{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:26:44Z","timestamp":1787599604840,"version":"build-2736575974"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Body feminization surgery (BFS) is an evolving component of gender-affirming care that increasingly incorporates hybrid approaches such as circumferential liposuction, gluteal augmentation, and minimally invasive rib remodeling. While these combinations yield favorable aesthetic outcomes, data regarding their thromboembolic safety profile remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate early thromboembolic events following hybrid body feminization surgery and to assess the potential value of scheduled postoperative Doppler ultrasound surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was performed of 52 transfeminine patients who underwent hybrid BFS between November 2023 and February 2025. All patients received standardized pharmacologic and mechanical thromboprophylaxis. Doppler ultrasound examinations were scheduled on postoperative days 1, 3, 7, and 10 to detect early thromboembolic events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A significant improvement in waist-to-hip ratio was observed (mean reduction 32%,\n                      <jats:italic>p\u2009<\/jats:italic>\n                      &lt;\u20090.001). Three thromboembolic events (5.7%) were identified: two asymptomatic deep vein thromboses (3.8%) detected during routine Doppler surveillance and one symptomatic pulmonary embolism (1.9%) occurring after unauthorized early long-haul travel. Doppler screening enabled detection of otherwise clinically silent events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hybrid BFS may be associated with a higher-than-expected incidence of early thromboembolic events in a moderate-risk population undergoing complex, multicomponent aesthetic surgery. Scheduled Doppler ultrasound surveillance may facilitate early detection of subclinical events and warrants further evaluation in this context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence IV<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-06206-2","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:10:57Z","timestamp":1787598657000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Body Feminization Surgery 4.0: Do We Need a Safety Update?"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3261-9410","authenticated-orcid":false,"given":"Alexander","family":"Aslani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Frontado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Arani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"6206_CR1","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.bjps.2025.01.047","volume":"103","author":"CL Kalmar","year":"2025","unstructured":"Kalmar CL, Nemani SV, Assi PE, Kassis S. Epidemiology and disparities of gender-affirming surgery in the United States. J Plast Reconstr Aesthet Surg. 2025;103:256\u201362. https:\/\/doi.org\/10.1016\/j.bjps.2025.01.047.","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"3","key":"6206_CR2","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1097\/PRS.0000000000010254","volume":"152","author":"MJ Stein","year":"2013","unstructured":"Stein MJ, Sasson DC, Harrast J, et al. A 16-year review of clinical practice patterns in liposuction based on continuous certification by the American board of plastic surgery. Plast Reconstr Surg. 2013;152(3):523\u201331. https:\/\/doi.org\/10.1097\/PRS.0000000000010254.","journal-title":"Plast Reconstr Surg"},{"issue":"20","key":"6206_CR3","doi-asserted-by":"publisher","first-page":"4217","DOI":"10.1007\/s00266-024-04260-2","volume":"48","author":"L Triana","year":"2024","unstructured":"Triana L, Palacios Huatuco RM, Campilgio G, Liscano E. Trends in surgical and nonsurgical aesthetic procedures: a 14-year analysis of the international society of aesthetic plastic surgery (ISAPS). Aesthet Plast Surg. 2024;48(20):4217\u201327. https:\/\/doi.org\/10.1007\/s00266-024-04260-2.","journal-title":"Aesthet Plast Surg"},{"issue":"5","key":"6206_CR4","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1097\/PRS.0000000000009049","volume":"149","author":"D Del Vecchio","year":"2022","unstructured":"Del Vecchio D, Bravo MG, Mandlik V, Aslani A. Body feminization combining large-volume fat grafting and gluteal implants. Plast Reconstr Surg. 2022;149(5):1197\u2013203. https:\/\/doi.org\/10.1097\/PRS.0000000000009049.","journal-title":"Plast Reconstr Surg"},{"issue":"2","key":"6206_CR5","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1530\/EJE-17-0496","volume":"178","author":"M Klaver","year":"2018","unstructured":"Klaver M, de Blok CJM, Wiepjes CM, et al. Changes in regional body fat, lean body mass and body shape in trans persons using cross-sex hormonal therapy: results from a multicenter prospective study. Eur J Endocrinol. 2018;178(2):163\u201371. https:\/\/doi.org\/10.1530\/EJE-17-0496.","journal-title":"Eur J Endocrinol"},{"issue":"3","key":"6206_CR6","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00266-020-01988-5","volume":"45","author":"LM Ferreira","year":"2021","unstructured":"Ferreira LM, Ferreira PEN, Bernardes ABS, et al. Aesthetic contouring of the chest wall with rib resection. Aesthet Plast Surg. 2021;45(3):1099\u2013104. https:\/\/doi.org\/10.1007\/s00266-020-01988-5.","journal-title":"Aesthet Plast Surg"},{"key":"6206_CR7","doi-asserted-by":"publisher","first-page":"e485","DOI":"10.1097\/GOX.000000000000485","volume":"11","author":"YH Chiu","year":"2023","unstructured":"Chiu YH, Chiu YJ, Lee CC, Wang TH, Lee JL. Ant waist surgery: aesthetic removal of floating ribs to decrease the waist-hip ratio. Plast Reconstr Surg Glob Open. 2023;11:e485. https:\/\/doi.org\/10.1097\/GOX.000000000000485.","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"7","key":"6206_CR8","doi-asserted-by":"publisher","first-page":"e3680","DOI":"10.1097\/GOX.0000000000003680","volume":"9","author":"KU Kudzaev","year":"2021","unstructured":"Kudzaev KU, Kraiushkin IA. Waist narrowing without removal of ribs. Plast Reconstr Surg Glob Open. 2021;9(7):e3680. https:\/\/doi.org\/10.1097\/GOX.0000000000003680.","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"5","key":"6206_CR9","doi-asserted-by":"publisher","first-page":"639e","DOI":"10.1097\/PRS.0000000000004338","volume":"141","author":"D Del Vecchio","year":"2018","unstructured":"Del Vecchio D, Wall S. Expansion vibration lipofilling: a new technique in large-volume fat transplantation. Plast Reconstr Surg. 2018;141(5):639e\u201349e. https:\/\/doi.org\/10.1097\/PRS.0000000000004338.","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"6206_CR10","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1016\/j.cps.2023.07.002","volume":"50","author":"P Pazmi\u00f1o","year":"2023","unstructured":"Pazmi\u00f1o P. Ultrasound-guided gluteal fat grafting: A to Z. Clin Plast Surg. 2023;50(4):587\u2013601. https:\/\/doi.org\/10.1016\/j.cps.2023.07.002.","journal-title":"Clin Plast Surg"},{"issue":"1","key":"6206_CR11","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1097\/PRS.0000000000009790","volume":"151","author":"A Aslani","year":"2023","unstructured":"Aslani A, Del Vecchio D, Bravo MG, Zholtikov V, Palhazi P. The dual-plane gluteal augmentation: an anatomical demonstration of a new pocket design. Plast Reconstr Surg. 2023;151(1):45\u201350. https:\/\/doi.org\/10.1097\/PRS.0000000000009790.","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"6206_CR12","first-page":"337","volume":"37","author":"J Winocour","year":"2017","unstructured":"Winocour J, Gupta V, Kaoutzanis C, Shi H, Shack RB, Grotting JC, et al. Venous thromboembolism in the cosmetic patient: analysis of 129,007 patients. Aesthet Surg J. 2017;37(3):337\u201349.","journal-title":"Aesthet Surg J"},{"issue":"3","key":"6206_CR13","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1097\/PRS.0b013e31818dbffd","volume":"122","author":"M Seruya","year":"2008","unstructured":"Seruya M, Iorio ML, Davison SP. Efficacy and safety of venous thromboembolism prophylaxis in highest-risk plastic surgery patients. Plast Reconstr Surg. 2008;122(3):1701\u20139.","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"6206_CR14","doi-asserted-by":"publisher","first-page":"205","DOI":"10.7326\/M17-2785","volume":"169","author":"D Getahun","year":"2018","unstructured":"Getahun D, Nash R, Flanders WD, et al. Cross-sex hormones and acute cardiovascular events in transgender persons: a cohort study. Ann Intern Med. 2018;169(4):205\u201313. https:\/\/doi.org\/10.7326\/M17-2785.","journal-title":"Ann Intern Med"},{"issue":"10","key":"6206_CR15","doi-asserted-by":"publisher","first-page":"e1539","DOI":"10.1097\/GOX.0000000000001539","volume":"5","author":"L C\u00e1rdenas-Camarena","year":"2017","unstructured":"C\u00e1rdenas-Camarena L, Andr\u00e9s Gerardo LP, Dur\u00e1n H, Bayter-Mar\u00edn JE. Strategies for reducing fatal complications in liposuction. Plast Reconstr Surg Glob Open. 2017;5(10):e1539. https:\/\/doi.org\/10.1097\/GOX.0000000000001539.","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"4","key":"6206_CR16","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1097\/PRS.0000000000004219","volume":"141","author":"L C\u00e1rdenas-Camarena","year":"2018","unstructured":"C\u00e1rdenas-Camarena L, Dur\u00e1n H, Robles-Cervantes JA, Bayter-Mar\u00edn JE. Critical differences between microscopic (MIFE) and macroscopic (MAFE) fat embolism during liposuction and gluteal lipoinjection. Plast Reconstr Surg. 2018;141(4):880\u201390.","journal-title":"Plast Reconstr Surg"},{"issue":"7","key":"6206_CR17","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1093\/asj\/sjx004","volume":"37","author":"MM Mofid","year":"2017","unstructured":"Mofid MM, Teitelbaum S, Suissa D, et al. Report on mortality from gluteal fat grafting: recommendations from the ASERF Task Force. Aesthet Surg J. 2017;37(7):796\u2013806.","journal-title":"Aesthet Surg J"},{"issue":"2","key":"6206_CR18","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1093\/asj\/sjac224","volume":"43","author":"P Pazmi\u00f1o","year":"2023","unstructured":"Pazmi\u00f1o P, Garcia O. Brazilian butt lift\u2013associated mortality: the South Florida experience. Aesthet Surg J. 2023;43(2):162\u201378.","journal-title":"Aesthet Surg J"},{"issue":"11","key":"6206_CR19","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1056\/NEJM199909093411103","volume":"341","author":"MM Samama","year":"1999","unstructured":"Samama MM, Cohen AT, Darmon JY, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N Engl J Med. 1999;341(11):793\u2013800. https:\/\/doi.org\/10.1056\/NEJM199909093411103.","journal-title":"N Engl J Med"},{"issue":"7","key":"6206_CR20","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1161\/01.CIR.0000138933.00456.8E","volume":"110","author":"A Leizorovicz","year":"2004","unstructured":"Leizorovicz A, Cohen AT, Turpie AGG, et al. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004;110(7):874\u20139. https:\/\/doi.org\/10.1161\/01.CIR.0000138933.00456.8E.","journal-title":"Circulation"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-06206-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-026-06206-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-06206-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:10:58Z","timestamp":1787598658000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-026-06206-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":20,"alternative-id":["6206"],"URL":"https:\/\/doi.org\/10.1007\/s00266-026-06206-2","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"assertion":[{"value":"3 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that they have no conflicts of interest to disclose.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all individual participants for the use of their anonymized photographs in this publication.","order":3,"name":"Ethics","label":"Informed Consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}