Abdulaziz Alsuhaim

Background Gynecomastia is benign enlargement of male breast tissue that may cause psychological distress and aesthetic concerns. Surgical correction can be complicated by scarring, contour irregularities, and nipple-areolar complex (NAC) deformity. Methods This article presents a narrative review and describes a surgical technique involving preoperative marking, VASER-assisted liposuction, circumferential de-epithelialization, controlled glandular excision, preservation of dermoglandular tissue beneath the NAC, and staged closure. Results The described approach combines contouring with preservation of NAC support and a staged closure intended to distribute tension. The photographs illustrate preoperative and postoperative appearances; comparative effectiveness, complication rates, and long-term outcomes have not been established. Conclusions Donut excision with dermoglandular preservation and staged closure is a described approach to gynecomastia correction. Comparative studies with longer follow-up and standardized patient-reported outcomes are needed to evaluate its safety and aesthetic benefits. Level of Evidence V 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 Abdominal contour deformities are a common concern for individuals seeking body reshaping procedures, often driven by cosmetic dissatisfaction and functional impairments associated with skin laxity, muscle diastasis, and excess adiposity. Traditional abdominoplasty techniques have evolved to address these anatomical challenges, yet optimizing both aesthetic outcomes and minimizing surgical morbidity remains a central goal in plastic surgery. Methods This study presents a refined abdominoplasty technique that emphasizes precise preoperative planning, preservation of vascular integrity, and layered anatomic enhancement to improve surgical outcomes. The approach begins with strategic preoperative markings while the patient is standing, allowing for accurate delineation of the midline, ASIS landmarks, and liposuction zones. Intraoperatively, liposuction is limited to lateral regions to preserve central perforators, followed by a lower transverse incision and cephalad dissection up to the umbilicus. A vertical midline incision facilitates full mobilization of the abdominal flap. Two-layer rectus plication is performed using looped Ethilon sutures to reinforce the abdominal wall from xiphoid to pubis. A key modification in this technique is the use of a fascio-dermal (Stratafix®) suture extending along the midline from the xiphoid to the umbilicus, which enhances definition of the linea alba and contributes to a more athletic abdominal contour. Umbilicoplasty is then performed by anchoring the rectus fascia to the umbilical stalk and creating a V-shaped incision in the abdominal flap to ensure natural umbilical positioning. Layered closure is completed with the patient in flexion, and two closed-suction drains are placed. Results This technique prioritizes both functional restoration and aesthetic refinement through targeted soft tissue management, preservation of key anatomical structures, and three-dimensional contouring. Conclusion It offers a reliable, reproducible approach adaptable to a range of patient presentations, especially those requiring improved muscle definition and natural umbilical aesthetics without extensive undermining. Level of Evidence V 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.

Introduction Hand rejuvenation addresses aging-related changes such as subcutaneous fat loss, skin degradation, and photodamage. Autologous fat transfer (AFT) has emerged as a promising treatment, offering durable volume augmentation and regenerative effects. This study aims to systematically review the evidence on the techniques, outcomes, and complications of AFT for hand rejuvenation. Methods A systematic review was conducted following the PRISMA guidelines, searching databases such as MEDLINE, SCOPUS, DOAJ, and PUBMED from inception to April 2024. Inclusion criteria were studies reporting on hand rejuvenation using fat grafting, including randomized clinical trials, observational studies, case reports, and case series. Data extraction and risk of bias assessment were performed independently by multiple reviewers blindly. Results Eleven studies published between 2001 and 2019 were included, comprising 303 patients with a strong female predominance. Study designs varied, with three randomized clinical trials, seven case series, and one prospective study. High satisfaction rates were consistently reported, with complications being generally infrequent and minor. Various fat grafting techniques were employed, with manual aspiration being the predominant fat harvesting method. Follow-up periods ranged from 5 to 38 months, facilitating thorough evaluation of treatment outcomes. Conclusion AFT for hand rejuvenation is effective and safe, offering high patient satisfaction and minimal complications. Long-term fat retention and regenerative effects of adipose-derived stem cells contribute to success. However, fat graft resorption may require multiple treatments. Future research should standardize assessment tools, volumetrically measure graft resorption, and conduct high-quality trials to optimize protocols. Level of Evidence II 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 Liposuction has become the most sought-after aesthetic surgery across the globe, increasing the demand for more developments in patient safety protocols. Evidence of the efficacy of tranexamic acid (TXA) in reducing intraoperative blood loss with minimal complications have led to its widespread applications across various surgical operations. However, the role and effectiveness of TXA in liposuction is not fully understood. Therefore, the purpose of this systematic review and meta-analysis is to investigate the effectiveness of TXA in minimizing intraoperative blood loss in patients undergoing liposuction. Methods In adherence to the preferred reporting items for systematic reviews and meta-analysis guidelines, a comprehensive search was conducted in multiple databases including, PubMed, Cochrane CENTRAL, and Web of Science. Only randomized controlled trials (RCTs) were included without time frame limitations. Our primary outcomes were hemoglobin levels, hematocrit levels, lipoaspirate volume, and associated complications. Results This meta-analysis provides a comprehensive analysis of five RCTs published between 2021–2023, involving 334 patients. The pooled mean difference for postoperative hemoglobin levels was statistically significant in favor of local TXA administration (MD 0.54; P = 0.03; I²= 0%). Analysis of postoperative hematocrit levels (g/dL) and lipoaspirate volume (L) mean differences were statistically insignificant (MD 0.76; P = 0.35; I²= 0%) and (MD 0.19; P = 0.82; I²= 85%) respectively. No complications related to the use of TXA occurred. Conclusion Although a statistically significant difference was seen in postoperative hemoglobin levels, it is imperative that the results are interpreted with caution, given the preliminary nature of the observed effect. Further large well-designed RCTs are required to solidify current TXA protocols and to provide comprehensive guidelines for its application in liposuction. Level of Evidence I 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.