Background: High-definition body contouring describes a unique surgical approach to create superior outcomes not afforded with conventional body contouring techniques. Achieving high-definition outcomes requires contouring in a 360-degree or circumferential manner, creating natural shadows and muscle highlights, and staying true to gender-specific aesthetic guidelines. These prerequisites make high-definition body contouring surgeries technically challenging and rigorous for all surgeons. Because of the complexity and scope of surgery, prolonged surgical times are a frequent reality. Objective: As such, surgeons should make all attempts to promote patient safety by reducing operative times. Methods: We have identified several measures that may improve high-definition body contouring outcomes and promote safety by minimizing operative times. Results: We discuss maneuvers that we have observed clinically that may to minimize operative times in high-definition body contouring which include (a) early planning of a customized, comprehensive, and accurate surgical design, (b) circumferential prepping and draping, (c) administering advanced ultrasound-assisted liposuction techniques, (d) utilizing ex vivo liposuction technique, (e) enacting the closed-loop canister fat graft system, (e) appreciating safe and hazardous zones during liposuction, and (f) considering staging of surgeries. Conclusion: This article discusses several experiential measures implemented to optimize high-definition body outcomes and safety by reducing operative times.
Radiologic imaging is integral to modern plastic and reconstructive surgery practice. However, many junior trainees receive minimal formal education on selecting the appropriate imaging modality for specific procedures. This gap can lead to overuse, misinterpretation, or omission of essential studies. The authors address this educational need by outlining when and why specific studies are indicated. This narrative review synthesizes current peer-reviewed literature and expert opinion to describe best imaging practices in plastic surgery. Clinical scenarios commonly encountered in general reconstruction, breast and aesthetic surgery, burn care, craniofacial and pediatric surgery, gender-affirming surgery, hand and upper extremity surgery, and microsurgery are reviewed for optimal imaging strategies. For each clinical domain, the review identifies first-line imaging modalities, adjunct studies when applicable, and procedural-specific considerations. Emphasis is placed on the clinical rationale for each imaging decision, including safety, diagnostic yield, and relevance to surgical planning. By linking imaging recommendations to practical scenarios and surgical decision-making, this guide supports early trainees in developing imaging literacy. Including detailed clinical questions when ordering studies and understanding modality-specific strengths are emphasized as essential habits for accurate diagnosis and efficient care. This review offers a subspecialty-specific, clinically oriented reference for imaging in plastic surgery. It equips junior trainees with foundational knowledge to select appropriate studies, communicate effectively with radiologists, and optimize patient outcomes.
The field of facial cosmetic and reconstructive surgery in the United States is represented by several prominent organizations, each specializing in distinct areas such as aesthetic and cosmetic enhancement, reconstructive techniques, and microvascular procedures. This article examines key cosmetic and reconstructive surgery organizations, focusing on their available online educational resources, interactive learning platforms, opportunities for knowledge advancement, and mechanisms for connecting established surgeons with emerging professionals through mentoring programs. A narrative review was conducted in PubMed using keywords “facial aesthetic surgery,” “facial esthetic surgery,” “facial cosmetic surgery,” “facial reconstructive surgery,” and “facial plastic surgery” to identify suitable organizations and collect relevant data. The inclusion criteria prioritized American organizations dedicated to facial aesthetic/cosmetic surgery. In addition, 2 internationally recognized cosmetic surgery organizations headquartered in the United States were included due to their prominence among US-based surgeons. Boards, councils, and international organizations, as well as organizations not focused on facial aesthetic/cosmetic surgery, were excluded. Data on online educational tools and learning opportunities was collected and analyzed directly from each organization’s official website. This article provides a descriptive overview of prominent American and selected international organizations dedicated to facial cosmetic/aesthetic and reconstructive surgery. It highlights their interactive online educational resources, specialized training opportunities, and structured networking and mentoring platforms aimed at fostering professional development and collaboration. In addition, the article outlines available patient-centered resources designed to assist individuals seeking surgical providers, postoperative care information, or revision strategies following unsatisfactory surgical outcomes. Brief historical context and organizational objectives are also summarized to provide comprehensive insights into each entity.
Alar rim retraction (ARR) is a challenging iatrogenic complication in rhinoplasty, causing aesthetic distortion and functional compromise. Complex secondary cases often involve compounded deficiencies in both the lower lateral cartilage (alar rim) and the caudal upper lateral cartilage (ULC). Current isolated grafting techniques (eg, Lateral Crural Extension Graft or LCEG) often fail to provide complete, harmonious correction in these dual-level defects, highlighting the need for a unified reconstructive strategy like the novel Lateral Crural-Rim Bridging Graft (LCRBG). A 32-year-old woman presented with progressive, unilateral ARR following primary rhinoplasty, causing asymmetric nostril show and functional distortion. She underwent secondary rhinoplasty using the LCRBG technique. A 2.5 cm × 8 mm septal cartilage graft was harvested and precisely secured to span from the residual lateral crus to the deficient caudal ULC. The procedure was well-tolerated and achieved the desired correction of the alar rim position. The LCRBG offers a novel, unified solution for complex secondary rhinoplasty, simultaneously correcting ARR and supporting the deficient caudal ULC. By bridging these 2 levels, it restores anatomical continuity, improves contour, and addresses limitations of traditional single-level grafting. Further prospective studies are necessary to fully validate its efficacy.
Objective: To describe perioperative findings and self-reported outcomes in a retrospective series of adolescent patients undergoing labiaplasty. Design: Retrospective observational study of 30 adolescent labiaplasty cases performed between September 2020 and April 2025 at a private medical center. Patients were aged 14 to 17.8 years (mean = 15 years). All procedures were performed under local anesthesia and required dual informed consent (patient and guardian). During this period, approximately 1000 labiaplasties were performed at the same center in women over 18 years of age. Methods: All patients underwent linear/curvilinear edge-reduction labiaplasty using a combination of radiofrequency and diode laser. Closure was achieved with interrupted 5-0 Monocryl (subdermal) and 5-0 Vicryl Rapide (cutaneous) sutures. Clitoral hood reduction was performed in most cases. Postoperative management included topical estrogen, oral antibiotics, and strict hygiene measures. Follow-up visits were scheduled at 1 and 6 weeks postoperatively, with telemedicine follow-up for patients living outside the city. Results: Thirty patients were analyzed. One hematoma (6×5×5 cm) required drainage, and four minor wound dehiscence healed spontaneously. No infections or sensory changes were reported. Most patients reported subjective functional and aesthetic improvement and high self-reported satisfaction. Most returned to school within 48 hours, while sports and physical activities were restricted for 6 weeks. Postoperative outcomes were assessed using a non-validated, surgeon-designed, self-reported questionnaire. Conclusions: In this limited retrospective case series, adolescent labiaplasty under local anesthesia was associated with high self-reported satisfaction and a low rate of short-term complications. These findings should be interpreted cautiously given the study design, non-validated outcome measures, and limited follow-up.
The objective of this study is to show a new closed rhinoplasty surgical technique that relates nasofacial anatomy with the Pythagorean theorem and the elastic forces quantified in Hooke’s Law The Pythagorean Theorem states that in any right triangle; the square of the hypotenuse is equal to the sum of the squares of the legs. Similarly, this concept can be applied to the nasal tripods of the nose if we consider that their structure is triangular with a central vertical leg shared, or columella. The nasal wings would be the hypotenuse, and the nasolabial junction would be the triangular base. In this context, if the lower leg is shortened, the central leg lengthens, causing the lateral crura, or hypotenuse, to narrow inward. In this article, we show the developed surgical technique. For the modification to be feasible, the legs must be freed while remaining intact. Based on these principles, we have designed Two new surgical tools to release and modify the nasal triangle. The conclusion is that this new technique can be performed with very good results in closed rhinoplasty without leaving scars.
Introduction: We have developed a novel, supra-periosteal injection technique for beautification of the central face. We describe its treatment outcomes and safety with a review of literatures. Materials and Methods: In this single-center, retrospective, case-series study, we evaluated a total of 27 women (n = 27) who received aesthetic facial beautification using the YVOIRE volume plus (LG Chem Inc., Seoul, Korea). To do this, we designed the diamond-shaped region in the central area of the face and determined injection landmarks and volumes. Treatment outcomes were compared between preoperatively and postoperatively and Global Aesthetic Improvement Scale (GAIS) scores were assessed at 3 months. In addition, the safety was assessed based on the incidence of postoperative complications. Results: At 3 months, the patients had a mean GAIS score of 3.70 ± 0.76 points, which corresponds to “Very much improved” or “Much improved.” Only non-serious complications occurred, all of which were resolved spontaneously or with symptomatic treatments. Discussion: But our results cannot be generalized; the possibility of a selection bias could not be completely ruled out because we included the patients from a single-center only. Conclusion: In conclusion, we describe treatment outcomes and safety of a supra-periosteal injection of YVOIRE volume plus to a diamond-shaped area in the central face for beautification in Asian women.
Background: Midface rejuvenation centers upon the treatment of facial wrinkles, resuspension of ptotic soft tissues, and facial volume replacement with permanency often requested. Objectives: Evaluate aesthetic permanent composite midface volume enhancement using bovine collagen gel suspended polymethylmethacrylate microspheres or Artefill with a name change to Bellafill, standard or patient-specific silastic implants, and autologous stem cell enriched fat grafting. Methods: Retrospective review of consecutive patients electing permanent midface volume following a composite midface volume analysis and protocol. Most midface silastic implants had preoperative photoimaging. Artefill was injected using microcannulas in the subdermal and/or supraperiosteal planes. Fat grafts were prepared using low suction extraction, administration within 1-2 hours of harvesting, centrifugation-filtered at 3000 rpms for 3 minutes without washing, and stem cell/stromal vascular fraction enrichment with platelet rich plasma to optimize graft survival. When simultaneously body contouring, ultrasound energy (60% pulsed mode) prior to fat harvesting was minimized. Results: Patients chose Artefill (154), silastic implants (52), and fat grafting (44). Combination Artefill and fat grafting were performed in 25%. Simultaneous facelifts with silastic implants performed in 23.1%. Combination silastic implants and artefill in 15.4%. The overall patient satisfaction rate for all permanent volume options was 95.6% (239 of 250 patients) using the Global Aesthetic Improvement Scale with very much improved or improved responses. The reason for lack of satisfaction was that volume replacement did not achieve their aesthetic goals. Artefill had two with excess fullness successfully treated. Fat grafting observed one seroma and two with isolated fullness successfully treated. Silastic implants had four with asymmetries successfully treated with replacement (n = 2) and Artefill filler addition (n = 2). Conclusions: Isolated or combination use of Artefill, silastic implants, and fat grafting are valuable components of a composite midface volume replacement strategy with high patient satisfaction and a low complication rate. A permanent volume replacement option flowsheet was presented to ease the volume decision process.
Permanent polyacrylamide hydrogel (PAAG) filler is associated with late-onset granulomatous inflammation, abscesses, and extensive scarring in lip augmentation cases. Scarring after granuloma and abscess management presents significant aesthetic and functional challenges. We report a challenging lip reconstruction in a patient with a history of multiple prior operations that addressed complications of PAAG.
Introduction: Reduction mammoplasty (RM) is a common plastic surgery procedure; it can significantly improve patients’ quality of life. However, some women with macromastia are extremely obese, increasing their risk of postoperative complications. At our institution, patients’ body mass index (BMI) must be less than 35 to be considered for the procedure. Therefore, many women fail to qualify for this elective surgery at initial screenings. This study is to determine how many patients failed to meet the BMI requirement initially, and how many of them could achieve the required lose weight and receive the procedure. Importantly, we examined the factors associated with successful weight reductions. Methods: With institutional review board approval, we reviewed the records of all consultations for RM in 2019 by a single academic plastic surgery unit. The outcome variables extracted were initial BMI, BMI at time of RM, and frequency and factors associated with achieving BMI of 35 or less. In addition to logistic regressions, we performed Fisher exact tests for categorical variables and t -test for continuous variables. Multicollinearity test was done to assure independence as was Bonferroni correction for multiple variables. Results: Fifty-two (52%) women who had a consultation for an RM had a BMI >35. The weight loss recommendation by the plastic surgeon remained constant during the study period and consisted of bariatric surgery consults, nutrition consults, and diet modification. Even though bariatric surgery referral was the most common recommendation (26, 50% of all patients), only 1 patient underwent bariatric surgery. The 3 key elements for diet modification were to improve the quantity and quality of food intake reducing total calorie to 1800 to 2000 Cal per day, multivitamin supplements, and intermittent fasting for longer than 12 hours to induce oxidation of fatty acid stores. Only 7 (14%) of women in this study were able to lose weight and undergo RM. These women had mild BMI excess and were significantly more likely to visit their primary care physician ( P = .0059) and adhere to the diet modifications and exercise ( P = .0049). Patients who did not receive RM had a significantly greater mean weight at 112.3 kg (14.1) compared with 102.5 kg (10.8) ( P = .0081). Conclusion: This study showed that only a small fraction of the obese patients seeking RM lost weight with preoperative counseling. The single most important factor associated with successful decrease in BMI to below 35 was starting BMI not to exceed 40.
Background: High-definition liposuction (HDL) has evolved to incorporate multiple energy-based technologies designed to enhance adipose removal while promoting skin and soft tissue contraction. These technologies commonly include ultrasound-assisted liposuction and helium plasma-based radiofrequency skin tightening, both frequently applied over extensive surface areas in a circumferential fashion. Although these modalities significantly improve outcomes over traditional body contouring techniques, their combined use may generate a cumulative inflammatory response that predisposes certain patients to hyperinflammatory fibrosis. Objective: This article reviews the pathophysiology of hyperinflammatory fibrosis, identifies HDL-specific risk factors, and proposes preventive and management strategies. Methods: We discuss contributory factors associated with the development of hyperinflammatory fibrosis following HDL, including cumulative energy delivery, mechanical tissue trauma, lymphatic disruption, preexisting skin and soft tissue redundancy, and prolonged postoperative edema. Results: Comprehensive preoperative, intraoperative, and postoperative strategies are outlined to reduce the incidence of hyperinflammatory fibrosis and to effectively manage it when present in patients undergoing HDL. Conclusion: By understanding the underlying pathophysiology, recognizing procedural risk factors, and implementing targeted prophylactic and therapeutic interventions, surgeons can minimize hyperinflammatory fibrosis and optimize aesthetic outcomes in HDL.
Objective: To synthesise feedback from patients, general practitioners (GPs), and surgeons regarding the mandatory GP referral process for cosmetic surgery, evaluating its perceived value and effectiveness. Methods: Combined analysis of patient and GP questionnaires, plus an audit of referral letter accuracy. Results: A mixed response from patients was observed, including the value seen in the GP referral mandate and the benefit of involving a regular GP for coordination of care. Other patients expressed concern, identifying minimal benefit from the mandate and highlighting inconvenience and cost issues. Fifty-five percent of patients stated they found the overall process ‘useful’. GPs also had mixed responses, though a majority suggested limited benefits to the policy. An audit for GP referral letter accuracy showed discrepancies in 60% of cases. Conclusion: A variety of results show the new policy is not seen as advantageous by all involved. The significant financial burden placed on Medicare, and many patients individually, was also analysed. While value in a GP referral is clearly seen in certain circumstances, an optional GP referral policy for cosmetic surgery would appear to show further benefit.
Purpose: This case study is to set out a safer labiaplasty technique to minimize hematoma formation, developed by the lead author and now used and taught throughout the world. Labiaplasty, or labia minora surgical reduction, is commonly performed to remove redundant tissue that protrudes outside the labia majora for the purpose of alleviating aesthetic and functional discomfort. It is commonly performed under local anesthesia in the office setting, and laser technology is frequently employed. Although the general incidence of post-labiaplasty hematomas is not high, it is undoubtedly one of the most complicated procedures, often with challenging complications. Methodology: This new technique, described here and involving ligation of the dominant central artery after dissection but before full excision, could make this procedure a safer alternative. This case report also includes a retrospective series study, all involving initial follow-up at 2 weeks and 1 month after discharge with extended follow-up evaluations conducted at 3 and 6 months, and a table summary of related past published studies. Major Findings and Conclusion: That the new technique is resulting in safer labioplsty.
Background: High-definition body sculpting expects the adoption of contour lines that adhere to ideal proportions. In high-definition buttock contouring specifically, there remains a lack of guidance for ideal buttock height proportions. Interestingly, a disproportionately lower number of Brazilian buttock lift (BBL) surgeries are being completed by Caucasian patients. This disinterest may partially be attributed to their dislike of exaggerated buttock sizes following BBL surgery. However, to date, ideal buttock height proportions have not been established for Caucasian clients. Objective: We determined to clarify the ideal back-to-buttock height proportions in Caucasian patients desiring buttock enhancement. Methods: We examined 10 Caucasian models to establish the ideal back-to-buttock-to-upper-leg height ratios. We then compared this presumed ideal standard to 20 Caucasian patients desiring buttock enhancement. Results: We determined that the ideal back-to-buttock-to-upper-leg height proportions for Caucasian models measured 40:25:35, respectively. The back-to-buttock-to-upper-leg height proportions of Caucasian patients desiring buttock enhancement were noted to be 48:25:37. The back-height proportion was found to be significantly longer, and the upper-leg height was significantly shorter in actual patients when compared to the models. Interestingly, the buttock height proportion was nearly identical between the groups. These findings demonstrated statistically significant differences but, more importantly, a similarity that might clarify why Caucasian patients are less likely to desire buttock enhancement. Conclusion: The decreased interest in buttock enhancement by Caucasian patients may stem from the fact that their buttock proportions mimic those set by model standards. The actual discrepancy in height proportions stems from a longer back and shorter upper legs in patients seeking buttock enhancement. **Level of Evidence: Level IV, Evidence from Multiple Case Studies
Background: Ex vivo liposuction is a novel procedure which describes the liposuction of soft tissues following removal from the patient for the purpose of autologous fat grafting. The liposuction of soft tissues after they have been excised has been coined ex vivo liposuction and contrasts traditional liposuction techniques, coined in vivo liposuction. In vivo liposuction describes conventional liposuction of soft tissues while attached to the patient. Excisional procedures that may be considered for ex vivo liposuction include brachioplasty, medial thigh tuck, upper body lift, tummy tuck, lateral thigh tuck, buttock tuck, and lower body lift. Objective: To introduce ex vivo liposuction as an innovative technical advancement of traditional liposuction in high-definition body contouring procedures requiring tissue excision in the surgical plan. Method: This article discusses the technical details of ex vivo liposuction and several advantages over in vivo liposuction in 137 cases involving excisional surgery. Results: The first advantage of ex vivo liposuction includes the ability to harvest greater volumes of fat in patients with limited fat reserves. The second advantage includes improved quality of harvested fat that may optimize fat graft take. A final advantage involves improving liposuction safety by limiting blood loss, minimizing intraoperative times, and providing a platform for less experienced providers to master the art of liposuction. No incidence of fat graft infection, fat necrosis, or fat emboli was observed. Conclusion: This article introduces a novel liposuction alternative, coined ex vivo liposuction, that may help body contouring specialists optimize their high-definition body contouring safety and outcomes.
Background: We present a novel vertical axillary line protocol that offers several benefits to high-definition (HD) liposuction and body contouring procedures. High-definition liposuction and body contouring are predicated on addressing the body circumferentially in a 360-degree manner. The vertical axillary line protocol utilizes a vertical line drawn from the armpit or axilla down to the mid-lateral thigh. The benefits of this vertical axillary line to HD body contouring are derived from its ability to delineate the junction between the front and back halves of the body. Objective: The vertical axillary line provides safety measures and superior outcomes for HD body contouring cases. By gauging the halfway point when performing liposuction around the waist, the vertical axillary line avoids theoretical point burns from the tip of the ultrasound probe, promotes preservation of perforators during abdominoplasty, and even avoids inadvertent injury to breast implants. In addition, it helps clarify gender-specific contouring guidelines. Finally, it provides anatomical landmarks to guide preoperative surgical markings in excisional body lifting procedures, thereby ensuring symmetry of incision lines. Method: The HD vertical axillary lines are defined by the axillary folds located along the anterior and posterior aspects of the armpit. The apex of the axilla is used to set the mid-HD vertical axillary line. The anterior and posterior axillary folds define the anterior HD vertical axillary line and posterior HD vertical axillary line, respectively. These 3 points (anterior, mid, posterior) define the start point of the HD vertical axillary lines, which are then extended down through the mid-point of the lateral thigh. Results: We present 8 cases to demonstrate how the HD vertical axillary line protocol may improve safety measures and aesthetic outcomes. Conclusion: In summary, we present a novel HD vertical axillary line protocol that may help improve both safety and aesthetic outcomes in HD liposuction and body contouring surgeries. Level of Evidence: Level V, clinical experience
Introduction: Third-generation ultrasound-assisted liposuction (UAL) or vibration amplification of sound energy at resonance (VASER) combined with helium-based plasma technology (HPT) or Renuvion creates a sculpted aesthetic outcome, while optimizing skin tightening in body contouring. Material & Methods: A multicenter retrospective chart review assessed safety and efficacy combining UAL with HPT in body contouring of 160 consecutive adult patients presenting from 2018 to 2022 in 2 clinical cosmetic practices. A prospective study evaluated a subset of patients regarding the overall energy delivery measured with the device joule counter using the manufacturers recommended treatment parameters for different anatomical areas. Results: Patient satisfaction rate was 95% (152 of 160 patients) using the Global Aesthetic Improvement Scale with no patients noting no change or worse result. No patient experienced a serious adverse effect. The most common complication (14/160 or 8.8%) was a seroma with 9 (5.6%) experiencing minor contour irregularities. Five requested additional liposuction to treated areas. All areas of revision removed less than 10% of the volume removed during the initial liposuction. The overall surgical revision rate was 4.4% (7/160). Radiofrequency (RF) energy delivery for abdomen, flanks, and lower back was 13.8, 15.6, and 3.2 (kJ/cm 2 ), respectively. Keeping treatment planes between 1.3 and 2.3 cm apart achieved 3D RF energy delivery of abdomen, flanks, and lower back of 31.7, 32.8, and 3.9 (kJ/cm 3 ), respectively. Conclusions: Third-generation ultrasound-assisted body liposuction combined with internal RF helium-based plasma yields superior patient satisfaction and aesthetic results with no serious adverse effects. Manufacturer energy delivery guidelines appear both safe and effective. Surgeon subjective assessment revealed improved skin retraction over UAL alone by the addition of helium-based plasma.
A 20-year liposuction single-surgeon experience investigating physician qualifications, identifying a preoperative risk assessment, and confirming a perioperative surgical management protocol with Part 1 of the project. The progression of surgical technique and implementation of new technologies optimized the aesthetic results while minimizing complications and side effects in Part 2. Both retrospective and prospective clinical studies and PubMed literature searches were carried out on all variables involved in the different surgical techniques to include microcannula suction-assisted liposuction (mSAL), standard cannula size suction-assisted liposuction (SAL), water-jet–assisted liposuction (WAL), third-generation ultrasound (Vibration Amplification of Sound Energy at Resonance [VASER]) liposuction, laser-assisted liposuction (LAL), nutational infrasonic liposuction (NIL), high-definition VASER liposuction, helium-based plasma radiofrequency technology (HBT), and lipoabdominoplasty. The evolution of liposuction reviewing the historical transformations in surgical technique and technologies is presented. Physician qualifications regarding training and education guidelines highlighting interspecialty published differences. Noting the minimum accepted duration, degree, and type of liposuction training to practice liposuction safely for our patients. Identifying the standard of care controversies to avoid medical malpractice litigation. The preoperative evaluation details a comprehensive body analysis, weight loss consultation reviewing all options for medical and surgical weight loss management, liposuction clinical indications, informed consent process, risk assessment strategies regarding avoiding lidocaine toxicity prevention, fluid overload prevention, minimizing and estimating blood loss and bruising, analyzing maximum fat output, thromboembolism risk calculation and prophylaxis, and analysis of simultaneous and staged ancillary aesthetic procedures. The day of surgery includes preoperative medical assessment, photographic documentation, surgical marking, anesthesia delivery and airway concerns, postsurgical therapeutic options, and postoperative pain management to minimize narcotic use with the risk of addiction, all to minimize side effects and complications and optimize aesthetic outcomes. Review of the medical literature reviewing the historical highlights on the evolution of the liposuction technique and implementation of new technologies and use of personal clinical studies comparing different variables in a controlled setting, identified best practices. The current clinical liposuction technique used by the author offers a superior methodology in both an awake patient in an office-based setting and surgery setting environment by implementing a comprehensive preoperative risk assessment and risk avoidance strategies to minimize side effects and complications in Part 1 of this liposuction protocol. Employing the optimal defined surgical step variables with VASER high-definition liposculpting to achieve a slender, muscular appearance and adding HBT to maximize skin tightening along with postoperative maneuvers using fitted compression, therapeutic ultrasound, and lymphatic massage attains best practices in liposuction.
