Objective. To present an improved model for preoperative surgical risk stratification in aesthetic plastic surgery — S.A.F.E. Score 2.0. Material and methods. Considering modern literature data, clinical experience and previous system for objective assessment of risk factors in body contouring, we developed a multifactorial surgical risk assessment model incorporating 10 parameters of the patient and surgical intervention. Each factor has three-level risk gradation with appropriate scores (1/2/4). Results. An improved integrated scale for surgical risk stratification in aesthetic plastic surgery — S.A.F.E. Score 2.0 — was developed. The last one is based on previous system for objective assessment of risk factors in body contouring. Prognostic approach to temperature assessment is developed where inadvertent perioperative hypothermia is considered not as a fixed intraoperative condition, but rather as a predictor of surgical risk during preoperative planning. The scale integrates validated international risk stratification tools, including the Caprini scale for assessing the risk of venous thromboembolic complications. This enhanced validity and reproducibility of the model. Quantitative standardization of individual risk factors, including smoker’s index (pack-years), reduced subjectivity of clinical assessment and improved accuracy of surgical risk stratification. The updated S.A.F.E. Score 2.0 includes the following risk factors: surgery time, risk of inadvertent perioperative hypothermia, smoking status, combination of procedures, body mass index, surgical area, lipoaspirate volume, red blood cell counts, ASA grade and risk of thromboembolic complications (Caprini scale). The total score allows the patient to be classified into one of three surgical risk categories. The proposed model can be considered as a basic element of emerging surgical risk management system in aesthetic plastic surgery (S.A.F.E. System), integrating patient parameters, surgical characteristics and prognostic models for perioperative complications. Conclusion. The integrated S.A.F.E. Score 2.0 scale is a simple and reproducible preoperative risk stratification tool enabling standardized safety assessment in aesthetic surgical procedures.
Objective. To evaluate clinical effectiveness and safety of Ellagen injectable dermal filler containing a combination of hyaluronic and poly-L-lactic acids for correction of age-related skin changes in the face, neck and décollete, as well as face and body skin scars. Material and methods. The filler was injected twice with a 60-day interval. Effectiveness for age-related changes was assessed in 60, 120, and 180 days after the first injection using Wrinkle Severity Rating Scale (WSRS) and Lemperle scale. POSAS (Patient and Observer Scar Assessment Scale) was used to assess scars. Overall aesthetic improvement was evaluated with Global Aesthetic Improvement Scale (GAIS). Results. Fifty patients (age 25–58 years, 88% female) were enrolled; 46 ones were analyzed. Among 37 patients with age-related indications, significant improvement was observed after 180 days: mean WSRS score reduction by 1.22 points (100% improved by ≥1 point) and mean Lemperle score reduction by 0.86 points (70% improved by ≥1 point). Improvement was similar across different areas (cheeks, perioral area, preauricular area, neck). Among 20 patients with scarring, POSAS scores improved significantly by 7.00 (physician assessment) and 5.05 points (patient assessment) after 180 days. After 60 days, all patients showed GAIS improvement. After 180 days, 89% of aesthetic and 85% of scar cases improved. All adverse effects were expected and regressed without intervention. Conclusion. Ellagen demonstrated a clear rejuvenation effect, including wrinkle reduction, improved aesthetic skin characteristics, and decreased scar severity. Safety profile was assessed as favorable.
Objective. To analyze modern data on perfusion disorders in abdominoplasty taking into account anatomical features of blood supply to anterior abdominal wall, risk factors of ischemic complications, and objective assessment of tissue perfusion. Material and methods. Analytical review of national and foreign literature was devoted to vascular anatomy of anterior abdominal wall, features of microcirculation in abdominoplasty, influence of surgical technique on tissue perfusion and modern methods of objective monitoring. Results. Viability of adipocutaneous flap in abdominoplasty is determined by combination of factors, including anatomical organization of vascular network, microcirculation, extent of surgical dissection, and tissue tension distribution. Impaired perfusion is regarded as one of the key mechanisms underlying ischemic complications, such as necrosis of adipocutaneous flap, impaired wound healing and seroma. Modern methods for visualization of microcirculation, including indocyanine green fluorescence angiography, infrared thermography, and near-infrared spectroscopy, enable more accurate assessment of tissue viability and detection of local hypoperfusion. Conclusion. Understanding the anatomical and physiological features of blood supply to anterior abdominal wall and mechanisms of microcirculation impairment is essential for prevention of ischemic complications in abdominoplasty. Modern surgical techniques and objective perfusion monitoring can contribute to higher safety of procedure and better clinical outcomes.
Objective. To summarize current data on causes, risk factors, classification, prevention, and surgical treatment of breast implant malposition; to identify limitations of modern evidence base. Material and methods. A narrative literature review was devoted to breast implant malposition after aesthetic augmentation, revision procedures, and implant-based breast reconstruction. We reviewed the PubMed, Scopus, Web of Science, Google Scholar, and eLibrary.ru databases. The review included studies containing eligible data on etiology, risk factors, classification, corrective methods, complications, recurrences, and long-term outcomes. Qualitative analysis was performed without quantitative synthesis due to heterogeneity of available data. Results. Breast implant malposition should be regarded not as a single complication but as a group of deformities associated with failure of specific implant pocket boundaries, soft-tissue characteristics, implant plane selection, and implant properties. In primary aesthetic augmentation, the incidence of clinically significant malposition is approximately 1.5—8%. In reconstructive practice, the rate of lateral and inferior malposition reaches 9.8%. The most consistent data concern prevention, including precise pocket creation, preservation or reconstruction of inframammary fold, matching implant dimensions to tissue capacity, and consideration of muscular component in subpectoral placement. Data on surgical treatment remains predominantly retrospective and heterogeneous. The most common techniques include capsulorrhaphy, capsular flaps, implant plane change, inframammary fold reconstruction, and internal pocket reinforcement. Conclusion. Durable results after surgical treatment of breast implant malposition are determined by precise identification of deformity mechanism and complete restoration of implant bed support. The most significant data concern prevention, while results of surgical correction indicate the need for further standardization and accumulation of comparable data on complications and recurrences.
Objective. To analyze modern approaches to mandibular contouring, their effectiveness, safety, and future perspectives considering development of osseous surgical techniques and digital surgical planning. Material and methods. We reviewed the PubMed, Scopus, Cochrane Library, and RSCI databases covering publications between 2005 and 2025. Keywords in Russian and English were used. Randomized controlled trials, cohort studies, systematic reviews, meta-analyses, and technical descriptions of surgical techniques were included. Primary screening revealed 1582 articles. After removal of duplicates and screening of titles and abstracts, 169 articles were selected for full-text evaluation. Ultimately, 45 studies met the inclusion criteria. Results. Minimally invasive methods such as dermal fillers and autologous fat grafting are widely used and demonstrate favorable safety profiles. However, their effects are temporary with mean duration of approximately 13 months. Alloplastic implants allow predictable augmentation but they are associated with risk of infection (up to 23.8%), implant migration and bone resorption. Osseous procedures, including sliding genioplasty and Chin-wing osteotomy, provide anatomical correction. Mean chin advancement after genioplasty is approximately 6.5 mm with soft-tissue response ratio of 77—91%. This ensures high predictability of aesthetic outcomes. Conclusion. Osseous surgical techniques remain the most effective option for moderate-to-severe mandibular contour deformities. Advances in three-dimensional virtual planning and patient-specific surgical guides significantly improve surgical accuracy and clinical outcomes.
