Polyamide hydrogel fillers, including Aquafilling, were previously used for breast augmentation but have since been associated with severe delayed complications. We describe the case of a 51-year-old woman who developed sepsis with marked hypotension and extensive thoracoabdominal and pelvic soft-tissue abscesses approximately 10 years after bilateral breast Aquafilling injection. Imaging showed widespread migrated filler-related fluid collections involving the chest wall, axillae, abdominal wall, and pelvic regions. Emergent incision and drainage, followed by staged debridement, led to clinical improvement and near-complete radiologic resolution before discharge. No recurrent infection was observed 9 months postoperatively. This case indicates that migrated polyamide hydrogel filler may remain a long-standing nidus for culture-negative infection approximately 10 years after injection. Prompt staged surgical source control should be considered when extensive filler-related abscesses are suspected.
Background Thread lifting alone often provides insufficient volumetric reduction in the neck, whereas liposuction may not adequately address skin laxity. A combined approach was therefore developed to remove fat while improving skin laxity. We evaluated a minimally invasive neck-contouring method that combines counter-directional thread traction lifting with syringe liposuction to improve the cervicomental angle (CMA) and redefine the mandibular border.Methods Fifty-one patients who underwent combined syringe liposuction and absorbable thread lifting (MINT Lift EASY) were retrospectively reviewed. The procedure included 30–40 mL of syringe liposuction per side. Bidirectional traction was achieved using two lateral threads anchored to the platysma-auricular ligament for superolateral lifting and one central thread to pull the skin and platysma centrally. Outcomes were assessed using CMA change, liposuction volume metrics, the Global Aesthetic Improvement Scale, ultrasound imaging, and complications.Results Overall, 51 patients were included (12 men and 39 women; mean age, 40 years). The CMA decreased by 14.94° at postoperative day 1, and by 6.58°, 10.17°, and 11.58° at 1, 3, and 12 months, respectively. Liposuction volume analysis showed an aspiration-to-tumescent volume ratio of 60.3%, a sedimented fat-to-tumescent volume ratio of 23.8%, and a sedimented fat-to-aspiration volume ratio of 40.1%. Ultrasonography confirmed anchoring of the thread barbs to the platysma muscle.Conclusions The combined technique was associated with consistent improvement in the CMA and submandibular border definition, with only minor complications. Similar to the traction vector used in classical platysmaplasty, this bidirectional thread-lifting technique, using superolateral and central vectors, may help contour the neckline.
Background This study evaluated the efficacy and safety of a topical cream containing terpinen-4-ol and niacinamide after 1064-nm picosecond neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment for reducing facial hyperpigmentation.Methods This split-face study was conducted between December 2025 and March 2026 and included 27 patients who underwent treatment with a 1064-nm picosecond Nd:YAG laser. The right hemiface received a topical cream containing terpinen-4-ol and niacinamide immediately after laser treatment, whereas the left hemiface received laser treatment alone. Skin pigmentation was assessed using an automated skin analysis device. Melanin severity scores (MSSs) were evaluated on both hemifaces at baseline and 4 weeks after treatment. The right and left hemifaces were compared at baseline and 4 weeks after treatment.Results Skin pigmentation scores improved significantly on both hemifaces from baseline to 4 weeks after treatment (P<0.001). However, the improvement was greater on the right hemiface than on the left hemiface, and this interhemifacial difference was statistically significant (P=0.004). Similarly, MSSs improved significantly on both hemifaces from baseline to 4 weeks after treatment (P<0.001). The improvement in MSSs was significantly greater on the right hemiface than on the left hemiface (P<0.001).Conclusions Applying a topical cream containing terpinen-4-ol and niacinamide after 1064-nm picosecond Nd:YAG laser treatment was associated with greater reduction in skin pigmentation than laser treatment alone and appeared to be a safe adjunctive therapy, with no reported complications.
Lipogranuloma is a chronic inflammatory response to lipid material within tissues and may develop secondary to fat necrosis, trauma, or exogenous lipid exposure. We report a case of postoperative mid-sternal lipogranuloma with milky discharge in a 35-year-old man that occurred 6 months after surgery for gynecomastia performed through a periareolar incision with adjunctive liposuction. The patient presented with two firm, non-tender nodules at the sternal midline, distant from the operative site, and laboratory findings were unremarkable. Surgical exploration revealed milky white discharge, and histopathologic examination demonstrated lipid-laden macrophages, multinucleated giant cells, and fibrosis, consistent with lipogranulomatous inflammation. No evidence of malignancy or infection was identified, and no recurrence was observed during 2 years of follow-up. The proposed mechanisms include displacement of residual ductal epithelium or lipid material during surgical manipulation, as well as postoperative fat necrosis leading to secondary lipogranulomatous inflammation. This case highlights that postoperative lipogranulomatous inflammation may present at sites distant from the primary operative field. Recognition of this entity is important in the evaluation of postoperative chest wall masses to avoid misdiagnosis and unnecessary intervention.
Postmastectomy radiation therapy (PMRT) can compromise soft-tissue quality and cause progressive fibrosis and contracture, thereby complicating delayed breast reconstruction even after prior implant removal. Delayed reconstruction is particularly challenging when radiation-associated distortion of the breast and nipple-areola complex (NAC) coexists with contralateral ptosis, because achieving symmetry requires coordinated restoration of both breast contour and nipple position. We report the case of a 50-year-old woman with invasive ductal carcinoma of the right breast who underwent nipple-sparing mastectomy followed by immediate tissue expander reconstruction with acellular dermal matrix. During adjuvant chemotherapy, she developed a periprosthetic infection that necessitated expander removal and capsulectomy. She subsequently completed PMRT, after which progressive breast contracture and severe NAC distortion developed. Ten months after completion of PMRT, delayed breast reconstruction was performed using a muscle-sparing free transverse rectus abdominis myocutaneous flap, with excision of compromised mastectomy skin, simultaneous free NAC grafting onto the flap skin paddle, and contralateral mastopexy to improve symmetry. The postoperative course was uneventful, and breast symmetry improved relative to the preoperative condition. This case illustrates a practical reconstructive option for managing severe NAC distortion in an irradiated, contracted breast after prosthetic failure.
Lower eyelid ectropion is commonly associated with anterior lamellar shortening after transcutaneous lower eyelid surgery; however, severe ectropion may also develop in older adults even in the absence of skin deficiency. We report a case of marked lower eyelid ectropion in a 78-year-old woman following orbital floor blowout fracture repair via a subciliary incision. Despite minimal anterior lamellar involvement, revision surgery revealed dense middle lamellar fibrosis resulting in significant vertical restriction of eyelid excursion. Targeted adhesiolysis at the level of the arcus marginalis, combined with lateral tarsal strip fixation, successfully restored eyelid position, with stable results maintained at 1-year follow-up. Notably, retrospective review of postoperative magnetic resonance imaging demonstrated an early preseptal hematoma followed by fibrotic changes in the septal region, providing radiologic correlation with the intraoperative findings. Although this case originated from reconstructive surgery, it delivers a cautionary message relevant to aesthetic lower eyelid procedures: in older adults undergoing subciliary incisions, postoperative hematoma may precipitate middle lamellar fibrosis and severe ectropion even without an anterior lamellar defect, underscoring the importance of meticulous hematoma prevention.
Buttock augmentation is an increasingly popular cosmetic procedure designed to enhance buttock contour, size, and shape. However, the safety profile of this procedure remains insufficiently established, and it carries risks of complications, including foreign body reactions and infections. These complications may be exacerbated by filler migration, resulting in large soft-tissue cavities that resemble pseudocysts. In this study, we describe two patients who developed severe complications following massive filler injections to the buttocks. A 56-year-old female patient presented with a 6×5 cm soft-tissue defect associated with an extensive underlying dead space, sinus tract formation, and a large pocket extending across the buttock. Additionally, a 50-year-old female patient developed diffuse cellulitis and multiple abscesses secondary to migration of an infected filler-related pseudocyst. Both patients underwent successful en bloc capsulectomy, resulting in marked clinical improvement without recurrence or postoperative complications. These cases underscore the serious complications associated with large-volume filler injections and highlight the importance of comprehensive surgical management in addressing late-stage adverse outcomes.
Injectable fillers have become an integral component of contemporary aesthetic plastic surgery, accounting for a substantial proportion of non-surgical cosmetic procedures worldwide. This review provides a comprehensive overview of current injectable filler trends in China, with a particular focus on material characteristics, facial contour stabilization injection strategies, emerging treatment areas, and safety considerations. Commonly used materials include hyaluronic acid fillers, collagen fillers, and collagen stimulators such as calcium hydroxylapatite, poly-L-lactic acid, poly-D,L-lactic acid, and polycaprolactone. Each material exhibits distinct rheological and biological properties that influence clinical indications, injection depth, longevity, and associated risk profiles. In particular, collagen fillers and collagen stimulators have received increasing attention for subtle contour refinement and tissue quality improvement in delicate or large-surface areas. A facial contour stabilization philosophy that differentiates outer and inner facial aesthetic units is increasingly adopted to achieve balanced rejuvenation while minimizing the risk of overfilling. Beyond facial contour refinement, injectable fillers are increasingly utilized for hand, knee, and auricular rejuvenation. Finally, safety issues, particularly facial overfilled syndrome, are discussed, underscoring the importance of conservative planning, anatomical precision, and evidence-based clinical decision-making.
Aging of the jawline commonly results in jowl deformity due to skin laxity and descent of subcutaneous tissues. Traditional correction methods, including rhytidectomy, can effectively address these issues but often involve substantial invasiveness and recovery time. A less invasive, targeted approach for isolated jowl correction is desirable. We present a novel surgical method of direct jowl excision using a triangular full-thickness wedge excision combined with local flap advancement. The excision was meticulously planned along relaxed skin tension lines, avoiding underlying muscular and neural structures, and was followed by layered closure. In our case, a 66-year-old woman who was previously dissatisfied with the outcomes of conventional rhytidectomy underwent direct jowl excision. At the 12-month follow-up, the patient demonstrated marked improvement in jowl prominence and jawline contour, with minimal scar visibility along the mandibular border. No complications or adverse outcomes occurred, and patient satisfaction was notably high. Direct jowl excision offers a focused, minimally invasive alternative for patients with isolated jowl deformities. It provides significant aesthetic improvement with low morbidity, rapid recovery, and acceptable scar formation. This technique should be considered a viable adjunct in the surgical toolkit for facial rejuvenation in carefully selected patients.
Background Transconjunctival fat removal (TFR) is a widely practiced aesthetic procedure for lower eyelid bulging, with the traction method commonly used to secure the surgical field. However, this approach carries risks such as lower eyelid skin penetration and extraocular muscle injury. To address these concerns, a compression method that avoids energy devices and enables blunt dissection through orbital compression was evaluated. Methods A retrospective study was conducted of 60 TFR cases performed by a single surgeon between March 2024 and February 2025. Patients were categorized into compression (n=30) and traction (n=30) method groups based on the technique used for surgical field exposure. Postoperative complications were assessed over a 1-month period. Results No significant differences were found in baseline demographics. Postoperative complications occurred in three cases (10.0%) in the compression group and two cases (6.7%) in the traction group (P=0.640). All complications were mild and resolved without reoperation. No severe adverse events, including orbital hemorrhage, infection, or visual impairment, were observed. One case of residual orbital fat in the compression group was attributed to limited visualization due to orbital pressure. Conclusions The compression method demonstrated a safety profile comparable to that of the traction method and may serve as a viable alternative, particularly for less experienced surgeons. It offers a simplified and potentially safer approach for performing TFR, supporting its utility in clinical practice and surgical training.
A 42-year-old female patient presented with a complete ear amputation resulting from a collision with a machine. The ear was avulsed by blunt trauma, meaning that it was torn away rather than being cleanly cut. Fortunately, the auricular cartilage remained intact and preserved its overall shape despite the amputation. However, the surrounding blood vessels were not suitable for microanastomosis. In the first-stage operation, the auricular cartilage was de-epithelialized and embedded into the postauricular area. Three months later, during the second-stage operation, the embedded auricular cartilage framework was elevated to achieve normal auricular projection. During the postoperative period, a customized mold based on the shape of the patient’s contralateral ear was fabricated using 3D printing technology and applied to the reconstructed ear to refine the contour and achieve a natural appearance. The overall outcome was favorable, with no complications observed during the postoperative care period.
Copolyamide-based hydrophilic fillers, such as Aquafilling, have been used off-label for breast augmentation; however, their long-term safety remains uncertain. Here, we report a rare case of a 26-year-old woman who developed widespread, recurrent soft-tissue abscesses and an anterior mediastinal fluid collection several years after a copolyamide breast filler injection. The patient required multiple surgical interventions and prolonged antibiotic therapy, highlighting the risk of severe delayed complications. This case underscores the importance of patient education, vigilant monitoring, and clinical caution, particularly in recognizing the potential for late-onset systemic dissemination and complications such as migration and infection associated with copolyamide breast filler injections.
Background Ear keloids are benign, fibroproliferative scars characterized by excessive collagen deposition, often triggered by ear piercing or trauma. Their high recurrence rates and the anatomical constraints of the ear complicate treatment, leading to cosmetic and psychological distress. Methods Between February 2023 and April 2025, 58 patients underwent surgical excision of ear keloids, including complete resection of the piercing channel and exclusion of keloid-covered skin for reconstruction. Procedures were performed under local anesthesia, using wedge or elliptical excisions tailored to the keloid location. Postoperative management included intralesional triamcinolone (40 mg/mL) at suture removal and oral tranilast for 1 month, with additional injections administered for suspected recurrence. Patients were followed up monthly. Results A total of 63 keloid lesions were treated in 58 patients. Recurrence occurred in three patients (5.2%), all of whom were managed with additional injections or revision surgery. Complications included one case of wound dehiscence and one hematoma. The mean patient age was 28.2 years, and 94.8% were female. Most keloids (65.1%) were located on the helix or antihelix, primarily caused by piercing. Conclusions Wide excision avoiding keloid-covered skin, combined with intralesional triamcinolone and oral tranilast, achieved a low recurrence rate (5.2%) for ear keloids. This multimodal approach effectively addresses recurrence risk while preserving aesthetic outcomes, although long-term follow-up is necessary to confirm the durability of results.
Scar formation from prior blepharoplasty often disturbs the layered anatomy of the upper eyelid, complicating identification of the levator aponeurosis. This challenge is especially pronounced in revision cases where prior dissection or resection was excessive, producing complications such as unintended triple eyelid folds or injury to the levator aponeurosis. We propose a dual refinement technique: a top-down approach to adhesiolysis, which enhances levator identification under scarred conditions and use of an orbicularis muscle strap instead of muscle resection, thereby preserving tissue volume and buffering postoperative adhesion. Additionally, splitting the orbicularis muscle 3 mm inferior to the upper skin incision line maintains subincisional soft tissue, reducing the likelihood of unwanted adhesions and fold formation. This technique was applied in a complex revision case, achieving both functional correction and stable aesthetic results while minimizing complications.
Background Transconjunctival lower eyelid fat removal is widely performed in Asian aesthetic practice, yet the domain-specific outcomes and the effects of age or adjunctive procedures remain unclear. Methods Fifty patients (median age, 50 years) completed a 1-month postoperative assessment. Satisfaction with bulging, pigmentation, and laxity was evaluated using the 5-point Periorbital Satisfaction Likert Scale (PSLS). Preoperative and postoperative photographs were independently assessed by two blinded physicians, and their mean score constituted the physician rating. Nonparametric tests, receiver operating characteristic (ROC) curve analysis (area under the curve, AUC), and ordinal logistic regression were performed. Results Median patient scores were 5 for bulging and 4 for pigmentation and laxity. Physician scores were significantly lower for pigmentation (P<0.001) and laxity (P=0.002) but not for bulging (P=0.080). Patient–physician correlations were moderate to strong (ρ=0.55–0.70), and inter-rater reliability was good (intraclass correlation coefficient=0.78). Patients younger than 50 years rated bulging (P=0.026) and laxity (P=0.003) more favorably than older patients. ROC analysis identified age cutoffs of 54 years for bulging (AUC=0.61) and pigmentation (AUC=0.51) and 47 years for laxity (AUC=0.75). Age negatively predicted bulging (odds ratio [OR], 0.95) and laxity (OR, 0.94), whereas periosteal hyaluronic acid filler positively predicted bulging (OR, 6.90) and pigmentation (OR, 5.05). Conclusions One month after surgery, satisfaction is highest for bulging but declines beyond the late forties, particularly for laxity. Deep periosteal hyaluronic acid augmentation enhances outcomes in bulging and pigmentation. The PSLS demonstrated good convergent validity and may support age-specific, multimodal strategies for periorbital rejuvenation.
Reconstruction of full-thickness alar defects presents a significant surgical challenge. The nasal ala is centrally located on the face, and even minor differences in appearance become easily noticeable, necessitating meticulous surgical attention. Several techniques have been described for nasal ala reconstruction, including the nasolabial flap, bilobed flap, and composite grafts. However, these conventional methods are often inadequate for addressing full-thickness tissue deficits. This report describes the case of an 83-year-old female patient with alar asymmetry resulting from full-thickness tissue loss of the left nasal ala following basal cell carcinoma resection. The patient underwent a single-stage alar reconstruction using a nasolabial flap in combination with a hinge flap to reconstruct both the outer and inner linings. This case underscores the complexity of alar reconstruction in the setting of full-thickness tissue loss.
Background Buried suture double eyelid blepharoplasty (BSB) is among the most frequently performed cosmetic surgical procedures. To reduce the incidence of complications and to enhance the longevity of the double eyelid crease, upper eyelid lipectomy (UEL) is sometimes performed concurrently with BSB in patients presenting with thick upper eyelids. However, the effectiveness of this combined approach remains unclear. This study aimed to evaluate the impact of adding UEL to BSB on postoperative complications.Methods A retrospective review was conducted on 102 patients who underwent BSB performed by a single surgeon at our institution between January and December 2024. Patients were divided into two groups: those receiving BSB alone (monotherapy group) and those undergoing BSB combined with UEL (combination group). Clinical characteristics and the incidence of postoperative complications were compared between the groups.Results Sixty-one patients were assigned to the monotherapy group, and 41 to the combination group. Postoperative complications occurred significantly more frequently in the monotherapy group compared to the combination group (21.3% vs. 4.9%, P=0.035). Importantly, no objective complications were observed in the combination group, resulting in a significant reduction compared to the monotherapy group (P=0.025). Additionally, the addition of UEL significantly reduced postoperative complications and was identified as an independent predictor for decreased complications (odds ratio, 0.16; 95% confidence interval, 0.03–0.81; P=0.027).Conclusions Concurrent UEL performed with BSB is associated with a reduced risk of postoperative complications. The combination of these procedures may improve postoperative outcomes and enhance patient satisfaction.
