Ioannis Kyriazidis

Background Structured aesthetic surgery training during residency is often inadequate, creating a global training gap. The International Society of Aesthetic Plastic Surgery (ISAPS) established a fellowship program to address this, but its educational impact has not been systematically evaluated. This study provides the first multicenter, international analysis of the ISAPS fellowship’s effect on procedural exposure, surgeon confidence, and career trajectory. Methods An online survey was distributed to all surgeons who had completed an ISAPS fellowship. The questionnaire captured demographics, residency-level aesthetic surgery exposure, fellowship case volume, perceived educational quality, post-fellowship confidence, and career changes. Trends in confidence across ascending procedural volume were analyzed using the one-sided Jonckheere–Terpstra test. Results Four hundred and sixty-nine former ISAPS fellows from 27 countries responded. Respondents reported minimal aesthetic surgery exposure during residency (median score 1 on a 6-point scale). The fellowship provided significant operative experience, with 35.0% of fellows logging over 50 cases in at least one procedure. Post-fellowship, 81.4% of participants reported increased operative confidence, a trend that was statistically significant for several key procedures (p < 0.05). The fellowship reshaped careers, with the proportion of fellows focused primarily on aesthetic surgery rising from 9.5 to 60.4%. Overall satisfaction was high, with 96.2% stating the fellowship pushed their career. The most cited area for improvement was the degree of hands-on surgical experience. Conclusions The ISAPS fellowship is a highly effective model for post-residency aesthetic surgery training. It successfully bridges the training gap by providing high-volume operative experience that translates directly into increased surgeon confidence, adoption of new techniques, and a career shift toward aesthetic practice. 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.

Closing wounds under high tension often requires complex maneuvers or significant non-dominant hand involvement. We present a novel, single-handed suturing technique that simplifies this process. Following standard loop formation, the needle holder passes under the long suture end, over the short end, and under again to grasp the free thread, creating a self-locking configuration. This technique limits the non-dominant hand to simply holding the suture end while maintaining precise tissue approximation. It works with both monofilament and braided sutures and is applicable to skin closure, fascial repair, and anatomically challenging locations. The straightforward execution makes it accessible to surgeons across all skill levels.

The SH-9Hospital knotting technique: analysis of innovation claims and biomechanical testing

Background: Three-dimensional (3D) imaging enhances surgical planning and documentation in plastic surgery, but high costs limit accessibility. Mobile light detection and ranging (LiDAR) technology offers a potential cost-effective alternative. Objectives: The objective of this research was to evaluate the accuracy and clinical utility of iPhone-based LiDAR scanning for breast measurements compared to traditional methods, and to establish standardized protocols for clinical implementation. Methods: In this prospective validation study, 25 consecutive patients (mean age: 44 years; range: 32-64 years; mean BMI: 23.2 kg/m2) undergoing breast procedures were evaluated with the “3D Scanner App” on the iPhone 15 Pro (Apple Inc., Cupertino, CA). Three standardized measurements (sternal notch-to-nipple, nipple-to-midline, nipple-to-inframammary fold) of LiDAR and manual techniques were compared. Technical error of measurement (TEM) and relative TEM (rTEM) were calculated. Interrater reliability, learning curve assessment, and cost-effectiveness analysis were performed. Results: LiDAR measurements showed very good accuracy for sternal notch-to-nipple (rTEM 1.43%, 95% CI: 1.21-1.65) and nipple-to-midline (rTEM 2.83%, 95% CI: 3.12-3.78) distances. Nipple-to-inframammary fold measurements showed poor accuracy (rTEM 13.05%, 95% CI: 8.21-9.39). Interrater reliability was excellent (ICC = 0.92). Learning curve analysis demonstrated measurement stability after 5 cases. Cost analysis revealed 97.8% reduction in initial investment compared to commercial 3D imaging systems. Conclusions: Mobile LiDAR offers a cost-effective tool for breast surgery planning and documentation. While measurements like sternum-to-nipple and nipple-to-midline are highly accurate, the relatively poor accuracy of nipple-to-IMF highlights limitations with complex curves. As this technology continues to evolve, further improvements in accuracy are anticipated, expanding its role in clinical use. Level of Evidence: 4 (Therapeutic):

The Brussels Breast Surgery Fellowship at Brussels University Hospital offers a unique 3-month clinical immersion in reconstructive and aesthetic breast surgery. Under the guidance of fellowship director Prof. Moustapha Hamdi and his esteemed colleagues, the fellow is exposed to a high volume and wide breadth of cases spanning autologous and implant-based breast reconstruction, oncoplastic surgery, breast reduction and mastopexy, implant augmentation, revision breast surgery, and fat grafting. The multidisciplinary team approach, involving close collaboration with breast surgeons, provides valuable experience in oncoplastic planning and execution. In addition to time in the operating theater, the fellow gains knowledge through outpatient clinics, didactic teaching sessions, and clinical research opportunities leveraging the department's extensive prospective database. As the 2023 fellowship awardee, I had the privilege of learning directly from Prof. Dr. Moustapha Hamdi and participating in over 130 cases across the reconstructive and aesthetic spectrum. Unique features of the fellowship included exposure to lymphedema surgery utilizing the Symani robotic system, advanced techniques like the internal bra, volume distribution mastopexies, observation of private aesthetic clinic cases, and optional participation in academic workshops. This fellowship represents an outstanding opportunity to refine one's skills in breast surgery and microsurgery while experiencing the rich culture of Belgium.