Scientific Abstract Presentations: Aesthetic Session 2 Friday, September 27 Fri, Sep 27 8:00-9:30 a.m. PDT

Purpose: Macromastia can negatively impact a patient's quality of life in several ways, and is associated with not only physical pain, but with emotional suffering as well (1). This study aims to quantify improvements in overall well-being following superior and superomedial Weiss pattern reduction mammaplasty.

Methods: Patients undergoing a reduction mammaplasty at a single institution were enrolled in this prospective study. Patients completed the BREAST-Q Reduction/Mastopexy Module, a standardized questionnaire used to evaluate patient-reported quality of life and satisfaction (2), at their preoperative clinic appointment and again at their postoperative clinic appointments. Paired t-tests were calculated to compare preoperative and postoperative scores.

Results: 10 BREAST-Q surveys were completed preoperatively and 10 were completed postoperatively following reduction mammaplasty, with a median follow-up time of 2.53 months (0.66-31.66 months). Average resected tissue was 714 grams per breast. Patients reported significant increases in physical well-being (p < 0.01) and with satisfaction with their breasts (p < 0.01). Psychosocial well-being and sexual well-being following reduction mammaplasty increased postoperatively but did not reach statistical significance (p > 0.05). Patients reported high satisfaction with nipples with a mean score of 16.1 out of 20 possible points, high satisfaction with outcome with a mean score of 22.3 out of 24 possible points, and high satisfaction with the information they received preoperatively with a mean score of 41 out of 48 possible points.

Conclusion: These results suggest that reduction mammaplasty is associated with increases in physical well-being, as well as high rates of overall satisfaction and satisfaction with postoperative appearance. Although objective data demonstrated decreased sensation of the NAC following reduction mammaplasty, this did not appear to impact the patients' sexual well-being. This data suggests that superior and superomedial Weiss pattern reduction mammaplasty are associated with greater benefits in the physical aspects of a patient's life, including physical pain and physical appearance, than in the emotional aspects of a patient's life, including psychosocial and sexual well-being, although these areas still demonstrated positive trends.

References: 1. Brown DM, Young VL. Reduction mammoplasty for macromastia. Aesthetic Plast Surg. 1993;17(3):211-223. doi:10.1007/BF00636264 2. Admqportfolio. Breast-Q: Breast cancer - Q-portfolio measuring what matters to patients. QPortfolio. May 10, 2017. Accessed February 27, 2024. https://qportfolio.org/breast-q/breast-cancer/#:~:text=The%20BREAST%2DQ%20conceptual%20framework,of%20multiple%20independently%20functioning%20scales.

Background: Microneedling has seen a rise in popularity as a non-surgical alternative for facial rejuvenation. Consequently, the aim of this systematic review was to evaluate the patient-reported outcomes (PROs) and safety profiles associated with this technique.

Methods: A systematic review was conducted adhering to PRISMA guidelines to investigate PROs of microneedling. Descriptive statistics and a proportion meta-analysis was utilized for patient satisfaction using Stata statistical software.

Results: A total of 21 papers encompassing 723 patients undergoing micro-needling procedures were included in the meta-analysis. Of the included patient cohort, 71% were female, 6% were male, and 23% were unknown. The average age of patients was 48.4 years. Pooled meta-analysis found that 83% of patients reported satisfaction with their treatment (95% CI [0.76; 0.88]). In 85% of cases, facial anesthetic was applied pre-intervention, with a median of 4 treatments (IQR 3-5) per patient. Furthermore, the most common reported adverse effects were transient erythema (6.77%), followed by scaling (1.65%), burning sensation (1.5%), and pruritus (0.41%).

Conclusion: The meta-analysis revealed that microneedling is associated with high patient satisfaction. Adverse effects were minimal and primarily encompassed transient erythema, scaling, burning sensation, and pruritus. The prevalence of high satisfaction alongside a low incidence of minor adverse effects underscores microneedling as a viable non-surgical alternative for facial rejuvenation. These findings can serve as a valuable reference for clinicians in informing patients and guiding practice, reinforcing the potential of microneedling in the spectrum of facial aesthetic procedures.

Aesthetic surgeons must often adapt to rapidly-changing consumer trends, which shape the services they offer. However, several external factors can influence the frequency by which patients undergo aesthetic procedures, including seasonal changes, as well as trends in national consumer spending. In our study, we refer to Google Trend values (GTVs), which define search queries of a specific topic as a proportion of all search queries, and consumer spending to trend historic demands in aesthetic surgery.

Data from the American Society of Plastic Surgeons (ASPS) revealed frequencies of the five most commonly-performed aesthetic surgical procedures in 2005-2020, which included breast augmentation, liposuction, rhinoplasty, rhytidectomy, and blepharoplasty. Data on total annual consumer spending was collected from the Bureau of Economic Analysis (BEA) for this time period. Consumer interest was determined by querying each of the five procedures on Google Trends, which were then evaluated based on seasonal popularity. Pearson correlation coefficient and one-way ANOVA were used to analyze relationships across consumer spending, procedure frequency, seasonal patterns, and GTVs.

From 2005-2020, a total of 4.69 million breast augmentations, 3.83 million liposuction procedures, 4.19 million rhinoplasties, 2.06 million rhytidectomy procedures (excluding 2005), and 3.67 million blepharoplasties were performed by ASPS plastic surgeons. With regard to Google Trend search queries, breast augmentation and liposuction were most popular in the spring (GTV = 54.43, p = 0.0008; GTV = 58.93, p < 0.0001, respectively) and least popular in the fall (GTV = 44.77, p = 0.0008; GTV = 46.09, p < 0.0001, respectively). Rhinoplasty queries peaked in the summer (GTV = 37.25, p = 0.024) and rhytidectomy queries in the winter (GTV = 18.36, p = 0.0014). The frequency of rhytidectomy surgeries was found to have a significant positive correlation to consumer spending trends (r = 0.71; p = 0.003), while the frequency of breast augmentation surgery showed a significantly negative correlation to consumer spending trends (r = -0.49; p = 0.05). There was a positive correlation found between the frequency of blepharoplasties (r = 0.65; p=0.007), rhytidectomies (r = 0.63; p = 0.01), and breast augmentations (r = 0.54; p = 0.03) and their corresponding GTVs.

The frequency of aesthetic surgeries and the volume of their online queries are significantly correlated to changes in consumer spending and seasonal patterns. Evaluating trends in aesthetic surgery can afford surgeons a greater familiarity with the ever-changing demands of a dynamic patient population. Understanding the conditions that elicit a higher demand of certain procedures can prompt surgeons to tailor their marketing and business practices and improve healthcare resource utilization. Future studies should further investigate similar trends by variation in geographical regions and may analyze the impact of sociocultural factors on the frequency of aesthetic procedures.

Background: Outpatient plastic surgery offers cost-effective solutions and enhanced privacy but demands careful patient assessment for suitability and vigilant anticipation of adverse events. This study provides recommendations to maximize patients' safety in the outpatient setting considering both patient- and procedure-specific factors, by analyzing over 40,000 consecutive cases spanning across three decades of clinical experience.

Methods: We retrospectively reviewed all consecutive cases completed by board-certified plastic surgeons at an accredited outpatient surgical center between 1995-2023. Patient demographics, operative details, and postoperative complications were recorded to determine both patient- and procedure-specific risk factors for complications and inpatient admissions. Operative details included total operative-time, lipoaspirate amount, and whether the procedure was a combined case. Complications included hematoma, seroma, wound-dehiscence, infection, and venous thromboembolic events (VTE). Additionally, we collected complications that required return to the operating room (ROR) and admission to an inpatient facility. 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. A subgroup-analysis for procedures of the face, breast and body was also performed.

Results: 42,720 consecutive cases were performed with an overall complication rate of 0.74 percent (n = 318). Compared with the control population, patients who experienced a VTE or an inpatient transfer, had a higher BMI (p < 0.001; p < 0.0001, respectively), longer operative duration (p = 0.0024; p = 0.0012, respectively) and were more likely to have undergone combined procedures (p < 0.001; p = 0.0001, respectively). Undergoing a combined procedure was the strongest predictive factor for VTE and inpatient admissions (OR = 12.65, p = 0.0009; OR = 3.73, p = 0.0002, respectively), followed by longer operative time (OR = 1.45, p = 0.006; OR = 1.32, p = 0.003, respectively).

Conclusion: To our knowledge, this is the largest long-term private practice plastic surgery study in accredited outpatient settings spanning almost 30 years, further confirming that outpatient plastic surgery can be done in a consistent and safe manner with proper preoperative evaluation and patient optimization. Postoperative monitoring should be considered for high-risk patients, particularly those with a BMI exceeding 26 kg/m², operative times surpassing 3 hours, lipoaspirate volumes greater than 3 liters, and patients undergoing combined procedures - particularly in cases involving abdominoplasty.

Introduction: Capsular contracture remains the most common and insidious complication in modern cosmetic breast augmentation. With incidence rates varying from 2-15% following primary breast augmentation, it is one of the leading indications for revisional augmentation procedures in the U.S. Capsulectomy, pocket revision and implant exchange is commonly considered the gold standard of surgical management for capsular contracture. However, clinical evidence to support this as a reproducible therapy is insufficient. Most recently, the use of pocket revision with acellular dermal matrices (ADM) has been widely adopted as effective treatment for recurrent capsular contracture. To date there has been no study documenting the efficacy of ovine-based or hybrid biologic/synthetic meshes in treatment of capsular contracture. In addition, this type of mesh has never been evaluated in comparison to standard porcine matrices that are commonly utilized for treatment of capsular contracture. In this study, we present a consecutive clinical comparison of the use of Ovitex™ PRS (a 2 ply reinforced absorbable matrix) to porcine mesh (i.e. Strattice™) in treatment of capsular contracture.

Methods: A retrospective analysis was conducted at two participating private practice centers from May 2016 to Nov 2023 on Patients undergoing revision breast augmentation for Baker grade III or IV capsular contracture utilizing Strattice™ (LifeCell Corporation, Branchburg, NJ) or Ovitex™PRS Resorbable (TELA Bio, Malvern, PA) Mesh. Patient charts were reviewed for patient outcomes and post-operative recurrence of capsular contracture. Cost of each type of mesh was determined and compared per square cm based on standard pricing from each vendor. Statistics were performed utilizing IBM SPSS v28.0 (Armonk, NY). Statistical Methods employed include descriptive statistics, Wilcoxon signed rank sum test was used to compare the primary outcome measure between both groups. In addition, multivariate regression analysis was conducted to control for confounding variables between both groups.

Results: Mean patient age was 55.9 ± 11.9years. A total of 89 breasts were included in the analysis with a mean follow up of 357 ± 206 days after surgery. 59(66.3%) breasts were treated with Ovitex™ and 30(33.7%) were treated with Strattice™. All patients experienced a reduction in Baker grades. Patients treated with Ovitex™ had a statistically significant decrease in grade change post-operatively when compared with the Strattice™ group (p < 0.05). Of note, 4 cases presented with recurrent contracture following previous placement of Strattice™ and were salvaged with Ovitex™, they all returned to Baker Grade 1. In the Ovitex™ group, 57 (96.6%) breasts exhibited a postoperative contracture grade of 1, while only 2(3.4%) experienced a grade 2 capsular contracture compared to 22(73.3%) and 7(23.3%)in the Strattice™ group, respectively. There was one recurrence of grade 3 capsular contracture in the Strattice™ cohort. Average cost was $27.37/cm2 for Strattice™ compared to $22.28/cm2 for Ovitex™.

Conclusion: Ovitex™ PRS Resorbable may be successfully utilized to treat capsular contracture. Patient outcomes are similar and may be superior to Strattice™ in recurrent capsular contracture, particularly when a previous acellular matrix had been utilized. Cost data shows significant cost savings with the use of Ovitex™ compared to Strattice™.

Background: Suction-assisted lipectomy, also known as liposuction, has proven effective in alleviating the symptoms experienced by patients with lipedema. However, its impact on lymphatic function remains largely unknown. This systematic review was designed to look for the literature evidence of liposuction-induced lymphedema for patients with lipedema. Methods: We aimed to review the literature for articles investigating the lymphatic function in liposuction patients using a specific search algorithm on these databases; Cleveland Clinic's Journals, Books@Ovid, MEDLINE, AGRICOLA, APA PsycInfo, and Embase. The techniques were classified, outcomes and complications analyzed, papers not mentioning lymphedema as an outcome were excluded. Results: Studies were identified and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Multiple languages were included. Case studies with less than 3 patients, commentary, expert opinion, editor's letter, and duplicate studies were excluded. 146 papers underwent abstract screening, 31 underwent full text screening yielding the final 5 papers included in our review. A total number of 255 patients included in this review from our final 5 papers. Only 13 patients developed lymphedema after liposuction. Of the identified cases, 5 of them had stage 2 lipedema, 5 had stage 3 lipedema, and none had stage 1 lipedema. All but one patient had tumescent lymph-sparing liposuction. The patients' ages ranged from 22 to 77 years old. Patients developed lymphedema after different liposuction sessions. This ranged from 1 to 3 sessions; however, this was underreported in the studies. The diagnosing method of lymphedema is underreported as well. Only mentioned in two patients were diagnosed using lymphoscintigraphy. Conclusions: Although there is significant body of evidence that liposuction improves lipedema, there may be a risk associated with impairing lymphatic function although the risk seems low. The findings of this review were not conclusive due to the low incidence of liposuction-induced lymphedema and may be due to underreporting. Therefore, there is a need for more endeavors to undertake retrospective cohort, case control and case series studies aimed at exploring the development of lymphedema after liposuction within different hospitals databases to help patients be fully informed about the procedure.

Purpose: Abdominoplasty is responsible for the majority of venous thromboembolic events (VTE) that occur in aesthetic surgery cases. The Caprini Risk Assessment Model is a validated tool developed to assess VTE risk and guide postoperative anticoagulation, often with a low molecular weight heparin like enoxaparin. However, many surgeons are hesitant to administer it following abdominoplasty due to concerns of postoperative hematoma. Apixaban, a newer oral anticoagulant, is emerging as a potential alternative to enoxaparin, but more research is needed to assess its association with hematoma development. Therefore, the goal of this study is to assess the safety and efficacy of apixaban as a method of anticoagulation for abdominoplasty patients.

Methods: A retrospective chart review was conducted on 282 consecutive abdominoplasty cases performed by the senior author between 2018 and 2023. Patient demographic information and surgical details were obtained from the chart, including concurrent procedures, length of time in the operating room, and any use of postoperative anticoagulation. The primary outcome variables, venous thromboembolism and hematoma, were recorded. Data was analyzed using IBM's SPSS Software (Armonk, NY) and statistical significance was set to p < 0.05.

Results/Complications: 282 patients were identified, 275 female (97.5%) and 7 male (2.5%), with an average age of 42.5 years (range 25 – 77). Average preoperative weight and BMI were 75.2 kg (44.2 – 128.2) and 27.5 (17.5 – 44.1), respectively. Average surgical duration was 227 minutes (104 - 426). Two-hundred sixty-one (92.6%) patients had concurrent direct lipectomy and liposuction, 266 (94.3%) rectus muscle plication, and 78 (27.7%) a concurrent breast procedure. Average follow up time was 6 months (0 – 37).

One-hundred eleven (39.4%) patients received postoperative anticoagulation. Eighty-seven (30.9%) were prescribed prophylactic apixaban. Twenty-four patients (8.5%) were prescribed an alternative blood thinner (enoxaparin or rivaroxaban). Patients who were prescribed apixaban had greater mean age (43.9 vs 41.7, p = 0.019), surgical duration (245.1 min. vs 216.4, p < 0.001), preoperative BMI (30.4 vs 25.7, p < 0.001), and weight (82.9 kg vs 70.2, p < 0.001) compared to those who were not.

Three patients (1.1%) developed VTE postoperatively. Of these, one was prescribed two weeks of postoperative enoxaparin and developed a PE one month from surgery. The second developed a PE within 24 hours of surgery on no postoperative anticoagulation. The third patient completed two weeks of apixaban after undergoing abdominoplasty with liposuction, direct lipectomy, rectus plication and mastopexy. She returned a month later for minor debridement surgery. Given the short duration of the surgery, she was not prescribed additional postoperative anticoagulation. One week later, she was hospitalized for a saddle PE and left popliteal DVT.

Four patients (1.4%) developed a postoperative hematoma requiring drainage in the operating room. None (0%) of these patients were on prophylactic anticoagulation when they developed the hematoma.

Conclusion: Apixaban is a safe and effective alternative to enoxaparin for VTE prophylaxis after abdominoplasty. Further studies with larger sample sizes and direct comparisons of various anticoagulants are needed to delineate the comparative safety and efficacy profiles.

Introduction: Lipedema, a chronic loose connective tissue disease (LCT) primarily affecting women, poses significant challenges in both diagnosis and treatment. Characterized by disproportionate lipedema tissue distribution in the extremities, buttocks, and lower abdominal wall, it is resistant to diet, exercise, and weight loss1-2. Lipedema, associated with comorbidities including lymphedema, venous disease, and joint disease, can lead to pain, mobility issues, edema, inflammation, poor quality of life, and psychological distress1. Although non-surgical options, including medical treatment, comprehensive decongestive therapy, exercise, and diet, can improve symptoms, liposuction is currently the only proven therapeutic treatment for lipedema3, 4. This systematic review and meta-analysis article aims to provide a comprehensive overview of liposuction as a treatment modality for lipedema, exploring its efficacy, safety, and long-term outcomes. Methods A literature search of PubMed (MEDLINE), Cochrane CENTRAL, and Google Scholar was conducted for relevant studies till 31st January 2024. Only studies reporting on patients undergoing liposuction for lipedema procedures were included. Results Nine studies reported that 668 patients underwent lipedema treatment, while the total procedures in each study ranged from 40 to 519. The mean time per procedure was 118 minutes. The Mean Total Lipoaspirate volume per liposuction ranged from 2482 mL to 6355 mL, while the Mean Volume of Removed Fat per Liposuction ranged from 1909 mL to 3831 mL. The infection rate varied from 0.34% to 1.4% between the two reported studies. Spontaneous pain as Visual Analogue Scores (VAS) was found to have decreased by standard mean difference (SMD) of 4.27 (95% CI [2.70, 5.83]; p<0.001). Quality of Life (QOL) was increased after liposuction in all studies by SMD 2.41(95% CI [1.71, 3.11]; p<0.00001). Sensitivity to pressure was also found to be decreased post-operatively after liposuction by SMD 1.41 (95% CI [0.52, 2.30]; p=0.002). Conclusion: In conclusion, our systematic review and meta-analysis support the efficacy of liposuction as an effective and safe treatment modality for lipedema, offering significant reductions in pain and sensitivity to pressure. Patients reported quality of life (QOL) increased post-operatively after liposuction. The infection rate was minimal, and a majority of complications were minor in severity. References:

1. 1. Fife CE, Maus EA, Carter MJ. Lipedema: a frequently misdiagnosed and misunderstood fatty deposition syndrome. Advances in Skin & Wound Care. 2010;23(2):81. doi:10.1097/01.ASW.0000363503.92360.91
2. Herbst KL, Kahn LA, Iker E, et al. Standard of care for lipedema in the United States. Phlebology. 2021;36(10):779-796. doi:10.1177/02683555211015887
3. Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results: Tumescent liposuction in lipoedema. British Journal of Dermatology. 2012;166(1):161-168. doi:10.1111/j.1365-2133.2011.10566.x
4. Warren Peled A, Kappos EA. Lipedema: diagnostic and management challenges. Int J Womens Health. 2016;8:389-395. doi:10.2147/IJWH.S106227

Purpose: Soft-tissue augmentation (STA) is a frequently performed procedure for both reconstructive and aesthetic purposes. Autologous fat and hyaluronic acid are the most used materials for STA, but the former is beset by inconsistent graft take and the need for a surgical procedure, whereas the latter, although available off the shelf, requires reapplication every 1-2 years as it induces little to no new tissue deposition. A previous study of microsphere dermal templates (MDT), novel collagen hydrogel scaffolds containing high-density collagen microspheres embedded in low-density collagen bulk, demonstrated significantly more rapid and robust vascularization compared to the commonly used commercial wound matrix Integra™. Herein we tested a flowable form of the MDT to see if it would similarly support local tissue ingrowth and induce the deposition of new and permanent tissue resulting in long lasting augmentation. Methods: Sterile 1% atelocollagen microspheres (80-300um in diameter) were mixed with 0.3% telocollagen bulk at different microsphere-to-bulk ratios, including 70:30, 50:50, 30:70, to fabricate a homogeneous viscous solution for injection. The mixed collagen suspension was then injected in a subcutaneous immunocompetent mouse model with 500ul placed bilaterally on the dorsa. The mixed collagen suspension was cured into hydrogel in situ after injection. Quantification of volume retention and histologic analysis of the injected substrates were performed. Results: All the collagen suspension groups were gel-like substances after mixture and were easily injected via an 18G needle subcutaneously with no leakage. The groups with higher collagen microsphere ratios showed greater volume retention after both 30 days (70:30: 112.4%, 50:50: 84.2%, 30:70: 53.6% of T0 volume) and 90 days (70:30: 121.9%, 50:50: 84.0%, 30:70: 63.9% of T0 volume). Maintenance of projection and shape of the injected hydrogel was correlated with higher collagen microsphere-to-bulk ratios. Robust neovessel formation was noticed grossly on the surface of the explants as early as 30 days (seen in Figure). Histologic analysis demonstrated an even distribution of collagen microspheres throughout the entirety of the injected hydrogel with appreciable cell infiltration and vascularization within the bulk collagen. The amount of M1 and M2 macrophages significantly decreased overtime, demonstrating minimal inflammation and there was no evidence of an adverse foreign body reaction. In addition, increased host collagen deposition and collagen maturation was noted over time in all groups, with the 70:30 groups showing the most robust tissue regeneration. Conclusions: In contrast to the rapid degradation seen with monophase collagen solutions that were initially used to provide soft tissue fill, this simple but unique composite collagen hydrogel promotes neovascularization and tissue regeneration resulting in complete maintenance of the volume and projection of the injected material. Longer term studies are ongoing to verify the longevity of the new tissue formed.

BACKGROUND: The test re-test (TRT) reliability of FACE-Q Aesthetic scales has yet to be assessed. The aim of this study was to establish the TRT reliability of 17 FACE-Q Aesthetic scales, as well as to determine the smallest detectable change (SDC) that can be identified by these scales. METHODS: Data were collected from an online international sample (i.e., Prolific). Participants ≥20 years old, who had been to a dermatologist or plastic surgeon for a facial aesthetic treatment within the past 12 months were asked to provide demographic and clinical information and complete an online REDcap survey consisting of 17 FACE-Q Aesthetic scales. Participants were asked if they would be willing to complete the survey again in 7 days. Only participants who reported no important change in the scale construct and completed the re-test within 14 days were included. RESULTS: A total of n=472 participants were invited to complete the TRT survey. The mean age of the sample was 36.6 (±11.5) years and 82.4% were female. With outlier data removed, all FACE-Q scales demonstrated an ICC>0.70 indicating 'good' TRT reliability. The standard error of measurement for included scales ranged from 3.37 – 11.87, corresponding to a range of SDC(group) from 0.95 to 3.23 and SDC(ind) from 9.34 to 32.91. CONCLUSION: All included FACE-Q scales demonstrated sufficient TRT reliability and stability overall after outlier data were removed.

Purpose: Abdominoplasty may be considered a procedure performed after a patient has already lost weight, but many surgeons have clinically observed that patients continue to lose weight in the postoperative period. This study sought to quantify continued weight loss following abdominoplasty.  

Methods: A retrospective chart review was conducted on all abdominoplasty cases performed by the senior author between 2018 and 2022. Patients were excluded from analysis if they did not have at least one postoperative weight recorded. Patient demographics were obtained, including preoperative weight and BMI. Subsequent weights were recorded at 3, 6, 12, 24, 36, and 60 months. One weight was documented 6-12 months prior to surgery to calculate preoperative weight loss. Independent samples t-tests and chi-square tests were used for comparisons of continuous and categorical variables, respectively. Data was analyzed using IBM's SPSS Software and significance was set to p < 0.05.

Results: 186 patients met inclusion criteria, 180 female (96.8%), 6 male (3.2%), with average age of 42.6 years (range 25 – 66). Average surgical duration was 226 minutes (104 - 426). 168 (90.3%) patients had direct lipectomy/liposuction performed at the time of abdominoplasty, and 173 (93%) had rectus muscle plication. 18 (9.7%) patients had prior bariatric surgery. Average follow up time was 7 months (0.23 – 37).

Average preoperative weight and BMI were 167.4 lbs (97.4 - 282.6) and 27.8 (17.5 - 41.8), respectively. The average weight and percentage of body weight change at last recorded follow up was –4.3 lbs (–64 to +29.8 lbs) and –2.2% (-40 to +17%). At the recorded intervals these changes were –5.7 lbs (-3.1%) at 3 months, -5.2 lbs (-2.7%) at 6 months, -4.5 lbs (-2.5%) at 12 months, -4.9 lbs (-2.6%) at 2 years, -6.0 lbs (-3.1%) at 3 years, and –9.8 lbs (-5.3%) at 5 years. 

Overall, 60.8% of patients lost weight postoperatively, compared to 39.2% who stayed the same or gained weight. Those who lost weight had a significantly greater preoperative weight (173.5 vs 157.7 lbs, p = 0.003) and BMI (29 vs 25.9, p < 0.001) compared to those who stayed the same or gained weight. No significant differences were noted in rates of prior bariatric surgery, pregnancy, hypertension, diabetes and former smoking status between these groups. A higher percentage of patients who underwent direct lipectomy and liposuction lost weight after surgery compared to those who didn't (64.3% vs 27.8%, p = 0.003).

Average weight change in the 12 months prior to surgery was –1.0 lbs (range –53 to +30.9 lbs). There was a small negative correlation detected between percentage of body weight lost prior to surgery and after (r = -0.26, p = 0.002).

Conclusion Most patients undergoing abdominoplasty experienced continued weight loss up to 5 years postoperatively. Those who continued to lose weight had higher preoperative weights/BMIs and were less likely to have significant weight reduction prior to surgery. Further studies are needed to assess changes in aesthetics and body contour with continued weight reduction and correlate results to patient satisfaction.

Purpose

Surgical elevation of the brow can affect the appearance of the facial upper third, midface, and nose. In particular, raising the brow can generate the appearance of a more rotated nasal tip. However, there is no quantitative data examining how browlift affects nasal aesthetics. The purpose of this study was to quantify the impact of open browlift on nasal morphometrics.

Methods

A retrospective study of adult patients undergoing open browlift was conducted. Three-dimensional photogrammetric evaluation of the facial upper third and nose was performed pre- and post-operatively (Vectra; Canfield Scientific, Parsippany, N.J.). Standard anthropometric points were placed and measured. Outcome variables were nasofrontal angle, tip projection, tip rotation (as a function of nasolabial angle), supratip break angle, nasal length, and the Goode ratio (defined as the ratio of nasal projection to nasal length). Data analyzed over time included preoperatively, at immediate (1-2 weeks) follow up, and at intermediate (>6 months) follow up. Statistical analysis was performed using dependent t-test to compare between time points, with values of p < 0.05 considered statistically significant.

Surgical maneuvers and approach were the same for all patients. An open browlift approach was undertaken, starting with a trichophytic incision in the anterior hairline and dissection carried down in the subperiosteal plane. The temporal fusion line was undermined to continue the dissection laterally, immediately superficial to the deep temporal fascia, and then down into the midface. The deep surface of the frontalis was radially scored with electrocautery to reduce muscle activity. Permanent sutures were placed in the periosteum deep to the peak of each eyebrow, then suspended on monocortical bone screws placed superiorly in the frontal bone. The trichophytic incision was closed with permanent suture.

Results

Total ten patients were included. The mean decrease in nasofrontal angle pre- and post-operatively was -2.98 degrees (p <0.01). The mean increase in nasal tip rotation was 3.09 degrees (p < 0.01). The mean increase in supratip break was 2.86 degrees (p < 0.01). These changes were maintained at intermediate follow up. Changes in tip projection, nasal length, and the Goode ratio were not statistically significant.

Conclusions

Open browlift appears to directly affect nasal aesthetics. In this study, patients undergoing open browlift experienced decreases in nasofrontal angle and increases in nasal tip rotation and supratip break. This study provides evidence that open browlift predictably affects nasal morphometrics, which may assist surgeons with preoperative counseling and intraoperative decision making.

Background: The facial skeleton undergoes dynamic resorption and remodeling with aging which impacts facial shape. Despite the recognition of these skeletal alterations, sparse research has been conducted to explore facial skeletal aging in-depth. This study aims to assess the aging pattern of the mandible, which forms the lower third of the face and the transition point to the neck, and comprehensively analyze normal population across different genders and age groups.

Methods: A retrospective study was approved by our institutional review board, where head and neck Computed Tomography (CT) scans and demographic data of white ethnicity were imported and analyzed. We divided our cohort into three age groups (20:39, 40:59, and 60:79 years old) and further stratified them by gender. We excluded trauma scans and edentulous individuals or any suspicion of deformities and orthodontics interventions. 3D CT scans were reconstructed by Machine-Learning (ML)-assisted scripts in Mimics software v.25 for each subject. Statistical shape modeling (SSM) was used to create an average 3D mandible for each age group. Of a total of 280 mandibles, we conducted pair-wise analysis where 20:39 SSM was compared to 40:59 and 60:79, and 40:59 was compared to 60:79 for each gender. Contour variation was analyzed using 3D overlays and heatmaps analysis. Furthermore, semi-automated anthropometric landmarks were identified, and linear and angular measurements were calculated.

Results: The most pronounced bone resorption was observed across the midline and the inferior border of the mandible. The ramus height showed marked decrease with aging in both genders, aligning with the linear measurements. This resorption is more extensive in females with 3 (± 5.23) mm reduction (p < 0.001) among the 60:79 age group. In contrast, Inter-rami and inter-condylar widths increased with age with a mean 4.42 mm widening, which shows rami divergence with aging (p < 0.01). The widening was more posterior towards the condyles for females and more anterior towards the coronoid process in males. Bigonial width did not show significant changes (p = 0.54). The gonial angle increased with aging in females from 119.3 to 123.2 degrees (p < 0.01). However, the gonial angle for males does not follow a clear pattern, except for the extra bone resorption in the characteristic gonion projection (> 3 mm), giving a smoother transition to the rami with aging. Anteriorly, even with retained anterior teeth, there is a subtle inward collapse of the middle height of the mandibular body, demonstrating high-level resorption across the alveolar side. This finding was particularly notable in females, where it leads to chin protrusion; with an increase of up to 11.1 degrees (p < 0.01) in the alveolar angle.

Conclusions: By leveraging AI-assisted shape analysis, we bridge the gap in aging research between historical knowledge and advanced technology. The mandibular bone resorption intensifies during the 5th and 6th decades, leading to structural changes such as rami divergence, slight alveolar inversion, and chin protrusion, particularly in females. These findings underscore the need for personalized aesthetic interventions as part of facial rejuvenation and reconstruction management based on age and gender.

Background: Various graft materials, including septal, auricular, and costal cartilage, as well as alloplastic implants, have been utilized for dorsal augmentation rhinoplasty. Autologous costal cartilage (ACC) is frequently used due to its availability and strength, despite potential complications such as hypertrophic chest scars and pneumothorax. Irradiated homologous costal cartilage (IHCC) has emerged as an alternative to mitigate these risks. Prior systematic reviews evaluating autologous and/or irradiated homologous grafts have been of low methodological quality. We conducted a high-quality systematic review to evaluate outcomes for ACC versus IHCC for dorsal augmentation. 

Methods: The study was registered a priori on PROSPERO (CRD42023445786). MEDLINE, EMBASE, Google Scholar, and the Cochrane Central Register of Controlled Trials databases were searched up to October 2023. Data extraction and quality assessment were performed by two independent authors. The main outcomes of interest were warping, resorption, revision rates, infection rates, and displacement. GRADE and Cochrane's ROBINS-I were used to assess the methodological quality and risk of bias respectively.  MEDLINEs:

Results Out of 1527 articles identified, 43 studies with 2774 participants were included in the overall analysis (29 retrospective, 14 prospective). IHCC grafting occurred in 1353 patients while ACC grafting occurred in 1913 patients. For both ACC and IHCC, warping was seen in 101/921 (11%) patients and 25/1252 (2%) patients respectively. 2% (16/760) patients in the ACC groups experienced resorption of graft compared to 6% (977/1235) in the IHCC group. 107/1492 (7%) patients had to undergo a revision surgery for various reasons in the ACC group compared to 49/1233 (4%) patients in the IHCC group. 3% (35/1325) patients had infection in the ACC group vs 2% (17/1135) in the HCC group. Displacement was observed in 28/1098 (3%) patients with ACC and 8/1042 (1%) patients with IHCC. 94% of patients reported very satisfactory or satisfactory results in both groups. Upon completing the risk of bias assessment, the majority of the papers showed a serious risk of bias.

Conclusion: Robust evidence for superiority of one graft type over the other for dorsal augmentation rhinoplasty is lacking. Prospective, level I data, incorporating standardized clinical and patient-reported outcomes is urgently needed, to optimize informed consent.