Scientific Abstract Presentations: Aesthetic Session 5 Friday, October 16 Fri, Oct 16 2:00-3:30 p.m. CDT

Background: Photography is integral to plastic surgery across the preoperative, perioperative, and postoperative stages. Unlike most medical specialties, many plastic surgeons operate within a business model, making postoperative photographs not only clinically relevant but also valuable marketing tools. Historically, concerns about image manipulation were limited by the technical constraints of conventional photo-editing tools. However, the advent of artificial intelligence (AI) has enabled the creation of highly realistic yet entirely fabricated images.

Methods: We conducted a cross-sectional survey to evaluate whether participants could distinguish authentic postoperative aesthetic body surgery photographs from AI-generated postoperative images. Twenty pairs of AI-generated preoperative and postoperative photographs were created and matched with fifteen pairs of authentic images. Participants were asked to judge each photograph as authentic or AI-generated, rate their confidence in their decision, and provide subjective assessments of the images.

Results: One hundred participants completed the survey between January 2026 - February 2026. The most frequent age range was 25–34 years (60%), followed by 55–64 years (20%). On average, participants correctly identified 44.7% of the images, with 44.0% accuracy for AI-generated images and 45.7% accuracy for authentic images. Notably, AI-generated images were rated as significantly more aesthetically pleasing than authentic images (mean attractiveness score: 7.09 vs. 6.49; p < 0.0001). There were no significant differences in overall percentage correct or AI image accuracy across age groups (p = 0.094; p = 0.417). Confidence in one's judgment had minimal impact on the ability to correctly classify images.

Conclusions: AI-generated postoperative images can be nearly indistinguishable from authentic photographs. Furthermore, viewers perceive AI-generated images as more aesthetically pleasing, potentially exacerbating unrealistic expectations of surgical outcomes. While this technology may have utility in pre- and perioperative planning, clear ethical guidelines are essential to prevent physician misrepresentation and ensure patient safety.

Background: TikTok has risen to the forefront of social media platforms with over 1.12 billion worldwide monthly users. The utilization of glucagon-like-peptide-1 (GLP-1) agonists have resulted in an increase in cosmetic plastic surgery interest following significant weight reduction. This study aims to analyze TikTok content related to medical weight loss medications and plastic surgery. Methods: The authors searched TikTok using several phrases including "Ozempic plastic surgery", "Wegovy plastic surgery", "semaglutide plastic surgery", and "GLP-1 plastic surgery." Video statistics and characteristics were reviewed and graded using the validated DISCERN tool. P-values <0.05 were noted to be statistically significant. Results: A total of 101 videos met inclusion criteria with a total of 2,662,385 views, 318,749 likes, 1033 comments, 54,245 shares. The majority of videos were produced by physicians (57.4%) followed by patients (23.8%). Non-physician health care providers had the highest average DISCERN score followed by physicians, although this was not significant. Conclusions: Although content varies across creator and video category subtypes, overall quality has improved in recent years and creators should look to provide qualified sources of healthcare information, foster an environment of shared decision making, and for providers to discuss how GLP-1 medications and plastic surgery may affect quality of life.

Background: Access points and incisions are critical considerations in aesthetic rhinoplasty, with closed endonasal and open trans-columellar approaches being the most common [1-3]. However, the open approach leaves an external scar and risks columellar vascular disruption, while the closed approach can limit surgical exposure [4,5]. While transoral access is well-documented for maxillary and paranasal sinus surgeries, its use in aesthetic rhinoplasty is limited. This clinical study explores the use of a transoral incision to access nasal bony and cartilaginous structures, aiming to avoid columellar incisions and visible scarring.

Methods: Seven female patients, aged 18 to 40, seeking aesthetic nasal improvement, underwent rhinoplasty using the transoral approach. The surgeries, performed under general anesthesia, involved nasal mucosal incisions followed by intraoral access. Those requiring an external incision for wide nasal alae were excluded from the study. A one-year follow-up included evaluation of preoperative and postoperative photographs.

Results: The transoral approach effectively accessed nasal structures in all seven patients, allowing for correction of various deformities including bulbous tip, osteocartilaginous hump, droopy tip, and broad nasal dorsum. All surgeries were without any complications. Mean patient age was 25.6 years old. Surgical time was longer compared to the trans-columellar approach, and temporary paresis of the superior orbicularis oris muscle was observed but resolved without lasting effects. Importantly, no visible scarring occurred.

Conclusion: The transoral access method offers a viable alternative for aesthetic rhinoplasty, minimizing external scars while achieving satisfactory outcomes. This technique presents a promising option for patients and surgeons seeking scarless rhinoplasty results. However, careful consideration of the approach's benefits and potential complications is essential for optimal patient outcomes and satisfaction.

References: 1. Adamson PA, Smith O, Tropper GJ. Incision and Scar Analysis in Open (External) Rhinoplasty. Arch Otolaryngol Neck Surg. 1990. doi:10.1001/archotol.1990.01870060029003 2. Gurlek A, Fariz A, Aydogan H, Ersoz-Ozturk A, Eren AT. Effects of different corticosteroids on edema and ecchymosis in open rhinoplasty. Aesthetic Plast Surg. 2006. doi:10.1007/s00266-005-0158-1 3. Inanli S, Sari M, Yanik M. A new consideration of scar formation in open rhinoplasty. J Craniofac Surg. 2009. doi:10.1097/SCS.0b013e3181ace082 4. Cafferty A, Becker DG. Open and Closed Rhinoplasty. Clin Plast Surg. 2016;43(1):17-27. 5. Tardy ME, Eugene Tardy M, Regan Thomas J. Rhinoplasty. Cummings Otolaryngol - Head Neck Surg. 2010:508-544.

Purpose: Abdominoplasty has high complication rates (23%–49%), notably seroma¹. Scarpa's fascia preservation may reduce morbidity by preserving lymphatics², yet high-quality evidence is limited, especially for post-bariatric and massive weight loss (MWL) patients. This study evaluates the impact of Scarpa's preservation on seroma incidence compared to the classical technique, accounting for MWL status and adjuvant liposuction.

Methods and materials: This PRISMA 2020-compliant meta-analysis searched PubMed, Embase, and CENTRAL from inception to January 2026, comparing Scarpa's preservation versus classical abdominoplasty. The primary outcome was seroma; secondary outcomes included total drain output, drain duration, and hospital stay. Data were pooled using Risk Ratio (RR) for dichotomous outcomes and Mean Difference (MD) for continuous outcomes (95% CI). Heterogeneity was assessed via Cochran's Q and I² statistics, with significance set at p < 0.05.

Experience: Eleven studies (1,122 patients) were included, involving abdominal deformities or post-bariatric status (n=599). Mean age ranged from 37–44 years, BMI from 25.4–44.3 kg/m², and resected tissue weight from 968–3,220g. Adjuvant liposuction was used in four studies and hernioplasty in one. Six studies did not use quilting or progressive tension sutures, whether five did not report this data. Most utilized closed-suction drains and seven used compression garments.

Results: In 914 patients, Scarpa's preservation significantly reduced seroma vs. classical abdominoplasty (RR 0.32; 95% CI 0.20–0.50; p < 0.0001; I²=0%). Secondary outcomes also favored Scarpa's: Total Drain Output (MD -404.18 mL; 95% CI -555.97 to -252.39; p < 0.01), Drain Duration (MD -3.35 days; 95% CI -4.98 to -1.73; p < 0.01), and Hospital Stay (MD -2.04 days; 95% CI -3.12 to -0.97; p < 0.01), despite high heterogeneity (I² > 87%). Subgroup analyses to evaluate scarpa's preservation effect in the outcomes included RCTs vs Observationals, post-bariatric/MWL vs mixed patients, and adjuvant liposuction vs no liposuction. For seroma, RR remained significant across all subgroups (p < 0.05; I² = 0%), except for RCTs (p = 0.053; I² = 47.3%) and no-liposuction (p = 0.47; I² = 47.5%). Secondary outcomes remained significant in all subgroups, though heterogeneity resolved only for drain duration without liposuction (I² = 0%). Total drain output reduction was more pronounced with liposuction (MD -395.54 mL; 95% CI -475.07 to -312; p < 0.01) vs. no-liposuction (MD -256.65 mL; 95% CI -361.03 to -152.28; p < 0.01).

Conclusion: Scarpa's fascia preservation significantly reduces seroma in abdominoplasty, including post-bariatric, MWL, and adjuvant liposuction patients. Improvements in drain metrics and hospital stay were also observed, though potentially influenced by adjuvant liposuction or clinical settings. Further randomized controlled trials are needed to confirm long-term safety.

References: 1. Ramirez AE, Hsieh TY, Cardenas JP, Lao WW. Abdominoplasty: My Preferred Techniques. Ann Plast Surg. 2021;86(3S):S229-S234. doi:10.1097/SAP.0000000000002639 2. Albertin G, Astolfi L, Fede C, et al. Detection of Lymphatic Vessels in the Superficial Fascia of the Abdomen. Life. 2023;13(3):836. doi:10.3390/life13030836

Background: The MENTOR MemoryGel BOOST (MGB) implant (Mentor Worldwide LLC, Irvine, CA), introduced in 2022, was engineered to improve breast augmentation and reconstruction outcomes by enhancing upper pole fullness and reducing rippling through its highly cohesive, precision-filled silicone gel fill.

Objectives: This study aimed to assess the early clinical outcomes, safety profile, complication rates, and reoperation trends in patients undergoing primary and revision breast augmentation with MGB implants.

Methods: A retrospective review was conducted of all patients who underwent primary (n=83) or revision (n=36) augmentation with MGB implants between March 2022 and January 2024 by a single senior surgeon. All patients had at least 6 months of follow-up. Demographics, implant characteristics, surgical techniques, and rates of postoperative complications were analyzed to assess device safety and efficacy. Kaplan-Meier curves estimated time-dependent risk-free survival from capsular contracture.

Results: One hundred and nineteen total patients received MGB implants. Patients had a mean age of 38.9 years with an average follow-up of 418 ± 179 days. Inframammary incision (74%) and subfascial placement (77%) predominated. Average implant volume was 381cc, with 84% of patients selecting a Moderate Plus profile. Complication rates were low: one superficial surgical-site infection (0.8%), and one Baker grade IV capsular contracture (0.8%), occurring in a former smoker. No hematoma, seroma, implant rupture, or rippling was observed during the study period. Reoperation occurred in 11 patients (9.2%), primarily for elective size increase (6.7%). One-year risk-free survival from capsular contracture was greater than 99%.

Conclusion: In this early clinical outcomes review, MGB implants demonstrated promising short-term safety with exceptionally low rates of infection and capsular contracture, and no implant-specific failures. Reoperations were primarily patient-driven rather than complication-related. These data support MGB implants as a reliable and effective option for both primary and revision augmentation. Longer-term follow-up will be critical to confirm sustained performance.

Background Hypertrophic scarring remains challenging, with scar quality representing a key determinant of aesthetic outcome. Mechanical tension during wound healing contributes to fibroproliferative remodeling and hypertrophic scar formation, yet few peri-incisional strategies directly address this force (1). Botulinum toxin A (BoNT-A) has emerged as a strategy to reduce muscular tension and modulate scar formation (2,3). However, evidence remains limited by small, heterogeneous studies. This review evaluates the efficacy and safety of peri-incisional BoNT-A and examines timing, anatomical site, and dosing as treatment modifiers.

Methods A PRISMA 2020-compliant systematic review was performed. MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov were searched through September 2025. Eligible studies included randomized controlled trials and prospective studies of peri-incisional BoNT-A administered intraoperatively or within 14 days of closure in adults (18 years or older).

Primary outcomes were scar quality by Vancouver Scar Scale (VSS), modified Stony Brook Scar Evaluation Scale (mSBSES), Patient and Observer Scar Assessment Scale (POSAS), and scar width. Secondary outcomes included patient satisfaction, symptom burden, and adverse events. Prespecified subgroup analyses evaluated treatment timing, anatomical site, and dose as effect modifiers. Risk of bias was assessed using ROB-2 and ROBINS-I.

Results Sixteen studies comprising 458 patients met inclusion criteria, including 15 randomized controlled trials and one prospective comparative study. Follow-up ranged from 1 week to 12 months, with most injections performed intraoperatively or within 24 hours of closure.

Objective scar outcomes improved at 3–6 months. Scar width was reduced in 6 of 7 trials (86%), with mean reductions of 0.3–2.2 mm. VSS scores improved in 5 of 7 studies (71%), with between-group differences ranging from 0.6–3.6 points. All four trials utilizing the mSBSES showed significant benefit. Observer-rated POSAS domains improved in 2 of 6 trials, whereas patient-reported scores were more variable.

Treatment response followed a tension-dependent pattern. Anatomically dynamic, high-tension regions showed the greatest benefit, with 11 of 12 studies reporting significant improvement. Earlier administration (within 7 days) was associated with greater benefit. Two randomized trials suggested a dose-tension relationship, with higher per-centimeter dosing associated with superior outcomes in high-tension closures.

Patient satisfaction improved in most studies, although patient-reported outcomes were heterogeneous. Adverse events were mild and transient, with no serious complications reported.

Conclusion Peri-incisional BoNT-A is associated with improved objective scar outcomes and a favorable safety profile. Effects are most pronounced in anatomically dynamic, high-tension regions, supporting a mechanobiologic role in modulating wound healing. Further standardized studies are needed to define optimal dosing, timing, and anatomical indications to support broader clinical integration.

References 1. Xiao Z, Zhang F, Lin W, Zhang M, Liu Y. Effect of Botulinum Toxin Type A on Transforming Growth Factor β1 in Fibroblasts Derived from Hypertrophic Scar: A Preliminary Report. Aesthetic Plastic Surgery. 2009;34(4):424-427.

2. Gassner HG, Brissett AE, Otley CC, et al. Botulinum Toxin to Improve Facial Wound Healing: A Prospective, Blinded, Placebo-Controlled Study. Mayo Clinic Proceedings. 2006;81(8):1023-1028.

3. Hu L, Zou Y, Chang SJ, et al. Effects of Botulinum Toxin on Improving Facial Surgical Scars. Plastic and Reconstructive Surgery. 2018;141(3):646-650.

INTRODUCTION: Facial injection of liquid silicone for volume restoration was one of the top 10 cosmetic procedures in the 1980-90s, but this treatment has been known to cause long-term problematic sequalae including granuloma formation, migration, and chronic inflammation. In addition, these patients are getting older and develop facial ptosis from the weight of cheek silicone. Many surgeons shy away from surgical correction; nonetheless, there are patients in need of surgical care and the development of more effective procedures.

METHODS: Patients who underwent silicone malar volumetric fill and developed midface ptosis over time underwent direct silicone cheek reduction and midface elevation with MACS facelift repair (n=42). 3D imaging was used to assess preoperative and postoperative (12 months) location of malar projection and change in cheek volume. FACE-Q patient satisfaction was also recorded.

RESULTS: There was a mean cheek point elevation of 9.2mm±1.5 vertically and 1.8mm±0.4 laterally; cheek volume was diminished by 2.3cc±0.3 per side. Delayed wound healing/preauricular eschars developed in 2/42 (5%), likely related to thin skin flaps and use of TXA injections. Both of these patients underwent scar revision. Since TXA injections were stopped, there have not been ischemic issues. There were no other complications or revision surgery. Finally, FACE-Q scores demonstrated a high level of patient satisfaction for facial appearance (75.1±8.1) and quality of life (82.4±8.3).

CONCLUSION: Correction of silicone injection face ptosis with volume reduction and mid-face lifting provides objective cheek elevation, volume reduction, and good patient satisfaction.

Background: Artificial intelligence (AI) has rapidly transformed clinical decision-making and operative planning, yet its potential to forecast the evolution of surgical science itself remains largely unexplored. As aesthetic surgery continues to expand globally, the ability to anticipate future research volume, thematic shifts, and geographic redistribution represents a critical unmet need for strategic planning, workforce development, and innovation stewardship within the specialty.

Objectives: To develop and validate an AI-assisted forecasting framework capable of modeling and predicting global aesthetic surgery research activity-including publication volume, thematic growth, and geographic diffusion-through 2030.

Methods: We conducted a population-level observational analysis of all PubMed-indexed aesthetic surgery publications from 2010 to 2024. A fully autonomous AI pipeline performed large-scale data ingestion and preprocessing, followed by high-fidelity semantic classification of publications by research domain and country using a curated keyword taxonomy (validated accuracy >97%). Annualized publication outputs were analyzed using multiple time-series approaches, including exponential smoothing and autoregressive models, with model selection guided by out-of-sample performance metrics. Long-horizon forecasts were generated with 95% confidence intervals to quantify uncertainty and trend stability.

Results: The framework processed 24,026 records, yielding a final analytic dataset of 23,521 eligible publications across 13 high-impact journals. Exponential smoothing demonstrated superior predictive performance (R² = 0.94; RMSE = 166.6) and was selected for primary forecasting. Global aesthetic surgery research output is projected to increase by 21.9% by 2030, reaching an estimated 2,939 publications annually (95% CI: 2,612–3,265). Minimally invasive and injectable research exhibited the steepest projected growth (+46.1 publications per year), emerging as the dominant driver of future scholarly output. Geographic modeling revealed accelerating expansion in upper-middle-income economies, while high-income regions demonstrated stable consolidation, reflecting maturation of established research ecosystems.

Conclusions: This study establishes AI-driven forecasting as a next-generation analytic paradigm for surgical meta-research. By integrating autonomous data extraction, semantic intelligence, and rigorously validated time-series modeling, the framework shifts aesthetic surgery research assessment from retrospective surveillance to prospective trajectory mapping. From an epidemiologic perspective, this approach enables early identification of inflection points, directional trend propagation, and structural reorganization within the scientific ecosystem. The resulting system is scalable, reproducible, and continuously recalibratable, positioning AI not merely as an analytic adjunct, but as a strategic instrument for anticipatory research governance, resource allocation, and human-capital planning in plastic and reconstructive surgery.

Background: Lipoabdominoplasty has evolved with high-definition liposuction to enhance abdominal surface definition. The lateral border of the rectus abdominis (linea semilunaris) is crucial for achieving symmetric and natural contours. However, correction of rectus diastasis performed after liposuction may induce medial displacement of the linea semilunaris, potentially altering surface anatomy. To date, the magnitude of linea semilunaris displacement following rectus abdominis plication has not been quantitatively evaluated. Methods: A prospective quantitative anatomical analysis was performed in patients undergoing rectus abdominis plication during lipoabdominoplasty. Measurements of diastasis width, plication length, and pre- and post-plication tissue positions of the linea semilunaris were used to calculate mean bilateral displacement of skin and fascia at the linea semilunaris. Associations between plication length and tissue displacement were evaluated using Pearson correlation coefficients and unadjusted and adjusted linear regression models, with age and body mass index included as covariates. Interaction models were tested to assess potential effect modification by age and body mass index (BMI). Results: Twenty-one patients were included. Mean diastasis width was 2.80 cm, and mean plication length was 4.28 cm. Mean skin displacement of the linea semilunaris was 1.66 cm, and mean fascia displacement was 1.87 cm. Plication length was significantly correlated with skin displacement (r = 0.61, p = 0.0035), but not with fascia displacement (r = 0.31, p = 0.1750). In adjusted linear regression analysis controlling for age and body mass index, greater plication length was independently associated with increased skin displacement (β = 0.62, p < 0.001; adjusted R² = 0.56). Plication length was not a significant predictor of fascial displacement in adjusted models. Conclusions: Plication length is a strong and independent predictor of medial displacement of the linea semilunaris at the skin level during high-definition lipoabdominoplasty, but not of fascia displacement. These findings provide a quantitative framework for anticipating surface landmark migration and may assist surgeons in refining preoperative anatomical markings.

Goals/Purpose: A well-defined cervicomental angle is essential for successful facial rejuvenation. Modern cervicoplasty involves a graded, sequential approach to deep structures, yet the quantitative impact of each specific step remains poorly defined. This study objectively evaluates sequential changes from standardized deep cervical dissection on three critical measurements defined by Bravo: Anterior Cervical Angle (ACA), Lateral Cervical Angle (LCA), and Posterior Cervical Angle (PCA) Cervical Angles.

Methods/Technique: Twelve fresh female cadavers (24 hemifaces) were utilized (mean age 64.4; mean BMI 26.8). A single team performed seven standardized stages: Baseline (C), Subplatysmal Fat Resection (SF), Mylohyoid Resection (MM), Digastric Resection/Plication (ABDM), Submandibular Gland Resection (SMG), Platysma Transection/Plication (PTP), and Parotid Tail Resection (TPG). Digital angular measurements and precise tissue volume/weight were recorded at each stage. Statistical analysis used paired t-tests or Wilcoxon Signed-Rank tests (p<0.05).

Results: Analysis revealed that specific stages led to incremental changes in different zones: ACA: Subplatysmal Fat Resection (SF) was the only technique yielding significant change, with a mean reduction from 136.0º to 109.0º (p=0.002). LCA: Partial Submandibular Gland Resection (SMG) significantly reduced the angle from 133.5º to 128.0º (p=0.009). PCA: No studied technique promoted statistically significant alterations. Tissue Quantification: SF yielded the largest mean resection (6.5g/7.2ml), followed by SMG (4.3g/4.4ml). Resections for MM (0.4g), ABDM (0.7g), and TPG (1.7g) were minimal. No significant correlation was found between the volume removed and the magnitude of angular change (p>0.05). The resistance of the PCA to change suggests that Zone 3 definition is highly dependent on complementary maneuvers (e.g., lateral platysma suspension and skin redraping) rather than deep resection alone.

Conclusion: This study provides quantitative evidence that deep cervical techniques produce highly specific alterations in cervical aesthetics. SF is the critical intervention for ACA (Zone 1) definition, while SMG defines the LCA (Zone 2). The lack of correlation between resection volume and angular change strongly suggests that aesthetic success is driven by precise anatomical release and targeted reduction of specific structures rather than aggressive debulking. References: Bravo FG. Reduction Neck Lift: The Importance of the Deep Structures of the Neck to the Successful Neck Lift. Clin Plast Surg. 2018;45(4):485-506. Bravo FG. Neck Contouring and Rejuvenation in Male Patients Through Dual-Plane Reduction Neck Lift. Clin Plast Surg. 2022;49(2):257-273. Larson JD, et al. Defining the fat compartments in the neck: a cadaver study. Aesthet Surg J. 2014;34(4):499-506. O'Daniel TG. Optimizing Outcomes in Neck Lift Surgery. Aesthet Surg J. 2021;41(8):871-892. Singer DP, Sullivan PK. Submandibular Gland I: An Anatomic Evaluation and Surgical Approach... for Facial Rejuvenation. Plast Reconstr Surg. 2003;112(4):1150-1154.

Background: Aerodigestive operations relevant to plastic surgery (e.g., rhinoseptoplasty and others) are classified as clean-contaminated and may cause transient bacteremia. These procedures are often staged months to a year before subsequent ultra-sterile implant-based operations due to concern for seeding and biofilm complications, but the postoperative bacteremia time course and relevance to delayed staging are unclear. Methods: A narrative review evaluated perioperative bacteremia incidence and clearance timelines across representative procedures. Findings were integrated with implant-related principles (peri-implant capsule development, biofilm susceptibility, infection-prevention strategies) and psychosocial impacts of prolonged staging. Results: Procedure-induced bacteremia clears rapidly within 30–60 minutes postoperatively, with no documented persistence or clinical complications attributed to the transient bacteremia. Cohorts in tonsillectomy/adenoidectomy demonstrate transient bacteremia with clearance by one hour. Dental extraction bacteremia occurs immediately, peaks early, and typically resolves within an hour. Palatal procedures show higher early prevalence but clears over minutes. Rhino/septoplasty-associated bacteremia appears rare or absent in available series. Implant-associated risks (early biofilm formation and long-term colonization potential) appear more closely tied to local contamination at implantation and perioperative technique than to remote, short-lived bacteremia. Conclusions: When detected, procedure-induced bacteremia clears rapidly within 30–60 minutes postoperatively, with no documented persistence or clinical complications attributed to the transient bacteremia. A patient-centered approach condensing staging to ~2–4 weeks-allowing re-epithelialization and resolution of acute inflammation-may better balance infection risk, implant physiology, and psychosocial well-being.

Introduction: Rhytidectomy remains one of the most frequently performed facial aesthetic procedures and is often undertaken to correct undesirable outcomes, refine prior results, or address continued facial aging (1). A growing trend towards younger patients seeking facelifts has also contributed to an increasing population pursuing revision procedures (2). Revision rhytidectomy has largely been found to be safe and effective, though altered dissection planes and age-related comorbidities can complicate surgery (3). We performed a systematic literature review to delineate patient demographics, operative details, and postoperative outcomes in revision rhytidectomy and to compare these findings with those reported for primary procedures to clarify indications and outcomes unique to revision surgery.

Methods/Technique: In accordance with PRISMA guidelines, a systematic search was performed using Ovid (Medline) and PubMed (Medline) to identify primary studies (1975–2025) on revision rhytidectomy. Two independent reviewers screened articles by title and abstract, followed by full-text review. Extracted data included patient sex, age, index procedure, revision indications, interval between surgeries, relevant comorbidities or medications, interval non-invasive treatments, and postoperative complications.

Results/Complications: Sixteen studies of the yielded 651 articles met inclusion criteria for final data extraction. All were retrospective, ranging from chart reviews to postoperative questionnaires. A total of 1,333 revision rhytidectomy procedures were identified. 87.4% of patients were female. Weighted mean ages at primary, secondary, and tertiary facelifts were 50.6, 60.6, and 66.2 years. Intervals were heterogenous, but where discrete data were provided, the mean time from primary to secondary rhytidectomy was 10.2 years. Techniques for both primary and revision rhytidectomy varied, though most employed a SMAS-based approach. Mixed cohorts with different index and revising surgeons were common. Adjuvant procedures, including platysmaplasty, submental work, blepharoplasty, laser resurfacing, radio-frequency treatment, and fat grafting, were frequently performed. Ancillary procedures were more common in revision cases, particularly fat grafting and volume-restorative techniques. Comorbidities and medication use were inconsistently reported but appeared higher in revision patients. Reported complications included hematoma/seroma, transient facial nerve weakness, delayed healing, and hypertrophic scarring; no permanent nerve injuries were reported.

Conclusion: The frequency of revision rhytidectomies is rising in parallel with increased demand for aesthetic surgery and greater patient longevity. Patients pursue secondary facelifts to address progressive facial aging and to correct suboptimal outcomes from the index procedure. Across the available literature, significant gaps persist, including heterogenous study designs, limited cohort sizes, and lack of standardized outcome reporting. These deficiencies underscore the need for prospective, rigorously designed studies to more clearly define patient characteristics, technical variables and factors influencing presentation, as well as to establish evidence-based strategies to optimize outcomes in revision rhytidectomy.

(1) Yang AJ, Hohman MH. Rhytidectomy. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025 Jan-. Updated 2023 Mar 1. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564338/ (2) New Statistics and Trends in Facial Plastic Surgery. American Academy of Facial Plastic and Reconstructive Surgery. February 4, 2025. Accessed May 18, 2025. https://www.aafprs.org/Media/PressReleases/2024AnnualTrendsSurvey.aspx. (3) Dibbs RP, Chamata E, Ferry AM, Friedman JD. Revision Facelift and Neck Lift. Semin Plast Surg. 2021 May;35(2):88-97. doi: 10.1055/s-0041-1727208. Epub 2021 Jun 8. PMID: 34121944; PMCID: PMC8186989.

Facelift surgery remains central to facial rejuvenation, yet the optimal technique is debated. This prospective cohort study compared clinical outcomes, patient satisfaction, and complication rates between deep plane and SMAS plication facelifts. A total of 166 patients underwent primary facelift surgery by a single surgeon between January 2019 and December 2024. Patients were assigned to deep plane (n=45) or SMAS plication (n=121) groups based on preoperative clinical assessment including degree of midfacial descent, skin laxity, and patient preference. Primary outcomes included facial rejuvenation rating, patient satisfaction, recovery duration, and complications. Mann–Whitney U and chi-squared tests were used for between-group comparisons; multivariable logistic regression adjusted for age and smoking status assessed predictors of postoperative complications. Median age was 49 years (IQR 42.7–56); 95.2% were female and 46% were overweight. Median follow-up was 3 months (IQR 8). Facial rejuvenation was rated excellent in 70.5% of SMAS versus 29.5% of deep plane patients (p=0.67). Patient satisfaction was high in both groups (p=0.09). Median recovery duration was 25.5 versus 30 days (p=0.65). Overall complication rates were 21.6% versus 28.7% (p=0.39). Transient facial nerve weakness occurred in 25% of deep plane and 31% of SMAS patients (p=0.70); no permanent nerve injuries were observed. The requirement for secondary procedures was 26.6% versus 73.4% (p=0.51). Multivariable logistic regression identified no significant predictors of postoperative complications, and no statistically significant interaction between facelift technique and BMI category was observed (p=0.703). Deep plane and SMAS plication facelifts demonstrated comparable early postoperative safety profiles, recovery times, and patient satisfaction. No statistically significant differences were observed between techniques, consistent with recent systematic reviews and meta-analyses reporting broadly similar outcomes across contemporary facelift approaches (1,2,3). These findings support individualized patient selection and surgeon expertise as the primary determinants of outcome rather than the specific technique employed (4,5).

1. Khoury S, Almubarak Z, Khan H, et al. Aesthetic Plast Surg. 2025. doi:10.1007/s00266-025-05118-x
2. Bater KL, Ishii L, Joseph A, et al. Aesthet Surg J. 2020;40:NP68-NP76. doi:10.1093/asj/sjz297
3. Awad YZ, Nasr MA, El-Sayed MNA. ZUMJ. 2025. doi:10.21608/ZUMJ.2025.352792.3795
4. Derby BM, Codner MA. Plast Reconstr Surg. 2017;139:151e-167e. doi:10.1097/PRS.0000000000002851
5. Mortada H, Alkilani N, et al. JPRAS Open. 2023;39:166-180. doi:10.1016/j.jpra.2023.06.003

Purpose: Miami is a leading destination for aesthetic surgery medical tourism, riddled by high-volume, budget-focused clinics offering reduced pricing and short wait times. Our hospital system encounters a substantial number of patients presenting with complications following aesthetic procedures performed in the community. This study evaluated the hospital course of these patients, along with operating surgeons and facilities. Methods: A retrospective chart review was completed for patients presenting to a Jackson Health System facility between January 2023 and December 2025 with complications arising from aesthetic surgery performed in the local community. Web-based search was subsequently conducted to assess surgeon qualifications and accreditation of operating facilities. Results: A total of 335 patients were identified. Seventy-eight percent (n=262) resided outside of Florida. Nearly half (n=157) presented with complications following Brazilian Butt Lift (BBL) procedures. The most common presenting diagnosis was anemia or hemorrhage (n=222, 65%). Emergent operative intervention was required in 25% (n=84) of cases. Among identified surgeons (n=255), 63% (n=160) were board-certified plastic surgeons, while 27% (n=71) completed a residency other than plastic surgery. Only 27% of operating facilities (n=81) had American Association for Accreditation of Ambulatory Surgery Facilities (QUAD A, formerly AAAASF) certification.
Conclusion: Miami's public hospital system is treating high acuity aesthetic surgery complications mostly related to anemia and hemorrhage in medical tourists having surgery at non-QUAD A facilities. While approximately two-thirds of surgeons are board certified in plastic surgery, the remaining providers completed residencies outside of plastic surgery, including non-surgical specialties. Given the low rate of QUAD A accreditation, many board-certified plastic surgeons are likely operating in facilities with less stringent standards. High-volume, budget-focused clinic models may therefore pose a significant threat to patient safety.