American Society of Plastic Surgeons

Energy-based devices are widely used for facial rejuvenation; as a result, an increasing proportion of patients presenting for facelift or necklift surgery have a history of prior treatment with ultrasound- or radiofrequency-based technologies. While the efficacy and safety of these devices are well-established, their cumulative effects on facial soft tissues critical to deep-layer facelift surgery remain under-recognized. This article examines three commonly used energy-based facial tightening modalities - microfocused ultrasound, high-frequency parallel beam ultrasound, and fractional radiofrequency microneedling - from the perspective of the facelift surgeon. Device-specific mechanisms of action and tissue-level effects are reviewed, followed by discussion of their potential operative implications and the senior author's experience-informed strategies for managing these patients. Recognition of these effects is essential for patient counseling, operative planning, and preservation of long-lasting surgical outcomes.

Regenerative peptides are gaining attention in regenerative medicine and plastic surgery for their potential to enhance surgical recovery and tissue regeneration. This review synthesizes evidence on four key peptides-focusing on their potential applications in wound healing, scar optimization, and aesthetic plastic surgery. Preclinical studies show promise, safety profiles appear favorable, but rigorous clinical trials are lacking. The paucity of human studies highlights an urgent need for high-quality research. Plastic surgeons are well-positioned to lead investigations, integrating regenerative peptides into perioperative care and evaluating their ability to optimize outcomes in aesthetic procedures.

Lipoabdominoplasty has soared in popularity. Advancements in the procedure have led to improved abdominal contours. Despite improvements in surgical techniques, postoperative complications persist, especially seroma formation. Drains are commonly used to reduce the risk of seroma formation; however, drains are a nuisance for patients and may contribute to long-term complications. Many surgical strategies have been proposed to reduce seroma formation in lipoabdominoplasty, including progressive tension sutures (PTS), minimal cautery, and preservation of Scarpa's fascia; however, these strategies in combination remain underexplored. The objective of this study was to determine the postoperative seroma rate of lipoabdominoplasty with combined PTS, minimal cautery, and Scarpa's fascia preservation without postoperative drains. This is a review of 350 patients who underwent drainless lipoabdominoplasty performed by a single surgeon from January 2017 to December 2024 at a single surgery center. Patient demographics, operative characteristics, and postoperative outcomes were collected. Descriptive analysis was performed. Pearson's χ2 and Mann-Whitney U tests were used to compare groups. Multiple logistic regression analysis was performed. Statistical significance was set at P < .05. Among 350 cases, a total of 286 full abdominoplasties, 50 belt lipectomies, and 14 modified float abdominoplasties were performed. There was a total of 32 (9.1%) complications, with a 2% seroma rate. There were no mortalities. All patients who developed complications recovered without sequelae. The drainless lipoabdominoplasty can be performed safely with a low seroma rate using a multimodality approach that includes progressive tension sutures, minimal cautery, and preservation of Scarpa's fascia.

Facial aging is characterized by soft tissue atrophy, subcutaneous fat redistribution, and dermal laxity, most pronounced in the lower face and submental region. High-intensity focused ultrasound (HIFU) is the benchmark noninvasive lifting modality, whereas microwave energy-based devices (MEBDs) have recently emerged, targeting adipose tissue and dermis. Although MEBD has been validated in body contouring, evidence for facial efficacy and safety remains limited. This study aimed to compare the efficacy and safety of MEBD and HIFU for facial rejuvenation in an East Asian population, emphasizing temporal improvement patterns, tolerability, and adverse events. The authors retrospectively analyzed 171 patients (MEBD: n = 89; HIFU: n = 82) treated at a single institution. MEBD used 7 and 3 mm handpieces for subcutaneous lipolysis and dermal tightening, guided by fat-compartment mapping. HIFU applied 600 shots at 3.0 and 4.5 mm depths targeting the dermis and superficial musculoaponeurotic system. Outcomes included blinded evaluator Global Aesthetic Improvement Scale (GAIS), Cutometer elasticity, Facial Aesthetic Surgery Outcome Questionnaire (FACE-Q) satisfaction, pain, and adverse events, assessed at baseline, 1 month, and 3 months. MEBD showed greater early improvements in GAIS, Cutometer parameters (R2, R5), and FACE-Q scores at 1 month, with lower pain (2.3 vs 4.7, P < .001) and fewer adverse events. By 3 months, HIFU surpassed MEBD in sustained GAIS, FACE-Q, and elasticity gains. Both modalities were safe, with only mild, transient effects. MEBD demonstrated rapid onset, superior tolerability, and lower complication rates, whereas HIFU provided stronger long-term lifting and elasticity improvements. These findings support complementary clinical roles and a compartment-based rationale for facial MEBD.

Conventional liposuction techniques involve visible incisions and scars. Newer methods offer less invasive options with improved patient satisfaction and fewer complications. Use of tranexamic acid (TXA) in tumescent solution has shown promise in reducing bleeding and bruising, enhancing postoperative outcomes. The purpose of this study was to describe TXA's effects in edema, ecchymosis, and pain in patients undergoing arm liposuction. A comparative contralateral randomized clinical trial was conducted at a single specialized plastic surgery institution in Bogotá, Colombia, from May of 2022 to February of 2024. The study involved adult patients aged 18 to 60 years undergoing arm liposuction, either alone or in combination with other procedures. Patients received TXA in 1 arm, and placebo in the contralateral arm, with random assignment and blinding for both patients and surgeons. The authors' study included 78 patients, resulting in 156 arms undergoing arm liposuction with either TXA or placebo. Most patients were female (78.2%), with a mean age of 37.6 years and a mean body mass index of 24.7 kg/m². Pain scores and ecchymosis were significantly lower in the TXA arm compared with the placebo arm on the first day after the procedure. No differences in arm circumference measurements were found between groups along the different time points. The overall complication rate was 8.97%. Adding TXA to tumescent solution for arm liposuction significantly reduces pain and bruising, improving patient recovery. Our randomized trial confirms TXA's safety and effectiveness, highlighting its potential as a valuable tool in body contouring procedures and postoperative care.

BackgroundBreast implantation induces fibrous capsule formation as a natural foreign body response. Although capsule-related complications often require capsulectomy, the need for capsulectomy during implant removal in patients with asymptomatic capsules remains unclear.ObjectivesIn this study, the authors aim to examine the capsule's degradation process over time and identify key cytokines involved in its remodeling.MethodsNine 7-week-old Sprague–Dawley rats received custom 2.25 cm silicone cohesive gel implants subcutaneously on both dorsal sides. Capsule tissues were collected at implant removal (0M) and 3-month (3M) and 6-month (6M) intervals following implant removal without capsulectomy. Tissues were analyzed histologically utilizing hematoxylin and eosin and Masson's trichrome staining. Immunohistochemical staining for matrix metalloproteinase-9 (MMP9), CD31, α-smooth muscle actin (αSMA), Type I collagen (COL1), and CD68 was quantified for comparative analysis.ResultsThe 0M group showed robust capsule formation with dense collagen and myofibroblasts. Over time, the capsules thinned (315 µm at 0M, 194.8 µm at 3M, 136.8 µm at 6M; P < .01), became structurally disrupted, and merged with surrounding adipose tissue. Notably, MMP9 and CD31 levels increased significantly, indicating enhanced matrix turnover and vascularization. αSMA and COL1 declined initially before partially rebounding at 6M, whereas CD68 exhibited trends consistent with ongoing remodeling.ConclusionsThe findings illustrate the natural degradation and remodeling of implant-induced capsules driven by specific cytokines and matrix markers. These insights may inform future guidelines on the necessity of capsulectomy during implant removal.

Current literature fails to examine gender differences of authors presenting abstracts at national plastic surgery meetings. This study aims to assess the ratio of female to male abstract presentations at Plastic Surgery The Meeting (PSTM).The gender of all abstract presenters from PSTM between 2010 and 2020 was recorded. The primary outcome variable was authorship (first, second, or last). Trends in gender authorship were assessed via Cochran-Armitage trend tests. Chi-square was utilized to evaluate the association between author gender and presentation type and author gender and subspecialty.Between 2010 and 2020, 3653 abstracts were presented (oral = 3035, 83.1%; poster = 618, 16.9%) with 19,328 (5175 females, 26.8%) authors. Of these, 34.5%, 32.0%, and 18.6% of first, second, and last authors were female, respectively. The total proportion of female authors increased from 153 (20.4%) in 2010 to 1065 (33.1%) by 2020. The proportion of female first, second, and last authors increased from 21.8% to 44.8%, 24.0% to 45.3%, and 14.3% to 22.1%, respectively, and demonstrated a positive linear trend ( P < 0.001 ). The proportion of female first authors in aesthetics (23.9%) was lower than that for breast (41.8%), cranio/maxillofacial/head & neck (38.5%), practice management (43.3%), and research/technology (39.4%) ( P < 0.001 ).Our study demonstrates a significant increase in female representation as first, second, and last authors in abstract presentations at PSTM within the last decade, although the absolute prevalence remains low.

INTRODUCTION Microsurgical education typically does not begin until surgical residency, and requires significant investment of time and practice.1 Various models and simulations have been reported to support microsurgical training, and have mostly focused on postgraduate surgical trainees.2 It has been demonstrated that medical students are capable of learning microsurgical techniques, and exposure to microsurgery may improve their interest in plastic surgery.3 There is limited literature on how exposure to microsurgery training influences the professional and technical development of senior medical students applying to plastic surgery residency. MATERIAL AND METHODS In the 2022–2023 application cycle, 19 fourth-year medical student subinterns completed a 4-hour, individual training session with an expert microsurgeon at our institution. The training session began with basic instruction on use and adjustment of the surgical microscope, names and handling of microsurgical instruments, suture placement, and knot-tying technique. The session culminated with the medical student performing an end-to-end anastomosis of a synthetic vessel (Fig. 1). Medical students completed pretraining and posttraining surveys, and responses were compared using Wilcoxon signed rank test.Fig. 1.: Medical student performing end-to-end anastomosis on a synthetic bessel. A, Medical student placing suture across vessel anastamosis. B, Completed vessel anastamosis by medical student.RESULTS Eighty-nine percent of students (17 of 19) came from institutions without a microsurgery fellowship program. Eighty-nine percent of students (15 of 19) had no prior hands-on microsurgery experience. Eighty-nine percent of students (17 of 19) were either extremely or somewhat uncomfortable performing end-to-end anastomoses of synthetic vessels. After the session, 74% of students (14 of 19) felt extremely or somewhat comfortable, with only 10% (2 of 19) feeling somewhat uncomfortable (P = 0.001). All students rated the session as very or extremely useful, with 95% finding the level of instruction and skills practiced reasonable. When asked to rank their interest in plastic surgery subspecialties, 26% (5 of 19) of students ranked microsurgery higher among subspecialties of interest than they did before the training session. Ninety-five percent of students reported that it was important for them to be at a residency program that would prepare them to perform microsurgery independently after graduation. CONCLUSIONS The subinternship is central to the plastic surgery applicant experience. Positive experiences such as engagement from faculty or negative experiences such as lack of operative or educational opportunities can leave a strong lasting impression of the program.4 Moreover, experiences during away rotations and the importance placed on resident training by faculty are among the most important residency characteristics considered by plastic surgery applicants.5 Our experience suggests that medical students can successfully learn microsurgical skills in a single training session, leading many to develop greater interest in the subspecialty. By exposing medical students to our institution’s microsurgery training, we hoped to enrich their rotation experience and demonstrate our educational mission. The findings are not without limitations, however. We did not collect formal qualitative data in this pilot study, which limits the interpretation of why a few students still felt uncomfortable with vessel anastomoses. Nevertheless, subjective exit interviews indicated strong engagement. Students desired additional training sessions, including on animal tissue models, to build comfort in their skills. Future studies will focus on quantifying these findings further and following this cohort as they continue their trajectory from student to plastic surgeon. DISCLOSURES Ethicon provided unrestricted education grant donations for microsutures. ZimmerBiomet provided unrestricted education grant donations of microsurgery training kits. None of the authors have financial interests with either corporation. The authors have no financial interest to declare in relation to the content of this article.