Aesthetic Society Members Research Articles

Contemporary Prophylactic Antibiotic Practices and Adjunct Therapies in Autologous Fat Grafting Procedures: A Survey of The Aesthetic Society Members.

Autologous fat grafting (AFG) is a widely used surgical technique that involves extracting a patient's own adipose tissue and transferring it to different areas of the body. This practice is still evolving. Guidelines for antibiotic prophylaxis and use of adjuncts in plastic surgery are currently limited, with a notable absence of standardized guidelines for AFG. In this survey, we assess contemporary antibiotic practices and adjuncts in AFG procedures. A 52-question survey was emailed to 3106 active members of The Aesthetic Society. Two hundred and ninety-three responses were recorded, representing a 9% response rate. We analyzed 288 responses. The most common AFG procedures were facial (38%), gluteal (34%), and breast (27%) augmentation. Preoperative antibiotics were used by 84.0% overall, with rates of 74.3%, 88.0%, and 92.7% in face, breast, and gluteal AFG, respectively. Lipoaspirate-antibiotic mixing was reported by 19.8%, mainly during gluteal AFG (46.9%), and less so in face (2.8%) and breast (8%) AFG. Notably, 46.9% of surgeons administered prolonged prophylaxis for 72 h or more. Tranexamic acid was utilized by 39.9% of the surveyed surgeons. Platelet-rich plasma was used by 5.6%. Doppler ultrasound was incorporated by 16.7% in AFG, with 21.5% in gluteal AFG, 14% in the face, and 19% in breast procedures. In this survey, we offer insights into antibiotic practices and adjunct therapies in AFG, especially intraoperative antibiotic mixing. Practices among members of The Aesthetic Society vary from guidelines. It is crucial to standardize practices and conduct further research to pave the way for evidence-based guidelines in AFG.

Potential Effects of Panfacial Filler Injections on Facelift Surgery and Outcomes: Survey Results of the Members of the Aesthetic Society

Abstract Goals/Purpose Facial soft tissue filler injections are being performed in the United States with increasing popularity. Even though there has been a trend towards noninvasive facial rejuvenation, surgery remains the standard of care for long lasting results for treatment of facial aging. Despite the well-known complications of soft tissue fillers, there remains a paucity of data regarding the potential adverse effects of prior repetitive panfacial soft tissue fillers on the technical aspects or outcome of facelift surgeries. The aim of this study was to understand the observations of the national aesthetic surgery community regarding facelift surgery in patients who have undergone repetitive panfacial fillers prior to their surgery. The primary outcome was to determine if the aesthetic community believed that a patient’s history of panfacial fillers led to potential difficulties or complications with their facelift procedure, so as to develop safer guidelines when performing surgery on these patients. Methods/Technique The authors developed a survey to examine the experiences among members of the Aesthetic Society with patients who have a history of repetitive panfacial fillers and then undergo facelift surgery. More specifically, it was to understand if a history of repetitive panfacial fillers had potential effects on the surgery itself and the post-operative outcomes. This survey contained 10 questions in total, included closed and open-ended questions, and was sent through email to 4,180 Aesthetic Society members. The survey was e-mailed twice, first in March 2022 and again in May 2022. The data was tabulated and examined to analyze the current techniques and perceived outcomes with repetitive panfacial fillers and facelifts. Categorial variables were reported as frequencies/percentages. Results/Complications In total, there were 156 responses, which was a 3.7% response rate. The majority of the respondents (80.8%) believed that less than 60% of their facelift patients had previous repetitive panfacial filler injections. Approximately one-half (51.9%) reported that a history of panfacial filler injections increased the difficulty of performing facelifts. A larger subset (39.7%) of respondents believed that a history of panfacial fillers increased complication rates, compared to the remaining who either disagreed (28.9%) or were unsure (31.4%). The most common complications following facelift surgery in those patients with known filler history included the undesirable palpability or visibility of filler (32.7%), compromised flap vascularity (15.4%), and decreased longevity of the lifting effect (9.6%). Conclusion The outcome of this survey identified that there may be a potential association with repetitive panfacial filler injections and outcomes following facelift surgery, although the exact effect on postoperative outcomes remained unclear. Large prospectively designed studies are needed to capture objective data comparing facelift patients with history of repetitive panfacial fillers with those facelift patients who have never had injectables. Given these results, the authors encourage careful history-taking to elicit an accurate filler injection record including complications after filler injections, as well as a thorough discussion with these patients preoperatively regarding the potential of panfacial fillers on the facelift procedure and potential outcomes.

Potential Effects of Repetitive Panfacial Filler Injections on Facelift Surgery and Surgical Outcomes: Survey Results of the Members of The Aesthetic Society.

Facial soft-tissue filler injections are being performed in the United States with increasing popularity.f. This study aimed to characterize the observations of The Aesthetic Society members regarding the potential impact of repetitive panfacial fillers on the outcomes of subsequent facelift surgery. A survey containing closed and open-ended questions was sent to The Aesthetic Society members through email. The response rate was 3.7%. The majority of the respondents (80.8%) believed that less than 60% of their facelift patients had previous repetitive panfacial filler injections. One half (51.9%) reported that a history of panfacial filler injections increased the difficulty of performing facelifts. A large subset (39.7%) of respondents believed that a history of panfacial fillers increased postoperative complication rates, while the remaining either disagreed (28.9%) or were unsure (31.4%). The most common complications following the facelift surgery included undesirable palpability or visibility of filler (32.7%), compromised flap vascularity (15.4%), and decreased longevity of the lifting effect (9.6%). This study identified a potential association with repetitive panfacial filler injections and outcomes following facelift surgery, although the exact effect on postoperative outcomes remains unclear. Large prospectively designed studies are needed to capture objective data comparing facelift patients with a history of repetitive panfacial fillers with those facelift patients who have never had injectables. Given the results of The Aesthetic Society members' survey, the authors encourage careful history-taking to elicit an accurate filler injection record including complications after filler injections, as well as engaging patients in a thorough preoperative discussion regarding the potential of panfacial fillers on the facelift procedure and postoperative outcomes.

US FDA Patient Decision Checklist for Breast Implants: Results of a Survey to Members of The Aesthetic Society, April 2022.

The US Food and Drug Administration (FDA), in response to concerns that patients undergoing breast implant surgery were not adequately informed about the risks of receiving an implanted medical device, mandated a Patient Decision Checklist (PDC) in October 2021. Breast implant manufactures communicated with plastic surgeons in 2022 regarding the use of the PDC as a condition for the sale of breast implants. Plastic surgeons voiced concerns over the accuracy of the content in the PDC and its confusing statements about the risk of adverse events associated with breast surgery. In April 2022, The Aesthetic Society developed a survey that was sent to its members regarding their experiences with the PDC. This was a 5-question survey, with 1 additional place for comments. The purpose of this survey was to develop data based on the 6-month experience of plastic surgeons with the PDC. A total of 206 Aesthetic Society members (9%) participated in the survey (1849 total active members in the United States). Patients deserve appropriate information prior to breast implant surgery to make an informed decision after reviewing the potential risks and benefits. The authors believe that there is still more work to be done to create an ideal PDC that is fair and balanced, scientifically describes risk incidence in a way that patients understand, and can be updated.

Commentary on: Current Upper Blepharoplasty and Ptosis Management Practice Patterns Among The Aesthetic Society Members.

Commentary on: Current Upper Blepharoplasty and Ptosis Management Practice Patterns Among The Aesthetic Society Members.

Current Upper Blepharoplasty and Ptosis Management Practice Patterns Among The Aesthetic Society Members.

Patients presenting for upper blepharoplasty can exhibit different aging patterns and we have anecdotally observed wide variability in upper blepharoplasty approaches among surgeons. However, upper blepharoplasty practice patterns have not been systematically analyzed among members of The Aesthetic Society. The aim of this study was to report upper blepharoplasty practice patterns, the recognition of different patient presenting features, and to assess the incidence and management of ptosis as reported by members of The Aesthetic Society. A 29-item electronic questionnaire was distributed to 1729 Aesthetic Society members with available email addresses. In total, 214 Aesthetic Society members submitted the questionnaire, for a response rate of 12.4%. There was a significantly increased rate of volume preservation among surgeons with greater experience (≥10 years in practice) and a high-volume (≥100 cases in past 12 months) of upper blepharoplasty cases. Furthermore, high-volume upper blepharoplasty surgeons were significantly more likely to perform concomitant upper lid fat grafting (P = 0.03), browlift (P = 0.02), and ptosis repair (P = 0.01). Ninety-five percent of respondents reported a mild/moderate ptosis (MRD1 2 to <4mm) incidence of <25%. Among surgeons who perform ptosis repair, 97.4% utilize levator advancement or plication as their most commonly used technique. High-volume upper blepharoplasty surgeons are more likely to preserve upper lid volume and perform concomitant browlift and ptosis repair. Our data suggest that different upper eyelid aging patterns and mild/moderate ptosis are underrecognized.

Venous Thromboembolism Prophylaxis in Aesthetic Surgery: A Survey of Plastic Surgeons' Practices.

Deep venous thrombosis and pulmonary embolism, collectively known as venous thromboembolism (VTE), are among the most feared yet preventable surgical complications. Although many recommendations exist to reduce the risk of VTE, the actual VTE prophylaxis practices of aesthetic plastic surgeons remain unknown. The primary aim of this study was to elucidate plastic surgeons' experiences with VTE, preferred VTE prophylaxis practices, and areas in which VTE prevention may be improved. Members of The Aesthetic Society were queried via a 55-question electronic survey regarding their experience with VTE as well as their VTE prophylaxis practices. Anonymous responses were collected and analyzed by the Mayo Clinic Survey Research Center. The survey was sent to 1729 of The Aesthetic Society members, of whom 286 responded. Fifty percent, 38%, and 6% of respondents reported having had a patient develop a deep venous thrombosis, pulmonary embolism, or death secondary to VTE, respectively. Procedures performed on the back or trunk were associated with the highest rate of VTE. Lower extremity procedures were associated with a significantly higher rate of VTE than expected. Over 90% of respondents reported utilizing a patient risk stratification assessment tool. Although at least one-half of respondents reported that the surgical facility in which they operate maintains some form of VTE prophylaxis protocol, 39% self-reported nonadherence with these protocols. Considerable variability exists in VTE prophylaxis practices among The Aesthetic Society responders. Future efforts should simplify guidelines and tailor prophylaxis recommendations to the aesthetic surgery population. Furthermore, education of plastic surgeons performing aesthetic surgery and more diligent surgical venue supervision is needed to narrow the gap between current recommendations and actual practices.

Browpexy: Lateral orbicularis muscle fixation as an adjunct to upper blepharoplasty

“Second Thoughts” focuses on ways in which aesthetic plastic surgeons have modified or even dramatically changed their techniques or clinical practice of aesthetic surgery over time to achieve optimal results. Contributors are Aesthetic Society members and other recognized experts.

Continuing medical education examination—facial aesthetic surgery

“Operative Strategies” is a fully illustrated guide to the favorite techniques of aesthetic plastic surgeons based on their significant clinical experience. Authors are Aesthetic Society members or other recognized experts. Learning Objectives: After studying this article, the reader should be able to: Determine the aesthetic objectives of an osseous genio-plasty. Describe the important surgical anatomy for genio-plasty. Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material covered in this article. The examination begins on page 517.

Forehead plasty for facial rejuvenation

“Operative Strategies” is a fully illustrated guide to the favorite techniques of aesthetic plastic surgeons based on their significant clinical experience. Authors are Aesthetic Society members or other recognized experts.

Is office-based aesthetic surgery still viable?

“Second Thoughts” focuses on ways in which aesthetic plastic surgeons have modified or even dramatically changed their techniques or clinical practice of aesthetic surgery over time to achieve optimal results. Contributors are Aesthetic Society members and other recognized experts.

Refinement of the brow lift technique that does not raise the hairline

“Second Thoughts” focuses on ways in which aesthetic plastic surgeons have modified or even dramatically changed their techniques over time to achieve optimal results. Contributors are Aesthetic Society members and other recognized experts.

A personal technique for facial rejuvenation

“Operative Strategies” is a fully illustrated guide to the favorite techniques of aesthetic plastic surgeons based on their significant clinical experience. Authors are Aesthetic Society members or other recognized experts. # Commentary {#article-title-10}

The alar sliding graft for correcting alar collapse and expanding the nasal tip

“Operative Strategies” is a fully illustrated guide to the favorite techniques of aesthetic plastic surgeons based on their significant clinical experience. Authors are Aesthetic Society members or other recognized experts.

Technical update on transumbilical breast augmentation

“Second Thoughts” focuses on ways in which aesthetic plastic surgeons have modified or even dramatically changed their techniques over time to achieve optimal results. Contributors are Aesthetic Society members and other recognized experts.

Advantages of W-plasty in the anterior neck

“Second Thoughts”” focuses on ways in which aesthetic surgeons have modified or even dramatically changed their techniques over time to achieve optimal results. Contributors are Aesthetic Society members and other recognized experts.

Simultaneous breast augmentation and mastopexy

“Operative Strategies” is a fully illustrated guide to the favorite techniques of aesthetic surgeons based on their significant clinical experience. Authors are Aesthetic Society members or other recognized experts.

Avoiding complications of transblepharoplasty lower-lid and midface rejuvenation

“Operative Strategies” is a fully illustrated guide to the favorite techniques of aesthetic surgeons based on their significant clinical experience. Authors are Aesthetic Society members or other recognized experts.

Lidocaine toxicity issues in lipoplasty

“Second Thoughts” focuses on ways in which aesthetic surgeons have modified or even dramatically changed their techniques over time to achieve optimal results. Contributors are Aesthetic Society members and other recognized experts.

How I Modified the Endoscopic Brow Lift

“Second Thoughts” focuses on ways in which aesthetic surgeons have modified or even dramatically changed their techniques over time to achieve optimal results. Contributors are Aesthetic Society members and other recognized experts.