Scientific Abstract Presentations: Aesthetic Session 5 Saturday, October 11 Sat, Oct 11 5:00-6:00 p.m. CDT

Purpose: Given the rising demand for aesthetic surgery, there has been a growing emphasis on aesthetic surgery training for plastic surgery residents. More recently, this was reflected by a change in the number of required aesthetic surgery case logs, increasing from 50 to 150 cases. Nonetheless, significant variability likely exists in the clinical and non-clinical aesthetic surgery education provided across different residency programs. This study aims to evaluate and compare the aesthetic surgery curricula across accredited United States plastic surgery residency programs.

Methods: In November 2023, the authors conducted a cross-sectional evaluation of 103 accredited United States plastic surgery residency programs. Using publicly available online resources, the authors assessed each program's non-clinical and clinical aesthetic surgery curriculum components. Emails were sent to program coordinators to confirm information identified online. Didactics on aesthetic surgery and injectables courses for residents were considered non-clinical components. Clinical components included the number of weeks spent on rotations with exposure to aesthetic surgery, presence of a dedicated resident cosmetic clinic, and the number of faculty performing aesthetic procedures.

Results: Most programs included information on aesthetic surgery education in their publicly available program curricula (n=97) and offered aesthetic surgery clinical experience primarily at their main residency institution rather than through affiliated surgical center (n=78). Forty-three programs (42%) had evidence of didactic education on aesthetic procedures and thirty programs (29%) advertised injectables courses. Of the programs with publicly available block schedules (n=36), residents averaged 20 weeks on rotations providing clinical exposure to aesthetic surgical procedures (range: 4 – 36 weeks). Thirty-eight programs (37%) incorporated elective time into their curriculum. Thighplasty (n=78) and facelift (n=82) were the least commonly mentioned procedures residents had exposure to. Only 32 programs (31%) advertised a dedicated resident aesthetic surgery clinic, 88% of which (n=28) specified injectables were available to the residents. Across all programs, there were a total of 516 core faculty widely (range: 0 to 16 per institution) and 64 adjunct faculty that performed aesthetic procedures. Eighty-three programs (81%) either did not have or mention adjunct faculty in the community specializing in aesthetic surgery. Identified adjunct faculty more often completed an aesthetic fellowship (14% vs 9%; p>0.05) and were significantly more often members of The Aesthetic Society than their core faculty counterparts (38% vs 20%; p<0.002).

Conclusion: Both clinical and non-clinical aesthetic surgery training varied substantially among United States plastic surgery residency programs. Fewer than half of programs mentioned non-clinical educational components including didactic education and injectable teaching courses. Only one-third of programs had a dedicated resident aesthetic clinic, which could provide residents with a more comprehensive clinical experience. Variability in time spent on rotations with aesthetic surgery exposure and faculty involvement highlights potential discrepancies in resident case exposure beyond the required minimum. Moreover, only one-third of programs offered elective time for residents to pursue additional aesthetic surgery opportunities. As the demand for aesthetic surgery grows, aesthetic surgery training may become more standardized. Due to variability in training, aesthetic fellowship training may be sought out, particularly in the field of facial aesthetics.

Weight loss associated with injectable glucagon-like peptide-1 (GLP-1) agonists, such as semaglutide derivatives like Ozempic, has led to a social media phenomenon named "Ozempic Face". The term describes facial volume loss resulting in an "aged" appearance, which has prompted consultations with plastic surgeons for facial rejuvenation. However, these observations are primarily anecdotal with a paucity of studies quantifying the facial changes associated with GLP-1 agonist use. This study objectively characterizes volumetric facial changes associated with GLP-1 medications and correlates patient perceptions of these changes.

Following institutional review board approval, a prospective observational study was conducted of patients initiating an injectable GLP-1 agonist regimen for weight loss. Eligible patients had a BMI > 30 kg/m2 and less than 3 months of prior GLP-1 agonist use. Baseline demographics, weight, and 3D images were captured for volumetric analysis using the Vectra XT three-dimensional (3D) imaging system (Canfield Scientific, Inc., New Jersey). At each visit, patients completed the FACE-Q Aesthetic Modules for satisfaction of the overall face, under chin area, cheeks, and lines and visual age analogue scale.

Patients were re-evaluated at approximately every three months to reassess weight, images, and FACE-Q outcomes with a planned final endpoint at two years. Volumetric differences were measured in bilateral buccal and under chin areas and all FACE-Q raw scores were converted to Rasch-transformed scores with a range of 0 to 100 with higher scores indicating better outcomes. Differences in Rasch-transformed FACE-Q scores were reported for each module between timepoints. Volumetric and FACE-Q scores were normalized to each patient's weight change between timepoints.

To date, 45 patients have been enrolled, with 18 patients (40%) reaching the three-month follow-up. Of these 18 patients, the mean age was 44.2 ± 10.7 years old, mean BMI was 39.5 ± 8.0 kg/m2, and mean weight was 112.6 ± 25.0 kg. On average, patients used a GLP-1 agonist for 4.0 ± 1.3 months, with a weight loss rate of 2.1 kg/month (8.0% body weight). At the 3-month follow-up, mean volume loss was 4.2 ± 3.5 cc in the buccal area and 17.9 ± 16.5 cc under the chin, corresponding to a rate of 1.56 cc/kg and 4.45 cc/kg, respectively. On the FACE-Q, patients reported looking 0.7 years older than their actual age for every kilogram lost. However, they were more satisfied with their overall appearance (+ 3.0 points/kg), under chin (+ 3.4 points/kg), cheek (+ 8.4 points/kg), and lines (+ 2.2 points/kg).

The present study provides the first objective and patient-reported outcomes regarding facial changes in weight loss patients secondary to GLP-1 agonists. Preliminary findings suggest that, within three months of initiating a GLP-1 regimen, patients experience a more slender facial appearance and increased satisfaction with their appearance despite slight perceptions of aging. These early results suggest that the 3-month time point may be too early to consider facial rejuvenation interventions. Continued research at the present institution will further explore longer term volumetric changes to identify the optimal time for rejuvenation and compare GLP-1-related facial changes with traditional weight loss methods.

Background and Purpose: Cosmetic surgery encompassed a 146-billion-dollar global market in 2024 that is projected to grow in the future (1). Furthermore, younger patients are now more likely to seek cosmetic procedures due to social media influences and changes in public attitudes towards aesthetic surgery (2). Choosing which procedure or combination of procedures is appropriate remains a daunting task for consumers and surgeons alike. The goal of this study was to leverage machine learning models capable of determining perceived age and attractiveness to objectively predict cosmetic outcomes in patients undergoing aesthetic procedures.

Materials and Methods: A dataset from the publicly available ASPS Before and After photos was compiled for facelift, browlift, and eyelid surgeries. Only photos with procedures documented in detail were included. Two machine learning models were trained to detect perceived age and beauty. Our age classifier algorithm was trained on over 400,000 annotated faces using a deep multi-layer perceptron approach. Beauty classification was trained using pulled averages from over 10,000 reference photos measured on a Likert scale between 0-100. Pre- and postoperative photographs were used to generate per patient age and beauty predictions before and after surgery. Primary outcomes included perceived change in age and beauty stratified by procedure. Uni- and multi-variate odds ratio (OR) analyses were performed to interrogate procedures and demographic factors associated with improvements in age perception, beauty, and a composite scaled scored of both. Vector field plots were constructed to demonstrate the relationship between preoperative perceived age, beauty, and composite benefit from surgery.

Results: A total of 676 patients operated on by 65 surgeons from 22 different states/provinces in the USA/Canada were included in the analysis. 328 (48.5%), 172 (25.4%), 82 (12.1%), and 427 (63.2%) underwent facelift, necklift, browlift, or eyelid surgeries, respectively. The majority of patients underwent a combination of procedures. Patients whose actual age was 25% lower than their perceived age were the most likely to see a composite benefit from surgery [16.71(3.50-126.60), p=0.0014] on univariate analysis. Multivariate OR analyses [OR (CI), p-value] revealed increased perceived preoperative age to be proportionately associated with improved younger appearance and combined age/beauty benefit independent of procedure [1.04 (0.99-1.08), p=-6.1 e-9]. Patients with higher preoperative beauty scores were less likely to see a benefit after surgery [0.90 (0.86-0.94), p=1.5 e-5]. The largest combined benefit was appreciated after Facelift+Necklift+Browlift+ Eyelid combined surgery [11.34 (1.84-103.34), p=0.015]. The vector plots demonstrate the complex multivariate relationships between preoperative perceived age/beauty and relative benefit per procedure, with areas in red highlighting greatest relative benefit.

Summary: Our study demonstrates the value of machine learning for objectively assessing aesthetic facial surgery using perceived age and beauty as novel preoperative markers. Perceived older preoperative age, decreased preoperative attractiveness, and increased number of concurrent procedures predicted improved cosmetic benefit. However, the interaction between perceived preoperative age and beauty demonstrated a complex, non-linear relationship when optimizing for postoperative composite benefit.

Citations: 1. Pandey D, Shivarkar A. Cosmetic Surgery and Procedures Market Size, Share, and Trends 2024 to 2034.; 2024. 2. Montemurro P, Porcnik A, Hedén P, Otte M. The Influence of Social Media and Easily Accessible Online Information on the Aesthetic Plastic Surgery Practice: Literature Review and Our Own Experience. Aesthetic Plast Surg. 2015;39(2). doi:10.1007/s00266-015-0454-3

Background: Current aging models are largely based on the White/Caucasian population with limited data on diverse ethnicities. As demand for patient-specific surgical planning in craniomaxillofacial surgeries increases, further understanding of facial aging in various ethnic/racial groups is necessary. Thus, the American Society of Plastic Surgeons (ASPS) reported an increasing demand for culturally tailored aesthetic enhancements [1]. The aim of this study is to expand our 3D statistical shape modeling (SSM) to describe the age-related changes in the Black/African American population. Methods: A retrospective analysis was conducted on 284 CT scans, stratified by gender and age groups (20-39, 40-59, and 60-79 years). We excluded any trauma scans, edentulous individuals, or any suspicion of deformities and orthodontic interventions. Machine Learning (ML) scripts were used to automate the 3D segmentation of the bony structures in Mimics software v.25.0. SSM was then applied to generate average models of the midface and mandibular skeletal structures for each age group. Linear measurements, angles, and volume differences were analyzed using pairwise comparisons, including 3D heatmaps for volumetric analyses and linear facial skeletal measurements.

Results: Of 128 females and 156 males, the mean ages for the young and old groups were 31.2 years (SD:± 5.9) and 67 years (SD:± 5.2), respectively. Over the midface, both genders exhibited significant increases in the distances between the supra- and infra- orbital foramen with age (p<0.01). The pyriform angle decreased significantly with age, with a reduction of 4.5° in females and 7.1° in males (p <0.01). Similarly, the maxillary angle showed contraction with aging by 4° in both genders (p<0.001). The nasofrontal angle, however, showed gender-specific variability, with Black females showing increased glabellar protrusion and males displaying glabellar flattening (p<001). Over the mandible, the measurements showed gender-specific remodeling. Thus, females demonstrated more bone contraction in comparison to males. The mandibular ramus height decreased by 5 mm in females (p= 0.001), while in males, it remained relatively stable, with a 1 mm reduction over time (p> 0.05). A similar trend was observed in the mandibular angle, where females showed an increase of 3.5° and 1° in males (p<0.001). Notably, while our previous study in the White population reported an expansion in mandibular intercondylar and bigonial widths by up to 7 mm with age, Black individuals demonstrated stability in both measurements. Furthermore, a small longitudinal series of CT scans spanning at least 10 years for the same patient, was analyzed separately to confirm the reliability of SSM in capturing the age-related skeletal changes. Consistent results and heatmap patterns revealed an average change of 0.5 mm per decade.

Conclusion: This study highlights age-related remodeling in the midface and mandible using advanced 3D imaging and analysis tools, identifying shared trends and distinct variations across diverse ethnic populations. SSM efficiently elucidated these patterns in facial aging on a population level. Such findings highlight the necessity of future research on ethnic-specific approaches in aesthetic and reconstructive craniomaxillofacial interventions.

[1] ASPS | 2023 Plastic Surgery Statistics Report (https://www.plasticsurgery.org/documents/news/statistics/2023/plastic-surgery-statistics-report-2023.pdf)

Background Prominent ears are a common congenital ear deformity that cause significant stress in children. Families typically pursue otoplasty once children experience unhappiness or bullying related to their ears. Most surgeons advise against performing otoplasty in children under five years old. While otoplasty is a relatively safe cosmetic procedure, trends in surgical timing and age-related complications are not well understood. This study evaluates over a decade of shifting trends in otoplasty timing and 30-day postoperative outcomes by age cohort.

Methods This study analyzed deidentified patient data in the global TriNetX database. Otoplasty patients were identified using CPT codes. Patients with congenital malformation syndromes, diseases of the blood and blood-forming organs, or endocrine/nutritional/metabolic diseases were excluded for comparability. Trends in otoplasty by age group were assessed over three time periods (2010-2014, 2015-2019, 2020-2025). Four age groups (<5, 5-10, 11-16, 17-22 years) were evaluated for differences in 30-day complication rates related to wound healing, bleeding, and infection.

Results 1,459 patients underwent otoplasty from 2010-2025. The proportion of procedures in ages 0–4 declined from 40.5% to 31.5%, while cases in ages 10-14 increased from 16.3% to 26.0%. Ages 5-9 remained stable at about 30%. 30-day all-cause complication rates were significantly higher in ages 0-4 than 5-10 (7.874% vs 1.381%, p < 0.0001). Rates of wound complications and return to operating room were also significantly higher in ages 0-4 than older age groups

Conclusions About 60% of otoplasties are performed between ages 0 and 10. Otoplasty trends in the last 15 years suggest the dominant age range for otoplasty is shifting older to include less children aged 0-4 years and more adolescents aged 10-14 years. 30-day all-cause complication rates support this transition, as ages 0-4 experience higher complications than their older peers. Our data suggest otoplasty can be safely performed as early as ages 5-10, and otoplasty before age 5 should be approached cautiously.

Background: Exosomes, nanosized extracellular vesicles, have emerged as a promising modality in aesthetic medicine for facial rejuvenation due to their role in promoting collagen synthesis, enhancing skin elasticity, and modulating pigmentation (1,2). Studies have demonstrated their efficacy in combination with laser and microneedling treatments, showing enhanced skin regeneration and accelerated healing (3,4). Objective: This systematic review aims to investigate the impact of exosome use in aesthetics, specifically in human clinical studies measuring outcomes in wrinkles, pigmentation, elasticity, skin texture, and overall aesthetic improvement. Methods: A literature search was conducted in Winter 2025 using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the Trip Medical Database, focusing on clinical studies using exosomes in aesthetic treatments. Our search yielded 195 articles, of which six met inclusion criteria. Results: The included studies explored exosomes in conjunction with CO₂ laser therapy (n=1), microneedling (n=2), and topical application only (n=3). Various aesthetic improvement metrics were assessed, with the most common being wrinkles (n=5), pigmentation (n=4), elasticity (n=3), skin texture (n=3), and overall aesthetic improvement (n=6), all showing statistically significant improvement (p<0.05). Elasticity demonstrated an average improvement of 7.2%. The studies using microneedling as the application modality reported an average 6.32% reduction in wrinkles. When used, the Global Aesthetic Improvement Scale (GAIS) scored at least one point higher compared to baseline. Common assessment tools included PRIMOS, VISIA, GAIS, and the Cutometer. Discussion: These six studies demonstrated positive results with exosome use, without significant adverse effects, across various application modalities. The findings support further investigation into exosomes as a safe and effective tool in aesthetic medicine, with the potential to enhance skin rejuvenation and overall aesthetic outcomes. The rapid advancements in technology provide numerous ways to quantify aesthetic results. However, the diversity of assessment techniques makes direct comparisons across studies challenging. This study highlights the need for a standardized approach to evaluating facial aesthetics to improve scientific analysis and clinical application. References: 1. Théry C, Zitvogel L, Amigorena S. Exosomes: composition, biogenesis, and function. Nat Rev Immunol. 2002;2(8):569-579. doi:10.1038/nri855 2. Zhang B, Gong J, He L, et al. Exosomes-based advancements for application in medical aesthetics. Front Bioeng Biotechnol. 2022;10:1083640. Published 2022 Dec 20. doi:10.3389/fbioe.2022.1083640 3. Kwon HH, Yang SH, Lee J, et al. Combination treatment with human adipose tissue stem cell-derived exosomes and fractional CO₂ laser for acne scars: A 12-week prospective, double-blind, randomized, split-face study. Acta Derm Venereol. 2020;100(18):adv00310. doi:10.2340/00015555-3666 4. Park GH, Kwon HH, Seok J, et al. Efficacy of combined treatment with human adipose tissue stem cell-derived exosome-containing solution and microneedling for facial skin aging: A 12-week prospective, randomized, split-face study. J Cosmet Dermatol. 2023;22(12):3418-3426. doi:10.1111/jocd.15872

Background: Extended superficial muscular aponeurotic system (SMAS) facelift techniques release zygomatic cutaneous and masseteric ligaments in the sub-SMAS plane, thus requiring surgical dissection inherently more invasive than SMAS plication counterparts. Some surgeons associate extended SMAS and deep plane techniques with higher complication rates due to this sub-SMAS dissection, although the current literature does not definitively support this. Therefore, this study aims to compare intraoperative and postoperative outcomes of extended SMAS versus SMAS plication techniques. Methods: A retrospective analysis of consecutive patients undergoing primary facelift surgery by a single surgeon between January 2014 and January 2024 was performed. Patients were subdivided into extended SMAS and SMAS plication groups. Age, BMI, sex, frequency of secondary facelifts, local tranexamic acid (TXA) injection, and comorbidities prevalence were matched to minimize bias. All patients received a subcutaneous infiltration of 0.5% lidocaine with 1:200,000 epinephrine, with or without 1 or 2 mg/mL of TXA. Patient demographics, adjunct procedures, surgical time, minor complications, and major complications were examined. SPSS 29.0 was used for analysis. T-test, Mann–Whitney U test, and Chi-Square were used as appropriate. Results: In total, 124 patients were identified: 62 in Group 1 (extended SMAS) and 62 in Group 2 (SMAS plication). The median follow-up time was 326 days. No significant difference in terms of age (P = 0.350), BMI (P = 0.053), sex (P = 0.668), follow-up time (P = 0.924), TXA use (P = 1), rate of ancillary lipo-grafting (P = 0.275), rate of ancillary phenol peel (P = 0.128), hypertension and diabetes mellitus prevalence (P = 1, 0.094, respectively) was observed. None of these patients developed a major complication. All minor complications reported in each group were not significantly different. The operative time was 22 minutes longer in extended SMAS but not significant (P = 0.075). Conclusions:
The extended SMAS technique requires more invasive sub-SMAS dissection than SMAS plication techniques. Complication profiles for a single surgeon were rare and comparable upon comparison between matched SMAS technique groups. Extended SMAS facelift is a safe and effective procedure preferred by the lead author for a majority of primary facelift patients. SMAS plication is particularly helpful in secondary cases and for patients with significant facial soft tissue loss. These observations underscore the necessity of customizing the surgical approach to align with the specific goals of each patient.

Background: Abdominoplasty is a commonly performed procedure that removes the excess of adipose tissue and skin, sometimes it also involves abdominal muscle repair. There is a growing incidence of psychiatric conditions, particularly major depressive disorder, in patients undergoing aesthetic plastic surgery. Concerns have emerged about the potential impact of serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), on postoperative outcomes, especially regarding the incidence of hematomas.

Purpose: This study aims to investigate whether the use of serotonergic antidepressants is associated with an increased risk of postoperative hematoma after abdominoplasty.

Methods: The TriNetX database was queried to identify patients who underwent abdominoplasty. Patients were classified in two cohorts: exposure cohort included patients who used SSRIs or SNRIs during the month before surgery, while control cohort included patients who did not use these medications during the same period. A propensity score-matching analysis was performed to adjust for demographics (age, sex, race, ethnicity), body mass index, comorbidities (nicotine dependence, diabetes mellitus, major depressive disorder, coagulation defects), and laboratory analyses (prothrombin time, activated partial thromboplastin time, and platelets). The primary outcome was hematoma occurrence at 30 days post-surgery. Secondary outcomes included seroma, wound dehiscence, surgical site infection, transfusion, and hematoma/seroma evacuation.

Results: Before propensity score-matching, the exposure group consisted of 3,196 patients and the control group had 26,149 patients. After matching, each group contained 3,178 individuals. Patients who used serotonergic antidepressants had a significantly increased risk of hematoma (risk ratio [RR] 1.66, p=0.029), seroma (RR 1.87, p=0.005), wound dehiscence (RR 1.79, p=0.012), surgical site infections (RR 1.38, p=0.047), transfusion (1.35, p=0.012), and hematoma/seroma evacuation (RR 1.83, p<0.001) within 30 days post-surgery.

Conclusion: Patients with a preoperative use of serotonergic antidepressants may be at an increased risk of hematoma and other complications following abdominoplasty. Further research is needed to investigate the mechanisms behind this association.

Background: Abdominoplasty is a commonly performed procedure that removes the excess of adipose tissue and skin, sometimes it also involves abdominal muscle repair. There is a growing incidence of psychiatric conditions, particularly major depressive disorder, in patients undergoing aesthetic plastic surgery. Concerns have emerged about the potential impact of serotonergic antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), on postoperative outcomes, especially regarding the incidence of hematomas.

Purpose: This study aims to investigate whether the use of serotonergic antidepressants is associated with an increased risk of postoperative hematoma after abdominoplasty.

Methods: The TriNetX database was queried to identify patients who underwent abdominoplasty. Patients were classified in two cohorts: exposure cohort included patients who used SSRIs or SNRIs during the month before surgery, while control cohort included patients who did not use these medications during the same period. A propensity score-matching analysis was performed to adjust for demographics (age, sex, race, ethnicity), body mass index, comorbidities (nicotine dependence, diabetes mellitus, major depressive disorder, coagulation defects), and laboratory analyses (prothrombin time, activated partial thromboplastin time, and platelets). The primary outcome was hematoma occurrence at 30 days post-surgery. Secondary outcomes included seroma, wound dehiscence, surgical site infection, transfusion, and hematoma/seroma evacuation.

Results: Before propensity score-matching, the exposure group consisted of 3,196 patients and the control group had 26,149 patients. After matching, each group contained 3,178 individuals. Patients who used serotonergic antidepressants had a significantly increased risk of hematoma (risk ratio [RR] 1.66, p=0.029), seroma (RR 1.87, p=0.005), wound dehiscence (RR 1.79, p=0.012), surgical site infections (RR 1.38, p=0.047), transfusion (1.35, p=0.012), and hematoma/seroma evacuation (RR 1.83, p<0.001) within 30 days post-surgery.

Conclusion: Patients with a preoperative use of serotonergic antidepressants may be at an increased risk of hematoma and other complications following abdominoplasty. Further research is needed to investigate the mechanisms behind this association.

Background: A recently published paper reported on healing issues in facelift patients who received tranexamic acid (TXA) mixed with their local anesthetic (1). While this is primarily anecdotal, it raises concerns about the use of TXA. Therefore, we compared the incidence of these healing problems between a large group of patients receiving TXA and a matched group not receiving it. Methods: A single-surgeon retrospective cohort study for patients who underwent facelift surgery between 2014 and 2024. Patients were categorized by TXA use. Age, BMI, sex, and hypertension prevalence were matched to minimize bias. All patients received general anesthesia and a subcutaneous injection of 0.5% lidocaine with 1:200,000 epinephrine. Operative time and complications were examined. Results: Each group included 261 patients. Median follow-up was 232 days. No significant differences in age (P = 0.221), BMI (P = 0.589), sex (P = 1), hypertension (P = 0.52), secondary facelift (P = 0.19), lipo-grafting (P = 0.66), phenol peel (P = 0.83) were observed. None of these patients developed a major complication. Minor wound healing problems occurred in 1 patient in the non-TXA group and 2 in the TXA group (P = 0.563). Hematomas occurred in 5 patients in each group (P = 1). All other minor complications were not significant. Non-TXA group's mean operative time was 20 minutes longer than that in TXA (P < 0.001). Conclusions: This study challenges prior assertions regarding TXA and its impact on wound healing complications. By analyzing a large, matched cohort, our findings support that the safety of TXA is upheld, as the rates of complications, including wound healing issues and hematomas, remain comparable (2). These results advocate for the utilization of TXA in facial aesthetic surgery, as it contributes to time efficiency in the operating room without posing additional risks. References: 1- Yalamanchili S, Talei B, Azizzadeh B, Auersvald A, Frankel AS. Wound Healing Complications With Tranexamic Acid: Not the Silver Bullet After All. Aesthet Surg J. 2023 Nov 16;43(12):1409-1415. doi: 10.1093/asj/sjad177. PMID: 37265094. 2- Coombs DM, Kwiecien GJ, Sinclair NR, Jin A, Zins JE. Local Infiltration of Tranexamic Acid During Facelift Improves Operating Room Efficiency: A Matched Patient Study. Aesthet Surg J. 2022 Aug 24;42(9):971-977. doi: 10.1093/asj/sjac067. PMID: 35350068.

Background: East Asian patients with unilateral cleft lip and nasal deformity(UCLND) have severe septal deviated. An innovated septal reconstruction method using both perpendicular plate of ethmoid (PPE) and cartilage septum may improve ventilation and achieve similar aesthetic improvements as septal reconstruction using costal cartilage. Methods: Patients with UCLND who underwent septal reconstruction using PPE or costal cartilage in the same period were retrospectively included in a 1:1 ratio. Comparison of preoperative and postoperative differences in NOSE and ROE scales and changes in scores between the two groups were made. Changes in nasal airway morphology and ventilatory function were analysed using computational fluid dynamics in a case using PPE. Results: A total of 24 patients were included for analysis. Patients undergoing septal reconstruction using PPE showed significant improvement in NOSE scores and ROE scores.The improvement in ROE scores was similar to patients undergoing septal reconstruction using costal cartilage. Computational fluid dynamics analysis showed that septal reconstruction using PPE improved the patient's bilateral nasal airway morphology and flow symmetry. Conclusions: The combined application of PPE and septal cartilage to reconstruct the nasal septum in East Asian patients with UCLND is effective to improve the ventilation function and nasal airway symmetry. This strategy can achieve aesthetically similar results to septal reconstruction using costal cartilage.