Scientific Abstract Presentations: Aesthetic Session 3 Thursday, October 15 Thu, Oct 15 5:00-6:00 p.m. CDT

Purpose Patients are increasingly turning to online platforms to choose their surgeons. Prior work has demonstrated significant discrepancies between physicians who self-identify as plastic surgeons on social media and their actual training history and American Board of Plastic Surgery (ABPS) certification. In a similar manner, this study evaluates the online presence of self-identified plastic surgeons using the Google search engine to identify potential misinformation and deceptive advertising.

Methods A systematic search was conducted using the Google search engine for the terms "plastic surgeon," "cosmetic surgeon," and "aesthetic surgeon" across the 50 most populous United States cities. For each term and city, the top 20 results were recorded, yielding 3,000 unique search results. Physician characteristics collected included gender, training history, and practice information. Demographic data extraction was performed using ChatGPT-4o and verified manually. Board certification status was confirmed using the ABPS online verification tool. Geographic regions were classified according to American Association of Medical Colleges regional divisions. Statistical analysis was performed using descriptive statistics and chi-square testing, with ad hoc analysis using standardized residuals.

Results A total of 1,526 unique physicians were identified. Most were male (75 percent) and attended medical school in the United States (92 percent). Twenty-two percent completed an integrated plastic surgery residency, while 60 percent completed an independent plastic surgery residency. The majority of physicians self-identified as plastic surgeons (92 percent), with the remainder identifying as cosmetic or aesthetic surgeons. Overall, 26 percent of physicians were not ABPS board certified. Among those self-identifying as plastic surgeons, 19 percent lacked ABPS certification. Twenty-one percent of all search results and 10 percent of self-identified plastic surgeons had no formal plastic surgery training. The southern region had a significantly higher proportion of physicians without plastic surgery training compared with other regions (p equals 0.002). Surgeons in the northeast were more likely to have completed independent plastic surgery training, while those in the south were more likely to have completed integrated training (p equals 0.001 and p less than 0.001, respectively). Surgeons with integrated training backgrounds were more likely to advertise injectable services compared with independently trained surgeons (p equals 0.005).

Conclusion A substantial proportion of physicians identified as plastic surgeons in Google search results lack formal plastic surgery training or ABPS board certification. This misrepresentation, previously identified on social media platforms, may mislead patients seeking qualified surgical care and poses a potential risk to patient safety. Regional differences in training pathways suggest variability in access to appropriately trained surgeons. Increased advocacy and oversight by professional organizations are needed to address inaccurate online advertising and uphold the standards of board-certified plastic surgery.

References:

1. Awad SK, Cowen J, Patel J, Aluri AK, Ananthasekar S, Singh NP, et al. Plastic Surgeons Are Underrepresented When Searching Hospital Websites for a Hand Surgeon. Plast Reconstr Surg. 2023;151(6):1055e-8e.

2. Singh NP, Boyd CJ, Aluri A, Kovac S, Mainali B, Girardi A, et al. One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites. Plastic and Reconstructive Surgery – Global Open. 2023;11(1):e4781.

3. Singh NP, Holohan MM, Harmon C, Fallah KN, Gross J, Patel A, et al. Instagram Versus Reality: Who Are Actually Plastic Surgeons? Plast Reconstr Surg Glob Open. 2025;13(1):e6426.

Purpose: Keloids and hypertrophic scars cause symptomatic and psychosocial morbidity, and multimodal regimens are widely used despite limited direct comparisons with single-modality therapy using standardized outcomes (1). We performed a blinded, image-based evaluation to compare changes in Vancouver Scar Scale (VSS) scores after single-modality versus multimodal treatment (2).

Methods: We conducted a retrospective observational study of patients treated at Stanford Hospital from 2006 to 2021 with available standardized clinical photographs obtained both prior to initiating therapy and after completion of treatment. Patients were grouped as single-modality therapy (intralesional triamcinolone acetonide (Kenalog), pulsed dye laser (PDL/V-beam) or multimodal therapy (combinations of Kenalog, 5-fluorouracil (5-FU), and/or PDL). Patients who underwent surgical excision/revision after initiation of nonsurgical therapy during the treatment course were excluded to avoid confounding from tissue removal. Pre- and post-treatment photographs were de-identified, paired by patient, randomly ordered within the overall image set, and evaluated independently by blinded medical professionals at multiple training levels (attending physicians, resident physicians, physician assistants, and medical students). Raters scored the scars based on vascularity, pigmentation, pliability, and height. For each patient, rater scores were used to calculate pre-to-post change (ΔVSS) for each domain. Timing was not standardized in this retrospective cohort.

Results: Sixty-seven patients met inclusion criteria: 24 received single-modality therapy and 43 received multimodal therapy. Single-modality treatments included Kenalog (n = 9), laser monotherapy (n = 3), and surgical excision/revision (n = 11); no patients received 5-FU monotherapy. Multimodal regimens included Kenalog + laser (n = 24), Kenalog + 5-FU (n = 1), and Kenalog + laser + 5-FU (n = 10). Across the full cohort, significant improvement was observed in pliability and height, while vascularity and pigmentation did not significantly change. After excluding surgically treated cases, improvements in pliability and height remained significant. When comparing single-modality versus multimodal therapy, no statistically significant between-group differences were detected in any VSS domain or total score, both in analyses including surgery and after excluding surgical cases. Similarly, comparisons among individual single-agent modalities and among multimodal regimens did not demonstrate significant pairwise differences in ΔVSS outcomes.

Conclusions: In this blinded photographic analysis, both single-modality and multimodal approaches were associated with measurable improvement predominantly in scar structural parameters (pliability and height), with limited change in vascularity and pigmentation. Multimodal therapy did not confer a statistically significant advantage over single-modality treatment in this real-world cohort. Prospective studies with standardized protocols, defined follow-up intervals, and inclusion of patient-reported outcomes are needed to clarify which scar phenotypes derive meaningful benefit from combination therapy.

1. Brissett AE, Sherris DA. Scar contractures, hypertrophic scars, and keloids. Facial Plast Surg. 2001;17(4):263-272.
2. Forbes-Duchart L, Marshall S, Strock A. Determination of inter-rater reliability in pediatric burn scar assessment using a modified version of the Vancouver Scar Scale. J Burn Care Res. 2007;28(3):460-467.

PURPOSE/ BACKGROUND: Tranexamic acid (TXA) is a synthetic antifibrinolytic that stabilizes fibrin clots by inhibiting plasminogen activation. Recently, TXA use has expanded to plastic surgery due to initial studies demonstrating improved effects on ecchymoses and edema in cosmetic procedures. However, there are limited consensus recommendations and formal specialty guidelines have not yet been established. Therefore, this study aimed to identify patient, procedural, and geographic factors associated with same day TXA administration across elective plastic surgery procedures.

METHODS: A multicenter retrospective cohort study was conducted using the TriNetX Research Network database. Inclusion criteria included adults ( 18 years old) undergoing elective plastic surgery procedures involving the face, breast and abdomen (17 specific CTP codes) between 2018 and 2024. Multivariable logistic regression was used to evaluate factors associated with TXA administration on the day of surgery, adjusting for demographic, clinical, and procedural characteristics.

RESULTS: A total of 125,750 patients were identified, of whom 9,543 (7.6%) received same-day TXA. In multivariable analysis, higher odds of same day TXA administration were observed in female patients (aOR 1.17, 95% CI: 1.08-1.27, p<0.001), in Asian (aOR 1.15, 95% CI: 1.01-1.31, p=0.029) and Black or African American patients (aOR 1.08, 95% CI: 1.00-1.16, p=0.040). Lower odds were observed with older age (aOR 0.99 per year, 95% CI: 0.99-0.99, p<0.001), Hispanic ethnicity (aOR 0.75, 95% CI: 0.69-0.81, p<0.001), smoking (aOR 0.87, 95% CI: 0.78-0.98, p=0.018), obesity (aOR 0.94, 95% CI: 0.88-1.00, p=0.049), and renal failure (aOR 0.78, 95% CI: 0.66-0.93, p=0.006). TXA use differed by region, with lower odds in the South (aOR 0.54, 95% CI: 0.50-0.58, p<0.001) and higher odds in the West (aOR 1.70, 95% CI: 1.60-1.80, p<0.001) relative to the Northeast. Procedure type was a major driver of TXA administration, with higher odds in facelift (aOR 3.97, 95% CI: 3.39-4.66, p<0.001), gynecomastia mastectomy (aOR 2.70, 95% CI: 2.32-3.13, p<0.001), and breast augmentation (aOR 1.65, 95% CI: 1.49-1.82, p<0.001), and lower odds in blepharoplasty (aOR 0.39, 95% CI: 0.35-0.44, p<0.001), implant insertion or replacement (aOR 0.61, 95% CI: 0.54-0.68, p<0.001), and breast reconstruction revision (aOR 0.61, 95% CI: 0.55-0.67, p<0.001).

CONCLUSION: Same day TXA administration in elective plastic surgery increased substantially between 2018 and 2024, reflecting growing adoption despite the absence of formal specialty-specific guidelines. TXA administration was highly variable and appeared to be driven strongly by procedure type and geographic region. Higher utilization in facelift, gynecomastia surgery, and breast augmentation, suggests that surgeons may preferentially adopt TXA in operations where hematoma risk can be greater. As utilization continues to rise, there is a need for prospective studies to evaluate efficacy, dosing strategies, and route of administration across procedure types. Establishing evidence-based, specialty-specific guidelines may optimize patient outcomes and equitable care in plastic surgery.

Purpose Choice between Deep Plane Facelift (DPF) and SMAS facelift is often guided by surgeon preference rather than comparative evidence, partly due to inconsistent outcome reporting. This study synthesizes available comparative data to determine whether DPF provides site-specific aesthetic advantages and whether these translate into global appearance and patient satisfaction.

Methods A PRISMA-guided systematic review of four databases identified 49 eligible studies evaluating DPF versus SMAS. Only four studies reported extractable comparative outcome data for aesthetic endpoints. Because most studies did not report variance measures (e.g., SD/SE), standardized meta-analysis of continuous outcomes was not feasible. Comparative analysis was therefore performed using (1) normalized mean-score scaling (0–100) for continuous aesthetic domains and (2) relative risk (RR) for binary satisfaction where available. Primary domains were overall appearance, malar eminence, and jowls/jawline.

Results Comparative outcomes demonstrated anatomy-dependent efficacy. DPF achieved higher normalized scores for: Malar eminence (midface): 66.3 vs 38.4 (DPF vs SMAS) Jowls/jawline: 75.6 vs 62.9 However, global outcomes did not favor DPF: Overall appearance: 72.8 (DPF) vs 75.0 (SMAS) Patient satisfaction: non-significant difference (RR = 1.13)

Conclusion Available comparative evidence suggests DPF may provide targeted advantages in midface projection and jawline/jowl correction, but these gains do not consistently translate into superior overall appearance or satisfaction. Procedure selection should therefore be anatomy-driven, reserving DPF for patients whose primary deformity is midface descent or requires maximal structural repositioning. The review also highlights a major limitation in the facelift outcomes literature: inadequate reporting of variance metrics prevents robust quantitative synthesis. Future comparative studies should report mean outcomes with SD/SE and standardized scales to enable reproducible, evidence-based guidelines.

PURPOSE: Penile enhancement ranks as the second most desired aesthetic surgery among men worldwide, and nationally, gender-affirming surgeries nearly tripled between 2016 and 2019, with genital reconstructive procedures becoming more common among older individuals. This increasing demand for cosmetic procedures targeting male genitalia underscores the need to better understand aesthetic preferences, enabling surgeons to align procedures with patient expectations. Gaps in the literature include the aesthetic appeal of structures surrounding the penis, such as the scrotum and Mons pubis, and overall genital aesthetics or the relationship between these subunits. Demographic variations in these preferences across race, gender, and sexual orientation also remain understudied. This study aims to address these limitations and quantify aesthetic preferences for the male external genitalia, offering a more holistic approach to aesthetic evaluation and surgical planning.

METHODS: A literature review on existing male external genitalia preferences was conducted. Subsequently, a 3D 'base' model of male external genitalia was created by a professional 3D designer using Blender 3D, guided by measurement preferences from the literature review. Additional 3D models were generated from the base model by adjusting one of five variables: mons projection, glans girth, shaft girth, shaft length, and scrotal volume. Models were manipulated by varying each variable by +/- standard deviation, generating 2 models per variable and 10 total models. An online survey using the models was created to collect respondents' data on aesthetic preferences and demographic information, including gender identity, sexual orientation, and ethnicity. Statistical analyses comparing attractiveness ratings across different demographics will be completed.

RESULTS: The literature review found mean flaccid and erectile shaft girths at 9.31cm and ranging from 11.66-12.23cm (mean 11.95cm), respectively (1, 2). Mean flaccid and erectile shaft lengths were 9.16cm and ranging from 13.12-14.15cm (mean 13.64cm), respectively (1, 2). Data on the mons projection, glans girth, and scrotal volume were insufficient or nonexistent. Currently, preliminary model data has been gathered. Multiple prototype models were generated, and ten were finalized based on anatomical accuracy and clinical relevance by a panel of experts. Additional data on aesthetic preferences is pending layperson analysis.

CONCLUSION: Insights from this study can be used as a tool to educate patients undergoing aesthetic surgeries for male genitalia, including penile lengthening, girth enhancement, scrotal reductions, penoscrotal web correction, and revision surgeries for hidden or buried penises. Results could also inform sub-industries of plastic surgery, such as fashion, fitness, and marketing, by highlighting features considered attractive in different demographics.

REFERENCES: (1) Veale D, Miles S, Bramley S, Muir G, Hodsoll J. Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men. BJU Int. 2015;115(6):978-986. doi:10.1111/bju.13010 (2) Herbenick D, Reece M, Schick V, Sanders SA. Erect penile length and circumference dimensions of 1,661 sexually active men in the United States. J Sex Med. 2014;11(1):93-101. doi:10.1111/jsm.12244

Introduction

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine gland–bearing skin, leading to recurrent abscesses, sinus tracts, and scarring. Massive weight loss (MWL) frequently leads to redundant skin that exacerbates friction, moisture, and secondary infection, particularly in areas prone to HS. Addressing both conditions concurrently may enable sustained disease control while improving contour, function, and quality of life.

Methods

We performed a single-institution retrospective review of patients who underwent surgical treatment for HS between August 1 2022 and 2025. Demographics, clinical characteristics (e.g. weight loss, medical and HS history), operative details, and post-operative outcomes (infection, dehiscence, seroma, hematoma, unplanned return to the operating room) were compared using non-parametric tests. Predictors of any postoperative complication were evaluating using Firth's penalized logistic regression to address rare events at the patient level and random-effects logistic regression to account for multiple procedures per patient at the surgery level. Variables identified as statistically (p<0.05) or clinically significant were included in multivariable models (R 4.5.1). Analyses were exploratory, and effect estimates are presented as odds ratios with 95% confidence intervals.

Results

Among 44 patients who underwent HS excision, 21 had a history of MWL with documented skin redundancy, and 23 were included as non-MWL controls. MWL status was not associated with differences in age or BMI at initial operation, race, sex, smoking, or HS treatment history (all p > 0.20). Major comorbidities (e.g., diabetes, endocrine disorders) were more common in MWL patients (76.2% vs. 39.1%, p=0.017). MWL patients also had significantly greater total excised tissue volume (median 4,128 cm3 vs 94 cm3, p<0.001) and more frequently underwent combination procedures (85.7% vs. 52.2%, p=0.024), with abdominal operations (panniculectomy and HS excision) occurring exclusively in this group (n=12). No other differences in treatment area or Hurley stage were observed.

At the patient level, MWL status showed a trend towards higher odds of any complication that did not reach statistical significance (OR 2.05, 95%CI 0.60-7.31, p=0.251). This association further attenuated after adjusting for age, comorbidities, smoking, and excised tissue volume (aOR 1.39, 95%CI 0.99-1.12, p=0.137).

At the surgery level (n=73 procedures), smoking increased odds of postoperative complications more than threefold (OR 3.26, 95%CI 1.06-10.01, p=0.039), as did excising multiple regions or undergoing combined procedures (OR 3.50, 95%CI 1.06-11.56, p=0.040). Greater excised tissue volume per operation (log-transformed) also predicted higher complication rates (p=0.007). MWL status demonstrated a trend towards increased per-surgery complication risk (OR 2.74 95%CI 0.89-8.42, p=0.078), though this association diminished after multivariable adjustment (OR 1.58 95%CI 0.45-5.57, p=0.479).

Conclusion

Surgical complexity and patient risk factors, rather than MWL status alone, appear to be the main drivers of postoperative complications. With appropriate patient selection and risk optimization, combining body contouring procedures with HS excision may allow patients to achieve durable disease control alongside improvements in contour, function, and quality of life.

Background: Widespread adoption of glucagon-like peptide-1 (GLP-1) receptor agonists has contributed to a growing population of patients presenting for body contouring following GLP-1-assisted weight loss.(1) Recent evidence has demonstrated that preoperative semaglutide use is associated with higher rates of wound dehiscence, surgical site infection, and delayed wound healing.(2) However, as the dual GLP-1/GIP receptor agonist tirzepatide gains adoption, a direct comparison of outcomes between semaglutide and tirzepatide users undergoing body contouring has not been previously reported.

Methods: A retrospective cohort study was performed using the TriNetX Global Collaborative Network, encompassing 168 healthcare organizations. Patients who underwent body contouring (CPT 15830–15839, 15847) between 2021 and 2024 with documented use of semaglutide (n=1,246) or tirzepatide (n=428) at least one month before surgery were identified. Patients with malignancy, type 1 diabetes mellitus, or concurrent use of both agents were excluded. Propensity score matching 11 characteristics yielded 409 patients per cohort with reduced standardized differences across covariates and <0.1 for demographic variables. Outcomes assessed within 90 days included wound dehiscence, surgical site infection (SSI), hematoma, hemorrhage, seroma, deep vein thrombosis (DVT), pulmonary embolism (PE), skin necrosis, and mortality.

Results: Following propensity score matching, the semaglutide cohort demonstrated lower rates of wound complications across all measured outcomes. Wound dehiscence occurred in 3.7% of semaglutide patients versus 6.6% of tirzepatide patients, approaching significance on risk analysis (risk difference −0.03, p=0.057) and reaching statistical significance on survival analysis (log-rank p=0.043; HR 0.53, 95% CI 0.28–0.99). SSI rates were 5.6% versus 8.6% (p=0.102; log-rank p=0.075), and combined hematoma, hemorrhage, and seroma rates were 3.4% versus 4.4% (p=0.471). DVT, PE, skin necrosis, and mortality occurred at insufficient rates for statistical analysis in either cohort.

Conclusions: This study represents the first direct comparison of postoperative outcomes between semaglutide and tirzepatide users in the setting of body contouring surgery. While subject to limitations of retrospective observational databases and electronic healthcare coding, both agents demonstrated low rates of serious adverse events, supporting the safety of operating on patients with a history of GLP-1 receptor agonist use. A consistent trend toward lower wound complication rates was observed with semaglutide, with wound dehiscence reaching statistical significance on survival analysis, suggesting that the specific GLP-1 receptor agonist may influence postoperative outcomes. Clinicians may consider enhanced perioperative optimization for tirzepatide users, including nutritional counseling, medication timing, and wound surveillance. As tirzepatide adoption increases, prospective studies are warranted to further characterize complication profiles between agents.

References 1. Khong J, Suresh R, Park KE, Soltanian H. New contours, different risks: a 9-year comparison of trends and postoperative complications in patients undergoing aesthetic surgery with previous bariatric surgery vs glucagon-like peptide 1 receptor agonist use. Aesthet Surg J. 2025;45(11):1159-1165. doi:10.1093/asj/sjaf131 2. Lewis JE, Ghogomu M, Hickman SJ, Ashade A, Hollis RJ, Lewis JE, Lee WC. Semaglutide and postoperative outcomes in nondiabetic patients following body contouring surgery. Aesthet Surg J. 2025;45(4):381-386. doi:10.1093/asj/sjae241

Background Abdominoplasty and panniculectomy are commonly performed body-contouring procedures, with demand continuing to rise as more patients undergo medical and surgical weight loss. At the same time, glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for the treatment of obesity and diabetes (1). These medications can significantly affect weight trajectory, nutritional status, and overall metabolic rate, which can all impact postoperative healing. However, the impact of preoperative GLP-1RA use on outcomes after body-contouring surgery remains unclear. This study evaluated whether preoperative GLP-1RA exposure is associated with 90-day postoperative complications following abdominoplasty or panniculectomy.

Methods A multicenter retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Data were queried from January 1, 2006 to February 19, 2026. Adults (>18 years old) undergoing abdominoplasty or infraumbilical panniculectomy (CPT codes 15847/15830) were queried. Patients were categorized into two cohorts based on medication Patients were stratified based on preoperative medication exposure within 1-12 months prior to surgery into a GLP-1 receptor agonist (GLP-1RA) cohort and a metformin comparator cohort. Propensity score matching (1:1) was performed to balance baseline characteristics. The primary analysis evaluated 90-day postoperative complications, including surgical site infection (SSI), wound disruption, seroma/hematoma/hemorrhage, emergency department (ED) visits, cellulitis, incision and drainage, and need for debridement. Outcomes were compared using measures of association, including risk ratios and odds ratios.

Results Before matching, 1,795 patients in the GLP-1RA cohort and 976 patients in the metformin cohort met inclusion criteria. After 1:1 propensity score matching, 955 patients remained in each cohort. At 90 days, the GLP-1RA cohort demonstrated a significantly lower risk of cellulitis/acute lymphangitis compared with the metformin cohort (3.2% vs. 5.7%, p=0.021). There were no significant differences between cohorts in surgical site infection (7.0% vs. 8.8%, p=0.158), wound disruption (7.7% vs. 9.2%, p=0.263), or seroma/hematoma/hemorrhage (7.9% vs. 6.1%, p=0.113). Rates of emergency department visits, incision and drainage, and need for debridement were also similar.

Conclusion Patients with preoperative GLP-1RA exposure exhibited 90-day major wound complication rates similar to those in metformin-treated patients undergoing abdominoplasty or panniculectomy. Notably, the GLP-1RA group demonstrated a reduced incidence of cellulitis, although further studies are needed to elucidate the impact of individual agents and perioperative dosing schedules on outcomes in these body-contouring procedures.

References 1. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384:989–1002.

Background. While pharmacologic weight loss therapies like glucagon-like peptide-1 receptor agonists (GLP-1RAs) have increased in popularity, body contouring patients' utilization of other weight loss modalities remains unclear. Aside from GLP-1RAs, other FDA-approved pharmacologic weight loss medications for non-syndromic obesity include orlistat, phentermine/topiramate, and bupropion/naltrexone.[1] This retrospective cohort study examined the weight loss modalities used by body contouring patients and their impact on procedure choice.

Methods. The TriNetX Research Network was queried for patients who received abdominoplasties (CPT 15847), panniculectomies (CPT 15830), brachioplasties (CPT 15836), and thighplasties (CPT 15832) between 2012 and 2024. Mann-Kendall test was used to assess monotonic trends in the annual incidence of each weight loss modality over time. Kendall's τ ranges from -1 to +1, where +1 is a perfect positive monotonic trend (consistent increase) and -1 is a perfect negative monotonic trend (consistent decrease). Utilization of weight loss modalities was stratified by type 2 diabetes diagnosis and procedure type. Benjamini-Hochberg adjustment was used to control for false discovery rates with multiple comparisons.

Results. 34,712 body contouring patients were included. Bariatric surgery (14.34%) was the most prevalent medical weight loss modality. By Mann-Kendall test, bariatric surgery (τ=0.87, p<0.001), bupropion (τ=0.73, p=0.004), naltrexone (τ=0.73, p=0.004), and liraglutide (τ=0.69, p=0.007) demonstrated the strongest increases in utilization overall. Subgroup analyses were performed to assess trends in patients with type 2 diabetes and patients without type 2 diabetes. Among patients without type 2 diabetes, bariatric surgery (τ=0.96, p<0.001) and liraglutide (τ=0.91, p<0.001) demonstrated the strongest increase in utilization trends. Among patients with type 2 diabetes, bariatric surgery (τ=0.87, p=0.007) and liraglutide (τ=0.38, p=0.15) similarly demonstrated the greatest increase in utilization. Patients in both cohorts also increasingly utilized bupropion, naltrexone, phentermine, and topiramate (all τ>0, p<0.032). Orlistat use significantly decreased in patients with type 2 diabetes (τ=-0.87, p<0.001) and patients without type 2 diabetes (τ=-0.60, p=0.02) over the study period. Patients' receipt of abdominal contouring and extremity contouring was also compared by weight loss modality. Patients who utilized bariatric surgery (95.34% vs 91.53%, p<0.001), liraglutide (94.06% vs 91.53%, p=0.009), and phentermine (93.78% vs 91.53%, p<0.001) had significantly higher rates of abdominal contouring procedures compared to non-medical weight loss controls. Patients who received bariatric surgery also had significantly lower rates of extremity contouring procedures compared to non-medical weight loss controls (9.20% vs 11.01%, p=0.001).

Conclusions. Body contouring patients increasingly utilize a variety of surgical and pharmacologic weight loss modalities. Patients using potent weight loss modalities may have an increased need for abdominal contouring compared to extremity contouring, potentially due to preferential abdominal skin laxity from massive weight loss.

References: 1. Chakhtoura M, Haber R, Ghezzawi M, Rhayem C, Tcheroyan R, Mantzoros CS. Pharmacotherapy of obesity: an update on the available medications and drugs under investigation. eClinicalMedicine. 2023;58. doi:10.1016/j.eclinm.2023.101882

Purpose Patients increasingly rely on social media for health information (1). One of the largest platforms, TikTok, remains largely unregulated, and studies show that up to half of health-related videos contain misleading or false information (2). In aesthetic plastic surgery, where patient expectations strongly influence satisfaction and perceived outcomes, exposure to inaccurate or incomplete information may directly affect consultations and decision-making. This study characterized publicly available TikTok content for the three most popular cosmetic surgery procedures (liposuction, breast augmentation, and abdominoplasty) and evaluated the quality and reliability of information using validated tools (3).

Methods A cross-sectional analysis of TikTok videos was conducted on September 9, 2025. A new account was created to minimize algorithmic bias. Search terms included both lay and medical terminology. Videos with more than 1,000 views were included, while non-English videos and unrelated content were excluded.

Three independent reviewers collected data on creator characteristics, engagement metrics, and content type (advertisement, before-and-after, educational, live procedure, patient experience, social/entertainment, and other). Creator professions were confirmed using TikTok biographies or online searches. Two validated 5-point scales were used: the Global Quality Score (GQS) was for quality and usefulness, and the modified DISCERN (mDISCERN) criteria for reliability and transparency (4,5). Statistical significance was set at p < 0.05.

Results
A total of 355 TikTok videos met our inclusion criteria: 129 liposuction, 127 breast augmentation, and 99 abdominoplasty. Most were created by patients (79%), plastic surgeons (12%), other non-medical professionals (6%), and other physicians (3%). Breast augmentation had the highest proportion of patient-created content (p<0.0001).

Before-and-after videos were most common (44%), followed by patient experiences (26%), social/entertainment (12%), and educational content (8%). Liposuction videos received the highest engagement, averaging 36,751 likes, 506 comments, and 3,303 shares, while abdominoplasty videos had significantly fewer comments and saves (p = 0.016 and p = 0.013).

The mean GQS was 3.17 ± 1.11 and mean mDISCERN was 0.72 ± 0.44, indicating moderate perceived usefulness but low reliability. Plastic surgeon-created videos scored significantly higher on both GQS (3.52 vs 3.21; p = 0.00068) and mDISCERN (2.40 vs 1.32; p < 0.0001). Educational videos demonstrated the highest GQS (4.57) and mDISCERN (3.04) scores, whereas social/entertainment and live procedure videos had the lowest across both metrics (p < 0.0001).

Conclusion TikTok is a powerful yet underutilized platform for patient education in aesthetic plastic surgery. High-engagement videos frequently emphasize visual transformation and personal narrative while lacking transparent discussion of risks and limitations. Although patient-generated content fosters peer dialogue about body image and recovery, it is often less accurate and less reliable than physician-created content.

Educational videos, though less common, demonstrated the highest quality and reliability scores, highlighting an opportunity for plastic surgeons to more actively shape online discourse by integrating patient narratives with evidence-based commentary. Given the strong association between preoperative expectations and postoperative satisfaction, improving the accuracy and transparency of social media content may represent an important strategy to enhance shared decision-making and mitigate unrealistic expectations.

References 1. De Martino I, D'Apolito R, McLawhorn AS, et al (2017) Social media for patients: benefits and drawbacks. Curr Rev Musculoskelet Med 10:141–145. https://doi.org/10.1007/S12178-017-9394-7/METRICS 2. Zargaran A, Sousi S, Zargaran D, Mosahebi A (2023) TikTok in Plastic Surgery: A Systematic Review of Its Uses. Aesthet Surg J Open Forum 5:ojad081. https://doi.org/10.1093/ASJOF/OJAD081 3. Plastic Surgery Statistics | American Society of Plastic Surgeons. https://www.plasticsurgery.org/news/plastic-surgery-statistics. Accessed 13 Jan 2026 4. Bernard A, Langille M, Hughes S, et al (2007) A systematic review of patient inflammatory bowel disease information resources on the World Wide Web. Am J Gastroenterol 102:2070–2077. https://doi.org/10.1111/J.1572-0241.2007.01325.X 5. Charnock D, Shepperd S, Needham G, Gann R (1999) DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health (1978) 53:105–111. https://doi.org/10.1136/JECH.53.2.105