Lower eyelid ectropion is commonly associated with anterior lamellar shortening after transcutaneous lower eyelid surgery; however, severe ectropion may also develop in older adults even in the absence of skin deficiency. We report a case of marked lower eyelid ectropion in a 78-year-old woman following orbital floor blowout fracture repair via a subciliary incision. Despite minimal anterior lamellar involvement, revision surgery revealed dense middle lamellar fibrosis resulting in significant vertical restriction of eyelid excursion. Targeted adhesiolysis at the level of the arcus marginalis, combined with lateral tarsal strip fixation, successfully restored eyelid position, with stable results maintained at 1-year follow-up. Notably, retrospective review of postoperative magnetic resonance imaging demonstrated an early preseptal hematoma followed by fibrotic changes in the septal region, providing radiologic correlation with the intraoperative findings. Although this case originated from reconstructive surgery, it delivers a cautionary message relevant to aesthetic lower eyelid procedures: in older adults undergoing subciliary incisions, postoperative hematoma may precipitate middle lamellar fibrosis and severe ectropion even without an anterior lamellar defect, underscoring the importance of meticulous hematoma prevention.

Lipogranuloma is a chronic inflammatory response to lipid material within tissues and may develop secondary to fat necrosis, trauma, or exogenous lipid exposure. We report a case of postoperative mid-sternal lipogranuloma with milky discharge in a 35-year-old man that occurred 6 months after surgery for gynecomastia performed through a periareolar incision with adjunctive liposuction. The patient presented with two firm, non-tender nodules at the sternal midline, distant from the operative site, and laboratory findings were unremarkable. Surgical exploration revealed milky white discharge, and histopathologic examination demonstrated lipid-laden macrophages, multinucleated giant cells, and fibrosis, consistent with lipogranulomatous inflammation. No evidence of malignancy or infection was identified, and no recurrence was observed during 2 years of follow-up. The proposed mechanisms include displacement of residual ductal epithelium or lipid material during surgical manipulation, as well as postoperative fat necrosis leading to secondary lipogranulomatous inflammation. This case highlights that postoperative lipogranulomatous inflammation may present at sites distant from the primary operative field. Recognition of this entity is important in the evaluation of postoperative chest wall masses to avoid misdiagnosis and unnecessary intervention.

Postmastectomy radiation therapy (PMRT) can compromise soft-tissue quality and cause progressive fibrosis and contracture, thereby complicating delayed breast reconstruction even after prior implant removal. Delayed reconstruction is particularly challenging when radiation-associated distortion of the breast and nipple-areola complex (NAC) coexists with contralateral ptosis, because achieving symmetry requires coordinated restoration of both breast contour and nipple position. We report the case of a 50-year-old woman with invasive ductal carcinoma of the right breast who underwent nipple-sparing mastectomy followed by immediate tissue expander reconstruction with acellular dermal matrix. During adjuvant chemotherapy, she developed a periprosthetic infection that necessitated expander removal and capsulectomy. She subsequently completed PMRT, after which progressive breast contracture and severe NAC distortion developed. Ten months after completion of PMRT, delayed breast reconstruction was performed using a muscle-sparing free transverse rectus abdominis myocutaneous flap, with excision of compromised mastectomy skin, simultaneous free NAC grafting onto the flap skin paddle, and contralateral mastopexy to improve symmetry. The postoperative course was uneventful, and breast symmetry improved relative to the preoperative condition. This case illustrates a practical reconstructive option for managing severe NAC distortion in an irradiated, contracted breast after prosthetic failure.

Buttock augmentation is an increasingly popular cosmetic procedure designed to enhance buttock contour, size, and shape. However, the safety profile of this procedure remains insufficiently established, and it carries risks of complications, including foreign body reactions and infections. These complications may be exacerbated by filler migration, resulting in large soft-tissue cavities that resemble pseudocysts. In this study, we describe two patients who developed severe complications following massive filler injections to the buttocks. A 56-year-old female patient presented with a 6×5 cm soft-tissue defect associated with an extensive underlying dead space, sinus tract formation, and a large pocket extending across the buttock. Additionally, a 50-year-old female patient developed diffuse cellulitis and multiple abscesses secondary to migration of an infected filler-related pseudocyst. Both patients underwent successful en bloc capsulectomy, resulting in marked clinical improvement without recurrence or postoperative complications. These cases underscore the serious complications associated with large-volume filler injections and highlight the importance of comprehensive surgical management in addressing late-stage adverse outcomes.

Injectable fillers have become an integral component of contemporary aesthetic plastic surgery, accounting for a substantial proportion of non-surgical cosmetic procedures worldwide. This review provides a comprehensive overview of current injectable filler trends in China, with a particular focus on material characteristics, facial contour stabilization injection strategies, emerging treatment areas, and safety considerations. Commonly used materials include hyaluronic acid fillers, collagen fillers, and collagen stimulators such as calcium hydroxylapatite, poly-L-lactic acid, poly-D,L-lactic acid, and polycaprolactone. Each material exhibits distinct rheological and biological properties that influence clinical indications, injection depth, longevity, and associated risk profiles. In particular, collagen fillers and collagen stimulators have received increasing attention for subtle contour refinement and tissue quality improvement in delicate or large-surface areas. A facial contour stabilization philosophy that differentiates outer and inner facial aesthetic units is increasingly adopted to achieve balanced rejuvenation while minimizing the risk of overfilling. Beyond facial contour refinement, injectable fillers are increasingly utilized for hand, knee, and auricular rejuvenation. Finally, safety issues, particularly facial overfilled syndrome, are discussed, underscoring the importance of conservative planning, anatomical precision, and evidence-based clinical decision-making.

Aging of the jawline commonly results in jowl deformity due to skin laxity and descent of subcutaneous tissues. Traditional correction methods, including rhytidectomy, can effectively address these issues but often involve substantial invasiveness and recovery time. A less invasive, targeted approach for isolated jowl correction is desirable. We present a novel surgical method of direct jowl excision using a triangular full-thickness wedge excision combined with local flap advancement. The excision was meticulously planned along relaxed skin tension lines, avoiding underlying muscular and neural structures, and was followed by layered closure. In our case, a 66-year-old woman who was previously dissatisfied with the outcomes of conventional rhytidectomy underwent direct jowl excision. At the 12-month follow-up, the patient demonstrated marked improvement in jowl prominence and jawline contour, with minimal scar visibility along the mandibular border. No complications or adverse outcomes occurred, and patient satisfaction was notably high. Direct jowl excision offers a focused, minimally invasive alternative for patients with isolated jowl deformities. It provides significant aesthetic improvement with low morbidity, rapid recovery, and acceptable scar formation. This technique should be considered a viable adjunct in the surgical toolkit for facial rejuvenation in carefully selected patients.

Background: Transconjunctival fat removal (TFR) is a widely practiced aesthetic procedure for lower eyelid bulging, with the traction method commonly used to secure the surgical field. However, this approach carries risks such as lower eyelid skin penetration and extraocular muscle injury. To address these concerns, a compression method that avoids energy devices and enables blunt dissection through orbital compression was evaluated. Methods: A retrospective study was conducted of 60 TFR cases performed by a single surgeon between March 2024 and February 2025. Patients were categorized into compression (n=30) and traction (n=30) method groups based on the technique used for surgical field exposure. Postoperative complications were assessed over a 1-month period. Results: No significant differences were found in baseline demographics. Postoperative complications occurred in three cases (10.0%) in the compression group and two cases (6.7%) in the traction group (P=0.640). All complications were mild and resolved without reoperation. No severe adverse events, including orbital hemorrhage, infection, or visual impairment, were observed. One case of residual orbital fat in the compression group was attributed to limited visualization due to orbital pressure. Conclusions The compression method demonstrated a safety profile comparable to that of the traction method and may serve as a viable alternative, particularly for less experienced surgeons. It offers a simplified and potentially safer approach for performing TFR, supporting its utility in clinical practice and surgical training.

A 42-year-old female patient presented with a complete ear amputation resulting from a collision with a machine. The ear was avulsed by blunt trauma, meaning that it was torn away rather than being cleanly cut. Fortunately, the auricular cartilage remained intact and preserved its overall shape despite the amputation. However, the surrounding blood vessels were not suitable for microanastomosis. In the first-stage operation, the auricular cartilage was de-epithelialized and embedded into the postauricular area. Three months later, during the second-stage operation, the embedded auricular cartilage framework was elevated to achieve normal auricular projection. During the postoperative period, a customized mold based on the shape of the patient’s contralateral ear was fabricated using 3D printing technology and applied to the reconstructed ear to refine the contour and achieve a natural appearance. The overall outcome was favorable, with no complications observed during the postoperative care period.