AI-enhanced "Two-thirds Guidelines" for Lipolifting: Addressing Multiple Hallmarks of Facial Aging.

Background: Facial aging involves complex changes such as volume loss, ligament weakening, and skin quality alterations. The "two-thirds guidelines" emerge as a novel strategy to combat these aging signs, drawing from an extensive analysis of 2800 facial fat grafting procedures conducted over two decades. Methods: Guided by facial lipolifting data, including patient age, fat type (microfat and nanofat), and injection depth, this study devises a systematic framework for multilayer fat rejuvenation and ligament restoration. The two-thirds guidelines advocate injecting two-thirds of the patient's age for microfat and one-third for nanofat, with specific injection codes for lower, middle, and upper facial regions. Results: A prospective study involving 400 patients confirms the efficacy of the two-thirds guidelines. However, applicability may vary for patients outside SD ranges, particularly concerning facial proportions and body mass index. Patients within the golden ratio range (1.4-1.9) report high satisfaction rates and a 50% fat graft uptake, with minimal complications. For patients outside this range, an artificial intelligence (AI) program was implemented. Conclusions: The two-thirds guidelines offer a comprehensive approach to facial rejuvenation, addressing volume loss, ligament weakening, and skin quality. They are applicable in early aging stages, promising enduring and natural outcomes while mitigating effects of weight fluctuations. These guidelines provide a safe, replicable, and adaptable approach to facial fat grafting, either standalone or in combination with facelift techniques, with minimized overfilling risks. A dataset obtained from 2800 patients serves as the foundation for developing an AI program tailored to aid doctors in diagnosing and treating similar cases.

In-Vitro Comparative Examination of the Effect of Stromal Vascular Fraction Isolated by Mechanical and Enzymatic Methods on Wound Healing.

BACKGROUND: Enzymatic digestion has been the gold standard for stromal vascular fraction (SVF) isolation but remains expensive and raises practical and legal concerns. Mechanical SVF isolation methods have been known to produce lower cell yields, but may potentially produce a more robust product by preserving the extracellular matrix niche. OBJECTIVES: The aim of this study was to compare mechanically dissociated SVF (M-SVF) and enzymatically digested SVF (E-SVF) in terms of wound-healing efficacy. METHODS: Lipoaspirate was partitioned into 2 equal groups and processed by either mechanical or enzymatic isolation methods. After SVF isolation, cell counts and viabilities were determined by flow cytometry and cell proliferation rates were measured by the WST-1 test. A wound-healing scratch assay test, which is commonly used to model in-vitro wound healing, was performed with both cell cocktails. Collagen type 1 (Col1A) gene expression level, which is known for its role in wound healing, was also measured for both groups. RESULTS: As predicted, E-SVF isolated more cells (mean [standard deviation], 1.74 [3.63] × 106/mL, n = 10, P = 0.015) than M-SVF (0.94 [1.69] × 106/mL, n = 10, P = 0.015), but no significant difference was observed in cell viability. However, M-SVF expressed over 2-fold higher levels of stem cell surface markers and a 10% higher proliferation rate compared with E-SVF. In addition, the migration rate and level of Col1A gene expression of M-SVF were found to be significantly higher than those of E-SVF. CONCLUSIONS: Although the cell yield of M-SVF was less than that of E-SVF, M-SVF appears to have superior wound-healing properties.

Micro-Shuttle Lifting of the Neck: A Percutaneous Loop Suspension Method Using a Novel Double-Ended Needle.

BACKGROUND: Most younger patients expect to be able to achieve significant improvements and lift to their neck, yet they don't want to undergo extensive surgery. They are now able to do that and restore their youthful appearance thanks to new concepts the techniques through volume redistribution. OBJECTIVES: The authors' goal was to achieve results that are comparable to a necklift and durable through minimally invasive surgery, utilizing punctures instead of incisions. METHODS: The concept of micro-shuttle lifting creates a percutaneous hammock to achieve the lifting of all different planes of the neck at once. This is accomplished by putting nonabsorbable sutures on nonundermined platsyma through the use of a double-ended (micro-shuttle) needle and anchoring it to fixed thread loops around the ears. Mitigation of gravitational force is accomplished through the loop suspensions, to obtain effective skin redraping over the suture-created internal splint. RESULTS: This combined technique for the neck was applied in 221 selected patients between December 2005 and May 2014, with follow-up ranging from 8 months to 7 years. The mean age of the patients was 42.5 years. Outcomes were satisfactory in all but 12 cases, of which 7 found the result inadequate. The operation time for the neck was less than 40 minutes under local anesthesia or local anesthesia with sedation, and the recovery time was 5-7 days. CONCLUSIONS: The sustainability of this percutaneous procedure does not rely on the suspensions, but rather on the skin redraping in the new position in a similar manner to orthopedic fracture treatment. In selected patients, this safe and simple percutaneous necklifting method can be quickly and easily performed under local anesthesia with long-term durability, low morbidity, and a high patient satisfaction rate. LEVEL OF EVIDENCE 4: Therapeutic.

Shuttle lifting of the nose: a minimally invasive approach for nose reshaping.

BACKGROUND: Suspension sutures are commonly used in numerous cosmetic surgical procedures. Several authors have described the use of such sutures as a part of classical rhinoplasty. On the other hand, it is not uncommon to see patients seeking nasal surgery for only a minimal hump deformity combined with an underrotated, underprojecting tip, which does not necessarily require all components of rhinoplasty. With the benefit of the suture suspension technique described here, such simple tip deformities can be reshaped percutaneously via minimal incisions. OBJECTIVE: In this study, the author describes an original technique based on the philosophy of vertical suspension lifts, achieving the suspension of the nasal tip with a percutaneous purse-string suture applied through small access punctures. PATIENTS AND METHODS: Between December 2005 and December 2008, 86 patients were selected to undergo rhinoplasty using the author's shuttle lifting technique. The procedure was performed with a double-sided needle or shuttle, smoothly anchoring the lower lateral cartilages in a vertical direction to the glabellar periosteum, excluding the skin envelope. RESULTS: Mean follow-up was 13 months, with a range of eight to 24 months. Outcomes were satisfactory in all but 12 cases, of which seven found the result inadequate; two of those patients underwent a definitive rhinoplasty operation. Five patients requested that the suture be detached because of an overexaggerated appearance. Operative time was less than 15 minutes in all patients, with an uneventful rapid recovery. CONCLUSIONS: As a minimally invasive nasal reshaping procedure, shuttle lifting is a good choice to achieve long-lasting, satisfactory results in selected patients with minimal hump deformity and an underrotated tip. The significance of this technique lies in the fact that it is one of very few office-based minimally invasive alternatives for aesthetic nasal surgery, with a recovery period of two to three days.