Scientific Abstract Presentations: Aesthetic Session 7 Saturday, October 17 Sat, Oct 17 8:00-9:30 a.m. CDT

Introduction: Costal cartilage (CC) is a widely used graft material in rhinoplasty, harvested from autologous (ACC) or cadaveric sources, such as fresh frozen (FFCC) or irradiated homologous costal cartilage (IHCC). Although all graft sources carry risks of infection, warping, and revision surgery, their comparative safety profiles remain unclear. Previous literature has been limited by small sample sizes, heterogeneous outcome definitions, and the absence of comprehensive comparative analyses across graft types. To address this gap, we synthesized available evidence to compare complication rates and surgical outcomes, thereby providing a more robust foundation to guide graft selection and inform surgical planning for this frequently performed procedure.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. OVID MEDLINE, OVID Embase, Cochrane CENTRAL, and Scopus were searched from inception to April 2025. Eligible studies included adult patients undergoing rhinoplasty with ACC, FFCC, or IHCC grafting. Primary outcomes were infection, warping, and revision. Secondary outcomes included donor site morbidity, graft survival, resorption, extrusion, and patient-reported outcomes. Data were pooled using random-effects proportional meta-analysis, with heterogeneity assessed by I². Post-hoc power analyses were performed to assess the robustness of results.

Results: Of 3109 records screened, 25 studies (n=2322 patients) met inclusion criteria (ACC=775, FFCC=1076, IHCC=471). The mean age across cohorts was 34 years, with a mean follow-up of 24 months. Most cases were revision rhinoplasties (n=1809, 78%). Grafts were commonly used for columellar struts, dorsal onlays, shield grafts, spreader grafts, and septal extensions. Infection was consistently rare across graft types: 2% with ACC, 1% with FFCC, and 1% with IHCC, with low heterogeneity. Warping was similarly infrequent, though slightly higher with ACC (3%) compared with FFCC and IHCC. Revision rates were more variable, being most frequent with ACC (7%) and IHCC (7%) and least with FFCC (1%). Donor site morbidity, reported only in ACC, included pain, scarring, and rare pneumothorax. Patient-reported outcomes were favorable across graft types but inconsistently measured, precluding pooled analysis. Post-hoc power analyses supported non-inferiority of all graft types with respect to infection and warping.

Conclusion: These findings demonstrate that infection and warping are rare across ACC, FFCC, and IHCC grafts in rhinoplasty, with broadly comparable safety profiles. Revision outcomes appeared most favorable with FFCC. These findings highlight the need for individualized graft selection that accounts for patient anatomy, surgeon experience, and resource availability. Future prospective, standardized studies are required to further define optimal graft selection strategies.

PURPOSE: Weight loss medications like glucagon-like peptide-1 (GLP-1) receptor agonists (RA) has drastically increased in popularity. Usage of medications has also emerged as a strategy for patients who have undergone bariatric surgery but struggled with weight loss plateau or weight regain. In body contouring, the combination of the two modalities may accelerate rapid weight loss and micronutrient deficiencies, potentially increasing the risk for surgical complications like poor wound healing and infection. In the current work, we compare postoperative outcomes following body contouring between post-bariatric surgery patients who are also on weight loss medications and those who are not.

METHODS: A retrospective cohort study of post-bariatric surgery patients who underwent body contouring at two public tertiary care centers from July 2022 to June 2025 was performed. The cohorts were stratified by the active use of weight loss medications within 30 days prior to contouring surgery. Postoperative complications included superficial/full thickness wounds, surgical site infection (SSI), seroma, hematoma, and hypertrophic/keloid scarring. Major complications including deep vein thrombosis/pulmonary embolism (DVT/PE), reoperation, and readmission were also examined. Post-bariatric surgery patients who were also on weight loss medications were compared to those who were not. Nearest-neighbor propensity score matching was used to match the two cohorts in a 2:1 ratio on covariates that were significant in univariate comparison.

RESULTS: 277 patients were included in the study, with a mean age of 45.3 and body mass index (BMI) of 30.6 kg/m2. The most common contouring procedure performed was panniculectomy or abdominoplasty (67.1%, n=186), followed by breast reduction or mastopexy (17.7%, n=49), brachioplasty (10.1%, n=28), thighplasty (4.7%, n=13), and back lift (0.36%, n=1). Of the total cohort, 39 patients (14.1%) were on weight loss medications, with most (n=34) being on GLP-1 RA. Compared to those who only underwent surgery, patients who were also on pharmacologic treatment had significantly older age (50.8 vs. 44.4), higher BMI (32.6 vs. 30.2 kg/m2), and higher prevalence of hypertension (41.0 vs. 24.4%) and diabetes (43.6 vs. 13.0%) (p<0.05). Following contouring surgery, the two cohorts had similar incidences of major complications (p>0.05). While the rates of seroma, hematoma, and hypertrophic/keloid scarring were comparable, patients who were on weight loss medications had significantly higher incidences of superficial wounds (10.3 vs. 2.94%, p=0.030), full thickness wounds or dehiscence (17.9 vs. 5.88%, p=0.008), and SSI (10.3 vs. 2.52%, p=0.016). After propensity score matching on age, BMI, hypertension, and diabetes (n=117), weight loss medication usage was associated with a significantly higher rate of full thickness wounds (17.9% vs. 3.8%, p=0.026) and similar rates of all other complications (p>0.05).

CONCLUSIONS: A significant subgroup of patients, 14% in our cohort, require weight loss medications even after bariatric surgery. In our propensity score-matched analysis, medication usage is found to be associated with a higher rate of dehiscence following body contouring, suggesting negative synergistic effects of pharmacologic weight loss and bariatric surgery on wound healing. Post-bariatric surgery patients who are also on weight loss medications should be appropriately counseled on the increased risk for poor wound healing following body contouring.

Purpose: Hyaluronic acid fillers surged in popularity during the early 2020s, secondary to the "zoom effect" and endorsement by prominent celebrities. This initial rise was paired with a 57% increase in filler reversal in 2021 according to The Aesthetic Society Databank Statistics. ASPS Procedural Statistics from 2023-2024 indicated only a 1% increase in HA filler injections, suggesting public interest in fillers may have reached a plateau. The aim of this study was to further investigate this phenomenon by examining current trends in public interest in filler and filler reversal.

Methods: Google Trends database (Mountain View, California, USA) search parameters were set to query data from October 2019 through October 2025 within the United States. Keywords relating to fillers and filler complications were entered in various combinations to obtain the highest yield search volume. Keywords were grouped according to topic and averaged to display a mean score. A secondary search was performed to specifically assess trends in lip filler. An economic subgroup analysis was performed comparing search volumes for specific terms ("filler" and "lip filler") from five states with the highest and lowest median household income, using data obtained from the United States Federal Reserve. Statistical Analysis was performed in JMP (Cary, NC).

Results: Search volume for both filler and filler removal increased across the study period (R2= 0.44, ß1=0.33, p<0.0001 and R2= 0.66, ß1=0.54, p<0.0001, respectively). There was similarly increased search volume for filler complications (R2= 0.77, ß1=0.57, p<0.0001). When assessing lip filler specifically, there was a similar increase for both lip filler (R2= 0.74, ß1=0.74, p<0.0001) and lip filler removal (R2= 0.75, ß1=0.71, p<0.0001). Linear regression analysis demonstrated a significant positive association between national search interest in fillers and search interest in filler removal (R² = 0.47, ß1=0.92, p < 0.0001). Search interest for hyaluronic acid filler brand names declined over time (R² = 0.37, ß1=-0.44, p < 0.0001), whereas non-hyaluronic acid filler brand names increased over time (R² = 0.50, ß1=0.34, p < 0.0001). There was no difference in socioeconomic groups in search volume for filler or filler removal.

Conclusion: Our analysis revealed increased search volume for filler-related terms over the last five years, indicating public interest has persisted beyond the initial pandemic-surge. Simultaneously, there has been increased search volume for filler complications, filler reversal, and non-hyaluronic acid fillers, suggesting increased public awareness of potential complications and alternatives.

Abstract Purpose: Old scars represent a therapeutic challenge due to completed remodeling and reduced biological responsiveness. While nano-fat grafting, botulinum toxin A (BoNT-A), and non-ablative laser therapy have individually demonstrated benefits in scar modulation, their isolated impact on long-standing scars is often limited, and their combined effect in mature scars has not been prospectively evaluated (1-3). This study aimed to assess the safety and efficacy of a standardized triple-modality protocol incorporating 1540-nm non-ablative laser therapy, nano-fat grafting, and BoNT-A injections for the treatment of old scars, and to evaluate whether a combination strategy targeting complementary biological mechanisms could achieve a synergistic clinical improvement in mature scars.

Methods: A prospective study was conducted including 25 patients with scars older than 1.5 years and up to 5 cm². All patients underwent an initial 1540-nm non-ablative fractional laser session. Approximately one month later, a second laser session was performed immediately prior to injection of a combined nano-fat and BoNT-A solution. Nano-fat was prepared from autologous lipoaspirate by centrifugation (2000 rpm, 1.5 minutes) followed by mechanical emulsification (>40 passes). A total of 30 units of BoNT-A were mixed with 3.5 mL of nano-fat, and the solution was injected at a dose of 1 mL/cm². Scar assessment was performed pre-treatment and at a mean follow-up of approximately 6 months using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Observer assessments were completed independently by the treating physician and an additional plastic surgeon. Statistical analysis was performed using paired t-tests.

Results: The mean patient age was 43±12.7 years. Surgical scars accounted for 52% of cases and traumatic scars for 28%. A significant improvement was observed in the mean VSS score, decreasing from 4.7 pre-treatment to 3.0 post-treatment (p<0.001). Observer POSAS scores demonstrated statistically significant improvement in vascularity (p=0.016), pigmentation (p<0.001), thickness (p<0.001), relief (p=0.011), pliability (p<0.001), surface area (p<0.001), and overall scar appearance (p<0.001). Patient-reported outcomes showed significant improvement in overall opinion of the scar (p=0.009). No major adverse events or complications were recorded.

Conclusions: The combined use of non-ablative laser therapy, nano-fat grafting, and BoNT-A injections was safe and resulted in significant objective and subjective improvement in mature scars. Statistically significant changes across validated observer-based measures, together with improved patient-reported scar perception, demonstrate clinical benefit in long-standing scars. These findings provide prospective evidence that the integration of these three modalities confers a synergistic effect and supports an effective multimodal approach for the management of challenging mature scars in plastic surgery practice.

Refernces: 1. Karmisholt KE, Banzhaf CA, Glud M, et al. Laser treatments in early wound healing improve scar appearance: a randomized split-wound trial with nonablative fractional laser exposures versus untreated controls. Br J Dermatol. 2018;179(6):1307-1314. 2. Uyulmaz S, Macedo NS, Rezaeian F, Giovanoli P, Lindenblatt N. Nano-fat grafting for scar treatment and skin quality improvement. Aesthet Surg J. 2018;38(4):421-428. 3. Austin E, Koo E, Jagdeo J. The cellular response of keloids and hypertrophic scars to botulinum toxin A: a comprehensive literature review. Dermatol Surg. 2018;44(2):149-157.

Purpose Deep plane facelift techniques provide reliable and long-lasting rejuvenation of the lower face and midface through predominantly vertical vectors of elevation (1,2). However, aging of the temporal region and lateral brow is frequently under-treated or addressed as a separate procedure, which may result in disharmony between the upper and midface. The purpose of this study is to evaluate the outcomes of a combined temporal lift and deep plane facelift using a unified vector approach to achieve balanced and natural facial rejuvenation.

Methods and Materials A retrospective analysis was performed on patients undergoing a combined temporal lift and deep plane facelift between March 2023 and August 2025. The surgical technique consisted of a multiplanar temporal dissection combined with a deep plane midface dissection, with communication between both anatomical spaces. Suspension of the midface and lateral brow was achieved using a continuous vertical and superolateral vector, anchored to deep fascial structures without cutaneous tension. Preoperative planning of brow position and shape was individualized according to patient anatomy and expectations, following established principles for upper facial rejuvenation (4,5). All procedures were performed by the senior author using standardized surgical and postoperative protocols.

Experience A total of 56 consecutive patients were included, with a mean age of 57.4 years and a mean follow-up of 18 months. Patients with a history of botulinum toxin injections within 6 months prior to surgery, as well as those with baldness or sparse temporal hair, were excluded from the study.

Results The combined approach resulted in consistent improvement of midface projection, lateral brow position, temporal contour, and overall facial harmony. The use of a unified vector facilitated a smooth transition between the upper and midface, avoiding segmental or overcorrected appearances. Patient-reported satisfaction was high, particularly regarding natural-looking results and global facial balance. Complications were infrequent, minor, and transient, consistent with safe temporal dissection planes described in anatomical studies (3).

Conclusions The combination of temporal lift and deep plane facelift using a unified vector approach is a safe and effective strategy for comprehensive upper and midface rejuvenation. By treating facial aging as a continuous anatomical process, this technique enhances harmony, durability, and natural aesthetic outcomes, while respecting established vectorial and anatomical principles (1–5).

1.⁠ ⁠Jacono AA, Malone MH. The extended deep plane facelift: a contemporary approach. Facial Plast Surg Clin North Am. 2019;27(3):365–374.

2.⁠ ⁠Benjamin Talei, Dan Gould, Hedyeh Ziai. Vectorial Analysis of Deep Plane Face and Neck Lift. Aesthetic Surg J. 2024 Sep 16;44 (10):1015-1022.

3.⁠ ⁠Sihag RK, Gupta SK, Sahni S, Aggarwal A. Frontotemporal branch of the facial nerve and fascial layers in the temporal region: A cadaveric study to define a safe dissection plane. Neurol India. 2020;68:1313–20.

4.⁠ ⁠Verpaele AM, Tonnard PL, Coppens G, et al. Long-term use of the Fogli temporal lift technique. Plast Reconstr Surg. 2015;135(2):324–334.

5.Zins JE, Meyers A. An algorithm for correction of the aging upper face. Clin Plast Surg. 2022;49:415-420.

Background: Rhinoplasty techniques must be tailored to the underlying anatomical characteristics of different ethnic groups. Caucasian rhinoplasty is predominantly reductive, addressing excess bone, cartilage, and soft tissue. In contrast, ethnic rhinoplasty; particularly in African and Asian patients, represents an augmentation and reconstructive procedure due to inherent deficiencies in bony and cartilaginous support combined with a thick, soft tissue envelope. These structural limitations require a fundamentally different surgical philosophy focused on framework reconstruction rather than reduction. Objectives: The objective of this study is to present a standardized reconstructive approach to ethnic rhinoplasty that emphasizes septal framework restoration to achieve stable improvements in nasal length, projection, dorsal contour, and tip support, while maintaining natural aesthetics and long-term durability. Methods: The series includes 140 patients (119 female, 21 male) aged 18–65 years who underwent primary ethnic rhinoplasty. The predominant anatomical features included short nasal length, consequent over-rotated tip, under-projection of the tip due to lack of caudal septal support, weak septal support in the cephalo-caudal direction, short nasal bones, fragile lower lateral cartilages, and a thick skin–subcutaneous–SMAS envelope. The surgical strategy prioritized reconstruction of the cartilaginous infrastructure. A double-sided four to six-piece septal extension graft was assembled using cadaveric cartilage in 96 cases and autologous rib cartilage in 44 cases. This construct was utilized to elongate and reinforce the septum, thereby contributing to nasal lengthening, projection enhancement, and tip and dorsal support. Dorsal augmentation was achieved using diced cartilage mixed with autologous blood and placed into a precisely prepared subcutaneous tunnel extending from the radix to the supratip region. In cases with severe soft tissue tightness, intraoperative dorsal skin expansion was performed. The lower lateral cartilage complex was fully released (including footplate release) and suspended to the reconstructed caudal septum, allowing the patient's native tip cartilages to define tip shape and projection. Selective thinning of the nasal skin was performed when indicated. Ancillary procedures, including columellar lengthening via V–Y advancement, alar base modification, nostril diameter reduction, nasal sill narrowing, and alar thickness reduction, were applied on a case-by-case basis. Results: The mean follow-up period was 2 years. No major complications were observed. There were no cases of graft infection, extrusion, warping, or clinically evident graft resorption. Three patients with extremely thick skin developed deep scar formation and persistent tip fullness. One patient required secondary revision. Reconstruction of the septal framework provided a stable structural backbone, eliminating the need for cap grafts for tip projection or solid block grafts for dorsal augmentation. Dorsal paste grafting resulted in smooth contours with minimal risk of asymmetry, graft visibility, or displacement. Conclusions: Ethnic rhinoplasty should be approached as a reconstructive and augmentative procedure centered on restoration of the cartilaginous infrastructure. Septal reconstruction using a multi-piece extension graft provides reliable support for nasal length, projection, and dorsal harmony while allowing the nasal tip to be shaped by native cartilage. This approach yields natural, durable results with a low complication rate and is well suited for the anatomical demands of ethnic noses.

Contemporary neck rejuvenation has advanced beyond superficial skin redraping and platysmal tightening to address deeper anatomic contents for improved contours. These issues include the following: persistent submandibular bulge, digastric prominence, subplatysmal fat, and gland ptosis may limit aesthetic outcomes if unrecognized or undertreated. The comprehensive deep structure neck lift integrates systematic preoperative analysis with meticulous subplatysmal dissection to optimize contour while prioritizing safety.

Evaluation begins with dynamic and static assessment of cervical convexities, mandibular definition, hyoid position, and gland visibility at rest and animation. Palpation helps differentiate subcutaneous from subplatysmal volume and identify submandibular gland ptosis versus hypertrophy. Patient selection is very important, and ideal candidates demonstrate stable weight, realistic expectations, and an anatomic basis for deep contouring rather than isolated skin laxity.

Operatively, wide subplatysmal exposure through a submental approach permits direct visualization of the anterior digastric muscles, subplatysmal fat compartments, and submandibular glands. Conservative excision of subplatysmal fat sharpens the cervicomental angle. Reduction and sculpting of the submandibular gland are performed via the submental incision with entry into the gland capsule anteriorly protecting the nerve and vascular structures posterior to the gland capsule. Approach to the submandibular gland is facilitated by identification of the anterior digastric muscle down to its tendon caudally. Partial glandular excision, or suture suspension may be tailored based on degree of ptosis and prominence.1 Hemostasis is meticulous to minimize hematoma risk in this vascular plane.

Appropriate management of digastric hypertrophy is done by partial resection and contouring and midline platysmal plication further refines the cervicomental contour. Layered closure with tension redistribution supports durable definition. Postoperative protocols emphasize compression, blood pressure control, low sialogogue diet, and attentive follow up.

When executed with a stepwise approach and respect for deep cervical anatomy, comprehensive deep structure neck lift techniques yield a sharper mandibular border, improved cervicomental angle, and enhanced lower facial harmony.2 Additional refinements to the procedure with limited skin delamination have also been demonstrated to further improve the skin quality of the neck and improve outcomes and skin flap vascularity.3 Although technically demanding, thoughtful analysis and disciplined surgical execution allow safe sculpting of the submandibular gland and associated deep contents, expanding the armamentarium of the modern facial rejuvenation surgeon and elevating aesthetic outcomes in appropriately selected patients.

References

1. Thomas Gerald O'Daniel, Optimizing Outcomes in Neck Lift Surgery, Aesthetic Surgery Journal, Volume 41, Issue 8, August 2021, Pages 871–892, https://doi.org/10.1093/asj/sjab056

2. Benjamin Talei, Orr Shauly, Troy Marxen, Ambika Menon, Daniel J Gould, The Mastoid Crevasse and 3-Dimensional Considerations in Deep Plane Neck Lifting, Aesthetic Surgery Journal, Volume 44, Issue 2, February 2024, Pages NP132–NP148, https://doi.org/10.1093/asj/sjad321

3. Roskies M, Bray D, Gordon NA, Gualdi A, Nayak LM, Talei B. Limited Delamination Modifications to the Extended Deep Plane Rhytidectomy: An Anatomical Basis for Improved Outcomes. Facial Plast Surg Aesthet Med. 2024 Nov-Dec;26(6):657-664. doi: 10.1089/fpsam.2024.0018. Epub 2024 Jul 29. PMID: 39072376.

Background:

In many Asian patients, an aesthetically "retruded" nose reflects not only low dorsal height but also underlying skeletal imbalance, including midfacial retrusion and limited anterior nasal spine (ANS) support. Therefore, dorsal augmentation alone may be insufficient to achieve a balanced profile. Columellar base augmentation can improve support and the nasolabial angle; however, cartilage-based methods may increase rigidity, limit upper-lip mobility, and produce unnatural animation. We evaluated a minimally invasive, soft tissue–only approach using a Fusion Sling composite flap incorporating superficial orbicularis oris–nasalis (SOON) tissue, designed to augment the alar/columellar base while preserving perioral dynamics, without rib cartilage harvest and without external incisions beyond standard rhinoplasty access.

Methods:

From 2023 to 2025, 214 consecutive Asian rhinoplasty patients underwent columellar base augmentation using the Fusion Sling–SOON composite flap. The technique combines a nondistensible, perichondrium-like "Fusion Sling" with vascularized SOON soft tissue to provide stable support and dynamic volume at the columellar base. Three fixation levels were used to allow graded augmentation: (1) caudal septal hinge, (2) mid-level septal extension graft (SEG), and (3) superior SEG. A subset of 63 patients underwent standardized 3D Vectra photogrammetry preoperatively and at 6–12 months postoperatively (mean 9.2 months). Primary endpoints were changes in nasolabial angle and columellar projection. Paired t-tests were performed (p<0.05).

Results:

In the 3D subset (n=63), mean nasolabial angle increased from 93.4°±4.2° to 101.0°±3.8° (mean +7.6°, 95% CI 6.8–8.4; p<0.001), and columellar projection increased by 1.9±0.6 mm (95% CI 1.7–2.1; p<0.001). Nasolabial angle changes were graded by fixation level (mild +3.2°, moderate +7.8°, large +12.4°). No major complications were observed in the overall cohort (0/214). No persistent upper-lip stiffness or clinically evident animation deformity was noted during follow-up.

Conclusions:

The Fusion Sling–SOON composite flap achieved significant, titratable columellar base augmentation while preserving physiologic perioral movement. This soft tissue–based strategy may mitigate stiffness-related limitations associated with cartilage-only augmentation in Asian rhinoplasty and may complement dorsal augmentation by addressing anterior support and profile balance.

Incorporation of the Vertical Vector in the Medial Approach Deep Plane Face Lift Dr. Rezarta Kapaj M.D., Dr. Zekeriya Kul M.D.

Introduction Anatomic understanding of the face lift anatomy has fundamentally changed since Dr. Bryan Mendelson introduced the spaces concept. Respecting anatomic bounderies, bloodless and minimal risk dissection is possible within the spaces. This concept created the basis of the deep plane face lift dissection and has been adopted widely since. While very effective on the lower face, the effect of Deep Plane face Lift in the Mid face remains limited to a non anatomic vector and for the midface, the High SMAS dissection remains superior. When we look at facial aging, we can clearly see that the main changes happen in the anterior mobile face and the vector of aging is universally inferiomedial. As such, the best way to correct these changes is to lift the ptotic unity using a superior vector. Current Deep Plane face Lift techniques are mostly based on a lateral approach and fixation using an oblique vector. Still, the ptotic malar fat pad can be elevated with the FAME procedure, advanced vertically and fixated on the infraorbital rim. Our aim in this study was to stabilize a vertical vector and firm fixation of the midface in order to overcome the superiority of the High SMAS techniques to Deep Plane techniques and to avoid overzealous fat grafting in most cases.

Material and Methods 30 patients have undergone this surgical technique between 2025 and 2026. All patients were female. The operation was done under general anesthesia in 75% of the cases and local and conscious sedation in 25% of the cases. The surgical technique was as follows: After the preauricular incision the skin flap was prepared and after identification of the orbicularis oculi fibers, a small window was created to enter the prezygomatic space. The upper and lower premasseteric spaces were dissected bluntly as previously described. The McGregor patch was identified and released and a surgical plan was created over the zygomaticus major muscle after the release of the zygomaticocutanous ligaments. The malar fat pad was elevated in a composite manner. Three sets of sutures were used for the vertical lifting of the malar fat pad. One of the sutures passed from the malar fat pad medially to the distal part of the zygomaticus major muscle, and two other sets laterally to the line of the zygomaticus major muscle. All sutures are secured firmly to the inferior orbital rim, lifting the fat pad in a vertical manner. The SMAS flap is secured to the fixed SMAS in an oblique manner. The edge of the flap is sutured to the parotis capsule, diminishing the tension of the main sutures and providing a better contour. The main follow up of the patients was 9 months. Patients and surgeons satisfaction was high.

Conclusion: The use of the vertical vector for the midface in a deep plane face lifts provides improved results and high patient satisfaction.

Objective Upper-face aging in Asian women presents a unique constellation of anatomical characteristics distinct from those typically seen in Caucasian patients. Upper eyelid fullness, largely attributed to hypertrophy of the brow fat pad, leads to progressive upper-lid hooding with age(1). Compounding this, many Asian women possess a prominent supraorbital ridge, particularly along the superolateral orbital rim(2). This bony projection deepens lateral upper-eyelid shadowing and intensifies hooding. More importantly, a pronounced supraorbital ridge restricts the upward-lateral traction vector necessary for elevating the lateral canthus, thereby limiting the effectiveness of conventional forehead- or brow-lift procedures. Standard techniques such as coronal, pretrichial, endoscopic, or transblepharoplasty lifts(3) mainly reposition soft tissue and cannot overcome bony constraints, leaving persistent lateral hooding and canthal ptosis despite otherwise well-executed soft-tissue lifts. The objective of this study was to introduce a safe, versatile, and effective technique that reshapes the supraorbital ridge to optimize the vector of forehead lifting, thereby permitting direct and significant elevation of the lateral canthus. By combining forehead lift or total facial lift with targeted lateral orbital rim remodeling through a single facelift incision, this method enhances surgical access, improves control of lifting direction, and minimizes intraoperative blood loss. This approach aims to address both soft-tissue laxity and skeletal prominence, offering a more complete rejuvenation strategy for Asian women with lateral hooding and age-related upper-face changes.

Methods From 2015 to 2024, the author performed forehead lift or total facelift combined with lateral orbital rim remodeling on patients presenting with aging of the upper face, lateral hooding, and varying degrees of lateral canthal ptosis. A single facelift incision was used to allow subperiosteal exposure of the lateral orbital rim and supraorbital ridge. Depending on individual anatomy, bony reduction or contouring was performed to create an unobstructed lifting vector. Forehead or total lift procedures were then completed with appropriate fixation. Operative data, complications, and patient satisfaction were prospectively recorded. Aesthetic outcomes were evaluated using standardized clinical photographs and the Global Aesthetic Improvement Scale (GAIS).

Results A total of 112 patients met inclusion criteria. All procedures were completed successfully. Mean operative time was 245 minutes; average blood loss was 40 mL. Follow-up ranged from 6.5 to 60 months. No major complications such as hematoma, nerve injury, or infection were observed. GAIS showed consistent improvement in lateral canthal position, reduction of lateral hooding, and overall upper-face rejuvenation with uniformly high patient satisfaction.

Conclusions This single-incision combined technique provides direct access to the supraorbital ridge and lateral orbital rim, allowing precise modification of the bony contour that typically limits the lateral lifting vector in conventional forehead-lift procedures. By correcting this structural restriction, the procedure enables more effective elevation of the lateral canthus and reliable improvement of lateral hooding. In addition, improved medial canthal tilt enhances palpebral fissure inclination, a well-recognized contributor to feminine facial attractiveness. This comprehensive approach offers excellent visualization, superior hemostatic control, and a safe and efficient method for achieving upper-face rejuvenation in Asian women with prominent supraorbital ridges.

References 1 - Seiff SR, Seiff BD. Anatomy of the Asian eyelid. Facial Plast Surg Clin North Am. 2007 Aug;15(3):309-14, v. doi: 10.1016/j.fsc.2007.04.010. PMID: 17658426. 2 - Yang B, Dong X, Zhang ZY, Tang XJ, Yin L. Fronto-Orbital Osteotomy Reshaping for Supraorbital Ridge Protrusion. J Craniofac Surg. 2015 Sep;26(6):1926-9. doi: 10.1097/SCS.0000000000001904. PMID: 26147020. 3 - Niamtu J 3rd. The subcutaneous brow- and forehead-lift: a face-lift for the forehead and brow. Dermatol Surg. 2008 Oct;34(10):1350-61; discussion 1362. doi: 10.1111/j.1524-4725.2008.34288.x. Epub 2008 Jul 3. PMID: 18627407.

Introduction

Umbilical hernia is frequently encountered in patients presenting for abdominoplasty, particularly in the presence of rectus diastasis and post-partum abdominal wall attenuation. While small defects may be amenable to suture repair, mesh reinforcement is increasingly advocated for defects ≥2 cm to reduce recurrence. However, the optimal plane of mesh placement during abdominoplasty remains debated. This study evaluates the technical considerations, safety profile, and biomechanical implications of various mesh planes in combined aesthetic–reconstructive surgery.

Methods

A retrospective review was conducted of patients undergoing abdominoplasty with simultaneous umbilical hernia repair over a period of five years from January 2020 to January 2025. Defects were assessed pre operatively & intraoperatively and repaired using one of three approaches: primary suture repair, retro-rectus (sublay) mesh placement, or intra peritoneal mesh placement. Onlay mesh was selectively used in early cases. All patients underwent concurrent rectus sheath plication. Outcomes assessed included hernia recurrence, seroma formation, wound complications, umbilical vascular compromise, and aesthetic satisfaction.

Results

Patients with defects <1.5 cm treated with primary repair demonstrated satisfactory outcomes without early recurrence. For defects ≥2 cm, retro-rectus mesh placement showed the lowest complication and recurrence rates. Intra-peritoneal placement yielded comparable reinforcement in moderate to large defects. Onlay mesh was associated with a higher incidence of seroma. Rectus sheath plication enhanced midline stability, without compromising mesh integrity. No cases of significant umbilical necrosis were observed

Conclusions

Mesh reinforcement during abdominoplasty can be performed safely with meticulous technique. Retro-rectus placement offers superior support and lower morbidity compared with superficial planes. The combination of deep mesh reinforcement and rectus plication provides durable abdominal wall restoration while preserving aesthetic outcomes. Thoughtful mesh plane selection is central to achieving both structural integrity and surgical finesse in combined procedures.

Background: Breast augmentation is the most performed aesthetic surgical procedure worldwide; however, long-term data focused exclusively on cosmetic patients undergoing secondary implant replacement or explantation remain limited. Understanding the causes and timing of secondary procedures is essential for accurate patient counseling and long-term surgical planning.

Methods: A prospective observational cohort study was conducted including 8,502 women who underwent secondary aesthetic breast surgery between 2012 and 2024 after primary cosmetic augmentation. Patients with reconstructive indications or PIP implants were excluded. Indications for secondary surgery were categorized as medical (implant rupture, capsular contracture, ptosis, or device-related defects) or elective aesthetic (patient-driven desire for size change, dissatisfaction, or preference-based modification). Kaplan–Meier survival analysis was used to estimate implant survival over time.

Results: The mean patient age was 40.7 ± 10.9 years, and the mean implant lifespan prior to revision was 9.37 ± 5.68 years. Implant replacement accounted for 83.5% of procedures, while 16.5% were explantations. The most frequent indications were implant aging (25.7%), rupture (17.1%), and capsular contracture (10.3%). Elective aesthetic motivations accounted for 33.9% of secondary procedures. Implant survival for physical integrity was 95.6% at 5 years, 84.1% at 10 years, and 66.0% at 15 years.

Conclusions: Secondary breast implant surgery in aesthetic patients is predominantly a predictable, time-dependent process rather than a consequence of early complications. A substantial proportion of procedures are patient-driven aesthetic decisions, supporting implant replacement as a natural component of long-term aesthetic breast care.

Introduction Abdominoplasty has undergone substantial technical and conceptual evolution over the past two decades, driven by advances in perioperative management, surgical technique, and the increasing adoption of personalized approaches to body contouring. We aimed to trace the evolution of abdominoplasty over a 20-year period through the experience of a single surgeon performing 600 consecutive procedures, highlighting technical refinements ("tips and tricks") associated with reduced complication rates and improved patient outcomes, as well as the current role of personalized surgery in enhancing aesthetic results and patient well-being. Materials and Methods Between October 2004 and October 2024, 600 consecutive abdominoplasty procedures were performed by a single surgeon. A retrospective analysis of a prospectively maintained database was conducted to assess perioperative management, operative variables, postoperative outcomes, and complications, and to document temporal trends in surgical practice over two decades. Patients were stratified into two temporal cohorts (first decade vs second decade). Complications were classified as minor or major. Predictors of adverse outcomes were analyzed and categorized as modifiable or non-modifiable risk factors. The impact of specific technical refinements and combined procedures was evaluated. Results Median operative time significantly decreased over time, reaching a median of 2 hours in the last five years. Postoperative length of stay declined from a median of 3 days to 1 day. The overall complication rate was markedly reduced from 49.8% in the first decade (26.8% minor; 23% major) to 25% in the second decade (18% minor; 7% major). Non-modifiable negative predictors included advanced age, diabetes mellitus, and surgical weight loss. Modifiable risk factors associated with poorer outcomes included preoperative obesity and elevated body mass index (BMI), active smoking, and preoperative anemia. Technical factors also influenced outcomes: the routine performance of rectus sheath plication was associated with improved overall results. Liposuction of the hypochondriac regions and flanks increased procedural safety and significantly reduced the risk of wound dehiscence and delayed healing. Concomitant body contouring procedures did not adversely affect outcomes, with the exception of suboptimal scarring, which has been recently mitigated by adjunctive fat grafting. The use of fibrin glue or quilting sutures emerged as a modifiable technical variable impacting outcomes. Conclusions Over the last 20 years, abdominoplasty has evolved into a safer and more standardized procedure, with significant reductions in operative time, hospital stay, and complication rates. The integration of refined surgical techniques and patient-specific risk stratification has contributed to improved outcomes in both aesthetic and post-bariatric populations. Abdominoplasty has become an effective reconstructive and reshaping procedure of the abdominal wall, providing meaningful improvements in quality of life and patient well-being. These findings support a personalized surgical strategy, emphasizing modifiable risk factor optimization and tailored technical planning to further enhance safety and outcomes.

Title: Hemostatic Net for Thick-Skinned Rhinoplasty: A Preliminary Case Series

Purpose: Thick nasal skin presents a persistent challenge in rhinoplasty, often limiting tip definition and contributing to prolonged edema. Hemostatic net and quilting suture techniques have been described in rhytidoplasty to reduce hematoma formation and improve skin redraping (1–3); however, their application in rhinoplasty has not been well reported. We describe a hemostatic net technique designed to enhance soft tissue redraping and postoperative contour control in patients with thick nasal skin and evaluate its safety and early outcomes.

Methods: A retrospective review was performed of 10 consecutive patients undergoing primary or revision rhinoplasty in whom a hemostatic net technique was applied to the nasal soft tissue envelope. The technique utilizes strategically placed transcutaneous sutures to provide uniform compression and support during the early postoperative period. Patients were evaluated for complications including skin necrosis, infection, hypertrophic scarring, contour irregularities, and delayed wound healing. Standardized preoperative and postoperative photographs were reviewed to assess soft tissue redraping and tip definition. Mean follow-up was 6.6 months (range, 1 to 13 months), with eight patients followed for at least 3 months.

Results: All patients tolerated the procedure without major complications. No cases of skin necrosis, hypertrophic scarring, infection, or soft tissue compromise were observed. Comparative photographic assessment demonstrated improved soft tissue redraping and enhanced tip definition in patients with thick nasal skin. Patient-reported satisfaction was uniformly high at most recent follow-up. No revisions related to soft tissue envelope management were required.

Conclusions: The hemostatic net technique appears to be a safe and reproducible adjunct for management of thick nasal skin in rhinoplasty. In this preliminary series, the method demonstrated favorable aesthetic outcomes and high patient satisfaction without significant soft tissue complications. This technique may offer improved postoperative edema control and skin redraping in select patients. Larger studies with longer follow-up are warranted to further evaluate long-term outcomes and comparative efficacy.

References: 1. Auersvald A, Auersvald LA. The hemostatic net in rhytidoplasty. Aesthetic Surg J. 2. Jones BM, Grover R. Avoiding hematoma in cervicofacial rhytidectomy. Plast Reconstr Surg. 3. Baker DC. Hematoma in rhytidectomy. Clin Plast Surg.