Report on the 12th National Congress AICPE (Associazione Italiana di Chirurgia Plastica Estetica) Held in Rimini, Italy, 6–8 June 2025

Abstract

The annual congress of the Italian Association of Plastic Aesthetic Surgery (AICPE) is one of the most relevant conference meetings in Europe concerning aesthetic plastic surgery as there are a number of participants, over 400, and an international team of invited speakers chosen for their renowned scientific value. The 12th meeting was held in Rimini (Italy) from 6 to 8 June 2025. The scientific issues concerned new advancements in aesthetic surgery. This book of abstracts contains research related to facial surgery, body contouring, breast surgery, and rhinoplasty, also including aesthetic medicine, AI’s impact on the medical profession, and forensic medicine. For the first time, the AICPE established an award in memory of Flavio Saccomanno for the best paper presented by a young surgeon with the endorsement of Surgical Techniques Development by MDPI.

1. I Lifting Elastici Laterali del Volto e del Collo Lateral Elastic Face and Neck Lifts

• S. Capurro ¹

¹ 

Plastic Surgery San Martino Genoa

1.1. Background-Aim

Minimally invasive surgical techniques are presented for face and neck lifts of the upper and lower thirds. For the upper third, the elastic temporal and eyebrow lift and elastic canthopexy are used; for the lower third, the elastic marionette line lift and elastic neck lifts are used. In these procedures, as in the vertical elastic MACS lift, no skin dissection is performed, and the scars are barely visible or not present. All the facelifts mentioned are outpatient and under local anaesthesia.

1.2. Methods

The techniques shown in the video communication were made possible by the invention of the atraumatic double-tipped surgical needle and the elastic thread that does not cut the tissues and turns into a “ligament”. Creating geometric figures, trapeziums, and isosceles triangles in the subcutaneous tissues allows for the traction and lifting of unwanted ptotic volumes without dissecting the tissues. In the neck, the implantation of three elastic sutures enables the elimination of vertical folds while creating a defined cervical-mandibular angle. The traction of the skin and platysma under the mandibular angle corrects the small folds of the neck, including those that derive from the volumetric asymmetry of the cheeks. The accesses are simple skin holes that do not leave a scar or an 8 mm incision behind one or both earlobes.

1.3. Results

The results are perfectly natural and permanent over time and create a true rejuvenation of the patients. The technique allows, if necessary, to maintain the results over time with the simple implantation of a new elastic thread. The persistence of the results demonstrates that the dissections are not required.

1.4. Conclusions

After these innovative facelifts, patients can immediately return home without any dressing. No trophic problems follow the large dissection of traditional facelifts, nor the resulting skin ageing. There are no bruises or hematomas. All ptotic tissues of the face and neck can be tractioned and lifted, creating aesthetic changes without artifacts. The different interventions can be performed sequentially based on the patient’s wishes and the rationality of the corrections.

2. Orbicularis Oculi Selective-Denervation (OOSD): A Secondary Long-Term Effect for Crow’s Feet Reduction Following Temporal Subcutaneous Brow Lift with Orbicularis Repositioning

• M. Gratteri ¹, M. Pascali ², L. Savani ¹, P. Persichetti ¹

¹ 

Dipartimento di Chirurgia Plastica, Ricostruttiva ed Estetica della Fondazione Policlinico Universitario Campus Bio-Medico di Roma

² 

Plastic Surgery Academy

2.1. Background-Aim

In the last decades various authors have experimented and described more invasive techniques for manipulation of the orbicularis muscle to surgically reduce crow’s feet. Nevertheless, scientific literature still has too few articles reporting experience with these surgeries leading to the inability to determine which is the most effective technique. The aim of the study was to report surgeons’ experience based on 462 cases of orbicularis oculi selective-denervation with crow’s feet correction following temporal subcutaneous brow lift with orbicularis repositioning and Temporal MORE. Furthermore, an overview of the anatomical evidences on the orbicularis oculi muscle was illustrated.

2.2. Methods

194 consecutive patients underwent temporal subcutaneous brow lift with orbicularis repositioning or Temporal MORE were included in this study. Follow-up was of 2 years. An evaluation of the pre- and post-operative photos was performed by a jury composed of 3 independent plastic surgeons basing on the Merz five-point dynamic Crow’s Feet Grading Scale. Statistical analysis was conducted with Prism9.

2.3. Results

Of the 194 analyzed cases, the 182 (93.81%) patients who had an initial score greater than or equal to 2 had a score at the first postoperative time (T3) of 0 or 1 showed a statistically significant reduction in score between T0 and T3. No statistically significant difference between T3 and T12 and between T12 and T24.

2.4. Conclusions

Temporal subcutaneous lift with orbicularis reposition and Temporal MORE allow crow’s feet relaxation providing long- term results maybe due to OOSD (Orbicularis oculi selective-denervation).

3. Use of Custom-Made Peek Prostheses for the Restoration of Facial Harmony

• A. Mentone ¹, A. Santorelli ², E. Esposito ³

¹ 

Chirurgo Maxillo Facciale, Napoli

² 

Chirurgo plastico, Napoli

³ 

Specializzanda in chirurgia plastica, Napoli

3.1. Background-Aim

Facial asymmetry is a common condition in the population caused by underdevelopment of the maxilla, trauma, congenital causes, or acquired deformities. This condition leads to issues that are not only functional but also aesthetic in nature. The treatment of facial asymmetry depends on the patient’s age, the etiology of the condition, and the degree of facial disharmony. The aim of our study is to demonstrate the effectiveness of facial prostheses PEEK custom-Made in the treatment of facial asymmetries.

3.2. Methods

The patients had localized facial asymmetries in both the upper maxillary region, the orbitozygomatic region, and the mandibular region. None of the patients wished to undergo invasive orthognathic surgery. Therefore, they opted for facial symmetry surgery using PEEK prostheses. The custom-made PEEK prostheses were designed based on the CT scans of the 3D facial structure. The implantation was performed through intraoral surgical access to avoid external scars, and the prostheses were subsequently fixed to the bone with titanium screws.

3.3. Results

A total of 10 patients underwent facial implantation in Peek in conjunction or not with other surgical interventions such as rhinoseptoplasty, mentoplasty and Lipofilling. 2 patients underwent bilateral mandibular zygomatic prosthesis implantation; 2 patients bilateral zygomatic prosthesis implantation; 3 patients had chin prosthesis implantation and 3 patients mono and bilateral mandibular prosthesis implantation. The average duration of the surgery was about 4 and a half hours under general anaesthesia. 80% of patients developed post-operative facial oedema and ecchymosis of the periorbital region. No patient has developed infections and/or intolerance to the materials used. Only one patient developed oropharyngeal candidiasis one week after the surgery, which was resolved with drug therapy.

3.4. Conclusions

Facial prosthesis surgery is a valid option for the treatment of facial asymmetries and the restoration of facial harmony. It offers reduced surgical times and a much faster postoperative recovery compared to other types of surgery, as well as a lasting and stable result over time.

4. Preservation Otoplasty

• A. Mentone ¹, A. Santorelli ², E. Esposito ³

¹ 

Chirurgo Maxillo Facciale, Napoli

² 

Chirurgo Plastico, Napoli

³ 

Specializzanda in chirurgia Plastica, Napoli

4.1. Background-Aim

Otoplasty is the technique for the correction of congenital and acquired deformities of prominent ears. Various strategies are available today for correcting such anomalies, many of which involve the resection of excess cartilage and its remodeling. The limitations of these techniques include the risk of permanent deformity of the ear flap, abnormal shell protrusions, and unsatisfactory results. The aim of this study is to propose a new preservation otoplasty technique for the correction of the prominent ears.

4.2. Methods

A total of 92 patients underwent corrective ear surgery from July 2023 to December 2024 for protruding ears with Preservation Otoplasty. Each operation was performed under local anesthesia only, without sedation. Preservation Otoplasty allows the correction of ear deformities without the removal or weakening of auricular cartilage and can be performed in conjunction with other ear correction techniques, such as loboplasty. A satisfaction questionnaire regarding the surgical outcome was administered to the patients at the postoperative follow-up, 6 months after the procedure, with a rating scale from 1 to 5.

4.3. Results

The surgery duration was approximately 40 min for bilateral correction. 65% of the patients were male, while 35% were female. The average age was approximately 32 years, with the youngest being 8 years old. 96% of patients did not develop postoperative complications. 4 patient developed keloids at the incision site. 30% developed a retroauricular hematoma, which resolved within a few weeks. 10% experienced mild wound dehiscence. Only 5 patients required re-operation. 93% of patients were very satisfied, 4% were moderately satisfied, and 3% were not very satisfied.

4.4. Conclusions

Preservation otoplasty for prominent ear correction is a reproducible and safe procedure with a short surgical time. This technique restores symmetry to protruding ears, prevents permanent deformities associated with cartilage removal, and provides optimal long-term results. It is associated with a low complication rate, excellent patient satisfaction, and reduced recovery times compared to other techniques.

5. Evolution of the Endoscopic Face Lifting

• R. Garofalo ¹

¹ 

Istituto di Chirurgia Pamphili—Roma

5.1. Background-Aim

The Endoscopic technique today offers many new opportunies to rejuvenate the face with a minimally invasive and long lasting system.

The treatment today extends from the forehad to the middle third up to the upper region of the lower third of the face.

5.2. Methods

The use of fixation systems effective (isse endo suture), the use of fibrine glue, of lipofilling and the botox in the post operative period, have extended the duration of the results of this surgery.

In recent years, the use of endoscopy to detach the tissues and the creation of two reduced incisions in the temporal and retroauricular region, have allowed the creation of sectorial smas and plications wich have broadened the indications of this tecnique.

Furthermore opportunity, through endoscopy, to lift the external corner canthal ligament without making incisions around the eye is a further advantage.

Finally, the presence of endo sutures allows the tissue to be lifted even after years without the need to detach the tissues again.

5.3. Results

The Authors present 145 patient trated with endoscopyc face lift. The patients were 105 women and 35 men. The age of the patients was between 35 and 64 years. Among these patients, 35 were smoker and 10 diabetics. There were two complications: a patient had stupor of the suborbital nerve, which resolved in 40 days; another patient had an adhesion in the temporal region, which resolved after two months.

5.4. Conclusions

The treated patients had more rapid recovery of the traditional facelift and fewer complications.

The quality of the skin tissue was maintained over time and the duration of the results remained stable on average five years following surgery.

6. My Research for Less Invasive Surgery in the Rejuvenation of Mid and Lower Thirds of the Face

• E. Riggio ¹

¹ 

Fondazione IRCCS Istituto Nazionale dei Tumori, Milano—Private practice in Milano, Palermo

6.1. Background-Aim

Mid and lower facial defects lend to different surgical solutions.

6.2. Methods

Patients asking for aesthetic improvement from lower eyelid-orbit to jawline and neck ranges from an age of 35 to over 70 years, female mostly.

6.3. Results

Patients were undergone according to different expectations to orbitozygomatic minilifting combined to lower blepharoplasty, elasticic malar suspension, middle-face macs lif with elastic threds. and full face lifting, reinforced by elastic threads. Distinct cases are reported to illustrate the synergic effect of more simultaneous procedures.

6.4. Conclusions

It is difficult to standardize an approach on the middle-lower face region and a personalized plan must be discussed with patients and their expectations. The conventional minilifting supported by elastic threads can represent a valid option by reducing the extension of facial dissections and the related complications.

7. The Role of Fat Grafting in Full Face Deep Plane Lifting

• A. Antonio ¹

¹ 

Private Clinic

7.1. Background-Aim

Facial aging must be considered as a multifactorial process. Two are mainly the districts affected by the aging processes: the subcutaneous volumes and the skin tissue.

In the aging process, on the one hand, the subcutaneous fat is reduced in quantity and changes location, sliding downwards according to different vectors depending on the districts, on the other hand, the skin undergoes a ptosis caused by both the loss of elasticity and the dislocation of the underlying tissues. For this reason, it is necessary to approach the problem by addressing both aspects to obtain a result that is as long-lasting and natural as possible.

In my experience, therefore, the combination of the deep plane face lift and the fat graft is a winning strategy.

7.2. Methods

Nanofat grafting was performed in 10 deep plane face lift to correct dark lower eyelids, nasolabial folds and jawline. Other 10 cases of deep plane face lift was performed without fat grafting.

7.3. Results

the face lift allows a repositioning of the SMAS compartment and therefore of the adipose structure contained in it and of the excess skin, on the other, the fat graft restores the volumetric losses caused by the physiological adipose atrophy of the face. Given the length of the operating times for the face lift phase, it follows the need to reduce the operating times of the fat graft through an easy-to-use device that allows for complete sterility. Furthermore, it is very important that the fat to be implanted is as pure as possible and with a high content of stem cells.

7.4. Conclusions

the combination of the deep plane face lift and the fat graft is a winning strategy.

8. Facial Lifting Personal Approach

• C. Bernardi ¹

¹ 

Saba Medica Plastic Surgery, Rome—Italy

8.1. Background-Aim

Introduction—Cervico-facial lifting is the main surgical treatment for facial rejuvenation in the presence of severe skin and tissue laxity. It is now an established scientific fact that to obtain a valid and stable correction of time it is necessary to act on the deep tissues, the Musculo-Aponeurotic System (SMAS), together with the removal of excess skin. Standardized SMAS treatments include both the creation of flaps with suspension and repositioning of them, and the plication system. The decisional choice that the Author makes with respect to the two treatments described above is based on clinical experience, or rather on the clinic observation that the less the tissues are relaxed, as happens more frequently in young patients, the more it is necessary to perform a significant tissue mobilization using the SMAS traction flap technique. In patients with more marked tissue flaccidity, however, the SMAS plication is very effective.

8.2. Methods

Materials and methods—The pre-tragal incisions are performed in women following the contour of the auricle, while in men on the hairless area, parallel to the beard attachment line; in the temporal area, particular attention is given to the sideburn line, always considering the potential rising that it could have following traction: if a significant lifting is not expected, the internal approach in the scalp is chosen, otherwise the anterior line is preferred for incision. Once the skin detachment has been performed, depending on the extent of excess skin to remove, the indication for the preparation of the SMAS flap or for the plication technique is assessed. The latter, largely preferred by the Author, is performed initially with 3–4 key suspension stiches with a 3:0 non-absorbable braided thread and then an overlock suture with a 4:0 slowly absorbable monofilament thread. The traction lines are established, according to vertical and/or oblique traction vectors, also taking into account the desired effects of the sutures, such as increased projection of the zygomatic region, but also reducing the risk of undesirable ones such as palpability and visibility. In the presence of marked platysmal bands, we prefer the submental approach with section of the bands at level of the cervical angle level and median corset suture. If fat is present, liposuction is also performed. In case of significant tissue relaxation in men, skin incisions and “Z-plasty” of the cervical angle could be considered.

8.3. Results

The Author illustrates some clinical cases of his experience underlining technical notes and elements of clinical evaluation of the results. All patients operated are followed after 1, 3, 6 and 12 months.

8.4. Conclusions

Discussion and Conclusion—In our clinical experience we absolutely confirm that the treatment of the SMAS is mandatory to obtain a stable and long-lasting result. In the facial region we have noticed that plications are more effective if they are performed close to the region to be lifted, such as those parallel to the nasolabial fold or the mandibular line. In the neck, however, median plication is very effective for corrections of median platysmal bandages, while laterally, flaps are preferable for more effective suspension and traction in the optimal definition of the cervico-facial angle.

9. Importance of Malar Augmentation in Facelift: Implants and Autologous Tissue

• G. Zabbia ¹, E. Cammarata ¹, A. Speciale ¹, M. Maltese ¹, A. Cordova ¹

¹ 

Unità Operativa Complessa di Chirurgia Plastica e Ricostruttiva Policlinico P. Giaccone, Palermo, Italy

9.1. Background-Aim

In recent years, the requests for facelift have continuously increased and the improvement of the malar region represents one of the fundamental pillars in treatment planning. Indeed, a prominent malar region is considered a sign of beauty and youth in Western countries. Many surgical procedures have been developed, involving the use of both implants and autologous tissues, all aimed at increasing malar projection and improving its shape. In this paper, we report our experience on malar volumetric augmentation.

9.2. Methods

The results obtained on a series of 47 patients undergoing malar augmentation by means of implants and/or autologous tissue, in association with traditional suspension techniques, from January 2018 to December 2023, were evaluated. Virtual planning techniques were preliminarily applied in case of prosthetic augmentation. Results were evaluated with an objective method by observing pre- and post-operative iconography. Postoperative complications and patient-reported satisfaction were recorded as well.

9.3. Results

Prosthetic implants allowed us to better predetermine the result, if carefully planned, and guaranteed a more lasting structural increase if compared to autologous techniques. However, they were associated with potential complications such as infection and exposure. Autologous procedures provided an increase of the volume of soft tissues with good results, but they were less predictable due to their association with many other variables such as age, facial anatomy, surgical technique and patient body’s response. Malar augmentation associated with facelift improve the aesthetic result of the mid face compared to the facelift alone and enhances the result of facelift itself. The combination of both autologous and prosthetic techniques provided the best results, with no major complications, a long-lasting result and a high patient-reported satisfaction.

9.4. Conclusions

Volumetric increase of the malar region is certainly an important aspect in facial rejuvenation. Facelift combined with malar augmentation give the best aesthetic result to patients. Understanding the mechanisms of bone and soft tissue aging guides us towards the choice of the most appropriate surgical technique to confer projection to the malar region.

10. HDS (High Definition Smas) Thread Lifting—Preliminary Results of a New Method for a Reliable Superficial Muscular Aponeurotic System Suspension for Face and Neck Rejuvenation

• L. Cravero ¹

¹ 

Private Practice, Torino

10.1. 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 (HDS-TL), implanting permanent threads from the temporal region in 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 is presented, along with both subjective and objective evaluation of its 2 years results.

10.2. Methods

40 patients were treated with permanent threads implantation for Superficial Muscular Aponeurotic System (SMAS) and platysma suspension. Images were taken before (t0), 52 (t1) and 104 weeks after (t2).

Objective evaluation was carried out by a blind observer using the Global Aesthetic Improvement Scale (iGAIS—investigator GAIS) whilst patients have been requested to report their degree of satisfaction too (sGAIS—subject GAIS) along the follow up period.

We used 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.

10.3. Results

32 of 40 patients completed the 1 year follow up whilst 22 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.

10.4. Conclusions

The reported results suggest that face and neck rejuvenation carried out by SMAS suspension with Infinite Threads^® remains stable for up to 24 months, with outcomes rated as satisfactory by both blind observer and patients themselves. The few recorded adverse events were mild or resolved spontaneously.

In conclusion the preliminary 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.

11. Facciale Neck Surgery: Treatment of the Cervicofacial Angle

• A. Paci ¹

¹ 

Studio Andrea PACI, ROMA

11.1. Background-Aim

The loss of the cervicofacial angle can result from various factors, including the natural aging of the muscular and cutaneous tissues, weight loss, excessive fat accumulation in the medial neck, and genetic predisposition. In cases where there is no obvious cutaneous laxity or muscle hypotonia, with or without platysmal bands, these factors should still be considered when there is a complete loss of the cervicofacial angle. This applies to adult patients who maintain good muscular and cutaneous tone with normal or moderate fat deposits.

In the reported case, the platysma is closed ventrally, and no platysmal bands are present. As a result, this excludes the need for surgical intervention to address them.

11.2. Methods

In our cases, treatment was performed through a submental access, followed by subcutaneous dissection and preparation of the platysma muscle up to the cricoid cartilage and laterally to the anterior margin of the sternocleidomastoid muscle. A portion of the platysma muscle was removed centrally, and a horizontal resection was made at the cervicofacial angle to define its contour. Prior to performing median sutures of the platysma, if indicated, the subplatysmal fat may be selectively thinned. In younger patients, treatment of the anterior digastric muscles is often unnecessary due to the good tone of these muscles. Liposculpture can be performed, if needed, after suturing the muscle and skin.

11.3. Results

In the reported cases, in which the cervico-facial angle had been recreated, the surgical procedure was concluded with the implant of a silicone chin prosthesis. This enhances the distinction between the supra- and subhyoid regions.

11.4. Conclusions

This technique not only restores the muscular plane while removing a portion of the platysma, but also ensures adequate coverage of the medium-deep structures of the neck. It contributes to a natural rounding of the neck and, most importantly, facilitates the definition and reconstruction of the cervicofacial angle.

12. Effectiveness of Facial Lifting Surgery in Combined Use with Nonabsorbable Suspension Thread

• A. Casadei ¹

¹ 

Libero Professionista Venezia-Mestre

12.1. Background-Aim

The effects of aging on skin, including thinning and loss of muscle tone, result in a flabby or drooping appearance of the face. The demands of an attractive appearance and smooth skin are wanted all around the world. There are a lot of factors which influence the choice of rejuvenation techniques, including anatomy of the facial skeleton, the severity of aging changes, social and economic status of the patient, and structure of the skin. Facelifting is a facial rejuvenation procedure in which by dissection of subcutaneous layers and different suturing techniques we are able to stretch the skin and make the patient look younger.

As any other cosmetic procedure, patient evaluation and selection are very important in the whole treatment plan. The surgeon should keep in mind that failing to plan is planning to fail.

This study aims to evaluate the reduction of surgical risk by reducing dissection, decreasing of recovery time, and achieving a more stable and long-lasting result.

12.2. Methods

This presentation gives the technique, current concepts, complications, and indications of facelift surgery associated with nonabsorbable suspension thread in order to measure the safety and performance of the procedure of face lift with SMAS plication in combination with implanted threads over a period ranging from 1 to 3 years (2021–2024). The dissection plane in this technique is supra-SMAS. After dissecting in the subcutaneous plane, SMAS layer is exposed. The mobile segment of SMAS layer is fixed to the posterior relatively immobile layer by mainly three sutures in a vertical direction. The excess of SMAS layer could be trimmed after suturing to prevent bulging. Then are positioned two or four threads each side to reinforce the tension of the cheek above all in patients with thick skin types.

12.3. Results

The results obtained recorded a shorter execution time than the deep plan. In addition, a reduction in convalescence time and side and adverse effects was observed, a maintenance of the result after three years in patients with thick skin.

12.4. Conclusions

The use of non-absorbable threads associated with facial surgery allows to achieve shorter dissection compared to traditional face surgery, easy to perform and not time spending, fewer side effects such as bruising and swelling, achieve a more stable result, and with the expectation of a long-lasting result.

13. Smas Facelift, with Lateral Smasectomia, Skin-Platysma Displacement (LSD) and Hemostatic NET

• C. Pellegrini ¹, E. Zainalzadeh ¹

¹ 

Libero Professionista

13.1. Background-Aim

Modern facelift techniques have benefited from the “repopularization” of the deep plane facelift and extended deep plane facelift (a technique that dates back to the 1990s). However, these methods involve greater invasiveness and increased risks, and the superiority of this technique has not been conclusively demonstrated. In fact, some significant scientific studies have shown that deep plane facelifts do not offer “superior results” in patients under 70. The lateral SMASectomy with a hemostatic net is a safe, versatile, and easily reproducible technique.

13.2. Methods

The authors describe the resection of a portion of the superficial musculoaponeurotic system (SMAS) at the junction of the mobile and fixed SMAS, which produces a powerful lift with aesthetic results similar to a traditional SMAS flap, but without the additional risks of nerve injury. The ability to alter the vector of motion of the underlying SMAS makes this technique adaptable to a variety of facial characteristics. In all procedures, the lateral skin-platysma displacement (LSD) technique (described by Mario Pelle Ceravolo) is used. This technique involves only a lateral approach to the neck, avoiding the submental incision. It not only transects the platysma completely, but also shifts the muscle’s anatomy, displacing it into a more lateral position, thus reducing the risk of paramedian band recurrence. The use of the hemostatic net, as described by André Auersvald, has drastically reduced the incidence of hematomas. The authors retrospectively reviewed the case records of 48 patients who underwent facelift procedures using this technique between January 2017 and January 2025. The procedures included a facelift incision, lateral SMASectomy, lateral skin- platysma displacement, and the use of a hemostatic net.

13.3. Results

The average age of the patients was 57.8 years, and the average follow-up duration was 18 months. Only one patient had a small hematoma that drained the following day, and three patients experienced temporary facial nerve injury, which resolved within two months.

13.4. Conclusions

The common goal of all facelift procedures is to achieve a safe, versatile outcome with few complications, a satisfactory result, and minimal downtime.

14. Technology in the Beautification of the Face Between Myth and Reality

• M. Sonnino ², A. Caggiati ¹, S. Tenna ³

¹ 

Specialista in chirurgia plastica circo massimo medical center Roma

² 

Specialista in chirurgia plastica Studio DAMA Roma

³ 

Tenna specialista in chirurgia plastica campus biomedico Roma

14.1. Background-Aim

The authors analyze, based on their specialized surgical training, the different anatomical areas of the face and the possible rejuvenation choices, keeping in mind what the results offered by major surgery would be. We are therefore looking for a valid alternative to the results of invasive surgery using methods supported by technological renewal now present on the market for many years and therefore with reliability and safety tested over time.

14.2. Methods

The techniques used by the Authors fall within the large sphere of minimally invasive surgical treatments (minimal surgical dissections) applicable to the zygomatic, genial, mandibular and neck regions.

14.3. Results

It is pointed out that good knowledge and experience is necessary to draw on the different techniques published over the years. This is to be able to cope with the different realities of skin sagging linked to various factors such as age, skin and the thickness of the adipose tissue. The methods used involve the use of Liposculpture, Lipofilling, particular semi-elastic traction threads different in relation to the anatomical region to be treated and skin tightening devices such as bipolar infissional radiofrequency) or needle radiofrequency. It is shown how the coupling of different technologies and surgical techniques, in relation to the different anatomical regions, can give comparable results, even over time, to those of Lifting with dissection of the aforementioned regions.

Particular attention is paid to the “hybrid” treatment of the facial region with scars comparable to the classic facelift but with no necking. Finally, the results relating to global facial treatments or sectoral treatments only on some regions are presented.

14.4. Conclusions

Skin tightening technologies like internal or needling radiofrequency are interesting tools for the plastic surgeon who want adopt less invasive procedures for face rejuvenation.

15. Evolution of Rhinoplasty Techniques over 40 Years: What Has Changed in My Practice

• R. D’Alessio ¹

¹ 

Roberto d’Alessio Chirurgia Plastica Private Practice, Napoli

15.1. Background-Aim

Over the past four decades, rhinoplasty techniques have undergone significant advancements, trasforming both aesthetic outcomes and surgical approaches. this evolution has been driven by innovations in surgical instruments, refined anatomical understanding, and a shift towards more individualized, minimally invasive procedures. The transition from traditional open techniques to more refined closed or endonasal methods has minimized scarring and shortened recovery times, while improving precision. Additionally, the integration of digital imaging, 3D modeling, and cartilage grafting techniques has allowed for more predictable results and enhanced patient satisfaction. This abstract highlights how these developments have reshaped my practice, focusing on both technical improvements and changes in patient expectations, leading to a more personalized and holistic approach to rhinoplasty.

15.2. Methods

This review examines the evolution of rhinoplasty techniques over the past 40 years, focusing on the key advancements that have shaped current practice. A retrospective analysis of surgical techniques was conducted by reviewing clinical records, surgical notes, and personal observations from a variety of cases spanning four decades. The changes in technique, from the early open procedures to the more recent closed and endonasal approaches, were analyzed in terms of their impact on aesthetic outcomes, recovery times, and patient satisfaction. Technological advancements, including the adoption of 3D imaging, digital planning, and new grafting materials, were explored through a review of relevant literature and case studies. Additionally, the role of patient-centered care, with an emphasis on individualized surgical planning, was considered in the context of modern rhinoplasty practices. Data were gathered from both personal experience and a comprehensive review of current literature to highlight the shifts in technique, tools, and patient expectations over the past four decades.

15.3. Results

Over the past 40 years, rhinoplasty has evolved significantly in terms of both technique and patient outcomes. The transition from open to closed and endonasal approaches has led to less invasive procedures with reduced scarring and faster recovery times. The introduction of 3D imaging and digital planning tools has enhanced preoperative precision, enabling more predictable and individualized surgical outcomes. Advances in grafting techniques, including the use of cartilage and synthetic materials, have allowed for more tailored reshaping of the nasal structures, improving both functional and aesthetic results. Patient satisfaction has increased due to these refinements, with a stronger focus on achieving natural-looking results that align with each patient’s unique facial anatomy.

15.4. Conclusions

The evolution of rhinoplasty techniques over the last four decades has fundamentally transformed the practice, emphasizing less invasive methods, greater precision, and a more personalized approach. Technological advancements and a deeper understanding of nasal anatomy have allowed surgeons to achieve more consistent and satisfactory outcomes. Moving forward, further integration of digital tools and continued refinement of surgical methods will likely continue to improve results, while keeping patient safety and satisfaction at the forefront.

16. The Young Surgeon’s Approach to Rhinoplasty: Where to Start?

• M. D’Alessio ¹, R. D’Alessio ³, S. Taglialatela ²

¹ 

Matteo d’Alessio private practice

² 

Plastikè STP

³ 

Roberto d’Alessio private practice, Napoli

16.1. Background-Aim

Rhinoplasty is one of the most complex aesthetic and functional surgeries, requiring precise techniques and a deep understanding of facial anatomy, respiratory physiology, and surgical methods. For a young surgeon, approaching rhinoplasty can seem like a challenge, but it is essential to build a solid theoretical and practical foundation in order to perform safe and effective procedures. This presentation will explore the initial steps for a young surgeon entering this specialty, starting with an in-depth understanding of the main rhinoplasty techniques, acquiring necessary skills through training and hands-on experience, and managing patient expectations, both aesthetic and functional. Critical points to consider during the learning phase will also be discussed, such as the importance of mentorship from experienced surgeons, the use of simulations and models, and ongoing updates on the latest technical and theoretical advancements. The goal is to provide a practical guide on how to successfully navigate the journey of specializing in rhinoplasty, optimizing outcomes, and reducing the risk of complications.

16.2. Methods

The presentation is based on a structured approach to guide the young surgeon in approaching rhinoplasty, combining theory, practice, and hands-on experience. The methods used include:

Literature Review: Analysis of the main scientific publications and guidelines on rhinoplasty, focusing on surgical techniques, common complications, and aesthetic and functional outcomes. This will provide a solid theoretical foundation to understand the challenges and opportunities in the field.

Practical Approach: Discussion of the main surgical techniques (closed vs. open approach), with examples of clinical cases and surgical video footage. Critical points to consider during the procedure and variations in techniques based on patient characteristics will be highlighted.

Simulations and Models: Presentation of the importance of using surgical simulations, anatomical models, and 3D software for pre-operative planning, allowing the young surgeon to improve skills without direct risk to the patient. Mentorship and Continuous Education: Discussion of the crucial role of experienced surgeons in the training of young specialists. The importance of supervision, feedback, and participation in continuing education courses to gain hands-on experience will be emphasized.

Patient Management: An in-depth look at how the young surgeon should approach patient evaluation, manage aesthetic and functional expectations, and communicate effectively during the pre- and post-operative process.

Complication Analysis: Study of the most common complications in rhinoplasty and strategies to minimize them. Suggestions will be included on how to handle unexpected situations and improve post-operative management to ensure rapid recovery and lasting results.

Feedback and Outcome Evaluation: Discussion on the importance of proper follow-up to monitor long-term results, focusing on both aesthetic and functional improvements, and critically analyzing performed procedures.

The ultimate goal is to provide a comprehensive overview of the necessary techniques and strategies to successfully approach rhinoplasty, minimizing the risk of errors and optimizing aesthetic and functional outcomes.

16.3. Results

The results of the presentation are based on the analysis of data and experiences gathered during the learning and practical journey of the young surgeon in rhinoplasty. Key results include:

Acquisition of Surgical Skills: Participants gained a solid understanding of the main surgical techniques used in rhinoplasty, focusing on both the closed and open approaches. Pre-operative simulations and the use of anatomical models allowed them to refine their technical skills in a safe and controlled environment.

Development of Planning Abilities: A significant improvement was observed in the ability to plan pre-operatively, thanks to the use of 3D software and simulations, which helped young surgeons visualize the necessary aesthetic and functional changes in advance.

Management of Patient Expectations: The young surgeons demonstrated increased awareness and competence in managing both aesthetic and functional patient expectations, improving communication and reducing the risk of post- operative dissatisfaction.

Reduction of Complications: A marked improvement in managing common complications was observed, thanks to practical training and mentorship from experienced surgeons. The ability to handle and resolve issues such as dorsal deformities or respiratory difficulties increased.

Improvement in Aesthetic and Functional Outcomes: The young surgeons achieved better aesthetic results, with patients satisfied both functionally and aesthetically. The precision in reshaping the nasal structure led to more harmonious and balanced results, reducing the need for corrective interventions.

Positive Feedback from Supervision and Mentoring: Surgeons who received direct, continuous feedback from expert mentors showed greater progress in enhancing their technical abilities and overall case management.

Patient Satisfaction and Follow-Up: Careful post-operative follow-up led to a reduction in post-operative complications and improved patient satisfaction. Aesthetic results were positively evaluated due to careful assessment and monitoring.

Overall, the proposed approach allowed young surgeons to build a solid foundation for tackling rhinoplasty competently and safely, reducing risks and improving overall outcomes.

16.4. Conclusions

The approach presented provides young surgeons with a structured pathway to mastering rhinoplasty, emphasizing the importance of theoretical knowledge, practical training, and mentorship. By focusing on key aspects such as surgical techniques, pre-operative planning, patient communication, and complication management, young surgeons can significantly enhance their competence in this complex procedure.

The integration of simulations, anatomical models, and continuous feedback from experienced mentors proved to be vital in improving technical skills and reducing the risk of complications. Additionally, a careful and thoughtful approach to managing patient expectations, both aesthetic and functional, contributes to higher levels of patient satisfaction and improved long-term outcomes.

In conclusion, a comprehensive and methodical approach to rhinoplasty, combining theory, hands-on practice, and mentorship, enables young surgeons to perform procedures safely and effectively, ultimately enhancing both aesthetic and functional results. Continuous education and feedback remain essential in the development of expertise in rhinoplasty.

17. Preservation Rhinoplasty Versus Structural Rhinoplasty: Indications for Each Technique

• M. Galati ¹

¹ 

Specialist in Plastic, Reconstructive and Aesthetic Surgery, Lecce-Milano

17.1. Background-Aim

The study presented aims to identify the cases of nasal deformities that are indicated for treatment with preservation rhinoplasty and the case that instead require structural technique.

17.2. Methods

Preservation rhinoplasty is a relatively recent approach that emphasizes the conservation of cartilaginous and ligamentous tissues during the surgical procedure of rhinoplasty.

17.3. Results

This approach provides natural and high-quality results, although it has precise and specific indications. While preservation rhinoplasty can achieve remarkable outcomes, it is primarily indicated in selected cases where the anatomical features of the nose allow for intervention without compromising its structure. In contrast to structural rhinoplasty, which involves the reconstruction and stabilization of nasal structures, preservation techniques focus more on maintaining the natural harmony of the nasal profile without resorting to aggressive resections. However, preservation rhinoplasty comes with a steeper learning curve, particularly when it comes to managing the nasal dorsum. In this context, a thorough assessment of the case is crucial to determine whether preservation or structural rhinoplasty should be used, depending on the patient’s unique characteristics and desired goals.

17.4. Conclusions

This study shows that preservation rhinoplasty is an ideal technique for some types of noses with particular characteristics and that it requires a long learning curve to perform it correctly. It also shows that it is not suitable for all types of noses, for some of which the structural technique is necessary.

18. Hybrid Rhinoplasty: Fusion of Structure and Preservation Approaches

• S. Tagliatela Scafati ¹, R. Russo ¹, M. D’Alessio ¹, V. Cosenza ¹

¹ 

Plastikè STP, Centro di chirurgia plastica e ricostruttiva, Giugliano in Campania (Napoli)

18.1. Background-Aim

Although rhinoplasty has ancient origins, its modern evolution has accelerated over the past century. Early techniques focused on tissue removal without a full understanding of nasal anatomy and long-term consequences. Over time, the emphasis shifted toward preserving supporting structures and maintaining the physiological function of the nose. The endonasal approach, despite its innovations, initially led to complications due to excessive tissue removal, while open rhinoplasty introduced new reconstructive possibilities. However, no single technique provides a universal solution. Hybrid rhinoplasty emerges from the need to integrate the most effective principles of both structural and preservation rhinoplasty, offering a balanced and personalized approach.

18.2. Methods

A retrospective analysis was conducted on the medical records of patients who underwent primary hybrid septorhinoplasty. Functional and aesthetic satisfaction was assessed using the Rhinoplasty Health Inventory and Nose Outcome Scale.

18.3. Results

The procedures performed showed a low revision rate and satisfactory aesthetic and functional outcomes.

18.4. Conclusions

The choice of surgical technique in rhinoplasty should be tailored to each patient. Integrating the principles of structural and preservation rhinoplasty allows for harmonious results while respecting nasal anatomy and function.

19. Double Lateral Ostetotomy in Deviated Crooked Nose

• S. Gentileschi ¹, A. Piccirillo ³, A.A. Caretto ²

¹ 

Direttore UO Chirurgia Plastica Fondazione Policlinico A.Gemelli IRCCS Università Cattolica del Sacro Cuore, Roma

² 

Fondazione Policlinico A.Gemelli IRCCS, Roma

³ 

Università Cattolica del Sacro Cuore, Roma

19.1. Background-Aim

To evaluate the efficacy and safety of double basal osteotomies in aesthetic rhinoplasty for the treatment of twisted deviated noses.

19.2. Methods

A retrospective analysis was conducted on 27 patients who underwent rhinoplasty with double basal osteotomies between 2022 and 2025. Inclusion criteria included evident nasal deviation, twisted nose, dorsal asymmetry, and a request for aesthetic-functional correction. The surgical technique involved bilateral double basal osteotomies combined with sagittal osteotomies. Postoperative follow-up lasted at least 12 months, with clinical and photographic assessment of nasal symmetry and aesthetic outcome scoring using a Likert scale.

19.3. Results

All patients demonstrated significant improvement in nasal axis alignment with satisfactory aesthetic outcomes. No major complications were reported, such as skeletal instability, palpable bony irregularities, or respiratory dysfunctions. Postoperative satisfaction levels were high, with a significant reduction in perceived nasal asymmetry.

19.4. Conclusions

Double basal osteotomies represent an effective and safe technique for correcting twisted deviated noses, allowing for better control of bone repositioning, reshaping, and symmetrical alignment of the ascending maxillary branches, while ensuring harmonious aesthetic results without complications. Their application can be considered a valuable option in cases of complex deviation, improving the predictability of correction and patient satisfaction.

20. Secondary Rhinoplasty: How to Treat the Stigma of the “Operated Look” and Convert IT into a Natural Result

• M. Moio ¹

¹ 

Private practice, Napoli

20.1. Background-Aim

Secondary rhinoplasty presents technical difficulties intrinsically linked to the unpredictability of anatomical conditions and the need to adapt surgical maneuvers to the situation and the patient’s requests. More and more often, requests for secondary surgery concern the need to normalize an unnatural and poorly functional result. We present a series of cases treated with personalized surgical techniques in order to recreate a natural and physiological nasal aesthetic.

20.2. Methods

Between December 2019 and December 2024, 73 cases of secondary rhinoplasty were treated with a specific request to “normalize” an excessively artifactual result. A combination of technical maneuvers was necessary to reconstruct a “normal” anatomy. All cases were corrected with the closed technique.

20.3. Results

The shape of the nose remained stable in all patients with an average follow-up of 18 months. Two cases required minor surgical correcions that were carried out under local anesthesia. No major complications were reported. In 6 cases, it was necessary to complement the result with an average number of two kenacort infiltrations at a distance of six months to help reduce post-operative cicatricial fibrosis.

20.4. Conclusions

Secondary rhinoplasty often represents a surgical challenge in which numerous skills are required to obtain a stable and satisfactory result. With the right approach and an adequate anatomical understanding, it is possible to bring a nose that has undergone multiple operations back to a condition of anatomical and functional “normality”.

21. Temporal More for Correction of Lower Eyelid Displacement After Cosmetic Blepharoplasty: A Prospective Study on 117 Patients

• M. Pascali ³, L. Savani ³, M. Gratteri ², C. Mirra ⁴, G. Marchese ¹, P. Persichetti ²

¹ 

Department of Oncological, Reconstructive Maxillo-Facial Surgery, “Sapienza University of Rome”, Rome, Italy

² 

Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University Hospital, Rome, Italy

³ 

Plastic Surgery Academy, Rome, Italy

⁴ 

Villa Bella Clinic, Salò, Italy

21.1. Background-Aim

Lower eyelid displacement is probably the most feared complication after lower blepharoplasty.

In order to properly plan revision surgery, it is crucial to understand in which lamella the problem lies, since different techniques may be used depending on it.

The authors report their experience using a particular temporal and midface lift approach, named Temporal MORE (Modified Orbicularis REpositioning) to correct lower eyelid displacement mainly due to a deficit of the anterior lamella with a lack of skin and orbicularis oculi muscle (OOM).

21.2. Methods

A prospective study was carried out on 117 patients operated between January 2021 and October 2023 for bilateral lower eyelid displacement after lower blepharoplasty.

Temporal MORE implies creation of an OOM/SMAS flap through a temporal approach, allowing superolateral repositioning of the infraorbital soft tissues and recruiting new skin and muscle in the lower lid. In all cases, canthoplasty or canthopexy and lower lid fat grafting were added.

Outcomes were assessed through a subjective (patients’ questionnaires) and objective evaluation (5 independent surgeons evaluating pre- and post-operative pictures).

Complications were recorded.

21.3. Results

Patients’ questionnaires showed high satisfaction with ocular symptoms improvement (decreasing from 74.91 to 9.03 out of 100) and cosmetic result (53.89/60).

Surgeons rated the postoperatives changes positively as well (51.98/60).

Strong correlation between patients’ and surgeons’ evaluation was found (r = 0.85).

As far as complications are concerned: 6 patients (5.13%) had prolonged mild chemosis. 3 patients (2.56%) developed hypertrophic temporal scar. 2 patients (1.71%) had transient frontal nerve palsy. 1 patient (0.85%) experienced temporal hematoma. 2 patients (1.71%) developed a slight asymmetry. 2 patients (1.71%) had relapse of lower eyelid displacement.

21.4. Conclusions

The combination of Temporal MORE, lateral canthal tightening and fat grafting has proven to be a highly effective procedure in the correction of lower eyelid displacement. The results of both subjective and objective evaluation, in addition to low complication and recurrence rate, suggest that this technique should be taken into consideration to correct eyelid displacement primarily caused by anterior lamella deficiency.

22. Rhinoplasty Complication

• A. Paci ¹

¹ 

Studio Andrea Paci, Roma

22.1. Background-Aim

Revising a rhinoplasty following previous nasal surgeries may present challenges and obscure underlying issues, potentially leading to suboptimal outcomes or complications. Here we outline the case of a tertiary rhinoplasty which resulted in a partial necrosis of the nasal tip and the successful treatment that followed.

22.2. Methods

Case of a female patient age 50: with a history of two open rhinoplasties. During the second, a septal graft was inserted in the left alar region. Following this, an extrusive process and infiltrations—likely related to cortisone—caused a left alar depression, together with other tip deformities. A complex tertiary rhinoplasty procedure was performed with the aim of correcting the residual tip irregularities. On the third post-operative day, a skin necrosis was diagnosed on the same left lateral portion of the tip. Through appropriate medications and a subsequent surgical procedure, the complication was successfully managed and resolved.

22.3. Results

Serial treatments for the partial thickness necrosis facilitated healing by secondary intention; however, this approach ultimately resulted in an unsatisfactory aesthetic outcome. Among the available therapeutic options for achieving optimal aesthetic restoration, a full-thickness skin graft was selected. The successful engraftment of the graft and its subsequent healing significantly enhanced the aesthetic outcome.

22.4. Conclusions

There are several therapeutic options for addressing this nasal complication; however, in this case, the decision to proceed with a skin graft proved to be successful.

23. Our Experience of Ectropion Treatment with Spacer Graft in Patients with Facial Palsy

• M. Sulamanidze ¹, M. Tsivtsivadze ³, K. Sulamanidze ²

¹ 

Clinic Total Charm Georgia, Department of Plastic and Aesthetic Surgery

² 

Clinic Total Charm Georgia, Unit of Aesthetic Plastic Surgery

³ 

Clinic Total Charm Georgia, Unit of Aesthetic Plastic Surgey

23.1. Background-Aim

In some diseases of the periorbital region, there are manifestations of retraction of the edge of the lower eyelid, its separation from the eyeball, hypotension, lagophthalmos and ectropion. Such deformities are most often treated by patients who have undergone paresis or paralysis of the facial nerve, trauma, or unsuccessful lower blepharoplasty. In this case, operations such as reconstruction, canthopexy and canthoplasty, shortening of the length of the lower eyelid margin, cartilage, or tendon transplantation, as well as lifting the margin of the eyelid with plastic spacers or spacers from autologous tissues are usually used.

Operations on the lateral canthus and with transplanted tendons are not always predictable, the existing plastic and cartilage structures are often bulky and do not give good aesthetic results, so we set the task to develop such an intervention that could be more delicate and effective.

23.2. Methods

We have developed bridge-like spacers which is made from polypropylene suture.

This spacer is used for the lower eyelids of various designs, which allow performing lateral and medial canthopexy, strengthening of the lower eyelid margin, lifting and support of the lower eyelid margin throughout.

23.3. Results

Bridge-like spacers are used for such pathologies of the lower eyelids as ectropion, sunken eyelids, their retraction, “round eye” syndrome… The proposed methods for using spacers are quite effective: the edge of the lower eyelid is strengthened, cranially lifted to the required level, its sagging and scleral clearance.

23.4. Conclusions

16 years of experience with the use of bridge thread spacers has shown that this technique is quite effective in obtaining good aesthetic and therapeutic results. In some cases, it may well replace the classical methods.

24. Breast Augmentation in Breast Asimmetries: How to Manage IT?

• M. Siliprandi ¹

¹ 

Humanitas Research Hospital

24.1. Background-Aim

Surgical planning and the choice of the right breast implants are determinant points in breast augmentation surgery. These aspects become even more critical when breast asymmetries are present. The Author proposes an algorithm for successfully planning and performing breast augmentation in breast asymmetries.

24.2. Methods

The Author has categorized breast asymmetries in different groups basing on: chest wall asymmetries, muscular asymmetries (including Poland Syndrome), shape asymmetries (including tuberous breast deformity) and volume asymmetries.

Basing on his personal experience and a review of literature, the Author has developed a treatment algorithm for correctly planning breast augmentation surgery in each asymmetry category.

24.3. Results

Even if breast asymmetries are present, the surgeon should employ the same implant in each of the two breasts. Different implants may be considered in chest wall asymmetries. Muscular asymmetries and/or Poland Syndrome affect the choice of the pocket plane, but do not generally imply the choice of asymmetrical implants. When addressing tuberous breast, volume and shape breast asymmetries, the same implants should be employed, and asymmetries should be corrected by remodeling the glandular tissue, the NAC and the skin envelope. Monolateral breast augmentation should be avoided.

24.4. Conclusions

Breast augmentation in breast asymmetries is a challenging surgery. A careful evaluation of the asymmetry type and entity drives to a successful surgery. Asymmetrical implants and/or monoliteral breast augmentation should be considered in few selected cases.

25. The Relation Inframammary Fold-Nipple in Breast Augmentation Planning and Surgery According to My Zenith-System Approach

• E. Riggio ¹

¹ 

Fondazione IRCCS Istituto Nazionale dei Tumori, MIlano. Private practice in Milano and Palermo

25.1. Background-Aim

Every planning for breast augmentation (BA) should have some firm anatomical landmark to take into account in the design of the new breast. Inframammary fold (IMF) position, Nipple (N) level, footprint width or height, N-IMF distance are potential candidates. Many surgeons try to enlarge inferiorly the pocket to place the chosen implants but, on the contrary, we have to choose implants for proper height and projection that permit us not to lower the implant placement excessively. In some case iti is to evaluate a mastopexy in order to elevate the nipple rather than lower the implant.

25.2. Methods

Five hundred BAs, prospectively observed. A proper measurement method was created and named Zenith system. It ideally correlates the implant point of maximal projection (vertex-zenith) and N: device vertex 1–2.5 cm beneath N (zenith range, 12–23°) related to a N-IMF 7–7.5 cm long at maximal stretch; a N-Sternum/lower-pole lines distance of 4–5 cm; 3) IMF lowered minimally; vertex at +/−1 from N. The surgical approach foresees narrow pockets, preferably dual(vertical)-plane.

25.3. Results

IMF was planned to be changed from 0 to 2 cm at maximum, with a mean of 0.35 cm, even with the bigger implants. Most of IMF position remained the same of the preop (75%). Mean follow-up was 34.7 months (range 3–144). Major and Minor Complication Rate after surgery: 15%, for patient; for implant side. Bottoming-out (0.6%). 9% with revision rates of 6% but when limiting to pocket revision only 3% per patient and 1.8% for implant side. The degree of satisfaction was good to optimal in 91% sufficient in 4%, average to poor in 5% of cases. A 25% of women with ptosis avoided a pexy (mostly for grade-1) using implants with projection from moderate to extra and size ranging 220–665 cc. In 25% of all BA a mastopexy was performed to change the N position. Conclusions. In my sample, nearly the 75% of BA did not lower the IMF and where performed, this should be minimal. Bottoming-out was strictly related to a mild weakening and lowering of IMF structure. The steadiest landmark is the IMF while N level with N-IMF distance change following breast augmentation in order to respect anatomy and improve the outcome.

25.4. Conclusions

In my sample, nearly the 75% of BA did not lower the IMF and, where performed, this should be minimal. Bottoming- out was strictly related to a mild weakening and lowering of IMF structure. The steadiest landmark is the IMF while N level with N-IMF distance change following breast augmentation with or not mastopexy, in order to respect anatomy and improve the outcome.

26. Generation Smooth Implants: Dual-Plane vs. Prepectoral Approach

• P. Vittorini ¹

¹ 

Presidio ospedaliero Villa Letizia-L’Aquila

26.1. Background-Aim

The evolution of next-generation smooth implants has sparked a renewed interest in surgical planning and implant placement strategies, particularly in the choice between dual-plane and prepectoral positioning. The selection of the optimal anatomical plane significantly impacts aesthetic outcomes, implant stability, and long-term safety.

26.2. Methods

While the dual-plane technique has historically been favored for its ability to reduce capsular contracture and provide a natural upper pole transition, it is not without drawbacks, including dynamic deformity and animation effects due to muscular interference. Conversely, the prepectoral approach, facilitated by advancements in implant technology and bioengineered matrices, offers a more stable and physiologic interaction between the prosthesis and the soft tissues, eliminating muscle-related distortions but posing unique challenges in cases of thin soft-tissue coverage.

26.3. Results

This presentation will analyze:

• The safety profile of next-generation smooth implants in each anatomical plane.
• The indications and contraindications for dual-plane vs. prepectoral placement.
• The role of preoperative planning in selecting the most appropriate approach based on patient anatomy, skin envelope characteristics, and long-term implant behavior.
• Technical refinements to maximize implant integration, minimize complications, and achieve optimal aesthetic and functional results.

26.4. Conclusions

A critical review of clinical cases and long-term outcomes will be presented, providing a comprehensive guide to decision-making in modern breast augmentation surgery.

27. Breast Implant Selection: Is There a Perfect Prosthesis for Every Occasion?

• M.C. Servillo ¹

¹ 

Villa Stuart—Bac Aesthetic Center, Roma

27.1. Background-Aim

The choice of breast implants is a crucial factor in aesthetic breast surgery. There is no “universal” implant suitable for every procedure, but rather a range of options that must be evaluated based on the patient’s anatomical characteristics and surgical goals. This presentation explores the role of implant selection in different clinical scenarios, highlighting how a personalized approach can optimize both aesthetic and functional outcomes. The objective of this study is to analyze the clinical and anatomical variables influencing the selection of breast implants in major breast surgery procedures.

27.2. Methods

This study is based on a retrospective analysis of patients who underwent breast cosmetic surgery. Parameters such as preoperative thoracic and breast morphology, tissue quality, degree of ptosis, patient’s aesthetic goals, and the type of implant used were evaluated. Implant selection was carried out using a decision-making algorithm that considers the specific surgical needs of each case. Inferior pole expansion was assessed using pre- and postoperative 3D imaging (at 6, 12, and 24 months), measuring projection and volumetric distribution. Additionally, the complication rate (secondary ptosis, capsular contracture, need for revision surgery) and patient satisfaction levels were recorded.

27.3. Results

Data analysis revealed differences in inferior pole expansion and stability depending on the implant positioning technique and the type of implant used. Polyurethane implants, due to their high adhesion capacity to tissues, demonstrated greater long-term stability, reducing secondary ptosis. Nanotextured implants exhibited a superior ability to expand the inferior pole, particularly in cases where the triple-plane technique was used, showing stabilization at 12 months based on data obtained from 3D imaging software.

27.4. Conclusions

The choice of implant significantly influences inferior pole expansion and the long-term aesthetic outcome. The use of 3D imaging allowed for an objective assessment of changes, providing valuable data to optimize implant selection based on the patient’s individual characteristics. A personalized approach improves result predictability and enhances both the aesthetic outcome and the stability of the procedure.

28. Constricted Lower Pole Breast Correction with High-Cohesivity Silicone Gel Anatomical Implant

• E.M. Buccheri ¹

¹ 

UltraClinic, Via Clitunno 22E Roma

28.1. Background-Aim

Lower pole constricted breasts, part of the spectrum of tuberous breast deformities, significantly impact patients’ self-esteem and body image. To address the complexity and variety of clinical presentation of this type of deformity, a wide assortment of different surgical approaches has been proposed. The authors sought to determine the effectiveness of high-cohesivity silicone gel texturized anatomical implants in correcting lower pole constricted breast, emphasizing implant choice and the role of implant features on patient outcomes.

28.2. Methods

The study retrospectively analyzed data from 468 Caucasian female patients treated from March 2009 to July 2022 for type I and II tuberous breast deformities. Surgical correction involved the use of extensive radial and horizontal scoring to release lower pole strictures and high-cohesiveness microtextured anatomical implants placement in a subfascial pocket. Major and minor complications during the follow-up were recorded.

28.3. Results

Implant volume ranged from 260 cc to 495 cc with an average of 345 cc. We report minimal major complications (Baker grade III–IV capsular contracture 4.2%, implant rotation 1.4%) within a mean follow-up time of 60 months. Further implant-related complications including bottoming out, double-bubble deformity, and wrinkling were not observed.

28.4. Conclusions

The selected surgical approach for correcting lower pole constricted breasts using high-cohesivity silicone gel texturized anatomical implants proves to be effective, offering predictable and satisfying outcomes for patients. The surgical approach, combining anatomical implant characteristics with precise lower pole expansion techniques, yielded stable, esthetically pleasing results that positively impacted patients’ quality of life.

29. A Method to Define the Incision at the New Inframammary Fold in Primary Breast Augmentation Surgeries with Polyurethane-Coated Implants: The Push and Rotate (Par) Method

• M. Mendanha ¹, M. Barbera ²

¹ 

Academia de Cirurgia Plástica Mário Mendanha

² 

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

29.1. Background-Aim

Primary breast augmentation requires careful preoperative planning to achieve optimal aesthetic results while minimizing complications and reoperations. One critical aspect of this planning is the positioning of the inframammary fold (IMF) and the corresponding incision placement. Incorrect incision placement can lead to visible scarring, double-bubble deformity, bottoming-out, and other complications. While several methods for determining the IMF location exist, many do not fully account for the dynamic elasticity of the breast tissues and surrounding structures. This study introduces the “Push and Rotate” (PAR) method, a simplified maneuver that evaluates the elasticity of the IMF, lower pole skin, and recruitable abdominal skin to identify the most caudal and aesthetically favorable location for the incision. The primary aim is to assess the reliability of the PAR method in ensuring optimal scar positioning and reducing postoperative complications.

29.2. Methods

A prospective study was conducted on patients undergoing primary breast augmentation using polyurethane-coated implants between 2018 and 2024. Inclusion criteria encompassed women seeking primary augmentation through an inframammary incision, while exclusion criteria included prior breast surgeries or concurrent procedures. Preoperative markings included the midline, current IMF, and breast footprint. The PAR maneuver involved holding the upper breast pole with four fingers and the lower pole with the thumb, pushing the breast caudally and rotating it anteriorly to recruit abdominal skin. The flexion point indicated the lowest possible incision site. Implant selection (shape, size, and projection) was guided by the patient’s anatomy and preferences. All procedures used subglandular or dual-plane pockets based on tissue thickness. Scar quality was evaluated using the Vancouver Scar Scale (VSS), and photographic documentation was performed pre- and postoperatively. Follow-up assessments included ultrasound evaluations and complication monitoring.

29.3. Results

A total of 165 patients with a mean age of 41 years were included, with an average follow-up of 41 months. The PAR method successfully identified the optimal incision location in all cases, resulting in well-defined IMFs postoperatively. Scars were consistently positioned within the IMF in 98% of breasts, with minimal visibility and a mean VSS score of 0.18. No cases of bottoming-out, NAC malposition, or double-bubble deformities were recorded. Patients demonstrated satisfactory lower pole convexity and central NAC positioning. Upper pole concavities, present in 34% of cases preoperatively, were corrected, achieving patient-desired profiles. Only a minority (1%) exhibited minor scar displacement associated with dual-plane pockets, likely due to muscle dynamics. No surgical complications such as hematoma, infection, seroma, or capsular contracture were observed.

29.4. Conclusions

The PAR method provides a reliable, patient-specific approach for determining the lowest safe and aesthetically optimal incision site in primary breast augmentation. By dynamically assessing tissue elasticity, this technique enhances preoperative planning and reduces complications related to IMF misplacement. Its simplicity, reproducibility, and applicability across various implant types make it a valuable tool for surgeons aiming to optimize surgical outcomes and patient satisfaction. Further studies with larger cohorts and extended follow-up periods are recommended to validate these findings and explore long-term outcomes.

30. Management of the Inframammary Sulcus in the Tuberous Breast: Triple Plane Procedure

• G. Zabbia ¹, F. Toia ¹, E. Cammarata ¹, M. Franza ¹, G. Biondo ¹, A. Cordova ¹

¹ 

Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy

30.1. Background-Aim

Tuberous breast deformity is a congenital malformative condition that manifests during puberty and is characterized by a variable degree of hypotrophy of the lower mammary quadrants, a reduced mammary base, a displaced inframammary sulcus, the presence of a periglandular fibrous cervix, areolar herniation (“snoopy sign”) and areolar size disproportion with associated possible mammary asymmetry. Correction of this deformity represents a surgical challenge that requires the formulation and combination of different strategies depending on the severity of the clinical condition and the patient’s expectations. The main goal of tuberous breast deformity correction is to achieve a pleasant and harmonious cosmetic appearance with simultaneously providing a stable and long-lasting result and a high level of patient satisfaction. Progressive expansion of the lower pole and neutralization of the memory of the primitive inframammary sulcus are fundamental factors to achieving these objectives.

30.2. Methods

From January 2023 to April 2025, we retrospectively analyzed 35 patients who underwent correction of tuberous breast deformity at the University Hospital “Paolo Giaccone” of Palermo and in private clinics. The patients’ demographic and clinical characteristics, surgical techniques, outcomes and postoperative complications, and duration of follow-up were recorded and analyzed. A careful anatomical assessment was performed for each patient in order to accurately determine the degree and characteristics of the breast deformity. In order to evaluate the results of our surgical approach, radiologic study and clinical images were collected before surgery and at 12, 24, and 36 months after surgery.

30.3. Results

The mean age was 30.3 years (range 18–47). In 48% of cases, patients had a grade I deformity, 35% had a grade II deformity, and 10% had a grade III deformity. In each case a different degree of asymmetry was present. All patients underwent correction of the breast deformity by bilateral anatomical breast prosthesis implantation in dual plane pocket with creation of an extended adipo-muscular flap in order to provide better coverage of the lower pole of the implant, set-up of a reverse adipose-glandular flap from the upper pole of the breast and autologous adipose tissue grafts taken from the homo or contralateral breast. Implants of the same volume and with the same high projection were used in all cases. In 100% of patients, all the necessary procedures were performed at the same time with the goal of performing a definitive correction. Postoperative complications occurred in 8.57% of cases (n = 3): 2 cases of periprosthetic seroma and 1 case of fat necrosis. In 14% of cases (n = 5), additional corrections were performed for scar revision, secondary areola reduction, and revision of the primitive inframammary sulcus due to an unsatisfactory cosmetic result.

30.4. Conclusions

Our proposed corrective surgical approach aims to achieve progressive expansion of the lower pole of the breast and correction of the inframammary primitive sulcus memory to eliminate the frequent need of lower pole surgical revision. The combination of a high-projection anatomical implant, an extended adipo-muscular flap and fat grafts has proven to be particularly effective in improving outcomes giving optimal shape and symmetry to the breasts.

31. Polyurethane, This Stranger! How to Abandon Prejudices About These Implants and Turn Them into the Most Valuable Allies for Managing Some Specific Cases

• V. Badiali ¹

¹ 

IEI—Istituto Estetico Italiano

31.1. Background-Aim

Too often we hear that implants covered in polyurethane foam are difficult to manage, impossible to remove, and in some cases can create complications and blemishes unlike other implants.

How can we consider these no longer defects of the implant but rather features that, in selected cases, can work in our favor.

31.2. Methods

The characteristics of this implant are discussed in depth and specific clinical cases are discussed in an attempt to clarify how, with certain caution, this material can become an irreplaceable ally.

31.3. Results

An attempt will be made to convey to the attendees all the ‘tips and tricks’ needed to handle these implants.

31.4. Conclusions

Different cases require different approaches and sometimes materials with different characteristics. We believe it is essential that a breast plastic surgery surgeon knows how to master this type of implant.

32. Augmentation Mastopexy: A Challenging Procedure

• A. Bruno ¹

¹ 

Private Practice—Clinica Santa Maria di Leuca, Roma

32.1. Background-Aim

Augmentation mastopexy often poses a challenge for the plastic surgeon, who must simultaneously manage opposing forces: the centripetal force of the mastopexy and the centrifugal force of the implant.

32.2. Methods

The technique illustrated by the Author is based on the pre-operative evaluation of vertical excess of skin and subcutaneous tissue. This allows for reliable planning of the pre-operative drawing. The technique follows a tailor- tack approach and consists of multiple stages: implant placement using the dual-plane technique; confirmation/ modification of the pre-operative drawings; significant reduction of the lower pole; mastopexy with superior or superomedial pedicle; inverted T-scar pattern. In our opinion, performing the mastopexy incision (as per pre-operative evaluation) initially does not guarantee an optimal result, as it may lead to an imperfect match between content and container.

32.3. Results

From 2019 to 2024, 203 augmentation mastopexy procedures were performed (as standalone procedures or in combination with other body contouring surgeries). There were no major complications or issues such as the waterfall effect, double bubble, or bottoming out.

32.4. Conclusions

A key point in the technique is the “tailored” approach and significant reduction of the lower pole. This allows for combining the advantages of placing the implant in the dual-plane position (reduced visibility and greater long-term stability), while eliminating the risk of relative glandular ptosis.

The mastopexy with implants procedure has always been considered the most complex in aesthetic breast surgery, to the extent that some surgical schools propose performing it in two separate stages. However, the technique presented here is reliable and avoids phenomena such as recurrent ptosis or the waterfall effect, thanks to the significant reduction of the lower pole. This results in breast aging being primarily attributable to the implant itself.

33. Artificial Intelligence, Genuine Outcome: Analysis of 72 Consecutive Cases of Subfascial Augmentation Mastopexy with Smooth Round Implants Supported by P4hb Scaffold

• F. Sofo ¹, G. Bistoni ², B. Cagli ¹

¹ 

Department of Plastic, Reconstructive and Aesthetic Surgery, Fondation Campus Bio-Medico di Roma, Rome, Italy

² 

Hospital General de Valencia, Valencia Spain

33.1. Background-AIM

Ptosis recurrence often leads to unsatifactory results after mastopexy, even more so when additional stress is provided by implants on already compromised native tissue. Poly-4-Hydroxybutyrate (P4HB) scaffold (GalaFLEX) with its favorable safety profile and proved mechanical strength represents a reasonable choice to provide stabilization in such setting.

33.2. Methods

72 consecutive patients undergoing augmentation mastopexy with round smooth implants in a subfascial plane from March 2020 to December 2023 and a 1 year minimum follow up were included in the study. Arbrea Breast Software, an artificial intelligence-based 3D simulator was used measure the curvilinear distance between nipple to inframammary fold (lower pole arch) and breast volume. Lower pole stretch was determined as the percentage increase from 6 weeks to each post operative time. The ratio between lower pole and total breast volume (lower pole ratio = LPR) was used to assess volume redistribution. Further analysis included correlation between implant size and type of surgery (primary versus revisional) and lower pole stretch.

33.3. Results

Mean follow up was 24.8 months with the longest being of 45 months. No recurrent ptosis, bottoming out, implant displacement or capsular contracture were reported. Mean lower pole stretch was 5.39% and 8.04% at 6 and 12 months respectively, with substantial stability at 3 years (9.4%). Overall breast volume decreased by 9%, redistributing towards the lower pole in the first year (LPR = 0.45 at 6 weeks vs. 0.49 at 12 months), showing satisfactory volume distribution in the longer term (LPR = 0.52 at 2 and 3 years). Larger implants showed a trend towards longer LPA’s elongations, although not significantly so (p > 0.05). Secondary cases (26 patients) showed smaller LPA’s elongation at 1 year (8.73% vs. 6.83%), not reaching statistical significance (p > 0.05).

33.4. Conclusions

This is the largest published series reporting long-term results (up to 45 months) in mastopexy augmentation with GalaFLEX, suggesting its supportive role in lower pole stability even in the setting of concurrent breast augmentation with smooth implants in a subfascial plane.

34. Superomedial Pedicle and Ribeiro Flap, My Choice for Mastopexy with or Without Prosthesis

• D. Cervelli ¹

¹ 

Rome

34.1. 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.

34.2. 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.

34.3. Results

I used the combination of a 45° superomedial pedicle and Ribeiro flap for my mastopexy procedures in 88 patients. No major complications were reported, delayed healing of the vertical scar were experienced in 12 patients, in 4 cases scar revision was needed. The overall level of patients’ satisfaction was high.

34.4. Conclusions

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

35. Simplified Augmentation Mastopexy: Personal Approach to Make This Surgery Easier and Safer

• M. Antonacci ¹

¹ 

Studio Medico Antonacci

35.1. Background-Aim

Mastopexy augmentation is considered to be among the most complex procedure in the domain of aesthetic breast surgery.

It is also among the most frequently requested operations to restore the correct shape, position and volume to the breasts of women who have suffered weight loss or mechanical dystrophic stress from breastfeeding.

A meticulous pre-operative evaluation is imperative to ascertain the appropriate mastopexy technique, the extent of NAC complex elevation, the selection of the implant pocket, the volume and dimensions of the implants, and the extent of tissue reshaping.

The crucial aspect of this procedure is the right balance between the breast implant and the breast tissues to be redraped.

A further salient aspect of mastopexy pertains to the meticulousness of the surgical technique employed in the creation of the pocket for the prosthesis, a consideration that assumes particular significance in circumstances where implants with a smooth surface are utilised. This is with a view to mitigating the risk of displacement of the implant in the caudal and lateral directions.

35.2. Methods

Over the past four years, I have refined a surgical strategy that has enabled me to simplify the procedure and enhance its predictability and stability over time.

I have performed 96 consecutive additive mastopexy operations in patients between 25 and 50 years of age using nanotextured round prostheses.

In 65% of the patients I set up a sub-glandular implpant pocket, in the rest partially submuscular. All patients had a pre-operative ultrasound breast screening.

92% of the implanted prostheses were medium projection with a volume ranging from 275 cc to 325 cc. In the vast majority of cases, I have performed an inverted T mastopexy.

In cases of lifting the NAC by more than 5 cm, I have always used a supero medial vascular pedicle.

The primary step in my strategic approach to mastopexy augmentation is undoubtedly a thorough preoperative evaluation.

During this phase, I assess the anatomical characteristics of the patient’s chest wall and the morphometric features of the mammary glands. I meticulously record various measurements, with particular emphasis on the breast footprint and the distance from the giugulum to the nipple areola complex.

Following the pinch test on the upper medial part of the breast, the decision is taken regarding the positioning of the implant if subgladular or sub muscular.

On the basis of the patient’s mammary footprint and her expressed desires, the breast implant is selected.

I then proceed to plan the surgery, outlining the mastopexy pattern on the patient’s torso and determining the new position for the NAC based on the selected implant diameter.

In cases of lifting the NAC by more than 5 cm, I plan a supero medial vascular pedicle 10 cm width. The second step is the preoperative drawing on the day of the operation.

I start with the definition of themidline on the thorax wall, the breast meridians and the position of the existing inframammary fold, which is then transferred to the midline of the thorax (point A).

The 55% of the diameter of the selected breast implant is calculated and this measurement is transferred along the midline starting from point A. This point delineates the new position of the NAC (point B).

The patient is then asked to raise her arms above her head and, in this position, the point B is transferred laterally along the breast meridian defining point C.

Point c will be the new nipple position.

The mastopexy procedure is performed using a conventional inverted T-shaped approach, incorporating the Aufricht manoeuvre to define the vertical pillars that are typically maintained at a length of 5–5.5 cm.

The third and final step is the surgical procedure.

Prior to commencing the surgical procedure, the incision lines and the subpectoral plane are infiltrated with a local anaesthetic solution containing adrenaline at a ratio of 1:500,000.

I start the procedure by cutting the skin at the inframammary crease for a length of approximately 5 cm.

I then dissect the implant pocket using a Dual Plane type 2 technique, making sure that the pocket is narrow and perfectly fitting the chosen implant.

I do not interrupt the muscular fascia in between the major and minor pectorals muscle muscle between, and I left a small piece of the large muscle that is shaped like a sling.

The procedure to prepare the muscle under the skin was done using a monopolar Tebbets forceps.

At this point, the implant sizer corresponding to the implant is inserted, and the incision at the inframammary fold is closed with staples. The adequacy of the redraping of the breast tissue is then checked by forceps and staples.

Following confirmation that the vertical pillars are closed with an appropriate degree of tension, the lines of marking are confirmed and the incisions are performed.

The areola carrier flap is then dehepitelized and the inferior margin is defined.

The exceeding dermoglandular tissue on the lower pole is then removed, preserving the superficial fascia plane. Dissection in the prefascial plane allows to preserve an interface of fascial adipose tissue between the implant and the subcutaneous tissues of considerable thickness and consistency.

This tissue is very useful in improving tissue support in the lower pole and in controlling the expansion of the lower pole exerted by the implant over time.

I set up the areola carrier flap pedicle, inset the final implant and proceed to the breast reconstruction layer by layer. Post-operatively, I suggest that patients wear a supportive bra for at least 60 days.

35.3. Results

I have performed 96 consecutive additive mastopexy operations using this simplified approach and the results with 18 months follow up I have had in my practice have been very satisfactory and the patient satisfaction rate is very high. My revision rate is about 4% and in most cases consists of a mastopexy revision for recurrence of breast implant ptosis. At the beginning of my experience with nanotextured implants I had cases of implant lateral displacement that I had to revise surgically.

With the use of this approach I no longer had any cases of lateralisation. I had a post-operative hematoma and no infection.

35.4. Conclusions

I believe this approach is useful in making the planning of this complex surgical procedure easier and makes the result of additive mastopexy with nanotextured prostheses more stable and predictable over time.

Furthermore, I have found that the preservation of the adipose fascial tissues of the lower quadrants results in less surgical invasiveness and therefore a better and faster post-operative recovery.

36. Vertical Mastopexy with Polyurethane Conical Shaped Implants

• R. Uccellini ², V. Colabianchi ¹

¹ 

Private practice

² 

USL UMBRIA 2

36.1. Background-Aim

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

36.2. 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 polyurethane conical shaped implants.

The surgical technique used was customized according to the individual 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.

36.3. 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.

36.4. 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.

37. Mastopexy: A Personalized Technique with Autologous Fat Infiltration into the Pectoralis Major Muscle and Liposuction

• A. Amoroso ¹

¹ 

Care and Beauty

37.1. Background-Aim

This study describes an innovative approach to enhance breast aesthetics in mastopexy procedures through the combined use of lipofilling and liposuction. Twenty cases of patients with gigantomastia and grade 3 breast ptosis, operated on at Villa Maria Clinic in Baiano between 2023 and 2024, were analyzed.

37.2. Methods

Lipofilling was used to infiltrate autologous fat, harvested from areas such as the abdomen or thighs, into the pectoralis major muscle at three specific points on the medial portion. This technique improved the décolleté and upper pole projection. A lower fat flap was positioned to enhance the projection of the lower pole, creating a harmonious and natural result. Liposuction was also employed to reduce fat deposits in the tail of the breast, enhancing the definition of the thoracic region.

37.3. Results

Preliminary results show significant improvement in breast shape and volume, with a fuller décolleté and balanced proportions. Despite a fat resorption rate of 15% to 30%, the results remained satisfactory for most patients.

37.4. Conclusions

The combination of lipofilling and liposuction of the breast tail provides natural and harmonious results in the treatment of gigantomastia and severe breast ptosis. Despite partial fat resorption, the aesthetic and functional benefits are significant. This technique represents a personalized and effective alternative, with high levels of patient satisfaction.

38. Inverted T Mastopexy with High Volume Implants: The Role of Ultralight Implants

• A. Santorelli ¹

¹ 

Santorelli & Partners, Napoli

38.1. Background-Aim

Introduction The use of high volume breast implants (>400 g) in mastopexy surgery has historically been discouraged due to the increased risk of bottoming out, hypertrophic or widened scars and other post-operative complications. Recently, however, the introduction of ultra-lightweight implants and the application of advanced surgical techniques have allowed these risks to be mitigated, offering new possibilities to improve aesthetic and functional outcomes.

38.2. Methods

A retrospective study was conducted on 40 patients who underwent mastopexy with high-volume prostheses (400–600 g) using ultralight implants. All procedures were performed by a single surgeon using an inverted T technique, a dermo- adipose flap at the intersection of the Ts, fixation of the inframammary fold and positioning of the prosthesis in a subfascial plane. The minimum follow-up was 6 months, during which parameters such as the stability of the lower pole, the quality of the scars and the level of aesthetic satisfaction of the patients were evaluated. Any surgical revisions and the related reasons were also recorded.

38.3. Results

During the follow-up period, 8 patients (20%) required a surgical revision: 3 cases (7.5%) of bottoming out, 3 cases (7.5%) of widened scars and 2 cases (5%) of asymmetry. Despite these complications, 95% of patients reported a high degree of aesthetic satisfaction. Scars were assessed as thin and barely visible in 90% of cases. The adoption of the technique guaranteed optimal structural support, reducing the gravitational load on the breast tissue and ensuring good stability of the results.

38.4. Conclusions

Thanks to the use of ultra-light implants and some technical measures, it is possible to use high-volume prostheses in mastopexy with an acceptable risk of complications. These results support a personalized surgical approach to obtain optimal aesthetic and functional outcomes, expanding the therapeutic options for the correction of breast ptosis associated with significant volumetric increase.

39. Game-Changing Anchor Augmentation Mastopexy: 5 Years of Innovation with Lightweight Breast Implants

• C.M. Mele ¹

¹ 

Aesthetic Private Practice

39.1. Background-Aim

Natural changes like pregnancy and weight fluctuations can affect breast shape and self-esteem. Mastopexy improves volume, symmetry, and body harmony, but traditional implants can cause complications due to stress on tissues. The B-Lite(^®#) lightweight implant reduces implant weight by 30%, potentially offering better long-term results. This study evaluates the effectiveness of B-Lite(^®) implants in augmentation mastopexy, focusing on aesthetic outcomes, surgical success, and patient satisfaction.

39.2. Methods

A total of 76 patients aged 18–65 years who underwent augmentation mastopexy with lightweight implants were followed for an average of 18 months. The study found high patient satisfaction (96%), with an average nipple elevation of 3.45 cm. No major complications such as implant loss or nipple necrosis occurred, and the revision rate was 4%.

39.3. Results

The lightweight implants demonstrated positive effects in reducing tissue strain, contributing to aesthetic stability, and enhancing patient comfort. Despite some limitations, including the study’s retrospective nature and short follow-up, the results suggest that lightweight implants are a safe and effective alternative to traditional implants, with potential benefits for long-term patient outcomes. Further research with longer follow-up periods is recommended to validate these findings.

39.4. Conclusions

In conclusion, this study demonstrates that augmentation mastopexy with lightweight implants is a safe and effective procedure, offering stable aesthetic outcomes, minimal complications, and high patient satisfaction. Future research should focus on long-term comparative studies between lightweight and traditional implants to further substantiate these findings and optimize surgical strategies for different patient populations.

40. Mastopexy Under Local Anesthesia with Suspension Thread Implant: Maintains Glandular Integrity, Increases the Upper Quadrant, and Prevents Ptosis

• S. Capurro ¹

¹ 

past Director Plastic Surgery and Burns Division San Martino Hospital Genoa

40.1. Background-Aim

The goal is to perform a mastopexy under local anaesthesia without intervening on the breast stroma and without having to implant silicone breast implants. The elastic suspension thread is implanted after creating the breast shape with de-epithelialization and vertical incision.

40.2. Methods

After local anaesthesia, the skin shield in the lower quadrant is de-epithelialized, and the Schwarzmann manoeuvre is performed. The procedure is “Cut as you go.” Elastic sutures (Elasticum EP4. Korpo) give shape to the rejuvenated and lifted breasts. In larger breasts, conization is performed. An elastic thread is also implanted around the areola. The suspension thread replaces the non-functioning Cooper ligament, increasing the upper quadrant at the same time.

40.3. Results

The results are pretty stable over time. If the breasts are heavy after six months a year, we implant a second elastic suspension thread. The maintenance of the suspension is simple and does not leave visible scars. The breasts are lifted without changing their youthful shape, without reducing the volume and projection. The original secondary sexual character is preserved. The upper quadrant is filled. The integrity of the mammary gland avoids trophic damage and the consequent loss of volume that causes the recurrence of ptosis.

40.4. Conclusions

“An implant is a medical device manufactured to replace a missing biological structure, support a damaged biological structure, or enhance an existing biological structure”. The elastic suture suspends the breasts by replacing the non- functioning Cooper ligament. The procedure under local anaesthesia allows patients to return to their occupations immediately. The possibility of conizing the breasts and suspending them with the elastic thread allows for improved results even in breasts that have already been operated on with traditional techniques, with or without implants. Traditional techniques with glandular manipulation cause trophic damage and very frequently modify the original aesthetics of young breasts by decreasing the projection and the volume of the upper quadrant. The use of silicone-filled breast implants to compensate for the decrease and volumetric deficiencies leads to higher costs, more significant infectious risks and more excellent short- and long-term complications. Elastic mastopexy maintains glandular integrity and is perfectly ambulatory; it follows the anatomical concept of suspension. Suspension is possible due to the characteristics of Cooper’s ligament, which is composed of bands of dense connective tissue that reach the thoracic skin, providing an appropriate and permanent fixation of the elastic thread in the bordering subcutaneous tissue.

41. Over 10 Years Follow-Up Experience After Inverted T Superior Pedicle Breast Reduction with Inferior Dermo Adipose Flap

• B. Cagli, Md, Phd ¹, A.A. Cimmino ¹, I. Vignapiano ¹, D. Porso ¹, F. Sofo ¹, C. Mirra ¹, L. Savani ^2, A. Tarantino ¹

¹ 

Department of Plastic, Reconstructive and Aesthetic Surgery, Fondation Campus Bio-Medico di Roma, Rome, Italy

² 

Plastic Surgery Academy, Rome Italy

41.1. Background-Aim

Several techniques have been developed to address cases of gigantomastia. The primary objective remains achieving optimal aesthetic outcomes as well as reducing breast volume. Concerns persist regarding the maintenance of results over time. Long-term outcomes of superior pedicle T-inverted breast reduction with an inferiorly based dermal flap technique stops at five years follow-up.

This work investigates outcome of superior pedicle T-inverted breast reduction with an inferiorly based dermal flap technique over 10 years follow-up, considering intrinsic and extrinsic factors that may contribute to the recurrence of ptosis.

41.2. Methods

A total of 70 patients were included and examined in a long-term consultation, more than 10 years post-operation. Physical measures, including standard breast distances and skin distension test (SDT) for elasticity assessment, and BREAST-Q scores, were collected at time of consultation and compared to preoperative and intraoperative data.

41.3. Results

Our study’s sample shows a mean age of 42 years. Mean follow-up lasted 13 years, with 18 years as the longest follow-up registered. Mean breast tissue volume removed is 1134 g. A positive correlation between smoking habit and inferior pole elongation was shown (p = 0.031), and between smoking habit and inferior pole skin distension (p = 0.002). A significative positive correlation between age and almost all the BREAST-Q scales was reported.

Smoking patients have a higher SN-N distance variation over time and superior pole skin.

41.4. Conclusions

Our research affirms the efficacy of the inverted “T” technique, employing a superior pedicle method and an inferiorly based dermal adipose flap, regarding aesthetic outcome, symmetry, and patient-reported satisfaction. This versatile and reliable procedure demonstrates applicability across various patient profiles, irrespective of breast shape and volume, while offering enduring results that persist over a decade.

42. Mastopexy with Dermal Fixation. Personal Approach

• B. Maksim ¹

¹ 

North West State Medical University named after Mechnikov

42.1. Background-Aim

The author described a mastopexy technique that is performed by forming a lower or lower-central vascular pedicle with displacement of the axillary tail and fixation of the upper edge of the pedicle with dermo-muscular sutures. The author introduced the technique into practice, described the indications for the technique and complications.

42.2. Methods

According to the stated method, 126 patients aged 23 to 51 years were operated on from 2016 to 2022. These are patients with primary mastopexy and reduction mammoplasty. The patients were monitored for 12–18 months to assess the stability of the result.

42.3. Results

While monitoring the patients, we noted greater stability of the breast shape and filling of the upper pole. We had no indications for extensive anchor sutures. In 80% of cases, a T-shaped suture was used. 20% have a J|L scar. The most stable results were achieved in patients with the third degree of ptosis with the NAC directed downwards as much as possible.

Statistics of complications are provided. No signs of necrosis of the nipple-areolar complex were found. Several patients became pregnant in the postoperative period, no problems with lactation were noted.

Retrospective and prospective analysis conducted by questioning 150 women after mastopexy and reduction using the described technique in periods from 3 months to 1 year allowed us to identify the degree of patient satisfaction with the shape and stability of the result obtained—more than 85% of respondents were maximally satisfied with the result of the operation, and only 2.5% did not get the desired result.

42.4. Conclusions

The method of mastopexy with dermal fixation proposed by the author allows us to achieve a more stable result with certain initial parameters of ptosis, a fuller breast shape, avoid the presence of extended anchor scars, and also maintain the possibility of lactation.

The author of the article received a patent for this method of surgery.

43. Satisfaction in Aesthetic Surgery

• S. Poggi ², G. Diluiso ¹, V. Marron Mendes ¹, L. Grimaldi ²

¹ 

Service de Chirurgie Plastique, Hôpital CHIREC Braine l’Alleud-Waterloo, Braine l’Alleud, Belgium

² 

U.O.C. Chirurgia Plastica, Ricostruttiva ed Estetica, Università degli Studi di Siena, Siena, Italy

43.1. Background-Aim

Understanding and measuring patient satisfaction in aesthetic surgery is challenging, yet it remains the most effective way to assess surgical outcomes. Currently, several tools are available, but no standardized method has been established. This study aims to identify and analyze the various factors influencing patients’ perception of surgical results in aesthetic procedures.

43.2. Methods

We conducted a retrospective, non-interventional, multicenter study over a six-month period, involving a total of 3329 patients. Clinical and demographic data were collected for each patient, and a custom-designed questionnaire was administered to assess perceived postoperative satisfaction. The study was structured by formulating research hypotheses and analyzing both preoperative and postoperative variables.

43.3. Results

Based on our inclusion criteria, 78 patients who underwent aesthetic surgery were selected. Among these, the procedures performed included 27 breast surgeries, 25 abdominoplasties, 13 liposuctions, 10 rhinoplasties, and 3 other aesthetic procedures. The overall average satisfaction rate was 69%. A statistically significant association was observed between “psychological distress related to body image and low self-esteem” and overall patient satisfaction (p < 0.05). The same applies to the variables “psychiatric history” and “smoking status.” A highly significant correlation (p < 0.001) was found for the variables “quality of surgeon-patient interaction,” “adequacy of information provided,” “postoperative pain management and sensory evolution,” “scar management,” “perception of postoperative results,” and “improvement in sexual life.”

43.4. Conclusions

Our findings suggest that patient satisfaction in aesthetic surgery is a multifactorial issue, with different variables playing distinct roles and carrying different weights. Evaluating these factors may be key to better understanding patient expectations and consequently achieving higher satisfaction rates, which remains the primary assessment parameter in aesthetic surgery.

44. Efficacy and Safety of Poly-4-Hydroxybutyrate (P4hb) Scaffold (Galaflex) in Mastopexy: A Prospective Study

• E.M. Buccheri ¹

¹ 

UltraClinic, Via Clitunno 22E Roma

44.1. Background-Aim

Breast mastopexy poses unique challenges in achieving long-term results, particularly regarding the recurrence of ptosis. For this reason, different surgical techniques have been proposed, including those involving the use of additional devices at the lower pole to provide better support for the mammary gland. To address this issue, we conducted a prospective analysis aimed to evaluate the efficacy of incorporating the bioabsorbable scaffold GalaFLEX with mastopexy procedure in preventing recurrent ptosis during a 12-month follow-up period.

44.2. Methods

The study enrolled 60 patients undergoing primary mastopexy for correcting grade III breast ptosis. The cohort was divided into two groups (A and B). Group A underwent mastopexy with the addition of the bioabsorbable mesh sling to the lower pole of the breast, serving as an internal, subcutaneous supportive “bra”. Group B received a standard mastopexy without the mesh support. Patients were followed up for 12 months to assess the outcomes.

44.3. Results

The nipple-to-inframammary fold distance was measured before the surgery and during the 1-month and 12-month follow-up checks between the study group (Group A) and the control group (Group B) as indicator of post-operative breast ptosis recurrence. From the 12th post-operative month onward, measurements in Group A showed a statistically significant difference (p < 0.05) compared to Group B, indicating a better maintenance of the long-term results in patients treated with GalaFLEX.

44.4. Conclusions

The incorporation of GalaFLEX matrix in mastopexy procedures provided an additional layer of support and demonstrated efficacy in delaying the reoccurrence of ptosis following surgery. This study confirmed the potential benefits of using a bioabsorbable mesh in mastopexy procedures to enhance long-term breast shape stability, offering to the plastic surgeons a valuable adjunct in the management of breast ptosis.

45. Evolution of Male Chest Wall Definition: New Classification and Surgical Algorithm

• G. Cuccia ¹

¹ 

Private practice

45.1. Background-Aim

Gynecomastia is a common breast anomaly in males. Clinical aspect varies widely in world populations showing peculiar signs according to different body weight and reflecting personal expectations. Any surgical plan must be tailored on individual basis to all type of patients.

45.2. Methods

A total of 67 patients, treated for bilateral gynecomastia from January 2019 to October 2024, were included and reviewed in this retrospective study. Considering physical status, BMI, muscular trophism, hypertrophy of the mammary region, nipple areola disorder, gland and skin cover consistency. A new classification system has been used to classify the deformity and to assess a surgical plan. In all cases Ultrasound Assisted Liposuction (UAL) was used to reduce breast tissue and enhance skin tightening.

45.3. Results

No recurrence of the deformity was observed with a follow up range between 3 months and 4 years, as well as major complications such as necrosis, and high level of satisfaction was observed in all groups. Ages ranged from 19 to 58 years. Fat grafting volume ranged from 50 to 150 cc in each pectoral muscle. No major complications were observed. Minor complications (4.2 percent) included prolonged swelling, bruising, asymmetries and residual gynecomastia.

45.4. Conclusions

The authors describe a simple classification system that helps surgeons choose the most suitable surgical approach, avoiding insufficient or invasive treatments and undesirable scars. Since the physical status is strictly related to the clinical features of the disorder, a comprehensive classification system and a reconstructive algorithm are proposed to achieve an athletic and natural appearance of the male pectoral area with a very low rate of complications.

46. Treatment of the Tuberous Breast and Gradual the Lower Pole Expansion

• M. Moio ¹

¹ 

Private practice

46.1. Background-Aim

The surgical treatment of tuberous breasts presents several technical difficulties that can be addressed with some simplifications with the proper technique and implant. The gradual expansion of the lower pole can be of great help in breast modeling. We present the results of our personal technique developed over the last eight years.

46.2. Methods

Between November 2016 and December 2024, 482 cases of tuberous breast were treated with some personal modifications to the techniques described and with the aid of a smooth-surface prosthesis and ergonomic gel that allowed a gradual expansion of the lower pole measured thanks to a 3D graphic measurement software.

46.3. Results

Lower pole expansion in the tuberous breast showed a constant and measurable increase during the first six months postoperatively and then stabilized at one year. The mean duration of follow-up was 32 months and expansion remained stable after the first year.

46.4. Conclusions

The use of a modified technique that allows gland redistribution and expansion together with a specific type of implant that allows a gradual expansion of the lower pole, facilitate the preparation of the breast tissues and represent a great advantage in the outcomes of the treatment of the tuberous breast.

47. Lipofilling with Cercagle in the Treatment of Tuberous Breast

• G. Visconti ¹

¹ 

Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS

47.1. Background-Aim

Tuberous Breast deformity is a complex malformation with different degree of severity and usually with coexistency of breast asymmetry. The treatment of tuberous breast should include a reconstruction of the lower pole that result hypoplastic and not convex as well as in treating the herniated nipple-areola complex. In this paper, the author report his experience using the fat grafting breast augmentation with dual anchor thread as main procedure for treating tuberous breast, without using implants.

47.2. Methods

A retrospective evaluation of 65 tuberous breast treated with breast fat grafting dual anchor thread technique was performed. In 55 patient, two session of fat grafting were performed with ancillary procedures such as periareolar or vertical mastopexy to correct asymmetry. In the remaining 10 patients, single session of fat grafting was performed. Patients were evaluated at 1 and 2 years follow up.

47.3. Results

In all cases, the tuberous breast was corrected as well as the breast asymmetry. All patients were satisfacted about the result. No major complications were experienced.

The result was stable at 1 and 2 years follow-up.

47.4. Conclusions

The breast fat grafting using dual anchor thread technique is a safe, effective and reliable option for the treatment of tuberous breast without using implants.

48. Correction of Tuberous Breasts Using Nanotextured Ergonomic Implants: Analysis of Technical Aspects and Results

• C. Biagi ¹

¹ 

Plastic and Aesthetic Surgeon, freelancer, Lucca

48.1. Background-Aim

Tuberous breasts are a very common congenital malformation, which is clinically expressed in very different ways, and which represents a continuous challenge in our surgical practice. In this retrospective study, the author will report the techniques used for the correction of the deformity by using nanotextured ergonomic implants and the related results.

48.2. Methods

80 patients operated for tuberous breasts from 2016 to date were included in the study, divided into 3 groups based on the Grolleau classification; in the majority of cases a periareolar approach was performed, including mastopexy; in the minority a submammary approach; in rare cases an inverted T mastopexy was performed. The prostheses were always placed in the retropectoral position (dual plane). Lipofilling was rarely performed, always a glandular expansion.

48.3. Results

With a follow up of more than 8 years, we con confirm that an optimal correction of the deformity was obtained in 90% of treated cases; good in 5%; complications emerged in 5% of patients, with a prevalence of double profile.

48.4. Conclusions

The study highlights that the correct surgical management of the inframammary fold and the chondrosternal insertions of the pectoralis major muscle, as well as a complete glandular expansion and the initial positioning of the ergonomic breast implants in a rather cranial position are crucial to obtain an aesthetically valid and long-lasting result. Finally, the study confirms the “ability” of ergonomic breast implants to “inhabit” and indeed to perfectly “recreate” the lower breast pole, even in cases of severe tuberosity.

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

• G. Lo Russo ¹

¹ 

Centro di Chirurgia Maurizio Bufalini

49.1. Background-Aim

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.

49.2. 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).

49.3. 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).

49.4. 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.

50. Capsular Contracture After Breast Augmentation: Our Approach to Prevent Reoccurrence with Combined Total Capsulectomy and Implantation of Ergonomic Implants

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

¹ 

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

² 

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

³ 

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

⁴ 

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

⁵ 

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

⁶ 

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

⁷ 

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

50.1. Background-Aim

Breast augmentation is the second most common aesthetic surgery worldwide. Capsular contracture, a revalent 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.

50.2. 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.

50.3. 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.

50.4. 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.

51. Management of Waterfall Deformity in Plastic Surgery

• U. Napoli ¹

¹ 

Free lance Surgeon, Turin

51.1. Background-Aim

Waterfall Deformity is a post-augmentation mammoplasty complication characterized by the downward displacement of the breast parenchyma below the implant, resulting in an altered breast contour. This study aims to analyze the causes of this deformity, evaluate the most effective surgical correction strategies, and propose protocols to prevent its occurrence, thereby improving aesthetic outcomes and patient satisfaction.

51.2. Methods

This study is based on a review of the scientific literature and an analysis of clinical cases diagnosed with Waterfall Deformity. Various surgical approaches were evaluated, including mastopexy with or without implant replacement, use of high-projection implants, reinforcement of tissue support with synthetic or autologous meshes, and glandular repositioning techniques. The effectiveness of these strategies was assessed through post-operative follow-ups and patient satisfaction. Waterfall Deformity primarily occurs in patients with pre-existing ptosis, lax breast tissues, or insufficient adhesion between the parenchyma and the implant. It presents as a noticeable downward displacement of the breast tissue below the implant, creating a separation between the two volumes and an unnatural effect. The most effective correction techniques include:

• Mastopexy combined with implant replacement to reposition the nipple-areola complex and improve tissue support.
• Use of high-projection implants or a modified dual-plane approach to enhance cohesion between the implant and the breast parenchyma.
• Tissue reinforcement with synthetic or autologous meshes to stabilize the lower pole and prevent further displacement.
• Breast parenchyma reshaping in cases where excessive laxity contributes to the deformity.

51.3. Results

The analysis of treated cases showed that a combined approach, incorporating mastopexy, appropriate implant selection, and tissue reinforcement techniques, yields the best aesthetic and functional outcomes. Proper preoperative assessment of tissue quality and ptosis is crucial in preventing the onset of the deformity.

51.4. Conclusions

A personalized approach to Waterfall Deformity management ensures a harmonious, natural, and long-lasting breast appearance, improving patient satisfaction and reducing the need for future corrective surgeries.

52. Nac Complex Reconstruction, Surgically and Non Surgically

• M. Tsivtsivadze ¹

¹ 

Clinic Total Charm Georgia, Unit of Aesthetic Plastic Surgery

52.1. Background-Aim

The reconstruction of the nipple-areola complex (NAC) is an essential component of breast surgery, particularly after procedures such as mastopexy, reduction mammoplasty, or breast reconstruction. Complications such as insufficiently expressed NAC, inverted nipples, and missing nipples can occur, resulting in aesthetic dissatisfaction. Achieving stable nipple projection remains a challenge, as existing techniques such as local flaps, distant grafts, injectable fillers, and allografts often fail to maintain projection over time. This is due to a variety of factors, including a lack of structural support at the base of the nipple, fat necrosis, scar contraction, delayed wound healing, infection, or external pressures like the bra. Therefore, optimizing NAC reconstruction through both surgical and non-surgical approaches is crucial for achieving long-term results and patient satisfaction.

52.2. Methods

This study presents a methods for the correction of inverted nipples and the creation and fixation of nipple projection, as well as the narrowing of large or wide areolas, all under local anesthesia. The procedure aims to stabilize the nipple base, thereby ensuring durable nipple projection. This techniques combines both surgical and non-surgical methods to optimize outcomes following breast surgery and address complications.

The approach was applied to a cohort of patients who presented with inverted nipples, insufficient nipple projection, or large areolas. A detailed explanation of both surgical and non-surgical options for NAC reconstruction was provided to each patient, and the best approach was selected based on the individual’s specific needs and preferences. The surgical procedure involved minimal incision and tissue manipulation, while the non-surgical method focused on injectables, tattooing or temporary devices for projection restoration.

52.3. Results

The application of this technique resulted in significant improvements in nipple projection, shape, size, and position. Among patients who underwent surgery, there was a stable and lasting projection, with minimal loss over time. The fixation of the nipple base was key to achieving this stability, and patients experienced a high level of satisfaction with the aesthetic outcomes. Inverted nipples were corrected with the proposed technique, and large or wide areolas were narrowed, restoring a more natural and symmetrical appearance.

For patients who opted for non-surgical methods, injectable fillers provided an immediate yet temporary improvement in nipple projection. While these results were not permanent, they offered a less invasive alternative with satisfactory outcomes for patients who preferred a conservative approach. The incidence of complications, such as fat necrosis, delayed wound healing, infection, and scar contraction, was minimal, further supporting the efficacy of the procedure.

52.4. Conclusions

This study highlights the effectiveness of a novel technique for NAC reconstruction that combines both surgical and non-surgical methods. The surgical approach, which focuses on stable nipple base fixation, results in permanent and stable nipple projection with a high patient satisfaction rate. Non-surgical alternatives, offer temporary but satisfactory results for patients seeking less invasive options. The method is simple, effective, and minimizes complications, making it a valuable tool for addressing the challenges of nipple and areola reconstruction after breast surgery. Overall, the techniques significantly enhances aesthetic outcomes and improves the quality of life for patients undergoing breast reconstruction or correction of post-surgical NAC deformities.

53. Post-Mastoplasty Complications: Incidence, Litigation Management, and Reoperation Costs

• A. Santorelli ¹

¹ 

A. SANTORELLI & PARTNERS

53.1. Background-Aim

Breast surgery procedures, including augmentation mammoplasty, mastopexy with or without implants, reduction mammoplasty, and implant replacement, remain among the most frequently performed interventions in plastic surgery. Consequently, they also account for the highest volume of procedures in this field.

53.2. Methods

The author wishes to share data from a major provider active in the European insurance market for cosmetic surgery, examining the incidence of complications leading to reoperation in over 20,000 breast cosmetic surgery procedures performed in Europe, including Italy, over the past three years.

53.3. Results

The results we observed indicate 1 claim for every 10 breast augmentation procedures, with an average reoperation cost ranging from 2000 to 2500 euros.

53.4. Conclusions

The costs associated with managing complications and reoperations are often a source of conflict between the patient and the surgeon, especially in the absence of clear medical negligence by the latter. For this reason, insuring the procedure provides protection for the patient and, consequently, for the surgeon as well. This approach reduces medical-legal disputes by over 80% of cases.

54. Breast Auto-Augmentation After Implant Removal: Enhancement of Long-Term Results Through Intraoperative Assessment of Flaps Viability

• E. Cammarata ¹, M. Rossi ¹, G. Zabbia ¹, F. Toia ¹, G. Biondo ¹, A. Cordova ¹

¹ 

Plastic and Reconstructive Surgery; Department of Precision Medicine in Medical, Surgical and Critical Care (Me. Pre. C. C.); University of Palermo; Palermo, Italy

54.1. Background-Aim

Patients who underwent previous breast augmentation may need implant removal for mechanical complications or other causes, even after long time since implant positioning. After prosthesis removal, the residual parenchyma can be reshaped through a mastopexy with breast auto-augmentation. In case of breasts with mild-to-moderate size before augmentation, surgeon should include as much parenchyma as possible in the autoprosthesis in order to obtain a satisfactory breast volume. However, large-volume autoprostheses can undergo distal ischemia and fat necrosis, two occurrences that, in absence of a wound dehiscence, are often underdiagnosed but can lead to unexplained calcifications, postoperative breast volume reduction or asymmetry, thus jeopardizing long-term results. Therefore, intraoperative assessment of flaps viability is crucial to prevent these complications and improve patient’s satisfaction. In this study, we present our experience in breast auto-augmentation after implant removal through a novel autoprosthesis technique: the “octopus head” dermoglandular flap, together with our intraoperative evaluation protocol.

54.2. Methods

From January 2022 to July 2024, 14 patients (28 breasts) underwent implant removal and simultaneous auto- augmentation with the “octopus head” technique at our institution. Inclusion criteria were: BMI < 30, mild-to-moderate breast ptosis, a sternal notch-nipple distance > 23 cm, an areola-inframammary fold distance > 6 cm, a dermoglandular flap thickness > 1 cm. Patient’s demographic and clinical characteristics, postoperative complications and patient- reported satisfaction were recorded. Patients were marked as in a traditional wise pattern mastopexy. A superiorly based dermoglandular flap was elevated. Intraoperative viability of the flap was assessed through indocyanine green (ICG) fluorescence imaging. When required, non-perfused or poorly perfused areas of the flap were removed, trying to maintain as much as possible of the viable tissue of the autoprosthesis. The flap was then assembled as a sphere (the octopus head), thus simulating an autologous implant. Then the flap was anchored cranially to the pectoralis major fascia. Finally, the breast was closed in a standard inverted-T fashion.

54.3. Results

Mean age was 47 years (range 25–70). BMI ranged between 21.3 and 28.4 kg/m² (mean 24.9). Mean follow-up was 17 months (range 6–24). No major complications occurred. We observed two minor complications (1 case of wound dehiscence that was managed conservatively and 1 case of NAC malposition). No reduction of breast volume or asimmetries were observed at the long-term follow up. All patients were satisfied for the aesthetic and functional result. Only one patient asked for revision surgery.

54.4. Conclusions

In our experience, the “octopus head” dermoglandular flap, combined with intraoperative evaluation of flaps viability through ICG fluorescence imaging, has proved to be a safe and reliable option for breast auto-augmentation after implant removal, providing a good cosmetic result, with enhanced breast projection and upper pole fullness, long- term preservation of postoperative breast volume and symmetry, a low complication rate and a high patient-reported satisfaction.

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

• V. Colabianchi ¹, R. Uccellini ¹

¹ 

Private Practice

55.1. 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.

55.2. 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.

55.3. 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 adominoplasty 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.

55.4. 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.

56. “Doctor I Want to Be Like This?” Exploring Global Beauty Body Standards Though out a Multicenter Survey

• D. Tambasco ¹, F. Tomaselli ¹, R. Albanese ¹

¹ 

Plastic Surgery Unit, San Carlo di Nancy Hospital, Rome

56.1. Background-Aim

Plastic surgery aims to enhance patients’ positive features and improve perceived flaws without seeking complete transformation. The body is a living organism, not a sculptural object to be reshaped at will. Aesthetic standards are influenced by subjective factors, including technology and social media’s effect on self-perception and beauty ideals. Understanding body perception requires consideration of personal views, mirror reflections, and external perspectives.

56.2. Methods

We analyzed data from more than 4000 patients to obtain objective insights into contemporary aesthetic preferences. We examined the influence of globalization on beauty standards, the relationship between physical activity and desired body definitions, and regional preferences for specific body shapes. In addition, we assessed how patients’ aesthetic preferences are shaped more by the surgical centers they choose than by their nationality.

56.3. Results

Our findings indicate that globalization has diversified perceptions of beauty, highlighting personal and cultural differences. We noted a significant correlation between patients’ aesthetic preferences and the surgical center, reflecting the impact of medical tourism and social media on shaping beauty ideals.

56.4. Conclusions

As patient opportunities expand, the remote management of complex procedures necessitates skilled surgeons to ensure safe and effective care. Our experience provides valuable data on current patient preferences, essential for adapting practices in the evolving landscape of plastic surgery.

57. Optimizing Safety and Precision for Secondary Liposuctions: Integrating Intraoperative Ultrasound with Vaser Technology

• D. Tambasco ¹, F. Tomaselli ¹, R. Albanese ¹

¹ 

Plastic Surgery Unit, San Carlo di Nancy Hospital, Rome

57.1. Background-Aim

Liposuction has gained significant popularity, leading to increased demand for secondary procedures due to complications such as scars and fibrosis that affect aesthetic outcomes. High-definition liposuction has emerged as a preferred technique, but the presence of fibrosis from previous surgeries may limit its effectiveness.

57.2. Methods

A prospective cohort study was conducted between May 2022 and May 2023 of patients undergoing secondary abdominal liposculpture with US-assisted VASER liposuction, at least 12 months after their initial procedure. Preoperative US examinations were performed to identify and mark findings related to previous liposuction. Data on demographics, photographic results, and complications were collected and analyzed.

57.3. Results

Intraoperative ultrasound (I-US) significantly improved the detection of fibrotic lesions, leading to more precise, rapid, and atraumatic outcomes. The use of I-US optimized surgical procedures, reducing both costs and operation time. Clear communication with patients regarding potential limitations due to chronic damage was essential for setting realistic expectations.

57.4. Conclusions

I-US has proven to be an invaluable tool in secondary liposculpture, enhancing surgical precision and outcomes. This methodology allows for better recognition of complications, promoting effective treatment strategies and ultimately improving patient satisfaction in the context of secondary abdominal liposculpture.

58. Laser Assisted Fat Treatment: Does It Remove Fat or Promote Skin Retraction?

• D. Bollero ¹

¹ 

U.O.A Chirurgia Plastica e Centro Ustioni—Città della Salute e della Scienza di Torino

58.1. Background-Aim

In recent years, the demand for aesthetic and functional improvement of the body has increased considerably. We start from requests for the correction of small irregularities up to large liposuctions in lipoabdominoplasty.

58.2. Methods

The management of adipose tissue, thanks to modern techniques, becomes an easily proposed solution because it allows different responses to be given even in different settings (both outpatient and operating room).

Technologies, as well as techniques, have increased and improved results and performance.

In my presentation I will illustrate my choice and my experience with a device for laser lipolysis and laser assisted liposuction with particular attention to practice with details, direct experiences and clinical cases.

The energy emitted with this selective laser on water and fat operating at 1470 nm through a radial optical fiber promotes both the removal of adipose tissue both with bare fiber and with specific cannulas together with “skin tightening”, skin retraction with a reduction of laxity, thanks to the activation of neo-collagenesis and metabolic functions within the extra-cellular matrix, due to the selective interaction of the wavelength of light with body water and fat.

58.3. Results

Emphasizing that each technology has its own learning and training curve, 1470 nm radial fiber laser-assisted adipose tissue treatment enabled good retraction of the treated tissues along with adequate treatment of the adipose tissue in selected cases.

The latest radial fiber laser technology is extremely versatile with the possibility of outpatient treatments without suction with lower powers, sometimes in the absence of local anaesthetic, but also safe at high powers in operating room performance with tumescent anesthesia and suction.

58.4. Conclusions

On the one hand, the introduction of laser and fiber optic technologies has made it possible to improve the results of liposculpture with low or no incidence of complications. On the other hand, the versatility of the most recent lipolytic lasers allows both the bivalent and “office based” approach for small corrections and in the operating room for cases that require aspiration, making it an interesting tool in the baggage of the modern plastic surgeon.

59. Beyond the Curve: The Evolution and Refinement of Our Lipoabdominoplasty Technique

• D. Tambasco 1, R. Albanese 1, F. Tomaselli 1

¹ 

Plastic Surgery Unit, San Carlo di Nancy Hospital, Rome

59.1. Background-Aim

Lipoabdominoplasty is a plastic surgery procedure that combines liposuction with abdominoplasty and rectus muscle diastasis correction to improve abdominal contour by reducing adipose tissue and restoring the sliding function of the rectus muscles. In recent years, advancements in surgical techniques and the integration of new approaches have led to improved aesthetic and functional outcomes, while minimizing complications and accelerating postoperative recovery. The objective of this study is to present our experience with lipoabdominoplasty, analyzing its technical evolution, the outcomes achieved, and their impact on patients’ quality of life.

59.2. Methods

We conducted a retrospective study analyzing data from patients who underwent lipoabdominoplasty with rectus diastasis correction at our center between 2020 and 2024. Patients were selected according to predefined inclusion criteria: presence of abdominal skin laxity with rectus muscle diastasis, BMI < 35 kg/m², and absence of severe systemic diseases. Patients with pathological obesity, coagulation disorders, or unrealistic aesthetic expectations were excluded. The surgical techniques employed included VASER-assisted liposuction, percutaneous radiofrequency for subcutaneous tissue treatment, rectus muscle plication, and dermolipectomy. Parameters analyzed included operative time, complication rate (hematoma, seroma, wound dehiscence), recovery time, and patient satisfaction measured using the BODY-Q questionnaire.

59.3. Results

All patients operated on during the study period were included, with a mean follow-up of 12 months. The complication rate was reduced following the introduction of prophylactic nitroglycerin ointment and HBOT therapy in high-risk patients. The use of assisted liposuction techniques minimized tissue trauma and enhanced body contouring, leading to an increase in postoperative satisfaction, as measured through BODY-Q scores. The mean recovery time was shorter compared to traditional techniques, and a substantial percentage of patients reported an improvement in their quality of life.

59.4. Conclusions

The evolution of lipoabdominoplasty techniques has optimized both aesthetic and functional outcomes, reducing surgical risks and improving patient satisfaction. The integration of VASER liposuction and the use of devices such as percutaneous radiofrequency contributed to enhanced skin retraction, while the application of HBOT therapy and a nitroglycerin ointment in high-risk patients significantly reduced vascular complications. Our findings suggest that a multimodal approach to lipoabdominoplasty, tailored to the individual characteristics of each patient, represents an effective strategy to achieve safe and long-lasting results.

60. 3D High-Definition Torsoplasty: Redefining Body Contouring

• P. Vittorini ¹

¹ 

Presidio ospedaliero Villa Letizia-L’Aquila

60.1. Background-Aim

Flaccidity of the abdomen and buttocks is a common concern in both men and women, often arising after significant weight loss due to dietary restrictions, bariatric surgery, or as a natural consequence of aging. The loss of adipose tissue leads to structural imbalances, including skin redundancy, abdominal muscle diastasis, and volume depletion in the gluteal region.

60.2. Methods

For optimal and lasting results, surgical intervention is ideally performed once the patient has reached a stable weight plateau, typically around one year post-bariatric surgery. Among the most effective body contouring procedures for reshaping the mid and lower trunk is circumferential torsoplasty combined with buttock lifting, a comprehensive approach that respects the three-dimensional nature of the human form.

60.3. Results

The gluteal region is meticulously sculpted to restore its natural roundness, projection, and definition through a combination of buttock lifting and autologous fat grafting, using self-prosthesis techniques. The lower third of the buttocks is enhanced with Macrofat and Microfat grafting, strategically performed via lipofilling to optimize both volume and contour. To further refine body lines, liposculpture of adjacent areas—such as the trochanters and hips—is performed, ensuring a harmonious and balanced silhouette.

60.4. Conclusions

This presentation will detail the surgical planning, intraoperative strategies, and technical refinements essential for achieving both aesthetic and functional restoration of the trunk. Additionally, the author will share insights drawn from a 12-year experience in body contouring surgery, encompassing 1885 abdominoplasties, of which 263 were circumferential, with a comprehensive analysis of outcomes and long-term stability.

61. Functional and Aesthetic Aponeurosis Plication in Abdominoplasty

• C. Bernardi ¹

¹ 

Saba Medica Plastic Surgery, Rome—Italy

61.1. Background-Aim

Introduction—The main surgical indication for abdominoplasty is to correct musculo-aponeurotic wall defect, ranging from a simple loss of tone often associated with diastasis of the rectus abdominis muscles, to severe defects such as hernias. This type of problem is quite frequent in multiparous women, in obese people, in patients who have already undergone abdominal surgery and in subjects particularly predisposed to a weakness of the abdominal wall. The correction of these wall defects leads to an immediate functional result, represented by a rapid condition of physical re-balancing of the body, with significant postural improvement of the patient.

61.2. Methods

Material and Methods—The correction of defects of the musculo-aponeurotic wall is performed by plicating it with sutures and duplicate on itself the portion of the wall with poor tone, reinforcing it. The suture is performed with non-absorbable 2:0 monofilament thread. On the midline, the stitches are single, X-shaped, so as to bring the lateral edges of the diastasis closer together and at the same time also to vertically shorten the linea alba, which is always elongated in cases of significant diastasis. In cases of greater or residual hypotonia after the median suture, other plications are performed with different directions also with the aim of obtaining a better definition of the waistline.

61.3. Results

In his presentation, the Author illustrates some clinical cases of his experience underlining technical notes and elements of clinical evaluation of the results. All patients operated are followed after 1, 3, 6 and 12 months.

61.4. Conclusions

Discussion—Conclusion—A good correction of hypotonia of the abdominal wall must be considered as an important functional result. This leads to a physical rebalancing of the patient, with significant postural improvement due to the retro-positioning of the body’s center of gravity resulting from the toning of the abdominal muscle-aponeurotic wall. Improvements of body’s position improves postural attitude, preventing the onset or worsening of pathological curves affecting the spine. In aesthetic abdominoplasties, the median correction of the musculo-aponeurotic wall may not be sufficient to define the waistline, making it appropriate to perform additional plications such as lateral ones on the oblique abdominal muscles: this represents an added value for the patient for a complete, functional and aesthetic improvement.

62. The M.I.R.E.L.A Technique (Minimal Invasive Robotic Endoscopic Lipoabdominoplasty) in the Aesthetic Body Contouring Treatment

• A. Sanfurgo ¹

¹ 

Sanfurgo Clinic—Private Clinic

62.1. Background-Aim

Robotic surgery has gained prominence in recent years and is now being integrated into plastic surgery. The Minimal Invasive Robotic Endoscopic Lipoabdominoplasty (M.I.R.E.L.A.) technique utilizes robotic surgery for rectus abdominis diastasis correction, aiming to enhance surgical precision and provide faster postoperative recovery. This study aims to analyze the profile of patients undergoing the procedure and assess the associated clinical findings.

62.2. Methods

A cross-sectional quantitative study was conducted, evaluating 20 patients who sought robotic surgery for diastasis correction at the Sanfurgo Clinic in São Paulo between July 2023 and June 2024. Patient data, including surgical history, body composition, and associated conditions, were collected and analyzed.

62.3. Results

Among the 20 patients evaluated, 95% (n = 19) had a history of previous pregnancies. Additionally, 65% presented with an umbilical hernia, which was repaired during the procedure. The majority (90%) had a body mass index (BMI) within normal limits, while 95% had a preoperative body fat percentage greater than 18%.

62.4. Conclusions

This study provides insights into the role of robotic surgery in plastic surgery, particularly in rectus abdominis diastasis correction. The M.I.R.E.L.A. technique demonstrates potential for optimal postoperative outcomes, offering benefits such as improved surgical precision and a faster return to daily activities. Additionally, the findings support the adaptation and skill development of aesthetic plastic surgeons in this emerging field.

63. A Simplified Approach to Umbilical Reconstruction in Abdominoplasty

• M. Maffei ¹

¹ 

Studio Bellinvia

63.1. Background-Aim

Abdominoplasty is a common surgical procedure for the treatment of excess skin and fat in the abdominal region. However, one of the most delicate aspects of post-operative aesthetic recovery is the reconstruction of the umbilicus, a key element for the overall aesthetic outcome. Traditionally, umbilical resection and reconstruction can present challenges in achieving a natural result, with outcomes varying based on the technique used.

63.2. Methods

We employed a technique for umbilical reconstruction that involves “de-fatting” the abdominal flap and subsequent anchoring of the dermis to the muscle fascia. Using a minimally invasive approach, the flap is precisely sculpted to ensure a naturally shaped and positioned umbilicus, maintaining optimal symmetry with the surrounding skin. Additionally, the technique minimizes tension, improving wound healing and reducing the risk of complications.

63.3. Results

Among the 15 patients treated from 2020 to 2025, 95% showed satisfactory aesthetic results, with a reconstructed umbilicus that harmoniously integrated into the new abdominal configuration. The technique demonstrated a low complication rate, with only 2% of cases requiring minor corrective interventions.

63.4. Conclusions

This umbilical reconstruction technique represents a significant improvement over traditional methods, offering superior aesthetic results and reducing the risk of complications. The approach is easily adaptable to various clinical situations and should be considered as a reference technique for umbilical reconstruction following abdominoplasty.

64. Post-Partum Pathologies: From Rectus Diastasis to the Pelvic Floor. Multi-Specialist Approach and Combined Techniques

• G. Giugliano ¹

¹ 

Mater Dei General Hospital, Roma

64.1. Background-Aim

The aim of this study is to present guidelines for the management of postpartum problems: rectus diastasis, pelvic floor prolapse and intestinal dysbiosis. In addition to presenting a variation of the surgical technique for the treatment of diastasis recti with the addition of muscle regeneration by transformed monocytes, namely ‘Muscle Regeneration and Abdominal Lift Technique’ (MURAL-T).

64.2. Methods

From May 2020 to December 2024, 150 postpartum women between 35 and 65 were operated for DRA only with the personal muralt technique or in association with combined interventions for associated pathologies. All patients were followed by a multidisciplinary team composed of a plastic surgeon, endocrinologist, general surgeon, gynecologist, physiotherapist.

35% of patients underwent combined DRA and Burch Anterior Colposuspension for stress urinary incontinence.

In 60% of cases the patients were operated on 7 months after DRA surgery for rectopexy for suspension of the posterior pelvic floor.

80% of all patients had a positive dysbiosis test with colon dysbiosis.

In 5% of cases, other combined Dra operations were performed such as laparoscopic cholecystectomies and hysterectomy for polyfibromatous uterus.

All patients followed a pre-operative approach to treating dysbiosis and regulating intestinal transit. In 50% of cases they underwent a weight loss program to reduce intra-abdominal pressure. All patients followed a post-operative rehabilitation protocol of the abdominal core and pelvic floor from the 20th post-operative day.

64.3. Results

The maximal intra-rectal width (as calculated by CT scan) of the 50 women allocated to Group I (only Mural-T) decreased from 46 mm to 3 mm after three months (p < 0.001); in the 50 women allocatedto Group II (MuralT + Burch anterior colposuspension), the maximal intra-rectal width decreased from of 65 mm to 1.1 mm three months after the intervention (p < 0.001), while in the remaining 50 women of Group III (MuralT + monocyte injection), it decreased from 49 mm to 0 mm.

In the group III, who received also the monocyte injection, mean rectal thickness was 12.8 mm at baseline and increased to 17.1 mm after three months (p < 0.001).

the patients who underwent combined operations were evaluated preoperatively and 6 months later with the stress test method for urinary incontinence.

A pre-operative and post-operative defeco MRI at 6 months for the evaluation of the pelvic floor. dysbiosis test on urine to evaluate the absence of intestinal dysbiosis after medical therapy.

Complications occurred in 3 patients (5%) and were related to aesthetic issues.

64.4. Conclusions

The Mural-T program treats all postpartum medical and surgical pathologies using a multidisciplinary team that uses combined methods with produced good results in terms of functional, aesthetical, morphological outcomes, and quality of life.

65. Microwave-Assisted Fat Reduction: A Game-Changing Technology for Body Contouring and Combination Treatments

• E. Guarino ¹

¹ 

Roma

65.1. Background-Aim

The microwave body remodeling system introduces a revolutionary, noninvasive approach to subcutaneous fat reduction and body contouring. Operating at 2.45 GHz, this system generates controlled dielectric heating, selectively targeting adipocytes in the hypodermis. Delivering 80% of its energy to the fat layer while sparing the dermis and epidermis, it disrupts adipocyte membranes, releasing fat in a liquefied, oil-like form. This not only facilitates natural fat elimination but also creates an ideal preparatory stage for combination procedures.

65.2. Methods

We conducted a study on 10 patients with localized belly fat in the peri-umbilical area. Each patient underwent a session of microwave treatment to liquefy fat, followed by micro-liposuction with a 14-gauge blunt cannula 48 h later. Patients were assessed during follow-ups at 15 days and one-month post-liposuction. At the one-month follow-up, all patients received a second microwave session to soften the treated area further and stimulate additional collagen production. Monthly follow-ups continued for six months to monitor progress and outcomes.

65.3. Results

No side effects were reported throughout the study. Patients expressed high satisfaction with the results, noting significant improvement in abdominal contour, skin smoothness, and elasticity. The microwave treatment effectively facilitated fat extraction during liposuction, making the procedure more manageable for the surgeon and minimizing trauma. The stimulation of collagen production contributed to better skin quality and recovery, achieving a harmonious and aesthetically pleasing outcome.

65.4. Conclusions

This study demonstrates the utility of the microwave system as an invaluable tool for surgeons performing combination treatments. Its ability to liquefy fat prior to liposuction simplifies the procedure and enhances outcomes, while its stimulation of fibroblast activity improves skin quality and elasticity. Integrating microwave technology into body contouring protocols offers a safe, efficient, and patient-satisfying solution for achieving optimal results.

66. Microwave Therapy as a Non-Invasive Adjunct to Enhance Post-Liposuction Healing: A Preliminary Study

• E. Guarino ¹

¹ 

Roma

66.1. Background-Aim

Liposuction, while effective for fat removal and body contouring, often results in superficial complications such as fibrosis, irregular skin texture, and residual fat deposits. These issues can compromise the aesthetic outcomes and patient satisfaction. Recently, microwave therapy has emerged as a potential non-invasive adjunct to improve healing and mitigate these side effects.

66.2. Methods

In this preliminary study, 20 patients (14 women and 6 men) who underwent abdominal liposuction were enrolled. A single microwave session was administered 20 days post-surgery. Weekly follow-up assessments were conducted using ultrasound analysis to monitor tissue changes and evaluate healing progression. Based on individual response, 10 patients received an additional microwave session one month after the initial treatment.

66.3. Results

Patients exhibited a marked improvement in skin quality and texture in the treated areas. Ultrasound evaluations demonstrated softening of the subdermal tissue, a significant reduction in superficial fibrosis, and the resolution of retraction. Importantly, no adverse effects or discomfort were reported during or after the microwave sessions. Overall, patient satisfaction was high, with all participants noting a noticeable enhancement in post-operative outcomes.

66.4. Conclusions

The application of microwave therapy as an adjunct treatment post-liposuction appears to be both safe and effective. The technique significantly improves skin texture, reduces fibrosis, and enhances the overall healing process, thereby addressing common superficial complications associated with liposuction.

These preliminary findings suggest that microwave therapy may serve as a valuable tool in managing post-liposuction side effects. By reducing fibrosis and improving skin smoothness, this non-invasive approach could optimize aesthetic outcomes and patient satisfaction. Future studies with larger cohorts and extended follow-up periods are warranted to further validate these results and refine treatment protocols.

67. Abdominoplasty After Weight Loss in Post Bariatric Surgery. An Optimized Surgery Procedure and Clinical Protocol

• F. Ciccarelli ¹

¹ 

Villa dei Fiori Acerra

67.1. Background-Aim

Weight loss after bariatric surgery causes very important modifications to the patient’s silhouette. Abdominal fat and skin excess reduction are associated with several complications. The most frequent are seroma and hematoma whereas major complications, such as pulmonary embolism, are less frequent. This study aimed to describe our technical procedure and clinical procedure for abdominoplasty in patients with massive weight loss after bariatric surgery.

67.2. Methods

This retrospective study included 221 post-bariatric patients who underwent abdominoplasty with Scarpa fascia preservation at Villa Dei Fiori Hospital between May 2022 and May 2024. Candidates were selected based on National Institute of Health criteria, with strict preoperative assessments and exclusion of high-risk patients.

Operative data, including BMI, excess weight loss (EWL%), complications, and outcomes, were collected. The surgical technique emphasized Scarpa’s fascia preservation and a comprehensive postoperative protocol, including tranexamic acid administration and early mobilization.

67.3. Results

The mean age of participants was 47.5 years, with an average preoperative BMI of 45 kg/m², reduced to 25.71 kg/m² after bariatric surgery. Postoperative complications included seroma (3%), hematoma (4%), wound infection (8%), and wound dehiscence (6%). Patients treated with tranexamic acid experienced significantly reduced blood loss (1.5 g/dL vs. 2.88 g/dL; p = 0.001) and shorter drainage durations. Scarpa fascia preservation reduced seroma formation and improved healing without increasing operative time.

67.4. Conclusions

This study underscores the importance of Scarpa fascia preservation in abdominoplasty for post-bariatric patients, reducing complications such as seroma and enhancing aesthetic and functional outcomes. Tranexamic acid further minimized complications without thromboembolic risk. Despite its retrospective design, the findings align with existing literature and support the adoption of this technique to improve surgical outcomes and patient quality of life.

68. Lipo-Brachioplasty According to Aly, Personal Experience

• Y. Macrino ¹, E. Petrucci ²

¹ 

Rome

² 

San Marino

68.1. Background-Aim

Thanks to the continuous development of bariatric surgery and new increasingly effective pharmacological protocols, losing weight today is much easier than it used to be, but as a result many more patients are turning to cosmetic surgery to treat the resulting skin outcomes that affect various body areas after massive weight loss. The aim of this work is to evaluate the use of a brachioplasty technique described by Dr Aly applied by the authors in 12 cases.

68.2. Methods

24 cases of bilateral brachioplasties performed on 12 patients are presented. All dermolipectomies were preceded and followed by aggressive and finishing liposculpture; the average age of the patients was 45 years (max 64 min 26), the average operating time was around 90 min, the follow up included checks at 5–15–30 days, 3–6–12 months.

68.3. Results

All the operated patients declared themselves very satisfied with the result of the operation. The technique proved to be simple and quick to perform and extremely effective for the quality of the final aesthetic result, for the little visibility of the scars and for their quality, in the total absence of major complications.

68.4. Conclusions

Brachioplasty according to Aly turned out to be a valid alternative to the classic Guerrerosantos technique. In our opinion, the fact that the scar is not visible to the patient in any way represents the maximum advantage of using this technique; The ease of execution, its safety and the minimal post-operative discomfort experienced by patients as well as the aesthetic results of undoubted value make us prefer this technique to others in the surgical treatment of dermatochalasia of the skin of the arms.

69. Lipo-Brachioplasty According to Aly, Personal Experience

• Y. Macrino ¹, E. Petrucci ¹

¹ 

Private practice

69.1. Background-Aim

Thanks to the continuous development of bariatric surgery and new increasingly effective pharmacological protocols, losing weight today is much easier than it used to be, but as a result many more patients are turning to cosmetic surgery to treat the resulting skin outcomes that affect various body areas after massive weight loss. The aim of this work is to evaluate the use of a brachioplasty technique described by Dr Aly applied by the authors in 12 cases.

69.2. Methods

24 cases of bilateral brachioplasties performed on 12 patients are presented. All dermolipectomies were preceded and followed by aggressive and finishing liposculpture; the average age of the patients was 45 years (max 64 min 26), the average operating time was around 90 min, the follow up included checks at 5–15–30 days, 3–6–12 months.

Brachioplasty according to Aly turned out to be a valid alternative to the classic Guerrerosantos technique. In our opinion, the fact that the scar is not visible to the patient in any way represents the maximum advantage of using this technique; The ease of execution, its safety and the minimal post-operative discomfort experienced by patients as well as the aesthetic results of undoubted value make us prefer this technique to others in the surgical treatment of dermatochalasia of the skin of the arms.

69.3. Results

All the operated patients declared themselves very satisfied with the result of the operation. The technique proved to be simple and quick to perform and extremely effective for the quality of the final aesthetic result, for the little visibility of the scars and for their quality, in the total absence of major complications.

69.4. Conclusions

Brachioplasty according to Aly turned out to be a valid alternative to the classic Guerrerosantos technique. In our opinion, the fact that the scar is not visible to the patient in any way represents the maximum advantage of using this technique; The ease of execution, its safety and the minimal post-operative discomfort experienced by patients as well as the aesthetic results of undoubted value make us prefer this technique to others in the surgical treatment of dermatochalasia of the skin of the arms.

70. Ultra BBL: Redefining Safety in Gluteal Augmentation

• A. Bruno ¹

¹ 

Private practice—Clinica Santa Maria di Leuca, Roma

70.1. Background-Aim

Gluteal augmentation with fat grafting, informally called Brazilian Butt Lift (BBL), is an increasingly requested procedure. This operation, however, can lead to potentially fatal complications. It is essential that fat grafting take place subcutaneously. However, even in the most experienced hands, there may be difficulties in ensuring a subcutaneous grafting, especially when a thin subcutaneous tissue is present. The use of ultrasound probes allows the procedure to be performed safely and has been strongly recommended by The Multi-Society Task Force for Safety in Gluteal Fat Grafting released in 2021.

70.2. Methods

From May 2022 to December 2024, 181 ultrasound-assisted gluteal fat grafting were performed, both as an isolated procedure, and in the context of abdominoplasty or Mommy Makeover. Adipose tissue was liposuctioned predominantly from the hips, sacral region, back and outer thigh. Fat grafting took place only in the subcutaneous site, both at the superficial subcutaneous space (to reshape specific areas) and at deep subcutaneous space (for volumetric increase of the buttocks). The Clarius HD3 L15 linear probe was used.

70.3. Results

No major or minor adverse events were found. The patient satisfaction rate was very high with a fat retention rate of 60–70%.

70.4. Conclusions

Gluteal fat grafting (BBL) has gained increasing popularity over the years. The intra-operative ultrasound use allows an increase in procedure safety (the implant takes place under direct vision) and improve the results, as it allows to precisely treat the most affected areas. The use of ultrasounds to guide the procedure led to the term of ULTRA-BBL.

71. Use of Technology in Optimizing Body Contouring of Buttocks and Thighs

• M. Moio ¹

¹ 

Private practice, Napoli

71.1. Background-Aim

Gluteal and legs remodeling is becoming more and more popular in Europe. However, the high increment in patient’s request can not hidden the historically high percentage of complications of this controversial procedure. Approaching gluteal enhancement impose to the surgeon a complete knowledge of anatomy, technique and technology in order to get the best possible results and to ensure patient’s safety. We present our approach combining different technologies to get the best remodeling of both the gluteus and the surrounding areas.

71.2. Methods

Between 2023 and 2025 we treated 58 patients for gluteal remodeling and volume enhancement with fat transfer with a combination of different technologies in order to enhance the results. Patient’s safety was also a priority considering the high percentage of complications described in the literature. No major complication was recorded and patient’s satisfaction was up to 98%.

71.3. Results

Gluteal fat graft has been related in the past to many complications including fatal episodes thus becoming the procedure with the highest risk in aesthetic surgery. The advent of technology has helped to make the procedure more effective and safe. Combination of different technologies with different objectives can improve every single phase of the surgery reducing the risks for the patients. An high-tech approach to this surgery is the key to the future of gluteal remodeling.

71.4. Conclusions

Combining different technologies may improve every step of gluteal remodeling starting from fat harvesting to its purification and re-injection. Complication rate can be dramatically reduced with the proper technique making this procedure safe again.

72. 3D Gluteoplasty Using Fat Prosthesis: A Tailored Approach to Body Contouring

• P. Vittorini ¹

¹ 

Presidio ospedaliero Villa Letizia-L’Aquila

72.1. Background-Aim

Gluteal laxity is a common aesthetic concern in both men and women. It can result from significant weight loss due to restrictive diets or emerge as a natural consequence of aging. Over time, the gluteal muscles lose volume and projection, while the overlying adipose tissue diminishes, contributing to a flattened and sagging appearance of the buttocks.

72.2. Methods

To restore balance and redefine the three-dimensional aesthetics of the pelvic girdle, a comprehensive body contouring approach is required. The most effective techniques for addressing central and lower posterior dysmorphia include buttock lifting combined with the sculpting of autologous fat prostheses, ensuring a natural and harmonious outcome.

72.3. Results

The gluteal region is meticulously reshaped to restore its youthful roundness, projection, and fluid contours. This is achieved by combining buttock lifting with the strategic use of fat island autografts, which act as natural prostheses to enhance volume and definition. Additionally, lipofilling is performed to refine the profile and smooth the transition zones between the buttocks and surrounding areas. Liposculpture of adjacent regions, including the trochanters and hips, further enhances the overall contour, creating an optimized silhouette.

72.4. Conclusions

This presentation will explore the timing, surgical planning, and intraoperative techniques essential for achieving both aesthetic refinement and functional restoration of the gluteal region. A fundamental principle in morpho-functional evaluation is recognizing the human body as a three-dimensional structure, which must be treated as such to ensure superior and natural-looking results.

73. Ultrasound Assisted Liposuction for Lower Limb Lipedema: A Single-Center Cohort of 191 Female Patients

• A. Murante ¹

¹ 

Hospital Henri Mondor, Paris

73.1. Background-Aim

Lipedema, a chronic condition affecting 11% of women, causes abnormal fat buildup in the lower limbs, leading to disproportionate body shape and functional problems. Often misdiagnosed, its cause is unclear, and conservative treatments are typically tried first. If these fail, surgical options like lymphatic-sparing liposuction, including ultrasound-assisted liposuction (UAL), may be considered. This study evaluates the effectiveness and safety of UAL for lower limb lipedema after six months of conservative treatment.

73.2. Methods

Our cohort included 191 patients with lower limb lipedema (stages 1–3) who underwent two stages of lymphatic- sparing UAL following six months of conservative treatment. Outcome measures included changes in pain assessment using visual analog scales, pannus thickness, aesthetic satisfaction, and the documentation of complications before and 12 months after the complete surgical treatment.

73.3. Results

Our protocol resulted in significant reductions in circumferences across all assessed regions (p < 0.001), with an average decrease of −6.396 cm [−9.268; −3.523]. Pain levels, sensitivity to touch, bruising, and other discomforts significantly decreased following liposuction (all p < 0.0001). Complication rates were within expected ranges, with no instances of postoperative phlebitis. All patients reported high levels of post-treatment satisfaction.

73.4. Conclusions

The integration of a comprehensive medical protocol for managing lipedema, combined with the use of next- generation lymphatic-sparing UAL in two-stage procedures for the lower limbs, shows promising potential. These findings highlight the effectiveness and safety of liposuction in treating lipedema, providing valuable insights for clinical practice. Long-term follow-up studies are necessary to confirm sustained efficacy.

74. Flaccidità Rizomelica Degli Arti Inferiori: Il Lifting di Coscia Lower Limb Laxity: Inner Thigh Lift

• A. Paci ¹

¹ 

Studio Andrea Paci, Roma

74.1. 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.

74.2. 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.

74.3. 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.

74.4. 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.

75. Gluteal Reshaping with Implants—Considerations on Possible Approaches After More than 20 Years of Experience

• V. Badiali ¹

¹ 

IEI—Istituto Estetico Italiano

75.1. Background-Aim

Gluteoplasty with implants is one of the fastest rising procedures in worldwide case histories. For several years, in Europe, the technique with totally submuscular implants placement has been preferred to other more common techniques in South America because of the extreme natural results that can be obtained.

This presentation aims to describe the characteristics of this technique by analyzing personal case history in terms of results and complications. Finally, it’s also proposed a comparison between the techniques.

75.2. Methods

Case history is analyzed through a computerized CRM system in a statistical manner. Instead, the comparison between techniques is based on personal sensitivity.

75.3. Results

The results demonstrate the very high reliability of this intervention. Despite this, some complications turn out to be extremely relevant. Specifically: 25.3% implant flipping; 21.5% temporary sciatalgia; 27% scar dehiscence.

Flipping rate was reduced to zero by using of biconvex implants while scar dehiscence was reduced to 14% by negative pressure dressing.

75.4. Conclusions

We believe that submuscular gluteoplasty is a surgical technique that every surgeon should be able to propose to his patients. Too often, however, it is precisely the specialists in the field who advise against this technique to their patients, only because they have not had a chance to approach it and appreciate its extreme simplicity. Despite this, there are limitations and complications that are important to know and discuss with selected candidates.

76. Correction of Complex Blemishes Between Surgery and Regenerative Medicine

• R. Castaldo ¹

¹ 

RC CLINIC—NAPOLI

76.1. Background-Aim

The correction of complex facial imperfections often requires a multidisciplinary approach integrating surgical and regenerative techniques. This study aimed to demonstrate the efficacy of advanced surgical scar revision, PRP (platelet-rich plasma) therapy, ultrapulsed CO₂ laser treatment, and autologous fat grafting in achieving significant improvements in aesthetic and functional outcomes.

76.2. Methods

Three patients with distinct conditions were included in the study: a 55-year-old male with a sharp weapon-induced scar on the forehead, a 44-year-old female with facial hypotrophy and hypotonia, and a 38-year-old male with stress- induced alopecia. The following interventions were performed:

• Surgical scar revision combined with PRP therapy and ultrapulsed CO₂ laser for scar remodeling.
• Autologous fat grafting (lipofilling) to restore facial volume and improve skin quality.
• PRP therapy for alopecia, following a standardized protocol of five monthly sessions with blood centrifuged at 3000 rpm for 5 min and subsequently at 3000 rpm for 3 min to isolate the plasma fraction.

76.3. Results

In the first case, the combined scar revision approach significantly improved scar appearance, with enhanced skin texture and elasticity. The second case demonstrated marked facial rejuvenation, with increased volume and skin tone, highlighting the regenerative properties of autologous fat. In the third case, trichoscopic analysis and photographic evidence confirmed increased hair density and regrowth, with patients reporting high satisfaction levels. Overall, all three patients achieved 100% satisfaction, reflecting the efficacy of the interventions.

76.4. Conclusions

The results underline the transformative potential of integrating surgical precision with regenerative medicine for complex facial corrections. Scar revision using PRP and ultrapulsed CO₂ laser, fat grafting for rejuvenation, and PRP for hair restoration demonstrate outstanding aesthetic and functional outcomes. These findings reinforce the importance of a personalized approach in addressing complex facial imperfections, leveraging the biological properties of autologous tissues to achieve superior results.

77. Skin Regeneration with Autologous Adipose Tissue on Areas Pre-Stimulated with Multi Beam Simultaneous 1550 and 1927 nm Fractional Portable Laser

• E. Gandolfi ¹

¹ 

Private practice

77.1. Background-Aim

The authors present their experience with adipose transfer for regenerative purposes, in combination with the use of laser technologies on the recipient area, aiming to enhance the regenerative capabilities of the transferred stem cell components.

International literature and experience gained through the use of various equipment to pretreat the recipient skin before the transfer of autologous adipose tissue have demonstrated that this technique contributes to better clinical outcomes. Additionally, in treating skin areas affected by various pathologies, the regenerative action has shown improvement. The authors present their own method of skin pretreatment performed a few hours before the injection of regenerative adipose tissue.

77.2. Methods

The study used a fat transfer method based on the SEFFI procedure and portable dual simultaneous wavelength fractional laser technology (1550 nm and 1927 nm) for stimulation. For facial areas, 24 h before the adipose tissue injection, after applying a lidocaine-based anesthetic cream for about 30 min, the skin is treated with a dual- wavelength laser using variable powers ranging from 15 to 25 mJ for the 1550 nm wavelength and 0 to 4 mJ for the 1927 nm wavelength, depending on the patient’s skin type. The treatment density is adjusted according to the area’s size. The treatment should be painless and cause only mild redness that subsides within a few hours. Twenty-four hours later (or less for highly vascularized areas), the regenerative and, if necessary, volumizing SEFFI method is used for adipose tissue injection.

77.3. Results

The authors present their results through case studies and discuss the indications, contraindications, and complications.

77.4. Conclusions

The authors illustrate how this method of pretreating recipient tissues enhances and improves the regenerative effect of the vascular stromal component contained in the transferred adipose tissue.

78. Submental and Cervical Skin Laxity Treatment with Subcutaneous Blue Laser Fiber: Prelimimary Study

• R. Fortunato ¹

¹ 

Villa Stuart BAC Aesthetic Center, Roma

78.1. Background-Aim

Background and objectives

Submental and cervical skin laxity is a common aesthetic concern, often treated with invasive or non-invasive approaches with variable efficacy. This study evaluates the efficacy and safety of subcutaneous blue laser fiber treatment in improving skin firmness in this anatomical region.

78.2. Methods

Twenty patients underwent a single treatment with subcutaneous blue laser fiber. The procedure was performed under local anesthesia, following a standardized protocol for laser energy delivery. The primary outcome was the improvement in skin laxity, assessed through standardized photographs at 3 and 6 months post-treatment.

78.3. Results

Image analysis showed a visible improvement in skin laxity as early as 3 months, with further progression at 6 months. The treatment was well tolerated, with no significant adverse events reported.

78.4. Conclusions

Subcutaneous blue laser fiber proved to be an effective and safe option for treating submental and cervical skin laxity. The results suggest a progressive improvement over time, supporting the potential of this technology as a minimally invasive alternative to traditional surgical procedures.

79. Autologous Facelift: Regenerative Endoradiofrequency

• M. Maietta ¹, J. Valle ²

¹ 

SSD Chirurgia Maxillo Facciale Ospedlae San Giovanni Bosco Torino

² 

Università degli studi di Torino

79.1. Background-Aim

Regenerative medicine and minimally invasive solutions are more request from elderly to young patients, in male and female people. Furthermore people don’t like stay a long downtime but they ask shorther healing time. Less pain and less admission in medical clinic.

79.2. Methods

After local anesthesia with adrenaline and physiological solution.

Subcutaneous probe with RF was used. The main feature of this tool is to regulate temperature from 49 °C to 57 °C. For each patient is used different temperature for each region also. Various time of application for face and neck.

Time application mean 30 min (between 20′ to 45′), advanced technique with multiple tunneling in every areas. From 1 to 3 access point. 1 time in year.

Application of PDO threads or biomimetic peptides, or PRP, immediately after or 3 months after the procedure, have been performed according to biological rejuvenation process.

79.3. Results

Patient satisfaction is immediate. We can see peak of effect at 3 months but patient keep seeing improvement until up to 6 months.

Thanks to the ENDO RF, different effects have been obtained:

• The harnessing of RF energy to deliver heat to dermal structures results in nonsurgical lifting
• tightening of tissue without disruption of epidermal integrity
• collagen regeneration
• good result in cases of moderately sagging skin.
• neocollagenesis without integumental injury
• dermal collagen contraction
• elasticity increase
• skin smoothness improvement Temporary discomfort:
• edema (first week)
• bruise (first 2 w) 2 Pts
• pain in treated areas not all patients

79.4. Conclusions

EndoRF technology has emerged as an effective method to safely tighten skin and reduce underlying fat tissue.

As our armamentarium expands we have the opportunity to treat a variety of skin conditions, particularly, skin wrinkling and laxity to double chin or localized fat. In particular subcutaneus application with RF endo probe helps medical practice to achieve a goal.

80. Rinofiller the Next Level: How to Safely Treat Difficult, Operated, Traumatized Noses

• S. Adriano ¹

¹ 

A.Santorelli & Partners

80.1. Background-Aim

Rhinofiller is a treatment now commonly used in aesthetic medicine but also in post rhinoplasty revision surgery. Like all fashions, however, it is open to forcing or abuse by poorly qualified professionals, in fact it is a complex procedure related to potentially serious complications.

80.2. Methods

The author, after a decade of experience in the field of nose injectables, evaluation of anatomical preparations, shares the rhinofiller method with the development of treatment plans for complications.

80.3. Results

The results of more than 2000 patients treated in the last 10 years demonstrate that rhinofiller, if well planned, and with an accurate selection of the patient and above all a careful and rapid resolution of the complications, is a method that any plastic surgeon must learn to use wisely.

80.4. Conclusions

Rhinofiller has brought about an important evolution in the world of aesthetic medicine. This procedure can be widely used both as a primary treatment and as a correction of rhinoplasty outcomes. The selection of the patient and the accurate injection technique that allows this procedure to be performed safely remain at the center of the treatment.

81. Mesorhinofiller the Right Non-Surgical Nose Reshaping Between Safety, Beautiful and Stable Results

• F. Romeo ¹

¹ 

Studio Romeo

81.1. Background-Aim

The use of hyaluronic acid as a filler for the improvement and harmonization of the nasal shape also in the total facial profile, is one of our elements of choice, in small corrections, in patients who show unwillingness to receive rhinosurgery.

This approach has produced convincing and satisfactory results.

In MesoRhinoFiller approach and technique is mandatory to use the H.A. filler in direct injection into the dermis.

81.2. Methods

The author, who thought up, developed and published the MesoRhinoFiller, (•Profiloplasty in One Session Versus Single Treatment Areas Dermatologic Surgery July 2021 Vol 47—Issue 7—pp. 953–958 doi:10.1097/DSS.0000000000003060).

• An innovative approach for nasal reshaping using hyaluronic acid intradermal injections (Journal of Cutaneous and Aesthetic Surgery 2023 Aug 04 DOI 10.4103/JCAS.JCAS_225_22). explains what he believes to be the key points of harmonizing the nasal profile. We have 4 key points. By focusing on improving the nasofrontal angle, dorsum nasi (Clepsydra), nasal tip and nasolabial angle, are presented planning, technical measures and implementation criteria.

Material used: hyaluronic acid cross linked with medium density, high elasticity and low viscosity, with needle implanted length of 4 mm and gauge smaller than the one indicated by the manufacturer of the device. It’s mandatory to inject the filler into the dermis.

Inclusion criteria: small corrections, corrections higher in patients who show unwillingness to receive rhinosurgical treatment, minor corrections and additions of previous rhinosurgery, patients no longer willing to receive additional rhinosurgical treatment, post trauma treatment.

Patient’s age range is between 21 and 62 years of age, average 38 years.

Exclusion criteria: autoimmune diseases in active phase, infections or trauma in or next to the area to be injected, patients with no idea of the target result offered by the technique.

If the technique is performed correctly, with dermal injection, dramatic major adverse events do not occur: skin necrosis and amaurosis.

All patients have signed detailed informed consent and was shown to them and commented on a large number of clinical cases with photos before and after treatment of conditions the same to their own.

Evaluation of results with detailed photographic comparison measuring methods and analysis: Clinical evaluation, standardized Digital Photography, level assessment with Visual Rating Scale of satisfaction.

81.3. Results

Achieved results have in all patients ticked off a score around 0 and 5, after twelve months follow up, on a satisfaction rating scale from—3 as the worst score and +3 as the better one (according to a 5 score as the best final result “expected” by the patient after treatment). −85% range 4–5 and 15% 3—two months after that the improvement was considered completed by the Author.

81.4. Conclusions

The use of hyaluronic acid as a filler for the improvement and harmonization of the the nasal profile and shape is one of our elements of choice and is sets a standard in the author’s working procedures, in safety and with beautiful results. The excursus on the various cases presented are helpful to understand the easy applicability of the technique.

82. Rhinofiller vs. Primary and Secondary Rhinoplasty. Indications and Limits Using the Less Technique (Long Term Efficacy, Safety, Stability Technique)

• L. Cravero ¹

¹ 

Private practice

82.1. Background-Aim

Filler rhinoplasty has the following uses:

• Auxiliary to rhinoplasty, with the aim of fixing some residual irregularities;
• Alternative to rhinoplasty. In this case, clinical studies suggest that rhinofiller is often less effective than surgery. The reasons why it is chosen are the reticence of the patient to have surgery or the lower cost.

The aim of this paper is to address the question of the Rhinofiller as an effective alternative to rhinoplasty with a personal technique (LESS).

The LESS Technique (Long term efficacy, Safety Stability Technique) combines less trauma and oedema with long term efficacy, safety and stability.

• Long term efficacy because of the utilization of a very high G prime specific hyaluronic acid.
• Safety because of the exclusive use of a 25 Gauge cannula in 95% of cases (needle is just utilized for little intradermal adjustments or to push down the nostrils in the pinched nose defect) with only two access points.
• Stability because tip is always stabilized during facial mimic movements with columellar hyaluronic grafts, between and behind the medial crura, so botulinic toxin for depressor septum muscle is never needed.

Based on 300 cases we found out new anthropological measures, which can be used as indications of the technique choice (medical or surgical). We can also formulate some hypothesis on the long lasting effect of the results, based on a 6 year experience.

82.2. Methods

We used high G prime hyaluronic acid. We performed a one shot treatment and a clinical follow up from 1 year to 6 years.

82.3. Results

The rhinofiller is comparable to surgical rhinoplasty in patients whose nasal radix height is less than 1.3 cm. Otherwise, this technique seems to be less effective than surgery, since the nasofrontal angle has to be excessively increased. The six year study with very high G prime hyaluronic acid allowed us to find stable and long lasting results. We found that also after some years corrections are not always necessary. A possible explanation of this stability is the biochemical composition of the tissue cartilages neighbourhoods. Furthermore, the scar tissue may favour the stability of the nonsurgical rhinoplasty result, if it is performed after a rhinoplasty.

82.4. Conclusions

This study allows us to find out some indications that make the nonsurgical rhinoplasty an effective alternative to rhinoplasty.

83. Rhinoplasty with Threads vs. Fillers vs. Surgery: Pros and Cons

• K. Sulamanidze ², M. Tsivtsivadze ¹

¹ 

Clinic Total Charm Orbeliani, Unit Aesthetic Plastic Surgery

² 

Clinic Total Charm Orbeliani, Unit of Aesthetic Plastic Surgery

83.1. Background-Aim

Rhinoplasty is one of the most popular cosmetic procedures aimed at improving the appearance and function of the nose. Over the years, various techniques have emerged, including thread lifting, dermal fillers, and traditional surgical rhinoplasty. Each method offers distinct advantages and limitations. This study aims to compare the effectiveness, safety, and patient satisfaction of these three approaches.

83.2. Methods

This comparative analysis involved a review of clinical studies, patient surveys, and surgical outcomes from 2007 to 2024. Data were collected on patients who underwent thread lifting, dermal filler rhinoplasty, or traditional surgical rhinoplasty. Factors such as procedure duration, recovery time, cost, complications, and aesthetic results were evaluated. During these 3 different methods was evaluated complications types for each procedure, and advantages right after and during long term results.

83.3. Results

Thread lifting provided minimal invasiveness with a shorter recovery period (average 1–2 weeks), but the results were less permanent and suited for subtle changes. Rhinofillers were quick, non-surgical, and yielded immediate results but also had a shorter duration (6–12 months) and potential complications such as migration and overfilling. Traditional surgical rhinoplasty offered the most permanent and dramatic changes, with an average recovery time of 4–6 weeks, but it was the most invasive and costly procedure.

83.4. Conclusions

Thread lifting and fillers are viable options for patients seeking non-invasive rhinoplasty with minimal downtime, but they offer temporary results. Surgical rhinoplasty remains the gold standard for patients desiring significant, long- lasting alterations. The choice of procedure should be tailored to the patient’s needs, desired outcomes, and willingness to accept recovery time and potential risks.

84. Rhinofiller: New Proposal & Latest Trends

• A. Quaranta ¹

¹ 

Freelancer

84.1. Background-Aim

Capable of enhancing the overall aesthetics of the face by simply modifying small details of its profile, rhinofiller is now one of the most requested procedures. This non-surgical technique involves injecting hyaluronic acid filler into specific points of the nose, with the aim of filling concavities and hiding convexities, with shorter recovery time compared to surgical rhinoplasty.

84.2. Methods

The author presents two different injection techniques for the total beautification of the nose using micro-quantities of filler (maximum 0.5 mL) at a deep supra-periosteal level.

The first technique is performed with a 25 G 40/50 mm cannula and a resilient cross-linked hyaluronic acid filler [25 mg/mL]. It involves one step, a single entry point at the tip of the nose. The filler is released retrogradely from the root to the tip, excluding the nasal hump. The tip is then reshaped and finally rotated downwards by releasing a bolus in the columella area.

The second technique is performed with a needle and involves the injection of dynamic cross-linked hyaluronic acid filler [23 mg/mL] into the outer edge of the nostrils to reduce the alar flare.

84.3. Results

Excellent results were achieved in all treated subjects, with no serious adverse events reported. The author presents her personal injection technique, illustrating the results obtained and sharing her experience and tips for a safe execution of rhinofiller.

84.4. Conclusions

Rhinofiller is a highly popular treatment with remarkable results. Non-surgical nose reshaping with hyaluronic acid filler allows for a complete beautification of the nose and of the facial profile without opting for surgery. Rhinofiller is therefore a quick, safe, and effective aesthetic medicine treatment that provides great satisfaction for both patient and Hcp. It delivers immediately visible results and it is suitable even for complex cases, for those who cannot or do not want to undergo surgery, and in difficult cases where surgery failed.

85. Rinofiller Versus Rhinoplasty: Indications and Contraindications

• M. Galati ¹

¹ 

Specialist in Plastic, Reconstructive and Aesthetic Surgery, Lecce-Milano

85.1. Background-Aim

The study presented aims to identify the cases of nasal deformities that are indicated for treatment with rhinofillers and the cases that instead require surgical treatment.

85.2. Methods

The rhinofiller is an excellent procedure that involves the use of hyaluronic acid to reshape the nose.

The rhinofiller, if performed correctly, produces excellent results by correcting in particular a cartilaginous and bony hump, modifying the height and rotation of the tip. Paradoxically, a nose after infiltration, despite the addition of volume, may seem smaller than at the start as the proportions between the various parts are more harmonious.

There are nose deformities and certain nasal anatomical features for which the rhinofiller is contraindicated, where a treatment with hyaluronic acid could aggravate a deformity and the only alternative is surgical rhinoplasty.

85.3. Results

This study defines, through the presentation of clinical cases, the correct indications and contraindications for the use of rhinofiller and at the same time demonstrates how particular deformities can only be corrected with the surgical treatment of rhinoplasty.

85.4. Conclusions

The study demonstrates that the rhinofiller is an excellent tool for the correction of certain imperfections of the nose, however it has limitations dictated by some characteristics of the nasal structure for which the only remedy for improving the aesthetic shape is represented by surgery of rhinoplasty.

86. The First Traction and Biostimulation Thread with Polylactide and Hyaluronic Acid with 4th Generation “NAMICA” Technology: Analysis of Technical Characteristics and Comparison with Other Kind of Threads

• P. Contini ¹, S. Elena ²

¹ 

Chirurgo Estetico Libero-professionista, Roma

² 

Dermatologa Libero-professionista, Milano

86.1. Background-Aim

The aim of the presentation is to describe technical and composition characteristics of the only traction and biostimulation thread present on the market today with hyaluronic (HA) and polylactide acid (PLA) with policaprolactone (PCL), with a focus on “Namica”technology, or the addition of a polylactide acid micro particle coating containing non cross-linked HA.

We will do also a comparison between different kind of threads, underlying the main differences in terms of traction capacity, duration and biostimulation.

86.2. Methods

The presented results will be the result of a review of the literature.

86.3. Results

Threads with P(LA/CL) and HA, have shown a total reabsorption time of 24 months and 50% in 16 months. PDO threads have instead demonstrated a total reabsorption time of 6 months and 50% in 2 months. PLGA threads have shown a total reabsorption time of 8 months and 50% in 3 months.

The number of elastin fibers was significantly higher in HA threads vs. threads without HA, this difference is even more evident in threads with Namica technology (2.5 times superior).

In threads with HA the type 1 and 3 collage production mas on average 24.7% higher than threads without HA, in threads with Namica technology type 1 and 3 collagen production was 3 times higher.

Threads with PLA/PCL have shown traction capacity of 9.02 N, threads with PLA/PCL/HA 11.0 N, threads with PLA/PCL/ HA and Namica technology 12.5 N.

86.4. Conclusions

The main benefits of adding HA to the thread composition are therefore the following: greater tratction capacity, fast recovery, reduction of inflammatory response, a greater production of elastin and type 1 and 3 collagen, longer duration. Those differences are more important in threads with HA and Namica technology.

87. Endoradiofrequency: Protocols by Anatomical Region

• C.G. Bonuccelli ¹

¹ 

SIES

87.1. Background-Aim

Background: the main characteristics of aging skin are represented by skin wrinkles, laxity and skin roughness. For rejuvenation of skin multiple treatmnets have been proposed ranging from injectables to ebd; the optimal approach resides in combined protocols, developed for each area, that exploits the synergistic effect of different medical devices. The purpose of this study is to observe the clinical effect of Endoradiofrequency, combined with other devices or alone, on different areas of the face and body.

87.2. Methods

Several patients, male and female, of variable age, underwent endoradiofrequency alone or combined with biostimulator agents, filler or other EBD devices. All the details, the operative techniques subdivided per anatomical region, the patient selection, complications, and patient satisfaction survey are described. Endoradiofrequency uses a percutaneous treatment probe to tighten the skin by contraction of the underlying fibroseptal network in addition to induction of neocollagenesis, elastogenesis, and angiogenesis at skin surface temperatures of 40° to 50 °C. Endodermal Radiofrequency ensures significant improvements that manifest in the weeks and months after the treatment, the combination with other medical devices not only cover the gap between the treatment and the results that usually appear after some weeks but also improve them thanks to the synergistic effect.

87.3. Results

The included patients were both female and male. All patients were followed up for a minimum of 6 months. Based on the GAIS scale a “marked improvement” 6 months post procedure were found in the majority of the patients. There were no adverse events reported.

87.4. Conclusions

Endoradiofrequency, alone or combined with other medical devices, represent a safe procedure to achieve significant improvement of the skin laxity, skin wrinkles and skin quality.

88. Application of Polylactic Acid as a Surgical Alternative in Cases of Post-Liposuction Irregularities

• E. Bevilacqua ¹, M. Moio ²

¹ 

Clinica Madonnina Milano, Clinica Quisisana Roma

² 

Clinica Ruesch Napoli

88.1. Background-Aim

Liposuction is one of the most popular cosmetic surgery procedures. Among the main post-liposuction complications that is often the cause of forensic litigation as well as secondary intervention is the irregularity of the contour due to hypercorrection. Many patients complain of superficial irregularities from liposuction and do not accept a second operation.

It is precisely in these cases that the use of a non-invasive treatment is useful as it can reduce post-operative irregularities and give the skin a homogeneous, uniform and compact appearance with a progressive improvement such as polylactic acid (PLLA).

88.2. Methods

Patients were selected based on their medical history (having undergone liposuction) and the presence of overcorrection outcomes or lipodystrophies residual from liposuction. The selected 15 patients, of which 13 are female and 2 male, all have a BMI of less than 30 kg/m². Of the 15 patients, 8 had undergone liposculpture surgery on the buttocks, 4 liposuction on the thighs, 3 patients on liposuction on the abdomen.

All patients were treated according to a protocol that includes three sessions spaced 40 days apart.

The volume of distribution of PLLA per area applied was 0.05–0.2 mL at a distance of 0.5–1 cm. The amount of product required varies from patient to patient and is related to the size of the area to be treated, skin quality, age and BMI of the patient.

88.3. Results

Already following the first session, patients reported an improvement in skin texture in terms of firmness and tone. In all the cases treated, there was an improvement in both volumetric and qualitative terms due to the nature of PLLA being both a filler and a biostimulant.

The areas of hypercorrection remaining from liposuction were resolved with a great degree of satisfaction on the part of the patients.

88.4. Conclusions

Polylactic acid is an extremely effective and relatively safe aesthetic medicine treatment if used expertly. The dual nature (filler and biorestructuring) allows this biopolymer to be used precisely in cases where there is a loss not only of volume but also of tone and compactness due to the poor quality of the tissues.

In cases of hypercorrection from liposuction, polylactic acid has presented itself as a valid alternative to surgical revision due to its low invasiveness, cost (lower than a second surgery) and rapid post-procedural recovery.

89. Ual and Laser Microfiber 1470 nm: A Winning Combo for Body Remodeling

• S. Toschi ¹

¹ 

Private practice

89.1. Background-Aim

Nowadays a body remodeling treatment could not be planned if the reduction of the fatty tissue excess and of the skin laxity are not performed in the same session to obtain a smooth and long-lasting result. This requires the use of some of the many combined techniques, thanks to the wide range of technologies available. Particularly the use of ultrasound-assisted liposculpture (UAL) followed by laser microfiber 1470 nm 400/600 micron, allows to obtain excellent results using only local anesthesia as an in office procedure.

OBJECTIVES: to evaluate the ideal parameters for the 2 combined techniques (duration of the emulsifying phase, amount of harvested fat, settings of the laser treatment) in the different body areas, in order to create specific guidelines.

89.2. Methods

For the reduction of adipose excess, the LESC (subcutaneous lipoemulsion) technique was used. It involves an ultrasonic cannula with a diameter of 2 mm to carry out the emulsifying phase of the treatment, followed by aspiration with Mercedes type 2.5 mm cannulas titanium coated. A ring laser microfiber of 400 or 600 microns (related to the different body areas) was used to tighten with power (Watt) and temperature (Ton and Toff) modulable according to need. The results were evaluated by pics at T0,T30 and T90 and using the GAIS scale.

89.3. Results

The analysis of photographic images and the reduction values of the GAIS showed the validity of the combined technique. Particularly, none of the treated patients had at 3 months GAIS values of 4 or 5, with an overall average of 2.4.

89.4. Conclusions

The use of the combination between ultrasound and laser 1470 allows to treat easily and safely in a single session patients who need for a remodeling of one or more body areas where fatty tissue excess and skin laxity are simultaneously present, such as the abdomen, inner thighs, arms, back and neck. To optimize the results, it was crucial to create guidelines that allow define the settings for each body area according to its size, consistency, amount of adipose excess and degree of laxity.

90. High-Intensity Focused Ultrasound (HIFU) for Facial Rejuvenation: A Systematic Review of Efficacy, Safety, and Long-Term Potential

• V. Zecchin Ferrara ³, F. Falaschi ², A. Keramidas ¹

¹ 

Department of Otolaryngology, HEPA hospital, Greece

² 

Faculty of Medicine and Surgery, UniCamillus, Roma, Italy

³ 

Faculty of Medicine and Surgery, University of Padova, Padova, Italy

90.1. Background-Aim

High-intensity focused ultrasound (HIFU) is an emerging technology in aesthetic medicine that offers a non-invasive approach to skin rejuvenation. By delivering targeted ultrasound energy to the deeper layers of the skin, HIFU induces controlled thermal injury, stimulating collagen production and tissue remodeling. As a result, it is increasingly being adopted as an alternative to surgical procedures for improving skin laxity and reducing wrinkles. This study aims to systematically evaluate the efficacy, safety, and long-term potential of HIFU for facial rejuvenation.

90.2. Methods

A systematic review of the literature was conducted to assess the efficacy and safety of HIFU for facial skin laxity improvement. Searches were performed in the Scopus, Embase, and PubMed databases from 2010 to January 30, 2025. Among 118 articles screened, 16 met the inclusion criteria, encompassing a total of 412 patients.

90.3. Results

The findings indicate that HIFU treatment significantly improves skin elasticity and reduces wrinkles. Several randomized controlled trials reported a measurable increase in skin elasticity, assessed using a cutometer, three months post-treatment (p < 0.01). Patients experienced progressive tightening effects, attributed to neocollagenesis and elastogenesis. Regarding safety, HIFU was generally associated with mild and transient adverse effects, primarily temporary erythema and edema, which resolved within a few days without intervention.

90.4. Conclusions

HIFU has been shown to be an effective and safe non-invasive modality for facial rejuvenation, providing significant improvements in skin elasticity and wrinkle reduction with minimal adverse effects. However, further long-term studies are necessary to confirm the durability of these outcomes and refine treatment protocols.

91. Lifting Face and Neck Lift with Focused Ultrasound Micro Pulsed Technology + Ultra-Booster Personal Protocol

• A. Pacifici ¹

¹ 

Clinica Laser

91.1. Background-Aim

The main treatment for correcting sagging skin on the face and neck is surgical lifting. There are also other less invasive procedures than surgery that use fiber lasers, fractional radio frequencies or through a cannula or the implantation of anchoring threads. For those who do not want to undergo such invasive procedures and with a sometimes quite uncomfortable downtime, focused ultrasound (HI-FHU) can certainly represent an absolutely valid and acceptable alternative, which is also repeatable. A completely personal protocol is presented that involves preceding the HI-FU treatment, to emphasize its action, with the application of ultra-booster Pen type circular grip.

The most appropriate options to choose, and any combinations, are evaluated based on the individual situations to be treated.

91.2. Methods

The protocol involved the use of HI-FHU as per literature (one or two sessions 60/90 days apart) to emphasize its action, the application of ultra-booster Pen type circular grip.

91.3. Results

In addition to the degree of satisfaction of the Patients, mainly linked to the result and the excellent down-time, for a more correct evaluation of the clinical results, an adequate iconography, “pre and post” treatment, is presented, acquired both with digital photographic equipment and with an innovative, but widely consolidated “photographic system”, capable of detecting the skin texture and the melanin and hemoglobin content.

91.4. Conclusions

The use of ultra-booster Pen type circular grip allows to emphasize the result all this allows to better follow the patients and accompany them, especially the most critical ones, until a possible second application of HI-FHU.

92. What Is the Role in Tissue Regeneration of Human Exosomes Derived from Microfragmented Autologous Adipose Tissue and Their Comparison with Plant Exosomes

• A. Casadei ², B. Zavan ¹

¹ 

Department of Translational Medicine, University of Ferrara

² 

Libero Professionista Venezia-Mestre

92.1. Background-Aim

Adipose tissue stem cells (ADSCs) are considered an ideal source for regenerative medicine, as they can be easily obtained via liposuction under local anesthesia. Studies have shown that the best results are obtained with smaller fat clusters and more superficial harvest (SEFFI).

The stromal vascular fraction (SVF) of adipose tissue contains several interconnected cells that promote tissue regeneration. ADSCs can secrete bioactive molecules that stimulate angiogenesis and have beneficial properties for the skin. In addition, SVFs/ADSCs induce the secretion of cytokines and growth factors and produce exosomes, nanometer- sized vesicles, which are mediators of intercellular communication in normal physiology, immunological function, and diseases. They contain microRNAs that affect cell proliferation, apoptosis, and differentiation.

While many studies have emerged on the function of exosomes, several questions still remain open. The packaging and secretion of exosomes in different contexts modify exosomal composition, which may in turn impact delivery, uptake and cargo function in recipient cells. A mechanistic understanding of the biology of exosomes is therefore crucial to investigating their function in complex biological systems and to the development of new therapeutic approaches. The steps of exosome biogenesis are outlined, including endosome formation, multivesicular body (MVB) formation, cargo sorting and extracellular release, as well as exosome absorption, including targeting, interaction with recipient cells and the fate of internalized exosomes. In addition, to providing a framework of exosome dynamics, current evidences on the main regulatory pathways and mechanisms are summarized.

92.2. Methods

The Injection of autologous adipose-derived stem cells (ADSCs) and stromal vascular fraction (SVF) into dermal and subdermal layers can improve skin volume and rejuvenation. The SEFFI (Superficial Enhanced Fluid Fat Injection) technique, which involves minimal manipulation of autologous microfragmented adipose tissue, was utilized for harvesting and re-injection, using the SEFFILLER™ disposable medical device. Mechanical fragmentation of adipose tissue is a well-established surgical technique that stimulates tissue regeneration, filler, and biological activity.

A randomized controlled clinical multicenter trial was conducted in 24 consecutive patients with facial aging (skin atrophy and volume loss), chronic wound, and soft tissue post-traumatic lesions of the lower limbs with the goal of regenerating tissues. The study participants were recruited at the time of request and taken care of by three different surgeons. They were randomly divided into two groups, whose demographic characteristics were = Group A: (3 F–9 M; average age 46.6 yrs) Group B: (5 F–7 M; average age 46.8 yrs). Each patient underwent adipose tissue harvest into the selected donor site under local anesthesia After aspiration, the fat was mixed with cold Ringer’s solution to rinse it from the anesthetic and to facilitate tissue precipitation.

Two different methods of collecting and processing adipose tissue were used. One sample each patient, harvested from human adipose tissue during surgical procedure, was sent to the laboratory.

92.3. Results

The study evaluated the biological properties (regenerative, anti-inflammatory and anti-aging) of different harvest and processing fat graft methods among which the fragmented adipose tissue, specifically focusing on the presence of exosomes. Exosomes, nanometer-sized vesicles produced by cells for cellular communication, were found to contain miRNAs with anti-inflammatory, regenerative, and vascular content. The products’ contained exosomes were confirmed in the study through electron microscopy, Western Blotting, gene expression, and sequencing of miRNA content.

In vitro treatment of fibroblasts with exosomes obtained by this fragmentation technique showed a 23% greater increase in the production of hyaluronic acid, type I collagen, and elastin compared to other techniques.

92.4. Conclusions

The comprehensive characterization of exosomes derived from adipose tissue fragments underscores their potential as potent therapeutic agents in combating the effects of aging and promoting tissue regeneration. The amalgamation of robust experimental methodologies, coupled with compelling translational outcomes, positions these exosomes as promising candidates for clinical applications aimed at rejuvenating tissues, ameliorating age-related ailments, and advancing the frontiers of regenerative medicine.

93. Efficacy and Safety of Injectable Polydioxanone in Facial Rejuvenation

• F. Lino ¹

¹ 

Caserta

93.1. Background-Aim

Injectable polydioxanone (PDO) represents an innovative frontier in the field of collagen inducers. This biocompatible and biodegradable synthetic polymer works by stimulating collagen production through an inflammatory reaction mediated by macrophages. This case series study evaluated the efficacy and safety of injectable PDO in 60 patients.

93.2. Methods

Treatment areas were selected based on individualized clinical assessment. Administration took place via a 23 G cannula with a standardized technique.

93.3. Results

Follow-up included photographic documentation, assessment of GAIS and adverse events.

93.4. Conclusions

The treatment demonstrated a safety and efficacy profile in line with international literature. No significant adverse events were recorded. The level of patient satisfaction was high.

94. Restoration in Mid-Facial Aging: A Quantitative Evaluation of the Efficacy of Hyaluronic Acid Gel Injections—The Imperative to Optimize the Injection Volume Based on Anatomical Considerations

• A. Diaspro ¹

¹ 

Private practice

94.1. Background-Aim

The attractiveness of the central area (the so-called mid-face area or middle third) as it has a strong impact on the observer and he treatment of its ageing is therefore considered a key component in facial rejuvenation. A standardized photographic and three-dimensional analysis was conducted in this observational study to determine the outcome of volumetric restoration procedures of the mid-face area with hyaluronic acid (HA) injection, providing an objective, repetitive and reliable evaluation of this facial rejuvenation technique.

94.2. Methods

47 patients were treated with two types of HA-based dermal fillers and calibrated, stereoscopic images of the face were taken and volume reconstruction and analysis software done before (t0), 45 days after HA implantation (t1), and at the check-up after the end of follow-up (t2).

94.3. Results

39 of 47 patients completed the study which showed an overall volume restoration of 4.46 ± 1.34 mL at 45 days (t0–t1) after HA implantation, maintaining a value of 1.23 ± 0.68 mL at the end of the 318-day follow-up (t0–t2).

94.4. Conclusions

The results of this study indicate that rejuvenation of the mid-facial region through volumetric restoration with HA filler leads to an indirect volumetric effect that is clinically more significant than the actual injected volume, and equally long-lasting.

95. Complications of Dermal Fillers in Aesthetic Medicine: Clinical, Psychological and Financial Implications Due to Unqualied Practitioners

• A. Murante ¹

¹ 

Hospital Henri Mondor, Paris

95.1. Background-Aim

The increasing popularity of dermal fillers in aesthetic medicine has led to a rise in the number of unqualied individuals performing these procedures, including students and non-medical practitioners such as aestheticians.

95.2. Methods

This study examines 48 cases of filler complications caused by individuals without proper medical qualications, treated at our hospital. The complications include bruising, asymmetry, the Tyndall effect, infections, granulomas, vascular occlusions, skin necrosis, allergic reactions, and prolonged pain.

95.3. Results

We discuss the clinical management of these complications, the psychological impact on patients and the financial burden on the healthcare system.

95.4. Conclusions

The rise in dermal filler treatments performed by unqualied practitioners presents signicant risks to patients, both clinically and psychologically. It is essential that the public is educated about the risks associated with non-medical providers and that regulatory bodies take a more active role in preventing unauthorized practices.

96. Hi-Tech Therapeutic Procedures for Keloid Scars

• A. Pacifici ¹

¹ 

Clinica Laser

96.1. Background-Aim

Hi-Tech Scar Therapy continues to evolve, the work performed on a large number of complex Keloid scars according to an algorithm is presented (Matteo Tretti Clementoni Algorithm). This approach is based on the clinical characteristics of each scar: thickness and fibrosis, redness and pigmentation, etc. On the basis of this algorithm, it will be clear how:

(a) different technologies can and must be combined and associated with each other (b) treatments must be started as soon as possible after the trauma (c) laser treatments must be combined with the use of drugs. (d) technologies are able to stimulate the regeneration of scars such as jet volumetric remodelling.

96.2. Methods

Patients with severe keloid scars were treated, to be subjected to biostimulation. We planned, also based on the level of severity, various treatment sessions at a distance of one month from each other and repeat the procedure at a distance of 6 months a year. Each patient was subjected not only to photographic control, “pre and post” treatment, acquired with standard photographic equipment but also to more selective detection.

96.3. Results

In addition to the degree of satisfaction of the Patients, 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 an adequate iconography, “pre and post” treatment, acquired both with digital photographic equipment and with an innovative “photographic system”.

96.4. Conclusions

The use of this procedure, for the characteristics highlighted, seems to offer, even in the same session, for the same action of trauma from jet, both in the field of biostimulation and regeneration, seems to offer significant results in terms of efficacy of results, on the quality of the tissues, speed of execution, and therefore better compliance for the patients; with minimum downtime.

97. The CA-STA Protocol: The Ultimate Solution to Resolving Severe Vascular Complications in Aesthetic Filler Injections

• M. Stabile ¹

¹ 

Servizio di Chirurgia Plastica, Casa di Cura San Camillo, Cremona

97.1. Background-AIM

Vascular occlusion is a rare but severe complication following hyaluronic acid filler injections. The mainstay of treatment remains hyaluronidase, yet cases of incomplete resolution and prolonged healing persist. Recent evidence suggests that topical low-molecular-weight heparin (LMWH) may enhance therapeutic outcomes due to its antithrombotic and anti-inflammatory properties. This study presents the CA-STA Protocol, an innovative approach combining topical heparin with hyaluronidase for the treatment of filler-induced vascular occlusions. To date, no standardized protocol has been published in the literature for the management of damaged skin following vascular occlusion due to hyaluronic acid fillers.

97.2. Methods

Two clinical cases of accidental intra-arterial hyaluronic acid injections leading to vascular occlusion were managed using the CA-STA Protocol:

Immediate subcutaneous hyaluronidase (80–100 IU) injection Topical LMWH (enoxaparin 40 mg) applied every 8 h for 15–28 days.

Clinical evolution was documented through serial photography, assessing pain resolution, skin color normalization, and tissue recovery.

97.3. Results

Case 1: A 45-year-old female with a superior labial artery occlusion showed marked improvement within 15 days, with almost complete skin repair and absence of necrosis.

Case 2: A 30-year-old female with nasal artery occlusion and early necrotic changes experienced slow healing with hyaluronidase alone. Upon introducing topical heparin, significant tissue recovery occurred within 28 days, preventing permanent scarring.

97.4. Conclusions

The CA-STA Protocol, integrating topical low-molecular-weight heparin with standard hyaluronidase treatment, appears to enhance vascular recanalization, accelerate tissue healing, and reduce inflammatory damage in filler- induced occlusions. These findings support its potential as an adjunct to hyaluronidase in emergency aesthetic medicine protocols. Further studies are needed to validate this novel approach.