This Week in Plastic Surgery — Jul 17, 2026

Welcome to This Week in Plastic Surgery. This week we are covering ten notable papers spanning advanced aesthetic body contouring techniques, innovations in facial rejuvenation and rhinoplasty, and new strategies in reconstructive and nerve surgery. Let's dive in.

We begin with body contouring, where minimally invasive approaches are expanding. In a multicenter cohort study published in Plastic and Reconstructive Surgery Global Open, researchers evaluated a technique called RibXcar, which uses ultrasound-guided percutaneous punctures for rib remodeling to modify the thoracic contour and reduce waist circumference [1]. Tracking over thirty-eight hundred female patients across eight countries, the authors reported a mean waist reduction of eleven centimeters and a ten-degree angular reduction of the lower ribs at one year. However, the procedure carries notable risks, including four cases of pneumothorax, one hemothorax, and two cases of chronic pain from bicortical fractures. Meanwhile, addressing skin laxity during liposuction remains a challenge. A prospective study in the same journal compared conventional radiofrequency-assisted liposuction to a technique called plastic internal low-angular retraction, or PILAR, which delivers targeted monopolar radiofrequency [3]. In a cohort of one hundred patients, the PILAR technique achieved similar contouring results but required roughly half the total energy and shorter device use times compared to conventional radiofrequency, suggesting a more efficient subdermal delivery method.

Moving to facial aesthetics, the debate between autologous fat grafting and hyaluronic acid fillers continues. A systematic review and meta-analysis in Aesthetic Plastic Surgery pooled nine comparative studies to evaluate patient satisfaction [2]. Although fat grafting showed a trend toward higher satisfaction, the difference was not statistically significant, and the analysis revealed massive heterogeneity among the studies. The authors note that while fat grafting offers durability, hyaluronic acid remains valuable for its convenience and reversibility. For periorbital rejuvenation, a retrospective study in Aesthetic Plastic Surgery evaluated a single-stage approach for patients presenting with both sunken upper eyelids and tear trough deformities [7]. Comparing isolated orbital fat release against orbital fat release combined with lower eyelid fat transfer in thirty-seven patients, the combination group demonstrated significantly greater improvement in upper eyelid appearance, providing a reliable option that avoids a secondary donor site. In the rhinoplasty arena, a review in the Aesthetic Surgery Journal marks nearly a decade since the introduction of preservation rhinoplasty [5]. The authors synthesize the evolution of these techniques, highlighting how preservation has transitioned from a niche concept to an established philosophy that minimizes secondary deformities by maintaining the dorsal bridge rather than rebuilding it.

In reconstructive surgery, restoring function in complex cases remains a priority. A retrospective study in Plastic and Reconstructive Surgery Global Open evaluated selective tibial-to-peroneal nerve transfers in twenty-one patients with severe foot drop [4]. Over a two-year average follow-up, more than three-quarters of the patients achieved a motor strength score of three or higher, allowing them to walk without an ankle-foot orthosis. The study highlighted that transferring two or more fascicles and performing concurrent common peroneal nerve neurolysis significantly improved final muscle strength. For microtia reconstruction, a prospective cohort study of forty-four patients in Aesthetic Plastic Surgery addressed the challenge of unwanted hair on reconstructed ears [6]. Researchers compared a novel intraoperative subcutaneous seventy-five-five-nanometer Alexandrite laser treatment during stage-three surgery against conventional preoperative external laser therapy. The subcutaneous approach achieved a statistically superior forty-eight percent hair reduction compared to forty-five percent in the external group, while using significantly lower laser energy and eliminating the need for separate outpatient laser sessions. In breast reconstruction, a retrospective study in Plastic and Reconstructive Surgery Global Open investigated minimal-access nipple-sparing mastectomy and prepectoral direct-to-implant reconstruction without using acellular dermal matrix or synthetic mesh [8]. In fourteen procedures, the technique proved feasible with no implant losses, though forty-three percent of patients developed seromas requiring multiple aspirations. Finally, managing chronic lymphedema requires precise, repeatable assessments. A narrative review in the same journal advocates for the integration of lymphatic ultrasound into longitudinal clinical decision-making [9]. By utilizing structured frameworks like the NECST and D-CUPS classifications, clinicians can noninvasively track lymphatic vessel degeneration and tissue changes, helping to optimize compression therapy and identify the ideal timing for lymphaticovenular anastomosis.

Pain management during aesthetic procedures is also evolving. In a study published in Aesthetic Plastic Surgery, researchers mapped the anatomical course of the transverse cervical nerve in forty-six heminecks and conducted a pilot trial in nine patients to facilitate cutaneous analgesia for neck injections [10]. The nerve consistently emerged at approximately fifty-three percent of the distance from the earlobe to the clavicular insertion along the posterior border of the sternocleidomastoid muscle. A landmark-guided block at this point achieved complete cutaneous anesthesia in all nine pilot patients, significantly reducing injection pain compared to topical lidocaine cream, though clinicians must remain vigilant of the adjacent external jugular vein.

If you only have time for one paper this week, make it the multicenter cohort study on the RibXcar technique for incisionless rib remodeling [1]. With over thirty-eight hundred patients, this paper provides critical safety and efficacy data on a highly debated, minimally invasive contouring procedure, highlighting both its dramatic waist-reduction potential and its rare but serious risks like pneumothorax.

Here are the key takeaways from this week in Plastic Surgery. First, while ultrasound-guided percutaneous rib remodeling can achieve substantial waist reduction, clinicians must counsel patients on the risk of thoracic complications like pneumothorax and hemothorax. Second, for foot drop reconstruction, selective tibial nerve transfer is highly effective, with outcomes significantly improved by transferring multiple fascicles and adding common peroneal nerve neurolysis. Third, intraoperative subcutaneous laser depilation during stage-three ear reconstruction offers superior hair reduction at lower energy levels than traditional external laser therapy, improving patient convenience. Finally, in prepectoral direct-to-implant breast reconstruction, omitting acellular dermal matrix or mesh is feasible and cost-effective, but surgeons should anticipate a high rate of postoperative seromas requiring aspiration.

That's your roundup for This Week in Plastic Surgery. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.