Scientific Abstract Presentations: Aesthetic Session 2 Thursday, October 15 Thu, Oct 15 3:30-4:30 p.m. CDT

Background Rhytidectomy is one of the most performed facial rejuvenation procedures, yet postoperative hematoma remains its most frequent and consequential complication, driving patient morbidity and compromising aesthetic outcomes. Tranexamic acid (TXA), a potent antifibrinolytic agent, has been widely adopted to mitigate surgical bleeding; however, a definitive high-level synthesis of evidence for its local application in rhytidectomy remains limited. The authors conducted a comprehensive systematic review and meta-analysis to highlight the efficacy and safety profile of local TXA compared with controls in patients undergoing rhytidectomy. Methods A systematic search of PubMed, Embase, Medline (EBSCO), and CENTRAL was conducted from inception through December 2025. Studies comparing local TXA with a control in adults undergoing rhytidectomy were included. Pooled effect estimates were calculated using a random-effects model, risk of bias was assessed with ROBINS-I, and the certainty of evidence was appraised using the GRADE framework. Results Seven studies met the inclusion criteria, comprising 1,122 patients (596 local TXA and 526 controls). Meta-analysis revealed local TXA was associated with a significant reduction in operative time (minutes) (SMD = –2.34; 95% CI [–3.49, –1.20]; p < 0.01), estimated blood loss (mL) (SMD = –4.53; 95% CI [–8.09, –0.97]; p = 0.01), 24-hour postoperative drain output (mL) (SMD = –1.10; 95% CI [–1.40, –0.79]; p < 0.01), and hematoma rates (OR = 0.35; 95% CI [0.15, 0.81]; p = 0.014). Conclusions In patients undergoing rhytidectomy, the application of local TXA significantly enhances surgical efficiency and patient safety by reducing operative time, blood loss, and postoperative complication rates.

Purpose: Both glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and bariatric surgery are established weight-loss interventions that can lead to excess skin, often necessitating body-contouring procedures. However, complication profiles following these skin-removing procedures in GLP-1 users versus bariatric patients remain poorly understood.

Methods: We conducted a retrospective cohort analysis using the TriNetX Global Collaborative Network. Adults aged 18–80 who underwent panniculectomy, abdominoplasty, mastopexy, breast reduction, or related excisional procedures were included. Cohort A comprised patients with prior GLP-1 RA use (n=5,200), while Cohort B included patients with previous bariatric surgery but no GLP-1 use (n=1,252). Propensity score matching yielded 1,196 patients per group. Outcomes within 90 days postoperatively included cellulitis, surgical site infection (SSI), abscess, need for incision and drainage (I&D), seroma/hematoma/hemorrhage, wound disruption, and emergency department (ED) visits.

Results: After matching, complication rates were largely comparable between groups for cellulitis (2.8% vs. 3.4%, p=0.38), SSI (1.7% vs. 1.5%, p=0.72), abscess (0.9% vs. 0.9%, p=0.99), need for I&D (0.9% vs. 1.0%, p=0.82), wound disruption (4.3% vs. 3.7%, p=0.47), and ED visits (4.9% vs. 5.0%, p=0.95). Notably, the GLP-1 cohort demonstrated a significantly lower risk of seroma/hematoma/hemorrhage (2.7% vs. 4.4%, risk ratio 0.62, 95% CI 0.40–0.96, p = 0.031).

Conclusions: Patients undergoing skin-removing procedures after GLP-1 use experience similar short-term complication rates to those with prior bariatric surgery, with a potential advantage of reduced seroma/hematoma/hemorrhage risk. These findings support the safety of body-contouring surgery in post–GLP-1 populations and may guide shared decision-making between medical and surgical weight-loss strategies.

Background. Abdominal body contouring surgeries can provide significant improvements to patients' quality of life, body image, and physical function following weight loss.[1] In recent years, there have been an expanding number of therapies to assist patients with weight loss. Phentermine is the most commonly prescribed antiobesity medication in the United States.[2] Despite its widespread utilization, surgical outcomes following phentermine-induced weight loss remain unclear. This study examined the postoperative outcomes of patients utilizing phentermine prior to abdominal contouring surgery.

Methods. A retrospective cohort study was performed on patients who underwent abdominoplasty or panniculectomy at a large academic institution between September 2013 and September 2025. Cohorts were stratified by preoperative phentermine use within two years prior to abdominal contouring surgery. Covariates for propensity score matching and multivariable logistic regression included age, sex, body mass index (BMI), diabetes, primary hypertension, adjunct weight loss therapies (GLP-1RA therapy or bariatric surgery), and total body weight loss percent (TBWL%).

Results. 582 patients were included, of whom 66 (11.34%) utilized phentermine preoperatively. Phentermine users were younger (47.14 vs. 50.93, p=0.008), had lower rates of hypertension (34.85% vs. 50.39%, p=0.025), and experienced higher TBWL% (10.21% vs. 5.86%, p=0.026) than phentermine non-users. Index weights, procedure weights, and BMIs at the time of abdominal body contouring surgery did not significantly differ by phentermine use. Among phentermine users, the mean duration of phentermine use was 69.4 weeks. Procedure type was similar by phentermine use (p=0.74). Propensity score matching paired 64 phentermine users with 125 phentermine non-users, and standardized mean differences less than 0.1 confirmed appropriate matching of cohorts. Rates of surgical site infection (17.2% vs. 3.2%, p=0.001) and composite complications (35.9% vs. 21.6%, p=0.038) were significantly higher among phentermine users compared to matched non-phentermine controls. On multivariable logistic regression, phentermine use was associated with significantly higher rates of wound dehiscence (OR 2.30 [1.08, 4.67], p=0.025), surgical site infection (OR 3.76 [1.64, 8.21], p=0.001), and composite complications (OR 2.26 [1.26, 3.99], p=0.005).

Conclusions. Preoperative phentermine use is associated with increased rates of wound healing complications after abdominal body contouring surgery. Abdominal contouring candidates utilizing phentermine as part of multimodal weight loss regimens should be counseled on these increased postoperative complication risks during surgical consultation.

References: 1. Mokhtar J, Akbarpoor F, Hadi M, et al. Patient Reported Outcome Measures Following Post-Bariatric Body Contouring: A Systematic Review and Meta-analysis. Plast Reconstr Surg. Published online October 20, 2025. doi:10.1097/PRS.0000000000012544 2. Berning P, Adhikari R, Schroer AE, et al. Longitudinal Analysis of Obesity Drug Use and Public Awareness. JAMA Netw Open. 2025;8(1):e2457232. doi:10.1001/jamanetworkopen.2024.57232

Background The acellular peritoneum matrix (APM) is an emerging biologic scaffold, similar to the acellular dermal matrix, that can be used adjunctively in various reconstructive procedures. Its unique regenerative properties and abundance of growth factors, proteins, and collagen promote revascularization and cellular integration within the surgical site to facilitate recovery. In rhytidectomy, persistent volume loss, recurrent laxity, and diminished tissue integrity, particularly in secondary or revision cases, remain significant challenges. The structural durability, contour support, and volume enhancement of APMs offer great promise for improved outcomes in rhytidectomy. However, to date, the clinical applications of APMs are limited, especially when used in the head and neck regions. With our study, we aim to better understand the safety of using APMs in rhytidectomy procedures.

Methods A retrospective review was conducted at a single site, including all patients who underwent rhytidectomy from 2021 to 2024. All patients undergoing primary, secondary, or revision rhytidectomy were included. Patients were categorized into two cohorts based on whether an APM was used during their procedure. Data was collected on patients' characteristics, comorbidities, and relevant surgical history. Postoperative complications, including hematoma, seroma, delayed wound healing, dehiscence, and need for reoperation, were documented over a twelve-month follow-up period.

Results A total of 86 patients were included; most were female (95.3%) and white (100%), with an average age of 64 ± 9 years and a BMI of 23.6 ± 3.6. Common comorbidities included smoking history (27.9%), hypertension (10.5%), diabetes mellitus (2.3%), and connective tissue disorder (1.2%). Overall, 24.4% had previously undergone rhytidectomy, and 47.7% underwent an additional procedure at the time of their facelift. Forty-one patients (47.7%) received APM during rhytidectomy, while 45 (52.3%) underwent rhytidectomy alone. The APM group more frequently had a prior rhytidectomy (41.5% vs. 8.9%; p=0.004) and a smoking history (29.3% vs. 17.8%; p=0.208), with no other significant baseline differences between groups. Postoperative complication rates within 12 months were similar between cohorts (APM 14.6% vs. control 11.1%; p=0.63). The most common complications were hematoma, seroma, and delayed wound healing, which occurred at comparable rates in both groups: hematoma (p=0.92), seroma (p=0.50), and delayed wound healing (p=0.92). No complications were attributable to the APM graft, and no cases of necrosis, infection, or foreign body reaction occurred.

Conclusions The use of APM in rhytidectomy is clinically safe, with no significant difference in postoperative complication rates compared to rhytidectomy alone. Furthermore, among those who did experience complications, it is unlikely that any adverse events were directly related to the APM. The absence of graft-related adverse events, including rejection, infection, or necrosis, supports APM's biocompatibility in rhytidectomy procedures. Moving forward with a greater understanding of the safety and risk of APM use will allow us to further characterize the clinical benefits of APM with rhytidectomy. Given its structural durability, regenerative properties, and potential to enhance contour and soft-tissue support, routine use of APMs may improve rhytidectomy outcomes, increase patient satisfaction, and reduce the need for a secondary rhytidectomy or long-term revisions.

Introduction Weight loss therapies, including GLP-1 receptor agonists and bariatric surgery, have led to increasing numbers of patients achieving massive weight loss. Up to 96% of these patients experience excess skin requiring body contouring procedures, often involving multiple anatomic regions.1 Surgeons must decide whether to combine procedures into a single operation or stage them sequentially. Combined procedures reduce anesthetic exposures, cost, and recovery periods, whereas staging may decrease physiologic stress by shortening operative time per case.2 However, large-scale, risk-adjusted data comparing short-term morbidity between these strategies are limited. We hypothesized that staging would not significantly reduce 30-day postoperative morbidity compared with combined procedures and therefore sought to compare complication rates using a national database.

Methods We conducted a retrospective propensity score–matched cohort study using the TriNetX Global Collaborative Network. Adult patients undergoing ≥2 procedures from various body contouring categories (abdominal, thigh, upper extremity, breast, posterior trunk) were identified. Combined procedures were defined as ≥2 anatomic regions performed on the same operative date. Staged procedures were defined as ≥2 regions performed on different dates within 90 days, 180 days, or 1 year. Outcomes included wound infection or sepsis, wound dehiscence, thromboembolic events (DVT/PE), pneumonia, urinary tract infection (UTI) and wound-related reoperation, all measured within 30 days of the index procedure. One-to-one nearest-neighbor propensity score matching was performed using age, sex, race/ethnicity, BMI documentation, bariatric surgery status, diabetes, and circulatory disease.

Results A total of 4,371 patients underwent combined procedures. Staged cohorts included 243 (90 days), 796 (180 days), and 1,680 (1 year). After matching, 240, 791, and 1,670 pairs were analyzed, with balanced baseline characteristics between groups.

Across all staging intervals, 30-day event rates were low and comparable. In the 180-day matched analysis (n=791 pairs), wound infection/sepsis occurred in 2.53% of staged cases versus 4.30% of combined cases (RR 0.59; p=0.053). Wound dehiscence rates were 4.68% versus 3.92% (RR 1.19; p=0.457), and wound-related reoperation occurred in 2.02% versus 2.78% (RR 0.73; p=0.325). Thromboembolic events were rare and similar between groups (0.84% vs 0.84%; p=1.000 in the 1-year analysis). Findings were consistent across the 90-day and 1-year staging definitions, and no measured outcome significantly favored either strategy.

Conclusion In this propensity score–matched national analysis, staging body contouring procedures did not reduce 30-day postoperative morbidity compared with combined procedures. Although limited by the absence of operative duration data and restriction to 30-day outcomes, this large-scale comparison demonstrates comparable short-term safety across sequencing strategies. Combined procedures did not confer increased early risk in appropriately selected patients, while staging remains a reasonable option when operative time reduction is clinically desirable. Operative sequencing should therefore be individualized rather than routinely dictated by presumed safety differences.

References: 1. Monpellier, Valerie M. M.D.; Antoniou, Evangelia E. M.Sc., Ph.D.; Mulkens, Sandra M.Sc., Ph.D.; Janssen, Ignace M. C. M.D.; Jansen, Anita T. M. M.Sc., Ph.D.; Mink van der Molen, Aebele B. M.D., Ph.D.. Body Contouring Surgery after Massive Weight Loss: Excess Skin, Body Satisfaction, and Qualification for Reimbursement in a Dutch Post–Bariatric Surgery Population. Plastic and Reconstructive Surgery 143(5):p 1353-1360, May 2019. | DOI: 10.1097/PRS.0000000000005525 2. Menkü Özdemir, Fethiye Damla MD; Uzun, Hakan MD, FEBOPRAS. Prospective Comparative Analysis of Synchronous Abdominoplasty and Mastopexy in Bariatric and Nonbariatric Massive Weight Loss Patients: Highlighting the Rising Trend of GLP-1 Analog Use. Annals of Plastic Surgery 96(3):p 272-276, March 2026. | DOI: 10.1097/SAP.0000000000004673

Purpose: Obesity is a known risk factor for impaired wound healing and postoperative complications in many surgical procedures. However, its influence on outcomes following upper eyelid surgery remains poorly defined. This study evaluates the safety of upper eyelid blepharoplasty across different body mass index (BMI) categories to determine whether increased BMI correlates with higher complication risk.

Methods and Materials: Patients ages 18 years and older who underwent upper eyelid blepharoplasty between 2010 and 2024 were identified from the TriNetX Research Network, a multi-institutional database using ICD-10 codes. Patients were stratified into three BMI cohorts: normal/overweight (BMI 18.5–29.99), obese (BMI 30–39.99), and morbidly obese (BMI ≥ 40). 1:1 propensity score matching using a greedy nearest-neighbor algorithm with a caliper of 0.1 pooled standard deviations was applied across demographics, comorbidities, body mass index, substance use, and psychiatric conditions. Postoperative Outcomes evaluated included general complications such as postoperative infection, wound dehiscence, hematoma/seroma/hemorrhage, acute kidney injury, cardiac arrest, sepsis, pneumonia, deep vein thrombosis (DVT), myocardial infarction (MI), death, urinary tract infection (UTI), stroke, and pulmonary embolism (PE) as well as ocular-specific events such as visual disturbances, ectropion, eyelid ptosis, dry eyelid syndrome, lagophthalmos, epiphora, and diplopia at 1-, 3-, and 6-month after surgery. Risk ratios (RRs) with 95% confidence intervals (CIs) and p-values were calculated.

Results: There was no increase in postoperative complications as BMI increased, and no significant differences were observed between the normal, obese, and morbidly obese groups. Between the normal and obese cohorts, complication rates were comparable across all time points. At 6 months, the cumulative incidence of postoperative infection was 1.07% in normal versus 1.38% in obese patients (comparing normal to obese: RR = 1.38, 95% CI 0.68–2.81, p = 0.37). Wound dehiscence occurred in 1.07% vs. 1.05% (RR = 0.98, 95% CI 0.76–1.47, p = 0.76), hematoma/seroma/hemorrhage in 0.17% vs. 0.13% (RR = 1.30, 95% CI 0.57–2.96, p = 0.53), and visual disturbances in 2.2% vs. 2.11% (RR = 1.04, 95% CI 0.78–1.40, p = 0.77). Similarly, between the obese and morbidly obese cohorts, complication rates remained statistically comparable at 6 months. Infection occurred in 1.35% vs. 1.48% (comparing obese to morbidly obese: RR = 1.09, 95% CI 0.72–1.66, p = 0.68), wound dehiscence in 1.05% vs. 1.03% (RR = 0.98, 95% CI 0.68–1.41, p = 0.90), hematoma/seroma/hemorrhage in 0.13% vs. 0.12% (RR = 0.94, 95% CI 0.50–1.74, p = 0.85), and visual disturbances in 2.11% vs. 2.36% (RR = 1.12, 95% CI 0.83–1.52, p = 0.44).

Conclusion: Elevated BMI was not associated with increased short-term complications following upper eyelid blepharoplasty. Across both BMI comparisons, no statistically significant differences were observed in postoperative infection, wound dehiscence, hematoma/seroma, or ocular-specific events. These findings support the safety of blepharoplasty in overweight/obese patients for either aesthetic or functional improvement, suggesting that upper eyelid surgery can be performed safely across BMI groups when patients are appropriately optimized preoperatively.

Purpose Botulinum toxin type A is the gold standard for treating moderate-to-severe facial wrinkles. Although multiple formulations are clinically effective and superior to placebo, direct head-to-head comparisons remain limited (1). We performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) to determine whether an optimal formulation exists.

Methods A PRISMA-compliant systematic review was conducted using MEDLINE, Embase, Scopus, Web of Science, and Cochrane Central from inception through October 2025. Only head-to-head RCTs comparing two or more commercially available botulinum toxin type A formulations in adults with moderate-to-severe facial wrinkles were included; placebo-controlled trials were excluded. The primary endpoint was responder-defined wrinkle improvement. Secondary outcomes included patient-reported satisfaction(PRS) and adverse events(AEs). Risk of bias was assessed using RoB2. A frequentist random-effects network meta-analysis was performed, reporting risk ratios (RR) with 95% confidence intervals (CI) and SUCRA-based rankings.

Results: A total of 48 RCTs including 5,781 patients were analyzed, with overall risk of bias predominantly low (RoB2), and only one study rated as high risk. Network meta-analysis and SUCRA rankings identified NTC121, an investigational botulinum neurotoxin not yet commercially registered, as the formulation with the highest probability of being the most effective treatment for wrinkle improvement. League table comparisons demonstrated statistically significant differences among several formulations. AbobotulinumtoxinA showed greater efficacy compared with incobotulinumtoxinA (RR 1.11; 95% CI 1.01–1.21), letibotulinumtoxinA (RR 1.09; 95% CI 1.01–1.18), and onabotulinumtoxinA (RR 1.10; 95% CI 1.01–1.20).NTC121 demonstrated statistically significant superiority over multiple marketed formulations, including incobotulinumtoxinA (RR 0.81; 95% CI 0.70–0.95), letibotulinumtoxinA (RR 0.83; 95% CI 0.71–0.95), onabotulinumtoxinA (RR 1.23; 95% CI 1.06–1.42), prabotulinumtoxinA (RR 1.18; 95% CI 1.01–1.38), and Prosigne(RR 1.22; 95% CI 1.03–1.46). Despite these statistically significant gradients in efficacy, no single commercially approved formulation demonstrated uniform superiority across all comparisons. PRS was consistently high across all botulinum toxin type A. However, outcomes varied according to assessment scale and follow-up duration, and no formulation showed a reproducible advantage in direct comparisons. Satisfaction generally declined over time, likely reflecting the natural attenuation of pharmacologic effect. AEs were predominantly mild and transient-most commonly headache, injection-site pain, bruising, and tenderness. Major AEs such as eyelid ptosis, strabismus, or infection were rare. Overall, all formulations demonstrated comparable and favorable safety profiles.

Conclusion: NTC121 demonstrated the highest probability of superior efficacy; however, among commercially approved botulinum toxin type A formulations, no single product consistently outperformed all others. While measurable efficacy differences exist, all formulations provide meaningful wrinkle improvement with high PRS and favorable safety.Treatment selection should therefore be individualized based on clinical context and product-specific characteristics rather than presumed categorical superiority.

References: 1- Camargo CP, Xia J, Costa CS, Gemperli R, Tatini MD, Bulsara MK, Riera R. Botulinum toxin type A for facial wrinkles. Cochrane Database Syst Rev. 2021 Jul 5;7(7):CD011301. doi: 10.1002/14651858.CD011301.pub2. PMID: 34224576; PMCID: PMC8407355. 2- Bonaparte JP, Ellis D, Quinn JG, Rabski J, Hutton B. A Comparative Assessment of Three Formulations of Botulinum Toxin Type A for Facial Rhytides: A Systematic Review with Meta-Analyses. Plast Reconstr Surg. 2016 Apr;137(4):1125-1140. doi: 10.1097/PRS.0000000000002004. PMID: 27018668.

Background: Equitable gender representation in plastic surgery is essential for fostering a diverse workforce and may influence patient comfort and trust in surgical care. Prior studies have described gender representation in integrated plastic surgery residency and select subspecialty fellowships, but aesthetic surgery fellowships remain understudied. We assessed whether female representation in aesthetic surgery fellowships aligns with that in integrated plastic surgery residency programs

Methods: A retrospective review of The Aesthetic Society Endorsed Fellowships was performed for fellowship start years 2020 to 2023 using publicly available information from The Aesthetic Society website, as well as individual fellowship program websites and social media. Fellow and program names were recorded, and fellow gender was categorized as male or female. For the same period, the gender distribution of integrated plastic surgery residents was obtained from the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book. Annual proportions of women in aesthetic fellowships were compared with those in integrated plastic surgery residencies using Fisher's exact test. Temporal trends in the proportion of women trainees over time were assessed separately for aesthetic fellows and residents using linear regression.

Results: A total of 37 aesthetic fellowships were analyzed, comprising 86 fellows. Overall, only 29.1% (25/86) of fellows were women, compared with 46.9% (2,030/4,329) of residents (p < 0.001). The proportion of women in fellowship, compared with residency, was not significantly different in 2020 (33.3% vs 43.2%, p = 0.48) or 2021 (30.0% vs 46.1%, p = 0.18), but was significantly lower in 2022 (23.8% vs 47.5%, p = 0.04) and 2023 (29.6% vs 50.2%, p = 0.05). Additionally, the proportion of women increased over time in integrated residency (slope = +2.24 percentage points/year, R² = 0.98, p = 0.008), whereas no significant change was observed in fellowship representation (slope = -1.73 percentage points/year, R² = 0.32, p = 0.43).

Conclusion: Integrated plastic surgery residency is moving toward a more balanced gender distribution, with the most recent year including more women than men. However, women remain underrepresented in aesthetic surgery fellowships relative to the resident pool, highlighting a discrepancy in aesthetic training. Future studies should identify drivers of this gender gap and evaluate strategies to address it, including sustained mentorship, greater transparency in fellowship selection, and expansion of fellowship programs and positions.

Introduction Revision rhinoplasty remains a field marked by complexity and high stakes, where the choice of graft material is primarily dictated by safety concerns. Autologous cartilage-widely championed as the gold standard-is often preferred due to its inherent biological compatibility, largely stemming from a historical fear of infectious and extrusive complications associated with synthetic implants. However, this preference often relies on fragmented literature and fails to consider the cumulative risk burden associated with harvesting autologous tissue. This study aims to critically re-evaluate the prevailing safety dogma by conducting a large-scale comparative meta-analysis. We seek to establish definitive complication benchmarks for autologous grafts and contextualize them against modern porous alloplastic alternatives, thereby defining the true Risk Trade-off inherent in graft material selection.

Methods A PRISMA-guided systematic review was conducted to identify studies reporting safety and complication outcomes in revision rhinoplasty. The search strategy yielded 3,518 initial records; after screening and eligibility evaluation, 30 studies were included in the broader project, of which 10 provided extractable data for the major safety endpoints analyzed in this abstract. To address the expected inter-study heterogeneity across centers and graft types, a DerSimonian–Laird random-effects meta-analysis with logit-transformed proportions was applied. Primary safety outcomes included Infection, Extrusion, Warping, and Donor-Site Morbidity. Pooled autologous complication rates (Set B) were compared with pooled alloplastic complication rates (Set C) to evaluate relative safety profiles and quantify risk trade-offs.

Results This meta-analysis concludes that the safety choice in revision rhinoplasty is a risk trade-off, dismantling the traditional binary of "Safe Autologous" versus "Risky Alloplastic." 1. The Zero-Sum Safety Game (Overall Risk) Quantitative synthesis demonstrated that the overall risk profiles of the two materials are statistically comparable. The total adverse event rate was 4.3% for Autologous grafts versus 3.4% for Alloplastic implants (p=0.74), supporting the "Zero-Sum Safety Game" hypothesis. This shows that when all risks (biological and synthetic) are summed, autologous grafts actually present a slightly higher (though non-significant) hazard profile. 2. Infection and the Myth of Superiority The pooled infection rate for Autologous grafts was 3.3%, a rate statistically indistinguishable from the 2.2% observed in the Alloplastic cohort (p=0.69). This finding directly challenges the dogma that implants carry a prohibitive infection risk. The similar rates suggest that the tissue trauma required for autologous harvest and shaping may contribute to bacterial contamination as significantly as the material itself. 3. The Biological Tax vs. Mechanical Predictability The data quantifies the specific "Biological Tax" patients pay for autologous safety, while highlighting the structural advantages of synthetic materials: Autologous Risk Burden: The greatest burden came from risks unique to biological tissue: Donor Morbidity was 6.2% and the Warping rate was 3.5%. This quantifies that nearly 1 in 16 patients suffers a complication outside the nose. Alloplastic Benefit: Conversely, modern porous implants offer Mechanical Predictability. The Extrusion Rate was near 0.0%, directly challenging the historical fear of implant loss. The structural trade-off is clear: Autologous grafts carry a significant risk of Distortion, while Alloplastic implants offer superior mechanical stability. 4. Final Interpretation The findings shift the safety debate from "Which is safer?" to "Which complication profile is more ethically justifiable for this patient?" The analysis suggests that the true safety objective for the surgeon is avoiding donor morbidity and maximizing structural predictability, allowing modern porous alloplastic grafts to offer a defensible safety profile as a structural alternative.

Conclusion The safety choice in revision rhinoplasty is a definitive framework of risk trade-offs. Autologous grafts impose a quantifiable ~10% risk burden from donor morbidity and warping that is not statistically compensated for by a superior infection profile. Conversely, modern porous alloplastic implants offer structural predictability and freedom from donor trauma, with an infection risk statistically equivalent to autologous tissue. Surgeons must transition counseling away from generalized safety dogma toward specific risk mitigation, recognizing that avoiding donor morbidity and structural warping may constitute a more significant safety objective than avoiding immunologic rejection.

Background: Aesthetic patients increasingly judge surgery success not only by the final result, but by how quickly they recover. Social media and direct-to-consumer marketing have fueled a surge of "recovery add-ons" (supplements, devices, boutique services, and even injectable peptides), often initiated before the surgeon is even asked. This creates a practical clinic problem: surgeons are now routinely asked to validate (or discourage) these interventions, often without clear, procedure-specific evidence. We developed a pragmatic grading framework to support consistent counseling and distinguish high-value recovery adjuncts from low-yield or higher-risk trends.
Methods: We reviewed nine commonly used or marketed recovery adjuncts in aesthetic surgery including structured pre-/postoperative exercise, manual lymphatic drainage (MLD), perioperative recovery protein shakes, hyperbaric oxygen therapy (HBOT), red-light therapy, Arnica, kinesiology taping, mindfulness/meditation apps, and injectable bioactive peptides (e.g., BPC-157, GHK-Cu, Thymosin β4). Each modality was graded across three domains: (1) clinical benefit, (2) safety/regulatory considerations, and (3) cost/logistical feasibility, to generate patient-facing recommendations categorized as "high-value," "selective," or "avoid." Recommendations were informed by the literature and practice-based clinical experience of a board-certified academic aesthetic plastic surgeon with over 20 years of experience. Results: Three adjuncts emerged as the best combination of evidence, safety, and practicality: preoperative exercise, MLD, and perioperative recovery protein shakes. Exercise appears most beneficial when started 3–8 weeks preoperatively. MLD is most appropriate when delivered by trained therapists for procedures where edema and discomfort are prominent (e.g., body contouring). Recovery shakes are broadly accessible, low-risk, and best positioned as a short perioperative course (approximately one week pre-op and one week post-op), with supportive data from surgical populations and emerging data relevant to aesthetic/body contouring evidence. In contrast, HBOT has the clearest role for complications and high-risk tissues (compromised flaps, irradiated tissue, nonhealing wounds) but has limited feasibility as a routine prophylactic recovery tool in aesthetic surgery. Red-light therapy, arnica, kinesiology taping, and mindfulness apps are generally low risk with modest and heterogeneous evidence; they may be offered selectively with transparent expectations. Injectable bioactive peptides lack clinical efficacy, safety data, and raise regulatory and product-quality concerns. As such, they should not be recommended outside of clinical trials. Conclusions: Recovery adjuncts are now part of routine aesthetic decision-making, but evidence quality varies widely. Our grading framework supports routine counseling on exercise, MLD, and recovery protein shakes as high-value options; encourages selective use of low-risk adjuncts with expectation management; reserves HBOT for complications; and recommends avoiding injectable peptides outside clinical trials. High-quality, procedure-specific trials and standardized protocols are needed to define best-practice recovery pathways.