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Liposuction is the most common procedure in plastic surgery and becoming increasingly common in male patients. Recently, liposuction has evolved from a procedure whose goal was primarily fat extraction, to one that sculpts tissue with the goal of enhancing muscular definition. The popularity of high-definition liposuction has increased rapidly due to visibility on social media and has broadened the patient population presenting for liposuction, particularly among men. Herein, the authors review patient selection, surgical technique, and postoperative outcomes following high-definition liposuction in male patients.

Over the past decades, the understanding of the nuances of forehead anatomy and facial aging has grown immensely. Safe and reliable options for forehead rejuvenation followed. Although noninvasive techniques are an important adjunct in forehead rejuvenation, the mainstay of treatment of the eyebrow is operative intervention. The senior author's technique has developed over many years, first focusing on the open coronal and anterior hairline approach to the forehead lift, then the endoscopic brow lift, and most recently, the lateral subcutaneous temporal lift. This technique allows for reliable and safe elevation of the lateral brow with minimal complications.

In 2000, Matarasso et al. performed a survey of American Society of Plastic Surgeons members' face lift practice patterns. Since that publication, the aesthetic marketplace has changed dramatically, as have ancillary face lift techniques. In an attempt to detail these changes, we repeated that original survey, adding questions to address more recent technical issues and advances. The goal of this report was to define current face lift practice patterns, compare current patterns to the previous ones, and define recent advances.A 38-question survey assessing face lift techniques, perioperative management, complications, and concomitant procedures was electronically distributed to a random cohort of American Society of Plastic Surgeons members. Data were recorded and statistically analyzed utilizing the Pearson chi-square test.A total of 251 forms were returned and analyzed. Details of demographics, face lift techniques, ancillary procedures, perioperative care, and complications are presented. Current results were compared to the previously published society member practice patterns delineated in the 2000 Plastic and Reconstructive Surgery publication.The basic approach of American Society of Plastic Surgeons members to the face lift operation has not changed dramatically over the past 20 years. The development of operative adjuncts, however, has been positive, including fat grafting techniques, concomitant use of skin resurfacing, and means of minimizing blood loss with tranexamic acid. In certain instances, respondents do not follow evidence-based guidelines for perioperative care. Finally, common complications of practicing members appear to coincide with published retrospective reviews.

Although body contouring has long been considered a female-dominated market, growing popularity among men has led to shifting market focus. The increase in male body contouring surgery has been fueled by increased recognition of its safety and efficacy, decreased stigma via social media awareness, and increasing desire among men who seek to remain competitive in the workforce. The growth of bariatric surgery has only compounded such trends, with a growing population of men seeking excisional procedures following massive weight loss. The authors review key features of the modern male abdominoplasty, with respect to anatomy, patient selection, surgical technique, and postoperative outcomes.

SUMMARY The American Society of Plastic Surgeons, the American Academy of Otolaryngology-Head and Neck Surgery, and the American Academy of Facial Plastic and Reconstructive Surgery commissioned the multidisciplinary Rhinoplasty Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing both functional and aesthetic rhinoplasty. One outcome measure and three process measures were identified. The outcome looked at patient satisfaction with rhinoplasty procedures. The process measures look at motivations and expectations of the procedure, airway assessment, and nonnarcotic shared decision-making strategies for pain management. All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the American Academy of Otolaryngology-Head and Neck Surgery Foundation, the American Academy of Facial Plastic and Reconstructive Surgery, The Rhinoplasty Society, and the American Association of Oral and Maxillofacial Surgeons. The Work Group recommends the use of these measures for quality initiatives, Continuing Medical Education, Maintenance of Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.

Background Asymmetry of the hips and its implication in body contouring procedures has not yet been reported. Hip asymmetry is common in the general population and may account for uneven abdominoplasty scar and the apparent discrepancies in volume following liposuction of the hips and flanks. The goal of this study was to determine the presence of hip asymmetry in women presenting for abdominal contouring surgery. Methods Analysis of preoperative photographs of 100 female patients was performed by three independent plastic surgeons. They were asked to evaluate for hip asymmetry and, when present, determine which side was higher. Adobe Photoshop was also used to objectively measure hip asymmetry. Patients were women with no known history of hip abnormalities; age ranged from 17 to 64 years and the body mass index ranged from 16 to 47 kg/m(2). Results All three plastic surgeon reviewers found that the majority of patients had hip asymmetry, with raters 1, 2, and 3 documenting discrepancies in hip height in 88, 60, and 76 percent of patients, respectively. The interrater reliability was 0.713. Chi-square statistical analysis suggested that the raters were not statistically different from one another (p = 0.086). The objective analysis found asymmetry in 82 percent of patients. Conclusions The results showed that the majority of patients who present for abdominal contouring surgery have asymmetric hips. Patients are usually unaware of the unevenness of their own hips; however, they often notice postoperative discrepancies in scar height after abdominoplasty or volume differences after liposuction.

Background Facial rejuvenation continues to be an increasing trend among males. The periorbital region deserves special mention given the overall differences in aesthetics between sexes. Objective To examine the aesthetics of the upper eyelid, lower eyelid, lateral canthus, and brow with respect to male periorbital rejuvenation. Methods The upper eyelid, lower eyelid, lateral canthus, and brow are examined, highlighting aesthetic differences in males and females. Results The authors outline principles so as to maintain a masculine appearance when treating the male upper eyelid, lower eyelid, lateral canthus, and brow. Conclusion With guiding principles, the male upper lid, lower lid, brow, and lateral canthus can be managed to achieve optimal, consistent results.

The isolated necklift is less frequently a focus of scholarly attention. The neck is generally considered to span from the jawline to the clavicle. Signs of aging in the neck often begin to show in the late 30s as the medial platysmal retaining ligaments become attenuated and muscular banding occurs as a result. Other changes of aging include growing prominence of pre- and subplatysmal fat, increasing skin laxity and texture changes, and hypertrophy of the digastric muscles and submandibular glands (which may also become ptotic). As reviewed in this chapter, the aging neck can be dealt with very effectively independently from the face. The ability to uncouple neck rejuvenation from facial rejuvenation is fortunate, as the aging of these regions may not coincide or be of equal concern to a given patient.

Patients with prior umbilical stalk detachment, secondary to limited abdominoplasty or prior umbilical hernia repair, may in the future be candidates for full abdominoplasty. In these patients, a circumferential incision around the umbilicus detaches the remaining cutaneous blood supply, prompting concern for umbilical viability. Minimal literature exists to guide clinical decision-making for these patients. Inquiries were made to Louisiana Society of Plastic Surgery members and the Plastic Surgery Education Network online forum of the American Society of Plastic Surgeons. Metrics obtained included patient age, sex, nature of primary surgery, time between umbilical stalk detachment and secondary full abdominoplasty, complications, and whether rectus plication was performed at the time of secondary surgery. Eleven physicians provided complete documentation for 18 cases. All patients healed without evidence of umbilical ischemia or necrosis. Average patient age was 40.6 years. Average interval between procedures was 3.6 years. Sixty-seven percent of patients had the umbilicus delayed before the secondary procedure, with the median delay time being 18 days. Rectus fascia was plicated during secondary surgery in 72 percent of patients. This is the first reported series of patients undergoing full abdominoplasty after prior umbilical stalk detachment. It is also the first time the Plastic Surgery Education Network online forum has been used to collect research data, highlighting its potential as a valuable research tool. The data set was obtained from a wide range of practices, which allows for consideration of various technical solutions when this or other diverse clinical scenarios are encountered. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.

The use of tobacco-based products, most notably cigarettes, is related directly to wound healing problems and poorer outcomes in plastic surgery. Current abstracts have highlighted the potential complications from nicotine, specifically following plastic surgery in patients who choose to smoke. Recently, products that use electricity to vaporize liquid nitrogen have been gaining popularity. New rules were recently proposed that would give the federal government authority over electronic cigarettes. However, the health-related issues surrounding e-cigarettes are still largely unknown or misunderstood. These issues also extend to their impact on surgical procedures, notably their effect on plastic surgical procedures that rely heavily on the vascularity of either the host wound bed or the replacement tissue.

Minimally invasive procedures in an aesthetic practice have grown over the past decade. Plastic surgery practices are embracing the incorporation of injectables and lasers as adjuncts to their surgical procedures. The use of botulinum toxin, hyaluronic acid fillers, and lasers has made a significant impact on the authors' practice. The authors describe the important considerations, consultation goals, and procedural steps with injectables and fillers. The novel use of deoxycholic acid injections is also described. The authors strongly think that as options continue to expand, plastic surgeons will benefit from taking an active role in adopting these new innovations.

Background:. Lipoabdominoplasty has evolved over the last 6 decades through contributions from numerous luminaries in plastic and reconstructive surgery. Methods:. The authors review historical perspective and provide a contemporary examination of trends in lipoabdominoplasty. Results:. In 1967, Pitanguy popularized abdominoplasty (without liposuction) as a technique for augmenting ventral hernias repairs and subsequently for aesthetic improvement of the abdomen. After the introduction of suction assisted lipectomy by Illouz in 1983, abdominoplasty became a central tool in a diverse armamentarium of anterior and lateral abdominal wall contouring procedures. Liposuction was initially utilized with mini-abdominoplasty in order to improve contour. Subsequently, Matarasso advanced the safe combination of liposuction with full abdominoplasty. Additionally, he systematized the variety of cutaneous undermining, excision, and liposuction procedures utilized in abdominal contouring as indicated by the degree of skin laxity and musculofascial diastasis. Lockwood advocated high lateral tension closure of the superficial fascial system of the abdomen to improve the contour of the hips and flanks. Saldanha advanced selective undermining and anterior abdominal wall perforator preservation to minimize wound healing and seroma complications associated with lipoabdominoplasty procedures. Conclusion:. In abdominal contour surgery, surgeons can rely on classic techniques and algorithms that have withstood the test of time while modifying their approaches with advances backed by compelling and rigorously obtained evidence.

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UNLABELLED Statistics reflect that pregnancies are occurring at a later age, multiple births are becoming more common, and a sizeable population--with a keen interest in nutrition, fitness, and a continued desire to retain a youthful figure--is aging. Consequently, postpartum reshaping is a priority for many women, enough so that the phrase "mommy makeover" has entered the vernacular. In this article, the senior author's practice was evaluated to explore patient goals, methods, and outcomes in reshaping the postpartum abdomen. A literature review was conducted to assess the state of the art in methods to meet these goals. The postpartum patient often uses her prepregnancy appearance as a barometer for her postpregnancy goals. Although aging is one force motivating women to pursue abdominoplasty, the majority desires the correction of changes related to pregnancy. The abdomen and breasts are the regions most visibly affected by pregnancy, although numerous aesthetic units of the trunk and surrounding regions concern patients seeking postpartum body contouring and they may be part of the patient's perception and idealization of her appearance. Abdominoplasty is central to postpartum body contouring, and numerous strategies such as concurrent flap, flank, or mons pubis liposuction and waistline enhancement methods are integral components of it. Consideration should also be given to the multiple body areas affected by pregnancy that may enhance the patient's overall appearance. In the appropriate context, multiple procedures can be safely and effectively combined to address the various regions affected by postpartum changes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.

Abdominoplasty and breast surgery are frequently appealing to patients as combined procedures. The practice of combining abdominoplasty with other procedures originates from abdominoplasty performed in conjunction with intraabdominal or gynecologic surgery. Initially, the focus of combined surgery was on ensuring safety and minimizing local (e.g., wound healing) complications. As surgeons began combining abdominoplasty with distant procedures such as breast surgery, because the individual procedures have little adverse impact on one another and are not altered because of the combination, concerns with systemic morbidity surpassed the initial focus on avoiding local complications. Prevention of venous thromboembolism became a paramount concern. The authors perform abdominoplasty in conjunction with other procedures more frequently than in isolation, reflecting broader societal demand. Indeed, because of the effects of pregnancy and aging, abdominoplasty is being performed in conjunction with breast surgery with frequency sufficient to have driven the term "mommy makeover" into mainstream parlance. Consideration regarding length of surgery and the other recommendations in this report allows for the safe and successful execution of this common combination.

Face-lift is the most effective procedure to rejuvenate the aging face. There are numerous approaches and techniques. In this chapter, we present in detail the techniques and steps of the face/necklift approach developed by the senior author utilizing barbed sutures and fibrin tissue sealant. This technique is safe, reduces surgical time, obviates drain use, and provides a pleasing outcome.