Scientific Abstract Presentations: Global Partners Session 1 Thursday, October 15 Thu, Oct 15 3:30-4:30 p.m. CDT

Introduction: The deep plane face lift has changed the game in facial rejuvenation and is becoming very popular between the younger generation. In the young cases this operation can be considered a facial beautification procedure rather then a rejuvenation. Scars remain one of the telltale signs of any surgical procedure and as such endoscopic scarless techniques are gaining popularity. In the selected young patient a nice neck contour can be created without the need to address deep structures by combining radiofrequency technology and precise liposuction. This is done in a scarless manner, under local anesthesia in the office setting. Material and Methods We present a preliminary report of 10 patients in whom the combination of a transtemporal upper and midface lift with radiofrequency assisted liposuction of the neck has been performed. The mean age of the patients was 31 years old. All the patients were females. The surgeries were all done under local anesthesia and sedation in an office setting. A 2.5-3 cm temporal incision was planned behind the hairline. A dissection plane was created in the innominate fascia, securing a better pull of the temporal area. Only this part of the operation was done in an open and blind manner. The superior temporal septum was released and the subperiosteal plane was entered in the forehead. The plane was advanced until visualization of the supraorbital and the supratrochlear bundles. If a nonincisional blepharoplasty was planned, the plane was continued in a supratarsal manner after incision of the supraorbital periosteum. The inferior temporal septum was then released with blunt dissection and the sentinel vein and zygomaticotemporal nerves were identified. LOT and the canthal ligament were released and signed with a 4.0 Ethibond suture in the cases that desired a slightly slanted look. Once the ORL was identified it was released after being marked with a 3.0 ethibond suture. The zygomatic and preseptal spaces were entered and the main zygomatic ligament was released.. 5 suspension sutures were used in a controlled manner for the midface lift using non absorbable sutures. 3.0 PDS was used in different vectors between the STS in the anterior hairline and DTS, for the temporal lift. The incisions were closed with 4.0 rapid vicryl. A pinch lower blepharoplasty was needed in most cases to correct the bunching created by the vertical lift of the midface. Attention was then given to the neck. A tumescent solutiuon was used by combining 100 cc saline with 20 cc lidocaine 1 mg of adrenaline . Usually 70-80 cc of the solution were injected with a blunt cannula in the supraplatismal plane. Using the RF probe RF was applied in these areas until the desired energies were reached. After this step a meticulous but kind of aggressive liposuction was done with 3 mm blunt cannulas until desired neck contour and mandibular border appearance were achieved. RF microneedling combined with nanofat was done as the last step. Only three stab incisions were used in the neck, placed submental and postauricular. Head bandage was used for one week. Patient satisfaction was very high with extra appraisal given to the fact that they had no visible scars and minimal downtime.

Conclusion The combination of a transtemporal upper and midface lift with radiofrequency assisted liposuction of the neck may be a powerful tool in facial beautification for the young patient.

Summary: Progressive tension sutures (PTS) are proven for dead-space control, but are usually placed in functional quilting patterns. We report a deliberate, anatomy-guided PTS pattern aligned to the linea alba and linea semilunaris to create high-definition abdominal contour while maintaining dead-space control.

Background and Purpose: Drainless closure strategies increasingly emphasize aesthetic refinements alongside seroma prevention (1,2). We evaluated early clinical outcomes of a high-definition anatomical-pattern PTS (HD-AP-PTS) technique that uses planned fascial fixation lines to "build" abdominal definition without sacrificing established PTS principles (3).

Methods and materials: Single-surgeon retrospective review of consecutive abdominal closures using HD-AP-PTS from September 2024 to August 2025; n=63. Interrupted absorbable sutures anchored Scarpa's fascia to the anterior rectus sheath and were placed progressively in a reproducible pattern: midline fixation along the linea alba, bilateral oblique fixation along the linea semilunaris, and lateral advancement to distribute closure tension and reduce shear. Drains were omitted for flap dead-space management; the circumferential lipoabdominoplasty subgroup received short-term drains for 1 to 2 days for liposuction fluid per protocol. Outcomes included clinically evident seroma, hematoma, wound dehiscence, and infection through last follow-up.

Experience and results: Procedures included 36 abdominoplasties, 4 circumferential 360-degree lipoabdominoplasties, and 23 deep inferior epigastric perforator (DIEP) flap donor-site closures, where wound morbidity can be clinically meaningful (4,5). Follow-up was 6 to 9 months. Seroma occurred in 0/63 patients, 0.0%, and hematoma in 0/63, 0.0%. Minor localized wound dehiscence occurred in 2/63, 3.2%, and was managed outpatient; superficial infection occurred in 1/63, 1.6%, and resolved with oral antibiotics and local wound care.

Conclusions: HD-AP-PTS is novel in converting PTS from passive quilting into an active contouring step by aligning fixation to aesthetic anatomic landmarks along the linea alba and linea semilunaris. In this consecutive series, HD-AP-PTS achieved zero seroma/hematoma and low short-term wound morbidity across aesthetic abdominoplasty and DIEP donor-site closure. This approach may offer a simple, reproducible method to improve abdominal definition while preserving the functional safety benefits that underpin PTS-based tension redistribution and dead-space obliteration.

Limitations: Retrospective single-surgeon design, no comparator group, limited follow-up, and no systematic assessment of subclinical seroma or objective aesthetic outcomes.

References: 1. Kapila AK, Iyer H, Mohanna P, et al. Enhancing abdominal donor site aesthetics: the double diamond drainless closure with barbed progressive tension sutures. J Plast Reconstr Aesthet Surg. 2024;96:53-55. 2. Hamdi M, Kapila AK, Waked K. Current status of autologous breast reconstruction in Europe: how to reduce donor site morbidity. Gland Surg. 2023;12:1760-1773. 3. Pollock TA, Pollock H. Progressive tension sutures in abdominoplasty: a review of 597 consecutive cases. Aesthet Surg J. 2012;32:729-742. 4. Lindenblatt N, Gruenherz L, Farhadi J. A systematic review of donor site aesthetic and complications after deep inferior epigastric perforator flap breast reconstruction. Gland Surg. 2019;8:389-398. 5. Nagarkar P, Lakhiani C, Cheng A, et al. No-drain DIEP flap donor-site closure using barbed progressive tension sutures. Plast Reconstr Surg Glob Open. 2016;4:e672.

Introduction: Pre-operative simulation technologies are increasingly utilized in plastic surgery to enhance surgical planning and patient communication. While their technical benefits have been established, the impact on patient-reported outcomes (PROs), particularly satisfaction and perceived accuracy, remains underexplored. This systematic review evaluated the effect of pre-operative simulation on patient-reported satisfaction, decision-making, and perceived accuracy in breast and facial aesthetic plastic surgery. Methods: A systematic search of MEDLINE, Embase, and Cochrane databases up to April 2025 identified studies reporting PROs in adult patients undergoing breast (aesthetic or reconstructive) or facial aesthetic surgery with pre-operative simulation. Data on demographics, simulation type, satisfaction, accuracy, and complications were extracted and analyzed. Results: Seventeen studies (1,333 patients; 970 simulation, 363 control) met inclusion criteria. Breast surgery patients using simulation showed significantly higher satisfaction with appearance (Breast-Q: 75.0 vs. 58.1; p<0.0001), surgical outcomes (84.9% vs. 78.8%; p=0.0114), and psychosocial well-being (p<0.001). Simulation patients reported higher satisfaction with the simulation experience (95.4%) and greater trust in their surgeon (95.2%), with lower complication rates (4.1% vs. 41.5%; p<0.00001). In facial surgery, simulation users demonstrated greater overall satisfaction (79.2% vs. 67.3%; p=0.018) and improved understanding of outcomes. Perceived accuracy was higher in breast (91.0%) than facial surgery (74.1%; p<0.00001). Across procedures, simulation enhanced shared decision-making and surgeon-patient rapport. Conclusion: Pre-operative simulation significantly improves patient satisfaction, trust, and engagement in plastic surgery, particularly in breast procedures. Broader adoption and standardized evaluation of simulation technologies are warranted to optimize patient-centered outcomes across aesthetic and reconstructive subspecialties.

Surgical treatment of breast cancer patients in Croatia is in the hands of Plastic, Reconstructive, and Aesthetic Surgeons. In the Department of Plastic, Reconstructive, and Aesthetic Surgery, Clinical Hospital Dubrava, in Zagreb, Croatia. We started using skin and nipple sparing mastectomy SNSM in treating patients with breast cancer in 1996, so we are in a position to contribute to a 30-year longitudinal clinical follow-up study. In continued elaboration of our previous 15-year retrospective study involving skin and nipple-areola complex sparing mastectomies (SNSM) published previously. In this presentation, we provide a revised and updated analysis for a larger 30-year breast cancer patient cohort that has undergone SNSMs. As an important part of all breast reconstructive techniques, the SNSM maintains its position as an advantageous radical surgery that preserves breast integrity, the nipple-areolar complex, and the inframammary fold. These patients represent 10% of the total patients treated for breast cancer at our department, as early diagnosis of breast cancer allows for breast-conservative surgery in most patients. To the best of our knowledge, this represents the longest presented follow-up study in SNSM surgery in breast cancer patients to-date. Our results point to an even lower breast cancer recurrence rate in the SNSM patient cohort, in this longer revised era. In the second 15-year period, we have made modifications to our standard technique both for mastectomy and reconstruction. Neo-adjuvant chemotherapy has also influenced the results and decisions. We have changed the plane of reconstruction for the majority of patients. There have been changes to implant selection, both due to BIA ALCL and capsular contracture, while acellular dermal matrix and mesh reconstruction have also been introduced. Due to these changes, previously reported complications have been reduced.

Introduction:

Bilateral facial paralysis is a very rare condition that occurs more commonly in the congenital type of facial paralysis i.e. Moebius Syndrome. (The traumatic and iatrogenic forms of bilateral paralysis are exceptionally rare) It is supremely debilitating for the affected individual since facial expression is absent, speech is impaired and lagophthalmos with paradox epiphora are present in varying degrees.

Materials and methods:

Fifteen patients with Moebius syndrome and bilateral facial paralysis received 23 gracilis free flaps for reanimation. Seven patients received only unilateral flaps whereas 8 received bilateral reanimations. The muscle was innervated through coaptation to the masseteric nerve. The lagophthalmos was treated in the majority of cases with either a gold weight or a platinum/iridium chain placed in the pre-tarsal space. The technique will be described in detail. The success of this technique and the superior results compared to cross facial nerve grafting, lead us to perform this technique to most unilateral congenital/traumatic/iatrogenic and other long standing facial paralysis in addition to the bilateral forms.

Conclusion:

A total of 64 free flaps were performed with no flap losses from 2003 till today. All but two flaps exhibited contracture and smile production. We believe the Gracilis muscle is an ideal muscle for this type of reanimation. It is long, thin, expendable and easy to harvest. It's anatomic location facilitates a simultaneous two-team approach. The single stage procedure and one nerve coaptation allow a stronger muscle contracture and more symmetrical smiles. In the young a significant element of brain plasticity leads to spontaneity in smiling, independent from teeth clenching.

Introduction and aim: The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight loss has increased substantially worldwide. However, data on the perioperative impact of GLP-1 RA use in patients undergoing body contouring surgery remain limited (1). This study evaluated the association between preoperative GLP-1 RA use and postoperative outcomes following body contouring surgery after weight loss.

Patients, Materials and Methods: This single-center retrospective cohort study included adult patients undergoing their first body contouring procedure after weight loss at Aalborg University Hospital, Denmark, between December 1 2022, and December 1 2024. Patients were categorized according to preoperative GLP-1 exposure. The primary outcome was any postoperative complication within 90 days. Secondary outcomes included minor and major complications. Multivariable generalized linear models were used to assess associations, adjusting for age, sex, body mass index (BMI), BMI point loss, ASA classification, diabetes mellitus, procedure type, and surgery duration.

Results: Among 222 patients 44 (19.8%) received GLP-1 RA preoperatively. No participants were lost to follow-up. Postoperative complications were more frequent in the GLP-1 RA group than in non-exposed patients (77.3% vs. 53.9%, p = 0.0055). GLP-1 use remained strongly associated with postoperative complications in multivariable analysis (β = 0.238, p = 0.008). Further analysis revealed associations for both minor (p = 0.045) and major complications (p = 0.008), with a stronger association for major complications.

Conclusion: Preoperative GLP-1 RA use was associated with an increased risk of postoperative complications following body contouring surgery after weight loss. Careful preoperative assessment and perioperative planning may be warranted

Use of AI tools: Yes.

References: 1. Lee CC, Newland M, Yau A, Chroneos R, Johnson TS. Impact of GLP-1 Agonist on Surgical Wound Complications Following Plastic and Reconstructive Surgery: A Propensity Matched Cohort Large Database Analysis. Plastic and reconstructive surgery (1963). Published online 2025. doi:10.1097/PRS.0000000000012703

Objective: Ten patients with substance loss were covered with free fascial flaps: Superficial temporal fascia (STF) 7 cases; serratus anterior fascia (SAF) 3 cases. Result: Of the 10 cases, there were 7 men and 3 women. The average age was 39 years (20 to 63 years). The etiology was burns in 5 cases and traumatic in 5 cases. The size of the substance loss ranged from 15 to 112 cm2, with an average of 50 cm2. There was 1 failure (1 case of electrical burn) due to venous reasons, which was not included in the evaluation of functional and aesthetic results. Functional evaluation was performed in comparison to the contralateral (healthy) side (Table 2). When there was a section of the extensor tendons (3 cases), one patient presented with a 15% deficit and another with 20%. The other patient, who had a section of the extensor pollicis longus, recovered symmetrical mobility to the contralateral side.

For patients who presented with a section or exposure of the flexors (4 cases), in all cases, they recovered flexion identical to the healthy side.

The worst result was for a digital substance loss with respectively: 20% extension deficit and 25% flexion deficit The average aesthetic evaluation of the coverage was 3.66 for the OSAS score and 3.77 for the POSAS score. At the donor site, the average scar burden was 2.77 (score from 1 to 7; 7 being the worst). No functional deficit was ever described.

Conclusion: Fascial flaps correspond to a highly vascularized and gliding sheet, thus avoiding adhesions between tendinous structures and the covering tissue. Furthermore, their thinness allows for optimal integration, minimizing the scar burden. Although rarely reported, fascial flaps are, in our opinion, very interesting for covering substance loss in hands.

Plastic surgery is entering a phase in which clinical excellence increasingly depends on the integration of surgical expertise with data science, outcome analytics, and healthcare systems engineering. Across reconstructive domains - including microsurgery, burn care, oncologic reconstruction, and complex wound management - large clinical datasets and computational methods are enabling new forms of decision support that extend beyond traditional experience-based practice.

This session introduces the concept of "data-driven plastic surgery" informed by recent translational research integrating artificial intelligence into clinical workflows. Examples include machine-learning–based prediction of wound healing trajectories, contactless perfusion assessment in microsurgical reconstruction, and quantitative evaluation of operative resource allocation aimed at improving fairness and sustainability within surgical systems. These approaches demonstrate how predictive modeling can enhance perioperative risk stratification, optimize monitoring strategies, and support evidence-informed organizational decision-making.

Importantly, the discussion emphasizes interpretability and clinical integration rather than technological replacement of surgical judgment. Lessons learned from prospective clinical studies and implementation projects illustrate challenges related to data quality, workflow adoption, ethical considerations, and interdisciplinary collaboration between surgeons, engineers, and data scientists.

Beyond individual technologies, the session proposes a systems-level perspective in which plastic surgeons act as integrators of complex care pathways-linking outcomes research, digital innovation, and reconstructive problem-solving. Case-based examples from burn reconstruction, oncologic surgery, and microsurgical practice demonstrate how data-informed approaches can simultaneously improve patient outcomes, resource utilization, and equity within surgical care.

By combining surgical craftsmanship with predictive analytics and systems thinking, data-driven methodologies position plastic surgery at the forefront of modern interdisciplinary medicine and redefine the surgeon's role as both operator and architect of evolving healthcare systems.

Introduction Dupuytren's disease (DD) is a fibro-proliferative disorder of unknown aetiology. It affects the palm and is characterised by progressive fibrosis, thickening of palmar fascia, and excess collagen deposition. Patients present with nodules, progressing to the cords, causing flexion deformity in ~50% and resulting in loss of hand function. Although excision is the standard treatment for DD, recurrence remains high and a 2015 Cochrane review concluded there is insufficient evidence to show superiority of any procedure being used. Genetic and other studies have implicated WNT signalling in Dupuytren pathology, including WNT4 dysregulation. However, it is not yet clear how WNT signalling or whether WNT4 plays an important role in triggering Dupuytren's disease. Aim To investigate whether downregulation of WNT4 expression leads to 'Dupuytren's-like' transcriptome changes in normal skin fibroblasts. Method Fibroblasts were isolated from the wrists of control healthy adult males and from a family that had inherited DD. Normal skin fibroblasts were treated with WNT4 siRNA and transcriptome of normal skin untreated, normal skin siRNA treated and DD family fibroblasts compared using RNASeq.

Results Analysis of the transcriptomes from DD patient and normal skin fibroblasts showed significant differences including in WNT4 expression. Downregulation of WNT4 in normal skin fibroblasts using siRNA led to 'DD-like' changes in the transcriptome.

Conclusions In people susceptible to DD WNT4 is downregulated even in non-fibrotic fibroblasts. Knockdown of WNT4 in normal fibroblasts led to changes that made cells 'DD-like', suggesting downregulation of WNT4 is a driver of Dupuytren's disease. Previous studies have shown that WNT4 is downregulated in DD disease in the cord cells. However, this study shows that WNT4 is down regulated in 'non-disease' cells, , and that downregulating WNT4 in normal skin fibroblasts leads to widespread 'DD like' changes in the transcriptome, suggesting WNT4 downregulation is a key driver of DD disease.

Purpose: Tongue reconstruction following oncologic resection aims to restore speech, swallowing, and oral sensation. The anterolateral thigh flap is widely used because of its reliability and versatility in soft tissue reconstruction (1,5). However, conventional designs may be bulky and insensate, limiting optimal functional integration. This study evaluates a sensate suprafascial Trishul pattern anterolateral thigh flap designed to improve anatomical conformity, flap pliability, and sensory restoration. Methods: A retrospective study was performed on 20 patients who underwent tongue reconstruction with the Trishul pattern flap following hemi glossectomy or subtotal glossectomy. The flap design consists of a central primary lobe with three tapered extensions that allow intraoperative shaping to recreate tongue bulk, tip, and lateral margins. Elevation in the suprafascial plane provides a thinner and more pliable flap, reducing donor site morbidity and the need for secondary debulking (2). Sensory nerve coaptation was performed with the lingual nerve or inferior alveolar nerve when feasible. Functional outcomes were assessed at 3 and 6 months using Speech Intelligibility Scores, Functional Oral Intake Scale, MD Anderson Dysphagia Inventory, two point discrimination testing, and EORTC QLQ H and N35 questionnaires. Results: All flaps survived without major complications. The Trishul configuration enabled improved intraoral fit and contour with minimal requirement for secondary revision procedures. Mean time to resumption of oral intake was 6.2 days. At 6 months follow up, 90 percent of patients demonstrated intelligible speech, 85 percent resumed a normal diet, and 80 percent regained protective oral sensation. Quality of life scores improved across key functional domains. Compared with previously described shaped anterolateral thigh flaps such as mushroom shaped and ghost shaped configurations, the Trishul pattern allows more adaptable intraoperative contouring for complex tongue defects (3,4). Conclusions: The sensate suprafascial Trishul pattern anterolateral thigh flap offers a customizable and anatomically adaptive option for tongue reconstruction. Its tailored geometry combined with sensory nerve coaptation facilitates improved functional integration and oral rehabilitation compared with conventional flap designs. References 1. Vincent A, Kohlert S, Lee TS, Inman J, Ducic Y. Free flap reconstruction of the tongue. Semin Plast Surg. 2019;33:38–45. 2. Chen YC, Scaglioni MF, Kuo YR, Erdmann D. Suprafascial anterolateral thigh flap harvest a simplified approach for reduced donor site morbidity. Plast Reconstr Surg Glob Open. 2016;4:e1075. 3. Schonauer F, Murone V, De Gregorio L, Cavaliere A. The ghost shaped anterolateral thigh flap for total tongue reconstruction. JPRAS Open. 2024;41:400–405. 4. Longo B, Pagnoni M, Ferri G, Morello R, Santanelli F. The mushroom shaped anterolateral thigh perforator flap for subtotal tongue reconstruction. Plast Reconstr Surg. 2013;132:656–663. 5. Tong XJ, Tang ZG, Shan ZF, Guo XC. The anterolateral thigh flap for soft tissue reconstruction in patients with tongue squamous cell carcinoma. World J Surg Oncol. 2016;14:213.