Reply: Immediate Hybrid Breast Reconstruction: Dual-Plane Approach Using Prepectoral Implants and Retropectoral Fat Grafting.

Reply: Assessing Risks in Intramuscular Fat Grafting: A Systematic Review and Meta-Analysis of Complications.

Dermal fillers are widely used in aesthetic practice; however, none fully meet expectations in terms of biocompatibility, predictability, and long-term stability. Autologous plasma gel (PG) has been proposed as a biological alternative, yet comparative experimental data remain limited. To evaluate PG as a dermal filler and compare its volumetric behavior and histopathological characteristics with hyaluronic acid fillers and autologous fat graft (FG) in a rat model. Thirty-two male Sprague-Dawley rats were included. In a within-subject design, PG, FG, and two commercial hyaluronic acid fillers (HA-1 and HA-2) were injected into predefined dorsal quadrants. Volumetric assessment was performed using computed tomography at 1, 3, and 5 months. Histopathological evaluation focused on material persistence, neovascularization, and inflammatory response. At 1-3months, PG demonstrated lower volume compared with the other materials. By 5months, no significant differences were observed. Despite lower early volume, PG exhibited a more stable volumetric profile over time compared with FG and became comparable to hyaluronic acid fillers at later time points. Histologically, PG showed lower inflammatory and neovascularization scores, while material persistence remained similar across groups. PG demonstrated favorable biocompatibility and a stable longitudinal volume profile in this experimental model. Although early volume was lower, long-term outcomes were comparable to established fillers, supporting further clinical investigation of PG as an autologous filler option. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Large-volume autologous fat grafting for aesthetic augmentation is often complicated by cysts and fibrosis, suggesting that its survival mechanisms differ from those of small-volume grafts. To investigate the survival biology of large-volume fat grafts and evaluate the effects of mechanical pressure on tissue structure, viability, and long-term graft outcome. A 3-dimensional in vitro model using human adipose tissue in a scaffold was established. Constructs were cultured under 0, 6 or 12 mmHg of pressure to assess structural integrity, solute permeability, cell viability and molecular changes. The viable outer layer was then transplanted into nude mice to evaluate volume retention, necrosis and fibrosis. In vitro, a porous interstitial network supported tissue survival to a depth of approximately 8 mm. Pressure dose-dependently disrupted this network, reducing solute permeability from 76.4% to 21.3% and impairing viability. Pressure also induced a form of "latent injury," consistent with YAP-related mechanotransductive signaling, lineage-related molecular changes and metabolic stress. In vivo, although gross volume retention was similar among groups, pressure-conditioned grafts developed marked necrosis, with fibrosis increasing from 22.1% in controls to 53.3% in the 12 mmHg group at 8 weeks. Large-volume fat graft survival depends in part on the integrity of a pressure-sensitive porous network. Mechanical pressure may induce a clinically relevant "latent injury," consistent with molecular changes observed in vitro, which may contribute to later fibrosis. Minimizing mechanical stress during harvest, processing, handling and implantation may help preserve graft integrity and improve long-term outcomes.

Gluteal fat grafting is associated with rare but potentially fatal complications, particularly fat embolism related to inadvertent intramuscular injection. Current safety recommendations emphasize strict subcutaneous fat placement. Intraoperative ultrasound has been proposed as a tool to enhance procedural safety; however, the extent and quality of supporting evidence remains unclear. A scoping review was conducted according to PRISMA-ScR and Joanna Briggs Institute methodology. Six electronic databases were searched from the earliest available records through March 2025. Studies including adult patients undergoing ultrasound-guided gluteal fat grafting were eligible. Nine studies published between 2018 and 2025 met inclusion criteria. Evidence consisted predominantly of observational case series and one systematic review with meta-analysis; no randomized or high-quality comparative studies were identified. Ultrasound was primarily used to guide cannula positioning and confirm subcutaneous fat injection in real time. Verification of the injection plane relied mainly on intraoperative visualization rather than standardized imaging-based confirmation. No cases of fat embolism or procedure-related mortality were reported. Additional procedural benefits were described but were largely qualitative and infrequently assessed using comparative outcome measures. Intraoperative ultrasound appears to be a useful safety adjunct in gluteal fat grafting; however, current evidence is limited and primarily non-comparative. Further comparative studies are required to establish its clinical benefit.

Liposculpture with autologous fat grafting represents an advanced body contouring approach that enhances muscular definition and volume through selective extraction and anatomical redistribution of adipose tissue. While these procedures are primarily used for aesthetic refinement, emerging evidence suggests autologous fat transfer may also induce significant biological adaptations within grafted muscle. Evaluate the biological implications of intramuscular fat grafting. A retrospective within-subject controlled study was conducted. One year postoperatively, paired biopsies were harvested from the fat-grafted muscle pectoralis major (MPM) and the untreated muscle vastus lateralis (MVL) in 7 male patients following liposculpture and intramuscular fat transfer using the Percutaneous Retrograde Intramuscular Echo-Guided Fat Grafting (PRIME-GRAFT) technique. Subsequent assessments were performed via histological and transcriptome analyses. Histological evaluation comparing treated MPM to untreated MVL one year following liposculpture and intramuscular fat grafting via PRIME-GRAFT technique demonstrated significant reduction in fibrosis and elevated glycogen concentrations within treated muscles. Reduced collagen deposition and elevated glycogen content findings are biologically associated with improved tissue composition. Microarray transcriptomic profiling revealed 70 differentially expressed genes, 51 being up-regulated and 19 down-regulated. Differentially expressed genes showed upregulation of genes associated with Gene Ontology (GO) terms related to muscle structure, organization, extracellular matrix remodeling, energy metabolism, stem cell and cytoskeleton proliferation and organization. PRIME-GRAFT technique induces histological and transcriptional signatures suggesting improved muscle stress resilience, homeostasis, and tissue regeneration. Autologous intramuscular fat transfer provides not only aesthetic improvement but also histological and transcriptomic changes consistent with enhanced muscle integrity and regenerative potential.

Superior orbital sulcus hollowness is a common aesthetic concern that may result from structural changes, trauma, or excessive fat removal during upper blepharoplasty, and it can be further exacerbated by age-related orbital remodeling. Traditional corrective approaches such as fat redistribution and autologous fat grafting carry limitations, including graft atrophy and the risk of embolic complications. This study evaluated the safety and outcomes of superior orbital sulcus correction using a medial-pedicled preseptal orbicularis oculi muscle flap. This retrospective study analyzed 481 patients who underwent upper blepharoplasty between January 2017 and June 2024, of whom 45 received additional correction of superior orbital sulcus hollowness with a medial-pedicled preseptal orbicularis oculi muscle flap. Exclusion criteria included male sex, previous upper eyelid surgery, levator dehiscence, less than six months of follow-up, and refusal to complete the FACE-Q Adverse Effects questionnaire. The mean follow-up duration was 8 months, and the mean patient age was 51.4 years. Postoperative complications and patient-reported outcomes were evaluated and compared with those of patients undergoing conventional upper blepharoplasty. Early postoperative complications, including transient lagophthalmos and edema, were self-limiting. In the conventional blepharoplasty group, 16 patients developed medial canthal scarring, with four requiring revision. In the flap group, transient supraorbital hypoesthesia occurred in 71% of patients and resolved within a few months, and no cases of flap necrosis were observed. Statistical analysis using the Mann-Whitney U test demonstrated no significant difference in FACE-Q scores between the two groups (U = 8828.0, p = 0.251). The medial-pedicled preseptal orbicularis oculi muscle flap appears to be a safe, reproducible, and anatomically sound technique for selected patients with superior orbital sulcus hollowness. Although the relatively uniform flap volume may not fully correct the deformity in all cases and patient numbers were limited, this method provides a promising alternative to fat grafting without adding long-term complications, with the potential to enhance aesthetic outcomes and patient satisfaction. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

To summarize current evidence on Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) applications and outcomes in facial plastic surgery. PRP and PRF are autologous platelet concentrates with regenerative potential. They release growth factors that promote tissue repair, angiogenesis, extracellular matrix remodeling, graft integration, and scar remodeling, making them increasingly relevant in facial plastic surgery. A narrative review of clinical studies, meta-analyses, and systematic reviews was conducted. Key outcomes included wound healing, graft retention, postoperative edema and ecchymosis, scar improvement, and patient satisfaction. PRP improved wound healing, reduced crusting, and enhanced patient satisfaction in rhinoplasty, while PRF decreased cartilage resorption and improved graft stability. In rhytidectomy, PRP offered modest reductions in edema and ecchymosis. Both agents enhanced scar revision and fat graft outcomes, with PRF showing superior remodeling and long-term graft retention. In periorbital rejuvenation, PRP improved pigmentation and satisfaction, whereas PRF improved skin texture and wrinkles. Both were safe with minimal adverse events. PRP and PRF are effective biologic adjuncts in facial plastic surgery, supporting tissue regeneration, graft integration, and aesthetic outcomes. Efficacy is influenced by patient factors and technique. High-quality, procedure-specific trials are needed to optimize protocols.

Acute visual loss following transsphenoidal pituitary surgery is rare but potentially reversible if promptly identified and treated. Migration of fat graft into the sella is an infrequently recognised but treatable cause. A woman in her early 60s presented with pituitary acromegaly and underwent endoscopic endonasal transsphenoidal surgery for a pituitary macroadenoma. Postoperatively, she developed sudden bilateral visual loss. MRI revealed optic chiasm compression by migrated fat graft used for sellar reconstruction. Emergency re-exploration and decompression led to complete restoration of vision. Fat graft migration can cause chiasmal compression and sudden painless vision loss after pituitary surgery. Immediate imaging and decompression are critical for visual recovery.

Breast lipofilling is a commonly utilized method in plastic surgery for breast reconstruction and augmentation. However, the procedure is often limited by the unpredictable survival of fat grafts, leading to dissatisfied patients and associated risks of complications. To address these challenges, recent innovations in fat processing methods, such as the Cell Enriched Lipotransfer (CELT) technique, have been developed to improve both graft retention and overall clinical outcomes. This study aims to compare patient satisfaction and complication rates associated with different fat preparation techniques- including filtration, sedimentation, and CELT method-in breast lipofilling procedures. All patients who underwent breast lipofilling between 2010 and 2022, were identified. Patients were followed for an average of 20 months (range: 3 -173 months). Data including patient demographics, fat preparation methods, and outcomes were extracted from clinical records. Patient satisfaction was assessed using a modified BreastQ questionnaire, and complications were recorded from postoperative follow-ups. We included 572 breast lipofillings (7 male; 374 female) with a mean age of 45.34 ± 12.2 years (range 14-79). Patient demographics did not differ statistically significantly (p = 0.85). A total of 464 lipofilling interventions (82.8%) were eligible for analysis, as 99 lipofilling interventions (87 patients) were lost to follow-up or refused to participate in the questionnaire. The surgical site complication rate of the study was as follows: CELT (8.0%), filtration (14.9%), and sedimentation (16.4%). Specific complications for CELT included oil cyst formation (4.8%), hematomas (1.6%), no infections (0%), and postoperative wound healing disorders (1.6%). The CELT method resulted in a significantly higher patient satisfaction rate (p < 0.001) with a mean score of 1.70 (where 1 indicates very satisfied) and the lowest complication rate of 8.0%. Satisfaction rates for other techniques were as follows: Filtration (2.31) and Sedimentation (mean score of 2.43). In subgroup analyses, outcomes did not differ significantly between radiated and non-radiated patients in this cohort (p ≥ 0.06). The Cell Enriched Lipotransfer (CELT) method has emerged as a highly effective fat preparation technique for breast lipofilling, demonstrating enhanced patient satisfaction and a lower incidence of complications. However, further validation through larger-scale, prospective studies is essential to confirm these findings and establish robust evidence.

This study aimed to perform a retrospective analysis of clinical data from 94 patients with sunken upper eyelid, investigating the etiologies, types, and surgical approaches for this condition, so as to provide a theoretical basis for the clinical prevention and treatment of sunken upper eyelid. Clinical data of 94 patients who underwent sunken upper eyelid correction in our hospital from June 2024 to May 2025 were retrospectively summarized and analyzed. The collected data included general patient information (age and gender), history of previous upper eyelid surgery, presence of comorbidities (e.g., multiple eyelids, wide double eyelids, and blepharoptosis), as well as the surgical method employed, surgical outcomes, and occurrence of surgical complications. All patients were followed up for 6-9 months postoperatively. Patient satisfaction was evaluated based on indicators such as bilateral upper eyelid morphology, fullness, and symmetry. Among the 94 included patients with sunken upper eyelid, there were 84 females and 10 males, with a mean age of 34 years. According to the presence of a previous upper eyelid surgery history, the patients were categorized into two groups: 16 cases (17.0%) of primary sunken upper eyelid (without a history of upper eyelid surgery) and 78 cases (83.0%) of secondary sunken upper eyelid (with a history of upper eyelid surgery). Analysis of surgical records showed that 12 patients underwent autologous granular fat injection transplantation, while 82 patients received open surgical correction for sunken upper eyelid. The causes of sunken upper eyelid in this study mainly included two types: absolute deficiency of orbital septal fat content (58 cases, 70.7%) and relative deficiency of orbital septal fat content (24 cases, 29.3%). The mean preoperative depth of sunken upper eyelid was 8.2mm, and this value significantly decreased to 2.7mm at the last postoperative follow-up (p < 0.05). The mean Global Aesthetic Improvement Scale score at the last follow-up was 2.34. Clinically, sunken upper eyelid is mostly caused by excessive removal of orbital septal fat during previous upper blepharoplasty. A comprehensive repair strategy is recommended, which prioritizes the restoration of orbital septal fat volume via orbital septal fat release or transposition and flake fat grafting, supplemented by autologous granular fat injection transplantation. For patients with comorbidities such as multiple eyelids, wide double eyelids, or blepharoptosis, simultaneous correction of these comorbidities while addressing the sunken upper eyelid is advisable to achieve optimal clinical outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Defects of the nasal complex can cause significant functional and psychosocial impairment whether acquired or congenitally inherited. Iatrogenic nasal deformities are uncommon complication of supportive care in neonates. Poor placement, insufficient immobilization of the cannula or prolongated nasopharyngeal intubation can result in injury to the nasal lining and can lead to aplasia of the nasal cartilage. We present the case of a 17‑year‑old female who developed an iatrogenic nasal deformity following prolonged nasotracheal intubation as a premature neonate at seven months gestation, necessitating a three‑month NICU stay. On examination, right nostril asymmetry and breathing difficulties were noted. During open rhinoplasty, agenesis of the medial and lateral crura of the right lower lateral cartilage was discovered - an anatomical deficiency creating a significant reconstructive challenge. Our surgical approach employed two stages: first, fat grafting to restore soft tissue volume and contour; second, autologous cartilage grafting from the septum (with options including conchal cartilage or dorsal hump cartilage) to reconstruct the undeveloped lower lateral cartilages. This method successfully restored nasal symmetry and improved airway function. The case underscores the importance of recognizing iatrogenic cartilage damage in patients with neonatal airway interventions and illustrates effective staged reconstructive strategies for such rare but impactful deformities.

Facial sunken deformity caused by trauma, surgery, or skin disease often leads to aesthetic and functional impairment. Autologous fat grafting is widely used for volume restoration but is challenged by poor graft survival in scarred tissue. Combining fat grafting with botulinum toxin A (BoNTA) may improve graft retention via enhanced vascularization and reduced mechanical tension. We retrospectively analyzed 43 patients with facial sunken deformity treated from January 2021 to January 2024. All patients were treated with V-shaped dissector cannula for subscar tissue release, fat harvesting from the abdomen, filtration of lipoaspirate, and fat grafting combined with local BoNTA injection. Outcomes were assessed using pre- and postoperative clinical photographs, 3D facial volumetric scanning, and patient satisfaction over a 6- to 12-month follow-up. Significant volume restoration was observed postoperatively with stable long-term outcomes. No serious complications occurred. Patients reported high satisfaction with aesthetic improvement and functional recovery. The combined technique of V-shaped dissector cannula subcision, filtered fat grafting, and local BoNTA injection is a safe and effective method to correct facial sunken deformity, improving fat graft survival and contour restoration. This approach offers a promising option for managing challenging scar-related deformities. This study proposes the following three technical innovations to enhance fat graft survival and improve the appearance of concave scars: (1) using a V-shaped dissector cannulato fully release underlying scar tissue; (2) processing fat using a filter to optimize graft quality; and (3) using botulinum toxin to promote fat vascularization. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Soft-tissue support remains a critical factor in both reconstructive and aesthetic breast surgery. Bioresorbable synthetic scaffolds, such as poly-4-hydroxybutyrate (P4HB), have been introduced as an alternative to acellular dermal matrices to provide structural reinforcement while gradually integrating into host tissue. This study evaluates the clinical indications, surgical applications, and early postoperative outcomes associated with the use of a bioresorbable P4HB scaffold in implant-based breast surgery. A retrospective review was conducted of patients who underwent breast surgery with P4HB scaffold reinforcement. Surgical indications were analyzed per treated breast and categorized as oncologic or non-oncologic. Associated procedures, including fat grafting and implant exchange versus primary implantation, were recorded when available. Postoperative complications were assessed per patient. Descriptive statistics were used to summarize surgical indications, technical approaches, and outcomes. A total of 31 patients and 52 treated breasts were included. Surgical indications were evenly distributed between breasts with and without disease. All breasts with disease were managed in the context of post-mastectomy reconstruction. In breasts without disease, scaffold reinforcement was primarily used for contralateral symmetrization, followed by primary or revisional aesthetic procedures. Fat grafting was frequently performed as an adjunct technique. Most cases involved primary implant placement, with a small proportion representing revision surgery. The overall postoperative complication rate was low, with the majority of patients experiencing an uneventful recovery. P4HB scaffold reinforcement demonstrated a favorable safety profile and versatile clinical applicability in both reconstructive and aesthetic breast surgery. Its integration into implant-based procedures, often in combination with adjunctive techniques, supports its role as a reliable option for soft-tissue support. Further studies with longer follow-up and comparative designs are needed to better define long-term outcomes and optimize indications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Poly-L-lactic acid (PLLA) is a well-established facial filler recognized for its ability to stimulate collagen synthesis. While emerging evidence suggests that PLLA modulates the differentiation and lipolysis of dermal adipocytes, its role in autologous fat transplantation remains unclear. In vitro, mature adipocytes were treated with lactate or PLLA during ceiling culture to explore the regulatory mechanisms of PLLA-mediated dedifferentiation. Subsequently, we established a murine model of PLLA and adipose tissue co-transplantation, with grafts harvested at 7, 30, and 90days. Graft survival was assessed via volumetric analysis, histological evaluation, and qPCR to validate the in vitro findings. PLLA-derived lactate facilitates adipocyte dedifferentiation at low-to-moderate concentrations. This phenotypic reversion was abrogated by pharmacological inhibition of monocarboxylate transporters (MCTs). Additionally, lactate-induced DFATs exhibited enhanced angiogenic potential. In vivo, co-transplantation of PLLA and adipose tissue significantly enhanced volume retention and neovascularization. PLLA implantation triggered only a transient acute inflammatory response that stabilized subsequently without inducing chronic fibrosis, ensuring long-term biocompatibility. As a biocompatible synthetic material, PLLA degrades into lactate and enhances fat graft volume retention by promoting dedifferentiation of adipocytes. This finding indicates that PLLA holds broad application prospects in fat transplantation. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable.

Facial feminization surgery (FFS) reduces gender dysphoria and improves psychosocial well-being in transfeminine patients, but its multiprocedural nature leads to long operative times, increasing anesthetic risk, and limiting daily surgical output. This study analyzes operative times across FFS procedures and describes a comprehensive approach that maximizes efficiency during multiprocedural FFS. 55 patients who underwent FFS from August 2024 through October 2025 were included. A four-person operating team was utilized in all cases. Fourteen patients (25.5%) underwent full FFS, 22 (40.0%) underwent near-full FFS, and 19 (34.5%) underwent partial FFS, totaling 267 procedures (mean: 4.9 procedures per patient). The mean operative time for full FFS was 196.4±39.4 minutes. Frontal sinus setback averaged 50.0±19.1 minutes, compared with 24.4±7.8 minutes for frontal sinus contouring with egg burr alone. Thyroid cartilage reduction averaged 31.6±8.9 minutes, genioplasty averaged 25.7±9.9 minutes, mandibular angle reduction averaged 25.1±9.6 minutes, lip augmentation averaged 8.2±2.2 minutes, fat grafting to the cheeks averaged 5.0±2.3 minutes, and open septorhinoplasty averaged 75.5±22.6 minutes. No intraoperative complications occurred. Two patients (3.6%) developed minor intraoral infections one month postoperatively, both resolving with oral antibiotics. Through deliberate procedural sequencing, concurrent task execution, and a well-trained team, full FFS can be completed efficiently without compromising patient outcomes or trainee education. This approach reduces anesthetic exposure and enables multiple FFS cases within a single day, expanding access in a field where surgical demand exceeds available capacity.

To evaluate the efficacy and safety of combined double-eyelid revision and autologous fat grafting via the supraorbital approach for correcting post-blepharoplasty upper-eyelid depression. A consecutive retrospective cohort of 32 patients (30 females; mean age 43 years) with post-blepharoplasty upper-eyelid depression underwent combined double-eyelid revision and autologous fat grafting via the supraorbital approach between January 2020 and January 2025. Lipoaspirate obtained from the thigh or abdomen was refined by centrifugation and injected into the retro-orbicularis oculi fat (ROOF) layer through the same supraorbital incision. Efficacy was assessed six months postoperatively using the Global Aesthetic Improvement Scale (GAIS) and a 5-point patient-rated Likert scale. All 64 eyelids achieved immediate volume restoration and a natural supratarsal fold, no palpable nodules or eyelid dysfunction occurred. At 6months, 81.3% (26/32) were judged "very much improved" and 12.5% (4/32) "much improved" on GAIS; 87.5% (28/32) self-rated the outcome as "excellent." Mild recurrent hollowing occurred in 4 patients (12.5%), of whom 3 underwent secondary grafting. The supraorbital route enables accurate placement and even distribution of fat with minimal trauma during revision double-eyelid surgery. Upper-eyelid depression was effectively corrected and aesthetic outcomes significantly improved, confirming the feasibility and safety of this technique in a single-center retrospective cohort. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cerebrospinal fluid (CSF) leak after retrosigmoid vestibular schwannoma resection remains a challenging complication. Historically, surgeons reopened the prior retrosigmoid incision for transmastoid repair because the safety of creating a separate postauricular incision was uncertain, with concerns regarding wound breakdown and infection. However, limited data support this practice, and a focused mastoid incision may offer improved access and patient tolerance. This study evaluated wound healing outcomes following transmastoid repair using a new postauricular incision for persistent CSF leak after retrosigmoid surgery in patients without serviceable hearing. We retrospectively reviewed 27 patients who underwent transmastoid repair for persistent postoperative CSF leak after retrosigmoid craniotomy for vestibular schwannoma (2000-2025). Demographics, operative details, timing of leak diagnosis and repair, wound complications, readmissions, antibiotic use, and culture results were analyzed. Median age was 48 years (IQR 41-56); 67% were male, and mean BMI was 29.0 kg/m2. Mastoid obliteration was performed in 96%, with fat grafting in 93%. A new postauricular incision was used in all cases. Median time to leak diagnosis was 13 days (IQR 4-79), and median time to repair was 2 days (IQR 1-5). One patient (3.7%) developed a superficial wound abscess; no dehiscence or flap necrosis occurred. At median follow-up of 34 months (IQR 2.9-87.7), all wounds were healed. CSF leak recurred in two patients (7.4%) and three (11.1%) required reoperation. A separate postauricular incision for transmastoid CSF leak repair was not associated with increased wound morbidity. Durable wound healing was achieved in all patients, with 93% legal control, supporting this anatomy-driven approach.

Infections caused by nontuberculous mycobacteria (NTM), particularly Mycobacterium abscessus, represent rare but increasingly reported complications following cosmetic fat transplantation. However, standardized and effective treatment protocols remain underexplored. This study aimed to evaluate the efficacy of anti-tuberculosis (anti-TB) medication combined with local vacuum aspiration in treating multiple wound infections caused by Mycobacterium abscessus complex following autologous fat transplantation. Between June 2017 and June 2019, 10 patients with M. abscessus complex infection after autologous fat grafting were enrolled, involving a total of 70 infected wounds (31 facial, 32 breast, and 7 thigh sites). Prior to minimal-incision open debridement, ultrasound localization was performed. Necrotic granulation tissue was thoroughly curetted, followed by vacuum sealing drainage (VSD) with continuous aspiration. Irrigation and drainage tubes were subsequently placed to promote granulation tissue formation. All patients received standardized anti-TB drug therapy. During a follow-up period ranging from 8 to 16 months (mean: 12 months), all 70 wounds in the 10 enrolled patients achieved satisfactory healing in terms of both deep tissue repair and superficial appearance. No recurrence of infection was observed throughout the follow-up period. Wound closure was accomplished without the need for additional surgical reconstruction in all cases. The combination of anti-TB chemotherapy and vacuum aspiration consistently promoted granulation tissue formation and controlled local inflammation, leading to functionally and cosmetically acceptable outcomes across all anatomical sites, including face, breast, and thigh regions. The combination of minimal-incision debridement, local vacuum aspiration, and anti-TB medication provides an effective and practical treatment for M. abscessus infections secondary to autologous fat grafting. This integrated approach is recommended for managing such challenging postoperative infections. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background:Traditional fat grafting techniques predominantly rely on static assessment and homogeneous fat filling, yet clinical practice has revealed limitations such as poor adaptability to dynamic expressions and unnatural contour transitions. Recent studies have demonstrated that centrifugally stratified fat layers exhibit distinct biological properties. However, achieving harmonious integration of volumetric restoration and dynamic expression through precise dynamic evaluation combined with layered and progressive grafting of multimorphological fat remains a critical clinical challenge. Building on facial dynamized anatomy, this study proposes a dynamic assessment–multimorphological fat grafting strategy, aiming to establish a personalized rejuvenation protocol aligned with facial biomechanical principles.Methods:A total of 305 patients (19–56 y old) were enrolled from December 2019 to February 2023. Fat harvested from the thighs or abdomen was processed into 3 forms: high-density macrofat, high-density microfat, and stromal vascular fraction gel. These were injected dynamically into multiple facial regions, angles, depths, and layers using specialized cannulas. Follow-up ranged from 6 months to 3 years to assess clinical outcomes and patient satisfaction.Results:All 305 patients showed significant improvement in facial volume loss, skin elasticity, and fine wrinkles, achieving a rounded and youthful facial contour. Patient satisfaction rates were high, with 95.1% reporting satisfaction and 4.9% indicating basic satisfaction. No complications such as nodules or cysts were observed.Conclusions:Dynamic multiform fat grafting demonstrates high efficacy and patient satisfaction, offering natural and harmonious outcomes.