Scientific Abstract Presentations: Aesthetic Session 3 Saturday, September 28 Sat, Sep 28 8:00-9:30 a.m. PDT

INTRODUCTION Panniculectomy and abdominoplasty are frequently performed by plastic surgeons to address both aesthetic and functional concerns. The variability in surgical approaches significantly influences the duration of surgery, complications, and overall outcomes (1). STRATAFIX™ (Ethicon, Somerville, NJ, USA) is an absorbable knotless suture that provides a few key advantages over conventional suture, such as reducing operating room time, eliminating potential knot-related complications, and reducing suturing difficulty (2). It is widely used by plastic surgeons; however, there is a lack of data on its use for panniculectomy and abdominoplasty. We aimed to study its efficacy and safety for panniculectomy and abdominoplasty.

METHODS A retrospective cohort study included patients undergoing panniculectomy or abdominoplasty between January 2020 to September 2023 at a single institution with a follow-up of 90 days after surgery. Patient demographics, treatment characteristics, and outcomes were collected from the electronic medical records. Patients were stratified into two cohorts: those who underwent subdermal closure with STRATAFIX (n=22, 23.6%) and those who did not (n=71, 76.3%). The primary outcome measure was to compare the difference in complication rates between the cohorts. The secondary outcome included the measurement of the operative time.

RESULTS Of 93 patients meeting the inclusion criteria, mean age and BMI were 44 years [SD 9.7], and 32.9 kg/m2 [SD 6.7] respectively. Baseline demographics like age, BMI, smoking status, and comorbidities were similar across both cohorts. The history of massive weight loss(p=0.008), functional etiology for surgery(p=0.001), and use of closed-incision negative pressure therapy (ciNPT) (p<0.001) were significantly higher in the non-STRATAFIX cohort. Complications were higher in the non-STRATAFIX group (22.5% vs. 13.6%, p=0.037). Major infection rates requiring IV antibiotics were 7% (n=5)in the non-STRATAFIX group and 4.5% (n=1) in the STRATAFIX group (p=0.68). Oral antibiotic-treated minor infections were equal at 7% (n=5) and 4.5% (n=1) respectively (p=0.68). Seroma occurred in 1.4%(n=1) of non-STRATAFIX patients, with none in the STRATAFIX group. Major wound complications were 11.3% (n=8) in the non-STRATAFIX and 4.5%(n=1) in the STRATAFIX cohort (p=0.37). Hematoma was reported in 2.8%(n=2) of non-STRATAFIX patients. No re-operations, hypertrophic scars, skin necrosis, scar contracture, or suture granuloma were noted in either group. Fat necrosis was more common in the STRATAFIX group (9.1% (n=2) vs. 4.2%(n=3), p=0.38). Logistic regression analysis controlling for age, BMI, etiology, smoking, history of weight loss, and ciNPT usage reaffirmed these findings. For standalone panniculectomy and abdominoplasties (n=51), the average operative time was 140.46 minutes [SD 68.8] for the non- STRATAFIX cohort (n=39), against 118 minutes [SD 56.3] for the STRATAFIX cohort (n=12) (p=0.31).

CONCLUSION Overall complications, individual complications, and operative time were lesser in patients with STRATAFIX for subdermal closure, however not statistically significant. Further studies with larger sample sizes may be needed to confirm these findings and achieve statistical significance.

REFERENCES 1. Janis, J. E et al Panniculectomy: Practical Pearls and Pitfalls. Plast. Reconstr. Surg. Glob. Open 8, e3029 (2020). 2. Vieira RB et al Evaluation of three methods of suture for skin closure in total knee arthroplasty: a randomized trial. BMC Musculoskelet Disord. 2021 Aug 30;22(1):747.

Purpose: Rhinoplasty is one of the most commonly performed facial surgeries in the USA [1]. There exist many major and minor nasal tip support structures that impact tip projection [2, 3]. Overprojection may result from anatomic factors or may occur iatrogenically during primary rhinoplasty. Achieving reliable, reproducible, and stable results is the aim of nasal tip deprojection rhinoplasty. The senior author's technique, detailed here, effectively corrects overprojection while preserving tip strength and minimizing the need for subsequent revisions.

Methods and Materials: A retrospective chart review of 2,003 rhinoplasty cases in the senior author's practice was conducted between July 2014 to June 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases with nasal tip deprojection, with a minimum of 12 months of follow-up. Outcomes of interest included the rate of operative revisions, overall rate of operative take-back, and the rate of postoperative infection.

Results: 447 patients met the inclusion criteria. The mean age of our study group was 32.1 years old, with 409 females. 291 cases were primary rhinoplasties. Mean follow-up period was 22.4 months. Eight patients (1.8%) required empiric antibiotics postoperatively, with 17 patients (3.8%) requiring operative revision.

Conclusions: Our case series demonstrates that combining resection of the medial crura with lateral crural steal and a columellar strut graft allows us to achieve considerable nasal tip deprojection with control over tip rotation and a strong foundation for long-term stability. The comprehensive patient follow-up spanning at least 12 months further supports the reliability of our technique.

References: 1. The Aesthetic Society. Aesthetic Plastic Surgery National Databank Statistics for 2022. Available at: https://www.theaestheticsociety.org/media/procedural-statistics. Accessed February 6, 2024. 2. Erol O, Buyuklu F, Koycu A, et al. Evaluation of Nasal Tip Support in Septorhinoplasty. Aesthetic Plast Surg. 2019;43:1021–1027. 3. Han SK, Lee DG, Kim JB, et al. An Anatomic Study of Nasal Tip Supporting Structures. Ann Plast Surg. 2004;52:134–139.

BACKGROUND: While advances in aesthetic devices represent new therapies for aesthetic improvement of the skin, chemical peels remain a reliable and effective therapy that can be adjusted to the individual patient's skin type with differing peeling agents and their formulations. The aim of this study is to share techniques for the preparation, application, and post-application management of chemical peels for aesthetic improvement of the facial skin.

METHODS/TECHNIQUE: Consent was obtained from the patients to share their results for this study. Five patients received chemical peels in applications that included use of Glytone Enerpeel products: 1) 30% Pyruvic Acid, 10% Lactic Acid (LA), 0.5% Ferulic Acid; 2) 20% trichloroacetic acid (TCA), 10% LA and 0.5% Kojic Acid, 3) 25% TCA; 4) 40% TCA and 5) 50% Pyruvic Acid formulations. All received 3.75% trichloroacetic (TCA), 15% LA peels to the eyelids and lips. Immediate pre-procedure and post-procedure photos were collected for patients and follow-up was done on day seven.

Application of a peel should ideally be preceded by four to eight weeks of tretinoin as a pretreatment that enhances the peeling agent's penetration. Prior to applying the peeling agent, a lipid reagent should be applied at the medial and lateral canthus to protect the eyes, as well as alar bases and oral commissures to protect these regions.

Application of the peeling agent can be done with a nylon brush, which exfoliates skin and deeper penetration. When brushing caudally from the neck, a "feathering" pattern should be done at the edge to conceal the line demarcation between peeled and unpeeled skin. Stronger formulations can cause significant level II to III frosting, a process where the skin appears white-coated or completely white due to significant protein denaturation of the keratin. The degree of frosting should be monitored when applying, with consideration also given to patient skin type, tolerance, and area of the face.

Following application of the peeling agent a neutralizing wipe, such as an amino acid-based solution, should be gently pressed where the peeling agent was applied but should not be rubbed. An epidermal "mask" of exfoliated skin should form approximately three days after the procedure for moderate to deep peels. The patient should be counseled to continue applying the recovery balm generously and allow the skin to heal from the inside out.

RESULTS: The results of the senior author's methods resulted in no complications for any of the patients. All patients expressed satisfaction with their results. While slight variation existed from patient to patient, results were consistent, and patients showed good recovery from the procedure (Figure 1).

CONCLUSION: Chemical peels remain an effective therapy for aesthetic improvement of the skin of the face and neck. The techniques and types of peeling agents discussed maximize penetration and even distribution of the agent while taking into account patient tolerance, skin type, and needs. Plastic surgeons should be facile with this excellent tool for skin rejuvenation in the aesthetic surgery armamentarium.

Background: Super-microsurgical lymphaticovenous anastomosis (LVA) has been developed in the field of extreme lymphedema. We reported that the histological changes in the microlymphatic vessels of chronic lymphedema of the extremities depend on the degree of progression of the lymphedema, and that in irreversible advanced lymphedema, the junctions of lymphatic endothelium of the lymphatic capillaries are remodeled from discrete bouton-like structures to continuous zipper-like structures1. LVA may also be useful to treat eyelid lymphedema. The aim of the study was to test the therapeutic effect of LVA on eyelid edema in Morbihan disease and to determine whether pathological changes that could be considered chronic lymphedema of the skin occur. Methods: A retrospective case-control study was performed. Postoperative recurrence rates were compared between the patients who underwent debulking surgery plus LVA (study group) and the patients who underwent debulking surgery (control group) for Morbihan disease. The three-dimensional microstructures of the excised skin were pathologically compared with the eyelid skin without edema to determine whether they caused tissue changes that should be diagnosed as chronic lymphedema. Result: No significant short-term complications occurred after surgery in either group. The recurrence rate within 1 year after surgery was significantly lower in the study group than in the control group (1/7 vs 5/6, respectfully, p = 0,03). Pathologically, patients with Morbihan disease showed signs of changes in the microstructure of capillary lymphatic in the dermis, which is characteristic of chronic lymphedema in advanced stage. Discussion: LVA reduced the risk of postoperative recurrence during debulking surgery in Morbihan disease with DBF on ICG angiography. The excised skin also developed pathological change that should be treated as in advanced-stage lymphedema. These clinical and pathological results suggested that debulking surgery plus LVA might be a suitable treatment option for Molbihan disease.

1. Itai N, Gantumur E, Tsujita-Inoue K, Mitsukawa N, Akita S, Kajiya K. Lymphangiogenesis and Lymphatic Zippering in Skin Associated with the Progression of Lymphedema. J Invest Dermatol. 2023. Online ahead of print.

Background: Nasal tip rotation relies on structural support from the upper and lower lateral cartilages, the caudal septum, the medial crura, and the anterior septal angle. Comprehensive understanding of the distinct and combined effects of maneuvers influencing these structures and thereby tip rotation is required to facilitate judicious preoperative planning. This study aims to characterize the effects of intraoperative maneuvers affecting tip rotation.

Materials/Methods: This is a retrospective study of patients who underwent primary rhinoplasty at a single private practice between 2001 and 2022. Preoperative and postoperative standardized right profile images were compared. Tip rotation was quantified using the nasolabial angle. Patients were stratified into one of three categories: overrotated, ideally rotated (male: 95.96±2.57°, female: 97.7±2.32°), and underrotated. Matched pairs analyses were used to determine significant differences between preoperative and postoperative values. Logistic regressions and Wilcoxon signed-rank tests was employed to detect significant effects of maneuvers on postoperative values.

Results: Three hundred eighty-six patients (310 female, 76 male; mean age: 31.15±13.99 years) were included. The mean time between surgery and follow-up was 897.09±888.79 days. Preoperatively, 250 patients were overrotated, 79 patients were underrotated, and 57 were optimally rotated. For overrotated patients, the mean preoperative nasolabial angle was 110.98±6.89° and the postoperative mean was 106.90±8.88°. For underrotated patients, the preoperative mean was 85.62±8.87° compared to a postoperative mean of 91.54±8.12°. Finally, optimally rotated patients had a preoperative mean of 97.25±1.61° and a postoperative mean of 99.37±6.33°. For both underrotated (p=0.0010) and overrotated (p<0.0001) patients, significant changes in nasolabial angle were achieved in the desired direction. Preoperatively optimally rotated patients did not experience significant changes in the nasolabial angle (p=0.0588). For patients within the range of ideal nasolabial angles preoperatively, the columellar strut was found to significantly increase tip rotation (p=0.0345), as were tip cartilage onlay grafts (p=0.0192). Patients who were preoperatively underrotated significantly benefitted from the caudal septum wedge (p=0.0491) and caudal septum rectangle (p=0.0025)-both of which significantly increased tip rotation. The caudal septum rectangle was also found to play a significant role in derotating the tip in patients who were preoperatively overrotated (p=0.0266). Preoperatively overrotated patients further benefitted from tip cartilage shield grafts, which significantly decreased tip rotation for this patient group (p=0.0111). Linear regression identified the caudal septum rectangle as the most significant factor driving increased rotation (t ratio: 3.13, p=0.0106); the lobule graft was found to be the second most effective (t ratio: 2.30, p=0.0441). Linear regression further identified that tip rotation suture was most effective when combined with the caudal septum wedge (p=0.03164), as opposed to combination with the columellar strut (p=0.18536) or the caudal septum rectangle (p=0.28504).

Conclusions: Derotation was most significantly driven by tip cartilage shield grafts and caudal septum rectangles; increased rotation was most significantly influenced by columellar strut grafts, lobule grafts, tip onlay grafts, caudal septum wedges, and caudal septum rectangles, with the latter having the most profound effect overall. These findings also imply that the tip rotation suture yields optimal results when combined with the caudal septum wedge.

Purpose: Venous thromboembolism (VTE) is a complication of abdominoplasty with low incidence but devastating consequences (1). A history of COVID-19 may cause additional thromboembolic effects on patients, although the duration of this is unclear given the limited follow-up information available for long and post-COVID conditions (2,3). A prior small retrospective study suggested that a history of COVID infection may increase VTE rates after lipoabdominoplasty (3). Our study aims to further assess in a larger population patient risk of VTE for those with a history of COVID-19 after abdominoplasty.

Methods: The TriNetX LLC. National Health Research database was queried to identify patients who underwent cosmetic abdominoplasty in the years 2017-2020 (pre-Covid pandemic) and 2020-2023 (post-Covid pandemic). In addition, post-pandemic patients were further studied by querying the data to look for those with a history of COVID versus those without. These cohorts were analyzed to calculate the incidence rate of VTE in the 30 days post operative.

Results: A cohort of 3,381 patients who underwent cosmetic abdominoplasty on prophylactic anticoagulation was identified. There were total of 1,486 patients in the pre-pandemic and 1,895 patients in the post-pandemic group. In the post-pandemic group, there were 361 patients with a prior history of COVID and 1534 patients without. The rate of VTE was not significantly different in the pre (2.0%) versus post (2.1%) pandemic cohorts (p=0.91). However, in the post-pandemic cohort, there was a significant difference in VTE rates between patients with (4.2%) and without (1.8%) prior history of COVID (p= 0.01).

Conclusion: Our study showed there was no significant increase in VTE incidence after abdominoplasty during the pandemic. However, patients with a history of COVID may be more susceptible to postoperative VTEs as its true long term morbid effects are yet to be fully understood. Therefore, history of COVID should be carefully considered when determining a patient's VTE risk and warrants further study for optimal peri-operative and postoperative anticoagulation strategies.

References: 1. Kalmar CL, Thayer WP, Kassis S, Higdon KK, Perdikis G. Pulmonary Embolism Risk After Cosmetic Abdominoplasty and Functional Panniculectomy. Ann Plast Surg. 2022;89(6):664-669. doi:10.1097/SAP.0000000000003281 2. Ortega-Paz L, Talasaz AH, Sadeghipour P, et al. COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment. Semin Thromb Hemost. 2023;49(8):816-832. doi:10.1055/s-0042-1757634 3. Reyad KA, Abelhalim MM, Tallal RE. Prevalence of Deep Venous Thrombosis in Abdominoplasty Patients after COVID-19 Convalescence: An Alarming Flag. Plast Reconstr Surg Glob Open. 2022;10(2):e4196. Published 2022 Feb 28. doi:10.1097/GOX.0000000000004196

Background The integration of neck liposuction with BodyTite Manipulus Radiofrequency (RF) technology and buccal fat pad excision for enhanced neck rejuvenation promise heightened precision and efficacy in sculpting the neck and jawline. Neck liposuction, coupled with RF technology, provides controlled thermal energy for adipose tissue treatment and collagen remodeling, while buccal fat pad excision offers refined contouring of the lower face and neck. This integrated approach aims to optimize patient outcomes and advance the field of aesthetic plastic surgery.

Methods A prospective study was conducted from 2016 to 2023 on 90 consecutive patients who presented to the author's private clinic and required neck remodeling surgery for aesthetic purposes. Patients were monitored and clinic appointments were scheduled at intervals of 0, 1, 2, and 6 months post-treatment for evaluation. A tape measure recorded submental length at 1 and 6 months, and a satisfaction survey was administered one week before surgery and after six months. Physicians assessed improvement using a five-point scale for patient satisfaction and a four-point scale for overall improvement.

Results All patients underwent successful RFAL treatment, consistently achieving satisfaction with the outcomes. The average reduction in submental length measured 9.8 mm during the 6-month follow-up period. Additionally, the removal of buccal fat pads played a pivotal role in facial slimming and enhancing the aesthetics of the upper cheek region.

Conclusions The integration of neck liposuction with BodyTite RF technology and buccal fat pad excision offers a promising approach for enhanced neck rejuvenation and facial contouring. This combined method demonstrates heightened precision and efficacy in sculpting the neck and jawline, aiming to optimize patient outcomes and advance the field of aesthetic plastic surgery.

Background: Medical tourism has historically been characterized by patients seeking out inaccessible care in more medically advanced countries. In aesthetics, the reverse may be true, with citizens from developed countries traveling abroad. This may be driven by a combination of factors such as cost-effectiveness, privacy, and access to niche treatments. However, there is limited literature defining the extent of this trend. We hypothesize that the current United States aesthetics market is driving medical tourists to other countries, and aim to quantify global trends, as well as analyze the geographical flow of aesthetic medical tourists.

Methods: Data from the International Society of Aesthetic Plastic Surgery (ISAPS) Global Surveys from 2016 to 2022 was collected from 7,545 surgeons worldwide. Estimates for medical tourism procedures were derived using ISAPS country-specific annual total surgical and non-surgical aesthetic procedures and medical tourism percentile breakdowns. Trend analysis and compound annual growth rate (CAGR) calculations, representing a compounding percentage yearly increase, were conducted. To address missing annual values in countries' reports for CAGR calculations, we applied mean imputation to each country's dataset when feasible, but excluded countries from the analysis if they lacked data for three or more years.

Results: The United States was consistently reported as one of the top countries of origin for medical tourists from 2016 to 2022 - and was the top country of origin for those traveling to Brazil, Colombia, India, Italy, Mexico, and Thailand. Other top countries of origin included the United Kingdom, Canada, Switzerland, Australia, Portugal, and Spain. There were regional preferences in destination choice with European medical tourists predominantly favoring nearby countries, those from Australia choosing destinations in Asia, and those from North America often selecting locations within the continent.

The estimated global CAGR for aesthetic procedures defined as medical tourism (those traveling from one country to another for surgery) was 9.9%. The country with the highest growth rate was Argentina at 21.9%, followed by Romania at 17.0%. Mexico saw the largest increase in share of global medical tourism procedures, rising from 6.3% in 2016 to 9.4% in 2022. Other fast-growing destinations included Turkey (13.6%), and Colombia (13.4%). In contrast, India and Italy underwent declines, with CAGRs of -11.4% and -5.5% respectively. The United States saw a slight decline in share from 14.2% to 12.1% but still led in total volume of procedures.

Conclusions: Our study highlights trends and changes in the aesthetic procedure tourism market from 2016 to 2022. Notably, many United States citizens are seeking procedures abroad. Mexico and Turkey are emerging as leading destinations, experiencing growth in total annual procedures. This contrasts with the decline seen in traveling to the United States, potentially reflecting a saturated, cost-prohibitive market. These findings support the need for targeted research to elucidate the factors driving these changes, such as pricing, patient preferences, procedural specifics, and surgical outcomes. Understanding these underlying motivations for medical tourism may allow countries to develop responsive healthcare policies and promote the ethical evolution of aesthetic medical tourism with an emphasis on patient safety.

Purpose: Online marketplaces have made it increasingly possible for non-medical professionals to order professional-grade medical products and devices for home use, including neurotoxins, dermal fillers, chemical peels, and lasers.(1) Online communities promote products, share techniques, and support other users in their do-it-yourself (DIY) aesthetic journeys. This study aimed to learn more about the demographics of this group, their motivations, and complications incurred from DIY procedures.

Methods: A survey was distributed to the public using Amazon Mechanical Turk, Reddit, and TikTok. Inclusion criteria included adults eighteen years of age and older. Participants were inquired regarding their knowledge of, perceived safety of, and experience with DIY cosmetic procedures. Descriptive and univariate statistics were performed on survey responses. Additional pertinent viewpoints from DIY Facebook groups and subreddits were manually extracted. Survey results were validated by cross-referencing with posts and internally-run surveys in DIY Facebook groups and subreddits.

Results: Of 385 complete and validated survey responses, 18 respondents reported performing DIY procedures. The average age was 42.9-years-old, median household income was $75,000-99,000 USD, and the majority (78.8%) had completed a college degree. The primary motivation for pursuing DIY procedures was cost-savings (44.4%), followed by desire to personally control outcomes (33.3%). The most popular procedures were neurotoxin injections and microneedling. Less common DIY procedures included thread lifts, dermal fillers, mole removal, professional-grade chemical peels, laser treatments, and plasma pen skin tightening. Complications reported included vascular injuries, scarring, hyperpigmentation, allergic reactions, fat necrosis, and infection. Most supplies were purchased from foreign beauty supply websites (66.7%). Over one-third (38.9%) of respondents were uncomfortable disclosing their DIY history with a physician, citing "fear of judgment" as their primary reason. Respondents reported a desire for more affordable pricing of professional cosmetic procedures, increased availability of educational information focused on safe techniques, and decreased judgment from plastic surgeons.

Conclusion: There is a privately expanding online community of patients performing DIY professional-grade cosmetic procedures. This group is largely composed of college-educated, middle-aged females, who desire low-cost aesthetic improvements, and obtain products from foreign beauty websites. This group is highly secretive as they do not want to compromise their imported product streams, and many influencers stand to profit from marketing foreign medical products. For these reasons, a considerable limitation of our study was the low number of responses from individuals within the DIY community. However, while users of online forums rarely report complications, numerous serious negative complications were reported anonymously in our survey. Respondents who had suffered complications reported feeling as though they lacked support both within their online communities, and from medical professionals, revealing a need for increased attention on this issue from the plastic surgery community. Plastic surgeons should be aware of potential histories of at-home procedures, educate patients about risks of unsupervised procedures, and provide non-judgemental support to patients presenting with complications. Furthermore, plastic surgeons should advocate for increased regulation of online marketplaces to prevent the import of non-FDA-approved products and complications from DIY procedures.

References: 1. Brennan R, Wells JSG, Van Hout M. "Saving Face": An Online Study of the Injecting Use of DIY Botox and Dermal Filler Kits. Plast Surg (Oakv). 2018;26(3):154-159. doi:10.1177/2292550318767432

Background: Many patients who undergo a rhinoplasty procedure prefer to maintain their ethnic characteristics rather than aim toward Euro-western ideals. Effective communication of these preferences are important during the preoperative consultation. Recent Artificial Intelligence (AI) 3D morphing now offers the ability to plan rhinoplasty nasal shaping based on a patient's preferences. It is not known whether these morphing tools create improved rhinoplasty outcomes.

Methods: Rhinoplasty patients who emphasized ethnic considerations (based on a validated survey) underwent either preoperative 1) Deep Surface AI or Vectra morphing or 2) No morphing (n=392) to communicate their preferences. Structured rhinoplasty used cadaveric cartilage (MTF) for procedures because of lack of septal cartilage. Outcome assessment was based on perioperative complications, long term stability (1-year), need for revisions, and patient-reported functional and aesthetic outcomes using the SCHNOS validated questionnaire, as well as, Patient-Reported Outcomes Measurement Information System (PROMIS) for psychosocial indicator assessment.

Results: The 2 ethnic rhinoplasty groups studied (Morphing vs No Morphing) had similar demographics, operative techniques, complications (2% vs 3%), and revisions (3% vs 5%). Operative techniques included variations of: Upper vault narrowing, dorsal onlay graft (to raise radix), spreader grafts, columellar strut grafts, tip graft, alar base resection, lateral wall osteotomy with use of cadaveric (MTF) grafts. Patients who underwent preoperative 3D 'morphing' to record patient nasal shape preferences based on their ethnic considerations and cultural ideals compared to 'no morphing' had greater improvement in functional and aesthetic (SCHNOS) scores (3.2±0.4 vs 2.0±0.3) and a greater decrease in Psychosocial Indicators (PROMIS scores): Anxiety (58.5±6.6 vs. 55.2±8.6), Depression (50.6±7.6 vs. 48.7±9.4), Meaning and Purpose (49.6±7.6 vs. 51.7±9.4).

Conclusions: Nasal reshaping with ethnic considerations based on patient preferences can have more successful outcomes with the utilization of 3D morphing programs like Deep Surface AI and operative techniques tailored to these preferences.

Background: Breast ptosis results from an involution of breast parenchyma with the underlying Coopers' ligaments becoming stretched over time resulting in a complete loss of support to the breast mound. This loss in volume results in a decrease in upper pole fullness, an increase in the lower pole fullness and width, and in addition a loss of breast projection. Many techniques have been described to address the components of a youthful breast. Mastopexy presents many challenges including avoiding tissues from "bottoming out" with a boxy look, maintaining upper pole fullness, as well as ideally providing an "implant-like" look with a round, projected mound.

The authors present their experience using a specialized technique to address the components of a ptotic breast. The procedure uses a superior medial pedicle for nipple transposition. This is combined with an inferior dermoglandular pedicle for auto-augmentation (Graff/Briggs flap), to improve the upper pole fullness and increase projection. In order to avoid the superior medial pedicle from bottom out, superior suture suspension of the superior medial flap to the pectoralis muscle fascia is utilized. Finally, the lower pole excess skin is deepithelized and superiorly based dermal grafts from the tissue that is routinely discarded is used to provide support to the breast mount medial and lateral pillars and avoid the superior medial flap from migrating.

Methods: Analysis of electronic records of patients who underwent breast suspension with ligament reconstruction between April 24th, 2012 and September 13th, 2023 were analyzed. A total of 95 consecutive cases were discovered. Photographic records were taken before and during follow-up clinic visits at 1 month, 3 months, 6-8 months and occasionally greater.

Results: Breast suspension with ligament reconstruction mammaplasty was successfully achieve in 95 consecutive patients. Average age was 40 years old (standard deviation 7 years, maximum: 54 years, minimum: 25 years). Average body mass index (BMI) was 30 (standard deviation: 4, maximum: 45, minimum: 21) Complications were as follows: Partial areola necrosis (N = 2, 2.1%), partial inferior dermoglandular distal tip necrosis (N = 4, 4.2%), and minor complications including small wound breakdown in the vertical limb closure (N = 6, 6.3%). No cases of bottom out deformity were recorded, but patients with poor quality of skin may eventually have a natural descent of the whole breast mound occur without ptosis.

Conclusion: Breast suspension with ligament reconstruction mammaplasty offers a safe and reliable technique that improves patient surgical results. This technique is not indicated for all types of breasts. Nevertheless, it provides another option to the plastic surgeon armamentarium to address the challenges of mastopexies.

Introduction: Gummy smiles, marked by an excessive gingival display greater than 2-3 mm, detrimentally affect facial aesthetics and self-esteem. Traditional correction methods, such as botulinum toxin injections, offer temporary solutions requiring frequent repetition, while more invasive surgical options like orthodontics and gingival manipulations come with increased complexity and variable effectiveness. This study evaluates Micro-Autologous Fat Transplantation (MAFT) as a minimally invasive, durable alternative for long-term gummy smile correction. Materials and Methods: From October 2015 to December 2023, 52 patients were treated with MAFT. Fat was harvested, processed, and micro-injected into the nasolabial fold, ergotrid, and upper lip under total intravenous anesthesia. Assessments included preoperative and postoperative gingival display, patient satisfaction, and complications, with follow-ups at one, three, six months, or longer. Results: With an average follow-up of 65 months, significant reductions in gingival display were observed. The procedure's mean duration was 50 minutes, delivering an average of 17.2 mL of fat. Reductions in gingival display averaged 4.6 mm for the right canine incisor, 4.7 mm for the left canine incisor, 4.8 mm for the right canine, and 4.4 mm for the left canine. Patient satisfaction was high, with 92% reporting satisfaction or greater, and minimal discomfort reported. No major complications were noted, and any minor side effects were transient. Conclusion: MAFT emerges as a safe, highly effective, and patient-preferred method for correcting gummy smiles, providing a long-term solution that enhances facial aesthetic harmony and patient quality of life. This study solidifies MAFT's standing as a leading alternative to more invasive traditional methods, advocating for its broader adoption in cosmetic surgery. Future research might explore MAFT's efficacy in broader applications, potentially transforming approaches to facial aesthetics. Future studies should focus on standardizing treatment protocols, expanding patient numbers, and extending follow-up to better evaluate MAFT's long-term efficacy and broader applications in cosmetic surgery.

Reference: 1. Polo M. botulinum toxin type A in the treatment of excessive gingival display. Am J Orthod Dentofacial Orthop. 2005;127(2):214-218; quiz 261. 2. Miskinyar SA. A new method for correcting a gummy smile. Plast Reconstr Surg. 1983;72(3):397-400. 3. Ezquerra F, Berrazueta MJ, Ruiz-Capillas A, Arregui JS. New approach to the gummy smile. Plast Reconstr Surg. 1999;104(4):1143-1150; discussion 1151. 4. Coleman SR. Structural fat grafting. Aesthet Surg J. 1998;18(5):386, 388. 5. Shu-Hung Huang, Yu-Hao Huang, Tsai-Ming Lin et al. Micro-Autologous Fat Transplantation for Treating a Gummy Smile. Aesthet Surg J. 2018 Aug 16;38(9):925-937.

SAFETY AND EFFICACY OF COMBINING DEEP PLASMA RESURFACING WITH FACELIFTS

Abstract

Goals/Purpose

Deep facial skin resurfacing with radio-frequency (RF) plasma technology started in the early 2010's. When compared to other deep facial resurfacing techniques such as phenol chemical peels or C02 and erbium ablative laser skin resurfacing, plasma resurfacing results in better correction of superficial and deep rhytids, photo-damage and more tissue contraction resulting and improved skin and tissue tightening. Performing deep plasma skin resurfacing at the same time as the rhytidectomy procedure offers the patient improved facial rejuvenation results in one surgical session and recovery period.

Methods/Technique

A retrospective review of a single surgeon's experience from 2017-current is presented. A total of 90 patients were treated in one session, combining a face and necklift procedure with fat grafting and full face deep plasma skin resurfacing. Patients ages range from 50-86, with 88 females and 2 males. The procedures were performed under IV sedation (88 patients) and 2 under general anesthesia (2 patients). Once adequate general or IV sedation was administered, tumescent solution was infiltrated into the face and neck (average volume of 180 cc total). Rhytidectomy techniques performed included SMAS plication, SMAS imbrication or Deep plane techniques (surgeon choice depending on the patient's facial anatomy). A concurrent necklift and platysmaplasty was also performed. Next, full face resurfacing was performed with helium RF plasma in a majority of the patients (80), while nitrogen RF plasma was performed in 8 patients. Settings for the helium RF plasma were at 40% energy at 4 liter flow, single pass on the whole face, a second pass was performed on the chin and peri-oral areas. The energy was decreased to 20% at 4 liter flow on the areas of the rhytidectomy lateral elevated skin flaps. For the 8 patients treated with the nitrogen plasma, energy settings were at 4 kilojoules (kj), single pass, and was lowered to 3 kj over the areas of the lateral elevated skin flaps. Finally, fat grafting was performed on the face via Coleman's technique. The patients were followed the next day, weekly, then monthly. Longest follow-up is at 7 years post-operative.

Results/Complications

There were three complications. One patient experienced a late onset cellulitis on her forehead at 7 weeks post-operative, and this resolved with a one week course of oral antibiotics. Two patients had small areas of hypertrophic scarring on their chin areas that resolved completely with light C02 resurfacing combined with laser-assisted drug delivery of kenalog 40. There were no incidents of skin necrosis on the areas of the elevated rhytidectomy or necklift skin flaps. Aesthetic results showed very good correction of deep and superficial rhytids, photo damage and much improved overall quality of the skin.

Conclusion

This small series over the course of seven years shows the safety and efficacy of performing deep RF plasma resurfacing immediately after rhytidectomy procedures. The elevated skin flap can be treated effectively by lowering the energy settings of the plasma devices. Patients can appreciate a single session surgical procedure that results in comprehensive facial and neck rejuvenation, with less downtime when compared to a staged procedure.

Abstract Introduction Health literacy is an independent predictor of population health status and treatment outcomes and is directly related to the readability of available patient education materials (PEMs). The National Institutes of Health (NIH) and the American Medical Association (AMA) have recommended that PEMs be written at a level lower than the 8th-grade education level. Objectives To assess the readability of online PEMs about the most common plastic surgery procedures published by several academic institutions across the US. We then evaluated the utility of ChatGPT (OpenAI Inc., San Francisco, CA) to improve the readability while maintaining the comprehensibility of those materials. Methods Online PEMs regarding five common plastic surgery procedures (according to the American Society of Plastic Surgeons), including liposuction, breast augmentation, abdominoplasty, breast lift, and eyelid surgery were collected from the websites of 20 top institutions in plastic surgery (according to the Plastic Surgery Research Council). The materials were assessed using six readability scales. ChatGPT was then used to create improved texts with lower readability scores within the recommended NIH/AMA range. Grammarly (Grammarly Inc., San Francisco, CA) was used to assess the comprehensibility of the text before and after the use of ChatGPT. Statistical analysis was performed using SPSS 28.0 (IBM Inc., Armonk, NY). Results None of the PEMs were written at or below the AMA/NIH's recommended reading level. The average educational level required to comprehend the texts across all institutions, as assessed by the readability scales, was at the 12th-grade level, with no significant difference between institutions. Some materials require a college-level education or higher. The level of comprehensibility of the text was 84.8 out of 100. After using ChatGPT, the average readability grade improved to the 7th-8th grade level, with a mean difference of 4.2 compared to the original text (p<0.001) (Figure 1). The level of comprehensibility also significantly improved to 87.6 (p<0.001). Conclusions Online PEMs help improve healthcare utilization, preventative care, patient-physician communication, and patient satisfaction. However, current materials related to plastic surgery procedures are not written at or below the AMA/NIH's recommended education level, which could impact the utility of those PEMs for the general public. ChatGPT is an innovative AI tool that is increasingly utilized in healthcare. In this study, we showed that the utility of AI can help improve the readability of PEMs while also enhancing the comprehensibility of the materials.