Scientific Abstract Presentations: Aesthetic Session 4 Saturday, October 11 Sat, Oct 11 2:00-3:30 p.m. CDT

Background: Cosmetic surgical procedures have become increasingly prevalent, with a rising number of individuals seeking aesthetic enhancements. While research exists on perioperative risk factors in cosmetic surgery, large-scale, standardized studies evaluating comprehensive risk stratification remain relatively limited. This study aims to identify predictors of postoperative complications in cosmetic surgery, with a specific emphasis on age as a potential risk factor.

Methods: A retrospective cohort study was performed utilizing data from the National Surgical Quality Improvement Program (NSQIP) database from 2008 till 2023. A total of 10,135 patients who underwent various cosmetic procedures were included. Preoperative demographics, comorbidities, and operative characteristics were analyzed. Multivariable logistic regression was employed to determine independent predictors of overall, surgical, and medical complications.

Results: The mean age of the study population was 42.13 ± 12.2 years, with an average body mass index (BMI) of 26 ± 5.3. The most frequently performed procedures included breast augmentation with implants (35.3%) and panniculectomy (30.1%). The overall complication rate was 3.1%, with surgical complications occurring in 1.5% of patients and medical complications in 0.5%. Multivariable analysis revealed BMI as a significant predictor of overall complications (OR: 1.085, p < 0.0001), as well as surgical (p < 0.0001) and medical (p < 0.0001) complications. Increasing age was independently associated with a heightened risk of overall (p = 0.0036), surgical (p = 0.02), and medical (p = 0.0342) complications. Additionally, a history of chronic obstructive pulmonary disease (COPD) (OR: 4.292, p = 0.03) and significant weight loss (OR: 25.23, p = 0.03) were identified as notable risk factors.

Conclusions: This study identifies age as an independent risk factor for postoperative complications in cosmetic surgery, emphasizing the need for age-specific risk stratification when selecting surgical candidates. Additionally, BMI and preexisting comorbidities, such as COPD and significant weight loss, contribute to increased perioperative risk. Given the growing number of patients undergoing aesthetic procedures, these findings underscore the importance of personalized surgical planning and preoperative optimization to enhance patient safety and outcomes.

AN UPDATE AND COMPREHENSIVE REVIEW OF TREATMENT OPTIONS FOR HAND REJUVENATION

Author: Dr DORAN KALMIN1

Organisation: 1Launceston General Hospital, Department of Plastic and Reconstructive Surgery, Tasmania Introduction: The appearance of hands is an accurate isolated predicter of a person's age.1 Age related changes in the hand include thinning of the dermis, epidermis and fibrofatty tissue, pigmentation from photodamage and trauma, prominent veins, tactile roughness, intrinsic muscle atrophy and arthritis. Increasingly, procedures targeting the aesthetic appearance of hands makes up a growing proportion of hand surgeons' work with innovative treatments available to address the ageing hand.

Methods: The MEDLINE database was searched to identify relevant studies. Search terms include: "hand rejuvenation" "hand ageing" "fat grafting" "dermal filler" and "lasers". Studies published from 2000 to 2024 were included.

Results 96.7% of patients seeking hand rejuvenation are females. Topical treatments including sodium copper chlorophyllin, alpha-hydroxy acid and retinol that reverse photodamage and add moisture. Results are unpredictable with short longevity. Laser therapies improve deteriorating skin quality and pigmentation, the two most effective are the Q-switched ruby laser and Intensive Pulsed Light (IPL). Dermal fillers and fat grafting improve the appearance of tendons and veins. These have high patient satisfaction rates with low complication rates. Most authors recommend filler and fat be injected in the dorsal superficial lamina layer to prevent damage to sensory nerves and veins.

Conclusions Hand rejuvenation is a growing area with treatment options generally very safe with rare complications and have high patient satisfaction. The most common methods in the literature are fat grafting, injectable fillers and laser treatments.

References 1. Bains RD, Thorpe H, Southern S. Hand aging: patients' opinions. Plast Reconstr Surg. 2006;117(7):2212-8.

Introduction Obesity, characterized by the accumulation of adipose tissue, is a chronic condition with rapidly increasing prevalence worldwide, particularly among adults. Adipose tissue secretes adipokines, which play a crucial role in maintaining metabolic homeostasis. Dysregulation of gut hormones may lead to dysregulation of adipokines and among these adipokines leptin is considered a critical hormone that plays a key role in fat mass regulation. Several studies have demonstrated a reduction in leptin levels (indicative of improved leptin sensitivity) following surgical subcutaneous fat removal (SSFR) procedures. In this paper, we look at hormonal predictors of fat mass limiting the predictors to gut hormones and adipokines. We aim to assess the interplay between these hormone levels and total body fat% to gain an understanding of the regulatory mechanism underpinning fat mass regulation in patients pre and post body contouring surgery who may or may not have had prior bariatric surgery. Methods Subjects who underwent body contouring surgeries at the Department of Plastic Surgery, Hamad General Hospital, from January 2021 to December 2023 were included in this study. Each subject was prospectively followed up at three time points. At each follow-up, body composition analysis, oral glucose tolerance tests, glycemic indices, and hormonal levels were assessed. Descriptive and inferential statistical methods were employed to analyze changes and correlations between variables. Results Subjects that attended the visits were 34, 22 and 27 at visits 1,2 and 3 respectively. Median levels of leptin and spexin exhibited fluctuations across visits. However, these changes were not statistically significant. In contrast, GLP-1, GIP, PP, LEAP2 and Amylin levels demonstrated significant variations across visits with an initial increase in visit 2 followed by reduction in visit 3 indicating noteworthy changes over time. When predictors of lean phenotype were analyzed using logistic regression (Table 2), there was a significant negative association with serum leptin levels and serum GIP levels. On the other hand, there was an increase of lean phenotype with history of bariatric surgery after accounting for the impact of leptin, and gut hormones. To better understand the relationships, a margins plot demonstrated that the probability of lean phenotype was predicted by amylin, Spexin, GIP and leptin levels (Figure 1). The only predictor of leptin sensitivity (proxy through lower tertile leptin levels) was fat mass % with greater fat mass being associated with decrease in leptin sensitivity (Figure 2). Suggested overall relationships of these hormones to fat phenotype is depicted in Figure 3. Conclusion This molecular epidemiological study suggests that for the first time, that amylin and GIP in tandem with leptin and spexin predict the fat phenotype of patients. Rising levels of amylin and declining levels of all other hormones predicted the lean phenotype. These results suggest that a combination of gut hormones and adipokines is associated with fat phenotype in humans.

Introduction: Rhinoplasty is both a complex and challenging surgical procedure, particularly when it comes to addressing the nasal tip. Our group previously demonstrated the success of a mastoid fascia graft in camouflaging nasal tip contour irregularities, however, sometimes the nasal tip needs more projection (1). For these patients, we have introduced the hybrid tip graft (HTG) which combines our previously described mastoid fascia tip graft with an underlay of lower lateral cartilage (LLC), to provide additional projection and definition. Methods: A retrospective analysis of HTG for nasal tip aesthetics during open rhinoplasty in the senior author's practice was conducted from May 2021 to June 2022. The HTG is created with crushed LLC with an overlay of mastoid fascia graft. Patients were included in the study if they underwent open rhinoplasty with HTG with a minimum of 12-months of follow-up. Patients were evaluated for need for revision surgery or infection. Results: 729 patients met the inclusion criteria, with 666 female patients with an average age of 31.9 years old. Primary rhinoplasties were performed on 510 (70%) patients. Average follow up was 21.9 months (range: 12-36 month). 21 patient (2.9%) required antibiotics for management of post-operative infection. 11 patients (1.5%) required a revision surgery, of which only 2 (0.3%) were initially primary rhinoplasties. Of the revision surgeries, only 4 (0.5%) were revisions that required the tip to be readdressed. Conclusion: HTG is a safe, novel method to provide additional nasal tip projection, with stable results, that do not compromise the ability to camouflage tip irregularities. This technique can also be used with other soft cartilage when necessary. Use of HTG is associated with minimal morbidity and is a useful, predictable tool in many rhinoplasty patients.

1. Tugertimur B, Datta S, Goote P, Hanna SA, Morris M, Mattos D, Reish RG. Mastoid Fascia Tissue Graft as a Tip Camouflage Technique in Rhinoplasty: A Reliable Alternative to Soft Cartilage Grafts. Plast Reconstr Surg. 2024 Jul 19

Introduction: Rhinoplasty is both a complex and challenging surgical procedure, particularly when it comes to addressing the nasal tip. Our group previously demonstrated the success of a mastoid fascia graft in camouflaging nasal tip contour irregularities, however, sometimes the nasal tip needs more projection (1). For these patients, we have introduced the hybrid tip graft (HTG) which combines our previously described mastoid fascia tip graft with an underlay of lower lateral cartilage (LLC), to provide additional projection and definition. Methods: A retrospective analysis of HTG for nasal tip aesthetics during open rhinoplasty in the senior author's practice was conducted from May 2021 to June 2022. The HTG is created with crushed LLC with an overlay of mastoid fascia graft. Patients were included in the study if they underwent open rhinoplasty with HTG with a minimum of 12-months of follow-up. Patients were evaluated for need for revision surgery or infection. Results: 729 patients met the inclusion criteria, with 666 female patients with an average age of 31.9 years old. Primary rhinoplasties were performed on 510 (70%) patients. Average follow up was 21.9 months (range: 12-36 month). 21 patient (2.9%) required antibiotics for management of post-operative infection. 11 patients (1.5%) required a revision surgery, of which only 2 (0.3%) were initially primary rhinoplasties. Of the revision surgeries, only 4 (0.5%) were revisions that required the tip to be readdressed. Conclusion: HTG is a safe, novel method to provide additional nasal tip projection, with stable results, that do not compromise the ability to camouflage tip irregularities. This technique can also be used with other soft cartilage when necessary. Use of HTG is associated with minimal morbidity and is a useful, predictable tool in many rhinoplasty patients.

1. Tugertimur B, Datta S, Goote P, Hanna SA, Morris M, Mattos D, Reish RG. Mastoid Fascia Tissue Graft as a Tip Camouflage Technique in Rhinoplasty: A Reliable Alternative to Soft Cartilage Grafts. Plast Reconstr Surg. 2024 Jul 19

Introduction: Rhinoplasty is both a complex and challenging surgical procedure, particularly when it comes to addressing the nasal tip. Our group previously demonstrated the success of a mastoid fascia graft in camouflaging nasal tip contour irregularities, however, sometimes the nasal tip needs more projection (1). For these patients, we have introduced the hybrid tip graft (HTG) which combines our previously described mastoid fascia tip graft with an underlay of lower lateral cartilage (LLC), to provide additional projection and definition. Methods: A retrospective analysis of HTG for nasal tip aesthetics during open rhinoplasty in the senior author's practice was conducted from May 2021 to June 2022. The HTG is created with crushed LLC with an overlay of mastoid fascia graft. Patients were included in the study if they underwent open rhinoplasty with HTG with a minimum of 12-months of follow-up. Patients were evaluated for need for revision surgery or infection. Results: 729 patients met the inclusion criteria, with 666 female patients with an average age of 31.9 years old. Primary rhinoplasties were performed on 510 (70%) patients. Average follow up was 21.9 months (range: 12-36 month). 21 patient (2.9%) required antibiotics for management of post-operative infection. 11 patients (1.5%) required a revision surgery, of which only 2 (0.3%) were initially primary rhinoplasties. Of the revision surgeries, only 4 (0.5%) were revisions that required the tip to be readdressed. Conclusion: HTG is a safe, novel method to provide additional nasal tip projection, with stable results, that do not compromise the ability to camouflage tip irregularities. This technique can also be used with other soft cartilage when necessary. Use of HTG is associated with minimal morbidity and is a useful, predictable tool in many rhinoplasty patients.

1. Tugertimur B, Datta S, Goote P, Hanna SA, Morris M, Mattos D, Reish RG. Mastoid Fascia Tissue Graft as a Tip Camouflage Technique in Rhinoplasty: A Reliable Alternative to Soft Cartilage Grafts. Plast Reconstr Surg. 2024 Jul 19

Introduction: Achieving a smooth, refined nasal profile remains a significant challenge, particularly in thin-skinned patients who are more susceptible to contour irregularities. Many techniques are used to address this problem, including diced cartilage, fascia, dermal matrices, and implants. This study aims to evaluate the effectiveness of using morselized bone grafts (MBG)–specifically, unused bone rasp material that is typically discarded–as a technique for contouring and refining the nasal dorsum. Methods: A retrospective chart review of rhinoplasty cases in the senior author's practice was conducted between January 2021 and June 2022. Patients who underwent MBG for dorsal contouring with a minimum of 12 months of follow-up were included. Outcomes of interest were rate of postoperative infection and the rate of operative revisions. Results: A total of 953 patients were included in the study. The mean age was 31.6 years old. The mean follow-up period was 23.5 months, with a minimum of 12 months of follow up for each patient. The rate of postoperative infection in our case series was 2.7%, with 26 patients requiring postoperative antibiotics. 17 (1.8%) patients required operative revision. No patients sought revision rhinoplasty for concerns related to dorsal irregularities or contour defects. Conclusion: MBG use for nasal dorsum aesthetics is a safe, convenient, and effective technique for camouflaging and concealing nasal dorsum irregularities in both primary and revision rhinoplasty. Additionally, MBG use is an efficient alternative to other techniques for addressing dorsal aesthetics with no additional donor-site morbidity when paired with boney dorsal reduction.

Introduction: Achieving a smooth, refined nasal profile remains a significant challenge, particularly in thin-skinned patients who are more susceptible to contour irregularities. Many techniques are used to address this problem, including diced cartilage, fascia, dermal matrices, and implants. This study aims to evaluate the effectiveness of using morselized bone grafts (MBG)–specifically, unused bone rasp material that is typically discarded–as a technique for contouring and refining the nasal dorsum. Methods: A retrospective chart review of rhinoplasty cases in the senior author's practice was conducted between January 2021 and June 2022. Patients who underwent MBG for dorsal contouring with a minimum of 12 months of follow-up were included. Outcomes of interest were rate of postoperative infection and the rate of operative revisions. Results: A total of 953 patients were included in the study. The mean age was 31.6 years old. The mean follow-up period was 23.5 months, with a minimum of 12 months of follow up for each patient. The rate of postoperative infection in our case series was 2.7%, with 26 patients requiring postoperative antibiotics. 17 (1.8%) patients required operative revision. No patients sought revision rhinoplasty for concerns related to dorsal irregularities or contour defects. Conclusion: MBG use for nasal dorsum aesthetics is a safe, convenient, and effective technique for camouflaging and concealing nasal dorsum irregularities in both primary and revision rhinoplasty. Additionally, MBG use is an efficient alternative to other techniques for addressing dorsal aesthetics with no additional donor-site morbidity when paired with boney dorsal reduction.

Introduction: Achieving a smooth, refined nasal profile remains a significant challenge, particularly in thin-skinned patients who are more susceptible to contour irregularities. Many techniques are used to address this problem, including diced cartilage, fascia, dermal matrices, and implants. This study aims to evaluate the effectiveness of using morselized bone grafts (MBG)–specifically, unused bone rasp material that is typically discarded–as a technique for contouring and refining the nasal dorsum. Methods: A retrospective chart review of rhinoplasty cases in the senior author's practice was conducted between January 2021 and June 2022. Patients who underwent MBG for dorsal contouring with a minimum of 12 months of follow-up were included. Outcomes of interest were rate of postoperative infection and the rate of operative revisions. Results: A total of 953 patients were included in the study. The mean age was 31.6 years old. The mean follow-up period was 23.5 months, with a minimum of 12 months of follow up for each patient. The rate of postoperative infection in our case series was 2.7%, with 26 patients requiring postoperative antibiotics. 17 (1.8%) patients required operative revision. No patients sought revision rhinoplasty for concerns related to dorsal irregularities or contour defects. Conclusion: MBG use for nasal dorsum aesthetics is a safe, convenient, and effective technique for camouflaging and concealing nasal dorsum irregularities in both primary and revision rhinoplasty. Additionally, MBG use is an efficient alternative to other techniques for addressing dorsal aesthetics with no additional donor-site morbidity when paired with boney dorsal reduction.

Introduction The rising prevalence of massive weight loss-typically defined as either a loss of 50% of a patient's excess body weight or a reduction of 100 pounds-has driven an increased demand for post–massive weight loss body contouring procedures. While numerous studies have focused on clinical outcomes and patient factors following these procedures, no comprehensive analysis has yet quantified and compared insurance coverage policies over time and across multiple payers. This abstract presents a unique examination of publicly available guidelines from Medicare, Blue Cross Blue Shield (BCBS), UnitedHealthcare, Aetna, Cigna, and Humana, aiming to illuminate evolving coverage trends and ultimately assist surgeons in optimizing patient selection and preoperative planning.

Methods We performed a comparative policy analysis using publicly available guidelines from Medicare, BCBS, UnitedHealthcare, Aetna, Cigna, and Humana. Quantitative criteria for abdominal and non-abdominal body contouring procedures were extracted, and historical policy data (2000–2023) were reviewed to document trends in coverage evolution.

Results Most insurers require a ≥50% excess weight loss threshold and mandate 6–12 months of weight stability. For abdominal procedures (abdominoplasty/panniculectomy), approximately 70% of policies specify that the pannus must extend 8–10 cm below the pubic symphysis, and 90% require documentation of ≥3 episodes of recurrent skin infections or related complications within 12 months. These criteria yield a coverage rate of approximately 65–70% for abdominal procedures. In contrast, non-abdominal procedures (e.g., brachioplasty, thighplasty, trunk lifts) are approved in only 20–30% of cases. Functional criteria for coverage were strictly physical and did not guarantee approval. The literature review demonstrated a clear policy evolution: from <30% coverage in the early 2000s to ~65–70% for abdominal procedures by 2020, while non-abdominal procedures have consistently remained at a 20–30% approval rate.

Conclusion Our analysis reveals significant variability in insurance coverage for post–massive weight loss body contouring procedures. Quantitative thresholds for coverage have become relatively well-established for abdominal procedures, whereas non-abdominal procedures are rarely approved and lack standard criteria for coverage. These discrepancies highlight the need for standardized, evidence-based guidelines in non-abdominal procedures, thus allowing surgeons to optimize patient selection, enhance preoperative documentation, and better manage patient expectations regarding insurance approval. This will ultimately lead to more efficient and effective care, an increasingly relevant issue for the growing post-massive weight loss population. Future multicenter studies are warranted to validate these criteria and assess their long-term clinical impact.

Introduction The rising prevalence of massive weight loss-typically defined as either a loss of 50% of a patient's excess body weight or a reduction of 100 pounds-has driven an increased demand for post–massive weight loss body contouring procedures. While numerous studies have focused on clinical outcomes and patient factors following these procedures, no comprehensive analysis has yet quantified and compared insurance coverage policies over time and across multiple payers. This abstract presents a unique examination of publicly available guidelines from Medicare, Blue Cross Blue Shield (BCBS), UnitedHealthcare, Aetna, Cigna, and Humana, aiming to illuminate evolving coverage trends and ultimately assist surgeons in optimizing patient selection and preoperative planning.

Methods We performed a comparative policy analysis using publicly available guidelines from Medicare, BCBS, UnitedHealthcare, Aetna, Cigna, and Humana. Quantitative criteria for abdominal and non-abdominal body contouring procedures were extracted, and historical policy data (2000–2023) were reviewed to document trends in coverage evolution.

Results Most insurers require a ≥50% excess weight loss threshold and mandate 6–12 months of weight stability. For abdominal procedures (abdominoplasty/panniculectomy), approximately 70% of policies specify that the pannus must extend 8–10 cm below the pubic symphysis, and 90% require documentation of ≥3 episodes of recurrent skin infections or related complications within 12 months. These criteria yield a coverage rate of approximately 65–70% for abdominal procedures. In contrast, non-abdominal procedures (e.g., brachioplasty, thighplasty, trunk lifts) are approved in only 20–30% of cases. Functional criteria for coverage were strictly physical and did not guarantee approval. The literature review demonstrated a clear policy evolution: from <30% coverage in the early 2000s to ~65–70% for abdominal procedures by 2020, while non-abdominal procedures have consistently remained at a 20–30% approval rate.

Conclusion Our analysis reveals significant variability in insurance coverage for post–massive weight loss body contouring procedures. Quantitative thresholds for coverage have become relatively well-established for abdominal procedures, whereas non-abdominal procedures are rarely approved and lack standard criteria for coverage. These discrepancies highlight the need for standardized, evidence-based guidelines in non-abdominal procedures, thus allowing surgeons to optimize patient selection, enhance preoperative documentation, and better manage patient expectations regarding insurance approval. This will ultimately lead to more efficient and effective care, an increasingly relevant issue for the growing post-massive weight loss population. Future multicenter studies are warranted to validate these criteria and assess their long-term clinical impact.

Introduction The rising prevalence of massive weight loss-typically defined as either a loss of 50% of a patient's excess body weight or a reduction of 100 pounds-has driven an increased demand for post–massive weight loss body contouring procedures. While numerous studies have focused on clinical outcomes and patient factors following these procedures, no comprehensive analysis has yet quantified and compared insurance coverage policies over time and across multiple payers. This abstract presents a unique examination of publicly available guidelines from Medicare, Blue Cross Blue Shield (BCBS), UnitedHealthcare, Aetna, Cigna, and Humana, aiming to illuminate evolving coverage trends and ultimately assist surgeons in optimizing patient selection and preoperative planning.

Methods We performed a comparative policy analysis using publicly available guidelines from Medicare, BCBS, UnitedHealthcare, Aetna, Cigna, and Humana. Quantitative criteria for abdominal and non-abdominal body contouring procedures were extracted, and historical policy data (2000–2023) were reviewed to document trends in coverage evolution.

Results Most insurers require a ≥50% excess weight loss threshold and mandate 6–12 months of weight stability. For abdominal procedures (abdominoplasty/panniculectomy), approximately 70% of policies specify that the pannus must extend 8–10 cm below the pubic symphysis, and 90% require documentation of ≥3 episodes of recurrent skin infections or related complications within 12 months. These criteria yield a coverage rate of approximately 65–70% for abdominal procedures. In contrast, non-abdominal procedures (e.g., brachioplasty, thighplasty, trunk lifts) are approved in only 20–30% of cases. Functional criteria for coverage were strictly physical and did not guarantee approval. The literature review demonstrated a clear policy evolution: from <30% coverage in the early 2000s to ~65–70% for abdominal procedures by 2020, while non-abdominal procedures have consistently remained at a 20–30% approval rate.

Conclusion Our analysis reveals significant variability in insurance coverage for post–massive weight loss body contouring procedures. Quantitative thresholds for coverage have become relatively well-established for abdominal procedures, whereas non-abdominal procedures are rarely approved and lack standard criteria for coverage. These discrepancies highlight the need for standardized, evidence-based guidelines in non-abdominal procedures, thus allowing surgeons to optimize patient selection, enhance preoperative documentation, and better manage patient expectations regarding insurance approval. This will ultimately lead to more efficient and effective care, an increasingly relevant issue for the growing post-massive weight loss population. Future multicenter studies are warranted to validate these criteria and assess their long-term clinical impact.

Introduction The rising prevalence of massive weight loss-typically defined as either a loss of 50% of a patient's excess body weight or a reduction of 100 pounds-has driven an increased demand for post–massive weight loss body contouring procedures. While numerous studies have focused on clinical outcomes and patient factors following these procedures, no comprehensive analysis has yet quantified and compared insurance coverage policies over time and across multiple payers. This abstract presents a unique examination of publicly available guidelines from Medicare, Blue Cross Blue Shield (BCBS), UnitedHealthcare, Aetna, Cigna, and Humana, aiming to illuminate evolving coverage trends and ultimately assist surgeons in optimizing patient selection and preoperative planning.

Methods We performed a comparative policy analysis using publicly available guidelines from Medicare, BCBS, UnitedHealthcare, Aetna, Cigna, and Humana. Quantitative criteria for abdominal and non-abdominal body contouring procedures were extracted, and historical policy data (2000–2023) were reviewed to document trends in coverage evolution.

Results Most insurers require a ≥50% excess weight loss threshold and mandate 6–12 months of weight stability. For abdominal procedures (abdominoplasty/panniculectomy), approximately 70% of policies specify that the pannus must extend 8–10 cm below the pubic symphysis, and 90% require documentation of ≥3 episodes of recurrent skin infections or related complications within 12 months. These criteria yield a coverage rate of approximately 65–70% for abdominal procedures. In contrast, non-abdominal procedures (e.g., brachioplasty, thighplasty, trunk lifts) are approved in only 20–30% of cases. Functional criteria for coverage were strictly physical and did not guarantee approval. The literature review demonstrated a clear policy evolution: from <30% coverage in the early 2000s to ~65–70% for abdominal procedures by 2020, while non-abdominal procedures have consistently remained at a 20–30% approval rate.

Conclusion Our analysis reveals significant variability in insurance coverage for post–massive weight loss body contouring procedures. Quantitative thresholds for coverage have become relatively well-established for abdominal procedures, whereas non-abdominal procedures are rarely approved and lack standard criteria for coverage. These discrepancies highlight the need for standardized, evidence-based guidelines in non-abdominal procedures, thus allowing surgeons to optimize patient selection, enhance preoperative documentation, and better manage patient expectations regarding insurance approval. This will ultimately lead to more efficient and effective care, an increasingly relevant issue for the growing post-massive weight loss population. Future multicenter studies are warranted to validate these criteria and assess their long-term clinical impact.

Background: In 2006, Matarasso et al. published an American Society of Plastic Surgeons (ASPS) member survey detailing abdominoplasty practice patterns. The purpose of the current study is to explore how surgical techniques, ancillary procedures, practice patterns, and surgical outcomes have changed in the interim. Methods: A 38-question descriptive survey was designed based on Matarasso's 2006 study. Selected modifications were incorporated to investigate new techniques and trends. Surveys were distributed anonymously to a random cohort of 1,765 ASPS members. Results were compared to the 2006 survey and to current practice recommendations in the plastic surgery literature. Results: A total of 256 responses (14.5% response rate) were received. Full abdominoplasty with rectus plication and umbilical transposition was the most performed abdominal contouring technique by the majority of respondents in both studies. Utilization of abdominal flap liposuction as an adjunct to abdominoplasty decreased from 54% in 2006 to 48.6% in 2023. Use of ultrasound-assisted liposuction also decreased from 13% to 6.4%, while that of power-assisted liposuction increased from 14% to 50.7%. Progressive tension sutures and tranexamic acid were novel practice tools incorporated by 49.8% and 38.3% of respondents, respectively. Drain use decreased from 98% in 2006 to 82.5%. Willingness to perform concomitant breast surgery was universally high for both surveys. Current respondents were, however, less likely to perform intraabdominal or facial surgeries compared to 2006. Conclusions: Nuanced changes in the abdominoplasty operation have occurred over the past twenty years, as have adjuncts utilized to improve results and limit morbidity.

Background: In 2006, Matarasso et al. published an American Society of Plastic Surgeons (ASPS) member survey detailing abdominoplasty practice patterns. The purpose of the current study is to explore how surgical techniques, ancillary procedures, practice patterns, and surgical outcomes have changed in the interim. Methods: A 38-question descriptive survey was designed based on Matarasso's 2006 study. Selected modifications were incorporated to investigate new techniques and trends. Surveys were distributed anonymously to a random cohort of 1,765 ASPS members. Results were compared to the 2006 survey and to current practice recommendations in the plastic surgery literature. Results: A total of 256 responses (14.5% response rate) were received. Full abdominoplasty with rectus plication and umbilical transposition was the most performed abdominal contouring technique by the majority of respondents in both studies. Utilization of abdominal flap liposuction as an adjunct to abdominoplasty decreased from 54% in 2006 to 48.6% in 2023. Use of ultrasound-assisted liposuction also decreased from 13% to 6.4%, while that of power-assisted liposuction increased from 14% to 50.7%. Progressive tension sutures and tranexamic acid were novel practice tools incorporated by 49.8% and 38.3% of respondents, respectively. Drain use decreased from 98% in 2006 to 82.5%. Willingness to perform concomitant breast surgery was universally high for both surveys. Current respondents were, however, less likely to perform intraabdominal or facial surgeries compared to 2006. Conclusions: Nuanced changes in the abdominoplasty operation have occurred over the past twenty years, as have adjuncts utilized to improve results and limit morbidity.

Background: In 2006, Matarasso et al. published an American Society of Plastic Surgeons (ASPS) member survey detailing abdominoplasty practice patterns. The purpose of the current study is to explore how surgical techniques, ancillary procedures, practice patterns, and surgical outcomes have changed in the interim. Methods: A 38-question descriptive survey was designed based on Matarasso's 2006 study. Selected modifications were incorporated to investigate new techniques and trends. Surveys were distributed anonymously to a random cohort of 1,765 ASPS members. Results were compared to the 2006 survey and to current practice recommendations in the plastic surgery literature. Results: A total of 256 responses (14.5% response rate) were received. Full abdominoplasty with rectus plication and umbilical transposition was the most performed abdominal contouring technique by the majority of respondents in both studies. Utilization of abdominal flap liposuction as an adjunct to abdominoplasty decreased from 54% in 2006 to 48.6% in 2023. Use of ultrasound-assisted liposuction also decreased from 13% to 6.4%, while that of power-assisted liposuction increased from 14% to 50.7%. Progressive tension sutures and tranexamic acid were novel practice tools incorporated by 49.8% and 38.3% of respondents, respectively. Drain use decreased from 98% in 2006 to 82.5%. Willingness to perform concomitant breast surgery was universally high for both surveys. Current respondents were, however, less likely to perform intraabdominal or facial surgeries compared to 2006. Conclusions: Nuanced changes in the abdominoplasty operation have occurred over the past twenty years, as have adjuncts utilized to improve results and limit morbidity.

Background: In 2006, Matarasso et al. published an American Society of Plastic Surgeons (ASPS) member survey detailing abdominoplasty practice patterns. The purpose of the current study is to explore how surgical techniques, ancillary procedures, practice patterns, and surgical outcomes have changed in the interim. Methods: A 38-question descriptive survey was designed based on Matarasso's 2006 study. Selected modifications were incorporated to investigate new techniques and trends. Surveys were distributed anonymously to a random cohort of 1,765 ASPS members. Results were compared to the 2006 survey and to current practice recommendations in the plastic surgery literature. Results: A total of 256 responses (14.5% response rate) were received. Full abdominoplasty with rectus plication and umbilical transposition was the most performed abdominal contouring technique by the majority of respondents in both studies. Utilization of abdominal flap liposuction as an adjunct to abdominoplasty decreased from 54% in 2006 to 48.6% in 2023. Use of ultrasound-assisted liposuction also decreased from 13% to 6.4%, while that of power-assisted liposuction increased from 14% to 50.7%. Progressive tension sutures and tranexamic acid were novel practice tools incorporated by 49.8% and 38.3% of respondents, respectively. Drain use decreased from 98% in 2006 to 82.5%. Willingness to perform concomitant breast surgery was universally high for both surveys. Current respondents were, however, less likely to perform intraabdominal or facial surgeries compared to 2006. Conclusions: Nuanced changes in the abdominoplasty operation have occurred over the past twenty years, as have adjuncts utilized to improve results and limit morbidity.

PURPOSE: Rhinoplasty is one of the most frequently performed plastic surgeries worldwide, involving different techniques to manage the nasal dorsum. However, the potential differences in outcomes between the dorsal preservation (DP) and dorsal reduction (DR) techniques remain unclear. This meta-analysis evaluates the DP and DR techniques in terms of functional and aesthetic outcomes, revisions surgeries needed and post-operative hump recurrence. METHODS: We searched PubMed, Cochrane, and Embase up to January 20 th, 2025, for studies comparing DP versus DR in rhinoplasty patients. The primary outcome was the standardized functional outcome scores in the long-term postoperative period. Secondary outcomes included: standardized functional outcome in the short-term postoperative period, subjective aesthetic outcomes in the short-term and long-term postoperative periods, standardized aesthetic outcome and total SCHNOS in the long-term postoperative period, revisions surgeries needed, and hump recurrence. Subgroup analyses were performed to evaluate different scales (SCHNOS, NOSE, VAS and UQ). RESULTS: Ten studies comprising 1,339 patients were included. DP was associated with higher satisfaction in the UQ subgroup for subjective aesthetic outcome in the short-term postoperative period (MD 1.13 points [CI 95% 0.74; 1.52]; p <0.001, I²= 0%), however a significantly higher rate of hump recurrence was also observed in this group (RR 2.94 [CI 95% 1.23; 7.03]; p = 0.02, I² = 0%). No significant differences were found in standardized functional outcomes (in the short-term and long-term), subjective aesthetic outcome, standardized aesthetic outcome or total SCHNOS (in the long-term), and revision surgeries needed between the DP and DR groups. CONCLUSION: The DP technique showed no significant differences compared to the DR group in standardized functional outcomes (in the long-term and short-term), subjective aesthetic outcome, standardized aesthetic outcome or total SCHNOS (in the long-term), and revision surgeries needed. DP was associated with statistically higher satisfaction scores in the UQ subgroup for subjective aesthetic outcome in the short- term period, but also was associated with a significantly higher rate of hump recurrence.

Purpose: Surgical techniques to address facial aging can be broadly categorized as either "conventional" or "short scar" facelifts (1-3). The senior author has used the minimal access cranial suspension (MACS) lift for patients with lesser degrees of facial aging, while reserving a conventional facelift for more advanced aging (4). Critics of the MACS lift have argued that it produces inferior results compared to traditional facelift (4-5). The aim of this study is to assess the efficacy of the MACS lift by comparing results obtained with conventional facelift, in a single practice.

Methods: A retrospective review was performed to identify all patients who underwent facial rejuvenation surgery by the senior author between January 2011 and June 2024. Demographic data, type of procedure, and patient-reported satisfaction were recorded. Clinical photographs were evaluated by four independent graders without a background in Plastic Surgery, and each patient was assigned a global aesthetic improvement score (GAIS) from 1-5 (1 = worse, 5 = very much improved).

Results: 157 patients underwent 160 facial rejuvenation procedures: 93 (58%) MACS lifts and 67 (42%) conventional facelifts. The mean follow up was 4 months and post-operative patient satisfaction was 87%. Forty patients were randomly selected for photo analysis, n=20 for both MACS and conventional facelift. Mean overall GAIS was 4.12. The mean GAIS for conventional facelift was 4.11 compared to 4.13 for the MACS lift.

Conclusion: The short scar facelift and conventional facelift each offer unique advantages with equivalent outcomes and success in properly selected patients. Both procedures should be in a surgeon's armamentarium to provide an individualized approach to facial aging.

References: 1. Ivy, Edward J. M.D.; Lorenc, Paul Z. M.D.; Aston, Sherrell J. M.D.. Is There a Difference? A Prospective Study Comparing Lateral and Standard SMAS Face Lifts with Extended SMAS and Composite Rhytidectomies. Plastic and Reconstructive Surgery 98(7):p 1135-1143, December 1996. 2. Avashia, Yash J. MD1; Stuzin, James M. MD2; Cason, Roger W. MD3; Savetsky, Ira L. MD1; Rohrich, Rod J. MD1. An Evidence-Based and Case-Based Comparison of Modern Face Lift Techniques. Plastic and Reconstructive Surgery 152(1):p 51e-65e, July 2023. 3. Tonnard, Patrick M.D.; Verpaele, Alexis M.D.; Monstrey, Stan M.D., Ph.D.; Van Landuyt, Koen M.D.; Blondeel, Philippe M.D., Ph.D.; Hamdi, Moustapha M.D.; Matton, Guido M.D.; Tonnard, Patrick L. M.D.. Minimal Access Cranial Suspension Lift: A Modified S-Lift. Plastic and Reconstructive Surgery 109(6):p 2074-2086, May 2002. 4. Mast, Bruce A. MD. Advantages and Limitations of the MACS Lift for Facial Rejuvenation. Annals of Plastic Surgery 72(6):p S139-S143, June 2014. 5. Lotte F. Hijkoop, Hieronymus P.J.D. Stevens, Berend van der Lei. The minimal access cranial suspension (MACS) lift: A systematic review of literature 18 years after its introduction. Journal of Plastic, Reconstructive & Aesthetic Surgery 75(3):p 1187-1196, March 2022.

This retrospective study aimed to assess the safety and outcomes of combined aesthetic surgical procedures compared to single procedures by analyzing risk factors, complication rates, and postoperative results. Conducted at two medical centers in Riyadh, Saudi Arabia, the study reviewed patient records from January 2019 to December 2022 for surgeries performed by a senior surgeon. Included patients underwent either single aesthetic procedures (e.g., abdominoplasty, liposuction, breast augmentation) or combined procedures frequently paired with abdominoplasty. Data encompassed 670 patients, with outcomes tracked for complications (infections, seromas, hematomas), reoperations, and 30-day hospital readmissions. Patient demographics, operative details, and postoperative events were extracted from medical records, with statistical analysis using chi-squared tests and multivariable logistic regression.

The cohort included 670 patients (median age 37 years, 89.1% female), with 188 (28.1%) undergoing combined procedures and 482 (71.9%) single procedures. Follow-up averaged 12 months, capturing final outcomes. Combined procedures most commonly involved abdominoplasty with liposuction (15.4%) or breast surgery (6.1%). The overall complication rate was 7.9%, with infections predominant (28.3% of complications). Combined procedures exhibited significantly higher complication rates than single procedures (49.1% vs. 26.3%, p < 0.001). Specific combinations-abdominoplasty with breast surgery (p = 0.011) and abdominoplasty with liposuction (p = 0.002)-showed elevated risks. Reoperation rates were 10.4%, with no significant difference between groups, while readmissions occurred in less than 1% of cases. Multivariable analysis identified combined procedures (OR 2.59, 95% CI 1.27-5.33, p = 0.009) and prior plastic surgery (OR 2.14, 95% CI 1.01-4.41, p = 0.042) as independent risk factors for complications. Single procedures, such as augmentation mammaplasty, had lower complication rates (1.9% vs. 14.6%, p = 0.010).

The findings indicate that combining aesthetic procedures increases complication risks, particularly with abdominoplasty paired with liposuction or breast surgery, compared to isolated surgeries. Despite advantages like reduced recovery time and cost, the elevated risk underscores the need for meticulous patient selection and preoperative planning. Surgeons should prioritize individualized risk assessment and patient counseling to optimize safety and satisfaction. These results align with prior studies reporting higher morbidity in combined surgeries, emphasizing the balance between efficiency and risk in aesthetic practice (1, 2).

References:

Winocour J, Gupta V, Ramirez JR, et al. Plast Reconstr Surg. 2015;136(5):720e-726e. Michot A, Alet J, Pélissier P, et al. Ann Chir Plast Esthet. 2015;61(1):e9-e19.

Purpose: While the anatomy of the gluteal region is relatively straightforward to learn for a board-certified plastic surgeon, the technique for fat grafting under ultrasound guidance requires a level of hands-on training. However, a survey distributed to members of The Aesthetic Society in March of 2023 found that more than of respondents thought accessibility and availability of training for ultrasound-guided Brazilian Butt Lift (BBL) procedures was insufficient (1). One limiting factor for making training more widely available is the absence of an anatomically relevant, cost-effective, and easily executable clinical model. This report will showcase the intricacies and advantages of the novel hemi-abdominoplasty model and compare it to that of the established cadaver model in hopes of improving the availability and accessibility of ultrasound-guided BBL training.

Methods: The authors simulated conducting two ultrasound-guided BBL workshops for 20 participants in South Florida, one using the hemi-abdominoplasty model and the other utilizing the validated cadaver model. Models were compared based on total expense and complexity of technical planning. The hemi-abdominoplasty model utilizes an abdominoplasty specimen that is bonded to a portion of pork belly with skin to create a hemi-buttock. While the abdominoplasty specimen provides the intact dermis, superficial fat compartment, and deep fat compartment, the pork belly with skin represents the underlying gluteal muscle and fascia. To commence the workshop participants should receive a brief demonstration on how to identify the gluteal layers on ultrasound using the hemi-abdominoplasty model. The attendees can then practice injecting food-colored grits (substitute for adipose tissue) subcutaneously, with instructions to inject green grits into the superficial fat compartment and the purple grits into the deep fat compartment under ultrasound guidance. Following injection, the model can be bread loafed (sliced into sections) to determine whether the injection was in the correct plane.

Results: Cadaver specimens that met the specific criteria for validation were quoted to cost $4,580 per specimen ($2,290 per participant), or $45,800 for 10 stations. Adding in the cost required for specimen delivery and disposal ($7,770), the total for conducting a workshop would exceed $53,570. Alternatively, the calculated cost per hemi-abdominoplasty model was $32, totaling $640 for a 20-participant workshop. Benefits of the hemi-abdominoplasty model include not having to find and coordinate with an outside company to procure, deliver, and dispose of the validated cadaver specimens. Abdominoplasty specimens can be procured from local plastic surgeons performing an abdominoplasty procedure in the days preceding the workshop and can be disposed of as medical waste following the end of the workshop. Moreover, bonding the abdominoplasty specimen to the pork belly is relatively simple and can be completed by any staff member within a few minutes.

Conclusions: Compared to the validated cadaver model, the hemi-abdominoplasty model requires less technical planning and incurs significantly lower costs. The improved reproducibility of this model makes it a viable option for implementation at local, regional, and national plastic surgery meetings, enhancing the accessibility and availability of ultrasound-guided BBL training.

1) Finkelstein ER, Wo L, Garcia O, Kassira W. The Brazilian Butt Lift Remains the Deadliest Aesthetic Surgery Procedure: Are Plastic Surgeons Adjusting Their Surgical Practice to Promote Safety?. Aesthet Surg J. 2023;44(1):NP69-NP76.

Background Facelift remains a mainstay in the treatment of facial aging, with approximately 100,000 facelifts performed by American Society of Plastic Surgery members in 2023.1 Previously, our group published a review of short-term complications following facelift surgery, with an emphasis on prevention, recognition, and treatment.2 Here, we present the companion to that publication, focusing on long-term complications following facelift surgery.

Methods A review was performed of available literature regarding the prevention and treatment of long-term complications following facelift surgery. Using both the available literature and the experience of the senior author (J.Z.), we present a discussion of long-term complications following facelift surger¬¬y, with strategies to manage complications if they were to occur. Results From the review, ten long-term complications following facelift surgery were identified. In some series, platysmal banding was cited as the most common reason for reoperation after facelift, with some authors citing incidence as high as 30% 3 Based on some surgeons' experience, this complication can be prevented and treated by performing a revision midline platysmaplasty, but others advocate for denervation of the platysma by transecting the cervical branch. Contrary to previous literature, we found the cobra deformity to be the next most common adverse, long-term finding. This problem is more complex than previously cited and is multifactorial in nature. Recurrent nasolabial folds and jowls were the third most common reason for re-operation, which was at times associated with prominent submandibular glands..4 As suggested by previous studies, only partial resection of the gland has led to reliable, long-standing results. There are a number of complications associated with aberrant healing , including pixie ear, loss of tragal definition and hypertrophic scarring. While these complications may not be preventable, risk can be reduced by ensuring there is not excess tension on any portion of the closure and judiciously limiting skin resection.

Conclusion Facelift is an effective, safe means to treat signs of facial aging, but risk of long term-complications remains real. While short-term complications are often functional, long-term complications tend to be related to unsatisfactory cosmetic outcomes. In our experience, recurrent platysmal banding and cobra deformity result from ongoing and continued laxity of aging soft tissue, and their occurrence is relatively unpreventable. On the other hand, other complications can generally be prevented with careful pre-operative assessment and intraoperative technical refinements.

1. American Society of Plastic Surgeons. 2023 Plastic Surgery Statistics Report. Published online 2023. https://www.plasticsurgery.org/documents/news/statistics/2023/plastic-surgery-statistics-report-2023.pdf
2. Sinclair NR, Coombs DM, Kwiecien G, Zins JE. How to Prevent and Treat Complications in Facelift Surgery, Part 1: Short-Term Complications. Aesthetic Surgery Journal Open Forum. 2021;3(1):ojab007. doi:10.1093/asjof/ojab007
3. Stuzin JM. Discussion: Treatment of Anterior Neck Aging without a Submental Approach: Lateral Skin-Platysma Displacement, a New and Proven Technique for Platysma Bands and Skin Laxity. Plast Reconstr Surg. 2017;139(2):322-323. doi:10.1097/PRS.0000000000003031
4. Matarasso A, Elkwood A, Rankin M, Elkowitz M. National plastic surgery survey: face lift techniques and complications. Plast Reconstr Surg. 2000;106(5):1185-1195; discussion 1196. doi:10.1097/00006534-200010000-00033

Background: Rhinoplasty is a complex operation that warrants careful consideration of both functional and aesthetic principles. Despite its prevalence within plastic surgery and otolaryngology fields, its exposure and education are highly variable among training programs, ultimately impacting the confidence of trainees in surgical practice. Moreover, the purpose of this study is multi-fold: 1) to identify the various methods utilized for educating residents on the technical and clinical aspects of rhinoplasty; 2) to evaluate the outcomes associated with these various educational approaches; 3) to identify barriers (if present) that may obstruct exposure and education of rhinoplasty; 4) to suggest alternative methods and solutions for residents to leverage for optimizing education and instruction within rhinoplasty.

Methods: A review was conducted using the PubMed / MEDLINE database using a combination of the following key terms: "rhinoplasty," "rhinoplasty education," and "resident training." Articles were included that 1) discussed methods of educating residents on the technical and clinical aspects of rhinoplasty, and 2) reported outcomes to objectively assess such methods. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Thirteen studies were included in the analysis. The majority of the studies discussed three-dimensional printed models and surgical simulators, followed by cadaver laboratories, detailed rhinoplasty educational programming, and video-assisted learning tools. In terms of assessed outcomes, surveys were utilized to assess residents' confidence before and after intervention, test their knowledge on various clinical aspects, and their perceived effectiveness of these tools.

Conclusion: This study highlights the various measures taken to provide education and instruction on rhinoplasty. Beyond intra-operating teaching and modeling, surgical simulators are highly effective and valuable for residents to practice technical maneuvers including septal dissection and osteotomies. There are notable limitations to these methods of instruction, namely the mastery of aesthetic judgment, surgical approach, reliance on tactile feedback, perception of the procedure in the academic plastic surgery, and practice model for resident education. Future efforts should be made to leverage artificial intelligence and software technologies in elevating education in rhinoplasty.

Purpose: The obesity epidemic affects over 100 million adults in the United States (U.S.). Glucagon-like peptide 1 (GLP-1) receptor agonists, originally designed for type-2 diabetes, have gained popularity after clinical trials demonstrated their weight loss potential. Recent surveys suggest that 32 million U.S. adults have trialed these medications. Terms like "Ozempic® face", "Ozempic® butt" and "Ozempic® body" have been coined to describe the rapid volume loss from semaglutide therapy resulting in signs of advanced aging. The objective of our study was to review plastic surgery publications discussing GLP-1 receptor agonists and characterize the public's perception on the effect of these medications on weight loss.

Methods: A systematic review of the PubMed database was conducted to identify articles discussing GLP-1 receptor agonist use in plastic surgery. Articles in non-English languages or on non-human subjects were excluded. Included articles were qualitatively analyzed and a bias assessment was completed using standardized checklists. To supplement this review, Google® Trends and Google® News were used to track public interest in these medications and their effect on face and body morphology over the past five years, noting breakout related queries defined by search growth exceeding 5,000%.

Results: Many recurrent themes were identified in the twenty-three articles included in this systematic review: 1) Several injectable drugs on the market are used on- and off-label for weight loss, 2) GLP-1 receptor agonists cause morphological changes resembling signs of advanced aging, 3) Surgical and non-surgical options exist to address these changes, 4) Adverse gastrointestinal effects of these medications help guide peri-operative management, 5) Important contraindications exist to their use that prescribing providers should be aware of. Online searches for "Ozempic" were highest of all the GLP-1 receptor agonists searched (linear trend=0.050 compared to 0.018 for "Wegovy" and 0.017 for "Mounjaro"). Breakout related queries included "Ozempic face", "Ozempic celebrities", and "Ozempic shortage". Online searches for "Ozempic face" have rapidly risen since January 2023, when the first article discussing this phenomenon was reported in the news. These searches were linked to rising searches for "face filler" and "plastic surgeons". Compared to the rate of change for "Ozempic face" (linear trend=0.012), "Ozempic butt" and "Ozempic body" have seen lower search volumes over time (linear trend=0.0015 for both).

Conclusions: The sale and use of GLP-1 receptor agonists is growing at an unprecedented rate. In our Google® Trends and Google® News analysis, we found that the popularization of "Ozempic® face" has been linked to rising searches for "face filler" and "plastic surgeons". As the unintended morphological changes of GLP-1 receptor agonists become increasingly reported, so does the public interest in seeking rejuvenation procedures. Although limited by study biases, this systematic review can help the plastic surgery community prepare for the rising needs of this patient population by understanding the risk and benefit profile of GLP-1 receptor agonists and developing clear clinical practice guidelines for their safe use.