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Sachin M Shridharani,1 Justin M Broyles,2 Alan Matarasso11The Department of Plastic Surgery, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA; 2The Department of Plastic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USAAbstract: Since its introduction by Illouz and others over 30 years ago, suction-assisted lipectomy/liposuction/lipoplasty has evolved tremendously and has developed into one of the most popular procedures in aesthetic plastic surgery. Liposuction is an effective procedure employed to treat localized adipose deposits in patients not suffering from generalized obesity. These accumulations of subcutaneous fat often occur in predictable distributions in both men and women. A cannula connected to a suction-generating source allows for small incisions to be strategically placed and large volumes of fat to be removed. This fat removal leads to improved harmonious balance of a patient's physique and improved body contour. Various surgical techniques are available and have evolved as technology has improved. Current technology for liposuction includes suction-assisted lipectomy, ultrasound-assisted, power-assisted, laser-assisted, and radiofrequency-assisted. The choice of technology and technique often depends on patient characteristics and surgeon preference. The objective of this review is to provide a thorough assessment of current technologies available to plastic surgeons performing liposuction.Keywords: laser, lipoplasty, mesotherapy, power-assisted, radiofrequency, ultrasound, water-assisted, coolsculpting

Cryolipolysis (CL) is a noninvasive technique in which applicators cool tissue to temperatures that selectively destroy adipocytes. Since its introduction to the market, it has rapidly become one of the leading nonsurgical modalities to reduce fat in the aesthetic industry. Paradoxical adipose hyperplasia (PAH) is a rare adverse reaction to CL, in which there is initial reduction in fat volume, followed by abnormal fat growth exceeding the original volume in the treated area. The incidence of PAH is thought to be underreported, and its pathophysiology and management remains unclear. The objective of this study was to present a series of PAH cases and review efficacy of management modalities. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Background: The geographic proclivities of plastic surgery trainees have important ramifications for the field of plastic surgery. Methods: Names of American Society of Plastic Surgeons (ASPS) members who were board-certified in 2000, 2005, 2010, 2015, and 2019 were compiled for a cross-sectional analysis of geographic trends. Results: A total of 811 practitioners were reviewed, and 31 lacked sufficient data for further analysis. Plastic surgeons with large metropolitan-based practices were more likely to have trained in large urban areas for residency and fellowship (odds ratio of 4.06; 95% CI, 2.94 to 5.60, and odds ratio of 3.61; 95% CI, 1.90 to 6.85, respectively). 52% of subspecialty fellows and 46% of residents went on to establish practices over 500 miles apart from their respective training locations. Approximately 20% of residents and fellows established practices within 20 miles of their respective training institutions, and there was no significant difference for average distance between fellowship and practice location or between residency and practice location when differentiating based on education background (p = 0.16 and p = 0.22, respectively). The year of ABPS certification and gender also had no significant effect on the average distance between training location and current practice (p > 0.05). Conclusions: Data showed some persistent geographic tendencies that inform future practice location. A small minority of trainees chose to establish practices in the immediate vicinity of training locations, and geographic trends were largely independent of subspecialty fellowship type, gender, and career length.

BACKGROUND AND OBJECTIVE Botulinum toxin treatment is gaining popularity among men for cosmetic purposes driven by workplace competition and a desire for confidence and youthfulness. Because of the unique features of male facial anatomy, careful consideration is necessary during assessment and treatment execution. METHODS The peer-reviewed literature on male facial anatomy in relation to neuromodulator treatment was analyzed with a particular emphasis on studies involving male subjects and the use of botulinum toxin type A. RESULTS Anatomic differences in muscle mass and contraction patterns between men and women help guide treatment. Men appear to require higher doses for effective treatment of facial wrinkles and, in the case of glabellar lines, often require double the standard dose for women. Treatment of the frontalis muscle in men, responsible for forehead creases, requires precise dosage and placement to avoid brow ptosis. The lateral canthal wrinkles are often the first area that men seek consultation for. Although FDA approval for lower face regions is lacking, off-label use can still be considered. CONCLUSION Successful botulinum toxin treatment in men necessitates understanding facial anatomy, customized treatment plans, and appropriate dosing. Further research is warranted to refine protocols and enhance outcomes for male patients. [ABSTRACT FROM AUTHOR]

Background:. Numerous techniques have been described to correct brow aesthetics in facial rejuvenation. We report the senior author’s (A.M.) current approach for eyebrow elevation utilizing a lateral subcutaneous brow lift and, when indicated, a medial subgaleal brow lift. Furthermore, a systematic review of the literature was performed comparing the different surgical approaches and techniques. Methods:. A systematic review of the literature was performed using the MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials databases. Studies were included if the content was original, provided outcome data, and complications. Results:. The senior author (A.M.) has performed over 500 lateral temporal subcutaneous brow lifts for lateral brow ptosis. The vast majority was highly satisfied with the outcome and there were minimal complications. This represents the largest series of patients utilizing this technique. Twenty-six articles were reviewed and 5 met our screening criteria and were analyzed critically for inclusion and further objective review. All of the studies were retrospective in nature and report high patient satisfaction with an acceptable risk profile. Conclusions:. In this study, we described the largest series of patients undergoing lateral subcutaneous brow lifts (n > 500), as well as a systematic review of the current literature. The current literature described an overall high degree of patient satisfaction with low complication rates, similar to the senior author’s (A.M.) experience. This technique has emerged as a reliable technique for lateral brow elevation with a very low and acceptable risk profile.

Background In 2001, Elkwood and Matarasso published an American Society of Plastic Surgeons (ASPS) member survey detailing brow lift practice patterns. Interval changes in practice patterns have not been studied. Objectives The previous survey was revised to elucidate current trends in brow lift surgery. Methods A 34-question descriptive survey was distributed to a random group of 2360 ASPS members. Results were compared to the 2001 survey. Results A total of 257 responses were collected (11% response rate; ± 6% margin of error at 95% CI). The most frequent technique for the correction of brow ptosis in both surveys was the endoscopic approach. The use of hardware fixation has increased in endoscopic brow lifting, whereas the use of cortical tunnels has decreased. Although coronal brow lifting has decreased in frequency, hairline and isolated temporal lift have increased. Neuromodulators have replaced resurfacing techniques as the most common nonsurgical adjunct. Frequent use of neuromodulators has risen from 11.2% to 88.5%. Nearly 30% of current surgeons feel that neuromodulators have replaced formal brow lifting procedures to a significant degree. Conclusions In comparing the 2001 and current ASPS member survey there has been a clear transition to less invasive procedures over time. Although the endoscopic approach was the most popular means of forehead correction in both surveys, coronal brow lifting has decreased in frequency and the hairline and temporal approaches have increased. Neurotoxins have replaced laser resurfacing and chemical peeling methods as an adjunct, and in some cases replaced the invasive procedure entirely. Possible explanations for these findings will be discussed. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

The Lymphocyte-Activation Protein 3 (LAG-3) inhibitory receptor is expressed on regulatory plasma cells (PCs). Micro-environmental cells that express LAG-3 were found to be increased during the progression of smoldering multiple myeloma (SMM). To assess the possible role of LAG-3 expression on regulatory PCs in patients with plasma cell dyscrasia. Purified Cluster of Differentiation 138 (CD138+) PCs from patients with premalignant conditions, active multiple myeloma (MM), and controls were analyzed for the expression of LAG-3 by flow cytometry. Autologous CD8+T cells were incubated with sorted LAG-3pos or LAG-3neg PCs for 24 h. The expression of granzyme (Grz) in CD8+T cells was assessed by flow cytometry. LAG-3 expression on PCs in active MM (newly diagnosed and relapse refractory MM) was significantly increased compared to monoclonal gammopathy of undetermined significance (MGUS)/ SMM. Grz expression was significantly decreased in CD8+T cells incubated with CD138+LAG-3pos PCs, compared to CD138+LAG-3neg PCs in patients with plasma cell dyscrasia, n = 31, p = 0.0041. LAG-3 expression on malignant PCs can be involved in the development of MM from MGUS by decreasing the expression of Grz in CD8+T cells. [ABSTRACT FROM AUTHOR]