Report on the 13th National Congress AICPE (Associazione Italiana di Chirurgia Plastica Estetica) Held in Rome, Italy, 10–12 April 2026

Abstract

The annual congress of the Italian Association of Plastic Aesthetic Surgery (AICPE), with more than 700 members, represents one of the most relevant conference meetings in Europe relating to Aesthetic Plastic Surgery due to the number of participants and due to the faculty of invited speakers chosen for their renowned scientific value. The 13th meeting was held in Rome (Italy) from 10 to 12 April 2026. Key focus areas of the scientific program concerned breast (reduction, lifting supported or not by mesh, implant surfaces, augmentation), face and neck (lifting, blepharoplasty, malar implants, feminization), body (abdominoplasty and torsoplasty, post-partum and ex-obesity surgery, body and limb contouring, complication treatments) and nose surgery combined with medical innovations in energy devices, threads and aesthetic medicine procedures. Special attention was also given to the theme of the therapeutic role of aesthetic surgery, which is increasingly becoming an integral part of a clinical pathway useful for restoring the patient’s psycho-physical balance. Presented here is a report of the abstracts accepted due to their innovative or cutting-edge content that were selected to be given as oral presentations during the congress sessions. The 2nd edition of the Saccomanno memorial award for the best abstract presented by a young surgeon has been organized with the endorsement of Surgical Techniques Development by MDPI.

1. A New Algorithm for Masculine Chest-Wall Contouring in 560 Trans-Afab (Assigned Female at Birth) Patients: Clinical Outcomes and Patient-Reported Satisfaction Using the Trans-Q Questionnaire

• L. Scortecci and G. Lo Russo
• Day Surgery Maurizio Bufalini, Firenze
• BACKGROUND-AIM

Preoperative planning is a crucial aspect of chest-contouring surgery. Choosing the most appropriate surgical technique can be challenging, especially when multiple variables must be considered.

For this reason, we have described a new and simplified preoperative algorithm, applied to a cohort of 560 trans-AFAB (assigned female at birth) patients.

• METHODS

From 2016 to 2024, a total of 560 trans-AFAB patients underwent top surgery following the new algorithm, which uses the inferior border of the pectoralis major muscle as the main reference point to select one of three techniques: Periareolar incision (PA) when the nipple–areolar complex (NAC) is located on the inferior border of the pectoralis muscle;

Hemi-periareolar incision (EP) when the NAC is positioned above the inferior border of the pectoralis muscle; Double incision with free nipple graft (DI) when the NAC lies below the inferior border of the pectoralis muscle.

Complications, need for revisions, scar quality assessed with the Vancouver Scar Scale (VSS), and patient-reported outcomes collected through the TRANS-Q questionnaire were analyzed.

• RESULTS

The most frequently used technique was DI (82.4%), followed by EP (11.4%) and PA (6.2%). Hematoma occurred in 10.8% of patients, but only 1.7% required operative reintervention. Revision surgery was needed in 9% of cases.

The most common VSS score was 1, observed in 38.4% of patients.

The TRANS-Q questionnaire showed a significant improvement in postoperative well-being in the majority of patients (p-value: 1.41 × 10#¹#).

• CONCLUSIONS

This simple yet effective preoperative algorithm can rationally guide the selection of the surgical technique and optimize aesthetic outcomes in chest-contouring surgery for trans-AFAB patients.

High patient satisfaction and favorable surgical outcomes support the effectiveness of the proposed approach.

2. Correction of Severe Tuberous Breast Deformity with Anatomical Implants: A Case Series

• D. Dr. Pino
• Ospedale di Bressanone
• BACKGROUND-AIM

The correction of severe tuberous breast deformity represents a significant challenge for plastic surgeons due to complex anatomical constraints and high aesthetic expectations. This study aims to present our experience with personalized surgical approaches and the use of anatomical breast implants.

• METHODS

We report a case series of three patients with severe tuberous breast deformity treated using individualized surgical techniques tailored to the specific anatomical deformity and patient preferences, in combination with anatomical breast implants.

• RESULTS

The use of anatomical implants in combination with appropriate breast dissection techniques proved to be essential for achieving satisfactory aesthetic outcomes. All patients demonstrated a significant improvement in breast volume, shape and overall symmetry.

• CONCLUSIONS

In severe tuberous breast deformities, anatomical breast implants combined with a patient-specific surgical strategy represent an effective option to achieve stable and aesthetically pleasing results.

3. One-Stage Combined Correction of Tuberous Breast Deformity and Contralateral Ptosis in a Young Patient: A Case Report

• L.M. Lapalorcia ¹, G. Gualtieri ² and M. Candiani ³

¹ 

Specialista in Chirurgia Plastica, Ricostruttiva ed Estetica. Libero Professionista. Perugia, San Marino, Ferrara, Roma

² 

Specializzando in Chirurgia Plastica, Ricostruttiva ed Estetica, IV anno, Policlinico di Modena

³ 

Dirigente Medico UOC di Chirurgia Plastica, Professore a Contratto in Chirurgia Plastica, Università di Ferrara

• BACKGROUND-AIM

Breast asymmetries associated with tuberous deformities represent a significant surgical challenge, particularly in young patients, due to the complexity of the anatomical alterations and the associated aesthetic and psychological impact. The aim of this case report is to describe a combined and tailored surgical approach for the correction of a marked unilateral breast asymmetry, addressing different deformities on each side in order to restore symmetry, shape, and proportional balance of the breast complex.

• METHODS

An 18-year-old female patient presented with marked breast asymmetry, characterized by tuberous deformity of the right breast and ptosis of the left breast. On 28 August 2025, at Nova Clinic Srl (San Marino), the patient underwent right periareolar mastopexy using a Muti flap with placement of a Mentor M+ breast implant, combined with left reduction mammoplasty using an auto-prosthesis technique. In addition, bilateral breast lipofilling was performed with the injection of 50 g of autologous adipose tissue harvested from the abdominal region. The total operative time was 86 min.

• RESULTS

The postoperative course was uneventful, with no major complications observed. The combined surgical approach allowed the achievement of good breast symmetry, with improvement in breast shape, volume distribution, and overall proportions. The patient reported a high level of aesthetic satisfaction with the final outcome.

• CONCLUSIONS

The correction of breast asymmetry associated with tuberous deformity and contralateral ptosis requires a customized surgical strategy tailored to the specific characteristics of each breast. The combination of glandular remodeling techniques, breast implants, reduction mammoplasty with auto-prosthesis, and adjunctive lipofilling represents an effective and versatile approach for restoring breast symmetry and harmony in young patients, providing stable and satisfactory aesthetic results.

4. Preservation Breast Reduction: From Bell Shape to Hemispheric Form. A New Technique in Breast Reduction Surgery

• P. Vittorini
• Presidio Ospedaliero Villa Letizia -L’Aquila-
• BACKGROUND-AIM
• Background

Traditional breast reduction techniques rely on dermoglandular pedicles to preserve the vascular supply to the nipple– areola complex (NAC). However, in cases of gigantomastia or severe ptosis with a NAC–IMF distance exceeding 15–18 cm, these approaches may prove limiting in terms of projection, symmetry, and natural contouring.

• Objectives

To present a new breast reduction technique—Preservation Breast Reduction—that allows safe NAC elevation up to 20 cm without the use of vascularized pedicles, reshaping the breast from an elongated bell shape to a compact and projected hemispheric form.

• METHODS
• Materials and Methods

The technique consists of three key steps:

• Radial tension-free dermal plication above the areola to vertically shorten the mammary meridian and achieve stable NAC positioning at point A, without requiring a vascularized pedicle.
• Mobilization of the glandular base from the pectoralis major muscle, preserving both medial and lateral pedicles to ensure vascular supply to the NAC–glandular unit.
• En bloc resection of the lower quadrants, along a horizontal vector located 8–10 cm below the new NAC position. When needed, a central wedge excision with an inferior base is performed to further reduce volume and enhance breast conization.

The hemispheric shape is achieved by closing the glandular pillars along the central axis and anchoring the breast base to the pectoralis fascia in a craniocaudal direction.

• RESULTS

Applied to over 40 patients with gigantomastia or severe ptosis, the technique demonstrated high reliability in preserving NAC vascularity, achieving bilateral symmetry, and ensuring long-term aesthetic satisfaction. NAC elevation up to 20 cm was obtained with sustained vitality and natural upper pole projection, without the use of traditional pedicles.

• CONCLUSIONS
• Conclusions

Preservation Breast Reduction represents a conceptual and technical innovation in breast surgery. It redefines anatomical limits through a geometric, vector-based approach, overcoming the constraints of conventional techniques and offering a safe, stable, and effective solution even in the most complex cases.

5. The «Trefoil» Technique: Mastopexy with Three-Segment Fixation of the Inferior-Septal Pedicle

• M. Barsakov
• Pirogov Clinic, Saint-Petersburg American Academy of Aesthetic Surgery hospital, Dubai
• BACKGROUND-AIM

Correction of breast ptosis remains a demanding task in aesthetic surgery, especially in achieving stable upper pole projection and symmetrical nipple-areola positioning in moderate to severe ptosis. Traditional mastopexy techniques often fail to ensure lasting aesthetic outcomes.

• Objective:

To introduce and evaluate a patented original technique of mastopexy involving three-segment fixation of the lower- septal pedicle—the Trefoil Technique—developed by the author and protected by Eurasian patent No. 049059, issued 19 February 2025.

• METHODS

We operated on 108 patients aged 18 to 55 years with Regnault grade II–III breast ptosis from 2020 to 2024 according to the reported technique. The upper edge of the inferior-septal pedicle was vertically divided into three equal segments. Depending on the degree of ptosis, absorbable sutures were used to fix the segments to the pectoral fascia at 10, 12, and 2 o’clock:

• anterior edge for grade III ptosis,
• posterior edge for grade II–III,
• inner surface of the pedicle for grade II. Patients were followed up for 12–18 months.

• RESULTS

No areolar necrosis or persistent sensory loss was observed. Minor T-junction healing delay occurred in 2.6% of cases, managed conservatively. In 96% of patients, stable upper pole fullness and optimal areolar centralization were achieved. Upper pole projection demonstrated greater long-term stability than that observed in standard inferior pedicle-based mastopexies.

• CONCLUSIONS

The Trefoil Technique is a novel mastopexy method that provides durable breast shape and consistent upper pole fullness through anatomical tissue repositioning and multi-point fixation. It offers reliable outcomes with minimal complications and preserves both nipple vascularity and sensitivity. This technique serves as a strong, implant-free alternative to traditional inferior pedicle mastopexy.

6. Three-Flap Technique: A Novel Modification of Auto-Augmentation Mastopexy

• M. Barsakov
• Pirogov Clinic, Saint-Petersburg/The American Academy of Aesthetic Surgery Hospital, Dubai
• BACKGROUND-AIM

To develop and introduce into practice a technique of mastopexy based on the use of a modified Ribeiro flap, as well as elements of tissue movement and fixation designed to increase the stability of postoperative mastopexy. In addition, to give indications for the application of this surgical technique. The author called the technique «the three- flap technique».

• METHODS

We operated on 103 patients aged 18 to 53 years from 2019 to 2023 according to the reported method. These were patients with primary mastopexy, secondary mastopexy, and also patient with implant removal and one-stage mastopexy. The patients were followed up for 12–18 months to assess the stability of the result.

• RESULTS

In our observations of patients, we noted greater stability of the breast shape and filling of the upper pole. We did not have to resort to anchor scars, only an inverted T-shaped scar.

In the postoperative period, among the complications, we sometimes observed poor healing of the sutures in the area of the T-shaped scar. No vascular or neurological complications of the nipple-areolar complex were observed. Among those who became pregnant and gave birth in the postoperative period, there were no problems with lactation.

• CONCLUSIONS

Thus, in the world of plastic surgery methods of breast lift continue to improve, which is especially relevant in modern times, due to the increased attention to this operation.

The author’s proposed method of mastopexy with dermo-glandular autoflap allows obtaining in most cases a stable result, a fuller breast shape, avoiding the presence of extended anchoring scars, and also preserves the possibility of lactation.

The author of this article has obtained a patent for invention for this method of mastopexy.

7. J-Mastopexy with Double-Dermal-Pillar: Personal Approach

• A. Bruno
• Private Practice—Clinica Santa Maria di Leuca, Roma
• BACKGROUND-AIM

Short-scar mastopexy and reduction mammaplasty continue to evolve to optimize durable breast projection while reducing visible scarring and tension-related complications. Inferior-pedicle and inverted-T patterns are historically linked to progressive N-IMF elongation and pseudoptosis. This study describes our personal superior-pedicle mammaplasty using a J-shaped scar, round block (periareolar tightening) suture, and a double-faced central dermal pillar to enhance long-term support and shape.

• METHODS

We retrospectively analyzed 150 consecutive patients treated from January 2019 to December 2023 (116 mastopexies, 34 reductions up to 800 g). Standardized pre-operative markings identified a stable upper breast border as reference for NAC emergence. All cases used a superior or supero-medial pedicle, a limited central 5-mm dermal margin for closure, and creation of a 2-island dermal flap sutured dermis-to-dermis to form a robust central pillar. De-epithelialization was followed by a periareolar Hammond interlocking round block suture (2/0 PDS) to prevent N-IMF lengthening. When indicated, lateral chest wall liposuction and selective upper-quadrant lipofilling were added. No suction drains were placed. Outcomes included complications, need for revision, and NAC sensitivity preservation.

• RESULTS

No major complications, seromas, hematomas, or areolar necrosis occurred. Seven patients (4.7%) developed limited wound dehiscence at the J-curve, all resolved conservatively; 2 cases (1.3%) required minor scar revision under local anesthesia. No bottoming-out, secondary ptosis, or high-riding areola were observed. NAC sensitivity was preserved or promptly recovered in 98.6% of patients, with 2 transient hypoesthesia cases showing full return by 3 months.

• CONCLUSIONS

Superior-pedicle J-scar mammaplasty combined with an interlocking round block suture and a double-faced central dermal pillar yields reproducible, long-lasting breast conization and projection while significantly shortening vertical scar burden and mitigating pseudoptosis vectors. The technique demonstrates a low complication and revision rate, preserves NAC neurosensitivity, and expands short-scar applicability to moderate-to-significant ptosis, providing a reliable option for esthetic and functional breast reshaping.

8. Augmentation Mastopexy with Lightweight Breast Implants: Clinical and Aesthetic Outcomes at 24- Month Follow-Up

• C.M. Mele ¹, V. Rullo ² and S. D’Antonio ²

¹ 

Villa del Pino Clinic, C.so Vittorio Emanuele, 494, 80137 Naples, Italy

² 

Division of Plastic Surgery, AOU Federico II, Via S. Pansini, 5, 80131 Napoli (Na), Italy

• BACKGROUND-AIM

Augmentation-mastopexy is a complex procedure requiring both soft tissue support and long-term aesthetic stability. Implant weight is a key biomechanical factor contributing to inferior pole elongation and secondary ptosis. Lightweight Polytech B-Lite implants reduce implant mass by ~30% while maintaining volume and shape, potentially improving tissue sustainability. The aim of this study was to evaluate clinical, aesthetic, and patient-reported outcomes of B-Lite implants in prepectoral augmentation-mastopexy.

• METHODS

We retrospectively reviewed 73 female patients (146 breasts) undergoing primary prepectoral augmentation- mastopexy with B-Lite implants between January 2020 and December 2024. Inclusion criteria were ptosis ≥2#cm, BMI ≤30, and no previous breast surgery. Follow-up averaged 26.4 ± 9.1 months. Outcomes assessed included postoperative complications, standardized photographic evaluation of breast shape and projection, and BREAST-Q scores for satisfaction and quality of life.

• RESULTS

Mean implant volume was 325 ± 55#cc. Overall complication rate was 9.0%, including minor wound dehiscence in 4.1% and seroma in 2.7%; no hematomas or implant losses occurred. Late complications were capsular contracture (Baker ≥ II) in 2.7% and secondary ptosis in 4.1%. Revision surgery was required in 4.1% of cases, mainly for minor aesthetic refinements. Photographic assessment demonstrated stable upper-pole fullness and nipple–areola complex positioning. BREAST-Q scores significantly improved postoperatively: satisfaction with breasts 83.6 ± 9.4, psychosocial well-being 86.1 ± 8.7, and physical well-being 81.9 ± 10.2.

• CONCLUSIONS

Lightweight B-Lite implants in augmentation-mastopexy are associated with low complication rates, stable long-term aesthetic outcomes, and high patient satisfaction. Reduced implant weight may decrease biomechanical stress on soft tissues, supporting more durable and physiologically sustainable results.

9. Augmentation Mastopexy with Polyurethane-Coated Implants in the Prepectoral Plane: A 24-Month Follow-Up Study

• C.M. Mele ¹, A. Murante ¹, E. Auriemma ¹, G. Esposito ², L. Castiello ¹, V. Rullo ² and S. D’Antonio ²

¹ 

Villa del Pino Clinic, C.so Vittorio Emanuele, 494, 80137 Naples, Italy

² 

Division of Plastic Surgery, AOU Federico II, Via S. Pansini, 5, 80131 Napoli (Na), Italy

• BACKGROUND-AIM

Augmentation mastopexy addresses breast ptosis and volume loss. This study evaluates aesthetic stability, complication profile, and patient satisfaction following prepectoral placement of polyurethane-coated implants, with selective autologous fat grafting.

• METHODS

From January 2019 to December 2023, 169 patients (338 breasts) underwent augmentation mastopexy with round polyurethane-coated implants placed in the prepectoral plane. Selective fat grafting was performed in patients with thin soft tissue (pinch test < 2 cm) or asymmetries. The primary endpoint was nipple-to-jugular distance (NJD) to assess breast stability. Secondary outcome was nipple-to-inframammary fold (NAC–IMF) distance. Follow-up was conducted at 1, 6, 12, 18, and 24 months. Patient satisfaction was assessed at 12 months using a 5-point Likert scale. Complications were recorded.

• RESULTS

Mean preoperative NJD was 27.4 cm, decreasing to 21.5 cm at 1 month and remaining stable at 22.4 cm at 24 months (p < 0.001). NAC–IMF distance showed minimal change over 24 months (6.7 cm preoperative vs. 6.9 cm at 24 months). Complications were low: one capsular contracture (0.6%), one implant infection (0.6%), two minor wound dehiscences (1.2%), and three cases of delayed areolar healing (1.8%). No hematomas, seromas, or implant malpositions were observed. Patient satisfaction was high, with 78% rating results as “very satisfied” (score 5). Adjunctive fat grafting in 26 patients was safe, without major complications.

• CONCLUSIONS

Prepectoral augmentation mastopexy with polyurethane-coated implants provides stable, long-term breast positioning, low complication rates, and high patient satisfaction. Selective fat grafting enhances contour in thin tissue or asymmetries. This technique appears a reliable alternative to traditional submuscular or dual-plane approaches, combining aesthetic stability with minimal morbidity. Longer-term and larger studies are warranted to confirm these findings.

10. Autologous Internal Bra in Augmentation Mastopexy

• C. Crisafulli
• Gulglam Clinics
• BACKGROUND-AIM

A modified version of the Ribeiro flap used to protect and give support to the implants for a natural and long lasting result in primary and revision augmentation mastopexy.

• METHODS

Pre-operative planning, right implants selection and intra-operative technique will be exposed and shared in order to add another option to the synthetic internal bra used in the augmentation mastopexies.

• RESULTS

Evaluation of several cases with long term results and discussion about pro and cons of my technique.

• CONCLUSIONS

In my practice, in the middle east, treating several complicated cases and dealing with important skin laxities and poor skin quality I believe that the autologous internal bra is a good solution which leads to long lasting and natural results avoiding the use of a synthetic mesh.

11. Complementary Techniques in Mastopexy with Elastic Threads: A. Suspension and Conization, B. Intra-Areolar Reduction of the Areolas, C. Injectable Volume Augmentation

• S. Capurro
• Ex Director Plastic Surgery and Burns Division San Martino Hospital Genoa
• BACKGROUND-AIM

Patients are increasingly requesting improvement of sagging or deflated breasts that avoid the need for breast implants and provide a natural result. Elastic mastopexy with de-epithelialization is our preferred option for patients with a conformable breast volume. This procedure maintains the integrity of the breast stroma. The implantation of an elastic suspension thread ensures long-term results.

When breast volume is deficient, as often occurs in breasts that have lactated, and the patient is skinny and does not wish to have an implant, the surgeon faces a problem.

To solve this problem, we have considered injecting breast volume restoration after correcting the ptosis with elastic threads, if evident. For these patients, we decrease the size of the areola when it is excessively large.

• METHODS

Patients selected for injectable augmentation are predominantly young with small, sagging, or slightly drooping breasts. Ptosis, if present, is corrected with elastic thread implants. Large areolae are reduced with intraareolar excisions. The augmentation is performed with an injectable technique we have been using for over ten years on the face, called Volumetric Revitalization.

• RESULTS

The results are exciting and extremely well-received by patients. Ultrasound and mammography examinations before and after were regular without artifacts.

• CONCLUSIONS

Given the results achieved on the face, we believe that Volumetric Revitalization of the breast will yield more long- lasting results. Repeated injection augmentation can achieve a sufficiently stable increase in volume. This technique will satisfy patients who do not want breast implants despite having small breasts, as well as patients with sagging breasts unsuitable for elastic mastopexy, whose breasts can be lifted and enlarged. This in an extremely simple and economical way.

12. Flower Mastopexy: A One Stage Tailored Augmentation Mastopexy with Soft Tissue Support for Safe and Predictable Results. Our Experience with 238 Consecutive Patients

• G. Bistoni ¹ and F. Sofo ²

¹ 

Bistoni Plastic Surgery Clinic, Valencia

² 

Campus Biomedico Roma

• BACKGROUND-AIM

Augmentation mastopexy remains one of the most complex operations in the field of aesthetic surgery, with revision rates as high as 40%. When native breast volume is insufficient, deflated as a consequence of pregnancy or weight loss, an implant is often needed to achieve long term upper pole fullness. In view of this, surgeons have strived to obtain additional lower pole support, with the use of scaffolds.

• METHODS

The flower mastopexy has been used for primary and secondary cases of augmentation mastopexy for 6 years on 238 cases. Complications, satisfaction and stability have been evaluated.

• RESULTS

At one year, no patient presented with ptosis recurrence. Re-operation rate was <5%, main indication being upsizing. No drains were used in primary cases. Overall complications were of 14.5%. All but three patients reported high or very high satisfaction score.

• CONCLUSIONS

The combination of implants with scaffold reinforcement and tailor tack tissue remodeling has been beneficial in reducing the complication and re-operation rates. The flower augmentation mastopexy with soft tissue support can be considered a safe and reliable technique.

13. How to Solve Breast Ptosis with Hypoplasia and Abdominal Laxity by a Single Combined Approach

• E. Riggio
• Fondazione IRCCS Istituto Nazionale dei Tumori, Milano—Private practice in Milano, Palermo
• BACKGROUND-AIM

Mastopexy combined to augmentation is known to be difficult when a simultaneous surgery is performed. At the same time, the reverse upper abdominplasty is also known amd used if redundant skin and fat need to be removed from the upper abdomen thorugh pulling the skin upward and closes the incision along the folds beneath the breasts. By presenting this case surgery, we have tried to apply a disrumpting strategy, with the aim of merging the surgical procedures of breast augmenation and pexy, tummy tuck reshaping and reconstrutive tools, all together, in a single challenging stage in order to reach a total lifting of the trunk with short-scars invasivity.

• METHODS

We select the patient based on the anatomical defects simultaneously presented and on her expections for a global reshaping of breast and trunk using scar.lenghts in breast and abomen as minimal as possible.

A patient was enrolled and here the clinical onset:

Age 48 yrs—BMI 23.2—No smoke—Pregnancy: 1.

BREAST:

-

Large thorax with more prominent the upper right side;

-

Ptosis grade 2 with severe pseudoptosis;

-

Low Resilience: more compliant less stiff

-

APSS (Anterior Pull Skin Stretch) > 2 cm;

-

Pinch-test 3 cm;

-

Diameter 16 cm;

-

Pre A-IMF 12.5 cm at max.stretch;

-

Areola radius 2.5 cm and G-N 27, 5–27 cm

ABDOMEN: excessive skin and fat hanging, caused by weight changes and pregnancy, mostly exented at the upper half. FLANKS: fatty pads.

• The surgical strategy planned six surgical procedures: (a) breast sub-pec/verticalplane augmentation via submammary fold incision; (b) mastopexy through peri-areolar and submammary short; (c) reverse upper abdominoplasty; (d) use of a mesh to support breast and abdomen (biologically-derived, bioabsorbable 2D scaffold of P4HB poly-4-hydroxybutyrate); (e) breast volume supply and by an anterior intercostal artery perforator flap (like-ICAP flap) flipped over the new inframammary fold; (f) liposuction from abdomen to flanks.

• RESULTS

The fundamental surgical steps of the surgery were video-recorded to illustrate the technical details in the oral presentation.

Surgery time: less than 5 h. Breast Implants; perle 255 MP. Flanks—Liposuction: 800 cc for side, One drain for breast side.

Hospital stay: day surgery.

Recovery time to normal activities: 10 days, No physical efforts for one month, Follow-up 14 months. No reported relapse of ptosis and abdominal hanging.

Complications: only left submammary scar diastasis corrected in local anesthesia after 6 months. Patient Satisfaction; Optimal.

• CONCLUSIONS

Vision and strategy are mandatory in every surgery and must be supported by experience, A multi-faceted combined surgery, as the reported case, for a customized body makeover presents limitations as the good candidates to this surgery based on anatomical charactheristics and psyco-physical attitude of the patient, skilled experience in breast aesthetic surgery and reconstructive perforator flaps. The evolution of the plastic aesthetic techniques often pass through the trasformation and the suggestions coming from the reconstructive side of our speciality.

14. Mastopexy and Breast Augmentation: Case Series with Microtextured Ultraligh Implants with P4HB Mash and Polyurethane Implants vs. Textured Implants

• A. Amoroso
• Care e Beauty Surgery
• BACKGROUND-AIM

Mastopexy and breast augmentation techniques have undergone significant developments with the introduction of new types of implants and supporting materials. This study compares the aesthetic results of three groups of patients treated with microtextured ultralight implants and 5PHt mesh support, polyurethane-coated implants and traditional microtextured implants, respectively. The objective is to evaluate the behavior of breast tissue to determine the aesthetic advantages of the different solutions.

• METHODS

Thirty patients were included in the study, divided into three groups of ten each: group A (ultralight microtextured implants with 5PHt mesh), group B (polyurethane-coated implants) and group C (traditional textured implants). All patients underwent mastopexy and breast augmentation. Parameters evaluated included lower pole ptosis, measured at 6 and 12 months after surgery, and lower pole tissue thickening, assessed by ultrasonography and clinical examination. Aesthetic outcomes were also assessed by Patient Satisfaction Questionnaire (PSQ).

• RESULTS

Ptosis of the lower pole and thinning of tissues inferiorly and laterally was observed in two patients in group A and three in group B, while in group C, these features were observed in 8 patients. The p value obtained from the chi-square test (0.0149) is highly significant, suggesting that there are substantial differences between the groups in terms of the complications considered. Groups A and B showed significantly less lower pole ptosis than group C at 6 and 12 months. Lower pole thickening was greater in groups A and B than in group C, providing better support and a more natural cosmetic result. Patients in groups A and B reported a higher level of satisfaction (>4) than in group C (<4), indicating an appreciation for the aesthetic results achieved.

• CONCLUSIONS

The use of ultralight microtextured prostheses with 5PHt mesh (group A) and polyurethane prostheses (group B) has significant advantages over traditional textured prostheses in reducing lower pole ptosis and thickening the lower pole, thus improving the aesthetic results and patient satisfaction. This study supports the adoption of these two advanced technologies for mastopexy and breast augmentation procedures.

15. Mastopexy-Augmentation as a Compromise Procedure: Insights from a Retrospective Analysis of Long-Term Morphological Evolution Using Inferior Muscular Support

• M.C. Servillo
• Clinica Villa Stuart, Roma
• BACKGROUND-AIM

Mastopexy-augmentation is considered one of the most complex procedures in aesthetic breast surgery due to the need to reconcile often competing goals: glandular–cutaneous lifting, volumetric enhancement, and long-term morphological stability. Despite the standardization of surgical techniques, the final outcome is strongly influenced by the interaction between lifting vectors and implant-induced expansion forces. The aim of this study is to analyze the long-term evolution of outcomes and to discuss mastopexy-augmentation as a structural compromise procedure rather than a maximization of aesthetic goals.

• METHODS

A retrospective analysis was conducted on 213 patients who underwent mastopexy-augmentation with a follow-up ranging from 1 to 5 years. Patients were stratified according to the mastopexy pattern, and implants of different shapes and surfaces were selected based on the clinical presentation. In all cases, an inferior muscular support was employed, using either a triple-plane or a lower dual-plane technique, in order to provide additional control of the lower pole. Outcomes were evaluated over time through clinical follow-up, standardized photographic documentation, and three- dimensional imaging analysis using dedicated 3D software. The analysis focused on breast shape evolution, lower pole stability, and the occurrence of instability signs such as bottoming-out, secondary ptosis, or waterfall deformity.

• RESULTS

Longitudinal analysis showed that, despite the systematic use of inferior muscular support, outcome evolution varied significantly depending on the mastopexy pattern and the type of implant used, reflecting different balances between skin tension and implant load. Periareolar mastopexies demonstrated satisfactory results in selected cases but showed greater sensitivity to shape changes over time. Vertical and inverted-T mastopexies provided a more favorable balance between projection and lower pole control, although outcomes varied according to implant surface selection and tissue quality. No single approach proved universally superior; rather, each configuration exhibited specific advantages and limitations, confirming the intrinsic compromise nature of the procedure.

• CONCLUSIONS

Mastopexy-augmentation should be interpreted as a structural equilibrium procedure, in which inferior muscular support represents a valuable but not standalone tool. Retrospective long-term analysis demonstrates that morphological stability does not rely on a single technical choice, but rather on the conscious acceptance of trade-offs among lifting strategy, implant selection, and tissue response. Realistic planning and appropriate selection of these elements remain the key factors for achieving durable and coherent results.

16. Multilayered Fat-Grafting Mastopexy for Anatomical Volume Redistribution and Improved Breast Projection

• G. Giunta ¹, J. Hannouille ² and M. Hamdi ³

¹ 

Department of Plastic, Reconstructive and Aesthetic Surgery University Hospital (UZ) Brussels—CHIREC—Hôpital Delta, Brussels

² 

Service de Chirurgie Plastique Hôpital Universitaire de Bruxelles

³ 

Department of Plastic, Reconstructive and Aesthetic Surgery University Hospital (UZ) Brussels—CHIREC—Hôpital Delta, Brussels

• BACKGROUND-AIM

In mastopexy, achieving upper-pole fullness and long-term projection is often possible only with implants. Yet an increasing number of patients either prefer to avoid prostheses or request their removal (explantation surgery). This growing demand underscores the need for autologous strategies that provide structural support and projection without implants. We describe a three-plane fat-grafting mastopexy that uses multilayered volume redistribution to restore projection and refine breast contour in both primary and post-explant indications.

• METHODS

Between 2022 and 2024, 34 consecutive patients (mean age 38.2 years, BMI 25.1 kg/m²) underwent autoaugmentation mastopexy with multilayered autologous fat grafting. The procedure combines a Wise-pattern superior pedicle, volume-redistribution reshaping, and sequential fat grafting performed in three distinct planes:

• Intramuscular plane (pectoralis major) to restore basal projection;
• Intra-flap plane within the dermoglandular tissue to enhance the inferior pole;
• Subcutaneous plane for contour refinement and upper/medial pole enhancement. Patients were evaluated at 6 and 12 months for projection, breast symmetry, and patient satisfaction (5-point Likert scale). Complications and revision rates were recorded.

• RESULTS

Mean total graft volume was 150 mL per breast. No major complications occurred. Two patients (5.8%) developed small oil cysts. At 12 months, the projection ratio (upper/lower pole) improved, with maintained upper-pole convexity. Ninety-four percent of patients rated their overall satisfaction ≥4/5. No secondary implant augmentation was requested.

• CONCLUSIONS

Three-plane fat-grafting mastopexy offers a safe, reproducible method for autologous breast enhancement. By redistributing volume across complementary anatomical planes, the technique provides durable projection, harmonious contour, and high satisfaction—representing a valuable alternative for patients seeking implant-free or post-explant breast reshaping.

17. Nightmare Complications in Aesthetic Plastic Surgery: Recognition, Treatment, and Resolution

• S. Taglialatela Scafati ¹ and M. D’Alessio ²

¹ 

Plastiké STP, Napoli

² 

Studio d’Alessio, Napoli

• BACKGROUND-AIM

A common and dangerous misconception among patients is that aesthetic plastic surgery is inherently “complication- free.” In reality, plastic surgery is a fully fledged surgical discipline, and complications may range from mild and self-limiting to severe, unexpected, and potentially life-altering. To outline a pragmatic, science-driven approach to the prompt recognition, structured management, and definitive resolution of major complications in cosmetic plastic surgery.

• METHODS

When serious complications occur, the surgeon must remain objective and act according to evidence-based principles. Meticulous follow-up, persistence, and a high level of commitment are often required to restore both physical outcomes and psychological well-being. We will present five “nightmare” complications, each supported by sequential photographic documentation and video material, covering the entire clinical timeline: initial recognition, progression, decision-making, and final solution.

• RESULTS

The cases include: (1) skin necrosis following mastopexy, (2) infections caused by highly antibiotic-resistant staphylococcal strains, and (3) implant malposition/displacement with significant functional and psychological impact, among other challenging scenarios. For each case, key warning signs, pitfalls, and step-by-step corrective strategies will be demonstrated through standardized visual documentation.

• CONCLUSIONS

Severe complications in aesthetic plastic surgery demand composure, scientific reasoning, and tenacious longitudinal care. A structured, documented pathway from recognition to resolution can improve patient safety, optimize final outcomes, and support patients through the psychological burden that may accompany these events.

18. Octopus Mastopexy: An On-Demand, Tension-Free Approach to Simultaneous Augmentation–Mastopexy

• S. Taglialatela Scafati ¹, F. Russo ² and G. Polverino ²

¹ 

Plastiké STP, Napoli

² 

Divisione di Chirurgia Plastica, AOU “Federico II”, Napoli

• BACKGROUND-AIM

Simultaneous augmentation–mastopexy remains one of the most challenging procedures in aesthetic breast surgery, requiring a precise balance between volume enhancement and durable tissue tightening. Conventional techniques are frequently associated with recurrent ptosis, excessive tension on wound closure, and increased complication and revision rates.

• METHODS

A retrospective review was conducted of patients undergoing primary or secondary augmentation–mastopexy using the Octopus Mastopexy technique between January 2019 and January 2024. All procedures were performed by the senior author. The technique represents a standardized refinement of the inverted-T approach and is characterized by an implant-first sequence, selective and on-demand parenchymal reduction, and multivector pillar mobilization to evenly redistribute tension across the breast mound. Patient-reported outcomes were evaluated using the BREAST-Q questionnaire administered preoperatively and at a minimum of 12 months postoperatively.

• RESULTS

Ninety-five patients were included, with a mean age of 39.2 years and a mean implant volume of 300 cc. No major complications were observed. Minor wound dehiscence occurred in two patients and was managed conservatively. Six patients required revision due to recurrent glandular laxity or significant weight changes. BREAST-Q scores demonstrated significant postoperative improvement across all domains, including satisfaction with breasts, physical well-being, and psychosocial well-being.

• CONCLUSIONS

The Octopus Mastopexy provides a safe, stable, and reproducible solution for simultaneous augmentation–mastopexy. By minimizing closure tension and ensuring reliable nipple–areolar complex vascularization, this technique achieves durable aesthetic results while reducing complication and revision rates.

19. Oncoaesthetic Techniques in Breast Lifting for Restoring the Natural Breast Beauty

• M. Riccio, F. De Francesco and A. Aquinati
• SODC di Chirurgia Ricostruttiva e Chirurgia della Mano—AOU delle Marche, Ancona
• BACKGROUND-AIM

The modern standard of care for women affected by breast cancer is based on demolitive surgery and simultaneous breast reconstruction including controlateral breast’s symmetrization and nipple-areola complex (NAC) reconstruction. This operative approach has many patients advantages and at the same time reduces surgical times without compromising aesthetic outcomes. Total aesthtetic breast reconstruction (TABR) is a tailor-made compartimental hybrid breast reconstruction able to create an harmonic new breast in terms of shape, volume, projection, tissue composition, symmetrizzation with controlateral breast and nipple areola complex reconstruction. Nowadays, it is always recommended when it is possible considering type of cancer and patient’s anthropometric data.

• METHODS

We usually prefer total aesthetic breast reconstruction (TABR) using implants and autologous tissue (fat grafting and/or flaps) and finally we rebuild nipple areola complex (NAC) using fix-nip. In the past five years, we performed hybrid total breast reconstruction in 147 cases, using the fix-nip approach in 70 cases (65 monolateral and 5 bilateral). In 128 patients, we combined implants with autologous adipose tissue, while in 19 cases, we used flaps alongside adipose tissue. Our results showed a reduction in severe capsule contractures, relief of pain, and high patient satisfaction across all treated cases.

• RESULTS

The morphological outcomes achieved through hybrid compartmental breast reconstruction were superior to those obtained with prosthetic or solely autologous techniques. The hybrid compartmental technique allowed us to create new breasts with improved shape and projection, favorable texture, and reduced capsule contracture and pain. The implementation of the fix-nip technique facilitated a more projected and stable areola-nipple complex over time.

Various surgical techniques, from prostheses to autologous tissues, are available for breast reconstruction, but no single method consistently provides optimal results. Total aesthetic hybrid breast reconstruction can effectively create a natural, well-projected, and symmetrical new gland in a single stage. This technique combines the benefits of prosthetic implants—restoring volume and projection—with those of autologous adipose tissue, minimizing profile irregularities and improving projection where needed. Additionally, the fix-nip technique has enabled the creation of a more naturally projected and sensitive areola-nipple complex.

• CONCLUSIONS

Total hybrid tailored breast reconstruction has become a crucial approach to achieving optimal outcomes in terms of natural breast beauty. It combines the advantages of prosthetic implants—providing volume and projection—with those of autologous adipose tissue, minimizing profile irregularities while enhancing projection where necessary. Furthermore, the fix-nip technique has significantly enhanced the projection and sensitivity of the areola-nipple complex, leading to increased patient satisfaction.

20. Submuscular Autoprothesis in Mastopexy, My Best Choice for Long Term Results

• L. Canta
• Università Degli Studi di Napoli Federico II
• BACKGROUND-AIM

Mastopexy remains a challenging procedure, particularly when long-term shape stability and upper pole fullness are desired without the use of implants. Submuscular autoprothesis represents a tissue-preserving approach that exploits the patient’s own glandular and muscular structures to achieve durable and natural results. The aim of this study is to present the author’s experience with submuscular autoprothesis in mastopexy and to evaluate its effectiveness in achieving stable long-term outcomes.

• METHODS

A retrospective analysis was conducted on patients who underwent mastopexy with submuscular autoprothesis. Surgical planning was based on breast morphology, degree of ptosis, skin quality, and parenchymal distribution. The technique involves reshaping and repositioning the inferior glandular flap, secured in a submuscular plane to provide internal support and upper pole projection. Clinical follow-up focused on aesthetic outcomes, breast shape stability, complication rates, and patient satisfaction over the long term.

• RESULTS

Submuscular autoprothesis in mastopexy demonstrated reliable upper pole support, improved breast projection, and sustained shape over time. The procedure showed a low complication rate and minimized recurrence of ptosis. Patient satisfaction was high, particularly regarding natural appearance and long-term stability without the use of implants.

• CONCLUSIONS

Submuscular autoprothesis is a safe, effective, and reproducible technique in mastopexy, offering stable long- term results while respecting tissue biology. Based on the author’s experience, this approach represents a valuable alternative to implant-based mastopexy, especially in patients seeking natural and durable outcomes.

21. Superomedial Pedicle and Ribeiro Flap, My Choice for Reduction Mammoplasty and Mastopexy with or Without Prosthesis

• D. Cervelli
• Private Practice, Rome
• BACKGROUND-AIM

Since its first publication in 1975, the superomedial pedicle has been one the most used pedicle in breast reduction and mastopexy procedures. The traditional technique is characterized by a 90° nipple-areola complex (NAC) superomedial rotation. I started to use this pedicle in 2008 and, with time, I changed the degree of NAC rotation to 45° in order to reduce the lateral periareolar bump that I had experienced with the traditional rotation.

• METHODS

The 45° superomedial was associated with the Ribeiro flap (autoprosthesis) in my mastopexy surgeries, as full thickness dermoglandular flap in mastopexy without prosthesis or as a thin dermoglandular flap in mastopexy with prothesis. In the first case the aim was to improve the fullness of the upper pole of the breast, in the second case to provide a further support to the implant as an internal bra.

In selected cases, I used the combined techniques for reduction mammoplasties too, with the same surgical procedure as for mastopexy without implants, removing excessive tissue only from the medial and lateral poles of the breast.

• RESULTS

I used the combination of a 45° superomedial pedicle and Ribeiro flap for my mastopexy procedures in 102 patients, and for reduction mammoplasties in 27 patients. No major complications were reported, delayed healing of the vertical scar were experienced in 19 patients, in 7 cases scar revision was needed. The overall level of patients’ satisfaction was high.

• CONCLUSIONS

The combined technique showed to be highly versatile and effective in patients submitted to reduction mammoplasty and to mastopexy with or without prosthesis, as it ensures stable and long lasting results with a high degree of patients’ satisfaction.

22. Vertical Positioning of Poly-4-Hydroxybutyrate Mesh: A New Approach for Axial Breast Support and Long-Term Morphological Stability

• E. Trignano, S. De Riso, F. Ziani, E. Filigheddu and C. Rubino
• Università di Sassari
• BACKGROUND-AIM

Recurrent breast ptosis affects up to 30% of patients within the first postoperative year, particularly in the presence of hypotonic tissues or redundant skin. Absorbable scaffolds made of poly-4-hydroxybutyrate (P4HB) provide temporary internal support, yet most commonly used techniques rely on horizontal “hammock-like” positioning, which is biomechanically passive. This study introduces a vertical positioning technique designed to support the breast parenchyma along the gravitational axis and enhance long-term morphological stability.

• METHODS

Twenty patients were included: ten undergoing inverted-T mastopexy and ten augmentation mammoplasty. In all procedures, a vertically oriented P4HB scaffold was placed, anchored superiorly to the pectoralis major fascia, inferiorly to the inframammary fold, and additionally secured medially and laterally with interrupted 2-0 Vicryl sutures. This configuration creates an internal axial pillar aimed at stabilising the tissue and/or implant. Clinical and photographic follow-up was performed at 1, 3, 6, and 12 months.

• RESULTS

No cases of bottoming-out or recurrent ptosis were observed. The nipple–inframammary fold distance (N-IMF distance) remained stable, with a mean increase of <5% at 12 months. Upper-pole projection was preserved, and no major complications or revision surgeries occurred. All patients reported high satisfaction with the aesthetic outcome. In augmentation cases, improved implant positioning and a more defined lower pole contour were documented.

• CONCLUSIONS

Vertical positioning of P4HB scaffolds represents a conceptual evolution over horizontal configurations by providing active support along the gravitational vector and counteracting N-IMF lengthening. The technique proved safe, reproducible, and compatible with standard approaches. Its ability to maintain breast shape over time supports its use in both mastopexy and augmentation. Larger studies are warranted to further validate these findings.

23. Algorithm for Selecting the Most Appropriate Implant Surface in Complex Breast Surgery

• M. Moio
• Private Practice
• BACKGROUND-AIM

Complex breast surgery—particularly in cases involving secondary reconstruction, capsular contracture, thin soft- tissue envelopes, or post-oncologic deformities—requires highly individualized implant selection. The surface characteristics of breast implants can significantly influence outcomes, including capsular behavior, implant stability, and long-term complications. This study aims to develop and validate a structured decision-making algorithm to guide surgeons in selecting the most appropriate implant surface in complex breast surgery. We present our algorithm based on the experience that we developed over the last 8 years.

• METHODS

A cohort of 424 patients undergoing complex primary or secondary breast reconstruction between 2018 and 2025 was analyzed. Clinical variables included soft-tissue thickness, scar quality, capsular grade, previous implant history, and need for pocket modification. Diagnostic evaluation consisted of clinical examination, standardized ultrasound assessment of the soft-tissue envelope, and preoperative 3D surface imaging. Based on these parameters, a stepwise algorithm was applied to determine the optimal implant surface (smooth, microtextured, macrotextured, or hybrid). Surgical outcomes and complication rates were compared across algorithm-guided selections.

• RESULTS

Application of the algorithm resulted in a significant reduction in early mechanical complications and revision rates compared with non-algorithmic historical controls. Improved implant stability was observed in cases in which poliurethane were algorithmically recommended, while smooth implants were associated with reduced capsular thickening in patients with adequate soft-tissue coverage and appropriate skin expansion. Overall, 96% of cases achieved the predefined criteria for optimal aesthetic and functional outcomes.

• CONCLUSIONS

The proposed selection algorithm provides a reproducible and clinically effective framework for choosing the most appropriate implant surface in complex breast surgery. By integrating objective diagnostic parameters with surgical decision-making, it enhances outcome predictability and reduces complication rates, supporting its adoption as a standardized tool in advanced breast aesthetic and reconstruction.

24. Mastopexy with Polyurethane Implants vs. Nano-Textured Implants. Doubts, Concerns, Patient Selection Criteria, and Surgical Management

• V. Badiali
• IEI—Istituto Estetico Italiano
• BACKGROUND-AIM

Augmentation mastopexy represents one of the most complex procedures in aesthetic breast surgery, characterized by a high risk of result instability and re-operation. The choice of the implant is a determining factor for maintaining the shape and position of the nipple–areola complex. In recent years, the use of polyurethane implants and nano- textured implants has fueled a debate regarding their respective advantages and limitations. The aim of this study is to critically compare these two types of implants, analyzing their indications, limitations, and surgical management strategies, in order to define personalized patient selection criteria.

• METHODS

In recent years, the use of polyurethane implants and nano-textured implants has reignited the debate regarding their true indications in augmentation mastopexy. Polyurethane implants offer high tissue adherence, theoretically advantageous in cases of severe ptosis, poor skin quality, or a high risk of recurrence. However, they present specific challenges related to intra-operative handling, difficulty in revision, and the surgical learning curve. Nano-textured implants, on the other hand, allow for easier placement and revision but raise concerns regarding their ability to maintain long-term stability of the lower pole and implant position.

• RESULTS

What is the reality? Is it possible, after careful patient selection, to achieve excellent stability outcomes with both types of implants?

This presentation aims to identify the indications and technical details that allow one implant to be preferred over the other.

• CONCLUSIONS

Augmentation mastopexy cannot disregard an appropriate selection of implant type. Polyurethane implants are preferable in complex cases with a high risk of instability, whereas nano-textured implants require particular attention to the preservation of anatomical structures responsible for ensuring implant stability. A personalized approach, based on tissue analysis, degree of ptosis, and patient expectations, is essential to optimize outcomes and reduce the risk of reoperation.

25. Polyurethane and Short Scars: A Good Option for Long-Lasting Results in Mastopexy with Implants

• V.S. Pino and C. Gasperoni
• Clinica Quisisana
• BACKGROUND-AIM

Breast augmentation with implants is one of the most complex procedures in cosmetic surgery, and the most appropriate approach to avoid serious complications and to achieve the desired result is still debated. It is an effective and reliable technique that produces well-shaped breasts over time and reduces the amount of scarring. Polyurethane (PU)-coated implants have been shown to reduce the incidence of capsular contracture by forming a spongy mesh around the implant and biointegrating with the surrounding breast tissue. This tissue integration can also help maintain a stable breast shape and prevent implant displacement. The purpose of this study is to present our experience with a customized, short-scar breast augmentation technique guided by PU-coated implants for the management of ptosis and breast hypotrophy.

• METHODS

A retrospective analysis of our database was performed, enrolling a total of 464 women who had undergone mastopexy with polyurethane implants. Inclusion criteria were age between 32 and 65 years, with varying degrees of ptosis and moderate to severe skin laxity. The surgical technique involved the implantation of polyurethane-coated implants followed by a short-scar mastopexy. Follow-up assessments were performed at one month, six months, one year, and two years after surgery.

• RESULTS

In our retrospective study, a J-scar mastopexy was performed in 93% of cases. In 7% of cases, a vertical mastopexy was sufficient. The technique presented in the study demonstrated a favorable safety profile, with an overall complication rate of 4.5% and an overall reoperation rate of 6.89%. No major issues, including wound dehiscence, implant exposure, or nipple necrosis, were reported. Recurrent ptosis was observed in 2.37% of cases, with the majority requiring additional surgery. Upper pole projection was satisfactory in the long-term. Capsular contracture was observed in 2.8% of patients. The results obtained were shown to be stable during long-term follow-up, with high satisfaction rates.

• CONCLUSIONS

PU implants have undergone extensive safety reviews, and postoperative outcomes have been favorable in most cases, with minimal complications and a good safety profile. These data on PU implants, combined with improved tissue integration and a low risk of capsular contracture and implant displacement, make them a valid choice for this surgical procedure. Furthermore, breast reshaping achieved with the J-scar technique, while maintaining a natural breast attachment to the chest, allows for excellent aesthetic results and minimizes scarring, and is therefore our choice whenever possible. The described approach achieves effective skin reshaping and desired breast volume augmentation, minimizing the risk of complications and ensuring excellent long-term stability with a good long-term aesthetic outcome.

26. The Role of Polyurethane Implants: A Simple Solution for Complex Cases

• B. Cagli, F. Sofo, A.A. Cimmino, D. Porso, I. Vignapiano, A. Tarantino, A. Carlone and S. Salvatore
• Department of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Campus Bio-Medico di Roma, Rome, Italy
• BACKGROUND-AIM

Implant surface characteristics are a key determinant of both aesthetic outcomes and complication profiles in breast augmentation and reconstruction. Smooth and textured implants have traditionally been associated with complications such as capsular contracture, breast implant–associated anaplastic large cell lymphoma (BIA-ALCL), displacement and rotation of the implants, which frequently lead to reoperation, especially in complex revision cases. Polyurethane-coated implants have been introduced as a potential solution to these limitations, as the polyurethane foam provides high adherence to surrounding tissues and enhanced positional stability. The aim of this study is to evaluate the efficacy and safety of polyurethane-coated anatomical implants in secondary breast augmentation and to define their role as a valuable option in the management of complex cases, compared with conventional smooth and textured devices.

• METHODS

In this study, twenty-five consecutive patients undergoing revision breast augmentation using polyurethane-coated anatomical implants, were analyzed. All presenting complex revision indications. Minimum follow-up was 24 months. Indications for reoperation included capsular contracture (n = 14), malposition or rotation of anatomical implants (n = 4), late seroma (n = 3) and implant displacement (n = 4), all representing challenging clinical scenarios. Patient quality of life and satisfaction were assessed using BREAST-Q questionnaires at 1, 3, 6, 12 and 24 months. Standardized postoperative photographs, obtained at the same time points, were independently reviewed by two plastic surgeons and an external nurse, using a score from 1 to 5, to evaluate correction of the primary defect and overall aesthetic improvement.

• RESULTS

At 24 months, no major complications requiring additional surgery were recorded, and no cases of grade III–IV capsular contracture were observed. Based on the analysis of BREAST Q scores, the postoperative results were excellent in term of psychosocial well-being, sexual well-being, physical well-being and satisfaction with breast appearance. Correction of the primary defect was judged complete and stable at 12 and 24 months in all patients, with consistent overall aesthetic improvement documented by the external reviewers.

• CONCLUSIONS

In complex revision settings, the polyurethane foam coating provides strong adherence of the implant to surrounding tissues, ensuring reliable positional stability and allowing the surgeon to accurately predict the final outcome at the end of the procedure. Based on the low rate of capsular contracture and the long-term stability observed in this series, polyurethane-coated implants appear to represent a simple and effective solution for complex secondary breast augmentation cases and may be considered, in the absence of contraindications, a preferred option over smooth and textured implants in aesthetic breast surgery.

27. Use of Low-Volume Lightweight Breast Implants (LWBI): Is the Only Advantage the Lower Weight?

• M. Barbera ¹, P. Montemurro ² and M. Mendanha ³

¹ 

Università Cattolica del Sacro Cuore—Fondazione Policlinico Universitario A. Gemelli IRCCS, Unità di Chirurgia Plastica, Rome, Italy

² 

Akademikliniken, Stockholm, Sweden

³ 

Academia de Cirurgia Plástica Mário Mendanha, Porto

• BACKGROUND-AIM

Lightweight breast implants decouple volume from mass (≈30% lower weight) potentially reducing long-term tissue strain. Most series emphasize mass reduction; however, LWBI also integrate design features that may influence aesthetics in thin-tissue, low-volume cases.

In low-volume cases, additional design-related features may be clinically relevant: (i) a more compact/firm gel behavior that may enhance shape stability and help limit visible rippling in thin envelopes, particularly in subglandular augmentation and augmentation-mastopexy where maintaining upper-pole fullness is a key objective;

(ii) sharper edge definition with a cleaner implant–tissue transition, potentially reducing step-off deformity, especially in pre- muscular planes with limited subcutaneous/glandular coverage and when polyurethane-coated implants are used; (iii) a concave posterior base that may improve chest-wall conformity, creating a more uniformly tensioned anterior dome and potentially lowering the propensity for surface irregularities.

To assess rippling and step-off deformity in low-volume augmentation/augmentation-mastopexy with LWBI, alongside complications and patient-reported outcomes.

• METHODS

Retrospective single-center review of 91 consecutive patients (182 breasts) treated 2022–2024 with low-volume LWBI (mean 270 ± 35 cc; range 210–320). Procedures: 42 primary augmentations, 22 exchanges (9 with mastopexy), 27 augmentation-mastopexies. Planning followed the Akademikliniken method. Outcomes: rippling/step-off (clinical + photo review), double-bubble/bottoming-out, Baker III/IV capsular contracture, reoperation, BREAST-Q.

• RESULTS

Mean follow-up 18 ± 6 months. Rippling 3.3% (3/91); step-off 2.2% (2/91), none revised. Upper-pole convexity 98% (89/91). Baker III/IV capsular contracture 1.1% (1/91); reoperation 2.2% (2/91). BREAST-Q: Satisfaction with Breasts 86 ± 9; Outcome 90 ± 8.

• CONCLUSIONS

In low-volume settings, LWBI may offer clinically relevant advantages beyond reduced weight, with low rates of rippling/step-off and high midterm PROMs. Prospective comparative studies with standardized photography and longer follow-up are warranted.

28. Vertical Mastopexy with Conical Shaped Polyurethane Implants

• R. Uccellini and V. Colabianchi
• In Private Practice
• BACKGROUND-AIM

The authors present a new approach to vertical mastopexy with implants using a particular type of prosthesis that are conical in shape.

• METHODS

We selected a few cases of patients presenting with variable degrees of mammary ptosis. We used various mastopexy surgical techniques.

The implants chosen were conical shaped polyurethane implants. The surgical technique used was customized according to the specific anatomical characteristics for individual patients. In several cases, the technique used was that of a vertical mastopexy as originally described by Madelein Lejour, with modifications as proposed by Simeon Wall. Hence, in such patients, in the pre-operative markings, a wedge of inferior mammary tissue to be resected was demarcated. In other circumstances, the mammary implant was inserted first, and subsequently, an intra-operative “tailor tucking” was performed to determine the amount of excessive mammary tissue to be resected inferiorly. After such an evaluation, in a few cases, a simple round block mastopexy was deemed appropriate.

• RESULTS

In a number of patients, presenting with specific anatomical characteristics, the authors have decided to use mammary implants that are conical in shape and present distinctive volumetric parameters, as opposed to the more commonly used round or anatomical shaped implants. The reason for selecting conical implants is based on the verification that, in the majority of cases of mammary ptosis, excessive mammary tissue is present in the inferior and lateral quadrants of the breast. A conical shaped implant exerts more pressure right behind the neo areola position where more projection is desired and exerts less pressure in the inferior quadrants and along the vertical line of suture. The polyurethane shell provides greater stability to the implant that will not tend to migrate inferiorly.

• CONCLUSIONS

Conical shaped implants are still marginally utilized. Our experience produced initial encouraging results and we are evaluating the opportunity to use polyurethane shaped implants not only in cases of mammary ptosis, but also in selected cases of primary or secondary augmentation mastoplasty.

29. 1/3 SMR Breast for Athletic Patients

• R. Sergio
• Timeless Plastic Surgery
• BACKGROUND-AIM

To evaluate the impact of the one-third Selective Muscle Recruitment (1/3 SMR) technique on functional recovery and satisfaction in athletic patients undergoing breast augmentation with anatomical implants between 2021 and 2025.

• METHODS

Since 2021, 169 consecutive patients have been treated with the 1/3 SMR breast technique. The sample included 32 athletic patients (physical activity ≥2 times/week, 3 of whom were competitive athletes) and a control group of 32 non- athletic patients, matched for age, sex and smoking habits. Surgeon satisfaction, patient satisfaction, difficulty with movements, ability to lift loads equal to the preoperative level, and time to return to activities were evaluated. The 32 athletic patients were further divided into two subgroups (16 with early fascial release exercises starting on day 2, 16 without).

• RESULTS

Aesthetic outcomes, surgeon satisfaction and patient satisfaction were comparable between athletic and non-athletic patients. In athletic patients, a marked reduction in recovery time was observed: return to usual daily activities in 8–10 days and to the gym on average after 3 weeks, initially with all exercises except pectoral work and, from the following week, including pectoral exercises. In the subgroup with early exercises, greater recovery of shoulder mobility was found upon returning to the gym after 2 weeks and full use of the pectoral muscles after 3 weeks. No cases of implant rotation occurred in any of the groups.

• CONCLUSIONS

Athletic patients seem to derive a specific benefit from the 1/3 SMR technique, with faster postoperative recovery and maintenance of aesthetic results comparable to those of non-athletic patients. Habitual exposure to muscular stress and regeneration makes muscle thickness not a limiting factor for the use of the technique, which also contributes to the stability of anatomical implants.

30. Breast Asymmetry: A Standardized Method for Custom Procedure Selection

• S. Uderzo, S. Avvedimento and A. Santorelli
• Santorelli and Partners
• BACKGROUND-AIM

The correction of breast asymmetry in breast augmentation procedures represents one of the most common problems for the plastic surgeon. Currently, the choice of the type and volume of implants is mainly based on the surgeon’s experience and subjective evaluations. However, a more systematic and standardised approach could improve the accuracy of surgical decisions reducing the risk of surgical revisions and still tailoring the treatment to the patient.

• METHODS

In this retrospective observational study, a preoperative decision-making algorithm was applied in 60 patients undergoing breast augmentation for breast asymmetry from 2021 to 2023. A flowchart was created to guide the surgeon based on 4 unanimously recognised objective parameters: (1) pinch test (2) position of the nipple and areola complex (NAC) in relation to jugular point (SN), (3) distance between NAC and IMF, (4) volume differences between the two breasts.

The first parameter permits to establish the dissection plan for the implant: dual plane or sub-glandular. The second parameter guides the choice of the type of mastopexy on the basis of two cut-offs: if the asymmetry is less than 2 cm, a round-block suture is performed; between 2 and 5 cm, a correction resulting in a vertical scar is opted for; above 5 cm, a larger excision resulting in an inverted T scar is performed. The third parameter considers the NAC-IMF distance: if the difference is less than 2 cm, the IMF is balanced by fixing it 1 cm higher or lower; for greater asymmetries, the correction will be less conservative, resulting in an inverted T scar. Finally, as far as volume differences between the two breasts are concerned, if less than 50 g, an internal resection of the parenchyma can be performed; between 50 and 100 g, lipofilling is preferred on the less voluminous side; if greater than 100 g, implants of different volume are used, always preferring the same diameter with different projections. All patients were followed up from the first consult until clinical and photographic follow-up at 3, 6 and 12 months.

• RESULTS

Satisfactory clinical and subjective symmetrization was achieved in 54 patients (90.0%), while 4 patients (6.7%) showed residual asymmetry detectable only through measurement, without clinical relevance. Only 2 patients (3.3%) required secondary procedures due to clinically evident asymmetry. The overall success rate was 96.7% (p < 0.05 vs. 90% reference). Independent evaluation judged 83.3% of cases as “excellent” and 10% as “good.” Patient satisfaction was high in 86.7% of cases. In 6 patients (10.0%) with severe asymmetry, asymmetric scar patterns were required between the two breasts.

• CONCLUSIONS

This tool allows reducing the subjective variability of the operator, offering a reproducible and easily applicable methodology in the operating theatre using four objective measurements, improving the accuracy of the result. In our case studies, the algorithm has been shown to reduce decision-making and operating time as well as increase patient satisfaction. This approach will hopefully offer a structured and effective solution for the management of breast asymmetry in mastopexy and breast augmentation.

31. Breast Augmentation with the Preservation Technique: An Advanced Approach to Breast Tissue Preservation

• A. Dall’Antonia
• Ad Aesthetics
• BACKGROUND-AIM

La mastoplastica additiva tradizionale comporta spesso un significativo scollamento dei tessuti e la dissezione delle strutture di supporto del seno, con possibili ripercussioni sulla sensibilità, sulla stabilità della tasca e sulla qualità del risultato a lungo termine. La tecnica Preservé, basata sul concetto di Breast Tissue Preservation (BTP), propone un approccio alternativo che mira a ridurre il trauma tissutale, preservare l’anatomia naturale e migliorare la prevedibilità dell’esito chirurgico.

• METHODS

La tecnica si caratterizza per una dissezione minimamente invasiva e per la conservazione delle strutture fasciali e dei setti che contribuiscono al supporto del complesso mammario. I tessuti vengono mobilizzati in modo controllato, creando una tasca più stabile e fisiologica, con un minor impatto sulla sensibilità del complesso areola-capezzolo. L’impiego di protesi progettate per un’interazione più favorevole con i tessuti e per ridurre la risposta infiammatoria contribuisce a un miglioramento dell’integrazione implantare. L’approccio prevede inoltre un accesso chirurgico ridotto e una manipolazione minima dei tessuti, favorendo un recupero più rapido.

• RESULTS

L’obiettivo del lavoro è descrivere i principi della tecnica Preservé, evidenziandone il razionale, i vantaggi operativi e i potenziali benefici clinici rispetto agli approcci convenzionali. Verranno inoltre presentate osservazioni cliniche e casi pratici durante la comunicazione orale.

• CONCLUSIONS

I principali benefici osservati nei programmi clinici basati su BTP includono una minore incidenza di complicanze legate alla tasca, una migliore stabilità implantare nel tempo, una riduzione del trauma tissutale e una maggiore soddisfazione delle pazienti grazie alla naturalezza del risultato. La tecnica Preservé rappresenta quindi una possibile evoluzione della mastoplastica additiva verso una chirurgia più conservativa, stabile e rispettosa dell’anatomia.

32. Breast Augmentation: Cis or Trans It Doesn’t Matter

• G. Lo Russo, L. Scortecci and V. Giordano
• Centro Day Surgery Maurizio Bufalini
• BACKGROUND-AIM

Historically, gender-affirming breast augmentation was influenced by cultural stereotypes that equated femininity with conspicuous size and projection. Contemporary patients, both cisgender and transfeminine, now increasingly prefer natural, proportionate outcomes. Although thoracic proportions may differ, these anatomical variations do not neednecessitate different operations by identity. Guided by measurable parameters—sternal notch-to-nipple (S–N) and nipple-to-nipple (N–N) distances, base width, and soft-tissue characteristics—this study applies a single prepectoral anatomical implant philosophy, reflecting the senior surgeon’s intent to respect modern patient preferences while achieving harmonious, reproducible results.

• METHODS

A retrospective single-surgeon review of 105 consecutive primary augmentations was conducted. All procedures used prepectoral anatomical implants. Preoperative assessment included S–N and N–N distances and base width.

Planning prioritised width-matched implant selection, inframammary-fold (IMF) engineering (lowering ± radial scoring when required), and implant centralisation on the NAC axis. Patient-reported outcomes were evaluated using BREAST-Q Augmentation v2.0 (satisfaction with breasts, psychosocial, and sexual well-being) at ≥6 months, alongside early and late complication rates.

• RESULTS

The unified, measurement-based prepectoral anatomical approach was associated with high postoperative BREAST-Q satisfaction and quality-of-life gains, and low complication rates (infection, haematoma, capsular contracture, malposition)with a mean follow-up of 1 year (0.2–2 years). Implant volumes reflected individual thoracic geometry and aesthetic preference.

• CONCLUSIONS

Cis or transgender-does it really matter? When operative planning is grounded in objective chest measurements and executed with prepectoral anatomical implants, outcomes are natural, proportionate, and safe across all patients. This philosophy respects the ongoing shift in aesthetic preference, translating anatomy—not identity—into equitable surgical practice.

33. Dual Plane vs. Subfascial: Evolution of an Approach, Not an Antagonism

• A. Santorelli ¹ and S. Avvedimento ²

¹ 

A.Santorelli&Partners

² 

Ospedale A. Cardarelli

• BACKGROUND-AIM

The choice of prosthetic plane in breast augmentation surgery has undergone significant evolution in recent years. The subfascial approach, initially considered an intermediate alternative between the submuscular and subglandular planes, has progressively demonstrated that it guarantees natural aesthetic results with less morbidity and faster recovery times. However, the dual plane technique still plays a role in specific anatomical situations and in revision contexts. The aim of this study is to critically analyse the evolution of the transition from dual plane to subfascial, identifying the current indications for each approach.

• METHODS

A retrospective analysis was conducted on X patients who underwent primary or revision breast augmentation between January 2020 and June 2024. In X cases, the subfascial approach was used, and in X cases, the dual plane technique was used. Postoperative pain, recovery time, and aesthetic satisfaction at 12 months were assessed using the VAS scale. Early and late complications were recorded and compared between the two groups.

• RESULTS

Patients treated with the subfascial technique showed faster recovery and less postoperative pain (mean 2.3 vs. 4.8 VAS in the first 5 days). No cases of animation deformity were observed. The dual plane technique remained the specific indication in breasts with reduced glandular thickness, in revision of pre-existing submuscular planes, and in cases of insufficient tissue coverage. X patients in both groups underwent secondary surgery.

• CONCLUSIONS

The evolution from the dual plane approach to the subfascial approach represents a shift from a compromise to one of anatomical and functional integration. The subfascial approach guarantees more predictable results, reduced recovery times and lower morbidity, while leaving the dual plane approach a selective role in specific cases. It is therefore not a question of antagonism between techniques, but rather a rational evolution of the surgical approach.

34. Dynamic Sling Pocket: A Triple-Plane Technique for Primary Breast Augmentation

• M. Barsakov
• North-West State Medical University Named After Mechnikov
• BACKGROUND-AIM

Implant pocket design remains a critical factor in the long-term success of primary breast augmentation. Each of the conventional options—subglandular, subpectoral, and dual-plane—has inherent benefits but also significant drawbacks that may compromise surgical outcomes. Subglandular pockets offer excellent projection and ease of dissection, but are associated with higher risks of implant visibility, rippling, capsular contracture, and implant malposition, particularly in patients with thin soft tissue coverage. Subpectoral (total muscle) placement provides enhanced soft-tissue coverage but frequently results in animation deformity, upward and lateral implant displacement, and restricted expansion of the lower pole due to muscle tension. Dual-plane techniques, though widely accepted, may still lead to animation deformity and inferior malposition (bottoming-out) in patients with low tissue resistance, as the implant lacks structural support in the inferomedial quadrant. These limitations underline the need for a more functionally balanced pocket architecture—one that reinforces medial control, stabilizes the lower pole, and reduces animation-related issues without sacrificing aesthetics.

• METHODS

Between 2021 and 2024, a total of 705 primary breast augmentations (with or without mastopexy) were performed using the Dynamic Sling Pocket (DSP) technique. The method involves horizontal myotomy of the pectoralis major at the 4 o’clock or 8 o’clock axis, creating a medially fixed muscle-glandular sling over the lower implant pole. This results in:

• Submuscular upper coverage
• Subglandular lateral coverage
• Functional myoglandular support in the inferomedial pocket

Outcomes were assessed in terms of implant position, animation deformity, rippling (particularly along the lower cleavage line), and patient-reported satisfaction (BREAST-Q). Comparison was made with documented rates of complications in traditional pocket types.

• RESULTS

Among the 705 patients who underwent primary breast augmentation using the DSP technique, outcomes demonstrated high consistency and minimal complication rates:

• Distal implant malposition (about 1#cm): observed in 8 patients (1.02%); all were minor and did not require surgical revision.
• Minor animation deformity: recorded in 5 patients (0.64%), none of whom reported aesthetic dissatisfaction or functional impairment.
• Inferomedial rippling: occurred in 4 patients (0.51%), predominantly in those with low BMI (<18); no cases warranted implant replacement or fat grafting.
• No major complications such as capsular contracture, seroma, or significant implant malposition were observed during the follow-up period.

Among a subgroup of 180 patients who completed the BREAST-Q Augmentation Module at 12 months post-op, the following mean scores were recorded:

• Satisfaction with breasts—87.2,
• Psychosocial well-being—89.0,
• Sexual well-being—86.1,
• Physical well-being—91.4.

These results confirm the high safety, stability, and patient satisfaction associated with the Dynamic Sling Pocket approach, particularly in challenging primary cases with thin soft-tissue coverage or wide intermammary distance.

• CONCLUSIONS

Dynamic Sling Pocket combines the protective benefits of subpectoral coverage with the soft-tissue flexibility of dual- plane techniques while directly addressing their known shortcomings. The reinforcement of the inferomedial quadrant using a dynamic myoglandular sling ensures stable implant positioning, minimizes rippling along the cleavage, and substantially reduces the risk of animation deformity. This approach represents a reproducible, anatomically grounded advancement in pocket design for primary breast augmentation.

35. Lipofilling Updated in Breast Augmentation: Alba Technique

• G. Lanzano ¹, E.M. Buccheri ² and R. De Vita ³

¹ 

Itituto Europeo di Oncologia (IEO), Milano

² 

Ultra Clinic, Roma, Italia

³ 

Istituto Nazionale Tumori Regina Elena, Roma, Italia

• BACKGROUND-AIM

A standardized technique for primary breast augmentation with autologous fat grafting is presented, based on the distribution of the grafted volume according to ideal breast proportions, with 55% allocated to the lower pole and 45% to the upper pole. Fat placement was further standardized by delivering 50% of the graft in the subglandular plane and 50% in the subcutaneous plane through four predefined access points.

• METHODS

Forty-four Caucasian patients who underwent primary breast augmentation with autologous fat grafting using this standardized 45:55 volume distribution technique between September 2016 and January 2020 were included in this retrospective study. At the 1-year follow-up, both patients and the surgeon independently completed a visual analogue scale (VAS) questionnaire assessing postoperative satisfaction with breast shape and breast volume.

• RESULTS

At 12 months, based on VAS scores, 5 patients (13.5%) were dissatisfied with breast volume, and 2 of these (5.4%) were also dissatisfied with breast shape. Agreement between patients and surgeon was significant for both breast shape satisfaction (p < 0.0001) and breast volume satisfaction (p = 0.0035). After a secondary procedure, 3 patients (8.1%) remained dissatisfied with breast volume at 1-year follow-up, whereas all patients were satisfied with breast shape.

• CONCLUSIONS

This standardized 45:55 volume distribution technique may represent a useful approach for surgeons performing autologous fat grafting for primary breast augmentation. The procedure appears to be reliable, reproducible, and straightforward. Given the low complication rate observed, it may provide an effective balance between aesthetic outcomes and procedural safety.

36. Minimal Invasive Breast Augmentation Under Loco-Regional Anesthesia—Endoscopic Dual Plane vs. Pre-Pectoral Preservation

• A. Araco
• Jenevì Medical
• BACKGROUND-AIM
• Background

Breast augmentation with implants recorded over 1.6 billion procedures globally in 2022. To reduce surgical trauma and complications and facilitate a fast recovery, we employ an ultrasound-guided local–regional anesthesia technique, the creation of a partial submuscular implant pocket or pre-pectoral pocket by direct endoscopic visualization either by minimal skin access on the mammary folds.

• Objectives

The aim of this study is to compare the two different techniques of breast augmentation in reducing postoperative recovery time and complications, and increases patient satisfaction.

• METHODS
• Methods

Patients provided their consent through a signed form. We set strict inclusion and exclusion criteria. We prospectively evaluated postoperative pain and recovery times, the rate of complications, and patient satisfaction at 6- and 12- months post-surgery. All operations were performed by the same surgeon, by using the same brand breast implant.

• RESULTS
• Results

Between January 2023 and January 2024, 40 patients met the inclusion criteria and were randomly allocated among the two groups. The average operation time was 52.5 min. There was not significative difference among the two groups among sex, age, bmi, breast implant size and shape. Patients were discharged from the hospital within 2 to 3 h. All breast implant were round ergonomic shaped, smooth surface, average range size 220 cc. Eighty-nine percent of patients expressed great satisfaction with the result. None of the patients experienced postsurgical complications. No differences were found among the two techniques of breast augmentation.

• CONCLUSIONS
• Conclusions

Our study showed that either dual plane and pre-pettoral preservation breast augmentation conducted endoscopically under localized anesthesia are safe. Both techniques allow for quick recovery post-surgery and swift resumption of everyday activities. The overall complications were less than reported in scientific studies for the classic dual- plane technique o subglandular/subfascial in general anesthesia. Moreover, this approach yields excellent patient satisfaction. Additional prospective and randomized studies will be required to enhance the scientific validity.

37. Modern Evolution of the Transaxillary Technique in Breast Augmentation: A Semi-Videoscopic Approach

• D. Boliglowa ¹, M. Pontillo ², N. Velotti ² and N. Rocco ²

¹ 

Private Practice “Dominik Boliglowa Chirurg Plastyk”, Kraków, Poland

² 

Department of Advanced biomedical Sciences, Breast Unit University of Naples Federico II, Naples, Italy

• BACKGROUND-AIM

The continuous development of minimally invasive and image-guided techniques represents a fundamental trend across modern surgery. Videoscopic approaches have significantly improved precision, safety, reproducibility, and aesthetic outcomes while minimizing surgical scarring in multiple disciplines. In aesthetic plastic surgery, however, the adoption of videoscopic techniques has been more selective, mainly due to longer operative times compared with conventional open procedures. As a result, many surgeons seeking to avoid visible breast scars continue to perform transaxillary breast augmentation using a blind technique.

The traditional blind transaxillary approach offers the clear advantage of eliminating scars on the breast itself but may compromise pocket accuracy and implant positioning. The aim of this work was to refine the transaxillary approach by evolving from a conventional blind technique toward a semi-videoscopic (hybrid) method, combining the speed of blind dissection with the visual control of videoscopic assistance.

• METHODS

After completing and publishing a clinical evaluation of our semi-videoscopic transaxillary breast augmentation technique in comparison with the traditional blind approach, this hybrid method was fully integrated into routine clinical practice of the 1st author. The technique incorporates targeted videoscopic visualization during critical steps of dual-plane pocket creation, hemostasis, and implant positioning, while preserving selected elements of blind dissection to maintain procedural efficiency. A retrospective review was performed on consecutive patients who underwent semi-videoscopic transaxillary breast augmentation, assessing surgical safety, aesthetic outcomes, complication rates, operative time, and patient satisfaction.

• RESULTS

The implementation of the semi-videoscopic approach demonstrated high reproducibility and consistently favorable aesthetic outcomes. Videoscopic visualization improved control over implant pocket boundaries and inframammary fold definition. Operative times remained comparable to those of conventional breast augmentation. The incidence of implant malposition, animation deformity, and secondary corrective procedures was low. We used both anatomically shaped and round implants of any dimension. Patient satisfaction was high, and no increase in major complications was observed.

• CONCLUSIONS

The semi-videoscopic transaxillary technique represents a practical and clinically mature evolution of breast augmentation surgery. By combining the efficiency of blind dissection with the precision of videoscopic guidance, this hybrid approach enhances operative control and aesthetic predictability without compromising safety. Its adoption aligns aesthetic plastic surgery with contemporary minimally invasive surgical trends while preserving the scar-sparing advantages of the transaxillary route.

38. Modifications in Breast Reductions to Reduce the Complications—Our Experience

• K. Ramasamy
• Chennai Plastic Surgery
• BACKGROUND-AIM

Breast reduction surgery often faces challenges such as T-junction necrosis and nipple-areola complex (NAC) positioning in the same level, which can affect both safety and aesthetic outcomes. To present four surgical modifications designed to improve flap viability, reduce T-junction necrosis, and optimise NAC positioning in breast reduction procedures.

• METHODS

Our technique incorporates:

• The triple dermal pedicle method to minimize T-junction necrosis by enhancing vascular support.
• Preoperative marking of perforators to increase the reliability and versatility of the superior medial pedicle.
• Shifting the T-junction on the medial flap to reduce closure tension.
• Deciding the NAC position at the final surgical stage to ensure consistent symmetry and alignment.

These modifications were implemented across multiple cases, with postoperative follow-up focused on flap viability, wound healing, and aesthetic results.

• RESULTS

The triple dermal pedicle technique significantly lowered T-junction necrosis rates. Perforator marking improved pedicle reliability and flap versatility. Shifting the T-junction reduced tension, enhancing wound healing. Final-stage NAC positioning maintained nipple symmetry and alignment. Collectively, these refinements improved safety, surgical outcomes, and patient satisfaction.

• CONCLUSIONS

These straightforward modifications offer a safer and more adaptable breast reduction approach, effectively addressing T-junction risks and NAC placement challenges. Their adoption can elevate surgical success and patient confidence.

39. Primary Subglandular Breast Augmentation Under Tumescent Anesthesia After 15 Years of Experience

• A. Rusciani
• Skinlaser
• BACKGROUND-AIM

To establish a type of anesthesia for breast implant placement.

• METHODS

Data from 680 primary procedures are presented.

• RESULTS

After more than 15 years of experience and a significant number of procedures, we can confirm that this is a safe approach, can be performed as a day surgery procedure, and reduces anesthetic and surgical risks.

• CONCLUSIONS

Dopo più di 15 anni di esperienza ed un numero significativo di interventi possiamo affermare che è un approccio sicuro, che può essere svolto in regime di day surgery e permette di ridurre i rischio anestesiologici e chirurgici.

40. Safety and Indications of Different Pocket Planes in Breast Augmentation Dual Plane vs. Prepectoral

• P. Vittorini
• Presidio Ospedaliero Villa Letizia -L’Aquila-
• BACKGROUND-AIM

Primary breast augmentation is one of the most frequently performed cosmetic surgical procedures worldwide. Over the years, surgeons have continually sought the most appropriate pocket for implant placement, balancing safety, aesthetic outcomes, and long-term stability.

• Objectives

This presentation compares the different anatomical planes used in breast augmentation—subglandular, subfascial, and submuscular (dual plane and its variants)—with the aim of defining their specific clinical indications, potential complications, and expected aesthetic results.

• METHODS

The analysis is based on selected patient series undergoing breast augmentation with smooth or microtextured implants placed in various anatomical planes. The anatomical structure of the mammary ligaments, particularly the circummammary ligament and Cooper’s ligaments, was considered a key element in guiding the dissection and ensuring implant stability. High-definition surgical videos illustrate the technical steps of dissection, implant insertion, and inframammary fold (IMF) reconstruction. Special focus is given to the subfascial approach and to the modified dual plane technique used in patients with post-pregnancy hypomastia and pseudoptosis.

• RESULTS

The subglandular plane provides simple access but is associated with higher risk of implant visibility and capsular contracture.

-

The subfascial plane offers good implant coverage, reduced muscle interaction, and stable results over time, making it a valid option in secondary surgery or in athletic patients.

-

The submuscular (dual plane) approach allows for enhanced upper pole fullness and more durable outcomes in cases of skin laxity or ptosis, but may lead to animation deformities.

• CONCLUSIONS
• Conclusions

There is no single pocket plane that is superior in every case. The best results in terms of aesthetic balance and long-term stability are achieved through the correct selection of the surgical plane based on each patient’s unique anatomical features (breast volume and shape, skin quality, chest morphology) and the characteristics of the implant (surface and size). Personalized surgical planning remains the cornerstone of successful breast augmentation.

41. Subfascial Dual-Plane: Possible Combinations for Different Breast Types

• D. Cervelli
• Private Practice—Rome
• BACKGROUND-AIM

Subfascial breast implant positioning is often used by plastic surgeons worldwide. Usually the prosthesis is entirely placed under the pectorals major fascia, allowing, on one side, to avoid the pain and the animation risk, typical of the submuscular insetting, and, on the other side, partially reducing the risk of visibility of the implant and of low lasting aesthetic result, typical of the subglandular positioning.

• METHODS

From 2008 I currently use the subfascial plane with the traditional technique.

From 2018 I started to use it in combination with the subglandular or submuscular plane, in a sort of unusual dual- plane, dissecting differently in different breast types:

Submuscular upper pole + subfascial lower pole, for emptied breasts and expanded, but inelastic and ptotic lower pole, with no-ergonomic implants.

Subglandular upper pole + subfascial lower pole, with significant glandular remnant, but an inelastic and ptotic lower pole, with no ergonomic implants.

Subfascial upper pole + subglandular lower pole, for high density breasts, but with tuberous-like deformity or short lower pole, with ergonomic implants.

• RESULTS

I used the subfascial dual-plane in all its combinations for my breast augmentation or mastopexy procedures in 63 patients. No major complications were reported, no bottoming-out was noted in all follow-up period, in 3 cases a waterfall deformity was experienced in the combination of submuscular for the upper pole and subfascial for the inferior pole. In all those cases a revision was needed.

• CONCLUSIONS

The subfascial dual-plane in the different combinations showed to be highly versatile and effective in patients submitted to aesthetic breast procedures, as it ensures stable and long lasting results with a high degree of patients’ satisfaction.

42. Subfascial Muscle Sparing Technique: A Modified Procedure for Internal Breast Lifting and Augmentation

• G. Cuccia
• DanteMed Day Clinic
• BACKGROUND-AIM

Breast augmentation technique has advantages and indications, and the way for the perfect implant pocket plane is ongoing. An ideal dual plane should meet 3 requirements: adequate implant coverage, optimal control of breast shape, and maximal muscle preservation. The authors report a modified procedure for breast augmentation and lifting: the subfascial muscle sparing technique.

• METHODS

From January 2022 to Decembre 2025, 20 female patients with pseudoptosis, grade I–II breast ptosis were selected. Surgical access was achieved via the mammary fold or periareolar approach. The procedure involved internal mastopexy between the mammary gland and the pectoralis major muscle’s superomedial portion, coupled with anatomical implant insertion.

• RESULTS

Significant elevations in the areola and breast tissue were noted in patients with pseudoptosis and grade I–II breast ptosis, with a notable pre- and postoperative difference. Additionally, there was an improvement in areolar and breast tissue positioning in asymmetrical cases.

• CONCLUSIONS

The internal breast lift emerges as a safe and aesthetically pleasing alternative for patients with pseudoptosis and grade I–II breast ptosis. It effectively enhances areolar symmetry without the need for additional scars.

43. The New Frontier of Minimally Invasive Breast Augmentation. A True Innovation or a Marketing Ploy?

• V. Badiali
• IEI—Istituto Estetico Italiano
• BACKGROUND-AIM

In recent times, the concept of “minimally invasive breast augmentation” has gained increasing popularity, supported by new technologies, advances in prosthetic materials, and communication increasingly focused on reducing the impact of surgery. Techniques that promise minimal incisions, reduced operating times, accelerated recovery, and fewer complications are now being proposed as an alternative to traditional breast augmentation. However, the line between real surgical innovation and commercial simplification often remains blurred.

• METHODS

The aim of this study is to critically analyze the concept of minimally invasive breast augmentation, evaluating its anatomical, technical, and communication assumptions. The size of the surgical access, the management of the prosthetic pocket, the choice of the implant plane, the impact of more or less deep anesthesia, and the reduction in recovery times are taken into consideration. Particular attention is paid to communication aspects, in order to distinguish between a real innovation capable of expanding the audience of potential patients and a mere commercial operation.

• RESULTS

The analysis highlights how minimally invasive surgery cannot be defined exclusively by the size of the surgical incision, but must be understood as a comprehensive approach that reduces tissue trauma, preserves anatomy, and guarantees stable results over time. In this context, appropriate patient selection, surgeon experience, and correct indications remain determining factors.

• CONCLUSIONS

Minimally invasive breast augmentation can represent a real surgical evolution only if supported by scientific criteria, correct indications, and reproducible results. In the absence of these prerequisites, there is a risk that the term will be used primarily as a marketing tool rather than as a real advance in surgical practice.

44. The Use of the Subfascial Flap in Additive Mastoplasty

• R. Garofalo
• Istituto di Chirurgia Pamphili, Roma
• BACKGROUND-AIM

The insertion of breast implants into the subfascial plane of the pectoral muscle is a very useful technique in thin and/or athletic patients who require greater protection due to the thinness of the skin flap and for whom the dual plane technique is not appropriate.

Even in prosthetic replacements, the fascial flap provides better protection for the implant in cases of changes to the insertion plane.

• METHODS

The technique used involves creating a skin flap from the pectoral fascia and, if necessary, more rarely, advancing the rectus abdominis fascia.

The use of ultrasound and measurement with the pinch test (2.5 cm thick by 2 cm for the upper quadrants) allows for the selection of patients and, above all, increases the indications in patients who need to replace their prostheses.

• RESULTS

The authors present 110 cases, including 80 thin patients and 35 breast replacements. In 6 of the latter, it was possible to switch from the dual plane to the subfascial plane.

In 4 patients who had a periareolar scar, we also advanced a portion of the rectus abdominis muscle fascia flap. There were two patients with a post-operative haematoma, which was resolved with the use of a prolonged Redon drain for 7 days.

• CONCLUSIONS

The advantages of this technique are simply that it offers greater coverage of the skin flap and avoids sectioning the pectoral muscle where possible. It also reduces post-operative pain and the time required to refrain from sporting activities in slim patients with submuscular implants. The technique offers a good alternative in cases where the implant insertion plane needs to be modified.

45. Trans-Axillary Breast Augmentation: Objective and Subjective Assesment

• L. Piovano ¹ and A. Randazzo ²

¹ 

Libero Professionista Roma

² 

Medico Specializzando in Chirurgia Plastica, Ricostruttiva ed Estetica presso Università Cattolica del Sacro Cuore—Policlino Gemelli, Roma

• BACKGROUND-AIM

The Authors examine only axillary breast augmentation, focusing on the choice of the suitable patient for this procedure, specifying details of the operating technique.

• METHODS

In the last 30 years we have performed approximately 280 operations of this type, maintaining a standardization of the methods and procedure, only the breast prosthetic implants have changed in evolution.

• RESULTS

Evaluation of cases and improvement of the technique.

• CONCLUSIONS

In conclusion, the authors faithful to the school’s standardization of this procedure want to underline the validity of this intervention which is still current today, the only variable was the evolution of the breast implant market.

46. Unconventional Mastoplasty

• A. Borriello and B. Lo Sapio
• U.O. Chirurgia plastica Ospedale del Mare
• BACKGROUND-AIM

Breast augmentation is often considered a standardized aesthetic procedure. However, up to 10% of patients present anatomical or clinical variations that make conventional approaches unreliable. These “unconventional” cases—such as chest wall deformities, inframammary fold abnormalities, breast asymmetry, tuberous breast deformity, or revision surgery—require a tailored strategy focused on restoring proportion, symmetry, and long-term stability.

• METHODS

A comprehensive morphological evaluation is essential, including assessment of chest shape, tissue thickness, inframammary fold position, and lower pole development. Surgical planning integrates multiple tools: selection of implant shape and projection, management of the pocket, hybrid augmentation with autologous fat, and the use of glandular or capsular flaps when needed. Techniques such as dual-plane dissection, subfascial placement, or combined glandular remodeling are selected according to tissue characteristics. Particular attention is given to conditions such as tuberous breast, chest wall asymmetries, capsular contracture, malposition, and lower pole deficiency.

• RESULTS

A tailored approach allows the surgeon to correct structural asymmetries, compensate for thoracic deformities, and optimize soft-tissue coverage. Hybrid augmentation improves upper pole naturalness and reduces the visibility of implant borders in thin patients. In revision cases, adaptive techniques for capsule management and precise repositioning of the pocket help restore breast contour and symmetry.

• CONCLUSIONS

Unconventional breast augmentation is not a standard aesthetic procedure but a form of precision surgery requiring advanced anatomical understanding, three-dimensional planning, and technical versatility. The integration of implants, fat grafting, tissue remodeling, and individualized pocket design enables more predictable, harmonious, and durable outcomes in patients with complex breast anatomy.

47. Capsular Contracture After Breast Augmentation: Our Approach to Prevent Recurrence with Combined Total Capsulectomy and Implantation of Motiva Ergonomix Implants

• P.L. Serra ¹, M. Mariani ², M. Fabbri ², V. Murone ³, B. Scucchi ⁴, F. Contessi ⁵, I.E. Marin ⁶, C. Botti ⁷ and G. Botti ⁷

¹ 

Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari University Hospital Trust, Viale San Pietro 43, 07100, Sassari, Italy

² 

Department of Plastic and Reconstructive Surgery, Sacred Heart Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy

³ 

Plastic Surgery Resident Residency Program in Plastic Surgery, Azienda Ospedaliera Universitaria Federico II di Napoli, Via Sergio Pansini 5, 80131, Napoli, Italy

⁴ 

Section of Plastic Surgery, Department of Medical and Surgical Specialities, University of Padova, Padova, Italy

⁵ 

Clinic of Plastic and Reconstructive Surgery, Ospedale Santa Maria della Misericordia, 33100, Udine, Italy

⁶ 

Department of Plastic Reconstructive Surgery and Microsurgery, Careggi University Hospital, 50134, Firenze, Italy

⁷ 

VillaBella Clinic, Via Europa, 55, 25087, Salò, BS, Italy

• BACKGROUND-AIM

Breast augmentation is the second most common aesthetic surgery worldwide. Capsular contracture, a prevalent complication which affects up to 30% of patients post-surgery, often leads to further necessary surgeries.

This study investigates the effectiveness of total capsulectomy combined with Motiva Ergonomix^® implant replacement in resolving capsular contracture and minimizing recurrence rates.

• METHODS

We conducted a retrospective study of 1067 patients and enrolled 51 women with capsular contracture post-breast augmentation. Patients were treated between 2014 and 2023 in a single center by three surgeons. Capsular contracture severity was graded using Baker’s classification. Surgical interventions included total capsulectomy and implant replacement, using various incision techniques and changes in implant anatomical planes. Patients were followed up for a minimum of 12 months to a maximum of 9 years.

• RESULTS

A total of 51 patients with grade III or IV capsular contracture underwent revisional surgery, involving the implantation of 102 Motiva Ergonomix^® prostheses; 77 explanted implants resulted intact, 15 exhibited silicone bleeding, and 10 showed ruptured. Capsular contracture recurrence was observed in only 1.96% of cases during the follow-up period.

• CONCLUSIONS

The combination of total capsulectomy and implantation of Motiva Ergonomix^® implants significantly reduces the recurrence rate of capsular contracture. Despite the study’s limitations, including its single-center design and a small sample size, our results suggest that this approach is a viable and effective solution to manage this common complication in breast augmentation patients. Further multicentric studies are recommended to validate these results.

48. “Waterfall” Deformity. Algorithm of Diagnostics and Correction. Personal Approach

• M. Barsakov
• Pirogov Clinic, Saint-Petersburg, American Academy of Aesthetic Surgery hospital, Dubai
• BACKGROUND-AIM

Waterfall deformity is a frequent yet poorly classified complication following breast augmentation, characterized by glandular tissue descent over a stable implant. Despite its prevalence, there is no standardized definition, classification, or treatment protocol in the international literature. The condition is often confused with other deformities such as snoopy breast, double bubble, or implant malposition, complicating accurate diagnosis and surgical planning.

Objective: To develop an anatomical-functional classification of waterfall deformity and a clinically oriented surgical algorithm for each subtype.

• METHODS

A prospective analysis was conducted on 197 patients presenting with waterfall deformity following breast augmentation between 2017 and 2024. Clinical parameters included implant type, surgical plane (submuscular, subglandular, dual-plane), previous mastopexy, native breast anatomy, and ptosis severity. Based on clinical patterns, a four-type classification was proposed. Individualized surgical strategies were defined for each type, involving mastopexy, pocket remodeling, capsulectomy, and implant exchange.

• RESULTS

Four clinically significant types of waterfall deformity were identified:

• Type I—Glandular ptosis with dual-plane placement (14.7%)
• Type II—Snoopy breast deformity with cranial implant malposition (72.1%)
• Type III—Glandular ptosis with subglandular implant position (5.1%)
• Type IV—Capsular contracture combined with glandular ptosis (8.1%)

Each type was matched with a specific surgical correction algorithm. Patient satisfaction exceeded 90% at 12- month follow-up. Pocket remodeling with inferior muscular-capsular flap repositioning in Type II yielded stable and predictable outcomes. Dual-plane conversion in Type III reduced the risk of recurrence.

• CONCLUSIONS

Waterfall deformity is a clinically relevant complication that is often underdiagnosed. The proposed classification is the first to systematize its pathogenesis, clinical features, and surgical approaches. Differentiation from related conditions (e.g., snoopy breast and double bubble) prevents surgical missteps. The algorithm supports standardized secondary breast surgery and enhances outcome predictability.

• Conclusions:

• The most complete definition of postagumentation deformation “waterfall” has been formulated and a 4-type systematization has been proposed.
• The algorithm-based surgical approach demonstrates high efficacy and reproducibility.
• The methodology is suitable for both clinical use and surgical education.
• A differential and type-specific strategy significantly improves aesthetic results and reduces revision rates.

49. Asymmetry Management in Secondary Breast Augmentation

• E.M. Buccheri
• UltraClinic Plastic Surgery, Via Clitunno 22E, Rome
• BACKGROUND-AIM

Breast asymmetry represents one of the most challenging scenarios in aesthetic breast surgery, requiring a precise diagnostic framework and an individualized surgical strategy. Over the past years, I have developed a structured approach to addressing thoracic and breast asymmetries using prosthetic implants, integrating careful preoperative analysis, implant selection, and tailored intraoperative adjustments.

• METHODS

My experience highlights the importance of the first consultation evaluating any preoperative asymmetry and a detailed morphological assessment, including soft-tissue characteristics, nipple–areola complex position, inframammary fold height, and underlying chest wall deformities. Through standardized preoperative measurements and photographic analysis, asymmetries are classified according to severity and underlying anatomical drivers, enabling the creation of a predictable surgical plan.

The core of my method relies on differential implant selection—varying in volume, projection, and base width— combined with targeted pocket dissection. When appropriate, adjunctive procedures such as contralateral mastopexy, fold repositioning, or limited parenchymal reshaping are incorporated to achieve symmetry. Textured anatomical/ round implants are selected based on pocket stability needs, while intraoperative sizers and controlled lighting enhance the accuracy of final volume adjustment.

• RESULTS

Outcomes from my series demonstrate that a systematic algorithm significantly improves both objective symmetry and patient satisfaction, even in complex cases involving congenital chest wall asymmetries or postoperative deformities. Complication rates remain low, and revisions are primarily related to the natural evolution of soft tissues.

• CONCLUSIONS

Breast asymmetry management with prosthetic implants demands rigor, experience, and an individualized approach. My protocol and algorithm provides a reproducible framework that optimizes aesthetic outcomes and supports predictable, long-term results in a patient population with uniquely challenging anatomical variations.

50. Implant Extrusion: A Challenge for the Surgeon. Technical Indications for Explantation and Reimplantation

• S. Marianelli
• Unita’ di Chirurgia Plastica Estetica Clinica Chirurgica Leonardo Sovigliana Vinci
• BACKGROUND-AIM

Implant extrusion is a rare and severe issue that the surgeon must handle with deep knowledge of those surgical techniques aimed at saving the implant and those intended for restoring anatomic planes that can safely host a new breast implant.

• METHODS

The Authors have reported 3 implant extrusion cases, analysing the problems of origin that led to these complications. The adopted corrective techniques are hereby described, highlighting the importance of the use of capsular flaps and lipofilling techniques. Respect for correct timing between the many corrective procedures (three months) has proven to be fundamental for a successful final result.

The authors also underscore the importance of patient management, in order for her to be cooperative during the various phases of the restoration of the anatomic planes.

• RESULTS

The authors describe a first implant extrusion case, caused by the use of oversized implants. Progressive tissue thinning at sub-mammary fold scar level determined implant decubitus with consequent serous fistula.

The second case is characterised by implant extrusion resulting from post-pregnancy secondary mastitis, as the cause of a chronic infection which led to implant prophylactic removal.

The third case is due to the result of post-quadrantectomy breast reconstruction associated to radiotherapy. The authors describe the adopted surgical techniques in the various cases and related surgical timing.

• CONCLUSIONS

Surgical technique, strong nerves and patient management are the three characteristics that must be clear to the surgeon to best manage breast explantation and subsequent surgical timing for reimplantation.

The authors recommend respecting timing between the various corrective procedures, in order to obtain the adequate anatomic bases to host a new implant and achieve a good aesthetic result.

51. Pocket Conversion Strategies: Subpectoral to Subglandular/Subfascial

• B. Cagli, F. Sofo, A.A. Cimmino, D. Porso, I. Vignapiano, A. Carlone, A. Tarantino and S. Salvatore
• Department of Plastic, Reconstructive and Aesthetic Surgery, Fondazione Campus Bio-Medico di Roma, Rome, Italy
• BACKGROUND-AIM

Pocket selection is a critical factor in both aesthetic outcome and complication profile of primary and secondary breast augmentation. Subpectoral placement may be associated over time with animation deformity, chronic pain, implant malposition, double contour and severe capsular contracture, often leading to complex revision procedures. Conversion to a subglandular or subfascial position has been proposed as a strategy to address these issues, but concerns persist regarding implant stability and long-term safety. The aim of this study is to evaluate the efficacy and safety of pocket conversion from subpectoral to subglandular/subfascial in secondary augmentation mammoplasties and to define its role as a reliable option in the management of complex revision cases.

• METHODS

Eighteen consecutive patients undergoing revision breast augmentation with pocket conversion from subpectoral to subglandular or subfascial were analyzed, all presenting complex indications. Minimum follow-up was 24 months. Indications for reoperation included severe capsular contracture, grade III or IV, (n = 4), animation deformity and/ or pain (n = 6), water fall deformity (n = 4) and implant malposition (n = 4). The procedure consisted of partial or total capsulectomy/capsulotomy, release and inferior repositioning of the pectoralis major, and creation of a new prepectoral pocket (subglandular or subfascial) with implant exchange. Patient-reported outcomes were assessed using t BREAST-Q questionnaires at 1, 3, 6, 12 and 24 months. Standardized postoperative photographs, obtained at the same time points, were independently evaluated by two plastic surgeons and an external nurse using a 1–5 score to assess correction of the primary defect and overall aesthetic improvement.

• RESULTS

At 24-month follow-up, resolution of capsular contracture, animation deformity and functional symptoms was observed in all patients. No major complications requiring additional surgery were recorded, and no cases of high- grade (III–IV) capsular contracture were detected. BREAST-Q analysis demonstrated significant improvement in psychosocial, sexual and physical well-being, as well as in satisfaction with breast appearance. Correction of the primary defect and implant positional stability were judged complete and maintained at 12 and 24 months in all cases, with consistent overall aesthetic improvement documented by the external reviewers.

• CONCLUSIONS

In selected patients with complications related to subpectoral breast augmentation, conversion to a subglandular or subfascial pocket represents a safe and effective strategy in secondary or revision augmentation mammoplasties. This approach provides reliable correction of capsular contracture, animation deformity and malposition, improves patient- reported outcomes and ensures stable, predictable aesthetic results over time. In the absence of contraindications, pocket conversion to a prepectoral position should be considered a valuable option in the algorithm for managing complex revision breast augmentation.

52. Revisione Popcorn Technique as an Aid in Revision Mammoplasty

• A. Santorelli ¹ and S. Avvedimento ²

¹ 

A.Santorelli@Partners

² 

Ospedale A. Cardarelli Napoli

• BACKGROUND-AIM

Revision mammoplasty often requires adjustment of the prosthetic pocket to correct contour deformities and implant displacement. The popcorn technique or dermal tightening technique, performed using an electrosurgical unit, allows controlled capsulorrhaphy with progressive contraction and redefinition of the capsule without the need for extensive capsulectomy or capsular flaps. The aim of the study is to evaluate the efficacy and safety of the popcorn technique in revision breast surgery, with particular reference to the correction of lower pole defects and the stability of the result over time.

• METHODS

Patients who underwent revision mastoplasty between January 2021 and June 2024 using the popcorn technique for periprosthetic capsule management were retrospectively analysed. The procedure involved cauterising multiple, controlled areas of the capsule with an electrosurgical knife until uniform and adequate contraction was achieved, avoiding extensive dissection. Data on healing time, early and late complications, breast symmetry and aesthetic satisfaction were recorded.

• RESULTS

Eighteen consecutive cases were included. In all cases, effective remodelling of the prosthetic pocket was achieved. After a mean follow-up of 14 months, no secondary complications or complications requiring reoperation were observed. Minor complications (mild haematoma, seroma, or transient hypo aesthesia) resolved spontaneously. Postoperative aesthetic satisfaction, assessed using the VAS scale, was high in 91% of cases.

• CONCLUSIONS

The popcorn technique with an electrosurgical knife is an effective and reproducible method for capsular management in revision mastoplasty, allowing controlled remodelling of the capsule and recovery of the correct lower pole profile with minimal minimal morbidity and good long-term stability.

53. Secondary Breasts from Chaos to Order: A Method to Elementarise the Infinite Variety of Deformities

• U. Napoli
• Free Lance Surgeon, Turin
• BACKGROUND-AIM

Secondary breast augmentation and mastopexy after implants are among the most challenging procedures in aesthetic breast surgery because of heterogeneous deformities and previous surgical choices. This work proposes a simple four- question decision algorithm and a reproducible four-axis classification to standardise planning in secondary breast cases and to translate complex scenarios into a limited number of treatment patterns.

• METHODS

A stepwise algorithm was applied to consecutive patients undergoing revisional breast surgery after augmentation or mastopexy with implants. Preoperative assessment was standardised (suprasternal notch-nipple distance, nipple- inframammary fold distance, breast base width, soft-tissue quality, implant features and dominant deformity). Each breast was coded according to four axes: implant (maintain vs. remove), target volume (increase, maintain, decrease, no implant), envelope status (three levels of ptosis and skin excess) and capsule-pocket status (three levels of capsular and plane pathology). Surgical strategy was directly derived from each combination.

• RESULTS

The algorithm and coding system were applicable to all secondary breasts in the series and allowed immediate identification of the dominant problem and of one or two preferred surgical options for each pattern. The most frequent combinations involved oversizing with severe ptosis and capsular pathology, which were consistently treated with implant downsizing, pocket reconstruction and formal mastopexy. Surgeons reported improved clarity in case discussion and documentation, and patients more easily understood the rationale and limits of the proposed plan. Early complication and reoperation rates were comparable to the usual institutional experience in similar cases.

• CONCLUSIONS

A four-question decision algorithm combined with a four-axis code for implant, volume, envelope and capsule-pocket status can elementarise complex secondary breast deformities into a finite number of repeatable patterns. This structured approach appears to facilitate preoperative planning, teaching and communication with patients and may provide a basis for future outcome studies and multicentre comparisons in revisional breast surgery.

54. Secondary Mastopexy with Implant: Is It Possibile to Make It Easy, Safe and Reliable?

• R. D’Alessio and M. D’Alessio
• Libero Professionista Napoli
• BACKGROUND-AIM

Secondary mastopexy with implants is one of the most challenging procedures in aesthetic breast surgery due to residual anatomical variability, scar-related deformities, and altered tissue planes resulting from previous operations. The main difficulties include managing recurrent skin excess, redefining the nipple–areola complex, selecting and stabilizing the implant correctly, and restoring adequate tissue support to prevent further ptosis, bottoming-out, or implant malposition. The aim of the presentation is to demonstrate how, through careful planning and adequate execution of surgical times (even with the possible variations related to individual cases), it is possible to obtain pleasant, reproducible and stable results, in limited operating times.

• METHODS

The main difficulties include managing recurrent skin excess, redefining the nipple–areola complex, selecting and stabilizing the implant correctly, and restoring adequate tissue support to prevent further ptosis, bottoming-out, or implant malposition. Proposed solutions include rigorous preoperative planning with assessment of tissue quality and the integrity of existing capsules; the personalized use of implant pockets (advanced dual-plane, conversion to subfascial or selective prepectoral placement); the adoption of internal support techniques such as biological or synthetic meshes to stabilize the lower pole; and accurate implant selection based on objective measurements.

• RESULTS

The body of the presentation illustrates surgical details of the technique used, accompanied by short illustrative videos of the most significant stages and a list of results achieved in different conditions. Special attention is also given to the management of pre-existing scars and the prevention of complications such as seromas, areolar necrosis, or recurrent ptosis.

• CONCLUSIONS

The systematic approach described helps standardize the procedure, reduce intraoperative uncertainties, and improve both aesthetic and functional outcomes, making secondary mastopexy with implants a more controlled and reliable operation even in complex cases.

55. Volume Displacement in Breast Augmentation Mastopexy

• A. Innocenti
• Chirurgia Plastica e Microchirurgia Ricostruttiva—Azienda Ospedaliero Universitaria Careggi—Centro Medico Chirurgico Matteotti—Firenze
• BACKGROUND-AIM

Breast augmentation has become a highly standardized surgical procedure and is among the most frequently requested interventions. When appropriately planned, it can be considered safe and straightforward to perform.

• METHODS

However, in specific clinical scenarios such as congenital or acquired breast deformity, where correction of the breast cone is strictly required, or in particularly cases in which breast augmentation has to be combined with mastopexy the procedure could present significantly greater technical challenges requiring simultaneous management of several items such as parenchyma reshaping, extra skin removal, nipple areola complex positioning, selection of size and implant shape and surgical plane where to implant the prosthesis.

In some clinical conditions, the use of volume displacement techniques should be taken into consideration. It consists in the displacement of autologous tissue from a donor site to a recipient site. The application of local parenchymal flaps and the concept of volume displacement during mastopexy, reduction mammoplasty or in mammary cone reshaping is not a recent innovation; it was firstly introduced by Ribeiro and Backer in the early 1970.

Volume displacement provides autologous material that can be used to redefine the breast cone, enhance coverage of an eventual prosthetic implant, restore the fullness appearance of the upper pole, correcting the caudal bulk when present. The transfer of vascularized flaps allows more predictable result comparing to fat grafting and reduce the need of multiple surgical steps. Moreover, in selected cases, especially in post bariatric patients, usually suffered from a very inelastic breast tissue, it could reduce the dimension of the required implant, reducing the additional stress to the atrophic tissue related to the presence of the implant connected to its weight and movement.

• RESULTS

Autologous breast tissue also offers the advantage of adapting to weight fluctuations, thereby maintaining breast shape and volume in accordance with physiological changes occurring over time.

• CONCLUSIONS

The present work reports a substantial clinical series with a minimum follow-up of 3 and maximum of 14 years, focusing on specific corrective strategies employed in the management of congenital and acquired breast deformities.

56. Extending Lipo-Abdominopolasty Posteriorly to Improve Outcomes and Reduce Steps in Body Contouring Surgery. Blending the Gluteal Area into the Lumbar Area

• L.M. Lapalorcia ¹ and R. Martinelli ²

¹ 

Istituto clinico porta sole, Perugia

² 

Villa Anna Maria, Roma

• BACKGROUND-AIM

Standardizing and improving patient safety in major body contouring procedures is of crucial importance especially if patients are managed outside the national healthcare system. Quotes for surgery are high as major surgery is performed and patient’s expectation are high following enormous efforts for weight loss and desire to regain confidence and improve quality of life (QOL).

• METHODS

We present a series of 3 patients that presented to our offices following a major weight loss of more than 20% body weight. we highlight clinical peculiarities and outline surgical tips to increase safety and optimizing surgical time and global recovery after surgery.

• RESULTS

The patient were intubated and positioned in prone, with a support cushion under the pelvis to enhance cyphosis of the lower part of the spine. 1000 mL of tumescent solution with epinephrine 1:200,000 were infiltrated in the lumbar region, in the flank area and on the external surface of the thighs. Liposuction with a 4 mm mercedes tip cannula was used for harmonization of the flank and external thighs.

A lumbar belt of skin was then removed according to the preoperative markings.

Skin redundancy was thus reduced and the overall shape of the body improved dramatically on the posterior side of the body.

Patient’s satisfaction was evaluated with BODY Q and appearance and quality of life were always improved.

• CONCLUSIONS

Knowledge of basic liposuction techniques and ability to perform more complex lipectomy allowed to manage the patient successfully. No complications were observed, drains were removed on POD day one and wounds healed uneventfully.

57. Effectiveness of Hifem Technology in the Treatment of Rectus Abdominis in Older Adults: Insights for a New Integrated Approach

• K. Antoniadou and F. Flagiello
• Roma
• BACKGROUND-AIM

Diastasis of the rectus abdominis muscles is a common condition in the adult and elderly population, often associated with low back pain, impaired core stability and reduced functional capacity. The traditional management is predominantly surgical, especially in severe or symptomatic cases. The emergence of High Intensity Focused Electromagnetic technology, capable of inducing supramaximal muscle contractions and improving both muscle thickness and the quality of the abdominal wall connective tissues, has opened new clinical perspectives. The aim of this contribution is to evaluate, through a clinical case, the potential role of HIFEM as an integrative tool within conservative pathways for elderly patients who are not always eligible for surgery.

• METHODS

A clinical case involving a 70 year old male patient, 170 cm and 70 kg, was analyzed. Ultrasound assessment confirmed a diastasis of the rectus muscles measuring 4 cm in transverse width and 15 cm in longitudinal extension. The patient underwent an HIFEM protocol consisting of three treatment cycles performed in May 2023, October 2023 and April 2024, for a total of 14 sessions. The progression of the diastasis was monitored through sequential ultrasound evaluation in the months following each treatment cycle.

• RESULTS

Ultrasound follow up showed a progressive reduction in the inter rectus distance after the first two cycles, followed by stabilization of the result. This trend suggests a structural improvement of the abdominal wall, consistent with current literature describing the effects of HIFEM on increased rectus thickness, enhanced neuromuscular recruitment and strengthening of core musculature. The treatment was well tolerated and no adverse events were reported.

• CONCLUSIONS

Although it does not replace surgery in complex, symptomatic or hernia associated cases, HIFEM emerges as a potential integrative option in the conservative management of abdominal diastasis, particularly in elderly or polymorbid patients who are not suitable candidates for operative intervention. This case supports a positive contribution of high intensity electromagnetic stimulation to the structural and functional improvement of the abdominal wall. Larger prospective studies are needed to define standardized protocols and further clarify the effectiveness of HIFEM in the treatment of mild to moderate diastasis.

58. Guidelines and a Personal Algorithm for the Diagnosis and Treatment of Postpartum Disorders

• G. Giugliano
• Mater dei Genral Hospital Rome
• BACKGROUND-AIM

Introduction: Postpartum disorder often require a complex approach. The aim of this study is to present a medical and surgical evaluation algorithm and standardized guidelines based on a personal case series of over 400 patients over the last 10 years for immediate assessment and rapid, effective, and definitive therapy.

• METHODS

Materials and Methods: This review used clinical evalutation and clinical imaging. Selection criteria included multispecialty examinations, to clinically assess postpartum sequelae as well as previous abdominal surgery, medical imaging to assess the characteristics of diastasis recti and pelvic floor disorders; laboratory tests to assess intestinal dysbiosis and metabolic diseases; assessment of diastasis recti and pelvic floor muscle function; and the Postpartum Depression Self-Assessment Test (EPDS).

• RESULTS

Results: In most clinical studies, we found great variability in diagnostic criteria and methods, in the assessment of DRA, in the planning of postpartum disorders. To define our algorithm and the Muralt guidelines, we included: 800 pre- and post-operative abdominal and pelvic CT scans, 120 pre- and post-operative defecation MRIs, 2000 multi-specialty clinical examinations, 800 dysbiosis tests, 400 laboratory tests, and 400 EPDS questionnaires.

• CONCLUSIONS

Conclusion: Over the past decade, following our algorithm and guidelines, we have treated 95% of the symptoms in all 400 patients treated with the Muralt method. Our algorithm and guidelines have proven effective both in terms of rapid diagnosis and the multi-specialist pre- and post-operative approach, significantly reducing surgical procedures and reducing the patient’s functional and psychophysical recovery.

59. Impact of Lipoabdominoplasty and Rectus Diastasis Repair on Benzodiazepine Usage in Patients with Depression and Anxiety: A Prospective Study

• F. Tomaselli, R. Albanese and D. Tambasco
• Plastic Surgery Unit, San Carlo di Nancy Hospital, Rome
• BACKGROUND-AIM

Lipoabdominoplasty, primarily sought for cosmetic enhancement, has shown potential benefits beyond physical transformation. Emerging evidence suggests that aesthetic procedures may positively affect mental health by improving body image and self-esteem. This study aims to assess the impact of lipoabdominoplasty on pharmacologic therapy (i.e., benzodiazepines) use in patients with preexisting depression or anxiety disorders.

• METHODS

This prospective cohort study included 69 patients who underwent lipoabdominoplasty. All patients were taking benzodiazepines before surgery, with dosage frequency recorded. Follow-up assessments were conducted postoperatively to document changes in drug use and evaluate mental health improvements using validated scales, including the BODY-Q.

• RESULTS

A significant reduction in benzodiazepine use was observed postoperatively. At follow-up, 17% of patients discontinued medication, and 61% required a lower dosage (p < 0.05). Complications occurred in 16% of cases, including seroma (n = 6), infection (n = 2), hematoma (n = 2), and necrosis (n = 1); 1 patient required reintervention. BODY-Q scores demonstrated significant improvements in body image and self-esteem.

• CONCLUSIONS

Lipoabdominoplasty may contribute to reduced drug use, likely driven by improvements in body image and psychologic well-being. These findings underscore the potential of aesthetic surgery to enhance mental health in patients with depression or anxiety, offering an integrated holistic care approach.

60. Post-Partum Diastasis and Floppy Wall Laxity: A Personal Plication Strategy

• A. Bruno
• Private Practice—Clinica Santa Maria di Leuca, Roma
• BACKGROUND-AIM

Pathologic post-partum abdominal wall insufficiency—including rectus diastasis and a set of laxity patterns clinically defined as Floppy Wall—affects up to 30% of women following pregnancies. When symptomatic, it configures the entity-described syndrome Post partum Abdominal Wall Insufficiency Syndrome, often associated with lumbar back pain, post-prandial distension, pelvic instability, and stress-triggered urinary leakage. Restoring a stable musculo- fascial envelope during abdominoplasty may provide simultaneous esthetic and functional recovery. We report a single- surgeon personal approach integrating multi-axis vertical and horizontal plication to treat bidimensional wall failure and preserve long-term contouring.

• METHODS

This retrospective cohort (March 2021–March 2023) included 117 non-smoking adults (mean age 41.8 ± 7.2) undergoing aesthetic abdominoplasty with parietal dysfunction confirmed by standardized thinning/widening parameters and distortion index of the linea alba. Vertical plication was performed on rectus abdominis and oblique muscles to correct 2.0–11.4 cm diastasis; horizontal plication was selectively indicated in the umbilical or hypogastric areas when local redundancy or pathologic widening required it. Pedicle-compromising umbilical lengths, large umbilical hernias, or severe fibrosis patterns received conversional resection of the pedicle and neo-ombelicoplastica (optimized term) using H-wing design. In selected cases, lateral chest-wall liposuction and gluteal lipofilling were paired following operative-compatibility assessment. Outcomes included blinded 3-surgeon scar visibility panel categorization, six- month shoulder/elbow ROM gain, and 90-day seroma checks confirmed clinically and by ultrasound when suspected.

• RESULTS

No major infections, hematomas, or flap compromise occurred. 6-week drainage volumes met early-removal thresholds (<30 mL/24 h) by 48 h in 91.9% of patients. Dehiscenza was 3.0% overall (all conservatively managed). At 6 months, ROM gains reached 18° ± 2° with near-universal mobility improvement (95% “excellent” Likert rating). Confirmed seroma rate was 0.0% in the entire cohort with no ultrasound-confirmed late collections.

• CONCLUSIONS

Multi-vector vertical + horizontal plication provides reproducible restoration of a stable, conic, tension-balanced abdominal wall with rapid functional recovery and durable projection, effectively mitigating seroma vectors and pseudoptosi from N-IMF elongation. The approach is safe, efficient, and expands short-scar applicability even in moderate-to-severe parietal failure, preserving neurosensitivity and mobility without secondary conversion needs. Future multicentric prospective trials integrating validated PROMs are recommended.

61. Push Risk Away Technique for a High Definition, Fast Track Abdominoplasty

• V. Colabianchi and R. Uccellini
• In Private Practice
• BACKGROUND-AIM

An abdominoplasty is an operation that exerts its influence on several anatomical regions, with repercussions on multiple systems, especially the vascular and nervous system. We have tried to identify potential risk factors and have suggested a series of corrective measures.

• METHODS

Our clinical record comprises of a total number of 372 abdominoplasty operations.

From 2009 to 2023 we performed 325 procedures (171 F; 154 M) using the classic abdominoplasty technique as described by Planas; we refer to this group of patients as the “control group”.

Subsequently, we introduced some modifications to the surgical technique and we coined a term to refer to this modified procedure, defining it as PUSH RISK AWAY ABDOMINOPLASTY.

The acronym PUSH RISK AWAY synthesizes the criteria that we have implemented with this methodology.

Regional tap block anesthesia, combined with general anesthesia, allowed us to obtain pain-free results with the possibility of discharging the patient on the same day of surgery.

• RESULTS

Throughout 2024 we performed 47 cases with this modified technique.

Data documenting instances of complications in the control group is as follows:

Seroma (3.4%), haemorrhage (3.0%), dysesthesia (3.0%), dehiscence (2.1%), liponecrosis (1.8%), skin necrosis (1.2%), with a global complication rate of 14.7%, falling in line with the global complication rate derived from the international literature.

The preliminary results seen on patients treated with the PUSH RISK AWAY ABDOMINOPLASTY technique demonstrate a reduction of the incidence of complications (10.6%), albeit this data refers to 47 cases only.

The anesthesia technique was improved as well, combining general anesthesia with regional anesthesia with TAP blocks.

• CONCLUSIONS

A PUSH RISK AWAY abdominoplasty is a modified procedure in which we introduced specific refinements in the surgical technique. Preliminary results on 47 cases, show considerable improvements in terms of patient comfort and reduced post operative complications, as well as reduced patient admission time with most patients often discharged on the day of surgery. Further observation is required on a larger group of patients.

62. Refinements in Abdominoplasty: Rectus Muscle Diastasis Repair and “Scar Free Navel”

• A. Caggiati ¹ and S. Tenna ²

¹ 

Circo Massimo Medical Center Roma

² 

Chirurgia Plastica Campus Biomedico Roma

• BACKGROUND-AIM

Umbilicoplasty is the final step of a surgical procedure of abdominoplasty and represent the only site at risk for visible scar not concealed by underwear. Thus any visible scarring may indicate previous cosmetic surgery.

Anomalies of a new navel may include a visible periumbilical scar or an abrupt color transition between the skin of the navel and the skin of the abdominal flap to which it is sutured.

The authors present a method of repositioning the navel aimed at making both the periumbilical scar and the abrupt color changes between the skin of the umbilical stump and the skin of the abdominal flap less visible, and at recreating a vertical navel.

• METHODS

From 2013 to 2025, 187 abdominoplasties with umbilical repositioning were per-formed. The recipient site for the new navel is prepared with a long vertical incision 50% longer than the diameter of the umbilical stump. The incision edges are raised 8–10 mm subdermally. The site of the new navel is then defatted by full-thickness fat sampling of the abdominal flap.

The umbilical stump is secured to the midline of the abdominal wall with four non-absorbable stitches, leaving an umbilical stump approximately 30% of the thick-ness of the abdominal flap intended to receive it.

The de-epithelialized flaps are then inverted and sutured to the umbilical stump with two suture layers (PDS 4/0 and Vicryl Rapid 6/0).

• RESULTS

Procedures that involve abdominal skin resection at the new site of the umbilicus carry the risk of outward migration the periumbilical scar resulting in scar visibility.

The indicated procedure allows for inward bending of the skin edges of the ab-dominal flap, with final positioning of the periumbilical scar within the umbilical cone.

No specific complications of the procedure have been reported.

• CONCLUSIONS

The positioning of the scar inside the umbilical stomp is an undesirable event and possible by adopting minimal precautions at the end of an abdominoplasty procedure to make both the periumbilical scar and the inevitable colorimetric transition between the skin of the umbilical stomp and the abdominal skin less visible.

63. The Use of Dermagraft in the Treatment of Diastasis and Abdominal Wall Reconstruction

• A. Tambuscio
• Libero Professionista, Padova
• BACKGROUND-AIM

Diastasis recti is the most common abdominal wall defect in postpartum women. In addition, midline abdominal hernias and incisional hernias, resulting from previous surgical procedures, are frequently found. Correction of diastasis recti and other abdominal wall defects is often combined with abdominoplasty for complete aesthetic and functional improvement. Many muscle reconstruction techniques have been described over the years, most often involving direct suture techniques or the use of synthetic mesh. Only more recently has the use of dermagraft been described, as an autologous biological mesh for reinforcement in muscle wall reconstruction. The author presents his experience in the evaluation and correction of muscle wall defects, from direct fixation to the use of dermagraft.

• METHODS

One hundred and fifty-four consecutive female patients, aged 30–64, were enrolled from 2021 to 2025. They were affected by midline diastasis or hernia/incisional hernia, along with excess abdominal integument. Preoperative evaluation included a direct physical examination and imaging techniques such as ultrasound and CT. Body mass index and abdominal content displacement were also taken into consideration. Patients were divided into two groups: those eligible for abdominoplasty with direct wall reconstruction using fixation and those eligible for dermagraft reinforcement. Results were assessed using similar tools at months 1, 6, and 12.

• RESULTS

Analysis of the results obtained showed a partial recurrence rate of 2.3% in patients who underwent reconstruction using direct fixation (2/84) and 0% in patients who underwent dermagraft reconstruction (0/70). No complete recurrence was observed in the sample examined.

• CONCLUSIONS

Careful preoperative assessment of muscle wall defects and selection of the most appropriate reconstructive technique with standardized procedures significantly minimizes the risk of recurrence. The use of dermagraft has proven extremely effective in correcting major defects with a negligible increase in operating time, in the absence of complications, and at zero cost.

64. GlúteoGluteal Reshaping with Lifting Elastic Permanent Threads. Surgical Technique and Results

• E. Riggio
• Fondazione IRCCS Istituto Nazionale dei Tumori, Milano—Private practice in Milano, Palermo
• BACKGROUND-AIM

Correction of hanging buttocks is conventionally treated by long-scar lifting or, with some limits, with silicone implants. Introduction of elastic permanent threads in my practice has changed my strategy for gluteal reshaping, reducing conventional lifting and small implants. First aim is changing the shape; second, improving the gluteal ptosis.

• METHODS

The technique is minimally invasive, with anesthesiologist assistance, lasts 60–75 min. Skin Incisions are of 3–10 mm. Two circular loops in the subcutaneous layer with no fixations to musculoskeletal structures. The surgical procedure is performed by Elasticum^®, an elastic silicone-polyester thread with a long two-tipped Jano needle^®. A stab incision is carried out at 5 points. The needle guides the thread and, at each skin incision, is extracted up to the fourth depth mark, which means that 2 cm of the tip remains in the subcutaneous tissue. A circle along the outer boundaries of the buttock and another larger and lower circle outside the first circle. Paramount is the distance from the subgluteal fold (>3 cm) to be respected. Then according to the tension due to the thread circle, the upper portion of the buttock has been lifted and firmed up. Then, after the insertion of the second elastic thread, the lower portion lifts. Indications: all ptosis grades. (Video-demonstration).

• RESULTS

The patient candidates are female, mostly after pregnancy and after menopause, clinical results (buttock contour and lift improvements) with a follow-up (6 months-6 years) are good for 80%, average 15%, poor 5%. Recovery time: 3 weeks. Pain relief after one week. The result can be estimated after 3 months postop and last at long-term. Limitations: extremely thin soft tissue; obese patients; no indications for patients seeking for a “Brazilian” augmented buttock. Buttocks appear rejuvenated and have a more pleasing long-lasting shape.

• CONCLUSIONS

This technique is a minimally invasive procedure and compared to implants and extended lifting with long scars do not presents severe complications in trained hands. In addition, the outcome can be further improved with liposuction and/or lipofilling and, even if stable for years, it can be maintained by implanting further thread in the future.

65. Abdominoplasty and Body Contouring: Evolution of the Technique and Personal Method, a Comparative Perspective

• A. Amoroso
• Care e Beauty Surgery
• BACKGROUND-AIM

In recent years, abdominoplasty has evolved from a simple excisional procedure into a comprehensive trunk-reshaping operation. We present our personal technique, referred to as the Saldanha method, integrated with 360° body contouring and U-Graft fat modulation, including selective fat removal over the iliac crests, similar to the approach described by Flores.

Over 50 abdominoplasties using this method were performed during the study period. The aim of this work is to evaluate the effectiveness of this combined approach and to compare outcomes between cases in which 360° contouring and U-Graft were included or omitted.

• METHODS

A total of 50 consecutive patients underwent abdominoplasty using the Saldagna method within a 12-month period. They were divided into two comparative groups:

Group A—Full technique:

Saldanha abdominoplasty 360° body contouring.

U-Graft with iliac crest fat removal (Flores-like) Group B—Partial technique:

Abdominoplasty without 360° contouring No U-Graft to the iliac crests.

Outcome measures included:

Overall body contour improvement (anterior and posterior) Trunk definition.

Complications:

Skin necrosis Prolonged edema Seroma Postoperative pain.

Localized U-Graft infection Patient satisfaction (1–5 scale) Blinded photographic assessment.

• RESULTS

The full technique produced a markedly superior body contouring effect, with improved anterior and posterior shaping. Key findings include:

Enhanced lateral and lumbar definition in Group A More harmonious abdominal silhouette.

Clearer iliac crest contouring in cases with U-Graft Complications included:

Minor skin necrosis in a limited number of cases Edema common during early recovery.

Some seromas requiring drainage.

Increased postoperative pain associated with U-Graft Rare localized infections at U-Graft sites.

Patient satisfaction averaged 4.7 in Group A and 4.1 in Group B.

• CONCLUSIONS

The Saldanha method, combined with 360° contouring and U-Graft, demonstrates significant effectiveness in improving abdominal and trunk contour. The technique enhances both anterior and posterior abdominal aesthetics, providing a more balanced and natural body profile.

Complications were manageable, and overall patient satisfaction was high, confirming this approach as a reliable and valuable evolution in modern abdominoplasty.

66. Autologous Fat Grafting After Ultrasound-Assisted Emulsification: A Systematic Review

• N. D’Alterio ¹ and A. Murante ²

¹ 

AOU Federico II

² 

Libero Professionista

• BACKGROUND-AIM

Ultrasound-assisted fat emulsification has been proposed to enhance fat graft handling, adipocyte uniformity and graft integration. This systematic review evaluates the clinical and histological outcomes of immediate autologous fat reinjection following ultrasound emulsification.

• METHODS

A systematic search of PubMed, Scopus and Web of Science (2000–2025) was conducted. Studies involving fat harvesting, ultrasound emulsification and reinjection within the same operative session were included. Primary outcomes were graft survival, complication rates, and patient satisfaction.

• RESULTS

A total of 25 studies involving 582 patients were included. Ultrasound emulsification resulted in smaller adipocyte fragments and a relatively enriched stromal component. Reported graft survival ranged from 50% to 75%, with improved volumetric homogeneity in treated areas. Complications were mild and comparable to conventional lipofilling. Some studies indicated enhanced tissue integration related to increased stromal–vascular content.

• CONCLUSIONS

Immediate grafting of ultrasound-emulsified fat appears safe and potentially advantageous. However, available evidence remains limited by heterogeneity and small sample sizes. High-quality prospective studies are needed to validate these findings and establish standardized protocols.

67. GLP-1 Receptor Agonists and Body Contouring Surgery: Implications, Challenges, and Evolving Strategies

• R. Albanese, F. Tomaselli and D. Tambasco
• Plastic Surgery Unit, San Carlo di Nancy Hospital, Rome
• BACKGROUND-AIM

The widespread use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has significantly altered the profile of patients seeking body contouring surgery. Rapid pharmacologically induced weight loss affects tissue quality, body composition, and self-image, creating new expectations and clinical challenges. Growing evidence suggests that procedures such as lipoabdominoplasty may provide not only aesthetic enhancement but also psychological and functional benefits, with improvements in anxiety, depressive symptoms, and quality of life. In this evolving clinical context, it is essential to define the broader role of body contouring in promoting both physical and mental well-being.

• METHODS

Data were evaluated from a prospective cohort of patients undergoing lipoabdominoplasty with rectus diastasis repair, all diagnosed with anxiety or depression and receiving daily benzodiazepine therapy. Benzodiazepine dosage and patient-reported outcomes were collected before surgery and six months later. The analysis explored the relationship between surgical reshaping, rapid weight-loss–related tissue changes, and postoperative psychological outcomes, with particular focus on quality of life, body image, and medication use.

• RESULTS

The findings indicate that lipoabdominoplasty may lead to psychological and functional improvement, reflected in reduced need for anxiolytic medication and enhanced self-perception. A majority of patients required lower benzodiazepine dosages postoperatively, and a portion were able to discontinue therapy entirely. Patient-reported outcome measures demonstrated substantial improvements in body image, physical function, and psychosocial well- being. These results are particularly relevant in individuals who have experienced rapid weight loss from GLP-1 therapy, as body contouring helps restore anatomical harmony and reduces the emotional burden associated with altered body proportions.

• CONCLUSIONS

Body contouring surgery appears to play a multidimensional role in patients who undergo major metabolic and physical changes following GLP-1 treatment. Beyond restoring aesthetic balance, it contributes to psychological recovery, improved quality of life, and potential reduction in medication use. A multidisciplinary approach involving plastic surgeons, endocrinologists, and mental health professionals is essential to address the complex physiological and psychosocial needs of this patient population. Further large-scale and long-term studies are needed to better define perioperative strategies and understand the sustained impact of body contouring in this emerging clinical scenario.

68. Impact of GLP1-Agonists on Common Plastic Surgery Procedures Such as Body-Contouring and Body-Lifting—A Literature Review

• J. Fuhr and G.F. Romano
• Studio-Romano-Fuhr, Firenze
• BACKGROUND-AIM

GLP1-Agonists have become central in managing obesity and type 2 diabetes but become more and more important in simple pre-surgical weight loss approaches of our patients. They work primarily through appetite suppression and metabolic regulation.

However, rapid weight reduction induced by these medications often leads to esthetic challenges, including facial volume loss, skin laxity, body contour irregularities and muscle loss.

• METHODS

The objectives of this literature review were to review the effect of Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) on Plastic Surgeons daily procedures such as Body-contouring and Body-liftings.

• RESULTS

This review synthesizes available literature and clinical observations in Plastics Surgery to identify key esthetic concerns associated with GLP-1-induced weight loss.

• CONCLUSIONS

The aim of this review is to inform about pros and cons of this rapidly spreading medication and develop guidelines for the preparation and the surgical management of our patients.

69. Managing Severe Grade Gynecomastia Without Major Scars and Complications

• K. Ramasamy
• Chennai Plastic Surgery
• BACKGROUND-AIM

Gynecomastia is a prevalent male breast condition requiring surgical intervention for both aesthetic and functional restoration. Postoperative complications such as hematomas and seromas remain a major concern in high-volume practices. Keeping the Nipple areola complex (NAC) in ideal position is a challenge in high grade gynecomastia.

• METHODS

To share our 15-year experience managing over 5000 gynecomastia cases, focusing on the innovative plaster lift technique combined with quilting sutures to effectively minimize postoperative complications and enhance surgical outcomes. Our surgical protocol integrates minimal-access incisions with glandular excision and liposuction, supported by quilting sutures to eliminate dead space and stabilize flaps. The plaster lift technique is applied postoperatively to ensure NAC is nicely lifted up without loose skin. Patients were closely monitored for complications including seromas and hematomas.

• RESULTS

This approach resulted in a marked decrease in hematoma and seroma rates, improved scar aesthetics, and high patient satisfaction. Quilting sutures effectively prevented fluid accumulation by obliterating dead space, while the plaster lift technique delivered consistent NAC position in lower border of pectorals major without having double incision mastectomy scar. Our complication rates were substantially lower compared to conventional methods reported in the literature.

• CONCLUSIONS

The plaster lift technique combined with quilting sutures offers a safe, reliable, and reproducible strategy for male breast correction. Our extensive case series underscores how meticulous surgical technique, and postoperative management can improve outcomes and patient comfort.

70. Ultrasound-Assisted Lipoplasty Combined with Argon Plasma

• N.R. Pepe
• Private
• BACKGROUND-AIM

The author presents his own case series accumulated in the last year, using the combined technologies of ultrasound and argon plasma. The purpose of combining these technologies is to allow the skin to readjust to the new volume, as it is reduced through the lipoplasty procedure and due to the laxity caused by degenerative aging processes.

Ultrasound technology, applied before the suction phase, allows for easier removal of adipose tissues, enabling faster extraction using less aggressive cannulas. The ultrasound, by generating a controlled amount of heat without causing thermal side effects (which I unfortunately encountered with previous medical devices of the same technology), promotes the production of new collagen, ensuring better skin retraction over the new volume. The subsequent application of argon plasma technology, after the suction phase, promotes further retraction of the deep skin dermis and the retinacula cutis, which were previously heated by the ultrasound technology, in a minimally thermal way.

Aims. To demonstrate that using complementary technologies for distinct purposes—ultrasound for adipose-tissue emulsification and mitigation of blood loss, and argon plasma to enhance skin retraction while reducing postoperative edema and inflammatory response—extends operative time but improves the postoperative course and final outcome.

• METHODS

The combined use of these two technologies was initiated by the author in June 2022, and to date, 42 patients have been treated, 33 of whom were female. The ultrasound was applied in pulsed mode with dosages ranging from 60–80% for a duration of 2–3 min per 10 cm². In some cases, the suction phase was not performed as there was only a need to create tissue retraction; in other, more frequent cases, an average of 800 milliliters of low-blood adipose tissue was aspirated, reaching amounts close to three liters per session, but never exceeding this. The argon plasma phase involved three passes with flow rates of 1–2 L and power settings of 25–30. Compression garments were then used for at least two months.

• RESULTS

The results will be presented to evaluate the aesthetic outcomes. However, it can be noted that the surgical times were generally longer compared to traditional liposuction, though this was offset by reduced mechanical trauma, less postoperative lymphedema, and fewer bruises. It should also be noted that the retraction times are particularly long.

• CONCLUSIONS

The combination of technologies in the liposuction technique is a well-established practice. In the experience presented here, two different technologies are applied: one ultrasonic, which predominantly emulsifies the adipose tissue, and the other plasma-based, which predominantly retracts the fibrous tissue of the integumentary system in a non-thermal manner. Of course, the author’s research focuses on identifying the appropriate dosages to apply depending on the surgical situation, having tested the safety and effectiveness of the method. Although this is the early stage of the experience, the performance of this method can be considered applicable due to its significant and favorable risk/benefit ratio.

71. Use of Radiofrequency-Assisted Liposuction (Bodytite) for Upper Arms Lifting

• M. Tettamanzi, N. Pili, M. Rodio, C. Rubino, P.L. Serra, E. Trignano and C. Trignano
• Università degli studi di Sassari
• BACKGROUND-AIM

Body contouring surgery is increasingly requested by patients, both for aesthetic and post-bariatric purposes. There has also been a rapid increase in demand for noninvasive aesthetic treatments. While brachioplasty is burdened by numerous complications and unsatisfactory scars, and conventional liposuction is unsuitable for all patients, nonsurgical arm remodeling performed with radiofrequency-assisted liposuction (RFAL) allows to effectively treat most of patients, regardless of the amount of fat and ptosis of the skin and avoiding surgical excision.

• METHODS

A prospective study was conducted on 120 consecutive patients who presented to the author’s private clinic and required upper arm remodeling surgery for aesthetic purposes or after weight loss.

Patients were classified according to the modified classification of El Khatib and Teimourian. Pre- and posttreatment upper arm circumferences were taken after 6 months of follow-up to assess the degree of skin retraction obtained by treating the arm with RFAL. A satisfaction questionnaire regarding the appearance of the arms (Body-Q upper arm satisfaction) was administered to all patients before surgery and after 6 months of follow-up.

• RESULTS

All patients were effectively treated with RFAL, and no cases required conversion to brachioplasty. The average reduction in arm circumference was 3.75 cm at 6 months follow-up, and patients’ satisfaction increased from 35 to 87% posttreatment.

• CONCLUSIONS

Radio frequency is a valid tool to treat most patients with upper limbs skin laxity, with significant aesthetic results and a high degree of patient satisfaction, regardless of the degree of skin ptosis and lipodystrophy of the arm.

72. “A Paradigm Shift in Circumferential Body Contouring: Autologous Fat Prosthesis + J-Plasma for True 3D Torsoplasty”

• P. Vittorini
• Presidio Ospedaliero Villa Letizia -L’Aquila-
• BACKGROUND-AIM

Circumferential trunk reshaping today requires a fully three-dimensional approach capable of integrating definition, projection, and tissue quality. 3D High-Definition Torsoplasty advances this concept by combining high-definition liposculpture, structural dermo-adipose autologous prostheses, J-Plasma energy, and a 3D High-Definition LipoAbdominoplasty designed to restore tension, continuity, and harmony across the entire abdomen–flanks–buttocks unit.

• Objectives:

To present a codified, integrated technique that merges structural posterior reshaping (dermo-adipose autologous prostheses + limited lipofilling) with high-definition lipoabdominoplasty, and to evaluate the role of helium plasma radiofrequency (J-Plasma) in improving cutaneous retraction and transitional contour definition.

• METHODS

Between 2024 and 2025, 26 consecutive patients underwent 3D High-Definition Torsoplasty. The procedure includes:

• Bilateral dermo-adipose autologous prostheses, providing stable and structural gluteal projection.
• Limited complementary lipofilling (150–300 cc per buttock), injected exclusively in the subcutaneous plane to harmonize contour transitions.
• High-tension suspension of Scarpa’s fascia, restoring verticality, compactness, and three-dimensional tissue continuity.
• 3D High-Definition LipoAbdominoplasty, with selective liposculpture of the linea alba, semilunaris, periumbilical region, and iliac crests, combined with rectus plication when indicated and progressive-tension closure according to Pollock.
• J-Plasma Renuvion applied to transitional zones after tumescent liposuction to induce subcutaneous tightening through fibroseptal network contraction.

Outcomes included three-dimensional abdominal definition, waist concavity, gluteal projection, skin quality, volumetric stability of the autologous prostheses, and patient satisfaction.

• RESULTS

The integrated approach resulted in:

• sharper and more stable abdominal definition,
• improved waist concavity,
• enhanced gluteal projection and smoother three-dimensional transitions,
• significant reduction of residual laxity in critical zones due to J-Plasma.

The combination of high-definition lipoabdominoplasty with structural dermo-adipose prostheses improved circumferential coherence and the natural appearance of volumes. Complication rates were low, and patient satisfaction was consistently high.

• CONCLUSIONS

3D High-Definition Torsoplasty, enhanced by 3D High-Definition LipoAbdominoplasty and J-Plasma, represents a conceptual and technical evolution in circumferential body contouring.

The combined use of structural dermo-adipose prostheses, limited lipofilling, energy-based tightening, and three- dimensional abdominal definition provides more harmonious, natural, and long-lasting results.

This codified, anatomically coherent, and reproducible method offers a safe and comprehensive solution for modern body contouring, with high levels of patient satisfaction.

73. A Mininvasive Surgical Technique for Buttock Reshaping

• M. Berlanda
• Libero Professionista
• BACKGROUND-AIM

Introduction, aim of the work:

Author describes possibility to obtain a consistent buttock lifting by a mininvasive technique without implants nor tissue undermining using elastic thread.

• METHODS

Material and methods: The technique, performed under local anesthesia with light sedation, consists of using a two components elastic thread with double tips needle.

Exclusion criteria: autoimmunitary disease and extremely big as too skinny buttock.

• RESULTS
• Results:

Technique is performed since nearly 10 jears and results till now are positive with patient satisfaction.

• CONCLUSIONS
• Conclusion:

Elastic thread buttock lifting is the only mininvasive surgical technique that permits to obtain evident good results without implants, minimal incision, without tissue undermining.

74. Arm Lift: Personal Classification and Technical Details

• A. Paci
• Studio Andrea Paci
• BACKGROUND-AIM

The author presents a personal classification system for arm lift surgery based on the amount of tissue to be removed. Two distinct concepts—rhytidosis and brachyoptosis—are introduced; these conditions are not necessarily associated and are classified into different grades. The corresponding surgical techniques are described according to this classification.

• METHODS

Sixty-seven female patients who underwent arm lift surgery between January 2015 and September 2024 were retrospectively evaluated. Patient age ranged from 24 to 76 years. In 73% of cases, the procedure was performed as a standalone surgery, while in 27% it was combined with other procedures, including abdominoplasty, facelift, and mastopexy with implants.

Anesthesia consisted of local anesthesia in 9% of cases, local anesthesia with sedation in 54%, and general anesthesia in 27%. In 42% of patients, liposuction of the posterior arm region was performed prior to surgery. Only four cases were treated with a horizontal axillary scar associated with a 10-cm vertical extension. In the remaining 63 cases, a “closed” or “enlarged” lozenge excision was performed, with the scar located between the medial epicondyle and the axillary fossa; in 51% of these cases, an axillary Z-plasty was required.

• RESULTS

Five main factors should be evaluated when planning arm lift surgery: the presence or absence of rhytidosis associated with brachyoptosis; the distribution of excess tissue along the segments of the upper limb; the positioning of the ideal scar below the brachial sulcus; and reduction of the axillary circumference. Particular attention should be paid to adipose tissue when it involves the posterior aspect of the arm. An essential surgical step is the treatment of the brachial fascia. The proposed classification system assists in selecting the most appropriate surgical technique.

• CONCLUSIONS

According to the author, arm lift surgery effectively corrects rhytidosis and brachyoptosis of any degree, providing stable long-term results and satisfactory wound healing. The availability of a classification system with numerical references allows for a more precise, detailed, and reproducible diagnosis. This system serves the dual purpose of guiding surgical decision-making and improving clarity in case presentation. Although arm lift surgery does not present particular anatomical difficulties compared with other cosmetic procedures, it has specific technical key points that must be respected.

75. Beyond the Arm Lift: The Extended-Incision Brachioplasty Approach for Superior Aesthetic Results

• A. Margara
• Laserplast srl—Milano
• BACKGROUND-AIM

Brachioplasty in patients with moderate to severe arm laxity, particularly after massive weight loss, remains challenging due to the need to balance effective contouring with acceptable scarring. The extended-incision brachioplasty approach aims to improve arm shape and axillary contour in cases where standard techniques may provide suboptimal aesthetic results. The aim of this study is to evaluate the aesthetic outcomes and patient satisfaction associated with an extended-incision brachioplasty technique.

• METHODS

A consecutive series of patients undergoing extended-incision brachioplasty were retrospectively analyzed. Preoperative assessment included clinical evaluation and standardized photographic documentation. Surgical technique focused on extended skin excision, optimized scar placement, and tension-reducing strategies. Postoperative outcomes were assessed through clinical follow-up and a patient-reported satisfaction questionnaire (Body Q) evaluating arm shape, scar perception, functional impact, and overall satisfaction.

• RESULTS

The extended-incision approach resulted in significant improvement of arm contour and axillary definition. Complication rates were low and comparable to standard brachioplasty techniques. Patient-reported outcomes demonstrated high levels of overall satisfaction, with favorable acceptance of scar length in relation to the achieved aesthetic improvement.

• CONCLUSIONS

Extended-incision brachioplasty represents a safe, reproducible, and effective option for the treatment of moderate to severe brachial deformities, offering superior contouring results with high patient satisfaction when appropriately indicated.

76. Lower Limb Laxity: Inner Thigh Lift

• A. Paci
• Studio Andrea Paci
• BACKGROUND-AIM

Lower limb hypotonia and skin laxity can interest either the inner part or the entire upper leg. There are multiple causes for upper thigh skin laxity, such as massive weight loss or natural aging.

In the case of inner thigh hypotonia, the surgical goal is to give a firmer appearance by removing excess skin.

• METHODS

From 2014 to 2024 we performed 41 cases of inner thigh lift on patients whose age ranged between 24 and 67 years old. The surgical procedure was performed under general anesthesia with the patient in lithotomy position. The incision was vertical in the pubic area, then downward in the groin and wrapping around the back of the thigh hidden by the gluteal groove. The cutaneous dissection on the fascia was performed in relation to the skin resection: no wider dissection is necessary.

Following the skin resection, the flap dermis is fixed to the periosteum with three sutures: the first with the ischial pubic periosteum, the second with the pubic branch periosteum and the third with the pubic tubercle periosteum.

With these sutures we obtain the following: it ensures a firmness of the scar, avoiding its traction below the inguinal fold. Moreover, it avoids the physiological flap retraction and the traction during the lower limb movements.

• RESULTS

This type of surgery, which can be performed alone or combined with a preventive liposuction, achieved complete skin tightening of the upper third of the inner thigh in all patients. We had no scar healing complications like dehiscence or necrosis, no vascular, nerve or lymphatic injury. There was one case of hematoma that had to be drained surgically. In 2 cases after 8 months we had 1 cm inguinal scar traction, both on the left side, visible below the underwear and surgically corrected.

• CONCLUSIONS

This surgical procedure can remove the excess skin and laxity of the upper third of the inner thigh with also mild improvement in the medium third.

77. Reconstructive Surgery of the Upper and Lower Limbs in a Low-Resource Setting: Operative Experience and Analysis of 32 Cases from a Mission in Togo with Aicpe Onlus

• M. Ponzo ¹, A. Mele ², A. Gallo ², D. Matta ³, M. Sanna ² and N. Monni ²

¹ 

Università Campus Bio-Medico

² 

Private Clinic

³ 

Policlinico Palermo

• BACKGROUND-AIM

In many regions of sub-Saharan Africa, access to reconstructive limb surgery remains extremely limited. Burn sequelae, contractile scars, lipomatosis, traumatic defects, and congenital anomalies often result in significant functional impairment and reduced quality of life. The aim of this study is to describe the operative strategies adopted during a humanitarian surgical mission in Togo, with a specific focus on upper and lower limb procedures, case selection, and feasibility within a low-resource setting.

• METHODS

A retrospective analysis was conducted on all patients operated on by an Italian plastic surgery team during a one-week humanitarian mission (November 2025). Demographic data, diagnoses, anatomical sites involved, types of procedures, and anesthesia modalities were collected. Only patients who underwent surgical intervention were included.

• RESULTS

Thirty-two patients underwent surgical treatment. The mean age (n = 25 available) was 35 years (range 4–85 years), and seven patients were under 18. Primary indications included burn sequelae and post-burn contractures of the limbs (n = 8), tumoral or pseudotumoral lesions of the upper and lower extremities (n = 10), lipomas and lipomatosis (n = 6), traumatic defects—including one complete Achilles tendon rupture (n = 3)—and one congenital hand malformation. Procedures performed included Z-plasty sequences, excision with direct closure, local and regional flaps (including sural flap), skin grafting, use of dermal substitutes, and tendon repair. Anesthesia modalities consisted of local anesthesia with or without sedation (n = 17), general anesthesia (n = 11), or regional block (n = 3). No major intraoperative events were recorded.

• CONCLUSIONS

The mission demonstrated that effective reconstructive limb surgery can be safely performed in low-resource environments by prioritizing simple, reliable, and reproducible techniques. The management of complex scars, post- burn contractures, traumatic defects, and soft-tissue masses highlighted the importance of careful case selection and collaboration with local healthcare personnel. This experience provides a transferable operational model for limb reconstruction in comparable settings.

78. Scar-Concealed Brachioplasty via Postero-Medial Transition Zone

• A. Bruno
• Private Practice—Clinica Santa Maria di Leuca, Roma
• BACKGROUND-AIM

Brachioplasty is an essential body-contouring procedure for upper-arm reshaping in patients with significant post– massive weight loss skin redundancy. Traditional posterior or purely medial incisions often require trade-offs between scar conspicuity, closure tension, and functional recovery. We present a personal superior/postero-medial strategy integrating Power-Assisted Liposuction-assisted dermolipectomy, meticulous post-relaxed-skin marking, and dermis- sparing avulsion to optimize long-term aesthetics and mobility.

• METHODS

A retrospective STROBE-aligned cohort analysis was performed on 90 non-smoking adults (18–65 years) treated between 2018–2023 by a single senior plastic surgeon in Rome. Patients were stratified by incision pattern: posterior (n = 30), medial-bicipital-groove (n = 30), and refined postero-medial transitional placement (n = 30). All procedures used circumferential or selective major-axis liposuction (MicroAire PAL system when indicated), followed by cold-scalpel dermal-margin scoring (~5 mm) and controlled avulsion of defatted redundant skin. Major comorbidities, prior arm surgery, BMI > 35, smoking in the prior 6 months, and infections/hernias were exclusion criteria. Outcomes included scar satisfaction (BODY-Q Scar Satisfaction Module 0–100 scale), surgeon-assessed scar visibility in static/dynamic arm positions (blinded 3-surgeon panel), shoulder/elbow ROM gain at 6 months, and incidence of wound dehiscence, hypertrophic scarring, and seroma.

• RESULTS

The postero-medial incision achieved a mean BODY-Q scar satisfaction score of 85 ± 9 versus 72 ± 10 (medial) and 58 ± 11 (posterior) (p < 0.001). Six-month scar assessment showed high visibility in 40% of posterior, 25% moderately visible in medial, and only 10% minimally visible in postero-medial placement. ROM improved by 18° ± 2° in the postero- medial group compared with 15° ± 2° (medial) and 12° ± 3° (posterior) (p < 0.01). Dehiscence occurred in 3% (postero- medial), 7% (medial), and 10% (posterior); hypertrophic scarring in 5%, 10%, and 15%, respectively; seroma incidence was 3% (postero-medial) and >6% in other groups. No vascular-lymphatic flap compromise or sensory-limiting nerve- path injury occurred.

• CONCLUSIONS

Postero-medial transitional scar placement combined with dermis-sparing avulsion and knotless barbed-arc tension architecture provides the most favorable balance for esthetic scar concealment, complication mitigation, and arm mobility preservation in patients requiring radical upper-arm dermolipectomy. Our results support postero-medial positioning as a versatile and reproducible standard for moderate-to-severe skin redundancy, with superior patient satisfaction and sustained functional recovery.

79. Short-Scar Arms Lifting: Limits and Benefits

• C. Crisafulli
• Gulglam Clinics
• BACKGROUND-AIM

Short scar arms lifting is an effective procedure when performed on the right patients even after massive weight loss. In this presentation I will show how my approach changed reducing the incision and consequently the scar during the past 10 years and giving always pleasant results. Tips and tricks will be explained in order to avoid the complications. Before and After pictures will be exposed to show the different possible incisions.

• METHODS

Pre-operative planning and surgical technique will be explained and illustrated showing how my approach changed during the last 10 years due to the always more demanding patients.

• RESULTS

The association with the ultrasound liposuction and skin tightening device is the perfect combination to give a natural and long lasting result in selected patients. Nevertheless the fact of being a repeatable procedure most of the time falls to be the first choice avoiding the long scar approach.

• CONCLUSIONS

Short-scar arms lifting, is a valid and safe approach for those patients with mild skin laxity which are in between liposuction and long scar arms lifting. Not visible scar, quick procedure, fast recovery and good results made this approach the gold standard in my practice for arms lifting.

80. Tumescent Local Anesthesia in Body Contouring: Clinical Experience and Application to Medial Thigh Lift

• F. Ziani ¹, G. Arrica ¹, E. Filigheddu ¹, S. De Riso ¹, R. Cuomo ², G. Marcaccini ², S. Vacca ¹, C. Rubino ¹ and E. Trignano ¹

¹ 

University of Sassari

² 

University of Siena

• BACKGROUND-AIM

The growing preference for anesthesia-sparing techniques and outpatient surgical pathways has increased the use of pure tumescent local anesthesia (TLA) across body contouring procedures. TLA provides reliable analgesia, vasoconstriction, and a favorable safety profile, supporting less invasive perioperative management and enabling safe, rapid patient discharge. This study evaluated the feasibility, safety, and patient experience of pure TLA applied to medial thigh lift as a representative procedure within outpatient body contouring.

• METHODS

A retrospective review was conducted on 45 female patients (mean age 41.8 years; mean BMI 27.4 kg/m²) treated between November 2019 and June 2025. All procedures were performed using pure TLA without sedation. According to preoperative assessment, patients underwent horizontal skin excision alone or excision combined with liposuction. Outcomes included anesthetic stability, operative time, intra-operative comfort, recovery profile, complications, and patient satisfaction during follow-up.

• RESULTS

All 45 procedures were completed under pure TLA with no conversion to general anesthesia or sedation. Median operative time was 30 min for excision-only cases and 50 min when combined with liposuction. Intra-operative comfort was rated “excellent” in 86.7% and “good” in 13.3% of cases. No postoperative opioids were required. The overall complication rate was 24.4%, consisting exclusively of minor issues: wound dehiscence (11.1%), dog-ear deformity (6.7%), and scar hypertrophy or displacement (6.7%). No seroma, hematoma, infection, thromboembolic events, sensory deficits, or readmissions occurred. High patient satisfaction was consistently recorded during follow- up.

• CONCLUSIONS

Pure TLA provided stable anesthesia, high intra-operative comfort, rapid recovery, and no major complications. Its performance across an expanded cohort supports the broader use of pure TLA as an effective and resource-efficient anesthetic approach for selected outpatient body contouring procedures, including medial thigh lift.

81. Ultrasound Assisted Liposunction for Lower Limb Lipedema. A Single-Center Cohort of 191 Female Patients

• A. Murante
• Libero Professionista
• BACKGROUND-AIM

Lipedema, a chronic disorder affecting up to 11% of women, can also involve the upper limbs, causing symmetrical fat accumulation, pain, and disproportion between arms and the rest of the body. This condition is frequently misunderstood and underdiagnosed, with unclear etiology. Conservative therapies are the first-line approach, but in non-responsive cases, lymphatic-sparing liposuction techniques—such as ultrasound-assisted liposuction (UAL)—are considered viable treatment options for arm lipedema after six months of conservative management.

• METHODS

This cohort included 80 patients with upper limb lipedema (stage 1–3), treated using lymphatic-sparing UAL in a single-stage approach after six months of failed conservative therapy. Outcomes measured included changes in pain using visual analog scales (VAS), arm circumference, aesthetic satisfaction, and documentation of postoperative complications 12 months after surgery.

• RESULTS

The surgical protocol achieved statistically significant reductions in arm circumferences (p < 0.001), with an average reduction of −4.823 cm [−6.804; −2.842]. Pain, bruising, sensitivity, and functional complaints significantly decreased postoperatively (all p < 0.0001). Complications remained within acceptable limits, and no cases of upper limb phlebitis were recorded. High patient satisfaction was reported post-treatment.

• CONCLUSIONS

A structured approach combining conservative treatment and advanced lymphatic-sparing UAL for arm lipedema offers promising results. This study reinforces the efficacy and safety of VASER-assisted liposuction in the treatment of upper limb lipedema. Further long-term studies are needed to evaluate sustained outcomes and refine arm-specific protocols.

82. Seroma Prevention in Abdominoplasty Using Arbas Barbed Running Suture

• A. Bruno
• Private Practice—Clinica Santa Maria di Leuca, Roma
• BACKGROUND-AIM

Seroma formation remains one of the most frequent complications after abdominoplasty, historically reported in ~10–15% of patients despite adoption of suction drains and progressive tension sutures (PTS). Techniques based on multiple interrupted quilting sutures prolong operative times and may increase patient discomfort. The Absorbable Running Barbed Arch Suture (ARBAS) technique was developed to provide a faster, knotless method for lateral dead-space obliteration while preserving Scarpa’s fascia integrity and minimizing tension vectors across abdominal flap closure.

• METHODS

We conducted a retrospective STROBE-compliant observational analysis of 74 consecutive adult patients treated between April 2021 and May 2023 by a single senior surgeon. All patients underwent esthetic abdominoplasty with or without diastasis recti repair. A 45-cm 0 Ethicon PDS absorbable running barbed arc was passed from left-to-right along the superior ARBAS design line including flap-side Scarpa’s fascia, then reversed retrogradely to the origin without midline tunnel stitching to avoid neurovascular interference. Drains (12 Fr) emerged from the pubis and were removed at 48 h or when output was <30 mL/24 h. Outcomes included seroma incidence, drainage volume, drain-removal timing, and additional operative time.

• RESULTS

No seromas (0.0%) were observed. Mean drainage volume declined from 36 ± 12 mL (POD1) to 19 ± 8 mL (POD2), enabling drain removal by 48 h in 91.9% of patients—earlier than conventional averages (~3 days). ARBAS required only +8 min of additional operative time, markedly shorter than PTS (~20–25 min). No infections, hematomas, flap necrosis, or need for seroma aspiration were recorded. NAC sensitivity was preserved in all cases.

• CONCLUSIONS

ARBAS provides safe, effective, and time-efficient lateral dead-space management in esthetic abdominoplasty, supporting earlier drain removal, enhanced comfort, reproducible flap advancement, and a complication-sparing recovery trajectory. Its knotless running-barbed architecture significantly reduces closure time without compromising vascular or lymphatic safety. Multicenter and prospective trials integrating validated PROMs such as the SCAR-Q and BODY-Q are warranted to confirm generalizability and long-term adoption.

83. Wrong Indications Lead to Bad Results: How Do I Manage Male Chest-Wall Contouring Secondary Cases in Trans-Gender Patients

• G. Lo Russo
• Centro Day Surgery Maurizio Bufalini
• BACKGROUND-AIM

Introduction The recent increase in the number of scientific publications in chest-wall contouring surgery in cis man and trans AFAB (assigned female at birth) patients, reflects the importance of these to contributes to strengthening of the self-image. To reach the main goal, that is to masculinize the chest, an appropriate preoperative plan is crucial. The author describes a completely new preoperative algorithm which I used in primary and secondary cases of male chest-wall contouring. The algorithm was validated by TRANS-Q questionnaire in trans AFAB patients.

• METHODS

From 2016 to 2024 530 consecutive FtM transgender patients underwent surgery as part of the new algorithm which is based on the assessment of the position of the nipple areola complex (NAC) to the pectorals major muscle and can easily guide the surgeon between the three surgical options: periareolar (PA), Hemiperiareolar (HP) and double incision with free nipple graft (DI) technique for the trans AFAB patients and Hemiperiareolar (HP), Periareolar (PA) and key- hole adenectomy (KH) for cis-gender patients. Two different surgeons evaluate photography documentations and gave a score from 1 to 15 based on symmetry, correct placement of scar and scar quality. In 100 trans AFAB patients the TRANS-Q questionnaire was used to evaluate patient reported outcomes (PROs).

• RESULTS

Surgeons’ evaluation reported a median score of 14/15. The patients’ survey revealed a very high satisfaction rate with the aesthetic results. All patients reported good TRANS-Q satisfaction with their new chest shape, sexual well-being and quality of scars at short and long-term follow up (between 3 months to 7 years).

• CONCLUSIONS

The author proposes a new preoperative algorithm. This algorithm can be very useful on guiding the surgeon’s choice trough the different techniques on male chest-wall contouring. Wrong indications lead to bad results and this algorithm can help on avoiding secondary cases and can also be helpful managing them. This is confirmed by surgeons evaluation and patients self- satisfaction evaluated by TRANS-Q questionnaire.

84. Trivectorial Lifting of Smas and Platysma

• P. Santanchè and C. Bonarrigo
• Libero Professionista
• BACKGROUND-AIM

Thirty-five years of experience in the surgical management of the SMAS (Superficial Muscular Aponeurotic System) and Platysma muscle have led to the development of a standardized technique that yields excellent results in terms of naturalness and durability across all ages and various morphological situations.

• METHODS

The technique involves the dissection of a flap of SMAS and Platysma muscle, isolated from the underlying plane, and its repositioning according to three main vectors opposing the natural lines of relaxation. The skin, whose tone has been restored, is draped over this plane, and any excess is removed without additional tension. Skin dissection and hemostasis are performed using a low-temperature ultrasonic scalpel, which allows for precise control of bleeding. The tissues are adhered using fibrin glue, enabling the avoidance of drains and allowing for the removal of moderately compressive dressings the morning following the procedure, resulting in a face free of bruising and with very limited oedema.

• RESULTS

Social appearance typically resumes within two weeks, and it rarely takes less than ten years to return to a preoperative- like appearance.

• CONCLUSIONS

The trivectorial lifting of SMAS and Platysma has demonstrated over the years to be the most versatile technique and with the highest patient satisfaction even many years post-procedure.

85. A Long-Term Evaluation: Deep Plane Versus High Smas Face Lift

• M. Mariani ¹, M.C. Fabbri ¹, P.L. Serra ², V. Murone ³, B. Scucchi ⁴, C. Botti ⁵ and G. Botti ⁵

¹ 

Department of Plastic and Reconstructive Surgery, Catholic University of Sacro Cuore, University Hospital A. Gemelli, Rome, Italy

² 

Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari University Hospital Trust, Sassari, Italy

³ 

Residency Program in Plastic Surgery, Azienda Ospedaliera Universitaria Federico II di Napoli, Napoli, Italy

⁴ 

Residency Program in Plastic Surgery, Azienda Ospedaliera Universitaria di Padova, Padova, Italy

⁵ 

Villa Bella Clinic, Salò, Italy

• BACKGROUND-AIM

The Deep Plane Face Lift (DPFL) has recently gained popularity, although its origins date back to the 1970s. Despite potential advantages, our long-term clinical experience has revealed several unfavorable features. For this reason, the senior authors have adopted the High Superficial Musculoaponeurotic System Face Lift (HSFL) for many years. This study aims to evaluate the long-term critical aspects of DPFL and to illustrate how HSFL may address these limitations.

• METHODS

A long-term comparative assessment was conducted between the two main SMAS-dissection rhytidectomy techniques: DPFL and HSFL. The analysis is based on over two decades of standardized HSFL practice by the senior authors. Key technical differences—sub-SMAS entry point, extent of flap elevation, traction vectors, and anchorage to stable fixation points—were examined, together with their implications for aesthetic longevity. Clinical evaluation included extended follow-up and documentation of complications, focusing on cervical and zygomatic nerve function.

• RESULTS

DPFL, characterized by a more anterior entry into the sub-SMAS plane and a shorter flap, showed reduced effectiveness on the midface and a superolateral repositioning vector, predisposing to lateral sweep deformities and less stable long-term outcomes. The flap’s limited length prevents direct fixation to rigid structures. HSFL allows creation of a wider adipo–fascial–muscular flap incorporating the “SMAS triangle,” enabling vertical midface elevation, reliable fixation to stable anatomical landmarks, and improved tissue redistribution. Among 827 procedures over 10 years, only two transient cases of platysma paresis were observed, both resolving spontaneously. Long-term outcomes demonstrated more consistent improvements of the midface, jawline, and neck compared with DPFL.

• CONCLUSIONS

Although widely used, DPFL may lead to non-negligible late sequelae. Based on long-term experience, HSFL appears to offer more stable, predictable, and durable aesthetic results, representing a valuable alternative to reduce these complications.

86. Advancements in Minimally Invasive Neck and Lower-Face Contouring with Radiofrequency-Assisted Liposuction and Buccal Fat Pad Excision

• E. Filigheddu, F. Ziani, S. De Riso and E. Trignano
• Dipartimento di Scienze Chirurgiche, Microchirurgiche e Mediche, Unità di Chirurgia Plastica, Università di Sassari, Sassari, Italia
• BACKGROUND-AIM

The combination of neck liposuction, radiofrequency-assisted lipolysis (RFAL) using a bipolar radiofrequency device (RF device), and buccal fat pad excision has increasingly been adopted to enhance neck and lower-face contouring. RFAL provides controlled thermal energy for adipose remodeling and soft-tissue tightening, while buccal fat pad excision contributes to improved facial definition. This study aims to assess the clinical effectiveness, patient satisfaction, and safety profile of this integrated approach in neck rejuvenation.

• METHODS

A prospective study was conducted from 2016 to 2023 on 80 consecutive patients undergoing aesthetic neck contouring surgery. Follow-up examinations occurred at 0, 1, 3, 6, and 12 months. Submental length was measured at 1 and 6 months. Patient satisfaction was assessed preoperatively and at 6 months using a validated five-point scale. Physician-rated improvement was evaluated using a four-point scale.

• RESULTS

All patients completed treatment and follow-up. RFAL combined with neck liposuction consistently resulted in high satisfaction scores. Mean submental length decreased by 23 mm from baseline at 6 months. Buccal fat pad excision further enhanced lower-face refinement and contour definition. No major complications were observed.

• CONCLUSIONS

The integration of neck liposuction, RFAL, and buccal fat pad excision appears to be a safe and effective approach for neck and lower-face rejuvenation. The combined technique improves contour precision, supports high patient satisfaction, and may represent a valuable addition to the aesthetic plastic surgery armamentarium.

87. Advances in Deep Plane Facelift Technique: Limited-Delamination Cervicofacial Lift with Selective Platysma Transection to Prevent Recurrent Platysmal Bands

• A. Gualdi Di Castelgualdo ¹, L. Ponzielli ² and B. Agnelli ³

¹ 

Milano

² 

Università di Genova

³ 

Università degli studi dell’Insubria

• BACKGROUND-AIM

Over recent decades, the evolution of cervicofacial lifting techniques has emphasized the treatment of the superficial musculoaponeurotic system (SMAS) as a functional unit, with progressive reduction in the extent of subcutaneous undermining. Simultaneously, platysma management has emerged as a key element in cervical rejuvenation surgery, particularly in preventing the recurrence of platysmal bands. Traditional techniques using extensive dissection may compromise vascularity, increase dead space and prolong recovery time. This study describes an extended deep plane lifting approach with limited delamination, analyzing its anatomical basis, safety profile and potential clinical advantages.

• METHODS

A multicenter retrospective analysis was conducted on 3964 patients who underwent cervicofacial lifting using a modified technique performed by six experienced surgeons. The procedure includes early lateral access to the deep plane, selective preservation of dermo-SMAS fibrous septa, limited subcutaneous undermining in both face and neck, and controlled delamination with selective platysma transection. Postoperative complications and subjective assessment of outcomes by the operating surgeons were recorded.

• RESULTS

Mean patient age was 58 years (range 31–83), with female predominance (87.9%); 67.4% of cases were primary procedures. Major complications were rare: significant hematoma 0.1%, seroma 1.6%, minor infection 1.3%, with an overall revision rate of 0.8%. Surgeons reported improved flap handling, reduced risk of dyschromia and telangiectasia, and faster postoperative recovery compared with traditional techniques involving extensive delamination.

Preservation of dermofascial septa and cervical retaining ligaments, combined with sub-SMAS dissection, appears to provide a biomechanical advantage by improving flap excursion and reducing the forces required for elevation. Limited delamination helps reduce dead space and preserve cutaneous vascularity, with potential benefits in reducing necrosis risk and enhancing aesthetic quality of the periauricular region. Selective platysma transection is aimed at reducing dynamic tension and preventing recurrence of platysmal bands, with a favorable tolerability profile even in higher- risk patients.

• CONCLUSIONS

Cervicofacial lifting with limited delamination and selective platysma transection represents a valid evolution of the deep plane facelift, supported by solid anatomical foundations and encouraging preliminary data regarding complications, aesthetic outcomes and recovery time. Prospective controlled studies are necessary to confirm the durability of results and more precisely define indications in different patient subgroups.

88. HDS +(High Definition SMAS Thread Lifting Plus): A New Method for a Reliable and Natural Face and Neck “Restoration”

• L. Cravero and. A. Diaspro
• Private Practice
• BACKGROUND-AIM

While considered the golden standard for face and neck rejuvenation, patients are very often fearful of surgical facelift, due to concerns about scarring, potential nerve injury, prolonged social impact after surgery and the potential alteration of their physiognomy.

A new technique, called High Definition Smas Thread Lifting PLUS (HDS-TL+), is presented. This technique consists in:

1: implanting permanent threads from the temporal and retroauricolar region under the Superficial Muscular Aponeurotic System (SMAS), and piercing the retaining ligaments to achieve an effective and stable traction of the SMAS ending up in natural repositioning of facial and neck tissues.

2: treating the relaxation of retinacula cutis and, if present of the neck fat accumulation with radiofrequency.

3: Anatomical fat grafting of superficial and deep face fat compartments, to restore the amount of fat naturally present in younger face fat compartments.

4: Skin resurfacing with energy devices (fractional C02 laser, fractional radiofrequency).

• METHODS

40 patients were treated with HDS Thread lifting Plus. Images were taken before (t0), 52 (t1) and 104 weeks after (t2). At first we use a bipolar radiofrequency cannula in the subcutaneous tissues to reduce the retinacula cutis relaxation of the inferior third of the face, improve the mandibular line and, if necessary, reduce the accumulation of fat in the subcutaneous layer of the neck.

After that we use INFINITE-THREAD°, permanent suspension threads with the core in polyester and a solid silicon coating. The threads are thin and feature a diametre of 1.4 mm, There are four coags every 1,5 mm, the coags are effective because they are non reversing, conical and oriented with an “8 axis” cooking and a 45° degree rotation. The coags are gentle for the patient because of their structure in flexible silicon and their rounded tip.

Then we graft autologous fat in the superficial temporal-parietal compartments, in the deep and superficial medial cheek fat compartments and, if necessary in other anatomical face areas with depletion of fat.

At the end of the surgery we perform skin resurfacing with fractional radiofrequency.

• RESULTS

22 of 40 patients completed the 1 year follow up whilst 16 of 40 patients completed the 2 years follow-up. The recorded outcomes showed a satisfying midface volume restoration and lower face contouring after threads suspension, as recorded by a blind observer (iGAIS) and as reported by patients (sGAIS).

No severe adverse effects have been reported, while mild adverse events occurred in less than 5% of patients and either resolved spontaneously or were successfully managed following the intervention of the surgeon.

• CONCLUSIONS

The results presented by the Authors support the use of this innovative, scarless method for permanent suspension of face and neck tissues: albeit the limited period of follow-up, this technique could therefore be considered a safe and reliable alternative procedure to surgical deep plane face and neck lifting for selected patients.

89. Hybrid Facelift: Our Current Approach to the Evolution of Facelift Techniques

• C. Gasperoni and V.S. Pino
• Clinica Quisisana
• BACKGROUND-AIM

The facelift has evolved over time, from simple skin dissection to techniques involving the superficial fascial system and the platysma muscle. Facial anatomy has been extensively studied, allowing for an increasingly effective and targeted surgical approach. The face can be divided into three areas: the upper midface, the lower midface, and the lower face. Each of these areas has unique anatomical characteristics and therefore requires different approaches. Therefore, it can be considered a hybrid method, as there is no single approach to achieving a harmonious rejuvenation effect. The purpose of this study is to present our experience with the hybrid facelift.

• METHODS

To correct the lower face, the platysma muscle can be plicated or dissected and lifted upward and laterally. These are two different approaches with different indications. Plications are very safe and are indicated in secondary cases and in thin patients. In all other cases, we section the platysma, which is redistributed in a more cranial position. In the mid-lower face, subcutaneous dissection with plications or deeper dissection can be used. Once the platysma has been redistributed in the submental region, liposuction may be necessary. In the mid-lower face, a temporal incision in the scalp reaches the space between the superficial and deep temporal fascia. The dissection in this plane extends anteriorly toward the nose, penetrating the prezygomatic space and dissecting both the orbital retaining ligament and the lateral orbital thickening. Once released, these periorbital soft tissues are fixed in a superolateral position. A fat graft can be performed on the inferior orbital margin to smooth the transition between the eyelid and the zygomatic tissues.

• RESULTS

The complication rate and long-term aesthetic results have been evaluated in over 3000 patients who underwent hybrid facelifts. Facial and neck rejuvenation achieved with hybrid facelifts has produced excellent results. In the early postoperative period, the complication rate was very low, with 0.2% of cases of temporary stupor of the frontotemporal branch of the facial nerve and 0.4% of cases of hematoma. We have had no cases of facial nerve damage, patients are completely satisfied, and the results are very long-lasting.

• CONCLUSIONS

Effective facial rejuvenation is possible by customizing the surgical approach for each patient based on different techniques.

90. Is Direct Lifting (Kim’s Technique) Still a Valid Option in Neck Shaping and Lifting Surgery?

• A. Casadei and B. Biffoli
• Libero Professionista Venezia-Mestre
• BACKGROUND-AIM

The direct neck lift, according to Kim’s technique, is a surgical procedure in facial and neck aesthetic surgery aimed at improving the appearance of the neck by more aggressively removing skin laxity and fat deposits compared to traditional lifts. Originally developed to correct signs of aging, this method is based on removing excess skin and lifting the underlying tissues, with the goal of achieving a firmer, more toned, and well-defined neck.

The indications for this procedure include the presence of skin laxity and ptosis of the cutaneous and subcutaneous tissues of the neck, a thick neck, relaxed skin, prominent muscular bands (platysma), accumulation of medial adipose tissue (central neck fat) that does not respond to non-invasive treatments, and the characteristic deformity called “turkey neck,” which affects profile harmony.

The choice of this technique is directed at patients seeking a more defined and long-lasting improvement in neck appearance, in the absence of underlying pathologies. The procedure aims to reduce excess skin and reposition the deep tissues.

• METHODS

For preoperative evaluation, diagnostic methods such as ultrasounds and magnetic resonance imaging (MRI) are employed, allowing for analysis of the condition of the skin, muscles, and subcutaneous tissues. This ensures precise surgical planning and greater safety in achieving the desired outcome.

• RESULTS

Results demonstrate a significant improvement in the neck profile, with a noticeable reduction of excess skin and a smoother, more defined appearance. The stability of these results over time confirms the technique’s effectiveness, with a low complication rate and high patient satisfaction.

• CONCLUSIONS

In conclusion, the direct neck lift remains a valid aesthetic option for patients with relaxed neck skin, offering natural and durable results that significantly enhance profile harmony, aligning with the goals of rejuvenation and aesthetic improvement.

91. My Initial Experience with “Challenging” Surgery

• A. Colapietra
• Milan, Italy
• BACKGROUND-AIM

Deep-plane cervicofacial lifting is among the most advanced procedures for facial rejuvenation, enabling a natural and long-lasting anatomic repositioning of the deep tissues. The aim of this study is to report the author’s initial surgical experience with this technique, assessing the challenges encountered and their evolution over time.

• METHODS

Over a 4-year period, 56 patients underwent deep-plane cervicofacial lifting between 1 January 2021 and 31 December 2024. All procedures were performed by the same surgeon. The following data were recorded: demographic characteristics, follow-up duration, and the incidence of early and late complications (hematoma, facial nerve neuropraxia, skin necrosis, infection). Outcomes were assessed through pre- and postoperative photographic comparison.

• RESULTS

A total of 56 female patients presenting with malar ptosis, loss of cervicomandibular definition, and cervical laxity were analyzed. Mean follow-up was 12 months. Photographic evaluation documented stable maintenance of the suspension vectors, with improvement of the cervicomandibular contour and malar projection in all cases. One hematoma occurred, with no infections. One mild case of skin compromise and three cases of transient facial nerve neuropraxia were recorded.

• CONCLUSIONS

In the author’s experience, deep-plane cervicofacial lifting demonstrates a favorable safety and efficacy profile, even during the early phases of the learning curve, with stable and reproducible results. The outcomes showed reproducibility, a natural appearance, and long-term stability over time, supporting the deep-plane approach as a reference technique for cervicofacial rejuvenation.

92. Progressive Tension Suture Inner Net: A Valid Tool for Intra and Post Operative Management

• V. Finocchi ¹, R. Ambanese ² and E. Pellini ³

¹ 

Private practice

² 

Ospedale San Carlo/Roma

³ 

Private practice/Brasile/Porto Alegre

• BACKGROUND-AIM

Cervicofacial rejuvenation procedures often face challenges related to soft tissue repositioning, dead space management, and long-term contour stability. The internal hemostatic net (IHN) technique offers a systematic approach to deep fixation that improves surgical outcomes and reduces complications such as hematomas or tissue displacement.

• METHODS

The aim of this study aim is to describe a reproducible, layered suture technique for cervicofacial lifting that addresses deep neck contouring and flap stabilization through a combined submental and lateral approach, while minimizing the risk of postoperative complications. A prospective evaluation was conducted on patients undergoing cervicofacial lifting with IHN application. The technique involves 3 phases: submental quilting and fixation sutures after deep neck sculpting; lateral progressive tension and superficial musculoaponeurotic system-platysma anchoring sutures; and superficial quilting for flap adherence. A progressive reduction in suture caliber is applied according to tissue thickness. A double incision approach (submental and lateral) ensures controlled access and uniform distribution of vectors.

• RESULTS

The technique was applied in over 100 patients with consistent aesthetic improvements and no major complications. The elimination of dead space through deep-layer quilting and progressive tension sutures reduced hematoma rates and improved long-term contour definition. Minor complications were self-limiting and managed conservatively. The standardized sequence improved intraoperative control and postoperative predictability.

• CONCLUSIONS

The IHN technique provides a reliable, anatomically guided method for cervicofacial rejuvenation. By addressing the neck, face, and submental regions in a structured sequence, this approach enhances surgical precision, flap stability, and patient outcomes-offering a valuable contribution to aesthetic surgery literature.

93. Smas Plication Facelift and Platysmaplasty Under Tumescent Local Anesthesia

• S. De Riso, F. Ziani, G. Arrica, E. Filigheddu, C. Rubino and E. Trignano
• Università degli Studi di Sassari
• BACKGROUND-AIM

Facial rejuvenation increasingly uses techniques targeting the Superficial Muscular Aponeurotic System (SMAS) for natural, durable results. Advances in anesthesia, especially tumescent local anesthesia (TLA), have enhanced the safety and recovery of complex aesthetic procedures. This study evaluates the efficacy and safety of SMAS plication facelift, platysmaplasty, and neck liposuction under TLA in an outpatient setting over the past decade.

• METHODS

Between 2012 and 2022, eighty ASA I–II patients (mean age 56, range 47–65) underwent SMAS plication facelift, midline platysmaplasty, and submental liposuction under TLA. Preoperative workup included blood tests, ECG, and cardiology clearance. The tumescent solution (25 mL 2% lidocaine, 8 mEq sodium bicarbonate, 1 mL epinephrine in 1000 mL saline) was infiltrated at 100 mL per hemiface. Midazolam sedation was administered as needed. Surgical time averaged 150 min, including 40 min for TLA. Patients were monitored for three hours postoperatively and followed up to 36 months.

• RESULTS

The mean infiltrated volume was 200 mL per patient. There was no lidocaine or epinephrine toxicity, and no conversions to general anesthesia (GA). Over 36 months, complications occurred in 10%: hematoma (2.5%), seroma (1.25%), scarring (3.75%), paresthesia (1.25%), and “pixie ear” (1.25%). No infections or anesthesia-related events were observed. Patients reported high satisfaction, rapid recovery, and minimal discomfort.

• CONCLUSIONS

TLA effectively replaces GA for SMAS plication facelift with platysmaplasty and neck liposuction. It offers sufficient analgesia, supports precise dissection with less bleeding, and minimises postoperative edema and ecchymosis, leading to quicker recovery and improved patient comfort and satisfaction.

94. Browlifting: Definition of a Surgical Algorithm

• L. Piovano ¹ and A. Randazzo ²

¹ 

Libero professionista Roma

² 

Medico Specializzando in Chirurgia Plastica, Ricostruttiva ed Estetica presso Università Cattolica del Sacro Cuore—Policlino Gemelli, Roma

• BACKGROUND-AIM

The goal of the eyebrow lift (browlifting) is to make the upper third more harmonious in the context of the entire face. Various surgical techniques have been described in literature: endoscopic direct lift, transcutaneous direct lift, Castanãres technique lift, and trans-palpebral indirect lift. The authors focus on the selection of the suitable patient and the details of the operative technique, with particular regard to the Castanãres technique, in order to define a surgical algorithm for the rejuvenation and reshaping of the forehead and eyebrow.

• METHODS

In the last 15 years, we have performed 250 interventions of this type. The surgical approach is guided by an algorithm based on assessments carried out during the objective examination, including dynamics and gravitational heaviness, definition of relationships with the osteo-muscular structure, hypoplasia, and eyebrow-hairline distance. In particular, attention is paid to the Castanãres Technique, which is specifically indicated for reducing the aesthetic defect of a large eyebrow-hairline distance, improving the relative ptosis of the body and tail of the eyebrow itself.

• RESULTS

Evaluation of cases and refinement of the technique with particular attention to the stability of the result over time, the repositioning of the point of maximum eyebrow elevation, and the minimization of scars.

Patient satisfaction rates and specific complications for each technique are analyzed.

• CONCLUSIONS

In conclusion, the authors emphasize the validity of the various procedures for eyebrow lifting and the accurate selection of the technique based on individual anatomical characteristics and expectations, in order to develop a surgical algorithm capable of ensuring natural and long-lasting results.

95. Endoscopic 3D Lifting for the Oval of the Face

• F. Bernardini
• Oculoplastica Bernardini
• BACKGROUND-AIM

Traditional temporo-malar lifting including the new temporal MORE variation, consists in wide dissection and strong pull from the periphery of the face toward the center and relies in wide excision of redundant skin. Limitations of this technique consist in the fact that the forehead is not included, and brows are approached separately by means of direct trans-cutaneous approach. The resulting scars in front of the hairline or behind the brows can be visible and shortening of the distance between the tail of the brow and the temporal hairline can occur. The strategy of the endoscopic face lifting approach differs significantly as it consists of simultaneous dissection and synchronous elevation of the all the facial structures that undergo age-related descent, forehead, temples, brows and midface. There is no resulting skin excess to be excised, simply a temporary skin accumulation that redistributes shortly after, no visible scars and it allows elevation of the glabella and head of the brows where indicated.

• METHODS

Technique: the intervention requires initially a blind dissection to form an optical space to allow the endoscopic view. In the frontal part, one central and two paramedian incisions of 2 cm are hidden behind the airline, a blind dissection is performed under the periosteum, while maintaining an intact periosteum. In the temporalis area the dissection plane is above the superficial plane of the deep temporal fascia. From the temporal dissection the conjoint tendon is elevated, and the frontal and lateral pockets are joined together. Afrom these points onward the dissection is carried on only with under 3D endoscopic camera associated with 3D glasses that will allow the perfect visualization of the area.

Frontal Dissection: In the frontal part, the plane will be subperiosteal all the time. Always try to pre- serve the integrity of the periosteum until the orbital rim. Once the orbital rim is reached, coming from laterally to medially and bluntly elevating the periosteum, the supraorbital neurovascular bundle will be encountered. All the strands of periosteum need to be elevated at each side of the nerve and behind it. Past the supraorbital nerve, dissection will be aimed towards the glabella, elevating and dissecting the corrugator and procerus muscles; in between the muscle fibers of the corrugator muscles there will be the supratrochlear nerve. Fixation is achieved thanks to two paramedian absorbable cable sutures.

Temporo-Malar Dissection: The sentinel vein is the first landmark and it is kept intact; laterally to the sentinel vein, blunt dissection reveals the zygomatico-facial neurovascular bundle and more laterally to it lies the zygomatico- temporal nerve. The SOOF will be entered next by dissecting caudally between the sentinel vein and the zygomatico- facial nerve, while between the zygomatico-facial and zygomatico-temporal the midface will be dissected. Medially to the sentinel vein the dissection proceeds towards the orbit, where the lateral retinaculum and the lateral canthal tendon are released. The dissection proceeds caudally in the mid-face, after full release of the zygomatico-cutaneous ligament and the Mc Gregor patch and stops after reaching the naso-labial fold and the corner of the mouth. Fixation is achieved through multiple absorbable cable suture placed at different levels from caudal to cranial: 2 mid-facial (1 medial + 1 lateral), 1 paracanthal, 1 temporal, all tight to the deep temporal fascia. Most commonly the endoscopic lifting was associated to lower blepharoplasty in 92%, 36% upper blepharoplasty and fat grafting 88%.

• RESULTS

Retrospective review of 130 consecutive cases performed by the presenting author from January 2022 to December 2024. The patient population consisted in 97% female patients, with an average age of 53 years; results were graded at the last follow-up consultation, at least 6 month post-operatively. The aesthetic results were objectively evaluated and graded by 3 blind observers and subjective satisfaction was graded in each patient by a self-assessing questionnaire. Complications were minimal and resolved spontaneously in all the patients and included various degrees of bruising and swelling, 4 cases of temporary frontal nerve neuro-apraxia, 17 cases of self-limiting scalp hypo- and hyper- aesthesia in the territory of the sovra-orbital nerve; 2 patients experienced a temporal hematoma that required prompt intervention (drainage). The aesthetic outcome was considered highly satisfactory in 86% of the patients and satisfactory in the remaining 14%. Self-reported satisfaction questionnaire revealed similar high scoring in all the patients.

• CONCLUSIONS

Endoscopic face lifting is gaining popularity across the world thanks to multiple recent publications that expanded its indications, traditionally limited to the brows, to include the oval of the face. The results of the endoscopic lifting are magnified in this series by the concurrent effect of lower and upper blepharoplasty and by simultaneous fat grafting (SEFFI technique) that provided adequate volume replacement and skin regeneration to the entire face and specifically the perioral area, which in turn greatly reflected on the objective and subjective outcomes of the entire face. The Vision of the endoscopic face lifting is the main target area, the oval of the face instead of the periphery addressing simultaneously and harmonically all the structures involved in facial aging, aiming at restoring age related vertical tissue descent and volume loss; the periocular area is specifically addressed at the same time with upper and/or lower blepharoplasty, and the perioral area addressed mainly by volume replacement and skin regeneration.

96. Hybrid Upper Blepharoplasty

• F. Romeo
• Studio Libero Professionale ROMEO (Roma)
• BACKGROUND-AIM

The concept of upper-eyelid volumization is an essential component in the modern correction of hollow or sunken-eye conditions. The procedure of volumization agents with micronanofat or hyaluronic acid represents the main choice in our current clinical practice.

• METHODS

In our clinical practice, hollow or sunken eyes that do not require a surgical approach are improved via a retroseptal hyaluronic acid implant with U.E.F.A. technique. In cases where a peri-orbital surgical intervention is indicated (e.g., skin resection of the upper eyelid in hollow eye whith dermatochalasis, surgical approach for the lower eyelid etc.) we proceed with a micronanofatgraft, and we evaluate the aesthetic outcome (efficacy and symmetry) at 100 days post- treatment. Should a corrective enhancement be needed, hyaluronic acid is added. Patient satisfaction was assessed using a Visual Analog Scale (VAS).

• RESULTS

We demonstrate the validity of our therapeutic choices and their effectiveness through pre- and post-treatment pictures and videos illustrating the techniques used.

• CONCLUSIONS

Our results indicate that the selected treatment strategy and timing satisfy the predefined objectives, for the patient, the operator, and a neutral third-party observer, who assesses the result based solely on the photographic documentation provided by the operator and approved by the patient.

97. Lower Blepharoplasty After Hyaluronidase Treatment for Water-Retention Edema Caused by Hyaluronic Acid Fillers in the Lower Eyelids

• G. Bellinvia
• Clinica Surglab
• BACKGROUND-AIM

Hyaluronic acid fillers in the lower eyelid region may lead to persistent water-retention edema, contour irregularities, pseudo-herniation, and distortion of the lid–cheek junction. Hyaluronidase is the treatment of choice, but even when used in small doses it may produce unpredictable effects on filler degradation and surrounding tissues: in some cases the reduction is minimal, while in others it may be excessive. This variability can result in volume loss that is not always predictable or fully correctable with surgery alone.

This study evaluates the outcomes of lower blepharoplasty performed after enzymatic filler dissolution in patients presenting chronic edema and contour deformities secondary to HA fillers, with specific focus on the limitations of volumetric correction.

• METHODS

A total of 12 patients (28–65 years) with persistent lower eyelid edema following HA filler injections were treated with hyaluronidase and, after a minimum interval of 4–6 weeks, underwent lower blepharoplasty. Preoperative planning considered the potential variability of enzymatic response, including assessment of volume deficits induced by hyaluronidase. Surgical techniques included skin–muscle flap elevation, selective fat removal or repositioning, and orbicularis preservation.

• RESULTS

Resolution of filler-related edema was confirmed in all patients prior to surgery. Lower blepharoplasty improved eyelid contour and reduced residual irregularities. However, in some cases the unpredictable response to hyaluronidase resulted in greater or lesser volume reduction than expected, with occasional depressions of the eyelid groove not fully correctable through blepharoplasty and sometimes requiring secondary treatments (lipofilling or low–molecular weight fillers). No cases of recurrent edema or scleral show were observed. Patient satisfaction was good but depended on adequate preoperative counseling regarding the variability of enzymatic outcomes.

• CONCLUSIONS

Lower blepharoplasty after hyaluronidase is an effective approach for correcting edema and deformities secondary to HA fillers, but enzymatic response may be unpredictable even with minimal doses. Thorough patient counseling is essential to establish realistic expectations and plan potential complementary volumetric treatments.

98. Mini-Invasive Lower Blepharoplasty with Predictive Skin Mapping and Orbicularis Suspension

• M. Maffei
• UO Day Surgery SURGLAB
• BACKGROUND-AIM

Lower eyelid rejuvenation often poses challenges related to cutaneous excess, fat pseudo-herniation, muscle laxity, and the risk of postoperative scleral show. Traditional lower blepharoplasty techniques may weaken the orbicularis oculi muscle or require more extensive dissection, increasing complication rates. This study aims to present a minimally invasive lower blepharoplasty approach with orbicularis oculi suspension designed to preserve muscular integrity, allow selective removal of pseudo-fat pads through a small controlled muscular opening, minimize surgical risk, and provide predictable skin excision through preoperative cutaneous mapping.

• METHODS

A total of 234 patients aged 30 to 70 years underwent minimally invasive lower blepharoplasty with orbicularis oculi suspension. A subciliary incision was performed, extending approximately 1 cm laterally beyond the lateral canthus. Preoperative markings determined the exact amount of skin to be excised, similar to upper blepharoplasty planning. A small, precise opening in the orbicularis oculi muscle allowed targeted removal of pseudo-fat pads when indicated. Lateral dissection was then deepened to expose the periosteum, over which the orbicularis muscle was suspended using one or two absorbable braided sutures. Follow-up duration was 3 years.

• RESULTS

Patients demonstrated stable and long-lasting aesthetic improvement over the entire follow-up period. Complications were minimal and included small scar cysts or localized infections near the absorbable suture site. No cases of scleral show were observed. Patient satisfaction was consistently high.

• CONCLUSIONS

This minimally invasive lower blepharoplasty technique offers several advantages over traditional approaches: it preserves the orbicularis oculi muscle, allows selective removal of pseudo-fat pads through a controlled micro-access, virtually eliminates the risk of scleral show, permits accurate preoperative prediction of skin excision, and can be safely performed under local anesthesia with mild sedation. It is particularly suitable for patients requiring lower eyelid rejuvenation with limited skin excision and fat pseudo-herniation, ensuring natural, stable, and long-lasting outcomes.

99. Periocular Rejuvenation Through Endoscopic Lifting and/or Blepharoplasty

• R. Garofalo
• Istituto di Chirurgia Pamphili, Roma
• BACKGROUND-AIM

The use of endoscopic lifting allows blepharoplasty to be avoided in periocular rejuvenation through the release of the ligaments and the weakening of the orbicularis muscle.

However, sometimes a small skin ellipse in the upper eyelid is essential and, more rarely, transconjunctival removal of eyelid bags.

The use of lipofilling combined with endoscopic lifting often further reduces the need for blepharoplasty. The aim of this study is to clarify the indications for periocular rejuvenation treatment using the various techniques available.

• METHODS

The technique employed involves performing endoscopic lifting through incisions in the scalp and endoscopic treatment of the muscles and ligaments.

The blepharoplasties compared all involved resection of a small strip of upper (0.3/0.5 mm) and lower orbicularis muscle.

In no case was external cantoplasty performed. Preoperative photographs, tissue studies and accurate preoperative drawings always preceded the surgical procedure.

• RESULTS

The authors present 280 cases of patients aged between 35 and 75, of whom 130 were treated with endoscopy, 45 with associated minor skin resection of the upper eyelid, and 105 aged between 50 and 75 were treated with blepharoplasty. Only 8 cases of endoscopic face lifts required reoperation for a small resection of untread upper eyelid skin.

• CONCLUSIONS

Endoscopic eyelid surgery and traditional blepharoplasty are two techniques that can be used alone or in combination with each other to achieve a more complete and less invasive result.

Depending on the indications, age, tissue quality and objectives of the surgery, it is possible to select or combine the techniques.

100. Reduction in Postoperative Downtime, Side Effects and Complications in Blepharoplasty Following the Implementation of a Bloodless Atraumatic Technique (Bat)

• S. Noviello
• Sergio Noviello Cosmetic Surgery
• BACKGROUND-AIM

The popularity of blepharoplasty increased significantly during the 20th century, particularly following the emergence of modern beauty culture in the 1960s. Despite its extensive utilisation, recovery has historically been protracted, with patients commonly experiencing 2–3 weeks of bruising, swelling and transient visual impairment. These outcomes were historically accepted as inevitable, reflecting long-standing limitations in surgical precision and tissue- preservation strategies.

• METHODS

The Milano BAT Blepharoplasty Study (January 2015–January 2024) analysed a total of 580 procedures, comprising 340 upper and 240 complete blepharoplasties. All surgical procedures were executed utilising the Bloodless Atraumatic Technique (BAT), and were meticulously recorded through the utilisation of multi-camera systems and Ray-Ban Meta smart-glasses, thereby ensuring comprehensive documentation of all manoeuvres. The employment of systematic video analysis facilitated the identification of micro-traumas, redundant movements, inefficient handlings and sources of thermal or mechanical stress. Subsequent refinement of the protocols was driven by the dual objectives of reducing invasiveness and enhancing efficiency.

• RESULTS

The present study demonstrated that consistent application of the BAT protocol resulted in a significant reduction in postoperative downtime, bruising and swelling. The video review demonstrated that even minor deviations from the method, such as excessive traction or uncontrolled energy dispersion, increased tissue trauma and delayed recovery. Following the elimination of superfluous steps and the optimisation of instrument-tissue interactions, intraoperative bleeding was almost entirely eliminated, and postoperative inflammation decreased markedly. It was observed that patients experienced a reduction in the time taken to recover their vision, with minimal evidence of ecchymosis and a lower incidence of complications. These included haematoma, chemosis, conjunctivitis and scleral show.

The refinement of instruments, energy settings and surgical movements was imperative in order to achieve atraumatic outcomes. The primary focus of BAT is precision, controlled thermal delivery, minimal mechanical force and enhanced operative visibility. The aforementioned elements function collectively to impede the infiltration of blood into the tissues, thus attenuating pain, oedema and inflammatory responses.

• CONCLUSIONS

The Bloodless Atraumatic Technique (BAT) signifies a substantial advancement in blepharoplasty, offering reduced postoperative downtime and complication rates, along with enhanced patient satisfaction. Achieving optimal results necessitates the comprehensive implementation of the method, accompanied by specialised training and strict adherence to its established protocols. When executed correctly, the use of BAT establishes a new standard for safety, predictability and speed of recovery in aesthetic eyelid surgery.

101. The Impact of Diabetes on Upper Eyelid Blepharoplasty: Risk or Safety? A Comparative Study

• J. Viscardi and S. Giordano
• Department of Plastic and General Surgery, Turku University Hospital, Finland
• BACKGROUND-AIM

Dermatochalasis is characterized by excess upper-eyelid skin that may be accompanied by orbital fat prolapse, lacrimal gland prolapse, or involutional blepharoptosis. Upper eyelid blepharoplasty is the gold-standard treatment for dermatochalasis and is one of the most performed aesthetic surgical procedure worldwide, according to the 2024 ISAPS Global Survey. Because it is predominantly carried out in older patients, among whom diabetes mellitus (DM) is common, concerns arise regarding an increased risk of postoperative complications. It is not yet clear whether upper blepharoplasty can be safely performed in patients with DM. We aimed to investigate the safety of upper eyelid blepharoplasty in patients with DM.

• METHODS

We retrospectively analyzed data from 390 consecutive upper eyelid blepharoplasty procedures performed for dermatochalasis over a three-year period at Turku University Hospital. Patients were grouped according to DM status and type of antidiabetic therapy. Individuals with a history of prior eyelid or orbital surgery were excluded. Postoperative complications, clinical outcomes, and patient-reported aesthetic satisfaction scores (1–10) were compared between the DM and non-DM cohorts.

• RESULTS

The study included 390 patients: 59 with diabetes mellitus (DM) and 331 without DM. The DM cohort was significantly older and had higher rates of comorbidities, including hypertension, anticoagulant use, and hypercholesterolemia. The groups were otherwise comparable.

Operative time, surgical technique, estimated blood loss, and time to return to work did not differ significantly between cohorts. Follow-up duration was longer in the non-DM group (4.9 vs. 2.1 months, p = 0.006).

No significant differences were observed in the overall complication rate (6.8% vs. 3.6%, p = 0.260), although the odds ratio for postoperative complications in the DM cohort was 1.93 (95% CI, 0.60–6.12). The odds ratio for postoperative infection was 1.88 (95% CI, 0.19–18.44; p = 0.483). Patient-reported and surgeon-reported satisfaction scores were comparable between groups.

• CONCLUSIONS

Upper eyelid blepharoplasty appears to be safe in patients with diabetes mellitus, showing complication rates and aesthetic satisfaction comparable to those of non-diabetic individuals. Although a nonsignificant trend toward higher postoperative risk was observed in the diabetic cohort, no clinically relevant increase in adverse outcomes emerged. These findings suggest that, with appropriate patient selection and perioperative management, diabetes mellitus should not be considered a contraindication to upper eyelid blepharoplasty.

102. The Role of Brow Lift in Periocular Rejuvenation: A Retrospective 3D Imaging Analysis in Relation to Orbital Morphology

• M.C. Servillo
• Clinica Villa Stuart, Roma
• BACKGROUND-AIM

Brow descent plays a central role in periocular aging, significantly influencing upper eyelid aesthetics, orbital exposure, and overall facial expression. Isolated upper blepharoplasty may fail to address brow ptosis and, in some cases, may even exacerbate an unnatural or fatigued appearance. The objective of this study was to evaluate the aesthetic impact of brow lifting and to analyze postoperative changes using three-dimensional (3D) imaging, with particular attention to orbital shape and periocular proportions.

• METHODS

A retrospective study was conducted on 32 patients who underwent a direct brow lifting procedure as part of periocular rejuvenation. Preoperative and postoperative assessments were performed using standardized photography and 3D imaging software. Postoperative evaluations were carried out at 6 months and then annually, with an overall follow-up ranging from 6 months to 2 years. Quantitative and qualitative evaluations included brow position, brow shape, upper eyelid show, and orbital aperture. Orbital morphology was classified based on shape and vector orientation, and postoperative aesthetic outcomes were analyzed in relation to these anatomical characteristics. Patient satisfaction and surgeon-rated aesthetic improvement were also assessed during follow-up.

• RESULTS

Standardized photography and 3D imaging analysis demonstrated a consistent elevation and reshaping of the brow, with significant improvement in upper eyelid exposure and periocular balance. Aesthetic outcomes were influenced by orbital morphology. Three-dimensional evaluation allowed precise assessment of brow curvature, height, and its relationship with orbital shape, highlighting differences in aesthetic response that were not fully appreciable through two-dimensional analysis alone. Overall patient satisfaction was high, and no major complications were observed.

• CONCLUSIONS

Brow lifting represents a fundamental component of periocular rejuvenation and should be considered an integral part of upper facial aesthetic planning. Three-dimensional imaging provides a valuable tool for objective assessment of brow position, shape, and their relationship with orbital morphology. Tailoring brow lift strategies to individual orbital anatomy improves aesthetic outcomes and supports a more harmonious and natural periocular rejuvenation.

103. Treatment of Malar Mounds

• A. Paci
• Studio Andrea Paci
• BACKGROUND-AIM

The author presents his surgical experience in the treatment of malar mounds, describing the anatomical basis of the technique and the surgical approach. Particular attention is given to the differential diagnosis with other conditions causing lower eyelid edema that do not constitute an indication for this procedure.

• METHODS

Thirty-seven cases of malar mound treatment performed between 2020 and 2024 are reported, including both female and male patients aged 25 to 81 years. All procedures were bilateral. In 34% of cases, isolated malar mound treatment was performed; in 23%, the procedure was combined with complete blepharoplasty; in 15%, with complete blepharoplasty and eyebrow lifting; and in 15%, with complete blepharoplasty and C–F lifting.

Eighty-five percent of the procedures were performed under local anesthesia with sedation, and the remaining 15% under general anesthesia. The surgical technique consists of releasing the orbito-malar ligament and the zygomatic- cutaneous ligament through a lateral canthal and lower eyelid incision, which converge at the level of the lateral canthus within the so-called “lateral orbital thickening.” Tensioning of these structures results in expansion of the prezygomatic space and correction of the malar mound.

• RESULTS

Extended blepharoplasty represents one of the available techniques for the treatment of malar mounds. The procedure is technically straightforward, reproducible, and based on recognition of potential etiological factors, including descent of the prezygomatic space between the orbito-malar septum and the zygomatic-cutaneous ligament, within which the suborbicularis oculi fat (SOOF) is located. Repositioning of the ligamentous structures to the latero-canthal periosteum ensures long-term stability of the correction.

• CONCLUSIONS

After careful clinical evaluation and appropriate differential diagnosis—particularly considering the history of onset, stability, remission, and volumetric variability of the malar mounds—the indication for corrective surgery can be established. The extended technique is considered by the author to be reliable, predictable, and reproducible.

104. IL the Concept of Aesthetic in Reconstructive Surgery of the Face

• A. Caggiati ¹ and S. Tenna ²

¹ 

Circo Massimo Medical Center Roma

² 

Chirurgia Plastica Campus Biomedico Roma

• BACKGROUND-AIM

Skin cancers are the most frequently observed malignant tumors, and when they affect the face, they cause serious aesthetic concerns about postoperative social impairement further exacerbated by the decreasing average age of patients affected by this type of tumor.

The use of simple and traditional reconstructive techniques aimed at simply repairing facial skin loss (“fill the hole”) often results in blemishes characterized by visible or geometric scars, poor color and textural matching between the reconstructed areas and adjacent areas, and highly visible damage to donor areas.

• METHODS

The authors present an aesthetic reconstructive approache explained by several clinical examplesof aesthetic facial reconstruction techniques.

Surgeries are performed in 98% of cases under local anesthesia, combined with intravenous sedatio in thoise cases where the extent of the lesions or poor patient compliance may make it advisable to reduce the patient’s level of consciousness.

The results were evaluated on a scale (1–5 points: 0- visible deformation, 5-scar unrecognizable at close observation).

• RESULTS

The aesthetic reconstructive approach has been applied extensively over the last 25 years of oncology practice. The advantages offered by this approach are primarily: improved aesthetic results and greater reproducibility of results. The disadvantages: more complex planning, sometimes greater invasiveness, and the need for longer surgical procedures.

• CONCLUSIONS

An extensive basic knolwedge common reconstructive procedures of the face is required to approach to the modern concept of aesthetic reconstruction of the face. The consideration and respect for aesthetic units and subunits of the face together with a critical evaluation of donor areas has revolutionized facial reconstructive surgery represent a new reconstructive philosophy that goes beyond the reparative concept of “filling the hole” in favor of a restitutio ad integrum of the normal, or sometimes improved, conformation of the face.

105. Endo Deep Plane vs. Extended Gliding Brow Lift, the Best Options in Minimally Invasive Facial Surgery

• L. Canta
• Università degli Studi di Napoli Federico II
• BACKGROUND-AIM

Minimally invasive facial surgery has progressively evolved toward techniques that maximize aesthetic outcomes while minimizing tissue trauma and recovery time. Among brow lifting procedures, the endoscopic deep plane approach and the extended gliding brow lift have emerged as reliable options for rejuvenation of the upper and midface. The aim of this study is to compare these two techniques, highlighting their indications, advantages, and limitations based on the author’s clinical experience.

• METHODS

A comparative analysis was performed on patients undergoing brow lift using either the endoscopic deep plane technique or the extended gliding approach. Patient selection was based on degree of brow ptosis, forehead anatomy, skin quality, and associated midface aging. Surgical technique, operative time, invasiveness, complication rate, and postoperative recovery were evaluated. Clinical follow-up focused on brow position stability, harmony between the brow and midface, and overall aesthetic outcome.

• RESULTS

Both techniques provided effective brow elevation with natural and harmonious results. The endoscopic deep plane brow lift demonstrated excellent outcomes in the upper third of the face with minimal scarring and rapid recovery. The extended gliding brow lift showed superior efficacy in cases requiring a more pronounced effect on the midface and lateral brow, offering enhanced tissue mobilization and long-term stability. Complication rates were low and comparable between the two groups.

• CONCLUSIONS

The endoscopic deep plane and extended gliding brow lift are both valuable techniques in minimally invasive facial surgery. Their optimal use depends on careful patient selection and precise indication. Based on the author’s experience, a tailored approach allows the surgeon to choose the most appropriate technique to achieve natural, stable, and long-lasting facial rejuvenation results.

106. Eye Lengthening: Elastic Canthopexy and Elastic Temporal Lift. Which Technique Should I Choose?

• S. Capurro and S. Capurro
• Ex Director Plastic Surgery and Burns Division San Martino Hospital Genoa
• BACKGROUND-AIM

Permanent eye lengthening is of considerable interest in cosmetic surgery and is performed by us using two simple techniques that do not require tissue dissection and leave no scars: Elastic canthopexy and elastic temporal lift.

The study aims to identify the best option for different patients requiring eye lengthening. The decision is made by evaluating the region’s characteristics and the patient’s wishes.

• METHODS

Eye lengthening is achieved through the access of a 16G needle, dilated and deepened with a fine-tipped Klemmer, always positioned in the temporal fascia. Through this hole, the double-tipped needle (Jano needle) equipped with EP3.5 elastic thread (Elasticum) creates an isosceles triangle in elastic canthopexy. In elastic temporal lift, the shape is trapezoidal. In both procedures, the upper fixation line is at the hairline. In elastic canthopexy, the base of the triangular shape remains within the temporal fascia, and the apex is attached to the periocular retinaculum. In elastic temporal lift, access is in the upper portion of the temporal fascia, the base is connected to the galea capitis, and the procedure is subcutaneous, passing under the eyebrow, crossing the eyelid skin, and descending into the tissues above the lateral orbital arch, which are thus pulled, lengthening the gaze.

• RESULTS

The procedures have proven effective and without complications; in some cases, both procedures have been performed on the same patient, achieving the desired result.

• CONCLUSIONS

Elastic canthopexy and elastic temporal lift can easily be included in the range of routine facial aesthetic surgery procedures. These two techniques have numerous indications: rejuvenation of the gaze, lengthening of round eyes, often iatrogenic, modification and correction of the ocular inclination, correction of eyes that are too close together, correction of asymmetry, “scleral show,” eyebrow lifting, and correction of the lateral palpebral fold of the upper eyelid. Elastic canthopexy, if it creates a “Foxy eye,” narrows the palpebral fissure and, in small orbits, may require removal of excess lateral skin from the upper eyelids. If the gaze lengthening is horizontal and not oblique, an upper blepharoplasty is often not necessary. The elastic temporal lift elongates the gaze (less than elastic canthopexy) but lifts the eyebrows and lateral eyelid skin. Although rare, some patients require both techniques.

107. Long-Term Results of Facial Feminization Surgery in Treatment of Gender Dysphoria

• R.M. Fakin
• Clinic PD Dr. Richard Fakin
• BACKGROUND-AIM

Facial Feminization Surgery (FFS) is being increasingly requested by many trans-women who wish so to improve their passing and hence their quality of life. FFS involves a series of facial procedures, which can be combined, and the therapeutc concept is based on an induvidual patient assessment and their needs. In this single-surgeon experience series, we present surgical concepts and long-term review of complication rates.

• METHODS

Medical records were reviewed and post-operative physical examination as well as photographic documentation was performed in last 300 patients, who underwent FFS by the same surgeon within past 4 years.

• RESULTS

The main FFS procedures involved reduction of supraorbital bossing and indirect brown lifting (92%), chin feminization (65%), feminizing septo-rhinoplasty (28%), followed by less requested procedures, such as facial fat grafting (12%), bichectomy (7%), direct brown lifting (5%), and face and neck lifting (4%). Most of these interventions have been performed as multiprocedural (92%) and/or with a simultaneous breast augmentation in 43% of cases. The complication rate is 1.7%, involving a partial nerve palsy of a frontal branch of facial nerve (1 patient) and prolonged wound healing in 4 patients.

• CONCLUSIONS

Despite technical overlap in feminizing and esthetic indications, the surgical concepts and care for gender dysphoria patients vastly differ from that for the cis-gender population. This review includes comments on gender norms and outline considerations for the preoperative assessment and operative execution. It also demonstrates FFS to be safe and effective meausre in treating of gender dypshoria.

108. Custom-Made CAD/CAM Zygomatic Implants in Facial Feminization Surgery: A Retrospective Study of 20 Amab Patients

• G. Zabbia and G. Tondini
• Università di Palermo
• BACKGROUND-AIM

Facial feminization surgery (FFS) has a critical role in gender affirmation surgery for assignated male at birth(AMAB) patients. A restoration of an adequate malar projection is central to achieving feminine facial contours. Custom-made zygomatic implants designed with CAD/CAM technology offer tailored solutions for midface enhancement.

• METHODS

We analyzed 20 AMAB patients who underwent bilateral malar augmentation using customized CAD/CAM compact polyethylene or PEEK implants between 2018 and 2025. All patients had preoperative 3D-CT imaging and mirroring- based digital planning. Zigomatic bones thickness and surface irregularities were analyzed and a customized protothipe of the implant was reconstructed using CAD/CAM. Implants were prefabricated on individual models, implanted in a subperiosteal plane in addiction or not with other FSS procedures performed at the same surgical time. Aesthetic and functional outcomes were assessed clinically through follow-up pictures and with postoperative 3D imaging. Complications were recorded.

• RESULTS

All implants fit precisely without the need for intraoperative adjustment or fixation. No infections, hematomas, or implant dislocations occurred. Two cases of temporary stupor of the temporal branch of the facial nerve resolved spontaneously. Follow-up CT scans (in 11 patients) showed no signs of bone resorption or implant migration. The functional recovery and the aesthetic outcome regarding projection and symmetry of the midface were satisfactory in all cases. All patients were satisfied for the procedure.

• CONCLUSIONS

CAD/CAM-designed zygomatic implants provide a precise, safe, and durable method for midface feminization in AMAB patients. They enhance symmetry, reduce operative time, and obviate the need for fixation devices. This technique may be useful as an effective adjunct in FFS protocols.

109. A Retrospective Analysis of Nasal Thinning and Refinement in Indian Patients: Experience from 500 Cases

• M. Kapoor
• Dr. Monisha Kapoor Aesthetics, New Delhi
• BACKGROUND-AIM

Rhinoplasty (RP) in Indian patients presents challenges due to thick skin, bulbous tips, and poor septal support. The primary aesthetic goal for this group is a slimmer, sharper, and more defined nasal contour. The study aimed to retrospectively evaluate the efficacy and safety of a structured, structure-focused surgical approach in achieving nasal thinning and refinement across a large cohort.

• METHODS

A retrospective review was conducted on 500 consecutive patients of Indian ethnicity undergoing primary aesthetic Rhinoplasty. All procedures were performed using an open approach with a focus on stable, structural grafting. Key surgical maneuvers included: Tip Refinement (TR) (lateral crural overlay, dome-binding, precise suture management) to decrease tip width and increase projection, and tailored Dorsal Augmentation (DA) or reduction, often utilizing septal cartilage. Outcomes were assessed at a follow-up of twelve months.

• RESULTS

Post-operative analysis demonstrated significant and consistent reductions in both nasal tip width and alar base width. The Tip Refinement (TR) techniques successfully transformed bulbous tips into sharper, more defined aesthetic units without compromising nasal airway function. Overall complication rates were low, with minor irregularities being the most common issue requiring revision.

• CONCLUSIONS

A comprehensive, structure-focused Rhinoplasty approach, specifically adapted to mitigate the challenges of the Indian Nose (IN), is a highly effective and reproducible method for achieving the aesthetic goals of slimming and sharpening the nose in this demographic. The data supports the use of detailed pre-operative planning and meticulous execution of Tip Refinement (TR) and Dorsal Augmentation (DA) techniques.

110. Domal and Lateral Crura Reconstruction with Conchal Cartilage

• F. Segreto ¹, T.M. Marianetti ², A. Iademarco ², C. Rossi ¹, A.A. Cimmino ¹, P. Turco ¹ and P. Persichetti ¹

¹ 

Area di Chirurgia Plastica, Ricostruttiva ed Estetica; Fondazione Policlinico Campus Bio-Medico di Roma

² 

Area di Chirurgia Maxillo-Facciale, Clinica Assunzione di Maria Santissima, Roma

• BACKGROUND-AIM

Tip impairment following rhinoplasty may jeopardize the whole outcome, from both aesthetic and functional standpoints. Revision cases are technically demanding, and extra-nasal cartilage is often required to restore the cartilaginous framework. Moreover, precise domal reconstruction is extremely challenging, as well as paramount to achieve pleasant outcomes.

Despite several reports in the literature, to date there is still some lack of evidence about indications and technical details to achieve adequate tip reconstruction with the use of auricular cartilage, especially for like-with-like domal restoration. The aim of this study is to describe the authors’ modified technique for dome and tip reconstruction in revision rhinoplasty by mean of conchal cartilage.

• METHODS

The study included 59 patients who underwent revision rhinoplasty. Tip aesthetics, with focus on tip shape and definition, and patients’ satisfaction were assessed 12 months postoperatively using Visual Analog Scale and the rhinoplasty module of the FACE-Q, respectively.

Univariate statistical analysis and multivariable regression models were performed.

• RESULTS

Each FACE-Q domain, overall and Rasch transformed scores showed a statistically significant improvement at 12 months follow-up (p < 0.01). VAS scores for tip aesthetics also improved significantly at 12 months follow-up (p < 0.01). All findings were confirmed when controlled for eventual confounders. No complication was experienced.

• CONCLUSIONS

Domal and lateral crura reconstruction with conchal cartilage proved to be an easy-to-perform, reliable and effective technique in revision rhinoplasty. The approach can be tailored and fine-tuned to the single patient, with superior control of domal convexity, domal angle and lateral crural resting angles.

111. Managing the Nasal Tip in Rhinoplasty: Comparing Solutions

• M. Siliprandi
• Humanitas Research Hospital
• BACKGROUND-AIM

A proper balance between the nasal dorsum and tip is fundamental to surgical success in rhinoplasty. Depending on the case, the tip may be corrected either in isolation or in conjunction with the dorsum. The main corrective objectives can be summarized as: tip rotation, reduction, augmentation or reduction of projection, and definition or narrowing of the tip. The Author aimed to analyze these different solutions with reference to his own case series.

• METHODS

The Author categorized the main tip deformities into underprojection, overprojection, hypertrophy, under-rotation, and boxy tip. Based on his clinical series, selected cases falling into each of the aforementioned categories were analyzed, illustrating the respective appropriate surgical solutions.

Simple tip hypertrophies benefited from straightforward trimming and reshaping of the alar cartilages. Under- rotation of the tip was corrected by combining this technique with caudal septal resection. Tip underprojection was corrected through a structural approach using cartilage grafts. Tip overprojection, when indicated, was corrected by tip telescoping with division of the medial and lateral crura. Finally, wide or “boxy” tips were corrected using inter- and intradomal sutures. Tips presenting a combination of defects required combining the techniques described above.

• RESULTS

Proper planning of the surgical techniques allowed for satisfactory and effective outcomes, achieving an optimal tip– dorsum relationship. Skin thickness represented, in some cases, a limitation to achieving a highly defined tip, as did the fibro-scar tissue encountered in secondary tip rhinoplasty cases.

• CONCLUSIONS

In preoperative planning, the surgeon’s aesthetic ideal must always be balanced with the patient’s expectations. Tip projection must be evaluated as dependent on the planned final height of the dorsum, which in some patients may be desirable to maintain even if it exceeds standard aesthetic norms. Assessment of the soft tissues, in addition to the cartilaginous framework, is essential for predicting the final outcome.

112. Advantages of the Preservation Technique in the Crooked Noses

• A. Trivisonno
• Libera Professione Roma
• BACKGROUND-AIM

Correction of crooked noses remains one of the most challenging tasks in rhinoplasty. Deviation is never purely cartilaginous or purely bony; it is an intricate weave of mechanical memories between the septum, the perpendicular plate, and the nasal bones. Traditional techniques, although capable of correcting the quadrangular cartilage, often leave the deviated perpendicular plate untouched, which then gradually pulls the corrected septum back toward its original curve. Preservation rhinoplasty, instead, makes it possible to fully release the septum from its deviated bony matrix, reducing the forces responsible for recurrence and allowing a more stable and straighter reconstruction of the nasal framework.

• METHODS

More than 80 cases of crooked nose were analyzed, all treated with a strategy based on preservation rhinoplasty. Main technical steps:

1.

Release of the quadrangular septum

Precise separation of the septum from the perpendicular plate of the ethmoid, correcting deviation at its root: the septum is no longer captive within a deviated bony matrix.

2.

Management of the nasal bones

Asymmetric osteotomies with greater removal or mobilization on one side than the other, following the Pisa Tower principle:

concave side ⟶ greater expansion and mobility convex side ⟶ tighter control, less resection.

This guided asymmetry helps rebalance the bony axis and reduces residual lateral forces.

3.

Dorsal preservation

Conservation of the osteocartilaginous roof and management of the dorsum through push-down/let-down techniques, maintaining structural integrity and reducing torsional tendencies.

4.

Structural repositioning

Repositioning the straightened septum as a “new central pillar,” with stable suturing and minimal deforming memory.

• RESULTS

Significant reduction in deviation recurrence (>85% stable at 12 months).

-

Straighter nasal axis aligned with the glabellar–labial line.

-

Improved harmony between bony and cartilaginous components with fewer secondary rotations.

-

Greater stability compared to traditional techniques: once released from the deviated perpendicular plate, the septum is no longer dragged back into deviation.

-

Only 3 cases required minor revision (tip rotation fine-tuning).

• CONCLUSIONS

In the management of crooked noses, the preservation approach represents a paradigm shift:

-

releasing the quadrangular septum from the perpendicular plate eliminates the main vector of recurrence;

-

asymmetric osteotomies, calibrated according to the Pisa Tower principle, realign the bony framework in a stable manner;

-

maintaining the dorsum through preservation techniques reduces torsion and preserves structural continuity.

The combination of these elements, applied in more than 80 cases, offers a more predictable, stable, and anatomical correction of the deviated nose.

113. Asymmetric Osteotomies in Structural Rhinoplasty: A Pisa Tower–Inspired Approach for Crooked Noses

• N. Bianco ¹, A. Varricchio ², D. De Cicco ³ and S. D’Antonio ⁴

¹ 

Otorhinolaryngologist, Santa Rita Clinic, Via Morelli e Silvati 16, 83100 Avellino, Italy

² 

Medical doctor, Faculty of Medicine. Università Vita-Salute San Raffaele. Via Olgettina 58, 20132 Milan, Italy

³ 

Maxillofacial Surgeon, Maxillofacial Surgery Unit, Istitut Istituto Stomatologico Italiano. Via Pace 21, 20122 Milan, Italy

⁴ 

Plastic Surgery resident, Department of Plastic, Reconstructive and Aesthetic Surgery University of Naples “Federico II” Via Sergio Pansini 5, 80131 Naples, Italy

• BACKGROUND-AIM

Correction of the crooked nose remains one of the most challenging aspects of rhinoplasty because of asymmetric bony and cartilaginous deformities. The Pisa Tower Concept describes asymmetric osteotomies to realign the bony vault within a preservation rhinoplasty framework. This study aims to evaluate the outcomes of a structural adaptation of Pisa Tower–style asymmetric osteotomies integrated into a comprehensive structural rhinoplasty approach.

• METHODS

A retrospective study was conducted on 37 patients undergoing primary structural rhinoplasty for crooked nose deformity. The surgical protocol included asymmetric osteotomies based on Pisa Tower geometry, with wedge resection on the convex side and low-to-low or high-to-low lateral osteotomy on the concave side. Transverse or oblique osteotomies were selected according to the anatomical origin of the deviation. All patients underwent endoscopic L- strut septoplasty, dorsal hump reduction, and tip support using a septal extension graft. Outcomes were evaluated through photographic nasal axis deviation, computed tomography–based R–Webster measurements, a 5-point Likert satisfaction scale, and complication analysis at a mean follow-up of 18 months.

• RESULTS

Mean nasal axis deviation significantly improved from 7.9° ± 1.9° preoperatively to 1.2° ± 0.6° postoperatively (p = 0.0001). The R–Webster distance on the convex side decreased from 30.4 ± 4.8 mm to 23.1 ± 3.9 mm (p = 0.0003), while changes on the concave side were not statistically significant. Overall, 89.2% of patients reported high satisfaction (Likert score 4–5). Minor complications occurred in 13.5% of cases, with no major complications observed.

• CONCLUSIONS

Pisa Tower–style asymmetric osteotomies can be effectively combined with structural rhinoplasty, providing stable correction of bony deviation, high patient satisfaction, and a low complication rate. This approach extends the original Pisa Tower concept beyond preservation rhinoplasty into a structural rhinoplasty framework.

114. Power-Assisted Preservation Rhinoplasty: Experience in 97 Consecutive Cases

• S. Taglialatela Scafati and R. Russo
• Plastikè
• BACKGROUND-AIM

Preservation rhinoplasty has gained increasing relevance as a functional and aesthetic approach that respects the anatomical integrity of the nasal dorsum while reducing tissue trauma and recovery time. In parallel, the introduction of dedicated power-assisted instruments—such as high-speed burrs, micro-saws, and reciprocating rasps—has expanded technical possibilities in the management of bony and cartilaginous structures, enhancing precision, intraoperative control, and reproducibility. Despite growing interest in power-assisted surgery, clinical evidence regarding their exclusive application in dorsal preservation remains limited and fragmented, with scarce comparison to traditional or piezoelectric techniques. The aim of this study is to assess the clinical outcomes, technical implications, and safety of an exclusively power-assisted approach to dorsal preservation rhinoplasty, analyzing a consecutive cohort of treated patients and defining practical elements to support technique standardization.

• METHODS

A retrospective analysis was conducted on 97 Caucasian patients who underwent primary dorsal preservation rhinoplasty between January 2021 and January 2024. All procedures were performed using exclusively power-assisted tools (high-speed burrs, reciprocating rasps, and micro-saws) through either an open or closed approach. Evaluated parameters included functional and aesthetic outcomes measured using a validated rhinoplasty outcome scale at 6 and 12 months. Recovery times, duration of bruising, intra- and postoperative complications, and the need for revision surgery were recorded. Data were analyzed descriptively and, when applicable, with statistical testing to assess the clinical significance of observed changes.

• RESULTS

Mean improvement in nighttime breathing was +0.28 points, increasing from 3.87 to 4.15, with statistical significance. Early aesthetic recovery was favorable, with a mean bruising duration of 5.6 days in patients under 30 years and 6.8 days in older patients. The overall complication rate was 8.5%, with a low revision rate. No major intraoperative events occurred, confirming the safety and reproducibility of the technique. Six- and twelve-month evaluations demonstrated consistent improvement in all assessed parameters, with no evidence of secondary structural deformities or regression of results.

• CONCLUSIONS

Power-assisted preservation rhinoplasty emerges as a safe, precise, and versatile approach for dorsal reshaping, providing enhanced technical control, functional benefit, and rapid postoperative recovery. These findings suggest that power-assisted technology represents a valuable complement to traditional methods, particularly in cases performed via a closed approach. However, the lack of a control group and the homogeneity of the study population limit generalizability. Prospective comparative studies and more heterogeneous cohorts are needed to better define the role of power-assisted instruments in relation to piezoelectric and conventional techniques.

115. The Scroll Flap: How to Prepare It and Its Aesthetic and Functional Advantages

• V. Finocchi
• Private Practice
• BACKGROUND-AIM

The anatomical and functional integrity of the nasal valve region, including the scroll area and its ligamentous attachments, plays a critical role in both nasal airflow and aesthetic contour.

• METHODS

We describe a surgical technique that modifies and repositions the cephalic portion of the lateral crus, termed the Scroll Flap, to reinforce valvular structures and contribute to more stable tip and sidewall support. The flap remains partially attached to the soft tissue envelope and is repositioned to approximate its original anatomical orientation.

• RESULTS

This maneuver aims to reduce dead space, maintain soft tissue continuity, and facilitate more controlled skin redraping. By re-establishing the interface between the lateral crus, upper lateral cartilage, and surrounding soft tissue, the technique may also restore aspects of muscle-cartilage connection disrupted during traditional dissection.

• CONCLUSIONS

Although further study is warranted, the approach appears to provide both functional and aesthetic benefits, particularly in cases requiring tip rotation and scroll area reconstruction.

116. Management of Complications in Rhinoplasty

• F. Roselli
• Ospedale Gemelli Isola—Isola Tiberina Roma
• BACKGROUND-AIM

Secondary rhinoplasty is a surgical procedure that corrects problems resulting from previous nasal surgery, resulting in aesthetic dissatisfaction and/or breathing difficulties. Worldwide, the average percentage of patients undergoing revision rhinoseptoplasty varies from 10% to 18%. This procedure must address altered anatomy and often compromised structures. The tissue being operated on is scarred, the anatomy appears distorted, structural deficiencies may occur, and blood flow may be compromised. Reconstruction may require the use of grafts, requiring experience with complex cases and mastery of even advanced reconstructive techniques.

Our goal is to understand the various potential issues and possible solutions.

• METHODS

The procedures are performed for both aesthetic and functional issues. Each patient undergoes a medical examination and imaging tests, such as a CT scan, and for functional issues, a nasal fibroscopy. Finally, photographic documentation of the face is strongly recommended. A specific informed consent form for revision rhinoplasty surgery, with an autographed copy included in the medical record, must be completed carefully, including the medical history and pre- operative local physical examination.

Aesthetic procedures can be performed using either a closed or open technique, depending on the needs and the problem to be corrected. The procedure can be performed under general or local anesthesia, depending on the problem. Using grafts in revision rhinoplasty is very common. These grafts can be autologous, homologous, heterologous, or alloplastic. In particular, in the last 5 years, out of a total of 420 rhinoplasties or rhinoseptoplasties, 17 patients (4%) returned for revisions. Furthermore, 15 secondary or tertiary procedures were performed for the first or second time elsewhere. Usually I do a preservation rhinoplasty using the SPQR-Finocchi technique, 90% of the time as the primary procedure, 6 of the 17 patients operated had a small residual hump. 4 patients operated with the Joseph technique, with classic gibbotomy, 3 of these patients had irregularities of the bony dorsum and 1 patient had a supratip. The other 7 all had tip asymmetry, 1 patient showed migration of a free graft initially positioned in the supratip area and after 6 months it appeared inside the right nasal wing, causing swelling. 15 patients admitted following a previous procedure performed elsewhere, by using the Joseph technique, 2 patients had excessive resection of the hump, 3 had over-tips, 1 patient, one year after the previous procedure, had not formed a bony fusion between the nasal bones and the maxillary branches, presenting a gap between the two bone surfaces and the nasal dorsum still being too high compared to the tip, 2 patients had an anterior deviation of the nasal septum with lateral deviation of the tip, the remaining 4 patients had valvular collapse with excessive resection of the triangular cartilages, and 1 had alar resection, making the tip appear narrow and long, along with an over-tip, 1 patient had a tip that was still ptotic, and finally 1 patient had a nose that was still too long, extremely straight in profile with the dorsum and tip at the same height, valvular collapse, and untreated alar treatment, which also appeared asymmetrical due to different lengths.

• RESULTS

Defects that can be addressed:

-

Persistent dorsal hump or excessive or asymmetrical resection of the nose, resulting in a saddle-shaped or irregular nose. Deviated nasal axis. Problems with the grafts from the previous surgery, whether palpable or visible, that make the nose irregular or painful, possibly due to infection or displacement.

-

Tip defects, persistent bulbousness, pinched, asymmetrical, excessively rotated, or loss of projection after a few weeks. Asymmetry or irregularity of the nostrils.

-

Unnatural appearance or severe general irregularities, protuberances or depressions. Valvular collapse, which can affect both aesthetics and function.

-

Persistent nasal septal deviations, turbinate hypertrophy or atresia, synechiae, septal perforations.

Healing can be slower and more complex. Overall, 88% of patients experience significant immediate improvement, while 79% of patients are satisfied years later, with significant improvements in both breathing and appearance. Initial results are visible after 2–3 weeks, but swelling, especially at the tip, takes much longer to resolve, making the final result visible after 12 months. Once the healing period is complete, the revision result is generally long-lasting and stable.

• CONCLUSIONS

It is important to have realistic expectations. Although revision rhinoplasty can bring substantial improvements, perfect symmetry and finishing may not be possible. Factors that limit to have good results include any issues with the previous procedure, including the quality of the remaining tissue, the presence of scars, compromised blood flow, and individual healing. Some asymmetries or irregularities may persist. The goal is to realize a nose that is as natural as possible, more balanced and harmonious, but not necessarily perfect.

117. Rhinoplasty in Thicker Skin Individuals—Our Protocol—Indian Experience

• K. Ramasamy
• Chennai Plastic Surgery
• BACKGROUND-AIM

Rhinoplasty in patients with a thick skin-soft tissue envelope presents distinctive challenges. Increased sebaceous activity, reduced skin pliability and a bulky subcutaneous layer often obscure delicate framework modifications, making long-term tip definition difficult to achieve and maintain. Additionally, weak cartilage support, limited redraping capacity and a predisposition to prolonged tip edema, scar formation and extended recovery contribute to inconsistent aesthetic outcomes. To address these limitations we incorporated a protocol involving pre and postoperative oral isotretinoin and prolonged postoperative splinting, which has significantly improved skin behavior, edema control and overall aesthetic refinement.

• METHODS

A retrospective review was conducted on patients undergoing primary rhinoplasty at a tertiary-care aesthetic center in India. Parameters assessed included preoperative anatomy, adherence to the preoperative isotretinoin protocol, surgical modifications specific to thick-nose rhinoplasty, complications and patient-reported aesthetic and functional outcomes.

Isotretinoin was initiated preoperatively and continued postoperatively to reduce sebaceous gland activity and overall skin thickness. Five key intraoperative modifications were applied: targeted soft-tissue excision, creation of a reinforced structural framework, tranexamic acid irrigation, selective excision of excess skin and diced cartilage dorsal augmentation. Prolonged postoperative splinting was implemented to mitigate persistent tip edema, a common challenge in thick-skinned rhinoplasty.

• RESULTS

A comparative analysis of patients receiving prolonged splinting versus short-term splinting (n = 50) demonstrated a statistically significant improvement in aesthetic outcomes at 6 months with a p-value of <0.001. These findings highlight the effectiveness of combining isotretinoin therapy with targeted surgical modifications and extended splinting in optimizing results for thick-skinned rhinoplasty patients.

• CONCLUSIONS

Rhinoplasty in thick-skinned patients requires a tailored, structure-focused approach that enhances aesthetic harmony while respecting ethnic characteristics. A clear understanding of the anatomical and cultural nuances inherent to Indian noses is essential for achieving predictable and natural-looking results. Our evolving protocol integrating medical therapy with targeted surgical refinements adds valuable perspective to the global rhinoplasty community and offers a reproducible strategy for managing this challenging subset of patients.

118. “Enrichement Device-Free” Fat Enrichment for Regenerative Purposes

• A. Caggiati ¹, S. Tenna ² and A. Germani ¹

¹ 

Circo Massimo Medical Center Roma

² 

Chirurgia Plastica Campus Biomedico Roma

• BACKGROUND-AIM

Autologous fat-grafting is a common technique to restore volume and contour abnormalities in aesthetic and reconstructive surgery. Fat-tissue is usually harvested from a region that is more abundant, centrifuged and injected into a secondary site. Isolated adipose-tissue is composed of adipocytes and stromal vascular fraction-cells (SVF) including adipose stem-cells (ASC), preadipocytes, fibroblasts, vascular endothelial-cells, and a variety of immune- cells. From previous reports, it has become apparent that SVF and ASC might improve fat-graft survival, largely through their angiogenic properties. The study aimed to investigate SVF and ASC enrichment in the low and high density layers of fat obtained with both barbed and blunted multihole cannulae.

• METHODS

Fat-tissue was obtained from 5 female-patients who underwent lower abdominal liposuction between April 2014 to January 2015. Under local anesthesia and sedation, fat was harvested through a 50-mL syringe either by smooth cannula (SC), on the right side, and by barbed cannula (BC) on the left. After centrifugation (1000-rpm, 3-min) the oil and aqueous phases were discarded. The residual fat was divided into high- (HD), medium- and low-density (LD) fractions. Collagenase-digested HD and LD fat was analyzed by polychromatic flow cytometry to identify and enumerate distinct populations of fat-cells including ASC. Student’s t-test was used to compare yield, frequency and absolute numbers of cells/gram of tissue.

• RESULTS

A higher number of live-cells, of ASC, T-cells and 14+ dendritic-cells was detected in HD fractions compared to matched LD (p < 0.05). Between corresponding fractions, a larger yield was measured in BC- vs. SC-derived fractions. BC-derived HD contained on average 47% more ASC compared to SC-derived HD fraction (p < 0.05).

• CONCLUSIONS

The use of barbed cannulae for liposuction followed by fat-centrifugation and recovery of the HD fraction, yields a naturally ASC and dendritic enriched-fat without manipulation. It may promote adipogenesis and angiogenesis, increasing transplanted-fat viability and retention.

119. Regenerative Treatment of a Chronic Leg Ulcer Using Autologous PRP Gel and PRP Membrane: Case Report

• A. Mentone
• Napoli
• BACKGROUND-AIM

Chronic cutaneous ulcers represent a therapeutic challenge in plastic surgery, particularly in young patients seeking conservative and regenerative alternatives to invasive surgical procedures. This study aims to report the effectiveness of autologous platelet-rich plasma (PRP)gel and membrane in the treatment of a chronic leg ulcer.

• METHODS

A 25-year-old female patient with a chronic leg ulcer refractory to conventional treatments was managed with surgical debridement and two cycles of autologous PRP. PRP was obtained by venous blood collection and centrifugation, then applied as gel at baseline for two weeks and as a platelet membrane after four weeks from first treatment. PRP was left in situ for two weeks. Subsequent wound care included daily home dressings with topical clostebol acetate and neomycin sulfate, and weekly outpatient evaluations with additional debridement when required.

• RESULTS

Progressive reduction of fibrinous tissue, development of healthy granulation tissue, and complete re-epithelialization were observed. Full wound healing was achieved within three months without complications.

• CONCLUSIONS

Autologous PRP Gel and Membrane combined with surgical debridement proved to be an effective regenerative and conservative approach for chronic cutaneous ulcers, representing a valid alternative in selected patients unwilling to undergo more invasive reconstructive procedures.

120. Biostimulators and Face Lifting: When Layers Matter!

• C. Crisafulli
• Gulglam Clinics
• BACKGROUND-AIM

The good outcome of a face lifting depends also by the right undermining of the skin which structure sometime is modified due to the injectables received.

The biostimulators often are avoided by surgeons who perform face lifting due to the alteration of the skin layers quality and also due to the long term complication like lumps or granuloma that they can cause if injected in the wrong way.

• METHODS

Evaluation of intra-operative images of few patients who has been injected by myself months before primary and secondary face lifting.

• RESULTS

Despite a difficult dissection was expected the skin quality and the SMAS tissue of the areas injected were improved in terms of quality showing normal thickness and less scar tissue.

• CONCLUSIONS

This study reports how important is the knowledge of the anatomy in the specific of the skin layers and the materials injected in order to obtain a proper stimulation and avoid complication and or modification of the skin structure.

121. Collagen Comeback: PDLLA and CAHA Treatments for Menopausal Skin Health

• C. Crisafulli
• Gulglam Clinics
• BACKGROUND-AIM

During menopause, skin undergoes several changes due to hormonal shifts, primarily the decline in estrogen. This can lead to decreased skin elasticity, dryness, and increased visibility of wrinkles and fine lines. The treatments with PDLA and CaHa assure a proper boosting in the collagen production modulating the inflammation and improving the skin quality. In this presentation I will show the right injection layers and techniques according to the anatomy in order to achieve a pleasant result and prevent the complications.

• METHODS

With the right use on biostimulators such PDLLA or CaHa the collagen stimulation is boosted improving the skin quality. Anatomy, layers of injections and combined techniques will be shown in order to achieve the desired results and avoid the complications.

• RESULTS

Evaluation of several cases of face and body treated with PDLA and CaHa and combined procedures will show how the correct approach can slow down the aging process.

• CONCLUSIONS

PDLLA and CaHa are valid molecules to be used, with or without combination with other procedures, to “regenerate” and stimulate the production of collagen improving the skin quality on patients facing the menopause.

122. Injectable Polydioxanone: The Latest Collagen Inductor

• F. Lino
• Libera Professione Napoli
• BACKGROUND-AIM

Polydioxanone (PDO) is a biocompatible and biodegradable synthetic polymer, it has been used for many years in various fields of medicine and works by stimulating collagen production. The objective of this case series study is to confirm the efficacy and safety of treatment with injectable polydioxanone in accordance with data from international scientific literature.

• METHODS

The treatment protocol included the subdermal administration of injectable Polydioxanone using a 23G cannula and continuous retrograde linear technique in selected areas of the face in 1 session.

• RESULTS

80 patients were treated, the areas of the face subjected to treatment were chosen based on the patient’s clinical condition. Patients reported a medium to high degree of improvement. One temporary adverse event was reported.

• CONCLUSIONS

The treatment was found to be safe and effective; the results and adverse events are in agreement with international case series. Injectable PDO opens a new chapter in the book of collagen inductors.

123. New Regenerative Indications on the Use of a Synergic Binary Action Laser with Wavelengths of 1550 nm Simultaneously with 1927 nm

• E. Gandolfi and E. Shadrina
• Libero Professionista
• BACKGROUND-AIM

The authors present their experience with the use of a dual-wavelength laser (1550 nm and 1927 nm) for facial skin and tissue regeneration. They combine the action of the laser with stem cells contained in the stromal vascular fraction, as well as with synthetic or autologous products.

• METHODS

The authors present their working method using the dual-wavelength laser, adapting and diversifying its application according to the clinical indications and the different modalities of use of the technology.

• RESULTS

The authors present their results according of the new indications and the traditional indications for the use of these two wavelengths in binary use also in combination with the use of autologous exosomes and adipose tissue prepared with various methods.

• CONCLUSIONS

The authors present their conclusions, outlining the quality and quantity of the results achieved with the binary laser technology, also in combination with the use of various autologous substances.

124. Regeneration in Pluritreated Noses

• A. Trivisonno
• libera Professione Roma
• BACKGROUND-AIM

In secondary rhinoplasty, the entire nose can become a small fortress of fibrosis: a rigid dorsum, overcorrections, depressions, retractions, thickened skin, and often a compromised vascular supply. When scar forces dominate, they distort every attempt at cartilaginous reconstruction. Before correcting the form, it is therefore necessary to prepare the ground: reduce retractile memory, soften the planes, and restore tissue vitality. A preliminary regenerative phase allows the structural framework, in the second stage, to finally prevail over the scar.

• METHODS

Twenty consecutive patients undergoing secondary rhinoplasty were treated with a two-stage approach. First stage—Global regeneration.

Infiltration of the nose with a mixture of:

• Microfat (1–1.2 mm)
• Millimicrogel (0.5–0.8 mm) Biological objectives:
• reduction of diffuse fibrosis (dorsum, supratip, sidewalls, tip)
• improvement of vascularity and angiogenesis
• restoration of tissue glide across surgical planes
• enhancement of cutaneous trophism and reduction of thickening
• attenuation of scar-contractile forces that distort form and projection Second stage—Structural reconstruction

After 3 months, once tissue quality had improved, the second stage was performed:

• reconstruction of the dorsum (onlay graft, spreader graft, dorsal extension)
• restoration of lateral support (lateral crural strut, alar batten)
• tip reshaping (septal extension, columellar strut)
• correction of residual depressions and asymmetries

The skin, now more mobile and less retractile, allowed the cartilage grafts to settle and prevail without being deformed by previous scar forces.

• RESULTS

• Significant reduction of global nasal rigidity, with improved skin mobility and plane definition at 6–8 weeks.
• Improvement in perfusion and skin quality (thinner, more uniform, reduced chronic edema).
• During the second stage: greater precision in carving, reduced mechanical resistance during reshaping, and better graft adaptation.
• Stable aesthetic and functional outcomes in 17/20 cases, with no late distortions.
• Two cases showed mild loss of tip projection.

• CONCLUSIONS

Secondary rhinoplasty benefits markedly from a two-stage strategy.

The regenerative phase with microfat and milli-microgel restores a healthier biological environment: reducing fibrosis, improving vascularity, attenuating scar traction, and making the skin more compliant.

The structural second stage, performed on “re-programmed” tissues, allows cartilage grafts to dominate over the scar, ensuring more stable, harmonious, and predictable outcomes.

125. Scars: How to Make Them Less Visible as They Evolve

• A. Pacifici
• Clinica Laser Perugia
• BACKGROUND-AIM

Hi-tech scar therapy is constantly evolving and finds solid guidance in Matteo Tretti Clementoni’s algorithm, applied to a large number of cases and based on the specific clinical characteristics of each scar, such as thickness and degree of fibrosis, erythematous component, pigmentation, and level of tissue maturation. The application of this model clearly demonstrates how different technologies can and should be combined to simultaneously address different pathological factors. It also highlights the crucial importance of starting treatment as early as possible after the trauma to favorably modulate the repair processes. It confirms the importance of combining laser treatments with appropriate pharmacological protocols to enhance their effectiveness. Finally, it demonstrates that the most advanced technologies, such as Jet Volumetric Remodeling, are truly capable of stimulating internal regeneration of the scar, promoting progressive and more physiological tissue remodeling.

• METHODS

Patients with various types of scars eligible for high-tech therapies were treated. Depending on the severity and clinical characteristics of each case, a series of sessions spaced approximately one month apart was scheduled, with the option of repeating the procedure every few months to optimize results. Each patient was assessed through standardized pre- and post-treatment photographic examinations and through more selective and detailed scans, useful for more precisely documenting the morphological and chromatic evolution of the scars over the course of the treatment.

• RESULTS

In addition to the degree of patient satisfaction, mainly linked to the lack of use of needles and therefore also to less discomfort during the treatment, as well as less downtime, the satisfaction with the result was evaluated, not only subjective but also objective through adequate iconography, “pre” and “post” treatment, acquired both with digital photographic equipment and with an innovative “photographic system”.

• CONCLUSIONS

The use of these high-tech procedures, thanks to their intrinsic characteristics, appears to offer significant results in terms of both biostimulation and regeneration after a single session, with a marked improvement in tissue quality. Clinical efficacy, combined with rapid execution and the resulting improved patient compliance, is also associated with minimal downtime, making these technologies particularly advantageous for scar treatment.

126. The Effects of Combined RF and Hifes on Facial Soft Tissue Ptosis

• D. Bertossi
• Università degli Studi di Verona, Verona; Centro di Medicina, Villafranca di Verona (VR)
• BACKGROUND-AIM

Facial aging is a complex process involving changes in facial anatomy. Various skin components, underlying muscle, and fibromuscular fascia are involved. Facial aging is induced by skin quality and the condition of underlying muscles, which contribute to the overall appearance by lifting heavy facial structures.

This study aims to assess the safety and effectiveness of the novel radiofrequency (RF) and high-intensity facial muscle stimulation (HIFES) technology for treating soft tissue ptosis and wrinkles by facial tissue remodeling and to evaluate the effects of synchronized radiofrequency with high intensity facial stimulation technology on dermal collagen and elastin fibers.

• METHODS

This trial assessed the 6-month data of 35 subjects seeking facial soft tissue ptosis and wrinkles treatment. All subjects received four treatments, with a device utilizing RF and HIFES. The evaluation included a two-dimensional photographs assessment according to the Fitzpatrick Wrinkle and Elastosis Scale (FWES) and a three- dimensional (3D) photograph analysis for facial appearance with VAS evaluation scale. Pain andand subject satisfaction were assessed.

• RESULTS

Based on the data of 35 subjects, the significant improvement increased up to 5 months (2.7 points, p < 0.001) post-treatment. 3D photographs analysis documented visible soft tissue and structural rejuvenation and coincided with FWES evaluation, underlining the positive subjective appreciation of the results with 18.4% average wrinkle reduction at 2 months, further increasing to 46% wrinkle reduction at 5 months.

• CONCLUSIONS

Both subjective and objective evaluation tools, the RF and HIFES procedure for facial rejuvenation was found to be effective for treatment of soft tissue ptosis correction and wrinkles and skin texture improvement.

127. Hifu for Face and Neck Tightening

• S. Toschi
• Private Practice
• BACKGROUND-AIM
• INTRODUCTION

High Intense Focused Ultrasound (HIFU) represent a non-invasive technique for the multilayer treatment of the face and neck skin laxity). Ultrasounds are delivered by a piezo-ceramic transducer. When intensity of the energy reaches 65–70° the biological effect on the tissue is a thermal coagulation point (TCP) that is a controlled thermal damage (coagulative necrosis). Micro and macro TCPs can be generated in a precise target of the dermis without involving the surrounding tissue which remains untouched and represent a biological reserve to regenerate after the thermal damage.

• OBJECTIVES:

Following a HIFU session on the lower third of the face and neck, evaluate the safety of the method and the results obtained using the GAIS scale 12 weeks after treatment. Pain experienced by patients during HIFU treatment was assessed using the VAS scale in the immediate post-treatment.

• METHODS
• MATERIALS AND METHODS:

For this study, a cohort of 30 patients (mean age 51.4 years) with skin laxity of the lower third of the face and neck was recruited. The patients underwent a HIFU session using a 4 MHz ultrasound transducer at three different depths:

4.5 mm focal depth (energy 1.8 J, pulse duration 75 ms), 3 mm focal depth (energy 1.4 J, pulse duration 50 ms), 1.5 mm focal depth (energy 1.0 J, pulse duration 50 ms). No pre-treatment anesthetic cream was applied. The safety of the procedure was monitored throughout the study.

• RESULTS
• RESULTS:

The study showed significant improvements in reducing skin laxity due to tissue aging. After 12 weeks from the treatment, the average GAIS score is 2.2. 25% of patients reported an improvement in the result 8 weeks after treatment, compared to the already positive result obtained 4 weeks after the session. No patient recorded a GAIS score of 4 or 5 (respectively, no improvement and worsening). No patients reported severe pain or more during any phase of treatment. No side effects such as nerve damage and burns were detected, while a slight erythema for 24 h was detected in only one patient.

• CONCLUSIONS
• CONCLUSIONS:

Non-surgical rejuvenation treatment of the lower third of the face and neck with HIFU was well tolerated and showed improvement in all the treated patients.

128. The “All-In” Technique in Thread Lifts: An Innovative Approach for Greater Stability and Longer-Lasting Results

• G. Stelian
• dott.ssa Stelian
• BACKGROUND-AIM

Traction threads are a well-established tool in non-surgical facial rejuvenation, but conventional techniques may offer limited stability over time. The “all-in” technique aims to improve anchoring and traction quality by inserting the thread fully into the subcutaneous tissue along its entire length.

Objectives: To evaluate the effectiveness, stability of results, and safety of the “all-in” technique compared to traditional methods of traction thread placement.

• METHODS

Twenty patients (aged 37–68 years) were treated with PDO traction threads. The thread was inserted entirely into the subcutaneous plane following a defined anatomical vector, allowing for uniform distribution of the tensile force. The following were evaluated: degree of traction immediately and at 1, 3, and 6 months, stability of the result, incidence of complications, and patient satisfaction.

• RESULTS

The “all-in” technique showed a significant increase in traction stability already at 1 month, which was maintained at the 6-month follow-up. The complications observed were minimal and manageable (2%). Patient satisfaction was high (average 4/5). Compared to the standard technique, there was greater uniformity of lifting and better anchoring over time.

• CONCLUSIONS

The “all-in” technique represents an evolution of traction threads, offering a more stable and lasting result with a favorable safety profile. It can be considered an effective option for non-surgical facial rejuvenation in selected patients.

129. Temperature-Controlled Endo-Radiofrequency + HA Threads: A One-Step Procedure. Case Report

• P. Contini
• Roma
• BACKGROUND-AIM

Patients with grade 3 facial and neck ptosis, according to Baker classification, or patients with skin disorders (like acne scars or skin laxity) often need a combined approach to get better results. In these cases we usually suggest a previous treatment with thermo-regulated endo radiofrequency, two months before HA thread-lifting. Our idea was to try to perform both treatments in the same session, reducing patient’s stress, performing local anesthesia only one time, having the patient come to the office only once, putting together the benefits of thermo-lifting and thread-lifting.

• METHODS

@ThermaDAS is a new thermo-regulated monopolar endo RF wich allows endodermal treatment of face, neck and small part of the body, with a controlled temperature between 40 and 57 celsius degrees, providing skin retraction and collagen and elastin stimulation.

We use it normally two months before thread-lifting in Baker Grade 3 facial and neck ptosis or in patients with skin disorders like acne scars or subcutaneous fibrotic tissue, in order to improve tissue’s quality and thread lifting effect. In this case we started with endo RF and immediately after we performed thread lift of the neck, using @Excellence Visage Namica 19 cm.

• RESULTS

This combined treatment lasts 45 min (10 min for local anesthesia, 20 min for endo RF, 15 min for thread lift). Downtime was 48 h (a little bit more swelling if compared with only thread lift). The anchoring capacity of threads was similar to the two-step procedure (the treatment lines of the endo RF are perpendicular to the threads). Final result was similar to the two step treatment.

• CONCLUSIONS

Considering the similar final result, the short downtime, less stress for the patients, we think that this “one step procedure” could be a valid alternative in compliant patients.

Of course we need more data and a longer follow up to better standardize this treatment.