Abstract Bibliometric analysis of published literatures helps to characterizing scientific productivity, collaboration networks, key research themes, and the life cycle of scientific production and helps in defining the future research agenda. We conducted a systematic search of PubMed, Cochrane, and Scopus was conducted for English-language studies involving HIFU for facial rejuvenation and body contouring with particular attention to efficacy, safety, and patient-centred outcomes. Bibliometric data were exported to RStudio and analyzed using the bibliometrix package and Biblioshiny. The 27 manuscripts (2007-2025) originated from 11 journals and 144 authors, with a mean of 6.07 co-authors per article and an international collaboration rate of 18.52% were included in the analysis. The average annual growth rate in publications was 9.35%, and the mean citation count was 21.44 per document. The United States and South Korea dominated both productivity and citations, while Brazil, Thailand, Canada, Australia, Turkey, and China contributed smaller but growing outputs. Major themes centered on “subcutaneous fat,” “body contouring,” and “waist circumference,” indicating a strong focus on abdominal and body-shaping along with facial rejuvenation. Research on HIFU-based noninvasive body contouring and rejuvenation is still in an early but rapidly expanding stage, driven by a small number of highly collaborative expert centres and concentrated in a few dermatology and aesthetic surgery journals. While short-term efficacy and safety appear favourable, gaps remain regarding long-term outcomes, standardized treatment parameters, and patient-reported measures.

Abstract Glucagon-like peptide-1 (GLP-1)-based therapies are increasingly used to support weight loss. However, there can be significant sequelae with regard to the aesthetics of the face and neck, including midface volume loss; temple, infraorbital, and submalar hollowing; increased skin laxity; accentuation of wrinkles and folds; and worsened skin quality. Individuals seeking nonsurgical correction of these issues are likely to become increasingly common, but treatments have not yet been widely studied in this population. The aim of this paper is to provide experience-based guidance on multimodal nonsurgical aesthetic treatment of the face and neck in patients undergoing weight loss with GLP-1-based therapies. Four clinicians with extensive experience of this patient group completed a written questionnaire and were individually interviewed. Their joint knowledge and expertise form the basis of this guidance. In addition, a PubMed literature search was conducted up to 31 March 2025. Eligibility for nonsurgical modalities does not typically differ greatly in this group compared with other aesthetic patients, but consideration should be given to the optimal timing of treatment within the weight loss journey. Multimodal approaches are usually needed based on: volumizing with hyaluronic acid fillers; skin tightening with collagen-stimulating methods (such as energy-based devices); reduction of wrinkles and banding (particularly in the lower face and neck); and other skin quality treatments. Regular follow-up is crucial for tracking outcomes and evaluating evolving aesthetic needs. Holistic management should incorporate detailed patient education and ongoing nutritional, lifestyle, and psychological support. By following these principles, good aesthetic outcomes can be achieved.

Abstract Background Neck rejuvenation has evolved from superficial skin tightening to deeper structural modifications targeting the platysma, submental and subplatysmal fat, and the submandibular glands (SMG). Significant controversy surrounds the surgical maneuvers necessary to achieve the ideal neck. Objectives The objective is to introduce the Hyoid-to-Mastoid Crevasse (HMC) neo-ligament for neck rejuvenation that elevates the SMG via a suture secured from the hyoid periosteum to the mastoid crevasse. Moreover, we introduce the OnderKaak (OK) angle, representing the region overlying the submandibular gland, best appreciated from the posterior oblique view, also known as the reverse ogee view. Methods Patients who underwent deep plane facelift and neck lift with HMC neo-ligament performed between January 2024 and October 2024 were included. Cervicomental (CMA), gonial (GA), and OK angle measurements were recorded pre and postoperatively. Patients were divided into two cohorts: without SMG resection (“no-SMG resection”) and with SMG resection (“SMG resection”). Results A total of 25 patients were included. Fifteen patients (60%) underwent partial SMG resection, and 10 (40%) did not. Both cohorts demonstrated significant improvement in cervicomental, gonial, and OK angles (all p < 0.05). There was no difference in the mean change of CMA, GA, and OK angles between both cohorts (all p > 0.05). Conclusions The HMC neo-ligament can be used to achieve improved neck aesthetics, thus offering a new technique for neck lift surgery. This technique may be used with and without submandibular gland resection. We also introduce the novel OnderKaak angle to better characterize the improved contours delivered by the HMC neo-ligament.

Abstract Botulinum toxin type A (BoNT-A) is widely used in aesthetic and therapeutic medicine and is considered safe. Nonetheless, rare adverse reactions can occur, even in patients with no prior allergic history. We report the case of a 50-year-old woman who developed a localized inflammatory reaction characterized by erythema, edema, vesicles, burning, and pruritus following injections in the upper face. A reactivity test with another formulation in the subcutaneous tissue of the arm produced an even more severe response, suggesting greater immune reactivity in subcutaneous tissue compared to muscle. Considering the known differences among commercial formulations, including accessory proteins and stabilizers, the test excluded the hypothesis of an allergy specific to a single brand. Standard therapies with corticosteroids and antibiotics failed to produce improvement, while ozone therapy led to significant recovery. This case emphasizes the importance of individualized follow-up and highlights the need for further studies to elucidate the immunopathological mechanisms underlying such rare hypersensitivity reactions.

Abstract Background Waist reduction surgery is commonly performed using the scarless, ultrasound-guided monocortical fracture (RibXcar) technique. However, the effect of this technique on the respiratory function remains unclear. Objectives The aim of this study was to assess the respiratory function of patients who underwent this procedure, 6 months and 1 year postoperatively. Methods A prospective study was conducted to evaluate pulmonary function in patients who underwent costal remodeling using the RibXcar technique, with or without rib conversion surgery (Xonversion Ribs). Respiratory function was assessed through standard spirometry preoperatively, and then at 6 months and 1 year postoperatively. The analyzed variables included forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF) expressed as L or L/s, and the FEV1/FVC ratio. A p-value < 0.05 was considered statistically significant. Results This study included 294 women aged 18–38 years who underwent RibXcar (Group 1) surgery with or without rib conversion surgery (Xonversion Ribs) (Group 2). In both the groups, pulmonary function tests performed 6 months and 1 year postoperatively showed no significant differences from preoperative tests, with no evidence of obstructive or restrictive patterns. In Group 1, two cases of pain were recorded 10–15 days postoperatively and were managed satisfactorily. In Group 2, one case of pain was recorded 10 days postoperatively, with favorable evolution. Conclusions Pulmonary function tests performed 6 months and 1 year postoperatively showed no significant differences from those performed prior to waist reduction via RibXcar, with no evidence of obstructive or restrictive patterns.

Abstract Background Neuromuscular electrical stimulation (NMES) has gained popularity as a noninvasive approach for facial rejuvenation. Although NMES is known to increase muscle mass, its effects on facial muscle morphology and the relationship between muscle changes and the overlying facial contour have not been elucidated. Objectives To evaluate the effects of facial NMES on muscle mass and facial contours using 3-dimensional computed tomography (CT). Methods Fifteen healthy women were enrolled in this prospective split-face trial. One participant was excluded because of noncompliance, and data from 14 participants were analyzed. The NMES was applied to the left infraorbital and temple areas using a periorbital-specific flexible thin-film electrode device, with the right side serving as the control. Computed tomography examinations were conducted at baseline and after 8 weeks of NMES application. The thicknesses of the orbicularis oculi muscle (OOM) and temporal muscle, and the length of orbital fat herniation and temporal contours were quantitatively assessed. Results On the NMES-applied side, OOM thickness significantly increased and the length of fat herniation decreased (P < .001). Furthermore, temporal muscle thickness increased and the temple contour improved significantly on the NMES-applied side compared with the control side (P < .001). Strong negative correlations were observed between muscle thickness and the corresponding morphological changes (OOM vs length of fat herniation, r = −0.73; temporal muscle vs temple contour, r = −0.71). Conclusions In this pilot study, facial NMES enhanced muscle mass and ameliorated age-related morphological changes, suggesting its potential as a noninvasive strategy for facial rejuvenation. Level of Evidence: 3 (Therapeutic)

Abstract Background Correction of moderate-to-severe nasolabial folds (NLFs) is a key concern in aesthetic medicine. Poly-L-lactic acid (PLLA) microspheres, with biostimulatory properties, potentially offer longer-lasting results compared with hyaluronic acid (HA), the current standard of care. Objectives To evaluate the efficacy and safety of PLLA microspheres versus HA for the correction of moderate-to-severe NLFs. Methods In this multicenter, randomized, double-blind, parallel-controlled trial, 252 participants were enrolled across eight centers in China and assigned to receive either PLLA or HA filler. The primary endpoint was the effective correction ratio of Wrinkle Severity Rating Scale (WSRS) at 48 weeks, assessed by blinded independent reviewers. Secondary endpoints included WSRS change, Global Aesthetic Improvement Scale (GAIS) scores (investigator- and participant-assessed), treatment frequency, and safety outcomes. Results At 48 weeks, PLLA demonstrated a significantly higher effective correction ratio than HA (92.4% vs. 59.3%; difference, 33.1% [95% CI, 23.1–43.2]; p < 0.0001). HA outperformed PLLA at week 4, reflecting its immediate effect, whereas PLLA showed superior outcomes from week 36 onward with sustained improvement confirmed by WSRS and GAIS. PLLA required more frequent early treatments, while HA generally achieved correction with fewer sessions. Adverse events were mild and transient, with no serious complications in either group. Conclusions Under current protocols, HA offers rapid improvement, whereas PLLA requires multiple early sessions but yields more durable correction up to 48 weeks with similar safety. Filler selection should be individualized according to patient priorities.

Abstract Background Plastic surgery residency is highly competitive, with program directors using defined criteria for applicant selection. International evidence shows multiple factors influence both leadership decisions and applicant preferences. In Qatar, Accreditation Council for Graduate Medical Education–International (ACGME-I) accreditation and the new Qatari Board shape residency training, yet no local data examine whether directors’ selection criteria align with residents’ program choices or how accreditation and certification impact these decisions. Objectives We aimed to identify the selection criteria prioritized by current and former program directors and associate program directors, and to explore the key factors influencing residents’ decisions to join the Qatar Plastic Surgery Residency Program. Methods A cross-sectional study used structured, anonymous online questionnaires completed by all current and former program directors and associate program directors, and all residents in the Qatar Plastic Surgery Residency Program. Surveys assessed demographics, selection priorities, program choice factors, and perceptions of ACGME-I accreditation and Qatari Board certification. Data were analyzed descriptively, comparatively, and thematically. Results Six program directors participated. Grade Point Average and prior plastic surgery experience were the most influential selection criteria, while conference presentations and postgraduate degrees were least important. Directors also valued strong clinical rotation reputations, being a fresh graduate, passing licensing exams, and prior electives; basic science research and gender were less influential. Nineteen residents responded. ACGME-I accreditation was the strongest factor in program choice, followed by surgical exposure, structured teaching, case diversity, and mentorship. Most residents felt ACGME-I and Qatari Board certification enhanced training and career prospects. Conclusions Directors and residents aligned in valuing academic performance and high-quality clinical training, while accreditation and certification were key determinants of program choice. These findings provide the first local evidence to guide recruitment strategies and support ongoing development of plastic surgery training in Qatar.

Abstract Background Acellular dermal matrices (ADMs) originate from various tissues and are manufactured by different processes, which can influence material properties that affect host response upon implantation. Objectives Compare material properties and host responses to ADMs derived from human or porcine dermis. Methods The morphology of commercially available ADMs (human-derived AlloDerm [hADM], porcine-derived Strattice Pliable [pADM-S], porcine-derived Artia [pADM-A]) was evaluated via bright-field and scanning electron microscopy, and compared with unprocessed human and porcine dermis. Collagen melting temperatures were assessed via differential scanning calorimetry. Host responses to ADMs were assessed in rat (pADM-A and pADM-S) and nonhuman primate (NHP) models (pADM-A, pADM-S, and hADM). Histologic responses were evaluated for inflammation, fibroblast infiltration, and revascularization. Results Morphologically, the extracellular matrix (ECM) structures of hADM, pADM-A, and native human dermis were similarly loose, while that of pADM-S and native porcine dermis were tighter. Collagen melting temperatures were similar across all samples. Following 20-hour exposure to collagenase enzyme, hADM retained the most undigested collagen, followed by pADM-A, then pADM-S. Following 2 and 4 weeks of implantation in the rodent and NHP models, pADM-A yielded the most favorable host response with ample cell infiltration, vascularization, and minimal inflammation versus other implanted ADMs. Minimal to moderate inflammatory responses were observed for all materials; hADM and pADM-A demonstrated the lowest responses. Conclusions In both short-term preclinical implantation models, comparable morphologies and biochemistry of pADM-A and hADM allowed for similarly favorable host responses versus pADM-S. All ADMs assessed demonstrated responses consistent with a favorable regenerative mechanism of action.