Objective. Aesthetic narrowing of nasal dorsum without reducing its height or compromising its structural support. Material and methods. Over a 14-month period (April 2024 — May 2025), 87 surgeries were performed (84 women and 3 men). Autogenous bone grafts were used for nasal dorsum narrowing. Mean patient age was 33 years (range 19-47). Rhinoplasty was performed using closed and open approaches. Results. Postoperative monitoring (short-term and long-term) revealed no complications. The predicted aesthetic result, consistent with preoperative modeling, was achieved in 100% of cases. Conclusion. Original technique for nasal dorsum narrowing in preservation rhinoplasty ensures optimal nasal dorsum width and prevents postoperative complications.

Comments on the article: Sharova AA. Botulinum toxin type A injection in the middle and lower thirds of the face and neck area for aesthetic purposes. Plastic Surgery and Aesthetic Medicine. 2025;3:108–117. (In Russ.). https://doi.org/10.17116/plast.hirurgia2025031108.

Objective. To determine the incidence of aesthetic and functional complications depending on periorbital surgery and patient satisfaction with treatment outcomes. Material and methods. The study included 628 patients who underwent surgery between January 2019 and December 2024. Patients were divided into nine groups depending on surgical intervention, including various combinations of upper and lower blepharoplasty, as well as endoscopic frontotemporal lifting. This approach allowed for analysis of effectiveness and complications of each method. Results. The incidence of complications and patient satisfaction with periorbital surgery outcomes largely depends on surgical technique. Modern approaches, such as endoscopic lifting and fat-preserving techniques, significantly reduced the risk of complications and improved aesthetic results (patient satisfaction >90% in most groups). These findings highlight the necessity of individualized surgical planning and multidisciplinary approach for higher safety and effectiveness of treatment. Conclusion. Available experience enables refinement of surgical techniques, minimization of risks, and improvement of patient satisfaction with outcomes.

Facial paralysis can develop as a result of various causes due to anatomical features of the facial nerve. Ophthalmological risks are often not taken into account in rehabilitation and treatment aimed at restoring the functions of facial muscles and achieving favorable cosmetic results. However, lagophthalmos following denervation of the orbicularis oculi muscle can lead to irreversible decrease of visual acuity and even blindness. Therefore, maintaining the visual acuity is essential in patients with paralytic lagophthalmos. Static surgical techniques reducing or eliminating paralytic lagophthalmos have the greatest effect, predictable and stable results. The authors analyze 2.657 lagophthalmos corrections in patients with facial paralysis: correction of lower eyelid position (correction of lower eyelid ectropion and retraction using periosteal and mucoperiosteal flaps, suspension threads), correction of upper eyelid retraction and tarsoraphy. Correction of paralytic lagophthalmos through weighting the upper eyelid with palpebral implant is highlighted. The advantages and disadvantages of each technique, as well as appropriate indications are considered.

Objective. To evaluate the effectiveness of various methods of polyacrylamide gels (PAAG) removal from soft tissues of lower extremities. Material and methods. The authors present a 25-year experience of PAAG removal in 138 female patients. In 125 cases, PAAG was localized in soft tissues of lower legs, in 47 — thighs, in 9 — gluteal region. In 31 patients, PAAG was removed from multiple anatomical regions at intervals 8—26 months. These ones were analyzed as separate cases. Open method of gel removal was used in 18 cases, closed method with active aspiration — 55, closed method with pulsating cavity technique — in 96 cases. Results. Open method had no advantages and resulted unaesthetic scarring in 39% of cases. Closed aspiration method was followed by residual free PAAG in 71% of cases that required repeated surgeries in 49% of cases. Pulsating-cavity method yielded better results: residual free PAAG — 20% of cases (p<0.001), redo surgery rate — 5% (p<0.001). However, tissue hyperhydration exacerbated pre-existing lymphatic and venous insufficiency and led to fluid collections. This required punctures in 22% of cases. Conclusion. Preserving the compromised soft tissues in PAAG removal is justified to minimize the risk of secondary defects. Closed removal techniques offer aesthetic advantages over open approaches. PAAG removal requires careful individualized approach regarding potential complications and risks. Pulsating-cavity method may significantly improve postoperative outcomes, although condition of lymphatic and venous systems should be considered.

Objective. To estimate the effectiveness and safety of mesotherapeutic cocktail with peptides, picosecond laser and skin care products containing peptides for increasing skin elasticity, firmness and quality. Material and methods. At the first stage, 15 patients received injections of peptide-based mesotherapeutic cocktail and picosecond laser procedure at the same day. Moreover, they used skin care products with peptides within a month. Results were followed-up using photography and Global Aesthetic Improvement Scale (GAIS). At the second stage, umbilical region in 3 patients was divided into 5 areas for different procedures: area I — combination of 3 methods, area II — laser exposure alone, area III — mesotherapy alone, area IV — skin care alone, area V — control. Objective control implied ultrasound and histological examination of skin in each area. Results. After the first stage, macroscopic photographs revealed significantly better skin texture, smoothing of fine wrinkles, homogenization of color and reduction of hyperpigmentation. About 93.3% of patients and 93.3% of doctors presented the most positive opinion about treatment outcomes, and all respondents were satisfied with overall results. At the second stage, area I had significant dermis thickening, homogeneity and epidermis compaction, as well as slightly higher echogenicity compared to the control one. Histological examination revealed more intense collagen renewal process in areas I, II and III. Combined method of exposure was the most effective, while skin care products alone showed no significant effect. Conclusion. Combined techniques demonstrated effectiveness and safety. Indeed, this protocol can improve soft tissues of the face, neck and decollete, reduce fine lines and pigment spots.

A rare harmful case of invasive melanocytic nevus in a child is described. In accordance with guidelines, independent method, histological and IHC analysis, MRI, consultations with neurologist and neurosurgeon are recommended. Giant congenital melanocytic nevi are rare. In some cases, such nevi may not just be an isolated lesion, but symptom of phacomatosis (neurocutaneous melanosis). Differential diagnosis is usually difficult due to gradual progression of disease. Primary diagnostic screening usually includes MRI of the central nervous system, histological examination of nevi and consultations with appropriate specialists.

The authors present multiple-stage breast reconstruction after previous skin-sparing mastectomy with single-stage autologous TRAM flap reconstruction and subsequent flap liponecrosis. The patient with left-sided breast cancer underwent treatment including neoadjuvant chemo- and radiotherapy. The last ones are risk factors of flap liponecrosis. Fat necrosis is a common complication after autologous breast reconstruction. This event may be asymptomatic in most cases and also symptomatic with necessary surgical intervention. If fat necrosis leads to flap loss, surgeons still have different options to recreate the breast from lipofilling of small defects to expanders and implants. This case report is important due to no clear guidelines for the management of patients with fat necrosis after autologous breast reconstruction.

Objective. To evaluate long-term results and increase the effectiveness of breast shape correction and augmentation using fat transfer procedure. Material and methods. We analyzed the results of fat transfer breast augmentation in 342 patients aged 21-59 years (mean 36±7) between 2010 and 2022. The volume of injected adipose tissue ranged from 70 to 1260 ml into each breast. From 40 to 610 ml was injected under the gland on each side, and subcutaneously from 30 to 760 ml, that is, the ratio under the gland/subcutaneously was 55%/45%. Some patients underwent several lipofilling procedures, so the total number of clinical cases was 378. Satisfactory results after the first procedure were obtained in 316 (92.4%) patients, after the second procedure — in 20 (5.8%) patients, after the third procedure — in 3 (0.9%) patients, after the fourth procedure — in 2 (0.6%) patients. Only 1 (0.3%) patient required five procedures. Results. The follow-up period ranged from 3 months to 12 years (mean 5 years 3 months ± 2 years 10 months). When comparing preoperative and postoperative images and retrospectively analyzing surgical protocols and medical documentation, we observed persistent improvement of breast shape and volume in 3 months after injection of adipose tissue ≥400 ml into each gland. To increase the percentage of augmentation, we used an algorithm for recipient area enlargement. This algorithm allowed injection of larger volumes of adipose tissue around the mammary glands, provided stable effect of augmentation and breast shape improvement early after surgery (after 3 months). Conclusion. Injection of large volume of adipose tissue into the breast (≥400 ml into each gland) via recipient area enlargement provides stable simultaneous shape improvement and augmentation.

Objective. To describe surgical techniques of contouring in rhinoseptoplasty using cartilaginous autografts with various degrees of crushing as the final stage of surgery. Material and methods. There were 350 patients with congenital and acquired deformities of external nose between December 2022 and December 2023 who underwent contouring with autologous cartilaginous grafts. These patients underwent open and closed rhinoplasty. Mean age of patients was 37.5 years (range 18-57 years). We used autologous cartilaginous grafts with various degrees of grinding for contouring in primary or reconstructive rhinoplasty. Results. No complications were identified in early and delayed postoperative period. Aesthetic parameters of dorsum and tip of the nose were achieved. The result scheduled at the preoperative stage was obtained. Conclusion. Cartilaginous autografts with various degrees of grinding for contouring of the nose at the final surgical stages make it possible to camouflage all irregularities and voids, achieve necessary aesthetic bends and fullness, replenish the volume and obtain predictable aesthetic results.