's experience performing deep plasma skin resurfacing from 2017-current is presented. A total of 100 consecutive patients were treated with full face deep plasma skin resurfacing, 55 of these patients underwent a concurrent facelift and necklift. In 48 patients, MSC exosome application was performed immediately after the procedure. The amount of days to full re-epithelialization were compared between the Exosome treated group (48) and the non-treated group (52). Results: Range of re-epithelialization for the exosome treated group was 6-14 days, compared to 10-21 days in the non-exosome treated group. There were four complications, all with the non-exosome treated group. One patient was hospitalized due to severe constipation from post-op opiate use. Three patients developed hypertrophic scarring on the chin that were treated with triamcinolone. Conclusion: This series over the course of 7 years compares the course of healing of Exosome treated patients versus the non-exosome treated patients following deep plasma skin resurfacing procedures. The use of topical exosomes immediately after the procedure was shown to decrease the days to re-epithelialization from 10-21 days to 6-14 days. In addition, post-operative pain and narcotic use were significantly decreased in the exosome treated group. This is most likely due to down regulation of inflammatory pathways associated with exosome use. The more rapid rate to healing, re-epithelialization and re-establishment of the skin's protective phospholipid bi-layer also decreased other complications such as infections, prolonged erythema, hypo or hyper pigmentation, and hypertrophic scarring.

Background

Hyaluronic acid (HA) injections in the alar base region are increasingly popular for midface volume enhancement, particularly among Asian patients with posterior maxillary positioning. However, the presence of the facial artery (FA) in this region poses a risk of vascular complications, including arterial embolization and skin necrosis, while the proximity to the oral cavity increases the risk of infection due to inadvertent mucosal penetration. In many cosmetic clinics, HA injections are performed without prior vascular assessment using ultrasound or CT angiography. Therefore, a simpler and more practical safety method is needed. This study evaluates the efficacy of manual FA pulsation palpation and mucosal height assessment in identifying high-risk patients before HA injection.

Methods

This single-center study included 100 patients undergoing alar base HA injections between July 2023 and February 2025. FA pulsation was assessed at the alar base by placing the index finger inside the oral cavity and the thumb on the facial surface, gently pinching the area. FA pulsation was categorized as No, Weak, or Strong. Mucosal height was classified into three types: Type 1 (below the alar base), Type 2 (at the level of the alar base), and Type 3 (above the alar base). The prevalence of strong FA pulsation and high mucosal height was analyzed for risk stratification.

Results

Among the 100 patients (85 females, 15 males; mean age 39.0 ﾂｱ 11.2 years), FA pulsation was absent in 37 (37%), weak in 38 (38%), and strong in 25 (25%). Mucosal height classification revealed Type 1 in 22% of patients, Type 2 in 59%, and Type 3 in 28%. Notably, 5% of patients exhibited both strong FA pulsation and Type 3 mucosal height, identifying them as the highest-risk group for vascular occlusion and infection. Among patients who underwent HA injections using this screening method, no complications such as vascular occlusion, skin ischemia, or infection were observed.

Conclusion

Preprocedural bimanual FA pulsation palpation and mucosal height assessment are highly reliable screening methods for reducing complications associated with alar base HA injections. These techniques enable accurate risk stratification and personalized injection planning, minimizing the likelihood of vascular embolization and infection. High-risk patients, particularly those with strong FA pulsation and Type 3 mucosal height, may benefit from ultrasound-guided injections or deep periosteal placement to enhance procedural safety. This method serves as an effective screening tool for identifying high-risk patients before HA injection, ensuring a safer injection process. By implementing these simple palpation and observational techniques, clinicians can significantly reduce vascular and infectious complications.

The continuous advancement of surgical technology has facilitated the integration of novel techniques across various surgical fields, aiming to improve patient safety, enhance tissue dissection, and optimize clinical outcomes. In plastic surgery, particularly in patients with a history of multiple aesthetic procedures, the development of fibrotic tissue presents a significant challenge, complicating dissection and increasing the risk of surgical trauma.

This study evaluates the application of the UROLASE+ Thulium fiber laser for soft tissue dissection in aesthetic plastic surgery, specifically in 10 patients undergoing a facelift, brow lift, blepharoplasty, cheiloplasty and mammoplasty operations. To our knowledge, these are the first documented uses of this technology in such a context.

The findings demonstrate that the Thulium fiber laser provides superior hemostasis, enables precise and controlled dissection, and reduces tissue trauma compared to conventional methods. Histological analysis of the laser-treated tissues confirmed minimal collateral damage, preserved skin appendages, and effective coagulation of blood vessels, indicating enhanced tissue integrity and reduced risk of postoperative complications. Additionally, its application resulted in a lower rate of complications, improved hemostasis , ease of dissection and a shortened post-operative recovery period.

These results suggest that the Thulium fiber laser represents a promising alternative to traditional dissection techniques in aesthetic surgery, particularly for cases involving fibrotic soft tissues, offering both clinical and histological advantages.

Background: Facial vascularized composite allotransplantation (fVCA) has emerged as a transformative option for patients with severe facial defects, offering functional and aesthetic restoration. However, fVCA recipients often require multiple secondary revisions to optimize outcomes. This study aimed to analyze the relationship between secondary revisions and rejection episodes and identify predictive factors associated with increased revision rates following fVCA. Methods: Nine patients who underwent fVCA were followed from April 2009 to February 2023. Demographic information, clinical indications for transplantation, ischemia time, extent of fVCA (partial or full transplant), and the incidence of secondary revisions were recorded. 3mm punch mucosa and skin biopsies were performed to confirm rejection episodes. Linear regression analysis was performed to assess relationships between variables, and Pearson's correlation coefficients were calculated to evaluate the strength and direction of associations. Results: Nine patients with a mean age of 46.3±15.5 years were included. The mean donor-recipient age difference was -1.8±15 years. The median follow-up time was 106 months (range, 39 to 142 months) and the average number of revision procedures per patient was 5.3 ± 3.5 procedures. The most common indication for secondary surgery was redundant skin and soft-tissue ptosis. The number of secondary revisions per year was significantly associated with the incidence of biopsy-proven rejection episodes, demonstrating a strong correlation (r = 0.77, p = 0.01; n=9). A strong correlation was observed between recipient age and revision rates in cases where donors were no more than 10 years older than recipients (r = 0.81, p=0.02; n=7). However, this correlation weakened when considering recipients who received transplants from donors who were more than 10 years older (r = 0.59, p=0.09; n=9). Clinical indication for transplantation, ischemia time, and extent of fVCA were not associated with secondary revision rates. Conclusions: This is the largest study to date to analyze long-term secondary revisions in fVCA and the first to identify factors related to higher revision rates. Our findings suggest that revision rates are correlated with the incidence of rejection episodes. While a younger recipient age is associated with a lower secondary revision rate, a donor-recipient age difference exceeding 10 years significantly increases the revision burden in fVCA patients, potentially leading to a higher rejection rate. Future studies are indicated to explore the interplay between donor and recipient age and their collective impact on surgical outcomes in fVCA to refine patient selection, optimize long-term results, and understand the aging process in fVCA patients.

Background: Cellulite affects up to 98% of post-pubertal females and is characterized by structural changes in connective tissue, leading to visible dimpling. Traditional treatments provide limited and temporary improvement. This study evaluates the safety and efficacy of a novel combination approach using mechanical septal release and helium plasma RF to disrupt fibrous septae and stimulate collagen remodeling. Cellulite treatment often requires a bi-modality approach due to the different components creating the defect: namely Fibrous bands and loose skin Methods: This prospective, single-center, investigator-initiated trial (IIT) enrolled 22 subjects who underwent a single-session treatment consisting of mechanical septal release followed by helium plasma RF. Outcome measures were quantitative improvement from baseline in cellulite and skin laxity assessed via imaging at Day 30, 90 and 180. Additional outcome measures were Physician Global Aesthetic Improvement Scale (PGAIS), Subject Global Aesthetic Improvement Scale (SGAIS), and safety outcomes at D7, D30, D90, and D180. Results: Quantitative image analysis demonstrated progressive and sustained improvement in cellulite appearance and skin laxity from D30 to D90 and D180. At D30, 76.2% of subjects in the right thigh and 90.5% in the left thigh showed some level of improvement. At D90 (primary endpoint), 63.6% of subjects in the right thigh and 86.4% in the left thigh demonstrated improvement compared to baseline. At D180, 77.3% of subjects in the right thigh and 81.8% in the left thigh continued to show improvement. Physician-reported outcomes using PGAIS indicated continued improvement over time, with mean scores increasing from 2.6 ± 0.9 at D30 to 2.8 ± 1.0 at D90 and D180, suggesting sustained collagen remodeling. Subject-reported aesthetic improvement, measured by the SGAIS, peaked at D90 before stabilizing at D180, reflecting high patient satisfaction. The treatment demonstrated a favorable safety profile, with two mild adverse events (9%) considered likely related to the procedure, including one case of hematoma and one instance of transient shortness of breath attributed to helium exposure. Both events resolved without intervention. Importantly, no serious adverse events were reported, supporting the safety and tolerability of the combination approach. Conclusions: This study demonstrates that a novel combination approach using mechanical septal release and helium plasma RF provides a safe, well-tolerated, and effective treatment for cellulite and skin laxity, with progressive and sustained improvement up to 180 days post-treatment. The combination therapy disrupts fibrous septae while promoting collagen remodeling, resulting in visible and measurable aesthetic benefits. These findings support the integration of mechanical and energy-based approaches for cellulite treatment, warranting further long-term evaluation.

Background: Optimal wound closure techniques are crucial in plastic and reconstructive surgery to minimize scarring and enhance aesthetic and functional outcomes. Recent studies have explored the efficacy of the Modified Buried Vertical Mattress Suture (MBVMS) and its advantages over traditional techniques in achieving superior wound edge eversion, reducing tension, and preventing hypertrophic scar formation. This study synthesizes findings from our research group on the efficacy of MBVMS compared to the conventional buried intradermal suture (BIS) technique in thoracic and multilayered wound closures.

Methods: Three studies were analyzed: a case series on MBVMS in multilayered wound closure, a randomized controlled trial (RCT) assessing MBVMS versus BIS for thoracic incisions, and a prospective split-scar study comparing both techniques on costal cartilage donor site wounds. The studies utilized validated scar assessment tools, including the Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale (VSS), and Visual Analog Scale (VAS), to evaluate postoperative outcomes over three to twelve months.

Results: The MBVMS technique consistently demonstrated superior wound edge eversion immediately postoperatively and led to significantly lower POSAS, VSS, and VAS scores at follow-up assessments compared to BIS. The split-scar study revealed that MBVMS resulted in narrower scar width (p < 0.05) and improved scar aesthetics at three months. The RCT confirmed feasibility and higher patient satisfaction with MBVMS due to better approximation and tension distribution, which correlated with reduced hypertrophic scarring.

Conclusion: MBVMS presents a superior alternative to conventional suturing techniques for optimizing wound healing and aesthetic outcomes. By enhancing wound edge eversion and reducing skin tension, MBVMS reduces hypertrophic scarring, making it a preferred technique for high-tension wound closures. Future large-scale studies are warranted to further validate these findings across diverse surgical applications.

Background Back fat deposits are usually resistant to diet and exercise. The accumulation of fat in this area creates rolls or folds that lead to undesirable irregularities in body contour, reduce self-confidence and limit clothing choices. Corrective procedures include liposuction and lifting surgery. The indication for the choice of procedure is not very definite, and it seems that a number of patients need revision, but there is no precise information about its rate in the sources. Objectives The author has attempted to reduce the number of revisions and the need for lifting procedures by using skin net sutures in some areas of the back. Methods The author conducted a retrospective study of 200 patients who underwent back contouring alone or in combination with other procedures. Exclusion criteria included morbid obesity and MWL. Patients were divided into two groups: those who underwent liposuction and the use of skin tightening devices such as radiofrequency, and those who underwent liposuction and skin redistribution with skin net sutures. The revision rate was compared between the two groups. Results All patients were female, and their age range was from 19 to 62 years (Mean 40.45 years). The volume of liposuction is from a minimum of 1000 cc to a maximum of 3500 cc. The revision rate in the first group was about 8% and the average volume of fat removed was about 100 ml. Revision in the second group was less than one percent. Discussion The reason for revision is usually the patients complain, which is due to the presence of residual skin rolls. The volume of fat removed during revision was less than expected, and the amount of fibrosis appeared to be greater. It seems that during revision, the release of adhesive bands and skin redistribution are more effective in resolving the skin roll than the fat removed. If this skin distribution is performed with sutures in the first procedure, the result will be a significant reduction in the appearance of skin rolls or small folds. Conclusion By performing extensive liposuction of the back and releasing the skin boundaries between the rolls and folds, the skin is well redistributed with net sutures. This maneuver significantly reduces the number of revisions.