Scientific Abstract Presentations: Aesthetic Session 8 Saturday, October 17 Sat, Oct 17 10:30 a.m.-12:30 p.m. CDT

Background: Achieving a sharp and durable jawline with a well-defined gonial angle is a central goal of face and neck lift surgery. Although numerous techniques have been described to improve cervicomandibular contour, maintaining long-term definition of the anterior border of the sternocleidomastoid (SCM) muscle and the gonial angle remains challenging. SMAS flap–based techniques are widely accepted for their longevity; however, positioning the SMAS flap superficial to the SCM may result in progressive blunting of the anterior SCM contour and attenuation of gonial angle definition. Additionally, techniques relying on platysmal cabling or fixation of the platysma to the SCM fascia may cause distortion and conflict with established principles of anchoring superficially dissected tissues to deeper anatomical structures. Objectives: The objective of this study is to describe the "Deep Sling Maneuver", a novel modification of SMAS flap–based face and neck lift surgery designed to enhance jawline definition and gonial angle prominence through a controlled sub-SCM cleavage plane while preserving anatomical integrity and natural contour. Methods: The "Deep Sling Maneuver" is performed as part of a high-SMAS flap–based face and neck lift. Following elevation of a robust SMAS flap and creation of a posterior sling, a precise tunnel is created beneath the sternocleidomastoid muscle, immediately superficial to its posterior deep fascia. The posterior sling of the SMAS flap is then passed under the SCM and secured to the mastoid process. This maneuver accentuates the anterior border of the SCM muscle and enhances gonial angle definition without placing direct tension on the SCM fascia. The lower part of the platysma then is rotated superiorly and adapted over the rest of the muscle hence tightening the inferior neck. No platysmal cabling is used, and the platysma is not sutured to the SCM fascia directly. The spinal accessory nerve courses inferior to the tunnel plane and remains anatomically distant from the dissection. A consecutive series of 38 patients (34 female, 4 male) underwent this technique. Patient age ranged from 34 to 69 years, with a mean follow-up of 12 months. Results: All patients demonstrated improved jawline definition and increased gonial angle prominence both intraoperatively and postoperatively. The anterior border of the sternocleidomastoid muscle remained well defined, contributing to a sharp and natural cervicomandibular contour. These improvements were maintained throughout the follow-up period. No cases of spinal accessory nerve injury, SCM muscle dysfunction, or contour distortion related to platysmal suspension were observed. The maneuver was safely incorporated into standard high-SMAS face and neck lift procedures without an increase in operative morbidity. Conclusions: The "Deep Sling Maneuver" is a reproducible and anatomically sound technique for jawline and gonial angle enhancement in SMAS flap–based face and neck lift surgery. By routing a strong SMAS flap beneath the SCM, the technique preserves anterior SCM definition and achieves a sharp, natural, and durable cervicomandibular contour while adhering to fundamental principles of plastic and aesthetic surgery.

Introduction Revisional deep plane facelifting presents unique technical challenges, particularly during separate elevation the superficial musculoaponeurotic system (SMAS). In revisional cases, the SMAS is frequently attenuated, scarred, or partially disrupted from prior surgery, resulting in diminished tensile strength and unreliable suture suspension. These factors increase the risk of secondary tearing, loss of fixation, and suboptimal midface support. Durable SMAS fixation remains essential for long-lasting facial rejuvenation, as emphasized in high-SMAS and deep-plane facelift techniques.¹-³ Biologic scaffolds have been used in reconstructive surgery to reinforce soft tissues and support remodeling.⁴ A decellularized intact fish skin xenograft offers a novel reinforcement option with favorable handling characteristics and biocompatibility. We evaluated its use as a scaffold for SMAS repair and flap fixation in revisional facelift surgery.

Methods Twenty-three patients undergoing revisional facelifting were included in this bilateral case series. After elevation of the central SMAS flap, tissue integrity was assessed intraoperatively. When the SMAS appeared friable, scarred, or attenuated, primary repair was performed using interrupted 0-Vicryl sutures. A sheet of decellularized fish skin xenograft was then secured bilaterally to reinforce the SMAS repair and augment tensile strength. The reinforced SMAS–fish skin composite flap was advanced and fixated to the temporal fascia and zygomatic periosteum, creating a stable suspension layer capable of withstanding high-tension fixation. Fixation was performed using 2-0 PDS sutures. Patients were followed for a minimum of 12 months to evaluate durability, complications, and aesthetic outcomes.

Results Bilateral reinforcement was performed in all 23 patients, yielding 46 reinforced flap advancements. High-tension fixation to the temporal fascia and zygoma was achieved without difficulty. No intraoperative secondary tearing of the SMAS was observed following reinforcement. Postoperatively, there were no infections, seromas, graft-related complications, or clinically evident foreign body reactions. At 12-month follow-up, all patients demonstrated durable suspension with preservation of mid-cheek volume, improved jawline definition, and maintenance of youthful facial contours. No cases of graft palpability, contour irregularity, extrusion, or late inflammatory response were observed. Representative case photographs are shown in Figures 1 and 2, and an operative video will be presented.

Conclusion Decellularized fish skin xenograft can be safely and effectively utilized as a reinforcement scaffold for SMAS repair during cosmetic facelifting, particularly in revisional cases with compromised tissue integrity. This technique provides durable structural support and favorable aesthetic outcomes at 1-year follow-up without additional morbidity.

References 1. Barton FE Jr. The "high SMAS" face lift technique. Aesthet Surg J. 2002;22(5):481–487. 2. Jacono AA. The extended deep-plane facelift: A 20-year review of 1000 consecutive cases. Aesthet Surg J. 2016;36(8):897–911. 3. Sadati K, Motakef S. The triple-C SMAS plication facelift: A novel technique for natural facial rejuvenation. Plast Reconstr Surg Glob Open. 2019;7(6):e2299. 4. Tork S, Van Gils CC, Kim H, et al. Acellular dermal matrices: Applications in plastic surgery. Semin Plast Surg. 2019;33(1):30–38.

Introduction: Pulmonary embolism is the leading cause of death in aesthetic plastic surgery. There are several prevention models, and they are based on the protocol created by Caprini in 2004. However, it has a high false positive rate in aesthetic plastic surgery patients, and the sum of points does not necessarily correspond to a linear increase in risk. We have created a hybrid system that provides the list of possible risks in aesthetic patients, both clinical and those inherent to the type of surgery, grouped in degree of risk with a guide to make the doctor decide on the type of prophylaxis. Method: The guide was introduced in a hospital where only aesthetic plastic surgeries are performed. The risk factors were separated into three groups, signaling each group with a color according to the risk level. Red: high risk demanding the use of anticoagulants (table 1). Yellow: comprised the risk factors that are known to increase the risk of VTE but should not trigger the use in isolation of anticoagulants. Orange: The third group has all the temporary risks correlated to the procedure. In the chart was noted the age of the patient, the type of surgery and anesthesia, the age of the Surgeon and the surgery duration. Thousand (1000) consecutive aesthetic surgery patients were included and followed for 60 days when the patient was contacted asking for hematoma/bleeding episode or DVT/EP. For the research in this chart were noted also the type of prophylaxis used in each patient. Results: 1.000 consecutive patients were studied. The mean age was 41,19 years; 979 females. 61,3% were isolated procedures; 26,2 % were double and 12,5% were triple. The mean age of the surgeons was 57,76 years. The average surgical time was 03:23 hours. Red risks were cited 7 times; the yellow risk presented an average of 0,38, the orange DVT risks presented an average of 2,14. Elastic stockings were used in 97.03%, pneumatic stockings in 53.55%. Anticoagulation was used in 86,45% of the patients, beginning from 4 to 12 hours after the end of the surgery for 7 to 40 days. DVT/EP occurred in 7 patients (0,7%), and 6 during the use of anticoagulants. 61 cases (6,1%) had bleeding; 8 required blood transfusion, but before intake of anticoagulants. 53 patients returned to the operating room to surgical evacuation of hematoma, 34 cases 12 hours after starting anticoagulants. The anticoagulated hematomas appeared from 24 hrs. to 16 days after the anticoagulant intake. Conclusion: The high percentage of anticoagulant use compared to low risk indices suggest that doctors prefer to face the effects of bleeding than the consequences of a pulmonary embolism that can lead to death. The hematomas may be related to the use of anticoagulants (p<0,05). DVT/EP events still occurred and the rate (0,7%) was higher than expected. We believe that the decision should be made by the surgeon guided by a system that favors a qualitative analysis of the risks presented. This system is structured for clinical and legal use.

Purpose:
Demand for youthful and attractive periorbital aesthetics continues to increase, and blepharoplasty plays a central role in aesthetic surgery. Although numerous anatomical studies of the periorbital region have been reported, limited literature exists regarding surgical techniques specifically addressing formation of the pretarsal roll. In Asian patients, the pretarsal roll is a critical aesthetic feature that conveys a soft and approachable appearance and significantly influences surgical planning and postoperative satisfaction. Hyaluronic acid injection is minimally invasive but may be associated with Tyndall effect, edema, and inferior migration over time. Fat grafting offers longer-lasting results but carries risks of contour irregularity and fat visibility. Mizuno and Yamamoto described a transcutaneous technique using harvested fat grafts placed into the supramuscular space of the orbicularis oculi muscle (1). The present study proposes a less invasive transconjunctival technique for pretarsal roll augmentation performed simultaneously with lower blepharoplasty. Methods:
Between July 2025 and December 2025, 30 consecutive patients (60 eyelids) who underwent this procedure and completed at least 3 months of follow-up were retrospectively evaluated. All patients underwent transconjunctival lower eyelid fat repositioning combined with pretarsal roll augmentation. Standardized preoperative and postoperative photographs were analyzed to measure pretarsal roll height and width using calibrated digital assessment. Only final follow-up data were included. Surgical Technique:
A transconjunctival incision was made, and lower eyelid fat repositioning was performed. After mobilization and contouring of the lateral fat compartment, a sub–orbicularis oculi plane beneath the pretarsal orbicularis muscle was bluntly dissected through the same conjunctival approach to create a defined pocket. Finely minced autologous fat obtained from the lateral compartment was inserted into this space to form the pretarsal roll without external skin incision. Results:
Pretarsal roll formation was achieved in all cases. Mean pretarsal roll height increased from 0.4 mm preoperatively to 1.4 mm postoperatively. Mean width increased from 3.8 mm to 5.8 mm. Patient satisfaction was high at final follow-up. No major complications, including infection, fat necrosis, contour deformity, or visible nodules, were observed. Conclusions:
Pretarsal roll augmentation is highly demanded among Asian patients. Existing surgical techniques may require additional skin incision and may raise concerns regarding reproducibility. During transconjunctival fat repositioning, the lateral fat compartment may remain excessive or prone to recurrence; excessive lateral repositioning may contribute to midface flattening, particularly in Asian patients. This technique is characterized by repurposing redundant lateral fat for pretarsal augmentation. It requires no additional incision, minimizes tissue trauma, and appears to reduce the risks of contour irregularity and fat visibility. These findings suggest that this transconjunctival approach represents a reproducible and effective surgical option for pretarsal roll augmentation in Asian patients.

Reference Mizuno T, Yamamoto A. Pretarsal augmentation of the lower eyelids using fat grafts in Asian patients. Aesthet Surg J Open Forum. 2021;3(3):ojab020.

Abstract: Background: Helium plasma radiofrequency (RF) is an energy-based device designed to provide subdermal soft tissue coagulation and contraction. While anecdotal reports suggest improvement in skin quality following treatment, quantifiable data on histological changes and biological markers remain limited. The objective was to evaluate histological, clinical, and patient-reported outcomes following helium plasma treatment during lower facelift surgery, with a focus on skin quality parameters. Methods: This prospective, single-arm study was conducted at two U.S. sites. Seven subjects undergoing lower facelift surgery received adjunctive helium plasma RF treatment to the neck, submentum, and lower facial skin flap, with untreated mid- and upper-face areas serving as internal controls. Paired 3–5 mm punch biopsies were collected at baseline (pre-treatment) and Day 180 for histological and immunohistochemical evaluation of collagen, elastin, fibrillin-1, and inflammatory markers. Safety, healing, and aesthetic outcomes were assessed through Day 180. Results: Histological analyses demonstrated a 25% increase in elastin fibers (Van Gieson staining), along with a 34% reduction in inflammation (H&E staining). IHC results include a 55% increase in elastin staining intensity and 27% increase in the incidence of elastin expression. No significant fibrosis, epithelial disruption, or other adverse microscopic changes were observed. Clinically, all treated subjects showed improvement in both Investigator and Subject GAIS scores (100%) at every follow-up. By Day 180, all participants reported high satisfaction, noting improvements in elasticity, youthfulness, and radiance. No serious adverse events (SAEs) or unanticipated adverse device effects (UADEs) occurred. Conclusions: Helium plasma RF was well-tolerated and induced favorable dermal remodeling, characterized by elastin restoration and reduced inflammation without significant fibrosis. These findings provide the first direct human evidence that helium plasma RF initiates a regenerative biologic process that enhances skin quality by improving dermal structure, resilience, and elasticity.

Background The anterior vaginal wall serves as a critical structural support for the bladder base and bladder neck. As vaginal tissue undergoes atrophy or laxity - whether due to aging, hormonal changes, or childbirth - this supporting architecture weakens, allowing the bladder to descend and predisposing women to stress urinary incontinence (SUI). In recent years, hyaluronic acid (HA) injection into the vaginal wall has gained growing popularity as a minimally invasive treatment to restore volume and improve sexual satisfaction in women experiencing vaginal atrophy.1-3 Notably, a number of patients who underwent this procedure for sexual wellness indications spontaneously reported concurrent improvement in urinary incontinence symptoms.4,5 These clinical observations prompted the hypothesis that HA injection into the vaginal wall may mechanically reinforce bladder support and thereby reduce stress urinary incontinence.4,5 This prospective study was designed to objectively evaluate that hypothesis using digital perineometry alongside validated subjective symptom assessment. Methods Forty-six women presenting with vaginal laxity, sexual discomfort, or urinary incontinence were enrolled and received a single session of vaginal HA injection. Vaginal pressure was measured objectively at baseline and at 1, 3, and 6 months post-treatment using the MizCure digital perineometer. Urinary incontinence symptoms were concurrently assessed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Statistical comparisons between baseline and follow-up measurements were performed using paired t-tests, with significance defined as p < 0.05. Results Mean vaginal pressure increased significantly from a baseline of 22.73 ± 13.54 cmH₂O to 31.88 ± 13.72 cmH₂O at 1 month (p = 0.0041) and 31.06 ± 16.15 cmH₂O at 3 months (p = 0.0345), representing clinically meaningful improvements. At 6 months, pressure remained elevated at 28.81 ± 13.49 cmH₂O; however, this did not achieve statistical significance (p = 0.0916), consistent with the known metabolic degradation timeline of HA. Among the 23 patients who reported urinary incontinence at baseline, 20 (87%) demonstrated subjective improvement in symptoms, while 3 reported no change. The correlation between objective vaginal pressure gains and subjective urinary symptom relief was most robust during the 1–3 month post-treatment window. Conclusion This study provides objective evidence supporting the hypothesis that HA injection into the vaginal wall strengthens the structural support of the bladder neck and anterior vaginal wall, resulting in measurable increases in vaginal pressure and clinically significant improvement in stress urinary incontinence in the majority of affected patients. The high symptom improvement rate of 87% aligns with the biomechanical rationale that restoring vaginal tissue volume augments bladder support. The attenuation of effect at 6 months suggests that periodic re-injection may be required to sustain outcomes. Digital perineometry proved to be a reliable and practical tool for the objective quantification of treatment response. Future randomized controlled trials with larger cohorts are warranted to further validate these findings and establish standardized re-injection protocols.

References 1.Berreni et al. Evaluation of the effect of multipoint intra mucosal vaginal injection of a specific cross linked hyaluronic acid for vulvovaginal atrophy: a prospective bi centric pilot study BMC Women's Health (2021) 21:322 https://doi.org/10.1186/s12905-021-01435-w 2. Carlos Campagnaro M. dos Santos, MsC, Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review The Journal of Sexual Medicine, 2021, Pages 156–166, https://doi.org/10.1016/j.jsxm.2020.10.016
3.Bouraoui Kotti. Assessment of Female Genital Surgery Education in Plastic Surgery Training: Report of an Expert Opinion Survey Aesthetic Plast Surg. 2019 Aug;43(4):1102-1110. doi: 10.1007/s00266-019-01394-6.Epub 2019 May 13. 4.Piotr Kolczewski, Pharmaceuticals. Bipolar Radiofrequency and Non-Crosslinked Hyaluronic Acid Plus Calcium Hydroxyapatite in the Treatment of Stress Urinary Incontinence 2024;17:622. doi: 10.3390/ph17050622. 5.Maka I. Kakhian. Minimally invasive methods of correction of involutive changes in the genitals and stress urinary incontinence in females using implants based on hyaluronic acid modified with polyethylene glycol diglycidyl ether: A prospective study GYNECOLOGY. 2025; 27 (3): 247–254. doi.org/10.26442/20795696.2025.3.203440

Purpose: The eyebrows are central to upper facial aesthetics and expression. Brow ptosis contributes to periorbital aging and functional visual field impairment. The gliding brow lift (GBL), initially described by Viterbo et al. [1], has been refined to incorporate direct visualization and a nerve-sparing approach. Here, we present outcomes from a single-institution cohort, emphasizing standardized objective brow measurements and morphometric analysis. Methods: A retrospective review of 43 patients (82 brows; 2 unilateral) that underwent nerve-sparing GBL at our institution between 2021 and 2025 was performed. Standardized pre- and postoperative photographs were obtained, calibrated to a 12-mm iris diameter in InfinityView software. Vertical distances from a canthal horizontal reference line to the medial, mid-pupillary, apex, and tail of eyebrow points were measured. Pre- and postoperative values were compared using paired t-tests or Wilcoxon-signed-rank tests where appropriate, with significance set at p<0.05. Results: The average age was 58.8 years (SD 8.1), and most were female. Average postoperative follow-up was 9.1 months (range 3-26 months). Statistically significant postoperative elevation was observed across all eyebrow landmarks: medial (+1.45 mm; p<0.001), mid-pupillary (+2.35 mm; p<0.001), apex (+3.84 mm; p<0.001), and tail (+3.16 mm; p<0.001). No major complications (hematoma, infection, wound dehiscence) were recorded. Post-operative sensory exam demonstrated 9.1/10 sensation to light touch at 1-3 months post-operatively. Conclusion: The modified gliding brow lift under direct visualization is a reliable technique that provides durable brow elevation. Standardized photographic analysis confirms consistent improvement across brow subunits comparable to published studies of other techniques. A longer follow up study is necessary to report long term outcomes with this technique.

[1] Viterbo F, Auersvald A, O'Daniel TG. Gliding Brow Lift (GBL): A New Concept. Aesthetic Plast Surg. 2019;43(6):1536-1546.

Background- Septal cartilage is the preferred graft in rhinoplasty for its strength and accessibility. However, the quantity of usable cartilage varies ethnically, and normative data for Indian population is limited. This uncertainty may lead to intraoperative challenges and suboptimal surgical planning. Objectives- To quantify total and harvestable nasal septal cartilage area (SCA) in adults using computed tomography (CT) and to determine correlations with nasal bone length (NBL) and naso-frontal angle (NFA). Methods- A descriptive cross-sectional study was conducted on 136 adults undergoing head CT scans. Mid-sagittal CT images were analysed using Radiant DICOM software. Total SCA was traced, and the harvestable portion was calculated after excluding a 1 cm-wide dorsal and caudal L-strut. NBL and NFA were recorded. Data analysis done using SPSS v25. Results- Mean total SCA was 6.67 ± 1.85 cm², and the mean harvestable area was 3.36 ± 1.24 cm². Males had significantly larger total (7.18 ± 1.66 cm²) and harvestable (3.67 ± 1.10 cm²) areas than females (5.81 ± 1.89 cm² and 2.91 ± 1.30 cm², p < 0.05). SCA peaked in early adulthood and declined with age. NBL (r = 0.035) and NFA (r = 0.023) showed weak positive correlations with septal cartilage area. Conclusion- Age, sex and ethnicity influence cartilage dimensions significantly, whereas external nasal parameters correlate poorly. Pre-operative CT analysis improves surgical planning and predictability in rhinoplasty.

Purpose Recurrent central neck laxity remains a persistent challenge in facelift and necklift surgery, often undermining aesthetic outcomes. Despite advances in deep tissue support and flap redraping techniques, medial laxity is often observed due to under-correction, poor skin elasticity, and slippage of the skin flap away from maximal tension areas, particularly the submental region. To address this, secondary procedures and non-surgical tightening devices are commonly used, though with added cost, complexity, and patient burden (1) This study evaluated Skin Advancement Sutures (SAS), a novel technique adapted to facial surgery from progressive tension sutures used in abdominoplasty aimed to mediate current challenges in facelift and neck lift procedures. SAS easily integrates into existing surgical approaches adding minimal procedure time while reducing the need for revision surgery and designed to mitigate submittal relapse by distributing tension. This study evaluated SAS across a large patient cohort to assess efficacy, safety, and practicality.

Methods & Materials Two surgeons incorporated the SAS technique into 230 facelift and/or necklift procedures with 16-month follow-up. Procedures were performed under general anesthesia, IV sedation, or in select cases, oral sedation with inhaled nitrous oxide. Incisions were marked and injected with lidocaine/epinephrine, followed by tumescent anesthesia. Jowl liposuction was performed when indicated, and standard cheek subcutaneous undermining was combined with full neck undermining to the midline. In many cases a submental incision was used for central fat excision. Deep plane and superficial musculoaponeurotic system (SMAS) facelift techniques were utilized, with platysma and SMAS closures using absorbable or non-absorbable sutures. Neck suspension was achieved using either PDO or Prolene sutures, and platysmaplasty was not performed. SAS was performed using multiple rows (~6-8/side) of 3-0 Vicryl sutures. One suture at the lobule and two in the face were placed to gently advance the skin flap by anchoring subcutaneous fat to the platysma fascia or SMAS. Drains were used selectively.

Results SAS eliminated tension along the skin closure and improved flap adherence. The technique was easily integrated, adding minimal operative time while reducing postoperative laxity. No skin loss or post-operative dimpling was observed. Complications were minimal: one submental hematoma (0.43%), which was successfully evacuated without further complication and two patients (0.87%) with significant solar elastosis and poor skin laxity which required revision due to submental recurrence. Compared to historical controls, SAS demonstrated superior skin re-draping and reduced scarring, hematoma and serum formation. Feedback from peers who have adopted this method has been uniformly positive.

Conclusions The SAS technique represents a significant advancement addressing recurrent central neck laxity. By anchoring subcutaneous fat to deeper fascial structures, SAS enhances flap adherence, reduces medial slippage, and eliminates skin closure tension showing consistent improvement in aesthetic results, and reduced complications and revisions. Longitudinal follow-up will provide additional durability data, though high patient satisfaction and a low complication profile support SAS as a safe, effective, and practical adjunct that should be considered an essential adjunct in facelift and necklift procedures. 1. "Neck Recontouring: Suture Suspension Technique," DiBernardo, Barry and Giampapa, Vincent Plastic Surgical Forum Vol. XVI, P. 48-90

ABSTRACT: Introduction: Traditional lower eyelid blepharoplasty techniques with skin excision carries a significant risk of cicatricial ectropion and lagophthalmos, despite incorporating additional suspension procedures (canthoplasties or canthopexies). To avoid such complications, middle lamella injury and skin excision must be avoided. In leau of skin excision, the author recommends incorporating techniques such as Radiofrequency Microneedling (RFMN), plasma energy (skin resurfacing and/or subdermal tissue contraction ), fat grafting or fillers to the tear trough and lid cheek junction. An anatomical based pre-operative classification system is presented, paired with non-skin excisional treatment options to rejuvenate the lower eyelid. Methods/Technique: The author presents a case series of 160 patients treated in an 8 year period (2017-2025). Patients age range from 35-86, with 140 women and 20 men. Pre-operative anatomy classification and treatment algorithm proposed is as follows: Type 1: crepey lower eyelid skin Treatment: plasma skin resurfacing or radiofrequency microneedling (RFMN) Type 2: crepey lower eyelid skin, tear trough deformity Treatment: plasma skin resurfacing plus fat grafting to tear trough Type 3: crepey lower eyelid skin, tear trough deformity, protruberant fat pads; treatment: plasma skin resurfacing, fat grafting to tear trough, transconjunctival fat pad removal Type 4: crepey lower eyelid skin, tear trough deformity, protruberant fat pads, lid-cheek junction volume loss; treatment: plasma skin resurfacing, fat grafting tear trough and lid-cheek junction, malar fat pad elevation via midface lift or facelift Type 5: crepey lower eyelid skin, tear trough deformity, protruberant fat pads, lid-cheek junction volume loss, festoons; treatment: plasma skin resurfacing, fat grafting tear trough and lid-cheek junction, malar fat pad elevation via midface lift or facelift, subdermal helium RF plasma treatment of the lower eyelids and festoons

Patient Distribution: Ten Type 1, fifteen Type 2, seventy Type 3, sixty Type 4, and 5 Type 5. Treatments performed ranged from non-surgical (RFMN or plasma resurfacing) to surgical (transconjunctival blepharoplasty, sub-dermal tissue contraction with helium RF plasma, and/or fat grafting) as previously described. Patient follow up was one day after surgery, followed by weekly, monthly, then annually. The longest follow up is 6 years. One hundred and fifty five patients were Fitzpatrick 1-3, and five patients were Fitzpatrick 4 and 5. Helium radiofrequency plasma was utilized for one hundred and twenty five patients, and nitrogen plasma was utilized for thirty five patients.

Technique: The patient's treatment algorithm is determined based on their pre-operative classification as presented previously. After successful induction of anesthesia, the face is prepped and draped in the usual sterile fashion. Corneal protectors are placed. Local anesthesia infiltrated into the lower eyelids. Next, transconjunctival blepharoplasty performed first, trimming the medial, middle and lateral post-septal fat pads accordingly. Next, subdermal skin tightening is performed as follows: a lateral 1 mm entry point and 1 mm egress points established via skin punctures on the lateral and medial lower eyelids. The helium RF plasma micro handpiece is utilized for sub-dermal tissue contraction. Next, plasma resurfacing is performed with either helium rf plasma (Fitzpatrick 1-3) or Nitrogen plasma (Fitzpatrick 4-6). Finally fat grafting with macrofat is performed in the pre-periosteal layer along the infraorbital rim ( 1 cc-6 cc) . The patient is then instructed to apply nanofat cream and laser balm to the resurfaced areas twice a day, for up to two weeks after surgery. Results/Complications: There were no incidents of ectropion or lagophthalmos post-operatively. All patients had satisfactory improvement of the appearance of the lower eyelid and lid-cheek junction assessed via photographic documentation (comparing pre versus post-operative photos), and computerized measurements of decreased lower eyelid height and skin quality improvement. Conclusion: Lower eyelid rejuvenation can be effectively and safely achieved utilizing a combination of different techniques such as transconjunctival fat pad removal, helium or nitrogen plasma skin resurfacing, fat grafting the tear trough and lid cheek junction, and subdermal skin tightening with helium RF plasma. By avoiding skin excision, injury to the middle lamella is avoided, decreasing complications such as cicatricial ectropion and lagophthalmos. The pre-op anatomical classification system and proposed treatment algorithms can enhance aesthetic outcomes while minimizing adverse events.

Background Vaginal laxity and intercourse-related discomfort significantly impair quality of life and psychosocial well-being in affected women.1 Although surgical vaginal tightening may benefit selected patients, many symptomatic women remain reluctant due to concerns regarding invasiveness, anesthesia requirements, recovery downtime, irreversibility, and risk of complications. This gap in care has driven growing demand for office-based, minimally invasive alternatives.1 Cross-linked hyaluronic acid (HA), widely established in aesthetic medicine with a favorable safety profile, represents one such candidate - offering symptom relief through hydration enhancement and temporary tissue augmentation.2 However, because HA is resorbable, the durability of benefit and the real-world pattern of repeat treatment requests remain insufficiently characterized.3 This study therefore aimed to prospectively evaluate patient satisfaction, reinjection behavior, and safety following vaginal HA injection, and to define its appropriate clinical positioning as a low-barrier "entry" or "bridge" therapy within a step-up care pathway for women who are symptomatic yet hesitant to undergo surgery. Methods This single-center prospective observational study enrolled 46 women presenting with vaginal laxity, dyspareunia or intercourse-related dissatisfaction, and/or urinary incontinence. Exclusion criteria included prior pelvic surgery, active infection, and contraindications to HA. All participants provided informed consent, and all procedures were performed in an outpatient setting by a single physician. Each participant received at least one session of cross-linked HA injection distributed across the anterior, lateral, and posterior vaginal walls (mean total volume: 18.5 cc), using Neuramis Deep or Neuramis Volume (Medytox Inc., Seoul, Republic of Korea). Follow-up was conducted through 6 months. The primary outcome was patient satisfaction assessed via four categories: "better than expected," "satisfied with improvement," "partially satisfied but not completely," and "ineffective." Secondary outcomes included reinjection requests, number of additional sessions, and adverse events. Results At 6-month follow-up, satisfaction was rated "better than expected" by 26/46 (56.5%), "satisfied with improvement" by 12/46 (26.1%), "partially satisfied but not completely" by 2/46 (4.3%), and "ineffective" by 5/46 (10.9%). Overall, 40/46 (87.0%) reported at least partial satisfaction. Reinjection was requested by 11/46 (23.9%) patients, with additional sessions ranging from 1 to 5 (mean 0.72 per patient across the cohort). No serious adverse events occurred; mild discomfort and minor bleeding resolved spontaneously. In Japan, where this study was conducted, a single vaginal HA injection session is typically priced at approximately 200 USD (self-pay), a cost point that meaningfully contributes to its accessibility relative to surgical alternatives. Conclusions Office-based vaginal HA injection achieved high patient-reported satisfaction at 6 months without serious adverse events. Given the resorption kinetics of HA and the observed rate of reinjection requests, patients should be counseled that this may represent an ongoing rather than one-time expense. Nevertheless, these findings support a pragmatic role for vaginal HA injection as a low-barrier "entry" therapy: symptomatic women reluctant to undergo surgery can trial a minimally invasive, low-downtime option first, then continue maintenance injections if benefits justify costs, or escalate to more definitive interventions - including surgery - if improvement proves insufficient.

References 1. Carlos Campagnaro M. dos Santos, MsC, Hyaluronic Acid in Postmenopause Vaginal Atrophy: A Systematic Review The Journal of Sexual Medicine, 2021, Pages 156–166, https://doi.org/10.1016/j.jsxm.2020.10.016 2. Berreni et al. Evaluation of the effect of multipoint intra mucosal vaginal injection of a specific cross linked hyaluronic acid for vulvovaginal atrophy: a prospective bi centric pilot study BMC Women's Health (2021) 21:322 https://doi.org/10.1186/s12905-021-01435-w 3. G Buzzaccarini　Hyaluronic acid in vulvar and vaginal administration: evidence from a literature systematic review Climacteric. 2021 Dec;24(6):560-571. doi: 10.1080/13697137.2021.1898580. Epub 2021 Mar 24.

Objective: The purpose of this clinical study is to investigate the application of umbilical hernia repair with "Butterfly Methods" abdominoplasty in severe abdominal wall relaxation with umbilical hernia. Methods: 1. Preoperative aesthetic design: The lower abdominal incision was designed according to standard abdominoplasty. This conceals the cut line to the upper edge of the pubic hair. At the same time, the umbilical stem was designed with a "butterfly" incision, that is, the central "butterfly body" was the umbilical hernia ring area, and the outer umbilical stem was formed by the "butterfly wing" flap on both sides. 2. Flap dissection: Gradually dissection from the bottom up. The thin layer of fat on the deep fascia was retained when the flap was dissected from the sub-umbilical plane. The superior plane of the umbilicus is detached upward along the superficial layer of the deep fascia. Both sides of the umbilicus are detached to 2 cm above the costal margin and Central to subxiphoid. And then, the umbilical stem and its pedicle were retained according to the designed line. 3. Management of umbilical hernia and umbilical stem: The central skin of the umbilical stem was excised to expose the umbilical hernia ring and reinforced with non-absorbable sutures. The two sides of the "butterfly wing" flap were sutured subcutaneously to cover the suture line of the hernia ring, and the two sides of the " butterfly wing" flap were sutured subcutaneously to form an "0" -shaped depressed umbilical stem. 4. Abs folding: According to the degree of separation of rectus abdominis and external oblique, the double fold repair was performed with absorbable and non-absorbable sutures. The supra-umbilical and sub-umbilical regions were folded separately. Umbilical stem roots keep about 1 cm gap can be further deepened the umbilical stem. 5. Relaxation suture: The excess flap was removed, and the abdominal flap was sutured by progressive tension sutures. When locating to the umbilical stem, a longitudinal incision was made on the surface of the midline flap as the umbilical hole. The length of the incision was about 1.5-2cm according to the height and the patient's requirements. The umbilical stem was sutured to the umbilical foramen, and the flap was sutured to the anterior rectus sheath at about 8cm on both sides of the umbilical region to further create a concave umbilical aesthetic shape. Results: The recurrence rate of umbilical hernia in patients with severe abdominal wall relaxation and umbilical hernia repaired by standard abdominoplasty is high, and complications such as postoperative navel bulge and wide umbilical stem are prone to occur. But using the method of "butterfly" umbilical hernia repair technology, all patients felt present a concave shape appearance, follow-up umbilical hernia recurrence, the majority of patients are satisfied with the surgical effect. Due to the thin periumbilical fat, the depression of the umbilical region was not obvious in some patients, and the scar was obvious in some patients, so the anti-scar treatment was continued. Conclusion: The modified "butterfly wing method" of umbilical hernia repair abdominoplasty has a low recurrence rate of umbilical hernia, a depressed aesthetic shape of the umbilical part after operation, and high patient satisfaction. This technique is worthy of clinical application.

Background: Lower blepharoplasty remains one of the challenging aesthetic facial procedures due to the complex interplay between lower eyelid anatomy, midface and lid–cheek junction morphology. Traditional transcutaneous approaches may be effective in addressing tear-trough deformities; however, they fail to correct a negative orbital vector and may even accentuate a flat or skeletonized lid–cheek junction. Moreover, disruption of the orbicularis oculi muscle innervation-whether temporary or permanent-combined with scar contracture of the skin–muscle unit, significantly increases the risk of ectropion deformity. Temporary orbicularis atony is considered almost inevitable with transcutaneous approaches. These limitations have driven interest toward anatomy-preserving techniques that minimize tissue trauma while achieving aesthetic improvement. Objectives: The aim of this study is to present our long-term outcomes with a transconjunctival retroseptal lower blepharoplasty approach combined with microfat grafting to the prezygomatic space and nanofat grafting to the tear-trough region. The primary objective is to reduce inferior orbital fat protrusion while enhancing or correcting negative orbital vector, all while preserving the native anatomy and function of the orbicularis oculi muscle. Methods: This retrospective study includes patients operated between 2013 and 2025. A total of 178 patients (356 lower blepharoplasties) were treated bilaterally, with ages ranging from 19 to 69 years. The cohort consisted of 146 female and 32 male patients. The average follow-up period was 4 years. All procedures were performed under general anesthesia using a transconjunctival retroseptal approach. The nasal and central lower eyelid fat pads were routinely reduced, while the lateral fat pad was selectively addressed either through the same conjunctival incision or via the upper blepharoplasty incision. Autologous fat was harvested from the medial or lateral thigh and processed into microfat for volumization of the prezygomatic space, with an average of 8 cc per side (range: 4–15 cc). Additionally, 0.5–1 cc of nanofat was injected beneath the orbicularis oculi muscle to soften and correct the tear-trough sulcus. Importantly, the orbital and prezygomatic compartments were treated as separate anatomical units, respecting the zygomaticofacial and orbitomalar ligament boundaries. Pinch skin excision was performed in 75 patients. Conjunctival closure was achieved using 6/0 rapid Vicryl with buried knots in most cases. Results: Postoperative outcomes demonstrated consistent improvement in tear trough demarcation, reduction of lower eyelid fat bulging, shortening of the lower eyelid height, and enhancement of the negative orbital vector. These changes collectively resulted in a smoother and more youthful lid–cheek junction. The orbicularis oculi muscle was never transected, and no postoperative muscle atony was observed. No cases of ectropion or entropion were encountered. Mild chemosis developed in 8 patients and resolved with conservative management. Six patients reported under-correction of the tear trough region but did not request revision surgery. Conclusions: The no-touch transconjunctival lower blepharoplasty combined with strategic fat grafting offers an anatomy-preserving, minimally traumatic approach with a low complication profile and durable aesthetic outcomes. By simultaneously reducing orbital fat herniation and restoring prezygomatic volume, this technique not only corrects lower eyelid deformities but also contributes to harmonious midface rejuvenation and an improved lid–cheek junction.

Background Treating the aged face requires a thorough understanding of both osseous and soft-tissue anatomy, including the analogous lamellar layers of the face and neck, as well as the techniques designed to restore youthful skin tone and facial contours (1). Dermal fillers have been used for decades for soft-tissue augmentation and currently represent one of the most common minimally invasive procedures for facial rejuvenation (2). However, an important question remains: how does long-term filler application affect tissue characteristics when a subsequent surgical procedure is required?

Methods A total of 51 patients scheduled for deep plane facelift surgery were evaluated preoperatively. Patients underwent clinical assessment for prior facial filler treatments. In selected cases, high-resolution facial ultrasound was performed to detect residual filler material, and preoperative hyaluronidase was administered when clinically indicated.

Results Patients with prior injectable treatments commonly exhibit fibrosis, altered tissue compliance, residual product deposition, distortion of anatomical landmarks, and anomalous vascular networks, increasing technical complexity and surgical risk. Even when appropriate surgical planning and meticulous technique are employed, an increased postoperative inflammatory response may be encountered, partly related to the hydrophilic properties of hyaluronic acid molecules and their interaction with surrounding tissues, occasionally requiring prolonged edema management and closer postoperative follow-up. Careful preoperative assessment, including detailed injectable history and targeted ultrasound evaluation, along with strict adherence to anatomy-respecting dissection principles and a flexible, case-specific surgical strategy, were essential to mitigate complications. When these factors were anticipated, deep plane facelift could be performed with acceptable safety and satisfactory outcomes, despite the increased technical demands.

Conclusions Patients with a history of injectable treatments can significantly alter facial tissue planes, vascular anatomy, and postoperative behavior, increasing both surgical complexity and the likelihood of heightened postoperative inflammation. Thorough preoperative evaluation, including ultrasound assessment, meticulous anatomy-respecting dissection, intraoperative adaptability, and attentive postoperative management are critical to optimize safety and outcomes. Although deep plane facelift is feasible in patients with a history of facial fillers, it should be approached with caution and realistic expectations, recognizing that safety is highly dependent on appropriate patient selection and surgical expertise.

References 1 Wollina U, Goldman A. Dermal fillers: facts and controversies. Clin Dermatol. 2013 Nov-Dec;31(6):731–736. doi:10.1016/j.clindermatol.2013.05.010. 2 Derby, Brian M. M.D.; Codner, Mark A. M.D.. Evidence-Based Medicine: Face Lift. Plastic and Reconstructive Surgery 139(1):p 151e-167e, January 2017. | DOI: 10.1097/PRS.0000000000002851

Background

Objective quantification of lateral-profile change after rhinoplasty is limited not only by surgical variability but also by the absence of a standardized and reproducible photographic registration method. Because the nose itself is surgically altered, alignment using nasal landmarks introduces circular registration bias. We therefore developed a "nose-excluded" lateral-profile superimposition protocol anchored to stable, non-operated facial regions to quantify base- and tip-related projection changes using unified tragus-referenced linear indices.

Methods

This retrospective study included 81 Asian patients who underwent rhinoplasty combined with paranasal/base augmentation using autologous costal cartilage between April 2022 and April 2025. To preserve the integrity of the tragus as a reference landmark, only patients in whom auricular cartilage harvesting did not involve the tragal cartilage were included in the analysis. Standardized lateral photographs were obtained preoperatively and at 6 months postoperatively under fixed camera distance and natural head position.

Using ImageJ, pre- and postoperative images were superimposed by registering stable non-operated regions (upper–central forehead and periorbital area), intentionally excluding the nasal region from alignment ("nose-excluded registration").

Three scale-normalized projection indices were defined as postoperative/preoperative ratios of tragus-referenced linear distances: • R1: tragus-to-alar base • R2: tragus-to-columellar base (subnasale) • R3: tragus-to-pronasale (nasal tip) The tragus was selected as the reference point because it is anatomically stable, unaffected by rhinoplasty procedures, and reliably identifiable on lateral photographs.

Nasolabial angle (NLA) change was analyzed as a secondary outcome.

For reliability assessment, a stratified random subset of 30 cases (15 primary and 15 revision) underwent repeat measurements by the same evaluator. Intraclass correlation coefficients (ICC) and Bland–Altman analyses were performed.

Results

The cohort consisted of 40 primary and 41 revision cases (mean age 31.4 ± 7.6 years; 71 females, 10 males).

Base-related projection ratios were significantly greater than 1.0: • R1: 1.0206 ± 0.0150 (p < 0.001) • R2: 1.0201 ± 0.0134 (p < 0.001)

The nasal tip projection ratio (R3) was 1.0303 ± 0.0158 (p < 0.001).

Nasolabial angle increased from 86.3° preoperatively to 93.4° postoperatively, with a mean change of +7.07 ± 11.13° (p < 0.001).

No significant differences were observed between primary and revision cases for R1, R2, and R3 (all p > 0.05).

Intra-rater reliability demonstrated good to excellent agreement, with ICCs of 0.934 for R1 ratio, 0.902 for R2 ratio, 0.832 for R3 ratio, and 0.984 for NLA change. Bland–Altman analysis showed minimal bias (mean difference −0.0009) with 95% limits of agreement ranging from −0.021 to +0.019.

Conclusions

Nose-excluded photographic superimposition anchored to stable facial regions provides a reproducible framework for quantifying lateral-profile changes after rhinoplasty. By incorporating unified tragus-referenced base (R1–R2) and tip (R3) projection indices, this method enables standardized and bias-minimized reporting of midface and nasal projection changes, supporting more objective and comparable outcome evaluation beyond rhinoplasty alone. This framework may improve surgical planning, inter-study comparability, and objective outcome reporting in rhinoplasty and midface augmentation research.

This study aims to demonstrate that a relationship exists between the parotid fascia and the deep fascia of the infraorbital region, recently described bythe first author, that continues from the temporal region and covers the mimetic muscles that lift the upper lip.(1,2,3) Methods 100 hemifaces were dissected to show the relationship between these two deep fascial layers, a preauricular incision was performed, the Superficial musculo-aponevrotic layer was dissected and reflected. The dissection was then performed deep to the parotid fascia to reach the anterior border of the parotid gland. Another incision was placed in the temporal area, the temporoparietal fasciawas elevated, the superflcial layer of the deep temporal fascia was incised and dissected toward the zygomatic arch and the infraorbital region. Results In all specimens a relationship was present between the parotid layer and the superficial layer of the deep temporal fascia, that continued from the temporal region to the infraorbital one, after crossing the zygomatic arch. The two layers were in continuity in the superior third of the parotid gland, at the anterior borderof the gland where the branches forthe zygomaticus major, minorand the other muscles that lift the upper lip leave the gland to reach the muscles. Conclusions A relationship exists between the deep fascia of the infraorbital region, this relationship was observed in the superior third of the anterior border of the parotid gland at the level of the emergency of the branches of the facial nerve for the muscles that lift the upper lip and it was connected to the ligaments present in this area. This concept has major applications in midface surgery and in the suprafibromuscular facelift (4) References 1. Andretto Amodeo C. et al. The SOOF and the fascial planes, has everything already been explained? Jama Facial Plast Surg June 2014;16(1):36-41. 2. Keller, G.; Cray, J., " Suprafibromuscular Facelifting with Periosteal Suspension of the Superficial Musculo-aponeurotic System and Fat Pad of Bichat Rotation." Archives of Otolaryngology – Head and Neck Surgery, Vol.122, No 4. 377-384. April 1996. 3. Andretto Amodeo C, Keller G. Chiara's Fascia and the Suprafibromuscular Facelift: Anatomical and Surgical Concepts Applied in Midface Surgery. Plast Reconstr Surg Glob Open. 2023 Oct 18;11(10 Suppl):10-11. 4.Andretto Amodeo C, Eggerstedt M, Kim IA, Nabili V, Keller GS. The Deep Fascia of the Infraorbital Region, Deep Plane, and Suprafibromuscular Facelift: New Anatomy for Safer Facelifting. Facial Plast Surg. 2022 Dec;38(6):623-629.

Background: High-definition liposuction (HDL) has evolved to incorporate multiple energy-based modalities to enhance adipose removal and to contract loose skin and soft tissues. These modalities include ultrasound-assisted liposuction and helium plasma-based radiofrequency skin tightening; both routinely applied across large surface areas in a circumferential manner. While these techniques can produce superior contouring outcomes, they also introduce a cumulative inflammatory burden that may predispose patients to hyperinflammatory fibrosis. Objective: This manuscript reviews the hyperinflammatory fibrosis pathophysiology, risk factors inherent to HDL, and proposed prophylactic and management strategies. Methods: We discuss the risk factors to developing hyperinflammatory fibrosis following HDL that include cumulative energy exposure, mechanical trauma, lymphatic disruption, skin and soft tissue redundancy, and prolonged swelling. Results: We outline several preoperative, operative, and postoperative measures to prophylax against and to manage hyperinflammatory fibrosis for clients undergoing HDL./ Conclusion: We hope that our review of the pathophysiology, risk factors, as well as prophylactic and management measures will minimize hyperinflammatory fibrosis and optimize high-definition liposuction outcomes.

Background: Rejuvenation of the cervical region remains a significant challenge in facial plastic surgery. Traditional approaches often fail to address structural laxity, leading to the recurrence of platysmal bands and suboptimal definition of the mandibular border. This study presents a novel surgical technique designed to treat deep neck structures and the platysma comprehensively, ensuring improved contour and stability. Methods: The author describes a universal approach to cervical lifting that integrates precise management of deep neck compartments with a distinct platysmal manipulation strategy. The technique focuses on anterior partial square platysmal resection and combined posterior traction. Following the release of retaining ligaments and the reduction of subplatysmal fat and glands, specific suture placement facilitates the redraping of the cervical skin and muscle. A retrospective review was conducted on 60 patients who underwent this procedure between October 2024 and October 2025. Results: Post-operative analysis demonstrated significant improvement in the cervicomental angle and jawline definition across the cohort. The technique effectively addressed deep cervical structures and muscular laxity. Crucially, the recurrence of visible platysmal bands was not observed, with follow-up ranging from 3 to 12 months. Patient satisfaction rates were high, and no major complications were reported. Conclusions: The described technique offers a reliable and reproducible solution for neck rejuvenation. By targeting the deep anatomical causes of cervical aging and employing a specific platysmal strategy, this "universal approach" successfully restores a youthful neck contour while preventing the formation of platysmal bands.

Background Deep plane facelift surgery represents a technical challenge both intraoperatively and postoperatively. Prolonged operative time is associated with an increased risk of complications, including hematomas, nerve dysfunction that may be permanent, flap compromise, and thromboembolic events (1). In this context, proper risk identification and the implementation of specific preventive strategies are essential to optimize procedural safety and aesthetic outcomes.

Methods A narrative review of the available literature on PubMed was conducted focusing on complications associated with prolonged aesthetic facial surgery in high-risk patients. Preventive strategies were organized according to preoperative, intraoperative, and postoperative phases and integrated with the authors' clinical experience in patients undergoing deep plane facelift under these conditions.

Results The implementation of individualized preventive protocols-including pharmacologic thromboprophylaxis, intermittent pneumatic compression, strict body temperature control, placement of a hemostatic facial net (NET) at the end of the procedure while the patient remains under anesthesia to help prevent hematoma formation, and a tissue-preserving approach minimizing subcutaneous delamination/dissection and preserving deep anatomical structures whenever possible-along with intraoperative nerve stimulation to reduce nerve injury risk, early ambulation, and postoperative massage, was associated with favorable recovery, adequate functional preservation, and satisfactory aesthetic outcomes.

Conclusions Prolonged aesthetic facial surgery can be performed safely even in high-risk patients when a systematic preventive approach based on individualized risk stratification is applied (2). The adoption of structured protocols helps reduce the incidence of thromboembolic and surgical complications without compromising aesthetic results in deep plane facelift procedures.

References 1 Namin A, Shokri T, Vincent A, Saman M, Ducic Y. Complications in Facial Esthetic Surgery. Semin Plast Surg. 2020 Nov;34(4):272-276. doi: 10.1055/s-0040-1721764. Epub 2020 Dec 24. PMID: 33380913; PMCID: PMC7759431. 2 Benito-Ruiz J, Rouif MR, Seren JM, Schlaudraff KU, Fontbona M, Cervantes A. ISAPS Patient Safety Update: deep venous thrombosis and pulmonary embolism: stratification and prophylaxis in aesthetic surgery. Aesthetic Plast Surg. 2019;43(2):386–393.

Purpose: We propose a novel tissue advancement and closure strategy for body contouring based on biotensegrity principles (1) and preservation of the dermal white adipose tissue (dWAT) layer (2). The panniculus is a biotensegrity structure comprising solid non-compressible elements (Adipose globules) held together and shaped by tension elements (fibroreticular scaffold, fascia, and skin). Liposuction debulking of adipose renders the tension elements reduntant so it can be easily advanced (3). The innovation is to de-epithelialize (rather than excise) the "redundant" dermis and then plicate it (Figure1). Thus the entire tension load is transferred to the highest tension threshold tissue (dermis) sparing the weaker layers (adipose, fascia), and protecting underlying tissues (fibroreticular network, lymphatics, nerves). The dWAT layer is not discarded but kept as a reservoir of healing cells. The procedure is well tolerated and has a much lower complication rate than excision-based post-bariatric body contouring, which had a 55% complication rate according to a 2014 meta-analysis (4). Methods: A consecutive series of 84 patients seen from October 2024 to December 2025 had a total of 109 LipoPlication procedures, all performed under IV sedation and tumescent solution analgesia. We first performed liposuction using a 3mm Hunstead cannula to debulk the adipose globules and loosen the fibro-reticular scaffold. Towel clamps were then used to reapproximate proposed wound edges and adjusted after gaging tension. Margins were then marked with ink. The skin is de-epithelialized rather than removed. The opposing dermal surfaces are advanced and plicated using vertically oriented dermal mattress sutures to form a broad, load-bearing dermal wall. This eliminates dead space and protects underlying tissues No drains are needed. Follow up: 2 months to 17 months. Lipoplication technique can be applied to many areas . See (Fig.2) - Abdominoplasty, lateral thigh lift, Mastopexy lipoplication on same patient Results: A series of 84 patients who underwent 107 lipoplication procedures (abdominoplasty, brachioplasty, thoracic, and lower body lifts) are reviewed-The only complications seen were one seroma and 6 draining wounds, all belonging to a cohort of 9 patients that had de-epithilization by dermabrasion. Healing was rapid, edema minimal, post operative pain and discomfort minimal. Complication rates (including dermabrasion, which has been discontinued) were reduced almost tenfold compared with published series using traditional excision and layered closure. Conclusion: Lipo-Plication provides a reproducible, biologically rational framework for safe tissue advancement. It substitutes layered suture lines of varied tension thresholds for a 3-D construct of high tension threshold dermis and dWAT healing cells as a "healing wall". It reframes body-contouring closure around the tension dynamics of living tissue rather than predetermined excision pattern. It is a safe, low-morbidity procedure with a lower complication rate than present techniques.

References: 1- Levin S. A New Model for Biologic Constructs: Biotensegrity." Proceedings of the ASME 2003 International Mechanical Engineering Congress and Exposition. 2003:2. 2-Shook et al., 2020, Cell Stem Cell 26, 880–8953 3- Illouz YG. Aesthetic Plast Surg. 1992;16:237–245. 4- Hasanbegovic E, Sørensen JA. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2014;67(3):295–301.