Plastic Surgery: The Meeting ASPS Los Angeles 2016

Plastic Surgery: The Meeting 2016 

Presentation in ASPS Los Angeles

This is an original article written by Dr. Minhee Ryu from RNWOOD Plastic Surgery in Seoul, South Korea, translated in English for convenience: 

Dr. Minhee Ryu presented at Plastic Surgery: The Meeting 2016, organized by the American Society of Plastic Surgeons (ASPS) in Los Angeles, delivering a lecture on the “Anatomical Variation of Zygomatic Nerve Branches Around the Zygomaticus Major Muscle in Facelift.” The presentation detailed a rare anatomical anomaly where the zygomatic nerve pierced the deep fascia and coursed over the zygomaticus major muscle, emphasizing the importance of meticulous dissection to prevent nerve injury during facelift surgery. 

This finding contributed to a deeper understanding of facial nerve variability and safer surgical techniques. Beyond the academic sessions, Dr. Ryu reflected on emerging trends in aesthetic surgery—particularly the growing influence of non-surgical treatments—and underscored the importance of preserving surgical excellence, patient trust, and professional integrity amid a rapidly evolving global aesthetic landscape.

Please enjoy the full article below:

⚠ Trigger warning: This article contains images from surgical procedures that include blood. Viewer discretion is advised.

“Plastic Surgery: The Meeting 2016” organized by The American Society of Plastic Surgeons (ASPS) was held in Los Angeles on September 23rd~27th. I presented a lecture in regards to the Anatomical Variation of Zygomatic Nerve Branches Around Zygomaticus Major Muscle in Facelift. 

There needs to be major caution in order to avoid damaging facial nerves when detaching retaining ligaments during a facelift. Especially the retaining ligaments around the zygomatic area, where the zygomatic branches are adjacent, much circumspection is needed due to its anatomical structure. Generally, the zygomatic nerve passes beneath the deep fascia and travels under the zygomaticus major muscle (ZMM). However, in rare cases, it may course over the ZMM. Additionally, an orbicularis branch from the zygomatic nerve may occasionally branch off irregularly and extend to the orbicularis oculi muscle.

During a surgery, we encountered an unusual case. The zygomatic nerve pierced the deep fascia from the lateral side of the zygomaticus major muscle, giving off unusually thick branches to the orbicularis oculi muscle, and some branches also coursed over the ZMM. This variation was observed unilaterally and is considered a very rare anatomical anomaly, which prompted us to report it at this conference.

The significance of this finding allows for improvement in our understanding of the unusual pathway of the facial nerve and contributes to safer surgical procedures. Typically, the zygomatic nerve passes beneath the deep fascia and travels under the zygomaticus major muscle, making it relatively protected during dissection. However, in this rare case, where the nerve pierces the deep fascia laterally and courses over the ZMM, extra caution is required, particularly during release of the retaining ligaments.

Furthermore, the branching pattern of the orbicularis branch from the zygomatic nerve is not consistent. It is especially rare to observe such thick branches arising from the region of the zygomatic retaining ligament, which underscores the need for careful dissection in this area.

In an effort to avoid nerve damage for such clinical implications, I would like to mention several personal techniques. Although these cases are rarely observed, being aware and mindful of these variables can encourage safer surgeries. 

The academic conference held by The American Society of Plastic Surgeons (ASPS) encompasses a wide range of plastic surgeries outside of aesthetic purposes. The presentation done in Taiwan was especially lively. I met a few of my friends; among them, it was especially nice to see Sophia again, who had been at Chang Gung Memorial Hospital in Taiwan but moved to Tsinghua University Chang Gung Hospital in Beijing last year. Since we were staying in the same city and had a lot of things to catch-up on, we decided to keep in touch more often.

American academic conferences, there is usually always an event that everyone can enjoy all together. This time there was a jogging and salsa dance party-themed event called “Wellness Run & Walk.” I only participated in the morning jog.  The course began where the conference was held — the Los Angeles Convention Center — and continued 5km downtown to the Westin Hotel near Disney Concert Hall, where the movie Die Hard was filmed. It was a refreshing early morning experience.

Among various topics, a few Facial Rejuvenation presentations stood out to me. Dr. Coleman’s  “Surgical vs Non-Surgical Approaches to the Face and Neck,” in particular, left a deep impression. Western patients often have less prominent zygomatic and mandibular angles, so they look for facial contours that would accentuate those features in order to appear more attractive. Therefore, procedures that enhance volume in the cheekbones and jawline — such as implants or autologous fat grafts — are widely popularized. In his presentation, Dr. Coleman focused on the lower face and demonstrated a smooth lower facial contour through fat grafting. I was especially shocked at how he was able to achieve a defining and attractive mandibular angle contour simply through a fat graft. I believe this technique could also be used on patients who have excessively resected mandibular angles — commonly seen in Asian patients. 

During the Facelift video session, it was noteworthy to see the speakers discuss concepts that are often taken for granted in a detailed and logical way. Although surgical methods regarding the SMAS, facial nerves, and the anatomical structure of retaining ligaments are important, the speakers’ comprehensive observation on what is visible on the eyes (such as the skin) is meaningful and thoroughly discussed.

“The New Age of Aesthetics: Can Plastic Surgeons Maintain Their Leadership Role by Embracing Non-Surgical Technologies and Treatment?” session highlighted the evolving trends in aesthetic plastic surgery. The United States has also shown an increase in minimally invasive treatments such as filler, botox, laser, and many others. Consequently, competition in the field has intensified. Unlike surgery, where the surgeon’s experience and technical skill are critical determining factors of results, these non-invasive procedures tend to be more dependent on the use of devices and materials, with relatively easier accessibility. As a result of this bias towards non-surgical procedures, the number of non-specialist providers (i.e., general practitioners (GPs)) entering the aesthetic market is on the rise, leading to an increasingly fierce competition.

This situation raises a crucial question: how can board-certified plastic surgeons maintain a competitive edge in the realm of minimally invasive procedures? In conclusion, the speakers agreed that there needed to be an emphasis on promoting one’s specialties — how to differ in expertise and what is the (personal) branding — and actively integrating these procedures alongside surgical practices. While this might have been the most practical path forward in the current environment, there was something missing. 

In reality, patients find value in not just the surgeon themselves, but also the cost, communication, and overall service. Unfortunately, aesthetic plastic surgery will eventually no longer just be a space for plastic surgeons in an exclusive domain. Therefore, I want to emphasize the importance of putting effort in reinforcing patients’ values in association with the surgeon’s core expertise, especially in this global shift.

My first experience with the American Society of Plastic Surgeons (ASPS) academic conference meeting was back in 2008 in Chicago. At that time, the main venue was the McCormick Place Convention Center, and the band Chicago was invited to perform at the conference. I vividly remember how refreshing and inspiring that atmosphere was. Therefore, when an “American” academic conference is mentioned, my first thought is not about the passion in academia, but the ability to experience the balance of confidence and enjoyment. 

However, this academic conference felt slightly different. My heart was heavy knowing the obstacles that laid ahead for plastic surgeons worldwide. I look forward to continuing the legacy through hard work—along with good fortune—for what I believe in.

Dr. Minhee Ryu, M.D.

RNWOOD Plastic Surgery

Seoul, South Korea

(Source: https://blog.naver.com/rejuvemaster )

Dr. Minhee Ryu is a World-Class FACELIFT Specialist and Global Educator, who is deeply committed to sharing his facial rejuvenation surgery and anatomy expertise. As a lecturer, tutor, and demonstrator, he is invited to deliver DEEP PLANE FACELIFT presentations and perform live surgery and cadaver dissection Demonstrations in more than 15 countries, including Korea, the US, Europe, Singapore, Australia, Japan, and beyond.

Recognized worldwide for his expertise in DEEP PLANE FACELIFT, Dr. Ryu is a Faculty Member at MAFAC since 2016, a guest Faculty Member at Mayo Clinic since 2023, and an Editorial Board Member for the Aesthetic Plastic Surgery Journal (SCI) since 2019. He is an active member of KSPRS, ASPS, ASAPS, and ISAPS. As a global top-tier leader in Facelifts, Dr. Minhee Ryu makes dedicated contributions to academic advancement and surgical education.

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