Scientific Abstract Presentations: Aesthetic Session 4 Saturday, September 28 Sat, Sep 28 2:00-3:30 p.m. PDT

Abstract Background: Liposuction-assisted abdominal contouring is one of the most popular liposuction operations. (1) This seems to imply that "abdominal liposuction may be just a simple operation and a good postoperative result can be easily achieved by purely holding the cannula in hand and reciprocating." But this is just a trap. In fact, complications happen after abdominal liposuction, such as uneven skin, especially in the lower abdomen. (2,3) Besides, there are many contour deformities in the abdomen. (4,5) This requires doctors to perform liposuction according to different abdominal conditions. To refine the abdominal contouring procedures, our team dissected the abdominal SFS in fresh specimens, aiming to give a thorough topographic anatomy of SFS, present a theory about the abdominal fat accumulation mechanism, figure out the anatomical explanations of one or even two horizontal skin creases and the roll deformities between them, thus put forward a set of corresponding methods of contouring improvement. Methods: A total of 20 fresh female specimens (mean age, 54 years; age range, 35-76 years) were dissected. Dissections were made on one side of abdomen from skin to deep fascia. The SFS was lifted with removing as much of the fat as possible so as to clearly observe the retinaculum cutis. Besides, intact SSC tissue blocks were obtained on the other side of abdomen on the six horizontal planes and four vertical planes. The changes of SAT and DAT from medial to lateral, and from cephalic to caudal, were recorded. Results: The thigh was divided into three sections, namely, the median (four subunits: upper abdomen, mid-abdomen periumbilical zone, lower abdomen, suprapubic zone), the negative (two subunits: costal zone, subcostal zone), and the lateral section (two subunits: lateral chest, lateral abdomen). We found that the form of the SFS has regional variations. Therefore, based on these varied features, the SFS among the eight subunits of the abdomen fall into five categories based on amount, toughness and density in DAT (least, less, median, more, most; notated by degree I-V) and RCP (most loose, loose, average, tight, tightest; notated by degree I-V). Five different liposuction methods were formulated to manage these subunits: inward tightening (all-layer mass liposuction), primary flatten (mass liposuction), secondary flatten (normal aspiration), border feather-out (aspiration for smooth contour), restricted flatten (conservation aspiration) . Besides, the author proposed the anatomical explains about three scenarios of abdominal contour deformity: adhesion zones, roll deformities, depression in the negative section. Conclusions: The SFS of the abdomen showed a regional variation pattern, based on which we proposed a series of new anatomy-based liposuction approaches. Topographic anatomy of the SFS in the abdomen region helps us understand its contour deformities and provide an anatomic basis for surgical correction. A well-sculpted abdomen with its different sections presented in harmony can be safely obtained using these approaches. Reference： 1.Trussler AP, Kurkjian TJ, Hatef DA, Farkas JP, Rohrich RJ. Refinements in abdominoplasty: a critical outcomes analysis over a 20-year period. Plast Reconstr Surg. 2010;126(3):1063-1074. doi:10.1097/PRS.0b013e3181e60537 2.Taylor DA. Zones of Adhesion of the Abdomen: Implications for Abdominoplasty. Aesthet Surg J. 2017;37(2):190-199. doi:10.1093/asj/sjw140 3.Rohrich RJ, Smith PD, Marcantonio DR, Kenkel JM. The zones of adherence: role in minimizing and preventing contour deformities in liposuction. Plast Reconstr Surg. 2001;107(6):1562-1569. doi:10.1097/00006534-200105000-00043 4.Saldanha O, Ordenes AI, Goyeneche C, et al. Lipoabdominoplasty with Anatomical Definition. Plast Reconstr Surg. 2020;146(4):766-777. doi:10.1097/PRS.0000000000007184 5.Brauman D, Capocci J. Liposuction abdominoplasty: an advanced body contouring technique. Plast Reconstr Surg. 2009;124(5):1685-1695. doi:10.1097/PRS.0b013e3181b98c5d

Background: Postoperative hematoma stands out as one of the most common complications within the field of plastic and reconstructive surgery. With the shift towards favoring cosmetic surgical procedures in outpatient facilities over traditional operating rooms, hematoma prevention becomes critically important for enhancing patient safety and achieving optimal surgical outcomes. This study aims to identify the risk factors associated with hematoma development in outpatient settings and provides recommendations for enhanced patient safety by analyzing over 40,000 consecutive cases spanning across three decades.

Methods: All consecutive cases, performed by board-certified plastic surgeons at an accredited outpatient surgical facility from 1995 to 2023, were retrospectively reviewed. Patient demographics and operative details were recorded to determine both patient- and procedure-specific risk factors for developing hematomas following cosmetic procedures performed in the outpatient setting. Operative details included total operative-time, lipoaspirate amount, and whether the procedure was a combined case. Continuous variables were compared using a student t-test and logistic regressions were utilized to assess the predictive value of variables. Receiver operating characteristic (ROC) curves were created for each variable and the Youden's method was used to determine the optimal cutoff points.

Results: A total of 42,720 consecutive cases were performed across 29 years. A total of 318 complications were recorded, with hematoma accounting for 61.32 percent of all complications (n=195). The overall complication rate for hematomas was 0.46 percent. Most hematomas occurred in breast-related cases (34.6 percent, n=110). Compared with the control population, patients experiencing hematomas had lower BMI (p < 0.0001), shorter operative durations (p < 0.0001) and were less likely to have undergone a combined procedure (p < 0.0001). The leading predictive variable for a decreased risk of hematoma formation was undergoing a combined procedure, with combined cases associated with a 3.73 times lower risk for developing hematomas (OR 0.268; p < 0.0001). Longer operative time was associated with a 1.33 times lower risk of developing hematomas (OR 0.75; p = 0.0001).

Conclusions: This study presents the largest analysis of the risk factors associated with hematomas in outpatient plastic surgery settings, analyzing three decades of experience. The use of bleeding reduction modalities such as Tranexamic Acid (TXA) should be considered for patients with a BMI lower than 25.55 kg/m2 and operative time shorter than 2.07 hours, identified as significant risk factors for developing hematomas in cosmetic procedures in the outpatient setting.

The fat of the arms consists of superficial alveolar fat and deep lamellar fat separated by the superficial fascia (1).
The growing fat pads of the posterior arm (PAF) and shoulder pull down the posterior axillary fold and contents of the axilla causing irreversible damage and distortion to the topographic anatomy, visible after massive weight loss. The expanded skin and elongated ligaments contribute to the characteristic posterior axillary fold and lack of natural axillary dome with subsequent physical and psychological burden to the MWL patients. These changes need to be considered in planning of the reconstruction. There has not been sufficient focus on the importance of the axilla in MWL brachioplasty or how it differs from the postmenopausal batwing deformity of the upper arms. We designed a prospective study to test a procedure specifically designed to mend the underlying pathology of obesity and MWL. Liposuction Assisted Axillo Brachioplasty, LAAB.

Material and Methods A prospective pilot study was designed aiming to test the effect of liposuction of the PAF and specific axillo-brachioplasty (LAAB) on the axilla and evaluate the effect on the patient's preoperative complaints and wellbeing and allow for adjustments for future comparative studies on a larger scale.
We measured the diameter of the arm and axilla at points A, B and C, and applied a standardized questionnaire regarding body perception and psychosocial well-being, (BODY-Q, standardized Danish version translated to Norwegian). Pre and postoperatively and at follow up visits. The patients were examined after 6 months (4-12 months). Patients clinical data and complications were registered on study forms and informed consent attained applying to the standars of the Helsinki

Results Fifteen women, 30 arms. Age average; 48 (29 -66) interestingly most (12/15) were between 42-62, the same age as women otherwise request brachioplasty or slightly earlier. Follow-up was 6 months on average (4-12 months).
All 15 had a history of MWL operation average BMI 42 (39-52). The mean height 167cm (152-181). Weight 71.9kg,( 44- 94) BMI 24, range (19- 32.9).. Ten patients (67%) had gastric bypass surgery, four (27%) had a gastric sleeve operation, one had both. Three patients had diabetes and hypertension and, interestingly, they were the same patients. The rest did not have any comorbidities. Eight (53.3%) patients were postmenopausal at the date of surgery, and none had hormone replacement therapy. Three patients had a history of prior pregnancy and normal delivery. There were 3 smokers, one patient had connective tissue disorder (not Ehler Danlos). There were no correlations with any of the comorbidities related to the results. And there were no complications other than one minor skin erosion treated conservatively by the patients GP.
There was a significant improvement in all measurements A-C, most significantly at point A in the axilla where the reduction was associated with relief of preoperative ailments and high patient satisfaction.

Conclusion Among the most significant findings in this small series on MWL patients is the improvement of the axilla and its correlation with patient satisfaction. The study supports the clinical relevance of the posterior arm fat pad (PAF). A systematic debulking of the PAF does improve the axillary contour and facilitate restoration of the displaced axilla after MWL. The procedure is safe and uncomplicated with a very high patient satisfaction shown in this series. LAAB can be recommended to correct the loose axilla, reduce and tighten the residual fat and skin of the upper arm after MWL.

Reference: 1. Avelar J. Regional distribution and behavior of the subcutaneous tissue concerning selection and indication for liposuction. Aesthetic Plast Surg. 1989 Summer;13(3):155-65

Introduction: Body contouring has become a trend in aesthetic plastic surgery, with interventions aimed at meeting patients' aesthetic expectations (1). In the pursuit of the perfect body, deformities of the anterior thoracic cage, such as anterior lower rib cartilage prominence, have been identified as causes of dissatisfaction in these patients. This scenario let the development of ARCO, a unique surgical intervention for anterior rib remodeling; ARCO fulfills all innovation criteria, showcasing effectiveness and safety in the short and long term for the patient. This is substantiated by the best available scientific evidence, an aspect that has been somewhat overlooked in the development of new techniques in aesthetic plastic surgery (2).

Methods: A prospective study of the ARCO technique was conducted on patients in Colombia, performed by a single certified plastic surgeon. Pre-surgical and postoperative measurements of rib cage diameter at the eighth rib level were recorded. Spirometry assessments were conducted both pre and late postoperatively to evaluate long-term respiratory volume changes. Peak pulmonary values and compliance were documented to illustrate intraoperative safety. Additionally, a Body-Q satisfaction survey and complication reports were gathered.

Results: Among 34 patients, the average age was 34 years, and the mean body mass index was 25.1 kg/m². Significant chest perimeter reduction at the eighth rib level (Welch's Factor=9.3, p<0.001) was observed, averaging an 8 cm decrease. Peak and pulmonary compliance values remained stable throughout the procedure stages with no statistically significant differences. Spirometry variables indicated no restrictions in respiratory volumes: FVC (T-Student=0.371, p=0.712), FEV1 (T-Student=-0.82, p=0.414), FEV1/FVC (T-Student=0.32, p=0.743), PEF (T-Student=0.05, p=0.960), and FEF:25-75 (T-Student=0.366, p=0.715). Body-Q satisfaction was notably higher at the third postoperative month with ARCO compared to the preoperative consultation (T-Student=-2.29, p=0.025).

Discussion: ARCO effectively reduces chest perimeter at the eighth rib, enhancing the aesthetic appeal of the anterior rib margin and achieving high patient satisfaction. The technique addresses various risks associated with anterior rib remodeling, aiming to prevent complications like pneumothorax and hemopneumothorax (3). ARCO utilizes a greenstick fracture approach, avoiding the neurovascular bundle in the posterior rib border, and employs a piezo tome with ultrasonic waves of 25-29 Hz, posing no risk to neurovascular tissues that require frequencies above 50 Hz to be affected (4). Moreover, ARCO's fixation with osteogenic material ensures proper rib curvature, preventing malunion-related complications and eliminating the need for postoperative corsets. The intervention has not proven to be a safety risk for patients, as intra and postoperative respiratory reference values have not been statistically significantly altered.

REFERENCES 1. Andrades-P, Quispe-D, Dominguez-C, Jara-R, Cisternas-JP, Lobos-G, et al. Winged Ribs: An Underestimated Problem That May Compromise Breast Augmentation Outcomes. Aesthetic Plast Surg. 2019 Aug 15;43(4):899–904. 2. Ferreira-LM, Ferreira-PEN, Bernardes-ABS, dosAnjos-GF, Cosac-OM, Willhelm-RO, et al. Aesthetic Contouring of the Chest wall with Rib Resection. Vol. 45, Aesthetic Plastic Surgery. Springer; 2021. p.1099–104. 3. Pines-G, Gotler-Y, Lazar-LO, Lin-G. Clinical significance of rib fractures' anatomical patterns. Injury. 2020 Aug 1;51(8):1812–6. 4. Gerbault-O, Daniel-RK, Kosins-AM. The Role of Piezoelectric Instrumentation in Rhinoplasty Surgery. Aesthet Surg J. 2015 Oct 23;36(1):21–34.

Background Overdevelopment of the zygomatic bones often results in the protrusion and flaring of the midfacial region.1 This makes the face appear more square-shaped rather than the more favorable oval shape. Therefore, zygoma reduction surgery has become a commonly performed procedure for patients looking to obtain a more ideal facial shape.1,2 One of the main complications of zygoma reduction surgery is facial soft tissue ptosis.3,4 Previously, the evaluation of cheek soft tissue ptosis was only based subjectively by the patients and the surgeons.5 Our research aims to provide an objective evaluation of soft tissue sagging in the cheek region after zygoma reduction surgery through the utilization of artificial intelligence.

Methods In this study, we conducted research on 301 patients who underwent zygoma reduction surgery at our institution from January 2018 to September 2022. Following the exclusion criteria, which aimed to exclude inappropriate candidates, the study was conducted on a total of 72 patients. We utilized artificial intelligence (AI) for the evaluation of cheek sagging in our series of patients who underwent zygoma reduction surgery. We employed four methods: tracking facial landmarks, detecting changes in cheek curvature, and examining changes in the nasolabial fold and marionette's line. The obtained numerical results were then assessed for statistically significant differences using statistical validation methods.

Results Utilizing artificial intelligence with the four indicators demonstrated that there were no statistically significant differences between pre and post-surgery evaluations.

Conclusion In our series of patients, artificial intelligence analysis demonstrated that soft tissue ptosis did not occur. AI has the advantage of offering an objective evaluation for both the patient and the doctor. Future research can build upon this application to examine various influencing factors and develop new tools utilizing machine learning to evaluate and also predict the extent of cheek sagging in patients before undergoing surgery.

Reference 1. Lee HY, Yang HJ, Cho YN. Minimally invasive zygoma reduction. Plast Reconstr Surg. 2006;117(6):1972-1979. doi:10.1097/01.prs.0000210066.51480.3f 2. Hong SE, Liu SY, Kim JT, Lee JH. Intraoral zygoma reduction using L-shaped osteotomy. J Craniofac Surg. 2014;25(3):758-761. doi:10.1097/SCS.0000000000000759 3. Choi BK, Goh RC, Moaveni Z, Lo LJ. Patient satisfaction after zygoma and mandible reduction surgery: an outcome assessment. J Plast Reconstr Aesthet Surg. 2010;63(8):1260-1264. doi:10.1016/j.bjps.2009.07.041 4. Zhang J, Liu H, Liu Y, et al. A Systematic Review and Meta-Analysis of Complications among Various Reduction Malarplasty [published correction appears in Aesthetic Plast Surg. 2023 Dec;47(6):2909]. Aesthetic Plast Surg. 2023;47(3):1018-1038. doi:10.1007/s00266-022-03104-1 5. Gao J, Wei M, Yuan J, et al. Midfacial Soft Tissue Changes After Reduction Malarplasty: A Computed Tomographic Study. J Craniofac Surg. 2022;33(2):579-583. doi:10.1097/SCS.0000000000008013

Lipoabdominoplasty has solidified its place in the repertoire of plastic surgeons since its inception by Saldanha in 2001(1). Recent years have witnessed a notable advancement in liposuction techniques with the advent of high-definition liposuction pioneered by Hoyos(2), which highlights the muscular structures of the abdominal wall through precise marking with superficial liposuction.

This study aimed to assess the variation in the positioning of the linea semilunaris - or semilunar lines - (SLL) on the aponeurosis before and after rectus abdominis diastasis treatment and its correlation with the SLL observed on the skin in patients undergoing anatomical definition lipoabdominoplasty.

Thirteen patients from the author's private practice who underwent anatomical definition lipoabdominoplasty were included in this study conducted from January 2023 to January 2024. Preoperatively, the SLL were marked on the skin. Measurements of rectus abdominis diastasis size, plication, and distance from the SLL to the midline were taken under direct visualization after detachment of the abdominal flap. After plication, the new position of the SLL was evaluated, and their projection in the abdominal flap was recorded after closure.

Patients exhibited a mean rectus abdominis diastasis of 2.83cm, ranging from 1.9 to 3.6cm. Plication averaged 4.2cm, ranging from 3.4 to 6cm. Statistically significant differences were found in the positioning of SLL projection on the skin before and after rectus abdominis plication, both to the right and left (p<0.01), which was also confirmed through direct visualization (p<0.01). Additionally, a strong correlation (0.778) was observed between the size of the plication and the displacement of SLL projection on the skin according to the Pearson correlation test.

As anatomical definition lipoabdominoplasty gains popularity, achieving the correct final position of linea semilunaris after diastasis treatment is crucial to avoid aesthetic complications. Simão (2020) noted marking the SLL medially to their palpation-identified position, assuming positional modifications without specific measurements(3). To increase precision, some authors propose preoperative marking with ultrasonography; however, they also disregard possible changes in the positioning of the structures after the plication of the abdominal wall.(4) Our results showed significant displacement of the SLL when comparing pre- and post-operative distances from the midline after rectus abdominis plication. Medial misplacement of the SLL could lead to inadequate contouring of the rectus abdominis muscle, negatively affecting the aesthetic outcome. The author suggests marking the SLL preoperatively 1 to 3 cm more laterally, depending on diastasis width.

In conclusion, medial displacement of SLL projection in the skin occurs after rectus abdominis aponeurosis plication, emphasizing the need to address this displacement to achieve favorable aesthetic results.

1.Saldanha O. Lipoabdominoplasty without undermining. Aesthetic Surgery Journal. 2001;21(6):518-526. doi:https://doi.org/10.1067/maj.2001.121243 2. Hoyos A, Perez ME, Guarin DE, Montenegro A. A Report of 736 High-Definition Lipoabdominoplasties Performed in Conjunction with Circumferential VASER Liposuction. Plastic and Reconstructive Surgery. 2018;142(3):662-675. doi:https://doi.org/10.1097/prs.0000000000004705 3.Tiago Sarmento Simão. High Definition Lipoabdominoplasty. Aesthetic Plastic Surgery. 2020;44(6):2147-2157. doi:https://doi.org/10.1007/s00266-020-01917-6 4. Cipriani M, Maurício Viaro, Adrianzen G, et al. Ultrasonography as a Tool to Improve Preoperative Marking in Body Contour Surgery. Plastic and Reconstructive Surgery – Global Open. 2023;11(11):e5431-e5431. doi:https://doi.org/10.1097/gox.0000000000005431

Background: Abdominoplasty combined with hip expansion by fat grafting is essentially a lipoabdominoplasty that focuses on the waist and the hips to recreate an "hourglass profile". Recent advances in abdominoplasty techniques combined with a better understanding of the blood supply allow the definition of important anatomical structures of the abdomen with an athletic look. One of the techniques to achieve a smaller waist is the implementation of a wide abdominal plication which is in essence is an "internal corset". It is challenging to define the linea alba with this technique, as the tunnel for plication is wider than normal to expose the lateral border of the rectus abdominis muscle and the external oblique aponeurosis. Because the skin tone in patients requiring abdominoplasty is often compromised due to multiple factors the location of the linea alba can shift in the postoperative period. The authors present their experience using progressive steps to recreate the linea alba and the linea semilunaris.

Methods: Medical records of patients who underwent abdominoplasty combined with hip expansion by fat grafting and reconstruction of the linea alba and semilunaris from July 1st, 2019 and September 13th, 2023 were analyzed. Photographic records were taken before and during follow-up appointments at 1 month, 3 months, 6-8 months and greater than a year when possible. The technique utilizes VASER liposuction of the linea alba and linea semilunaris combined with MicroAire technology for fat extraction. Under direct vision, debulking of the fat and expansion of the linea alba is performed. In order to fix the lineal alba and control its depth and location to the midline, 2-3 progressive tension suture are used. Finally, we take the advantage of the medial migration of the abdominal flap that results from the wide abdominal plication to recreate the linea semilunaris.

Results: A total of 482 consecutive cases were identified. Average age was 39 years old (standard deviation 8 years, maximum: 61 years, minimum: 22 years). Average body mass index (BMI) was 29 (standard deviation: 0.4, maximum 42, minimum: 21) Complications were as follows: symptomatic anemia requiring transfusion (2, 0.4%), partial wound dehiscence (9, 1.9%), delayed wound healing (5, 1.0%), seroma (3, 0.6%), surgical site infection (7, 1.5%), symptomatic scar requiring revision or steroid injection (16, 3.3%), urinary retention (4, 0.8%), and other medical complications (5, 1.0%).

Conclusion: Abdominoplasty combined with hip expansion by fat grafting and reconstruction of the linea alba and semilunaris refines patients' surgical results providing a more athletic look. This technique does not compromise the abdominal flap and has low complication rates.

Botulinum toxin type A(BoNTA) is known to prevent fibroblast proliferation and expression of TGF-B1[1]. It also induces temporary muscle paralysis and decreases tension vectors. Fibroblasts induce scar contracture and hypertrophy by producing collagen fibers in wound healing processes.2 The pinhole method involves creating multiple small holes that extend from the epidermis layer to the deeper dermis using an ultra-pulse carbon dioxide (CO2) laser[2]. The effectiveness of this method in treating various skin conditions, such as hypertrophic scars, sebaceous hyperplasia, anetoderma, and elastosis perforans serpiginosa, has been proven. In contrast with the conventional CO2 ablative laser, the pinhole method can induce regeneration and realignment of collagen bundles at the desired depth. The aim of this study is to identify the effect of BoNTA and CO2 laser with pin hole method on the scar formation. 82 patients with forehead laceration were enrolled in this study and randomized into two groups with or without injection of BoNTA. When the patients presented to the clinic to remove the stitches, BoNTA was injected to the BoNTA group with 42 patients and saline was injected to the control group with 40 patients. The BoNTA was injected on dermal layer with 5U/cm. After that, half patients in both groups were treated with Co2 laser using the pin hole method 2~3times. We used the pinhole method with an ultra-pulse CO2 laser (UM-L30®, Union Medical Co. Ltd., Seoul, Korea) to treat the lesions. All laser treatments were performed by the same plastic surgeon. In the first session, multiple small holes, approximately 1 mm in diameter, were made along the entire lesion at 1-2 mm intervals to the depth of the papillary dermis, where the suture scar existed. The residual areas of the lesion were treated in the second and third sessions in the same manner. Follow-up was done in 1 month, 3 months, and 6 months. The scars were analyzed with the Patient and observer scar assessment scale (POSAS), Stony Brook Scar Evaluation Scales(SBSES) and Visual analogue scale(VAS) and analyzed with independent t-test, along with clinical photographs, cutometer and biopsies. In all scar scales, the scores changed into favorable direction in both groups and the changes were larger in BoNTA group compared with the control group. On SBSES and VAS, better improvements on BoNTA group showed statistical significance. Skin biopsy showed less collagen deposition on dermal layer in BoNTA group. Improvement of aesthetic, functional and emotional aspect of the scar formation in the groups treated with BoNTA and co2 laser was illustrated. The application of botulinum toxin type A and co2 laser may be expanded to prevent hypertrophic scar after trauma, burns or operations. Reference 1. Jeong HS, Lee BH, Sung HM, et al. Effect of botulinum toxin type A on differentiation of fibroblasts derived from scar tissue. Plast Reconstr Surg 2015 ;136: 171e–8e 2. Lee, S.J.; No, Y.A.; Kang, J.M.; Chung, W.S.; Kim, Y.K.; Seo, S.J.; Park, K.Y. Treatment of hesitation marks on the forearm by the pinhole method. Lasers Med. Sci. 2016; 31: 1339–1342.

Introduction: The demand for rhinoplasty in Asia is growing annually and short nasal deformity has been one of the main reasons for the surgery due to its high incidence. There is an urgent need for a rhinoplasty suitable for Asians because of their different facial features from Westerners. In previous research, we have developed M-shaped auricular cartilage grafts as a new method for the correction of short nose deformity with good effect for Asians. However, although the basic approach to M-shaped cartilage surgery is well understood, there is a great deal of variety and uncertainty when plastic surgeons perform the procedure, and there is still a lack of fixed standard guidance on the specific details. Based on the results of the finite element analysis, we gave clinical recommendations for the details of the M-shaped auricular rhinoplasty. Moreover, we evaluated the aesthetic and functional results of M-shaped auricular rhinoplasty compared to classical methods. Method: Finite element analysis was used to explore and compare cartilage stability with different suturing methods, sizes of M-shaped cartilage, and suturing positions. A 0.01 N load was applied to a 1 cm2 area of the nasal tip to simulate nasal tip palpation and the maximum deformations of the different groups were compared, which were used to make stability judgments. Besides, 45 patients were enrolled and divided into three groups of 15 patients: the first group of patients underwent M-shaped auricular rhinoplasty (Figure 1(A)), the second group underwent auricular-septal rhinoplasty (Figure 1(B)), and the third group underwent classical auricular rhinoplasty (Figure 1(C)). All of these patients underwent comprehensive rhinoplasty and all of them had silicone or expanded polytetrafluoroethylene implants in the dorsum of their noses. Six months after surgery, their postoperative satisfaction was assessed by three classic scales: ROE Scale, FACE-Q Rhinoplasty Module, and NOSE Scale. Results: In the finite element analysis, the maximum deformation of the model was minimal when the M-shaped cartilage was sutured medially in the middle of the septal cartilage and laterally in the outer corner of the lateral cartilage. In the postoperative evaluation, the patient score improvements on the three scales (ROE/FACE-Q/NOSE Scale) were higher in the M-shaped auricular rhinoplasty population (group 1: 1.65/1.79/0.11) compared with classical auricular rhinoplasty (group 3: 1.4/1.51/0.05); and the patient score improvements in the auricular-septal rhinoplasty population (group 2: 2.04/1.98/0.28) were the highest (Figure 2). Conclusions: In order to achieve optimal surgical results, M-shaped cartilage should be sutured medially in the middle of the septal cartilage and laterally in the outer corner of the lateral cartilage. In the retrospective clinical study part, the clinical efficacy of M-shaped auricular cartilage tip rhinoplasty was demonstrated: compared with classical auricular cartilage rhinoplasty, the effect of M-shaped auricular rhinoplasty is better; however, when compared with auricular-septal rhinoplasty, its effect is slightly worse.

Goals/Purpose: The purpose of this study is to evaluate the safety of minimally invasive rib repositioning. Rib procedures in aesthetics have always been of interest to plastic surgeons to be able to truly shape the skeletal body of an individual. In the past the morbidity and technical challenges of rib removal have limited its use in most practices. Our series describes how to safely use the ultrasound and piezotome to reposition the ribs safely while improving the overall contour of an individual.

Methods/Techniques: Our innovative technique involves the use of an ultrasound and piezotome to safely and effectively create a greenstick fracture of the free floating ribs (11th and 12th). In certain circumstances the 10th rib was also treated using this technique. Two parallel lines are marked 7 cm on each side of the midline on the posterior torso. The ribs are then verified with the use of the ultrasound to make sure the incision placement is in the correct position. A 1 cm incision is made on each side between the 11th and 12 ribs. The periosteum is then lifted with a freer. Once the periosteum has been lifted the piezotome is used to cut a single cortex of the rib. The rib can then be manually moved into position. The patient is then placed in a corset to splint and shape the waist for six weeks.

Results/Complications: A retrospective study was completed of patients treated at our practice using the ultrasound guided minimal incisions for rib repositioning. Thirty-one consecutive patients were included in the study over a one year period. Patients had a follow-up that ranged from 7 days to 210 days and averaged 90 days. No complications were associated with the ultrasound guided rib repositioning procedure. In the study we had no revision and no pneumothorax from any of the patients. Typically the patients were treated in combination with other procedures.

Conclusions: Minimal incision ultrasound guided rib repositioning is an effective and safe method to modern body contouring. As many patients have transitioned their aesthetic goals to more of an athletic appearance and less of a focus on buttock volume this has been instrumental in our practice. It has been revolutionary that we can change the structural shape of an individual through a 1 cm incision and accomplish this safely. Patients that were too skinny for a Brazilian Butt Lift or still felt square after a body contouring procedure now have options. In future studies we will evaluate the amount of structural change that is possible with this method with pre and post-op measurements.

Background: Solitary facelift in wide face produce unsatisfied result. Solitary facial bone reduction usually resulted in sagging of the face even in young age. Congenital lateral downward prominent supraorbital bone, usually resulted in congenital lateral hooding. Mongolian fold also will has limitation in med. Forehead lift. Therefore facelift in those patients will have unideal cosmetic outcome. The surgery for facelift or facial bone reduction usually each has a long operative time, swelling and blood loss consideration. Therefore, these two procedures are often performed separately. In recent years, an increasing demand for simultaneous facial bone reduction and facelift has been observed, however few studies(1,2,3,4) have examined safe and effective of simultaneous facial bone reduction and facelift.

Objective: The aim of this study was to present a safe, easy and flexible method for combining facelift and facial bone reduction through single facelift incision with minimal blood loss.

Methods: From 2015 to 2022, the senior author performed facial bone reduction with facelift by using a subcutaneous approach through single facelift incision in patients with wide facial bone and an aging face. Operative time, intraoperative blood loss, postoperative course, and complications were recorded.

Results: In total, 132 patients met the inclusion criteria and were included in the study. The combined surgery was successfully performed in all cases, and no serious complications were reported. The follow-up period ranged from 6.5 to 60 months. The average operating time was 187 minutes, and the mean intraoperative blood loss was minimal (30 mL). All patients were satisfied with the outcome, different scores were assessed with Global Aesthetic Improvement Scale.

Conclusions: The demand and pressure coming from the patients, it forces our plastic surgeon to reconsider the necessity in the near future. Facelift and facial bone reduction using a subcutaneous approach through single facelift incision provides complete visualization of the facial bone , superior hemostasis control result in an easy and safe surgery that does not require additional intraoral incisions.

References: 1. Zhou J, Qi Z, Jin X. Simultaneous surgery for contouring the prominent facial bone and mandibular angles with facelift in middle-aged patients. J Craniofac Surg 2020;31(2):448-452. 2. Lee YJ, Lee IS, Yang HJ. Reduction malarplasty combined with facelift via the prezygomatic space. Arch Aesthet Plast Surg 2020;26(4):138-143. 3. Lee YJ, Lee CL, Lee IS, et al. Facial Contouring Surgery Using Facelift Approach. J Craniofac Surg 2021; 32(8): 2840–2844. 4. Zou C, Wang JQ, Liu JF, et al. Reduction malarplasty with face-lift for older Asians with prominent Zygoma. Ann Plast Surg 2016;77(2):141-144.