Consensus and Evidence-Based Recommendations on the Impact of Minimally Invasive Treatments on Subsequent Facial Surgery for Additional Aesthetic Enhancement

Goals/Purpose: Minimally invasive treatments (MITs) continue to rise due to enhancements with minimal downtime. MITs include injectable agents, threads and energy-based devices (EBD). Despite the popularity, the long-term implications for facial surgery after these treatments are unknown. The purpose of this consensus is to understand the impact between MITs and later facial surgeries and to provide evidence-based recommendations to optimize outcomes.

Methods/Technique: An expert multidisciplinary panel composed of 7 plastic surgeons and 1 dermatologist developed recommendations on the impact of MITs on subsequent aesthetic facial surgery. Recommendations were identified through literature reviews, author surveys, and case-based discussions held over two virtual meetings. Recommendations were accepted if at least 75% of the expert panel voted in favor of the recommendation. Faculty responses were summarized using mean values on a five-point Likert scale, with 1 indicating strong disagreement and 5 indicating strong agreement.

Results/Complications: The experience and literature findings emphasize that while MITs do not inherently preclude future aesthetic facial surgery, they introduce potential complications that may influence surgical planning and outcomes. The most critical issue arise from tissue plane distortion and vascular compromise, particularly in patients treated with deeply delivered EBDs or improperly administered injectables.

Conclusion: The interplay between MITs and the subsequent facial surgery must be carefully considered. To mitigate these risks, preoperative assessments, careful timing of surgery relative to the last MITs, and specific intraoperative techniques should be considered.