Scientific Abstract Presentations: Aesthetic Session 1 Thursday, October 15 Thu, Oct 15 1:30-3:00 p.m. CDT

PURPOSE: As GLP-1 receptor agonist (GLP-1 RA) use expands, understanding downstream body contouring demand is critical for patient counseling and resource planning. This study compares plastic surgery utilization, anatomical distribution, and predictors across four weight loss pathways. We hypothesize that differences in weight loss modality, magnitude, and tempo-as well as associated hormonal and metabolic changes-may produce distinct patterns of soft tissue deflation and skin redundancy, thereby influencing which anatomical regions are disproportionately affected and ultimately reshaped through body contouring procedures.

METHODS: This retrospective cohort study used the TriNetX US Collaborative Network to examine adults with obesity (BMI ≥30 kg/m²) who initiated weight-loss treatment (January 2017–December 2024). Four mutually exclusive cohorts were constructed: GLP-1 monotherapy, bariatric surgery alone (sleeve gastrectomy or Roux-en-Y gastric bypass [RYGB]), bariatric-to-GLP-1 (BtoG), and GLP-1-to-bariatric (GtoB). Patients with prior plastic surgery or malignancy were excluded. Outcomes included facial, trunk, breast, and extremity procedures. Kaplan-Meier analysis estimated cumulative incidence over 8 years. Cox proportional hazards models identified independent predictors. Anatomical distributions were compared across modalities, sexes, and bariatric surgery types.

RESULTS: Among 703,438 patients (GLP-1 monotherapy, n=602,515; bariatric surgery, n=78,077; BtoG, n=10,502; GtoB, n=12,344), 6,188 underwent plastic surgery. Utilization followed a treatment-intensity gradient: 8-year cumulative incidence was 1.19% for GLP-1 monotherapy, 7.16% for bariatric surgery, 10.90% for BtoG, and 12.81% for GtoB (P<0.0001, GLP-1 vs. all surgical cohorts). Despite divergent baseline BMIs (GtoB 45.8 vs. BtoG 38.6 kg/m²), combined therapy cohorts converged on similar utilization (P=0.053), suggesting demand is driven by factors beyond obesity severity. Cox regression confirmed this: female sex (aHR 3.33, 95% CI 3.06–3.63) and eating disorders (aHR 2.23, 95% CI 2.06–2.41) were the strongest predictors, far exceeding BMI class III (aHR 1.43).

Weight loss modality shaped distinct anatomical patterns (P<0.0001). Among males, GLP-1 patients showed facial predominance (56.1%) versus balanced facial-trunk distributions in surgical cohorts (40–44% facial, 30–44% trunk). Among females, GLP-1 patients demonstrated nearly twice the breast procedure proportion (23.2%) versus surgical cohorts (12–17%), which showed trunk predominance (~40%). Within the GtoB cohort, procedure type altered anatomical demand. After prior GLP-1 exposure, Roux-en-Y gastric bypass was associated with facial and breast predominance (38.3% facial, 16.4% breast), whereas sleeve gastrectomy showed trunk predominance (50.6%; P<0.0001). This divergence may reflect the greater endogenous GLP-1 elevation observed after gastric bypass compared with sleeve gastrectomy.

CONCLUSIONS: Demographic and psychological factors, particularly female sex and eating disorders, drive plastic surgery utilization after weight loss more strongly than obesity severity. Weight loss modality determines distinct anatomical demand patterns, and prior GLP-1 exposure produces divergent body contouring profiles depending on subsequent bariatric surgery type, an interaction absent in other cohorts. These findings inform plastic surgery planning, preoperative counseling, and the role of mental health screening in this growing patient population.

Goals/Purpose: It has been reported that there are substantially higher rates of depression, anxiety, or other psychiatric disorders in patients who undergo breast augmentation. Selective serotonin reuptake inhibitors (SSRIs) comprise the most common antidepressant prescribed to patients with these conditions. Prior research has demonstrated that use of SSRIs may be associated with increased bleeding risks following cosmetic surgery of the breast. However, little research has been conducted on other potential risks of SSRI use prior to breast augmentation. This study, one of the largest to date on this subject, sought to determine whether SSRI use may confer higher risk of sustaining certain postoperative short- term and long-term complications following breast augmentation, particularly capsular contracture.

Methods/Technique: A retrospective cohort study was conducted using the TriNetX global database. Patients over the age of 18 who underwent breast augmentation were identified using the relevant ICD10- PCS codes. These patients were grouped based on whether or not they carried an SSRI prescription within 1 month preceding their index procedure. Propensity score matching was performed to control for demographics, such as age at index surgery, race, and ethnicity, and medical comorbidities, such as BMI, anxiety disorders, and mood disorders. Acute outcomes included opioid and non-opioid analgesic prescriptions within 7 days of the index procedure. Long-term outcomes included blood transfusion or hematoma within 60 days of index surgery, capsular contracture, and capsulectomy within 2 years of index surgery.

Results/Complications: We identified 1189 breast augmentation patients on SSRIs and 36,114 breast augmentation patients without SSRI prescriptions. After matching, each cohort contained 1154 patients. 1129 (97.8%) SSRI-using patients carried an opioid prescription while 1060 (91.9%) non-SSRI-using patients were on opioids within 1 week of surgery (risk difference of 6.0%, p < 0.0001). In this same timeframe, non-opioid analgesics were prescribed in 1075 (93.2%) SSRI-using patients and 967 (83.8%) non-SSRI-using patients (risk difference of 9.4%, p < 0.0001). 252 (26.2%) SSRI-using patients sustained a hematoma within 60 days of surgery while 199 (19.9%) non-SSRI-using patients sustained a hematoma (p < 0.01). Additionally, 250 (26.0%) patients on SSRIs had a capsular contracture within 2 years, which was a significantly higher rate compared to that of non-SSRI-using patients, 199 (19.9%) of which had a capsular contracture (p < 0.01). The same trend was found in capsulectomies; 176 (15.8%) SSRI-using patients underwent a capsulectomy within 2 years, which was a significantly higher rate than that of non- SSRI-using patients (133(11.7%), p < 0.01). There was no significant difference found between the groups in terms of 60-day blood transfusion (p > 0.05).

Conclusions: This study demonstrates that use of SSRIs may confer higher risk of opioid and non-opioid prescriptions within 1 week, as well as longer-term outcomes, such as hematoma within 60 days, and capsular contracture and capsulectomy within 2 years of breast augmentation. This may inform surgeons when counseling patients on risks of breast augmentation. Further research is warranted on the mechanism of SSRI's potential effect on outcomes of breast augmentation, specifically capsular contracture.

Background: Anemia is an established predictor of perioperative transfusion(1,2) in patients undergoing surgical body contouring. But while regression analyses have suggested that it increases risk of wound healing complications (3), this association is not well characterized. This study examines whether preoperative anemia independently increases the risk of dehiscence, surgical site infection (SSI), and seroma following trunk and extremity contouring procedures. Methods: We utilized a federated research network encompassing 44 healthcare organizations (TriNetX) to identify patients undergoing excisional body contouring procedures, including panniculectomy, abdominoplasty, brachioplasty, and thighplasty. The experimental cohort comprised patients diagnosed with iron deficiency or unspecified anemia within 3 months prior to surgery; the control cohort included patients undergoing the same procedures without a preceding anemia diagnosis. Patients with hereditary coagulation disorders or chronic anticoagulant use were excluded. Propensity score matching (1:1) was performed to balance age, sex, race/ethnicity, smoking status, diabetes, obesity, malignancy history, and prior bariatric surgery. Outcomes were assessed within a 90-day postoperative window, and included wound dehiscence, SSI, hematoma/seroma, venous thromboembolism (VTE), and postoperative blood transfusion. Results: Following propensity score matching, 3,892 patients were included in the final analysis (n=1,946 per cohort). Preoperative anemia was associated with a higher rate of wound dehiscence (9.3% vs 7.3%; RR 1.27; p=0.027), SSI (9.8% vs 7.1%; RR 1.37; p=0.003), hematoma/seroma (8.2% vs 5.9%; RR 1.4; p=0.004), and postoperative blood transfusion (2.5% vs 1.0%; RR 2.4, p=0.001). However, VTE rates did not differ significantly (1.3% vs 0.9%; p=0.215). Conclusion: Preoperative anemia is independently associated with increased rates of wound dehiscence, SSI, and hematoma/seroma following excisional body contouring surgery. Since body contouring has a relatively high baseline risk of postoperative wound healing complications, plastic surgeons should optimize preoperative hemoglobin levels to reduce wound complication risk, not solely to mitigate transfusion risk.

1. Masoomi H, et al. Frequency and risk factors of blood transfusion in abdominoplasty in post-bariatric surgery patients: data from the nationwide inpatient sample. Plast Reconstr Surg. 2015 May;135(5):861e-868e
2. Flores T, et al. Bariatric Surgery Before Abdominoplasty Is Associated with Increased Perioperative Anemia, Hemoglobin Loss and Drainage Fluid Volume: Analysis of 505 Body Contouring Procedures. J Clin Med. 2025 May 28;14(11):3783
3. Marchica P, et al. Retrospective Analysis of Predictive Factors for Complications in Abdominoplasty in Massive Weight Loss Patients. Aesth Plast Surg (2023) 47:1447–1458

Purpose: Previous studies have demonstrated that smoking increases postoperative complication risks and impairs wound healing across various plastic surgical procedures. However, evidence specific to upper eyelid surgery remains limited. This study evaluates the safety of upper eyelid blepharoplasty in smokers and examines whether smoking status meaningfully influences postoperative complication rates compared to non-smokers.

Methods and Materials: Patients ages 18 years and older who underwent upper eyelid blepharoplasty were identified from the TriNetX Research Network, a multi-institutional database, and stratified by smoking status between the years 2010 and 2020 using ICD-10 and CPT codes. 1:1 propensity score matching using a greedy nearest-neighbor algorithm with a 0.1 pooled standard deviation caliper was performed based on demographics, body mass index, major comorbidities, alcohol use, and psychiatric conditions. Postoperative complications including wound dehiscence, infection, hematoma/seroma, visual disturbances, and ectropion were assessed at different postoperative time points from 1 month through 2 years. Risk ratios (RRs) with 95% confidence intervals (CIs) and p-values were calculated.

Results: After propensity score matching, 2,396 patients were included in each cohort. Across all short- and mid-term follow-up intervals (1, 3, 6, 12, and 24 months), there was no significant difference between smokers and nonsmokers. At 1 month, wound dehiscence occurred in 0.0162% of smokers versus 0.0143% of nonsmokers (Comparing smokers to nonsmokers: RR = 1.15, 95% CI 0.73–1.83, p = 0.55). At 2 months, rates were 0.0166% vs. 0.0143% (RR = 1.18, 95% CI 0.75–1.87, p = 0.48), and at 3 months, 0.0181% vs. 0.0146% (RR = 1.24, 95% CI 0.79–1.96, p = 0.35). Similar trends persisted at 6 months (RR = 1.25, 95% CI 0.82–1.90, p = 0.34) and 2 years (RR = 1.23, 95% CI 0.86–1.77, p = 0.14), with no statistically significant differences observed. Visual disturbances occurred in 1.04% of smokers and 0.90% of nonsmokers at 2 months (RR = 1.17, 95% CI 0.54–2.55, p = 0.69) and remained similar at 2 years (RR = 1.15, 95% CI 0.90–1.47, p = 0.56). There were no significant differences in postoperative infection (p > 0.16 through 2 years), ectropion (p = 0.90), or hematoma/seroma formation (p = 0.42) between cohorts.

Conclusion: Within the first two years following surgery, smoking was not associated with a significant increase in postoperative complications after upper eyelid blepharoplasty. Across all intervals up to two years, complication rates remained low and comparable between smokers and non-smokers, reinforcing the overall safety of upper eyelid blepharoplasty in this population. Our findings suggest that, with appropriate patient selection and perioperative management, upper blepharoplasty can be safely performed in smokers pursuing either aesthetic refinement or functional improvement.

Background Ethnic rhinoplasty frequently requires multiple structural grafts in patients with limited septal cartilage [1]. Fresh frozen costal cartilage (FFCC) avoids donor-site morbidity of autologous rib harvest, but concerns persist regarding age-related graft behavior [2]. Older donor cartilage is perceived as rigid and brittle, whereas younger donor cartilage may be more prone to warping. The clinical impact of donor age on rhinoplasty outcomes remains undefined. This study evaluates complication rates and patient-reported outcomes following FFCC use stratified by donor age. Methods A retrospective review was performed of ethnic rhinoplasty patients treated with FFCC between 2017 and 2024 with ≥12 months follow-up. Donor age was obtained from MTF Biologics serial numbers and stratified into decades: 20s, 30s, 40s, 50s, and ≥60 years. Recorded variables included demographics, smoking status, BMI, and prior rhinoplasty history. Outcomes assessed were infection, graft exposure, warping, and revision surgery (aesthetic vs complication-related). Patient-reported functional and aesthetic outcomes were measured preoperatively and at 12 months using the validated SCHNOS questionnaire. Statistical analysis included chi-square and unpaired t-tests with significance set at p ≤ 0.05. Results Of 1,895 rhinoplasty cases, 945 met inclusion criteria. The cohort was 68% female with mean age 32.4 years, mean BMI 24.6, and mean follow-up 15.2 months. Demographics were comparable across donor age groups. Overall infection rate was 1.3% and did not differ by donor age; all infections occurred in revision cases. Dorsal graft warping occurred exclusively in the youngest donor group (20–29 years), affecting 5.3% of patients in that cohort, all requiring revision surgery (p < 0.05). No warping was observed in donor grafts ≥30 years. Overall revision rate was 4.2%, with 86% performed for aesthetic reasons and 14% for complications, without significant difference between donor age groups. Mean SCHNOS improvement was 2.9 overall, compared with 1.9 among revision patients and 1.7 among patients with graft warping (p < 0.05).

Conclusions Donor age significantly influences FFCC performance in ethnic rhinoplasty. Younger donor cartilage (20–29 years) demonstrates increased risk of dorsal warping, whereas grafts from donors ≥30 years show greater structural stability without increased infection or complication rates. Donor age should be considered during FFCC selection, particularly when dorsal onlay grafting is planned.

1. Rohrich RJ, Bolden K. Ethnic rhinoplasty. Clin Plast Surg. 2010;37(2):353-370. doi:10.1016/j.cps.2009.11.006
2. Hanna SA, Mattos D, Datta S, Reish RG. Outcomes of the use of fresh-frozen costal cartilage in rhinoplasty. Plast Reconstr Surg. 2024;154(2):324-328. doi:10.1097/PRS.0000000000011125

Purpose: As one of the most commonly performed aesthetic procedures, breast augmentation can be achieved through several surgical access routes (1). Transumbilical breast augmentation (TUBA) offers the advantage of implant placement through a concealed umbilical incision. However, despite its potential aesthetic appeal, the evidence supporting its safety, reproducibility, and clinical outcomes remains limited and heterogeneous.

Methods and Materials: A systematic literature search was conducted across MEDLINE, Embase, Scopus, Cochrane Library, and Web of Science databases through August 2025, with the review process conducted from August 2025 to February 2026. Studies enrolling adult women who underwent TUBA using either silicone or saline implants were considered eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using JBI and ROBINS-I V2 tools. The primary endpoints of this study were patient-reported satisfaction and the incidence of hematomas. Secondary endpoints included capsular contracture, reintervention, infection, seroma, intraoperative bleeding, implant malposition, inadvertent plane placement, implant rupture or deflation, operative time, and other adverse events. Random-effects GLMMs were used to pool proportions, with heterogeneity assessed by the I² statistic and explored through sensitivity analyses.

Results: A total of 583 records were identified through the search process, and 17 studies were ultimately included, comprising 6,605 patients and 13,210 breasts. Overall, patient-reported satisfaction was consistently high across the included studies. Fifteen studies including 5,179 patients assessed satisfaction, with most series reporting uniformly high or very high satisfaction rates, frequently exceeding 90%. Several studies indicated that the vast majority of patients would recommend the procedure, reflecting favorable perceptions regarding aesthetic outcomes such as breast volume, symmetry, and shape. When reported using numerical scales, mean satisfaction scores were high, further supporting positive patient experiences following TUBA. Hematoma was reported in fifteen studies encompassing 6,336 patients. The pooled incidence was 0.2% (95% CI: 0.1–0.5%), with no observed statistical heterogeneity, indicating a consistently low and stable rate across studies. Secondary outcomes demonstrated similarly low complication rates. Reintervention was reported in twelve studies involving 5,947 patients, with a pooled incidence of 2.3%, although substantial heterogeneity was observed. Capsular contracture occurred in 1.7% of cases, while infection rates were negligible. Other adverse events, including intraoperative bleeding, seroma, inadvertent plane placement, and implant rupture or deflation, were infrequent and generally below 1%. Operative time in most series ranged from 24 to 136 minutes, clustering around 60 minutes. Additional adverse events were variably reported and predominantly minor, limiting formal quantitative synthesis but suggesting an overall favorable safety profile.

Conclusions: Based on the available evidence, TUBA appears to be associated with high patient-reported satisfaction and a low incidence of major complications across the included studies. However, the strength of these findings is limited by the predominance of retrospective case series with moderate risk of bias and relatively short follow-up durations.

References: (1) Gonçalves FGA, Terada BD, da Silva LD, Almeida AS, Gemperli R, Camargo CP. A Systematic Review and Meta-Analysis of 11,686 Breasts Undergoing Transaxillary Augmentation: Why Leave a Trace When You Can Go Invisible? Plast Reconstr Surg. Published online February 2, 2026. doi:10.1097/PRS.0000000000012863

Background: Panniculectomy is a common body contouring procedure, with 171,064 performed in 2024. GLP-1 use has risen in recent years, and prior studies suggest higher rates of body contouring among GLP-1 users. However, data on post-operative complications in this population remains limited. This study compares morbidity outcomes in GLP-1 users following body contouring procedures. Methods: The US Collaborative TriNetX network was in queried in September 2025 for patients who underwent panniculectomy after initiating GLP-1 agonists at varying time intervals before surgery: 0–3, 4–6, and 7–11 months, as well as 1–4 years in yearly increments. These cohorts were compared to panniculectomy patients not on GLP-1 agonists up to 90 days post-surgery. Multivariate analysis was used to compare outcomes after 1:1 propensity score matching for comorbidities, body mass index, and hemoglobin A1c levels. Results: Panniculectomy was most common after GLP-1 initiation 1-2 years before surgery (n=712), followed by 2-3 years before surgery (n=552). There were no reported cases of DVT, PE, mortality, or aspiration within 90 days of undergoing panniculectomy. There was no significant difference in ED utilization or infection between groups. Notably, GLP-1 use for greater than 1 year was associated with higher rates of malnutrition and vitamin deficiency. Wound dehiscence was significantly higher in non-GLP-1 users compared to cohorts on GLP-1 agonists for 2-3 and 3-4 years prior to surgery. Conclusions: Extended GLP-1 use was associated with increased rates of malnutrition and vitamin deficiency, while most postoperative outcomes were comparable between GLP-1 users and non-users Notably, non-users demonstrated a higher risk of wound dehiscence compared to patients with prolonged GLP-1 exposure following panniculectomy. Further research is needed to clarify optimal perioperative GLP-1 agonist use.

Purpose Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are among the most commonly prescribed psychotropic medications and are frequently encountered in patients presenting for elective facial aesthetic surgery. Beyond their central nervous system effects, these agents can reduce intraplatelet serotonin, an important mediator of platelet aggregation, raising concern for impaired hemostasis and an increased risk of perioperative bleeding or hematoma formation. Evidence regarding SSRI/SNRI exposure and early outcomes after facial aesthetic procedures remains limited. We therefore sought to quantify the association between preoperative SSRI/SNRI use and short-term postoperative complications following facial aesthetic surgery in a large, real-world cohort.

Methods We performed a retrospective cohort study using the TriNetX Research Network, including adult patients undergoing facial aesthetic surgery. Exposure was defined as documented SSRI or SNRI use within 6 months prior to the index procedure. To reduce confounding, we used propensity score matching to balance cohorts on demographics, baseline comorbidities, and procedure type. Postoperative outcomes were evaluated at 7, 15, and 30 days and included bleeding/hematoma, postoperative infection, and wound dehiscence. Relative risks (RRs) with associated p-values were calculated to compare complication rates between exposed and unexposed cohorts.

Results After propensity score matching, 39,805 patients were identified in each cohort. SSRI/SNRI exposure was associated with an increased risk of bleeding/hematoma at 7 days (RR 1.33, p<0.02), with the elevated risk persisting at 15 days (RR 1.25, p<0.04) and 30 days (RR 1.26, p<0.02). Infection rates were also higher among exposed patients at 7 days (RR 1.62, p<0.0001), 15 days (RR 1.71, p<0.0001), and 30 days (RR 1.51, p<0.0001). Similarly, wound dehiscence occurred more frequently in the SSRI/SNRI cohort across all time points: 7 days (RR 1.93, p<0.0003), 15 days (RR 1.54, p<0.0007), and 30 days (RR 1.29, p<0.03). Although these associations were statistically significant, absolute event rates remained low.

Conclusion Preoperative SSRI/SNRI exposure is associated with statistically higher early risks of bleeding/hematoma, infection, and wound dehiscence following facial aesthetic surgery, though the absolute incidence of complications is low. These findings suggest that patients taking SSRIs/SNRIs may benefit from heightened early postoperative vigilance, including careful monitoring for hematoma and strict wound surveillance. These data support individualized counseling and shared decision-making when planning perioperative management of SSRIs/SNRIs for elective facial aesthetic procedures.

Introduction: Giant pannus excision is a complicated procedure that requires careful medical management and surgical planning. Existing literature focuses on perioperative outcomes and complication rates; less is known about long-term functional outcomes and patient quality of life. This study evaluates functional changes and patient satisfaction following giant pannus excision, with the goal of informing preoperative counseling and guiding care strategies.

Methods: Adults aged 18 years or older who underwent functional panniculectomy using a suspension technique at tertiary urban hospitals between December 2014 and August 2024 were included. Sociodemographic, clinical, and operative variables were collected. Patients completed a Qualtrics survey incorporating BODY-Q sections (appearance of abdomen, body contouring scars, body image, psychological functioning, physical functioning, and sexual functioning) as well as supplemental self-generated questions.

Results: Seven of the eligible twenty-three patients successfully completed the survey. The cohort was predominantly Caucasian (100%) and female (71.4%). Every patient had obesity related medical diagnoses (type 2 diabetes, hypertension, dyslipidemia, gastroesophageal reflux disease, obstructive sleep apnea, osteoarticular disease) and all but one patient had a psychiatric comorbidity (depression, anxiety, nonpsychotic psychiatric disease). Mean pre-panniculectomy BMI was 56.0 +/- 9.74 and mean resected pannus weight was 18685.8 +/- 12519.5 grams. Four patients had prior gastric bypass, and none had bariatric surgery afterward. No patients were prescribed weight loss medications preoperatively; two patients were prescribed semaglutide postoperatively; however, one patient discontinued the medication due to complications. The average postoperative weight loss after panniculectomy was 121.4+/-80.2 pounds. One patient pursued additional plastic surgery after panniculectomy (mon pubis reduction), and five patients are considering additional procedures, (brachioplasty n=2; thighplasty n=3). The average current BMI of patients is 47.9 +/- 5.08. Six patients are unhappy at their current weight, with 4 patients considering further weight loss (either surgical or medical). The mean interval from surgery to survey completion was 2241.6 +/- 1471 days. The average BODY Q scores for abdominal appearance, body contouring scars, body image, psychological function, physical function, and sexual function are 74.0, 96.0 , 51.0 , 71.0 , 59.0, and 34.0 respectively. All the patients reported improvement in their ability to maintain personal hygiene following panniculectomy.

Conclusions: Overall, patients reported high satisfaction after giant pannus removal. Although limited by a small size, these findings demonstrate the functional and psychological benefits of this surgery for patients with massive pannus burden.

INTRODUCTION: The rising prevalence of metabolic syndrome has led to increased use of GLP-1 receptor agonists (GLP-1 RAs) and growth of body contouring procedures. Although initially approved for the treatment of type 2 diabetes (T2D), GLP-1 RAs are now widely prescribed for weight management in patients without diabetes. Beyond improved glycemic control, the anti-inflammatory and cardioprotective effects of GLP-1 RAs may augment surgical candidacy for bariatric patients. However, GLP-1 RA users are at risk of micronutrient deficiency, which can affect post-operative wound healing. Existing GLP-1 RA studies report inconsistent effects on wound healing and postoperative outcomes, often ignoring micronutrient deficiency as a mediator (1-2). This is the first multicenter analysis investigating GLP-1 RAs' effects on post-operative complications after body contouring in both cohorts, while also accounting for micronutrient profiles of each cohort.

METHODS: A retrospective study was conducted using the US Collaborative Network in TriNetX. Two propensity-matched (e.g. demographics, confounding comorbidities) analyses compared postoperative outcomes between GLP-1 RA users and controls for two cohorts: (1) non-T2D patients with obesity (N=4,138) and (2) T2D patients on metformin (N=1,578). Each cohort was further stratified into two subcohorts based on GLP-1 RA use. A sensitivity analysis with additional matching for major micronutrient laboratory values (e.g. albumin, calcium, magnesium) was performed. Bivariable odds ratios (ORs) with 95% confidence intervals were calculated for wound dehiscence, surgical site infection (SSI), hematoma/seroma, and hemorrhage at 30-, 90-, and 180-days following body contouring surgery (abdominoplasty or panniculectomy).

RESULTS: Overall, baseline complication rates were higher in patients using GLP-1 RAs compared to non-users, regardless of T2D disease status. In the non-T2D obese cohort, GLP-1 RA users had 35% higher odds of hematomas/seromas (OR=1.35) and, after micronutrient matching, a 53% higher odds of SSI (OR=1.53). In the T2D cohort, GLP-1 use demonstrated 62% greater odds of wound dehiscence (90-day OR=1.62; 180-day OR=1.61) and more than triple the odds of SSI (90-day OR=3.40; 180-day OR=3.18). After micronutrient matching, findings were no longer significant.

CONCLUSION: GLP-1 RA use was associated with significantly higher odds of SSI in both cohorts and markedly elevated odds of wound dehiscence in metformin-treated T2D patients following body contouring. Considering these associations were attenuated after micronutrient matching, these findings highlight the importance of preoperative nutritional optimization in GLP-1 RA users, particularly in T2D patients.

REFERENCES: 1. Aschen SZ, Zhang A, O'Connell GM, Salingaros S, Andy C, Rohde CH, Spector JA. Association of Perioperative Glucagon-like Peptide-1 Receptor Agonist Use and Postoperative Outcomes. Ann Surg. 2025 Apr 1;281(4):600-607. doi: 10.1097/SLA.0000000000006614. Epub 2024 Dec 20. PMID: 39704067; PMCID: PMC12014183. 2. Koenig ZA, Rashid S, Hobbs GR, Uygur HS. "Perioperative GLP-1 Receptor Agonist Use & Surgical Outcomes in Non-bariatric Abdominal Panniculectomy: A 10-Year Retrospective Analysis". Plast Reconstr Surg. 2025 Aug 26. doi: 10.1097/PRS.0000000000012405. Epub ahead of print. PMID: 40875227.

Purpose: Body dysmorphic disorder (BDD) affects an estimated 15% of aesthetic surgery patients – over six times the general population rate - yet remains underdiagnosed at consultation. Up to 80% of cosmetic surgeons report having operated on a patient with probable BDD in hindsight, often recognizing it only after persistent dissatisfaction or repeated revision requests. While individual cosmetic procedures are broadly associated with improved patient satisfaction, literature has not comprehensively examined whether cumulative number of elective procedures can serve as a readily available clinical marker to identify patients who may benefit from preoperative BDD screening or post-operative mental health resources. This study uses validated patient-reported outcome (PRO) instruments to assess the relationship between aesthetic procedure quantity and body image. Methods: Cis-gender female patients who underwent elective aesthetic procedures at a single academic institution from January 2021 to December 2025 were recruited by phone to complete three validated instruments: the Body Dysmorphic Disorder Questionnaire - Aesthetic Surgery (BDDQ-AS), Body Appreciation Scale 2 (BAS-2), and Sociocultural Attitudes Towards Appearance Questionnaire v4 (SATAQ-v4). To isolate the effect of procedure history on body image, this cohort excluded patients with documented major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, or personality disorders. Reponses were stratified by cumulative number of aesthetic procedures (1, 2, 3, or 4) and compared using nonparametric tests. Results: Forty-one patients completed the survey (mean age 51.1 +/- 17.8 years). Rhinoplasty (n=15), botulinum toxin (n=11), blepharoplasty (n=10), liposuction (n=10), filler (n=9), and breast augmentation (n=9) were the most common procedures. Body appreciation was uniformly high regardless of procedure count (BAS-2 group means 4.14-4.27 out of 5; p=0.993), suggesting that elective aesthetic surgery is not associated with diminished body image in psychiatrically screened patients. However, five patients (12.2%) screened positive for BDD; all five had undergone three or more procedures: 4/10 (40%) in the 3-procedure group and 1/11 (9%) in the 4-procedure group, versus 0/20 (0%) among patients with one or two procedures (X^2=9.71, p=0.021). BDD-positive patients had significantly lower body appreciation (3.58 vs 4.30,p=0.029) and reported greater family pressure regarding appearance (p=0.032). Internalization of thin-body ideals also increased with cumulative procedure count (r=0.34, p=0.041). Three patients who spontaneously expressed plans for additional procedures in the upcoming year had the lowest body appreciation scores in the cohort (mean 3.33 vs 4.30, p=0.011). Conclusion: While body appreciation is preserved across aesthetic procedure groups, positive BDD screening clustered exclusively among patients with three or more procedures. These pilot data suggest that cumulative procedure count - information already available in the surgical record - may be a practical, low-burden indicator for targeted preoperative BDD screening. Furthermore, patients who express intent for additional procedures despite existing multi-procedure histories may warrant particular attention. A larger, age-stratified cohort (target N=200) including male patients and those with psychiatric comorbidity is being enrolled to validate these findings and establish screening thresholds.

Background: Capsular contracture remains one of the most common and challenging complications following cosmetic breast augmentation, yet its biological pathogenesis is incompletely defined. Emerging evidence implicates a multifactorial interplay between silicone exposure, microbial signals, immune activation, and extracellular matrix (ECM) remodeling. This systematic review synthesizes human mechanistic studies to define a unified biologic framework for capsular contracture.

Methods: A PRISMA-compliant search of PubMed/MEDLINE, Embase, and Cochrane CENTRAL identified human studies investigating histologic, cellular, molecular, or microbiologic mechanisms of capsular contracture specifically in cosmetic augmentation patients.

Results: Of 1,732 records, 19 studies met inclusion criteria. Progressive fibrosis was characterized by increased capsule thickness, altered collagen architecture, and enhanced ECM crosslinking, associated with elevated lysyl oxidase activity and MMP/TIMP imbalance. Early tension-mediated contractility was driven by fibroblast proliferation and α-SMA–positive myofibroblasts, whereas mature capsules exhibited matrix-dominant stiffness. Silicone particulate deposition was consistently observed and associated with foreign-body giant cells, chronic macrophage activation, and granulomatous inflammation. Microbiologic analyses identified increased biofilm burden and staphylococcal-dominant dysbiosis, though with study-to-study variability. Transcriptomic studies demonstrated pervasive innate and adaptive immune activation, including Th1/Th17 polarization, cytotoxic CD8⁺ signaling, reduced regulatory T-cell suppression, and oligoclonal T-cell expansion, along with upregulation of B-cell activation.

Conclusions: Human mechanistic evidence supports capsular contracture as a chronic immune-mediated foreign body response initiated by surgical injury and perpetuated by silicone particulate exposure, biofilm-associated dysbiosis, and sustained macrophage, T-cell, and B-cell activation. These immune cues drive progressive ECM deposition, collagen crosslinking, and long-term matrix stiffening. This integrated framework highlights potential therapeutic and implant-design targets, including macrophage polarization, B-cell activation pathways, and LOX inhibition, to mitigate capsular fibrosis.

Background: Ultrasound is increasingly used in facial aesthetic medicine to enhance injection accuracy and procedural safety, yet quantitative evidence evaluating its clinical impact remains limited [1,2]. This systematic review synthesizes outcome-based data comparing ultrasound-guided facial injections with conventional landmark-guided techniques. Methods: A PRISMA-compliant search of PubMed and Scopus (2003–2025) identified studies reporting clinical outcomes associated with ultrasound use in aesthetic injections, including safety outcomes such as bruising, vascular events, and complication resolution, as well as efficacy outcomes including wrinkle severity scores and injection accuracy. Comparative rates were extracted where available, and methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Results: A total of 177 studies met inclusion criteria, of which 52 (29%) provided quantifiable patient or procedural outcome data suitable for analysis. Across 488 ultrasound-guided filler procedures, no intravascular injections were reported, compared with published rates of up to 3% in landmark-guided series. Bruising rates decreased from 70% to 28.8% with ultrasound guidance, representing a 59% relative risk reduction. Prospective studies demonstrated a 38% improvement in validated Wrinkle Severity Rating Scale (WSRS) scores and superior tissue-plane accuracy (p < 0.05). Early ultrasound-guided management of vascular adverse events achieved near-complete symptom resolution when treated within 48 hours. Methodological quality was highest among prospective and randomized studies (mean MINORS score 22/24). Conclusions: Ultrasound guidance enhances the safety and precision of facial aesthetic injections by reducing bruising, mitigating intravascular risk, and improving aesthetic outcomes. These findings support ultrasound as an evidence-based adjunct that may improve patient safety and procedural accuracy in contemporary image-guided filler practice. 1. Velthuis PJ, Jansen O, Schelke LW, Moon HJ, Kadouch J, Ascher B, Cotofana S. A guide to Doppler ultrasound analysis of the face in cosmetic medicine. Part 1: Standard positions. Aesthet Surg J. 2021;41(11):NP1621-NP1632. doi:10.1093/asj/sjaa410 2. Gerber PA, Barsch M, Filler T, Gerber AM. Identification of facial vessels using Doppler ultrasound prior to cosmetic filler injection. J Dtsch Dermatol Ges. 2019;17(12):1281-1282. doi:10.1111/ddg.13977

Purpose: Suzetrigine is a novel Food and Drug Administration-approved non-opioid, selective sodium channel antagonist indicated for moderate-to-severe acute and neuropathic pain relief. Suzetrigine has previously been shown to reduce pain in controlled phase 3 clinical trials for surgical procedures. Until now, there has not been data on the use of Suzetrigine in rhinoplasty when compared to breakthrough pain-relieving opioid and non-opioid use. This abstract describes the safety and efficacy of Suzetrigine for use in patients undergoing rhinoplasty and septoplasty.

Methods: A cohort study was conducted with retrospective medical record review, evaluating patients who received rhinoplasty or septoplasty with same-day prescription of Suzetrigine. The control cohort consisted of patients who did not receive Suzetrigine after rhinoplasty or septoplasty during the same time period. Patients were included if they were over 18 years old and had at least one follow-up visit. Unpaired t-, Chi-squared, and Fisher's exact tests were used to assess the differences between the groups.

Results: Of 100 patients reviewed, 70 met inclusion criteria. Forty-five patients received Suzetrigine prescriptions, of whom n=38 (84.4%) successfully dispensed Suzetrigine from their pharmacy. Comparing patients who dispensed Suzetrigine and controls, there were no significant differences in age (p=0.3907), sex (p=0.23), race (all p >0.05), except for patients whose race was unknown (p=0.003). Additionally, non-Hispanic or Latino ethnicity was significantly different (p=0.03) between cohorts. There were no significant differences in smoking status (p=0.10), history of facial trauma (p=0.52), and presence of deviated nasal septum (p=0.24). Patients who received Suzetrigine were more likely to undergo other additional procedures at the same time as rhinoplasty and septoplasty (p<0.001). Serious adverse events were rare in both cohorts, with no difference in 90-day emergency department visits (p=0.16), admissions (p=0.15), or return to the operating room (p=0.15). Patients who were discharged with Suzetrigine were significantly less likely to be discharged with opioids (p < 0.001).

Conclusion: In this retrospective analysis, Suzetrigine demonstrated a favorable safety profile and was associated with a significant reduction in opioid prescriptions at discharge among patients undergoing rhinoplasty or septoplasty. Rates of serious adverse events were overall low and comparable between patients who received Suzetrigine and those who did not. Although small cohort size and demographic differences between cohorts limit generalizability, these findings suggest that Suzetrigine is a safe and effective non-opioid analgesic for use in patients undergoing rhinoplasty or septoplasty. Larger, prospective studies are warranted to further validate Suzetrigine's analgesic efficacy and define its role in multimodal pain management strategies.