Qatar's strong economy, high savings rate, and political stability have enabled it to implement one of the most ambitious sustainable development plans in the Middle East.This is clearly reflected in its healthcare system, which provides high-quality, often free services to citizens as part of its national welfare strategy. 1Qatar is among the few countries in the world where cosmetic surgical procedures are offered free of charge to all its citizens, including abdominoplasty, rhinoplasty, blepharoplasty, and body contouring, among others in the governmental hospitals. 2This rare national policy has led to significant positive and negative implications for the healthcare system, particularly for plastic surgery services and residency training.

Abstract Background Hematoma is the most common early complication following facelift surgery, leading to increased morbidity and suboptimal aesthetic outcomes. Hemostatic nets, adapted from abdominoplasty techniques, aim to reduce hematoma formation by eliminating dead space and stabilizing tissue planes. Objectives To evaluate the effectiveness and safety of hemostatic nets in facelift (rhytidectomy) procedures and determine their impact on postoperative complications, particularly hematoma formation. Methods A systematic review and meta-analysis were performed in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251027741). A comprehensive search of PubMed, Embase, and Scopus was conducted through April 2025 to identify studies evaluating the use of hemostatic nets in facelift procedures. Eligible studies included adult patients undergoing rhytidectomy, comparing outcomes with and without hemostatic net use. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for key complications. Results Seven studies involving 1,919 patients were included. Meta-analysis of five studies revealed a significant reduction in hematoma risk in the hemostatic net group (OR: 0.085; 95% CI: 0.01–0.57; p=0.0113). There were no statistically significant differences in skin necrosis (OR: 0.29; p=0.1057) or transient ischemia/edema (OR: 0.70; p=0.1855). Seroma and infection rates were low and comparable between groups. Conclusions Hemostatic nets significantly reduce hematoma incidence without increasing other postoperative complications. Their integration in facelift procedures represents a safe and effective adjunct, warranting further investigation through prospective, high-quality trials.

Abstract Goals/Purpose The nasal dorsum is a cornerstone of rhinoplasty aesthetics, playing a vital role in achieving facial harmony and balance. Achieving a smooth, refined nasal profile remains a significant challenge, particularly in thin-skinned patients who are more susceptible to contour irregularities. Many techniques are used to address this problem, including diced cartilage, fascia, acellular dermal matrices, and silicone implants. This study aims to evaluate the effectiveness of using morselized bone grafts (MBG)–specifically, unused bone rasp material that is typically discarded–as a technique for contouring and refining the nasal dorsum after dorsal reduction. Methods/Technique The senior surgeon exclusively utilizes an open approach to rhinoplasty, and all cases are performed under general anesthesia. After performing a dorsal hump reduction with a bone rasp, the MBG is stored on the back table for later use in the same case. After addressing other components of the rhinoplasty procedure, attention is turned back to the nasal dorsum, wherein any contour irregularities are filled with the MBG paste. A retrospective chart review of rhinoplasty cases in the senior author's practice was conducted between January 2021 and June 2022. The inclusion criteria were cosmetic or functional rhinoplasty cases in which autologous MBG was used for dorsum refinement and contouring with a minimum of 12 months of follow-up. 953 patients met the inclusion criteria and were included in the study. Outcomes of interest included the rate of postoperative infection, defined as patients with signs of infection requiring antibiotics after completing their standard course of prophylactic antibiotics, and the rate of operative revisions. Results/Complications The mean age of our study group was 31.6 years old, with 869 female patients. 640 cases were primary rhinoplasties. The mean follow-up period was 23.5 months, with a minimum of 12 months of follow up for each patient. The rate of postoperative infection in our case series was 2.7%, with 26 patients requiring postoperative antibiotics. 17 (1.8%) patients required operative revision, among whom 4 (23.5%) patients were revision cases. There were no patients who sought revision rhinoplasty for concerns related to dorsal irregularities or contour defects. Conclusion MBG use for nasal dorsum aesthetics is a safe, convenient, and effective technique in camouflaging and concealing nasal dorsum irregularities in both primary and revision rhinoplasty. Additionally, as there is no additional equipment required and minimal operative time added when performing this technique, MBG use is an efficient alternative to other techniques for addressing dorsal aesthetics with no additional donor-site morbidity when paired with boney dorsal reduction. Future steps will involve performing a five-year follow-up on this cohort of patients to assess for long-term dorsal aesthetics following MBG use.

Abstract Goals/Purpose Post-operative pain management is a crucial aspect of recovery after aesthetic surgery. Effective pain control leads to quicker ambulation and return to work, and decreased rates of DVT/PE, chronic pain, and opioid dependence. Non-English-speaking patients frequently encounter difficulties communicating with the medical system, and previous studies in other surgical fields suggest discrepancies in post-operative pain management between English-speaking and non-English-speaking patients. In this study, we aimed to evaluate whether primary spoken language affects postoperative pain management prescriptions following aesthetic surgery. Methods/Technique This study utilized TriNetX, a global health research platform that compiles data from electronic medical records in real-time. Ninety-seven healthcare organizations and 134,328,422 patients were queried for patients with a lifetime history of at least one of the United States’s top five aesthetic surgeries (liposuction, breast augmentation, abdominoplasty, mastopexy, or blepharoplasty), documented as SNOMED or CPT codes. TriNetX demographic codes for spoken language differentiated patients into two cohorts: English (En) and non-English (nonEn) speakers. Sub-cohorts were also broken down into (1) English, non-Spanish (En/nonSp); (2) Spanish, non-English (Sp/nonEn); and (3) non-English, non-Spanish (nonEn/nonSp) speakers. Propensity score matching was performed on thirteen characteristics that included patient age at first aesthetic surgery, sex, BMI, body weight, substance use, pain disorders, neoplasms, and socioeconomic and psychosocial circumstances. Risk analysis compared the proportions of patients prescribed intravenous opioids, oral opioids, and oral acetaminophen or ibuprofen 0-to-7 days after surgery across groups. Risk difference, risk ratio, and odds ratio were calculated for each pair of cohorts. Results/Complications This study utilized TriNetX, a global health research platform that compiles data from electronic medical records in real-time. Ninety-seven healthcare organizations and 134,328,422 patients were queried for patients with a lifetime history of at least one of the United States’s top five aesthetic surgeries (liposuction, breast augmentation, abdominoplasty, mastopexy, or blepharoplasty), documented as SNOMED or CPT codes. TriNetX demographic codes for spoken language differentiated patients into two cohorts: English (En) and non-English (nonEn) speakers. Sub-cohorts were also broken down into (1) English, non-Spanish (En/nonSp); (2) Spanish, non-English (Sp/nonEn); and (3) non-English, non-Spanish (nonEn/nonSp) speakers. Propensity score matching was performed on thirteen characteristics that included patient age at first aesthetic surgery, sex, BMI, body weight, substance use, pain disorders, neoplasms, and socioeconomic and psychosocial circumstances. Risk analysis compared the proportions of patients prescribed intravenous opioids, oral opioids, and oral acetaminophen or ibuprofen 0-to-7 days after surgery across groups. Risk difference, risk ratio, and odds ratio were calculated for each pair of cohorts. Conclusion English-speaking patients were significantly more likely than non-English speaking patients to receive opioid prescriptions following aesthetic surgery. Additionally, English-speaking patients were more likely to receive prescriptions for multimodal pain control regimens. Our data suggests there may be broad-scale language-based disparities and potential under-treatment of pain in non-English speaking aesthetic surgery patients. Plastic surgeons may aim to establish standardized postoperative pain-control protocols to reduce language-based discrepancies in postoperative pain management.

Abstract Goals/Purpose Aesthetic breast augmentation surgeries were the second most common surgical aesthetic procedure in the US in 2023.1 In a survey of residents and 4th-year medical students, 95% reported using online videos as a tool to learn about surgical procedures, the majority citing YouTube as the most common source.2 While videos can be a crucial learning tool for trainees, it is important that these resources undergo a thorough evaluation to establish their educational value. While prior studies in the otolaryngology and general surgery literature have investigated the quality of surgical YouTube videos,3,4 no studies have examined the quality of videos related to breast augmentation. Thus, the objective of this study is to compare the quality of breast augmentation educational videos. Methods/Technique A total of 640 intraoperative primary breast augmentation YouTube videos and 3,527 videos published in the Journal of Plastic and Reconstructive Surgery (PRS) video gallery were screened using predefined search terms. With the help of 3 attending surgeons who routinely perform breast augmentation, a 14-point rubric was created to identify critical perioperative and intraoperative surgical criteria that should be included in educational videos regarding primary breast augmentation. Each video was also assessed on audiovisual quality. All included videos were graded on a binary scale by two independent reviewers and interrater reliability was assessed using Kappa’s coefficient. Statistical significance was defined as a P < 0.05. Results/Complications A total of 11 Youtube videos, and 7 PRS videos met inclusion criteria. All PRS videos were deemed high quality, while only 45% of YouTube videos were rated as high quality. Moreover, the PRS videos were of a statistically significant higher quality than the YouTube videos, with an average score of 11.1 out of the 14 criteria compared to 9.0 respectively (P = 0.03). The videos posted to the academic video gallery were rated as higher quality in all three categories; audiovisual, perioperative and intraoperative criteria. The number of views, likes, duration, time since upload or channel subscribers were not strong predictors of the quality of YouTube videos. A high degree of interrater reliability was confirmed using Kappa's coefficient, with κ = 0.97. Conclusion This study found that the quality of surgical education videos on breast augmentation greatly varied from video to video within both Youtube and the PRS website. Videos within the peer-reviewed journal scored higher than those on Youtube. Trainees in prior studies have cited Youtube as a major source for educational content, and thus, are especially vulnerable to this low quality, as they may not be able to differentiate between good quality and inadequate content. Additionally, there was not a strong correlation with any of the commonly used metrics such as views and likes that a trainee might use to help identify higher quality content on Youtube. Thus, surgical trainees should use caution when deciding how to supplement their learning with online videos. A more reliable option for high quality surgical content is to watch videos posted to a peer-reviewed academic journal. Even with this, setting standards for video quality and essential criteria is useful for creating educational content through video content.

Abstract Goals/Purpose The enhanced recovery after surgery (ERAS) protocol has been demonstrated to reduce post-operative opioid prescriptions following breast reconstruction procedures. There is emerging evidence that ERAS protocols are efficacious for outpatient breast surgery, diminishing PACU opiate use, decreasing post operative nausea and vomiting, and decreasing outpatient opiate prescriptions. However, whether ERAS protocols impact intra-operative opiate use for outpatient breast surgeries is unknown. The purpose of this investigation was to determine the impact of ERAS protocols on intra-operative opiate use for outpatient breast surgery procedures and validate its utility in post-operative pain management for outpatient breast surgery. Methods/Technique A retrospective chart review was conducted of patients receiving outpatient breast surgery by a single surgeon at our institution four years prior to instituting the ERAS protocol in May of 2015 (pre-ERAS) and four years after instituting the ERAS protocol in May of 2019 (post-ERAS). The protocol included preoperative hydration, pectoral nerve blocks, peri-operative Gabapentin 200-300mg TID, Acetaminophen 1000 QID, Celecoxib 200-400mg BID or Ibuprofen 800mg TID and optional Orphenadrine 100mg BID for up to 7 days. Patients also received an educational component involving a supplemental brochure and discussions during their clinic visits. The intra-operative and PACU opiate use was obtained from anesthesia and hospital records. The type, route, and amount of opiate was documented and converted to oral morphine milligram equivalents (MME). The intra-operative and PACU opiate use and MMEs were compared between the two groups. Results/Complications A total of 316 patients were included in the pre-ERAS cohort and 257 patients were included in the post-ERAS cohort. Outpatient surgeries included breast reductions, secondary revision procedures for breast reconstruction including symmetry procedures, breast augmentation, primary breast reconstruction, and implant exchange. Post-ERAS patients received 30% fewer MMEs intraoperatively (50.9 MMEs vs 70.8 MMEs, p<0.0001). The post-ERAS cohort also received significantly fewer opiates in PACU (19.1 MMEs vs 30.3 MMEs, p<0.0001) and 30% of patients did not received any opiates in PACU. Although there were no significant differences between the two groups in the number of patients receiving IV medications such as fentanyl, hydromorphone, or morphine, fewer post-ERAS patients received oral opiates (p<0.0001). Conclusion This study validates prior literature demonstrating patients receiving ERAS protocols for outpatient breast surgery receive fewer opiates in PACU. This difference is attributable to a decrease in long-acting oral opiate prescriptions rather than acute onset intravenous (IV) medications frequently used in phase I of anesthesia. ERAS also significantly decreases intra-operative opiate administration which can be useful in diminishing post-operative nausea and vomiting

Abstract Goals/Purpose Breast procedures, for both reconstructive and aesthetic indications, persistently are subject to the effects of gravity. While various surgical techniques have emerged to prevent ptosis following these procedures, it remains a persistent challenge. To provide additional support for the weight of the native breast or an implant, plastic surgeons have utilized soft tissue support as an adjunct in reducing ptosis. Many soft tissue support implants have emerged including biologic meshes, synthetic meshes, and acellular dermal matrices. Poly-4-hydroxybutyrate (P4HB), a fully absorbable polymer, has found more recent applications in breast surgery. The objective of this study was to identify uses of P4HB in both reconstructive and aesthetic breast surgery reported in the literature and synthesize the available data on its outcomes and efficacy. Methods/Technique This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines with a publicly available protocol registered on PROSPERO (ID 591069). PubMed (MEDLINE), EMBASE, and Cochrane databases were searched for publications describing use of P4HB in breast surgery. Searches included all heading and keywords for the phrases: “P4HB,” “Poly-4-hydroxybutyrate,” “GalaFlex,” inclusive of the phrases “breast,” “surgery,” “reconstruction,” “implant,” “augmentation,” “operation,” or “procedure.” No language, article type, or publication date restrictions were included in the initial searches. All studies were reviewed by two independent reviewers (NV and CA). If there were any disagreements, CB reviewed the study and made the final decision regarding study inclusion. Inclusion criteria were (1) use of P4HB in aesthetic or reconstructive breast surgery, (2) be written in English. For articles selected for inclusion, bibliographies and citing references were screened from Scopus (Elsevier). From the included studies, cohort size, indication for P4HB, mean age, mean follow-up time, recurrence of ptosis, need for revisions, infection rates, and complication data were extracted. Due to significant heterogeneity in study designs, patient populations, and outcomes measured, meta-analytical techniques were not deemed feasible. Results/Complications Following removal of duplicates, a total of 358 studies were included for initial review. Following title and abstract screening, 338 studies were deemed ineligible for inclusion. Full-text review was performed on a total of 20 studies. Following review, 16 articles were deemed acceptable for final inclusion. Of the articles meeting inclusion criteria, 1,420 patients were represented of which 1,021 patients were treated with P4HB. Included studies consisted of four retrospective cohort studies, nine retrospective case series, one prospective case series, and two animal studies. P4HB was described as being used in a variety of clinical scenarios including soft tissue support in breast reconstruction (ADM-P4HB hybrid mesh, circumferential implant wrap, inferolateral sling, placement in the lateral gutter to re-establish the anterior axillary line), assistance in implant malposition, defining the medial cleavage area in breast augmentation, symmastia correction, soft tissue support for mastopexy, mastopexy augmentation, and a scaffold for nipple reconstruction. One study reported significantly lower time to drain removal with P4HB in immediate expander-based reconstruction versus ADM, though only by three days (15 vs 18 days, p = 0.008). A second study reported significantly higher rates of capsular contracture with use of P4HB in dual-plane two-stage breast reconstruction (46/96; 47.9%) compared to dual-plane implant placement with an acellular dermal matrix (ADM) sling (42/122; 34.4%), prepectoral implant placement with no mesh support (49/161; 30.4%), or total submuscular implant placement with no mesh support (3/14; 21.4%), (p=0.02). No other studies reported significantly higher rates of capsular contracture with the use of P4HB and no other significant differences in common postoperative complications including infection, seroma, hematoma, extrusion, delayed wound healing, or palpable scaffold requiring intervention were noted between comparison groups. All prospective and retrospective case series reported high rates of patient satisfaction and mesh take as well as low rates of recurrent ptosis, implant malposition, capsular contracture, and all other common postoperative complications with the use of P4HB. Two studies were in vivo animal models exploring the use of P4HB as a biocompatible scaffold in nipple reconstruction in which a P4HB nipple scaffold was subcutaneously implanted on the dorsa of immunocompromised adult male rats, both of which reported that the presence of P4HB scaffold promoted the growth and retention of fibrovascular tissue in a manner best mimicking the native human nipple with higher rates of nipple projection with respect to non-scaffolded comparison groups. Conclusion To our knowledge, this study is the most comprehensive evaluation of P4HB use in breast surgery. The data suggest that P4HB is a safe, cost-effective, and efficacious adjunct in a variety of indications. Given the two-year resorption timeline of P4HB, long-term follow up is crucial in evaluating the lasting efficacy of the polymer in supporting the weight of the native breast tissue or a breast prosthesis in preventing ptosis. Large-scale, randomized trials between P4HB and other types of soft-tissue support would be useful to determine non-inferiority or superiority of P4HB to other available options.

Abstract Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are widely used for Type 2 diabetes and weight management but may adversely affect skin quality, resulting in dermal thinning, decreased elasticity, and accelerated aging—a phenomenon referred to as “GLP-1 Face.” A novel topical serum, GLPSGLT (Aforé LLC), was developed to counteract these effects using a proprietary blend of a bioavailable retinoic acid derivative, peptides, and botanical agents to support keratinocyte function and dermal repair. The authors of the study aim to evaluate the safety and efficacy of GLPSGLT serum in improving facial skin quality in patients undergoing GLP-1 RA or SGLT-2 therapy. In this split-face, double-blind pilot study, 7 female patients (median age 55) on stable GLP-1 RA/SGLT-2 therapy applied GLPSGLT serum to one side of the face and placebo to the other, twice daily for 6 weeks. Assessments at baseline, Day 21, and Day 42 included the Global Ranking Scale (GRS), standardized photography reviewed by a blinded physician, and a 26-item patient-satisfaction questionnaire. Treated sides showed statistically significant improvements across all 13 GRS domains vs placebo (P < .0001), particularly in hydration, surface roughness, pigmentation, vasculature, visible pores, and static wrinkles. The blinded reviewer correctly identified the treated side in all cases. Patients reported greater satisfaction with skin texture, firmness, radiance, and hydration. No adverse events were reported. GLPSGLT serum significantly improved skin quality in GLP-1 RA/SGLT-2-treated patients and was well-tolerated, warranting further investigation in larger, histologically assessed cohorts. Level of Evidence: 4 (Therapeutic)

Abstract Goals/Purpose Traditional rhinoplasty tip grafts often lead to visibility issues, prompting patients to seek revision surgery. The mastoid fascia tissue graft (MFTG) provides a natural-looking alternative with fewer complications. MFTG remains less visible through the skin, enhancing long-term aesthetic results. This eight-year study on 193 patients examines MFTG's effectiveness in nasal tip refinement, evaluating revision and infection rates. Methods/Technique A retrospective analysis of MFTG use for nasal tip refinement during open rhinoplasty in the senior author's practice was conducted from July 2014 to June 2022. Inclusion criteria encompassed open rhinoplasty cases using mastoid tissue for tip refinement with at least 12 months of follow-up. Among 2003 cases, 193 met these criteria and were evaluated for subsequent revision and infection rates. Results/Complications The average patient age was 34.2 years (175 females, 18 males). Primary rhinoplasties were done on 114 patients, with 79 receiving revision surgeries. Average follow-up was 14.8 months. 6 patients (3.1%) needed extended antibiotics. Overall, 6 (3.1%) patients required revision rhinoplasty, comprising of 2 (1.8%) primary and 4 (5.1%) secondary rhinoplasty patients. These revisions were unrelated to the use of MFTG for nasal tip refinement. Conclusion MFTG use for nasal tip refinement is associated with low revision rates for both primary and secondary rhinoplasty compared to rates in current literature, without increase in complications or prolonged operative durations. MFTG for nasal tip refinement is a safe and convenient technique delivering excellent aesthetic outcomes with minimal morbidity.