Scientific Abstract Presentations: Aesthetic Session 4 Friday, October 16 Fri, Oct 16 8:00-9:30 a.m. CDT

Purpose Revision rhinoplasty is among the most technically demanding facial plastic operations due to scarred planes, altered vascularity, and elevated patient expectations. Autologous cartilage (septum, auricle, rib) is widely considered the standard graft material, largely for perceived biocompatibility and long-term safety. However, much of the supporting literature is dominated by small, single-surgeon series that frequently report "0% complications," raising concern for small-study bias rather than a true zero-risk profile. This study establishes quantitative benchmarks for autologous revision rhinoplasty outcomes and places them in context against modern alloplastic alternatives. We additionally test the "Indication Paradox" by evaluating whether surgical indication (pure aesthetic vs functional/mixed) is a primary driver of patient-reported success despite similar structural durability.

Methods A systematic review identified studies reporting efficacy outcomes in revision rhinoplasty using autologous grafts. The search yielded 3,518 records; after deduplication and screening, 30 articles were retained for the main project, with 9 studies pre-specified for this abstract subset. Given expected clinical heterogeneity, DerSimonian–Laird random-effects models were used for pooling. Primary outcomes were (1) revision/reoperation rate as a durability endpoint and (2) patient satisfaction as a subjective success endpoint. A subgroup analysis stratified studies by indication: "Pure Aesthetic" vs "Functional/Mixed." Because head-to-head comparative studies were limited, autologous benchmarks were contextualized against the largest identified single-arm alloplastic series.

Results Across eight autologous studies (N=9,773), the pooled revision rate was 3.0% (95% CI: 2.0–4.0%), establishing a pragmatic durability benchmark and mitigating small-study "zero-event" distortion. In contextual comparison, the reference alloplastic series reported a 0.8% revision rate, suggesting that revision risk in contemporary practice may reflect trade-offs between biologic safety and mechanical behavior rather than a single dominant failure mode. For subjective outcomes, six autologous studies (N=279) demonstrated pooled satisfaction of 91.0% (95% CI: 83.0–99.0%) with substantial heterogeneity (I²=80%), consistent with variability in patient selection, baseline deformity, follow-up, and satisfaction instruments. Subgroup analysis demonstrated a marked "Indication Paradox": Functional/Mixed cohorts showed higher satisfaction (98.0%) than Pure Aesthetic cohorts (83.3%), despite no statistically significant difference in structural durability (5.0% vs 3.0%, p=0.57). This pattern supports that patient-reported success is strongly indication-dependent, likely reflecting different expectation thresholds and the additive perceived benefit of airway improvement in functional cases. The aesthetic subgroup's satisfaction gap despite comparable revision rates suggests that minor contour irregularities or visibility can constitute meaningful "failure" for aesthetic-only patients even when graft survival is maintained.

Conclusion Autologous grafting in revision rhinoplasty demonstrates low failure rates (≈3%) and remains a dependable durability standard. However, indication is a dominant determinant of patient satisfaction, with aesthetic-only revisions showing substantially lower satisfaction than functional/mixed revisions despite similar structural revision rates. These data support indication-specific counseling and expectation calibration as core determinants of perceived success, and they justify continued comparative evaluation of modern alloplastic options for select cases where mechanical predictability and revision risk may differ from traditional assumptions.

Background: The advent of highly effective pharmacotherapies for obesity is poised to revolutionize the landscape of plastic surgery. As massive weight loss is increasingly achievable through non-surgical means, understanding the efficacy and safety of emerging agents is paramount for optimizing patient care prior to body contouring. Retatrutide (LY3437943), a novel GIP/GLP-1/glucagon receptor tri-agonist, represents a potential new frontier in medical weight management. We performed a systematic review and meta-analysis to quantify the impact of Retatrutide on key anthropometric and metabolic parameters relevant to aesthetic surgery.

Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane CENTRAL from inception to February 2, 2026, for randomized controlled trials (RCTs) comparing Retatrutide against placebo or other GLP-1 agonists. Data were pooled using a random-effects model. Mean differences (MDs) and risk ratios (RRs) were calculated with 95% confidence intervals (CIs). The primary endpoints were percent weight loss from baseline, reduction in waist circumference (cm), loss of visceral fat mass from baseline (%) measured by DEXA scan, and the incidence of ≥1 adverse drug reaction (ADR).

Results: Our analysis comprised five RCTs with 977 participants. Retatrutide demonstrated a profound, dose-dependent reduction in weight compared with placebo (MD –12.35%, 95% CI: [–14.81, –9.89]; p < 0.001). The effect was most pronounced at higher dosages and longer durations, such as the 8 and 12mg doses at 48 weeks (MD –22.46% and –23.28%). This was mirrored by significant decreases in both waist circumference (MD –9.83 cm; 95% CI [–13.52, –6.13]; p < 0.001) and visceral fat mass (MD –30.26 cm; 95% CI [–40.76, –19.76]; p < 0.001). In a direct comparison, Retatrutide was markedly superior to Dulaglutide for % weight loss (MD –8.73%, 95% CI [–11.90, –5.55]; p < 0.001). The overall risk of ADRs was significantly increased (RR 1.19; 95% CI [1.12, 1.27]; p < 0.001), particularly with 8mg and 12mg doses (RR 1.27 and 1.26, respectively).

Conclusion: Retatrutide induces substantial and clinically significant weight loss, accompanied by major improvements in central adiposity and visceral fat. For plastic surgeons, this uncovers a new era of pre-operative patient conditioning, potentially improving surgical outcomes and reducing risks associated with body contouring after massive weight loss. A thorough understanding of its dose-related adverse event profile is critical for appropriate patient counselling and multidisciplinary management.

Background: With rapid advancements in artificial intelligence (AI), its application in aesthetic surgery, particularly rhinoplasty, offers new opportunities for surgical planning, patient education, and visualization of outcomes. Yet, the aesthetic accuracy and cultural inclusivity of AI-generated facial imagery remain uncertain. This study aimed to assess whether AI image generators accurately represent the "ideal" female nose across diverse ethnicities based on established rhinoplasty guidelines. We hypothesized that AI-generated images would exhibit variable adherence to established rhinoplasty guidelines and limited representation of nasal diversity.

Methods: Standardized prompts requesting the "perfect nose," were entered into three publicly available AI text-to-image platforms (Dezgo, Freepik, and Imagine Art) to generate two frontal and two lateral "ideal" female facial images for each of the five ethnicities (African America, Asian, Caucasian, Hispanic, and Middle eastern), yielding 60 total images. Pixel-based nasal measurements were obtained in Fiji (ImageJ) using reference landmarks based on neoclassical canons, including nasolabial and columellar-labial angles, Goode's ratio, and standardized nasal width and length relationships. Each variable's fidelity to established anthropometric ideals was calculated using one-sample t-tests and two-way ANOVA with post hoc comparisons to assess differences in adherence to ideal proportions.

Results: AI-generated images showed significant deviations from the ideal nasal proportions described by established rhinoplasty aesthetic guidelines (p<0.05 for all frontal and lateral measurements). In frontal profile images, ethnic groups exhibited significant differences in deviation from ideal proportions for alar base–to–intercanthal distance (p < 0.01) and alar base–to–palpebral fissure width ratios (p < 0.01). Overall accuracy for frontal measurements varied significantly by ethnicity, with African American and Asian images demonstrating significantly greater deviation from the ideal relative to Caucasian images (mean difference = −0.01, CI [-0.14, -0.01], p=0.02 and mean difference = -0.07, 95% CI [-0.14, -0.01], p=0.03, respectively). For lateral profile, tip projection ratios (Goode's method) differed significantly across ethnic groups (p< 0.01). African American images showed greater deviations from the ideal tip projection range compared with Caucasian (mean difference = -0.22, CI [-0.34, -0.09], p<0.01), Hispanic (mean difference = -0.13, CI [-0.26, -0.01], p=0.04), and Middle Eastern images (mean difference = -0.23, CI [-0.36, -0.11], p<0.01), while Asian images differed significantly from Caucasian (mean difference = -0.17, CI [-0.30, -0.04], p<0.01) and Middle Eastern images (mean difference = -0.19, CI [-0.31, -0.06], p<0.01).

Conclusion: AI-generated depictions of African American and Asian females showed the greatest deviations from the classically established rhinoplasty guidelines of ideal nasal aesthetics, while Caucasian images most closely aligned with them. These findings highlight that both current AI training data and traditional aesthetic guidelines remain rooted in Western facial norms, emphasizing the need for more diverse, inclusive, and culturally representative standards of nasal aesthetics in surgical planning and AI mode development.

Introduction Body contouring procedures are commonly performed to address the skin laxity associated with massive weight loss (MWL). Historically, bariatric surgery has been the primary pathway to MWL. However, the rapid adoption of glucagon-like peptide-1 receptor agonists (GLP-1RAs) have introduced a new, non-surgical cohort of MWL patients seeking body contouring. As both patient populations present unique physiological profiles, it is crucial to understand if and how the method of weight loss impacts surgical outcomes. Our study addresses this gap by analyzing postoperative complications after body contouring surgery in patients who achieved weight loss via GLP-1RAs, bariatric surgery, or both.

Methods A preliminary retrospective review was performed of adult patients (n=265) who underwent various body contouring procedures after MWL between July 2009 and September 2024. Procedures include panniculectomy/abdominoplasty, breast reduction, mastopexy, brachioplasty, and thigh lift. Patients were stratified into three groups based on weight loss history: GLP-1RA use only (n=153), prior bariatric surgery (n=53), and both (n=59). Baseline data was collected and included demographics, BMI at time of surgery, type of plastic surgery procedure, and post-operative complications. Outcomes of interest included wound dehiscence, seroma, hematoma, infection, pulmonary embolism/DVT, and hypertrophic scarring. Statistical analysis was completed using Excel and R.

Results Overall, 48.3% of patients with a history of GLP-1RA use and/or bariatric surgery experienced at least one postoperative complication following body contouring surgery. Among those with GLP-1RA use alone, 43.8% of patients had wound healing complications, while 69.8% of those who had prior bariatric surgery alone experienced complications. For patients with a history of bariatric surgery combined with GLP-1RA use, 40.7% had wound healing complications. Comparisons showed a significantly lower risk of wound healing complications in the GLP-1RA only group versus the bariatric surgery only group (RR=0.63, 95% CI [0.49,0.81], p=0.002; NNT=4, 95% CI [3,9]). In the comparison of patients with a history of prior bariatric surgery, those with additional GLP-1RA use had a significantly lower complication rate than those with bariatric surgery alone (RR=0.58, 95% CI [0.41, 0.83], p=0.004; NNT=4, 95% CI [3, 9]). There was no significant difference in complications between the GLP-1RA-only group versus patients with both bariatric surgery history and GLP-1RA use.

Conclusion In this study, GLP-1RA use alone and GLP-1RA use combined with a history of bariatric surgery were both associated with a significantly lower rate of postoperative complications compared to bariatric surgery alone. These findings suggest a clinically beneficial role for GLP-1RAs in post-surgical healing in a high-risk patient population, potentially influencing preoperative counseling and postoperative management. As GLP-1RA prescribing volume continues to increase, further studies are warranted to examine the relationships of GLP-1RAs and their contribution to surgical risk profiles.

Background: Press and social media discourse discussing concepts such as "filler migration" and "filler fatigue" suggest that there may be shifting motivations among individuals to pursue more natural, stable long-term treatments for lip augmentation. Lip lifts offer targeted anatomic correction rather than altering the entire face or augmenting the soft tissue, producing unique changes that other procedures cannot attain. This study synthesizes current evidence on patient motivations, postoperative perceptions, and complications following lip lift surgery. Our aim is to identify recurring themes and provide a framework of patient-centered concepts for plastic surgeons to be aware of when counseling, planning, and treating patients undergoing this procedure.

Methods: A systematic search was conducted utilizing key words and phrases related to lip lift, patient satisfaction/perception, and outcomes. Studies published in the last 20 years discussing patient motivations, expectations, satisfaction, concerns, and/or outcomes were included. Articles focusing only on techniques or surgeon perspectives were excluded. Two reviewers independently screened records using Covidence, with discrepancies resolved by consensus or a third reviewer. Data included study characteristics, demographics, surgical technique, pre-operative patient motivations, postoperative patient concerns/complications, and satisfaction outcomes. A descriptive synthesis was performed to identify and group themes across studies. Specific items (e.g. terms or phrases) relating to patient concerns were extracted and quantified based on the number of sources mentioning that item.

Results: Of 771 studies title/abstracts screened, 43 full-text articles were reviewed. Ultimately, 11 studies covering 1,760 patients in eight countries were included. The bullhorn or modified bullhorn incision was the most frequently used technique (n=6). We identified 40 themes that fell into three main domains: aesthetics (78 mentions), physical/functional (20 mentions), and psychosocial well-being (8 mentions). Lip appearance (24 mentions; e.g. youthfulness, asymmetry) and philtrum/vermilion appearance (23 mentions; e.g. philtral length, Cupid's Bow definition) were most frequently mentioned under aesthetics. Visible scarring, scar quality, and amount of lift made up the majority of postoperative aesthetic factors. Scar revisions ranged from 3.5 to 23.2% and other revisions ranged from 0.6 to 6.1%. Recovery (e.g. swelling, numbness, stiffness) was an important physical/functional factor driving patient concerns (13 mentions), followed by oral function (6 mentions; e.g. difficulty eating, speaking, closing mouth). Impacts on self-identity and emotion such as confidence and embarrassment were less prominent with only 3 studies mentioning the topic. Interestingly, just one study discussed cultural aesthetic desires and expectations.

Conclusion: Our analysis identified dominating themes in the literature related to patient priorities and satisfaction. Aesthetic domains were most prominent, with patients prioritizing lip appearance and philtrum definition, though visible scarring emerged as a considerable postoperative concern. Physical and functional outcomes were often mentioned, particularly recovery (swelling, numbness) and oral function preservation, while psychosocial outcomes received minimal attention. These findings provide a framework for preoperative counseling-surgeons should discuss realistic outcomes, scar management, and recovery timelines. Future priorities include developing a standardized lip lift questionnaire, exploring cultural preferences and long-term psychosocial impacts.

Background: Persistent submandibular fullness despite platysmal tightening and fat reduction can mitigate cosmetic outcomes following aesthetic neck surgery. Surgeons routinely weigh superficial versus deep contributors when evaluating the aging neck, yet quantitative data comparing relative contributions of submandibular gland (SMG) morphology and other deep-neck structures in the same patient cohort are limited. Accordingly, characterizing how deep structure evolution is influenced by patient features such as age or body mass index (BMI) could refine operative prioritization and counseling.

Objective: To evaluate how age, sex, and BMI relate to SMG morphology, anterior digastric morphology, and hyoid-mandible relationships, and how the effects of these demographics concentrate in specific SMG/subplatysmal compartments.

Methods: We performed a retrospective two-timepoint imaging study of adults (≥18 years) with ≥2 accessible contrast-enhanced face/neck MRIs separated by ≥5 years. Manual bilateral segmentation and 3D analyses quantified total SMG volume, inframandibular SMG volume (axial), 3D infra-SMG volume, SMG heights (full and inframandibular; anterior/medial/posterior), anterior digastric volume, and hyoid/mandible measurements. Mixed-effects linear models estimated adjusted associations of sex, age, and BMI with 14 measured outcomes, accounting for within-patient clustering across repeated scans.

Results: Seventy-seven patients (42 female, 35 male) underwent paired timepoint 3D analyses (T1: age 51.7±19.3 years, BMI 26.45±5.35 kg/m2; T2: age 59.2±19.0 years, BMI 25.85±4.92 kg/m2; inter-scan interval 7.5±2.4 years). Older age was independently associated with larger SMG volumetric measures, including inframandibular gland volume (0.062 mL/year, p<0.001), total SMG volume (0.048 mL/year, p<0.001), and 3D infra-SMG volume (0.056 mL/year, p<0.001). Age was also associated with greater SMG height at multiple positions (full SMG and infra-SMG, anterior/medial/posterior), with the strongest effect at inframandibular medial height (0.182 mm/year, p<0.001), supporting a spatially-patterned aging signal that is most prominent in inframandibular and medial/posterior height measurements. BMI was positively associated with SMG volumetric outcomes (0.103-0.113 mL per kg/m2, all p≤0.003) but not with SMG heights, suggesting BMI relates to gland size without significantly moderating inferior displacement or vertical lengthening. Male sex was associated with larger SMG volumes and several height measures, particularly medial/posterior and inframandibular medial positions. Anterior digastric volume showed trend-level associations with age (p=0.072) and BMI (p=0.057), while standard hyoid positional distances were not significantly associated with age or BMI, suggesting comparatively weaker non-SMG signals in this cohort.

Conclusions: In this repeated-measures cohort, the strongest aging-related associations involved SMG volume and increased height consistent with a larger and lower/vertically lengthened gland after adjustment for sex and BMI. BMI was associated with SMG volume but not vertical length or position. Clinically, submandibular contour blunting may reflect predominantly size- and volume-driven fullness (more BMI-linked), position/vertical change (more age-linked), or both. Incorporating these measurements into preoperative assessment may improve patient selection for subplatysmal approaches, align expectations for cervicomental angle goals, and guide targeted imaging or interventions when exam findings suggest deep-neck fullness or a submandibular contour break. These data may also support standardized documentation of SMG-modulated neck anatomy, help surgeons decide when to prioritize SMG-focused interventions versus other deep contributors, and motivate prospective studies correlating imaging changes with postoperative satisfaction.

Purpose: Lower morbidity rates associated with sleeve gastrectomy have allowed this procedure to surpass gastric bypass in popularity despite reduced weight loss efficacy. While both gastric bypass and sleeve gastrectomy are tied to a distinct set of drawbacks, comparative complication rates after subsequent abdominal body contouring remain unknown. This study aims to compare complication rates between patients with a history of bariatric surgery after abdominal body contouring.

Methods: A retrospective chart review was conducted on n = 911 consecutive abdominal body contouring patients at a single academic institution between 2010 and 2020. Propensity score matching was employed yielding 280 well-matched pairs for complication comparison. Statistical significance was set to p <0.05.

Results: 309 patients with a history of sleeve gastrectomy were compared against 602 patients with a history of gastric bypass. Among baseline characteristics, gastric sleeve patients were more likely current tobacco users (p = 0.003) and exhibited longer operating times (305.9 minutes vs. 269.8 minutes, p < 0.001). After propensity score matching, sleeve gastrectomy patients had significantly higher rates of total complications (21.4% vs. 12.9%, p = 0.008) and nearly double the risk of surgical site infection (7.9% vs. 3.6%, p = 0.0452). The rates of hematoma, wound dehiscence, unplanned returns to the operating room, and 30-day readmission were uniformly greater among sleeve gastrectomy patients but did not reach statistical significance.

Conclusion: Gastric sleeve patients exhibited a higher rate of complications among our cohort of patients. Differences in patient compliance or effectiveness in reducing the risk of obesity-related comorbidities may contribute to this disparity.

Background

Surgical site infection (SSI) remains a persistent complication, with literature reporting a wide range of incidence 0.5-11% post operatively. While prior research has established an association between preoperative urinary tract infection (UTI) and elevated SSI risk in general, it remains unexplored within the plastic surgery literature. The objective of the study is to assess whether a preoperative diagnosis of a UTI is associated with risk of postoperative surgical site infection in elective plastic surgery trunk procedures.

Method

The TriNetX National Health database was queried to identify patients who underwent common elective plastic surgery procedures of the trunk between 2006 and 2025. UTI status within 30 days preoperatively was determined. Propensity score matching (PSM) was then performed to balance cohorts based on demographics and comorbidities. The incidence of surgical site infection (SSI) within 30 days postoperatively was evaluated.

Results

A total of 80,732 were analyzed, of which 1,796 (2.2%) had a documented diagnosis of preoperative UTI. After propensity matching and balancing the cohorts, we identified 1,796 patients in each UTI vs No-UTI groups. The incidence of SSI was 4.7% for the UTI group vs 3.1% for the No-UTI group. The UTI cohort was 1.52 times more likely to be diagnosed with a 30-day postoperative SSI compared to the no-UTI (95% CI: 1.09-2.113, p = 0.01).

Conclusion

Despite rigorous adherence to sterile technique and standardized infection prevention protocols, SSI is still a frequent complication we encounter. Preoperative UTI was found to be associated with higher incidence of postoperative SSI after elective plastic surgery procedures of the trunk. These findings suggest that preoperative UTI screening and treatment may represent a modifiable risk factor for SSI reduction in plastic surgery patients.

References:

1. Bahru TT, Gobena MA, Anteneh BT, Meskelu HA, Legese AT, Berhanu HT, Aschenaki WK, Zehredin EE, Dawud AS, Wakshume AA, Biyazn TT, Umer YS. Prevalence of Surgical Site Infection and Associated Factors Among Post-Operative Patients. Int Wound J. 2025 Jul;22(7):e70730. doi: 10.1111/iwj.70730. PMID: 40685844; PMCID: PMC12277540.

2. Gillespie BM, Harbeck E, Rattray M, Liang R, Walker R, Latimer S, Thalib L, Andersson AE, Griffin B, Ware R, Chaboyer W. Worldwide incidence of surgical site infections in general surgical patients: A systematic review and meta-analysis of 488,594 patients. Int J Surg. 2021 Nov;95:106136. doi: 10.1016/j.ijsu.2021.106136. Epub 2021 Oct 13. PMID: 34655800.

3. Jerliu A, Harrison L, Eljafarawi E, Castiglione C, Babigian A, McLoughlin RJ. Impact of Preoperative Urinary Tract Infection on Postoperative Outcomes in Plastic Surgery. Plast Reconstr Surg Glob Open. 2026 Jan 15;14(1):e7384. doi: 10.1097/GOX.0000000000007384. PMID: 41550083; PMCID: PMC12806578.

Purpose: Male cosmetic procedures have become an increasingly prominent aspect of aesthetic plastic surgery, with male patients demonstrating preferences distinct from those of females (1,2). Despite this growth, long-term procedure-specific evaluations of aesthetic interventions in males remains limited. In this study, the authors analyzed longitudinal trends in male cosmetic procedures using over two decades of statistical data from the American Society of Plastic Surgeons (ASPS).

Methods: Two national databases were used to evaluate male plastic surgery procedural trends: the American Society of Plastic Surgeons (ASPS) and The Aesthetic Society. ASPS statistics spanned 2005–2024; longitudinal analyses were restricted to years with stable reporting (2005–2018), with 2019–2024 assessed descriptively. The Aesthetic Society data included years 1997–2023; procedures with ≥10 years of data were eligible for longitudinal modeling. Surgical and minimally invasive procedures were analyzed separately. Changes in male participation share – percentage of total, surgical, and nonsurgical procedures – and procedural trends were assessed using log-linear regression to estimate annual percent change.

Results: Both the ASPS and Aesthetic Society datasets showed that absolute male procedural volume increased over time; however, growth in total cosmetic volume outpaced male utilization, resulting in a modest but statistically significant decline in the proportion of male participation across surgical (ASPS −0.11%, p=0.039; Aesthetic Society −0.27%, p<0.001), nonsurgical (ASPS −0.16%, p=0.0015), and total procedures (ASPS −0.21%, p<0.001; Aesthetic Society −0.13%, p=0.009). For specific procedures, data from ASPS demonstrated that minimally invasive procedures comprised 89–94% of all male cases, showing significant growth in botulinum toxin (+4.05%, p<0.001), hyaluronic acid fillers (+9.72%, p<0.001), polylactic acid (+9.55%, p<0.001), and laser skin resurfacing (+6.31%, p<0.001); in contrast, microdermabrasion (−2.43%, p<0.001) declined. Among surgical procedures, gynecomastia surgery (+3.79%, p<0.001) and pectoral implant placement (+9.34%, p=0.037) increased, whereas rhinoplasty (−6.80%, p=0.010) and hair transplantation (−4.44%, p=0.046) decreased. Data from The Aesthetic Society demonstrated similar surgical trends with sustained declines in surgical rhinoplasty (−7.37%, p<0.001) and hair transplantation (−7.87%, p=0.014), alongside decreases in facelift (−2.29%, p=0.017), blepharoplasty (−2.34%, p=0.002), and chin augmentation (−6.62%, p<0.001). On the other hand, there was significant growth in body contouring operations such as abdominoplasty (+5.40%, p<0.001), lower body lift (+7.69%, p=0.002), buttock lift (+4.75%, p=0.049), buttock augmentation (+9.08%, p=0.04), gynecomastia surgery (+2.42%, p<0.001), brachioplasty (+8.79%, p=0.004), and thigh lift (+6.23%, p=0.017). Within minimally invasive procedures, significant declines were observed in microdermabrasion (−11.89%, p=0.001) and chemical peels (−12.02%, p=0.001).

Conclusions: Across two national plastic surgery databases, longitudinal trends demonstrated a rise in male cosmetic procedure volume, although their proportional representation declined relative to females. For surgical operations, facial surgeries declined, whereas body contouring procedures saw growth. There was an increase in minimally invasive, skin-rejuvenation treatments such as botulinum toxin, fillers, and laser skin resurfacing. Collectively, the contrast between declining facial operations and the growth of minimally invasive facial procedures and body contouring surgery suggests that men may favor more discreet aesthetic enhancements, attempting to avoid overt postoperative changes that could draw attention or judgment. The increase in body contouring surgery also highlights the potential impact of GLP1 agonists.

Introduction Studies suggest that most autoimmune disease (AD) patients receive conventional disease-modifying antirheumatic drugs (cDMARDs) (1). Meanwhile, the use of biologic DMARDs (bDMARDs) is continually increasing (2). The literature suggests that not only should surgical patients with ADs be monitored carefully (3), but also that DMARDs may put them at higher risk of wound healing issues (4-5). This is the first large database study examining whether cDMARDs and bDMARDs confer higher risk of acute and long-term postoperative complications following body contouring procedures (BC). A sub-analysis compared outcomes between patients who use cDMARDs vs. bDMARDs.

Methods We identified adults in the TriNetX Research Network with ADs (rheumatoid arthritis, inflammatory bowel disease, lupus, etc.) who underwent abdominoplasty, panniculectomy, or breast reduction, with or without bDMARD or cDMARD use within 6 months prior to surgery. Patients were propensity-score matched based on demographics and comorbidities (specific type of AD, BMI, smoking, irradiation, diabetes, neoplasms, etc.). Measured acute outcomes (within 90 days) included wound dehiscence, hematoma, and infection. Long-term outcomes (within 5 years) included return to OR for revisions or re-explorations and scarring or aesthetic dissatisfaction warranting revisions.

Results We identified 1541 BC patients with ADs and preoperative cDMARD use, 6941 with the same ADs and cDMARD use, 468 with ADs and preoperative bDMARD use, and 9256 with the same ADs and no bDMARD use. There were 1316 matched cDMARD users and non-users, 432 matched bDMARD users and non-users, and 409 matched cDMARD and bDMARD users. No significant differences in any complications were found between the cDMARD and non-cDMARD cohorts. bDMARD users demonstrated modest, but significantly higher rates of OR return within 90 days (OR=2.152; 95% CI, 1.036-4.472; p=0.0358). No significant differences in any outcomes were found between the cDMARD and bDMARD cohorts.

Conclusions This represents the first database study investigating whether cDMARDs or bDMARDs impact postoperative risk profiles in patients with ADs undergoing body contouring. Although cDMARD users may face slightly higher risk of returning to the OR than autoimmune patients without DMARD use, our data suggests that DMARDs may not be completely contraindicative to undergoing BC. Further research is warranted on whether holding cDMARDs preoperatively results in significantly better outcomes following surgery.

References [1] Boytsov NN, et al. Health care effect of disease-modifying antirheumatic drug use on patients with rheumatoid arthritis. J Manag Care Spec Pharm 2019;25(8):10.18553. [2] McCormick N. Which patients with rheumatoid arthritis will start biologics, how soon, and why – much to learn from a universal coverage setting. JAMA Netw Open 2019;2(12):e1917065. [3] Tsai DM, et al. Implications of rheumatic disease and biological response-modifying agents in plastic surgery. Plast Reconstr Surg 2015;136(6):1327-1336. [4] Fung E, et al. Do disease-modifying anti-rheumatic drugs affect implant-based breast reconstruction outcomes in patients with autoimmune connective tissue disease? J Plast Reconstr Aesthet Surg 2025;109:90-98. [5] Kirloskar KM, et al. The relationship between autoimmune disease and disease-modifying antirheumatic drugs on wound healing. Advances in Wound Care 2022;11(12):650-656.

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have transformed the management of obesity and type 2 diabetes by inducing substantial weight loss. Emerging reports describe accelerated facial soft-tissue deflation and periorbital changes among treated patients, often referred to as "Ozempic face" (1,2). Given the thin skin and minimal subcutaneous tissue of the upper eyelid, rapid weight loss may exacerbate dermatochalasis and increase demand for surgical correction (3). However, the relationship between GLP-1 RA use and upper eyelid blepharoplasty remains unclear. This study aims to evaluate whether GLP-1 RA therapy is associated with an increased rate of upper eyelid blepharoplasty in a large multi-institutional cohort.

METHODS: A retrospective cohort study was conducted using the TriNetX Research Network. Female adults aged 18 years or older with diagnoses of diabetes mellitus and essential hypertension between January 2015 and January 2020 were identified. Patients prescribed GLP-1 RA (ATC class A10BJ) comprised the exposure cohort. Patients without GLP-1 RA therapy during the same period served as controls. The index event was first GLP-1 RA prescription for exposed patients and first ambulatory encounter for controls. Follow-up extended up to five years. The primary outcome was upper eyelid blepharoplasty (CPT 15823). Propensity score matching (1:1 nearest neighbor) was performed for age, race, body mass index (BMI), diabetes, hypertension, chronic kidney disease, hyperlipidemia, chronic obstructive pulmonary disease, and medication use. Kaplan–Meier survival analysis and Cox proportional hazards modeling were performed. A secondary matched analysis compared patients achieving weight loss without GLP-1 RA exposure to matched controls with stable BMI.

RESULTS: A total of 821,792 eligible female patients were identified, of whom 28,970 received GLP-1 RA therapy. After 1:1 propensity score matching, 23,349 patients remained in each cohort. Baseline characteristics were balanced (standardized mean differences < 0.10). At five-year follow-up, 96 GLP-1 RA users (0.41%) underwent upper eyelid blepharoplasty compared with 36 controls (0.15%). GLP-1 RA use was associated with an increased hazard of blepharoplasty (hazard ratio 2.22; 95% confidence interval 1.51–3.26; p < 0.001). Kaplan–Meier analysis demonstrated shorter time to surgery among GLP-1 RA users (log-rank p < 0.001). Mean BMI declined from 30.7 ± 5.2 to 27.97 ± 4.18 in the GLP-1 RA cohort, compared with 31.2 ± 6.5 to 29.90 ± 5.89 in controls. In the secondary analysis (24,690 patients per cohort), non–GLP-1 RA weight loss was not associated with increased blepharoplasty incidence (hazard ratio 1.31; 95% confidence interval 0.89–1.93; p = 0.56).

CONCLUSION: GLP-1 receptor agonist use is associated with a significantly increased rate and earlier timing of upper eyelid blepharoplasty compared with matched controls. Weight loss alone did not demonstrate the same association, suggesting a distinct pattern of facial remodeling related to GLP-1 RA therapy. As pharmacologic weight loss continues to expand, plastic surgeons should anticipate increased demand for periorbital rejuvenation and counsel patients regarding timing and expectations.

References Tay JQ. J Plast Reconstr Aesthet Surg. 2023;81:97–98. Ridha Z, Fabi SG, Zubair R, Dayan SH. Aesthetic Surg J. 2024;44(11):NP809–NP818. Sharma RK, Vittetoe KL, Barna AJ, et al. Otolaryngol Head Neck Surg. 2025;173(2):360–366.

Purpose: The term "Asian rhinoplasty" is a phrase used in published literature and clinical settings that describe the surgical strategies employed to treat unfavorable nasal characteristics thought to be common among individuals of Asian descent. We hypothesized that critical analysis of this term would reveal a homogenizing effect, oversimplifying anatomical variation in nasal profiles among Asian patients, limiting its usefulness. We performed a systematic review to evaluate the validity of the "Asian nose" concept by assessing the variation of nasal characteristics in Asian populations.

Methods: A systematic search of the MEDLINE databases identified studies published after January 1, 2010 containing the terms "rhinoplasty" and "Asia", "Korea", "China", "Japan", or "orient". Studies were eligible for inclusion if they reported sex-stratified pre-operative nasal measurements of East Asian patients. Measures of central tendency and variability were extracted for 6 nasal measurements: nasal length (NL), nasal height (NH), nasal tip projection (NTP), nasolabial angle (NLA), nasofacial angle (NFaA), and nasofrontal angle (NFrA). Random-effects models generated pooled mean estimates with 95% confidence intervals for each measurement. Cochran's Q test was used to determine whether significant heterogeneity existed among the studies for each sex-stratified measurement. Q-statistic exclusion (QE) deletion analyses were performed to assess the impact of outlier studies.

Results: Eighteen studies provided sufficient data for pooled analysis. Among females, significant heterogeneity was observed in several commonly targeted rhinoplasty parameters. The female pooled mean NLA was 97.1° (95% CI 93.0°-101.3°, N = 11; I² = 84.3%, p < 0.001), NTP was 19.7 mm (95% CI 18.0-21.5 mm, N = 7; I² = 61.0%, p = 0.018), and NFaA was 40.7° (95% CI 19.6°-61.8°, N = 4; I² = 99.1%, p < 0.001). Female NL, NH, and NFrA demonstrated no significant heterogeneity. Among males, NLA (92.5°, 95% CI 87.9°-97.2°, N = 6; I² = 74.1%, p = 0.003) and NTP (20.7 mm, 95% CI 16.1-25.3 mm, N = 3; I² = 85.9%, p = 0.001) demonstrated significant heterogeneity, whereas NL and NFrA did not. QE deletion analyses revealed heterogeneity with sequential removal of individual studies, indicating that variability was not driven by isolated outlier studies.

Conclusions: These findings suggest that there is meaningful variation across Asian subpopulations. The terms "Asian nose" and "Asian rhinoplasty" may oversimplify the nasal characteristics of Asian populations, limiting their usefulness in operative planning and in the scientific literature. These findings challenge the anatomical uniformity implied by race-based rhinoplasty terminology and support greater emphasis on measurement-based, patient-specific descriptors.

Background: While facelifts, or rhytidectomies, are most commonly performed in the fifth through seventh decades of life, patients today are starting to seek the procedure at younger ages. Contributing factors may include the rise of social media, video-based online communication, and GLP-1 use associated with facial volume loss. This study aimed to characterize recent trends in facelift interest and related online discourse via social media analysis.

Methods and Materials: Google Trends data for the term "facelift" from January 2021 to December 2025 were extracted and analyzed for search frequency and seasonal patterns, with a secondary analysis of the term "Ozempic face". Reddit posts from the subreddits r/PlasticSurgery and r/CosmeticSurgery included the top 1,000 highest engagement and trending posts. Duplicates were removed and posts were filtered for facelift-related terms ("facelift", "face lift", "rhytidectomy").

Results: Search volume for the term "facelift" increased by 63.5% in 2025 versus 2024, with a significant shift identified in late December 2024 following the height of "Ozempic face" searches in April 2024. Seasonal analysis demonstrated monthly variation, with peak search volume in February. Post-facelift posts (n=84) reported a mean age of 47 years (range 28 to 70) and frequently referenced specific surgeons (76%). The majority of these surgeons were based in the United States, and Turkey represented the most frequently cited country of international surgeons. Pre-facelift posts (n=79) reported a mean age of 39 years (range 20 to 62). These posts referenced specific surgeons in 18% of cases and requested surgeon recommendations in 34%. Among surgeons mentioned in pre-facelift posts, the United States and Turkey were cited with equal frequency. Weight loss or GLP-1 medications were mentioned in 5% of pre-facelift and 6% of post-facelift posts.

Conclusion: Interest in facelift surgery is rising, with online discourse driven by younger patients than traditionally observed. Social media analyses reveal both provider and patient-reported outcomes, proactive surgeon identification, and a notable presence of medical tourism. These findings highlight evolving trends in facial rejuvenation and the importance of understanding changing patient aesthetics and motivations.

Introduction: Although plastic surgery resident education is highly standardized, there is no widely adopted, structured curriculum for training in facial aesthetic injectables, including neuromodulators and dermal fillers. Current minimal procedural requirements are limited, and formal education in injectables may be deprioritized despite non-surgical aesthetic procedures representing the most commonly performed cosmetic interventions by ASPS members. To address this educational gap, we developed a comprehensive longitudinal resident curriculum in facial aesthetic injectables. This study describes the curriculum model and evaluates resident satisfaction. Methods: In 2023, a multifaceted injectable curriculum was implemented. An annual simulation laboratory is held at the start of each academic year, consisting of didactic instruction and hands-on facial marking, with injection of neuromodulators and dermal fillers using silicone facial models. Residents also participate annually in a live patient injectable clinic, stratified by post-graduate year (PGY) and supervised by attending plastic surgeons, with emphasis on facial analysis, product selection, and injection techniques. Patients pay a nominal fee; injectable products are donated by industry partners. PGY1-2 residents are trained in neuromodulator injections only, while PGY3 and above receive training in both neuromodulators and dermal fillers. Throughout the academic year, chief residents perform injectable procedures in the aesthetic clinic under direct attending supervision. Anonymous voluntary surveys are distributed following simulation labs and clinics to assess resident satisfaction. Both integrated and independent residents participate. Results: Since our program's inception, a total of 117 patient encounters have occurred. Of these, 51% received neuromodulator treatment alone, 12% received dermal filler alone, 37% received combined treatment. No adverse events were reported. 11 patients (9%) returned for touch up treatment 3-4 weeks following initial injection and 2 patients (4%) underwent partial filler dissolution with hyaluronidase. Resident satisfaction scores demonstrated that overall, the program is highly valued and viewed as educationally effective. The majority of residents rated live patient clinics as very good or excellent (n=26, 93%), and nearly all noted that their participation in the clinic improved their knowledge of injection techniques (n=27, 96%). Simulation sessions were also viewed positively, however, many trainees consistently identified increased live patient exposure as a priority. Conclusions: Structured training in facial aesthetic injectables is essential to ensure patient safety and high-quality outcomes in contemporary plastic surgery practice. We present a standardized, reproducible academic training model for resident education in aesthetic injectables. Resident feedback demonstrates high satisfaction and a strong desire for increased clinical exposure.