Aesthetic Surgery Practice Research Articles

Experience of Hyperbaric Chamber Usage in Aesthetic Plastic Surgery Practice for Recovery and Complication Prevention.

Hyperbaric oxygen therapy (HBOT) increases oxygen concentration in affected tissues that enhance the cellular hypoxia recovery process, neovascularization, fibroblast proliferation, increased reactive oxygen species, suppression of proinflammatory states, and vascular compression. The aim of this article is to demonstrate the experience in the use of the hyperbaric chamber as an adjunctive management for the prompt recovery of patients who underwent aesthetic plastic surgery. A retrospective descriptive study was conducted between 2021 and 2023, involving 296 patients who received HBOT after aesthetic surgical procedures, to demonstrate the recuperation time rate and the complication incidence in postoperative patients using HBOT. Most participants were women, with a median age of 33.5 years. Surgical procedures were grouped in liposculpture, abdominoplasty, and breast interventions. Complications related to the surgical event were low (10.7%), with occurrences of hematomas (n = 14, 4.72%), anemias (n = 9, 3.04%), and wound dehiscence (n = 8, 2.70%). There were no reports of surgical site infections or necrosis. Recovery times to get back to work were 10 days for liposuction, 3 days for breast interventions, and 21 days for abdominoplasty. This study demonstrated the experience of using a postoperative hyperbaric chamber in aesthetic plastic surgery to promote recovery processes. The patient cohort in this study showed shortened recovery times than the data obtained from the major international plastic surgery organizations. Also, HBOT patients had a low complication rate, without infections, indicating the potential efficacy of this adjunctive therapy. Overall, this study underscores the promising role of hyperbaric chamber therapy in facilitating postoperative recovery and mitigating complications.

"The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medspa Directorship and Practitioner Trends in Florida".

The rapid proliferation of medical spas in the US has raised concerns over the continued shift of non-surgical aesthetic treatments away from traditional core specialty integration and supervision, potentially affecting the surgical treatment guidance and education of cosmetic surgery patients. This study aimed to assess the current trends in the growth of independent medspa facilities as well as practitioner supervision, licensing, and specialization in the state of Florida. A comprehensive, statewide survey of all independent medspas in Florida, by municipality, employing Google and Yellow Pages search engines. Information gathered included the number of locations, business stakeholders, and director/practitioner licensing and certification obtained from the Florida Division of Corporations/Department of Health databases and respective medical boards. A total of 1,038 medspas were identified, revealing a 100% increase in number relative to 2021 estimates. Non-physician practitioners represented 84% of medspa providers, with core specialty medical director supervision present in only 22% of facilities and a large proportion of directors lacking specialty training (77%) or board certification (42%). Additionally, 25% of medspas appeared to disregard state guidelines pertaining to medical directorship, autonomous non-physician practice, and numerical/geographic restrictions on directorship, with 96% of facilities lacking licensing/registration with Florida's Agency for Health Care Administration. Medspa growth in Florida has been explosive, with continued departure from core supervision, increasingly limited specialty training/integration, and non-adherence to state guidelines. Enhanced regulation and integrated non-physician practitioner training are likely necessary to ensure patient safety and the cohesive practice of aesthetic medicine and surgery.

The Classification of Gluteal Augmentation.

Gluteal enhancement is a major growing trend within aesthetic surgery practice. Patient needs include volume augmentation and enhancement of the roundness of buttocks. In this letter we suggest a classification of gluteal augmentation procedures. The classification helps to analyze the case easier and applying the most adaptable procedure for each patient. Our classification of gluteal augmentation is divided to Pseudo-augmentation (illusionary) and Real (true) augmentation which is subdivided to Non-surgical and Surgical.

Development of aesthetic surgery in the Czech Republic - the situation before the COVID pandemic, during the pandemic, and expected changes in the practice of aesthetic surgery in the post-COVID period.

Development of aesthetic surgery in the Czech Republic - the situation before the COVID pandemic, during the pandemic, and expected changes in the practice of aesthetic surgery in the post-COVID period.

Aesthetic Surgery Training and Practice in India: A Survey.

Introduction Aesthetic surgery is a rapidly evolving subspecialty in high demand worldwide. To be considered a fully trained plastic surgeon, all the requirements of the curriculum must be met through to successful completion, including aesthetic surgery. At present, a disparity exists between the demand and provision of aesthetic surgery training in India. This survey evaluation highlights the responses, concerns, and possible solutions regarding training and practice of cosmetic surgery in India. Methods A meticulously crafted survey comprising of 19 questions discussing the background, training, and practice of cosmetic plastic surgery, was sent across to all accessible plastic surgeons trained or training in India. A total of 506 responses were received. The responses were analyzed and have been presented in this study. Results The survey was completed with all participants answering all the questions. Pertinent questions regarding practice setup, percentage of aesthetic work in practice, exposure of trainees to aesthetic procedures, and merits of an aesthetic fellowship revealed a lot about aesthetic training in India. The participants also expressed their level of satisfaction with their principal plastic surgery training. Summarizing these findings, suggestions for improvements in training were made. Conclusion Plastic surgery residency programs need to ensure that residents receive comprehensive exposure to both surgical and nonsurgical cosmetic procedures to ensure maintenance of service standards and optimum patient care. The information collected can help us formulate strategies to improvise the current cosmetic surgery training across India. Steps taken toward the same are also highlighted in the study.

REGULATING TEACHING AND PRACTICE OF AESTHETIC MEDICINE AND SURGERY

The practice of Aesthetic medicine and surgery sits across the divide of different specialties; Dermatolo­gy and Plastic Surgery in particular. Besides these two specialties Maxillofacial surgery, Ophthalmology, and Otolaryngology also practice aesthetic medicine and surgery. Aesthetic Medicine is evolving as a Specialty in itself globally, and in Pakistan. There is a growing demand for minimally invasive cosmetic procedures (MICPs) including Botox, fillers, chemical peels, and lasers. In 2018, 15.9 million MICPs were performed in the United States, an increase of 228 percent in com­parison to the year 2000.1 However, the exact data pertaining to these procedures is lacking in Pakistan. Dermatologists, and to an extent plastic surgeons, are considered more appropriately trained to address the growing demands of a population with aesthetic con­cerns.2 Besides these two specialties, other special­ties and non-medical providers such as aestheticians, nurse practitioners, and physician assistants are pro­viding these services the world over and locally. Accreditation Council for Graduate Medical Educa­tion (ACGME) has categorized Dermatologic surgery education into 3 categories: competency, significant exposure, and education. Though competency requires direct training, significant exposure may be achieved through direct observation or assistance, whereas edu­cation is defined as available educational material with­out direct exposure.3 There is no data pertaining to the satisfaction of residents regarding training in Cosmetic Dermatology and aesthetics during residency. However, studies from the West point towards a lack of satisfac­tion in training.4 Dermatology residency programs in Pakistan of­fered by the College of Physicians and Surgeons have incorporated mandatory rotations in Lasers and logging of cases at level 2 or observer status. A survey con­ducted by Asher et. al. amongst Dermatology residents working across Pakistan reported that 65 percent of the participants of the survey wanted to take up Der­matologic Surgery as a subspecialty after completing their fellowship in Dermatology.5 A survey reported that 70% of Canadian residents plan to offer aesthetic ser­vices in the future.6 In order, to bridge the gap and train doctors in aes­thetic medicine and surgery, there has been a mush­room growth of academies that conduct certificate courses charging the doctors heavily. On top of it, the practice of Aesthetics is costly and mostly conducted in private setups, with minimal regulations. Moreover, there has been a huge unregulated influx of allied healthcare professionals and nonphysician operators (NPOs’), in aesthetic medicine.7 Complications are more common in invasive proce­dures performed by cosmetic technicians, estheticians, and employees of medical and dental healthcare pro­viders who are not trained for these procedures and there is little or no physician supervision as compared to facilities run by dermatologists Unfortunately, most of institutes imparting education/training in aesthetic medicine offer a short course Thus, after attending a one-day training course, they start performing medi­cal procedures on patients without baseline knowledge and training. The College of Physicians and Surgeons Pakistan recently introduced Fellowship in Paediatric Dermatology as a subspecialty of Dermatology as well as Paediatrics. With the increase in the demand for Aesthetic procedures and practice by multiple special­ties, CPSP may introduce a subspecialty in Aesthetics or Cosmetic Dermatology which is under consideration by the Faculty of Dermatology of CPSP. It is the responsibility of various medical and pro­fessional associations of relevant specialties, in partic­ular dermatology and plastic surgery, to bridge the gap in teaching for their members in order to regulate the cost and quality of training. The College of Physicians and Surgeons on its part need to expedite the sub­specialty programs to address the needs of specialists aspiring to adopt Aesthetic medicine and surgery as a profession. Pakistan Medical and Dental Council (PMDC) should devise regulations pertaining to education as well as the practice of aesthetics in consultation with the College of Physicians and Surgeons and Public sector Universities. The rules and regulations adopted by the PMDC, be­ing the regulatory body, should be adopted by Provincial Healthcare regulatory bodies responsible for overseeing licensing and registration of both public and private sector healthcare establishments to ensure quality, efficiency, and safety in healthcare.

The Preoperative Management of Oral Contraceptive Pills in Aesthetic Plastic Surgery Practice in Saudi Arabia.

Oral contraceptive pills (OCPs) are the most popular contraception method in Saudi Arabia due to their accessibility and reversibility. However, there is no recommendation to stop OCP medication before or after elective aesthetic surgery. The study involves identifying plastic surgeons' behaviors and current practices in perioperative OCPs management in aesthetic surgery in Saudi Arabia, which is the first of its kind. A validated self-administered survey was distributed in February 2022 among all board-certified plastic surgeons in Saudi Arabia via social media. The questionnaire was developed to gather information on the perioperative management of OCPs in aesthetic surgery. A total of 46 board-certified plastic surgeons participated (overall response rate of 48.4%). Among the participants, 32 surgeons (69.6%) indicated that they instruct their patients to discontinue OCPs preoperatively. More than half of surgeons have instructed their patients to stop OCPs after plastic surgery (52.2%). Based on the three occupational characteristics of the surgeons, we found no significant associations between surgeons' practice patterns regarding OCP discontinuation preoperatively or postoperatively. In light of the fact that OCPs are reported to pose a risk for venous thromboembolic events, our survey found that most aesthetic surgeons cease their use both preoperatively and postoperatively. There is a need for a guideline regarding perioperative measures for OCPs.

A Decade of Telemedicine for Facial Plastic Surgery: Tips and Techniques from 2000 Consultations before the COVID Pandemic.

Many practices now offer telemedicine.1,2 Reports have reviewed telemedicine for follow-up care but not for initial consultation.3,4 This article reviews initial video consultations for aesthetic surgery done by Dr. Spiegel between 2012 and 2020. Before 2012, video consultations were performed but the information was not readily available. In 2012, 62 persons had a video consultation; by 2013, that number had more than doubled to 134. In 2014, possibly because of the increased availability of video conferencing software, the number of video consultations increased by 63% to 219. Between 2014 and 2019, the number of initial video consultations done by our practice stabilized, with an average of 232 per year over this period. In 2020, there were 437 video consultations, up 88% (Fig. 1). A total of 2024 initial video consultations were performed during this 9-year period.Fig. 1.: Video consults by year.There are advantages to this approach. For all participants, the costs of consultation are reduced, reflecting monetary as well as time savings. The prospective patient can work until the consultation starts from their own home or office and costs related to transportation to the office are eliminated. For the doctor, savings are realized in terms of reducing the need for room cleaning and preparation and patient amenities (ie, coffee, water, brochures). Typical new patient consultations only take 10 to 15 minutes, although some consultations may exceed this time frame. There are disadvantages as well. Successful aesthetic surgery practices design their offices to highlight the competence of the surgeon and the practice. With a video consultation, the patient remains in his or her own environment, so this ability is lost. In addition, some patients lack familiarity with the required technology. They may not know their username for programs such as Skype (Microsoft), may not understand that Apple devices are required for FaceTime, or may be unfamiliar with how to access Zoom. Some newer telehealth software programs ameliorate these problems by providing a simple emailed link. Possible issues also include camera malfunctions, speaker malfunctions, poor internet access, and bulky headphones obstructing the patient’s face. Lighting issues are common, and patients often sit in front of bright windows, where backlighting obscures their face. Patients are often unable to determine the proper degree of rotation from the camera to show their profile and may have a camera that is off to the side of their screen so the practitioner cannot see them face on. In addition, laptop cameras aim upward toward the face, so it can be difficult to get a proper view of the patient. In a video consultation, it is not possible to see inside the nose or mouth clearly or to feel tissues; it is necessary to communicate these limitations clearly to the patient. Patients often appear unprepared for the consultation. They may be driving, partially dressed, in bed, or in a public place with a lack of privacy. Patient privacy is an important consideration, but one that in a video consultation largely falls to the patient, who selects his or her own environment for the consultation. Some patients multitask during the consultation or ask the doctor to wait as they finish another task. The practitioner must keep in mind that there may be other people present out of the camera view. Video conferencing provides a net advantage for the medical practice and its availability is expected by patients. Our experience performing more than 1200 surgical procedures solely based on video consultation reinforces the reports of others that video consultations result in high levels of patient satisfaction.5 There are steps the surgeon can take for a successful video consultation. One must create a professional environment in which to perform telehealth services. Good lighting and a suitable background reinforce the proper image (Fig. 2). The telephone must be muted and a sign hung on the office door to prevent anyone from knocking or entering during these consultations.Fig. 2.: Office configuration for video consultations. Walls and backdrops are set to create a professional environment.Performing video consultations well takes practice. The doctor should look directly at the camera to reflect his or her engagement with the patient. To watch for patient reactions, it is helpful to position the camera close to the spot on the screen where the patient appears. Patients should be sent instructions before the consultation regarding lighting, hair position, cosmetics limitations, and equipment testing. In conclusion, our experience with more than 2000 video consultations reflects that this format can be successfully employed in facial plastic surgery consultations. High-quality experiences require physical preparation of the office environment and new communication protocols. Software and technology will continue to evolve to facilitate the process and permit more enhanced consultations opportunities as telemedicine consultations increase in frequency. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Cosmetic Surgery: A Subspecialty That Needs Specialized Training and Recognition

Introduction: This study was performed to provide a comprehensive review of the breadth and depth of fellowship training provided by the American Academy of Cosmetic Surgery (AACS), with direct comparison with other current aesthetic surgery training programs available in the United States. We hypothesized that this subspecialty training provides essential experience and confidence to perform aesthetic procedures, which are likely not adequately imparted during traditional residency training. We also address the notion that Cosmetic Surgery is not under the sole ownership of one specialty, but rather a subspecialty that flourishes by collaboration between multidisciplinary surgical backgrounds. Materials and Methods: We performed a cross-sectional study of survey data from 2 distinct groups—current fellows in a 1-year AACS program and surgeons who completed an AACS fellowship between July 2008 and June 2017, who have been in active cosmetic surgery practice ranging from 6 months to over 6 years. A survey was administered via email and distributed by the AACS central office. The responses were compared with data published in the Annals of Plastic Surgery concerning Recent Trends in Resident Career Choices after Plastic Surgery Training. Results: The Accreditation Council for Graduate Medical Education (ACGME) requirements for aesthetic surgical cases in a 6-year Plastic Surgery program are 150 cases, but 50% of graduating seniors feel inadequately prepared to transition straight into aesthetic surgery practice, whereas among AACS graduating fellows, 100% feel very prepared to go on the aesthetic surgery practice, having completed an average of 687 cases within the yearlong training program. We note that the survey response rate was 81% among current fellows versus 35% among practicing surgeons. Discussion: We believe that focused subspecialty training in cosmetic surgery after completion of a primary surgical residency in a form of a structured fellowship through AACS, American Society of Plastic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, Commission on Dental Accreditation, and American Society of Ophthalmic Plastic and Reconstructive Surgery (Oculoplastic) is the ideal preparation for the future. As we learn from each other through fellowship training, academic conferences, and research, this will further advance the subspecialty and ultimately improve patient care and outcomes. There is no evidence that these training programs provide less adequate preparation, although they are not accredited by the ACGME. To the contrary, the additional experience and knowledge gained during these fellowship training programs result in better outcomes and more competent practitioners. Conclusions: The development of subspecialty training and board certification for surgeons committed to cosmetic surgery yields the highest level of qualified providers. The diverse backgrounds of these providers continue to allow us to expand and innovate in this field. This study is aimed at moving this conversation forward in a positive direction.

Aesthetic Surgery Practice Resumption in the United Kingdom During the COVID-19 Pandemic.

BackgroundThe global COVID-19 pandemic has significantly impacted all aspects of healthcare, including the delivery of elective aesthetic surgery practice. We carried out a national, prospective data collection of the first aesthetic plastic surgery procedures carried out during the COVID-19 pandemic in the United Kingdom.ObjectivesOur aim was to explore the challenges aesthetic practice is facing and to identify if any problems or complications arose from carrying out aesthetic procedures during the COVID-19 pandemic.MethodsOver a 6-week period from June 15 th-August 2 nd, 2020, data was collected using a proforma for aesthetic plastic surgery cases. All patients had outcomes recorded for the audit period of 14 days post-surgery.ResultsOur results demonstrated that none of the 371 patients audited whom underwent aesthetic surgical procedures developed any symptoms of COVID-19-related illness and none required treatment for any subsequent respiratory illness.ConclusionsWe found no COVID-19–related cases or complications in a cohort of patients who underwent elective aesthetic procedures under strict screening and infection control protocols in the early resumption of elective service.

Impact of COVID-19 on Aesthetic Plastic Surgery Practice in the United Kingdom

BackgroundThe COVID-19 pandemic has transformed the delivery of medical and surgical services globally. Subsequently, all elective and aesthetic procedures have been cancelled or deferred in accordance with government-mandated quarantine measures. The Cosmetic Surgery Governance Forum (CSGF) is a network of aesthetic plastic surgery consultants which has enabled a sharing of expertise during challenging times. We conducted a cross-sectional survey to assess the impact of the COVID-19 pandemic on aesthetic plastic surgeons and their practice in the UK.MethodsOn 15 June 2020, 131 respondents from the CSGF and wider aesthetic plastic surgeons in the UK were invited to respond to an online survey. An anonymised questionnaire was created using SmartSurveyTM and distributed at the end of the quarantine period. Questions regarding their current scope of practice, willingness to recommence face-to-face consultations, financial loss and psychological impact were asked.ResultsA total of 101 Consultant Plastic surgeons (76%) completed the questionnaire. If strict protocols and adequate personal protective equipment were available, 50-55% of respondents would consider offering non-surgical treatments as soon as the private clinic was open. Furthermore, 51% would consider procedures under general anaesthetic, whilst 89% of respondents would offer local anaesthetic only in the initial phase. Moreover, 66% reported experiencing a psychological impact and 100% of respondents reported a significant financial impact.ConclusionsThis survey aims to give an account of the current state (May-July 2020) of aesthetic plastic surgery in the UK. There is ongoing uncertainty and deliberation regarding the timing and organisational changes required for aesthetic practice to restart.

Attitude and Practice of Aesthetic Surgery among Plastic Surgeons in Nigeria

BACKGROUND: Aesthetic surgery in developed countries is growing at an exponential rate. There is an increasing demand for cosmetic procedures in Nigeria but still, the practice is at a slow pace. Significant clients from Nigeria seek for these procedures outside Nigeria. 
 
 OBJECTIVE: This study aimed at determining the attitude and practice of aesthetic surgery among plastic surgeons in Nigeria
 
 METHOD: We conducted a cross-sectional study among the attendees of the annual conference of the National Association of Plastic Reconstructive and Aesthetic Surgeons held at Calabar, Nigeria, using a questionnaire on consented participants. 
 
 RESULTS: A total of 73 out of 84 Plastic surgeons participated in the study with a response rate of 86.9%. The mean age of the respondents was 45.4±7.2 years. Only 14 (19.2%) had undergone extra training in cosmetic surgery. Most respondents 53.4% prefer Nigerian over foreign hospitals for cosmetic surgery for various reasons. Poor awareness (42.5%) and religious beliefs (42.5%) contributed most to the poor acceptability of cosmetic surgery in Nigeria. The vast majority (97%) of Nigerian plastic surgeons want the public to be engaged in awareness sensitization on cosmetic surgery and their preferred mode of sensitization was through internet / social media (80.8%), television (74%), and radio (65.8%). Scar revision (78.1%) abdominoplasty (69.9%) and breast reduction (67.1) were the common cosmetic procedures performed by Nigerian plastic surgeons. 
 
 CONCLUSION: The attitude of Plastic surgeons in Nigeria to cosmetic surgery is influenced by the low acceptance of cosmetic surgery procedures by Nigerians. Attitudinal change programs, especially through social and other mass media, are desired to increase awareness and acceptance of cosmetic surgery in Nigeria.

Facial Fat Fitness: A New Paradigm to Understand Facial Aging and Aesthetics.

Traditionally, facial adipose tissue has been perceived and treated as a homogenous volume-occupying subcutaneous depot. However, recent research from across disciplines is converging to reveal a far more anatomically organized and functionally dynamic role of facial adipose tissue. In this narrative review, we will discuss new insights into adipocyte function and facial adipose anatomy that have far-reaching implications for the practice of aesthetic facial plastic surgery. These concepts are synthesized into a "facial fat fitness" model which can be used to explain clinical observations in facial aging and aesthetic surgery. Fat fitness relates to the quality of facial adipose tissue, as opposed to quantity, and describes whether adipose tissue is in a predominantly healthy hyperplastic or unhealthy hypertrophic state. Fat fitness is modulated by lifestyle factors, and may be impacted positively or negatively by facial aesthetic treatments. LEVEL OF EVIDENCE IV: 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 www.springer.com/00266 .

Aesthetic Surgery in Plastic Surgery Academia.

Aesthetic surgery is a critical component of academic plastic surgery. As institutions are placing increased focus on aesthetic surgery, there is an opportunity to identify factors that facilitate the creation and maintenance of successful aesthetic plastic surgery programs. The aim of this study was to conduct a national survey to evaluate the current state of academic aesthetic surgery and to identify factors that contribute to success. A REDCap 122-question survey was developed and validated by members of the Academic Aesthetic Surgery Roundtable (AASR). The national survey was distributed to department chairs and division chiefs with active ACGME-approved plastic surgery programs (n = 92). Responses underwent Pearson's chi-squared, Wilcoxon rank-sum, and postselection inference analyses. AASR members convened to interpret data and identify best practices. Responses were received from 64 of 92 queries (69.6%). The multivariate analysis concluded traits associated with successful academic aesthetic surgery practices included the presence of aesthetic surgery-focused, full-time faculty whose overall practice includes >50% aesthetic surgery (P = 0.040) and nonphysician aesthetic practitioners who provide injection services (P = 0.025). In the univariate analysis, factors associated with strong aesthetic surgery training programs included resident participation in faculty aesthetic clinics (P = 0.034), aesthetic research (P = 0.006), and discounted resident aesthetic clinics (P < 0.001). The growth of academic aesthetic surgery practices represents a significant opportunity for advancement of resident training, departmental financial success, and diversification of faculty practices. By identifying and sharing best practices and strategies, academic aesthetic surgery practices can be further enhanced.

Prospective study to identify the presence and prevalence of personality traits and other influences relevant to cosmetic surgery interest, patient selection and surgical outcome in a diverse aesthetic surgery practice

Prospective study to identify the presence and prevalence of personality traits and other influences relevant to cosmetic surgery interest, patient selection and surgical outcome in a diverse aesthetic surgery practice

Aesthetic Surgery Practice During COVID-19 Pandemic; Precautions and Recommendations

Aesthetic Surgery Practice During COVID-19 Pandemic; Precautions and Recommendations

Anthropometric Analysis of the Human Skull for Developmental Left-Sided Asymmetry, New Finding.

Facial and cranial asymmetry is common in bilateral vertebrates, particularly human beings. Through years of injecting fillers and performing face-lift operation on patients, we began to observe that more fillers were required on the right side to reach symmetry and also more loose skin and soft tissue was observed on the right side in the majority of patients (Fig.5). Here, we conducted an analytical study to comprehensively measure human skulls in order to observe and quantify this difference. We collected forty-one natural skulls available from five medical schools of Tehran province in Iran. Standard photography was conducted from the front, lateral, and superior views. Measurements and statistics were completed using Image J software (National Institutes of Health) for exact comparison of fixed-point distances on the samples. Comparison of right and left dimensions on the skulls revealed several fixed asymmetries. The most significant differences were measurements around the orbit. The distance between the upper orbit point and zygion (zy), zygion to sub-nasal, and orbital areas were significantly larger on the left side. Measuring the anterior gonion-pogonion distance showed a wider mandibular body on the left side. We did not find any considerable differences between any other left-sided and right-sided skull dimensions. Asymmetry of the face and body is a general rule in human anatomy, but correlation and consistency of this asymmetry between the left and right sides is a novel finding based on our measurements. Our findings showed that the orbit was significantly bigger in width, height, and surface area on the left side. We also quantified a narrower mandible on the right side. We hope these findings can be translated to aesthetic surgery practice to make the plastic surgeon and patient more familiar with the patient's specific anatomy in order to better predict, plan, and successfully implement aesthetic procedures such as injecting fillers or doing peri-orbital procedures. 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 www.springer.com/00266.

The Impact of Skin Care Product Sales in an Aesthetic Plastic Surgery Practice.

Despite significant growth of the global skin care market, many plastic surgeons do not offer skin care products through their aesthetic practice. However, skin care products represent a significant potential revenue stream for plastic surgeons, not only by generating revenue from product sales but by improving patient retention over time and, in turn, generating additional surgical and nonsurgical revenue. The purpose of this study was to determine the financial implications that skin care sales can have for an aesthetic surgery practice. Our hypothesis was that patients making skin care purchases would generate higher non-skin care revenue than patients not purchasing skin care products. A retrospective chart review was performed of all purchases made within a single aesthetic surgery practice during a 6-year period (2012-2017). Pre-tax revenue ($CAD) from each category was recorded for any patient who made a purchase during the study period. A total 3785 patients purchased skin care products, 5088 patients purchased nonsurgical treatments, and 3504 patients underwent surgery. Average patient spending was $720.73 (skin care), $1272.63 (nonsurgical), and $10,048.34 (surgery), respectively. Overall, patients who purchased skin care generated more revenue from the purchases of nonsurgical treatments and surgery than patients who did not purchase skin care products. Skin care sales not only generate revenue, but over time these patients spend more on nonsurgical and surgical treatments than patients who do not purchase skin care. Skin care is an important adjuvant to nonsurgical and surgical treatments that should be considered by all aesthetic surgeons.

Internet and Social Media as a Source of Information About Plastic Surgery: Comparison Between Public and Private Sector, A 2-center Study.

Background:The popularity of social media among plastic surgeons and patients has increased in the last years. We conducted this study to explore the differences in patients’ social media habits between public and private aesthetic plastic surgery practice.Methods:A 2-cohort study was conducted in aesthetic plastic surgery clinic and public department of plastic and surgery by surveying consecutive first-time patients.Results:Two hundred patients completed a 18-question survey at a private aesthetic plastic surgery clinic. The questionnaire was also filled by 113 patients at a public plastic surgery department. Facebook was the most popular social media platform in both groups. Word of mouth from other patients and the clinic’s website were the most-valued source of information about the surgeon and surgical procedure for patients of both studied groups. Patients from the aesthetic group were mainly women from small towns; they were significantly younger and better educated and used Instagram more frequently than patients from public group. The aesthetic group patients focused significantly more often on the surgeon’s credentials and on before and after photographs. They appreciated social media as a source of information for patients significantly more than public group patients who stated that social media were the worst source of information.Conclusions:Word of mouth from other patients remains the most-valued source of information about plastic surgery. However, proper use of social media and building online image in a professional manner can provide attract more patients to the aesthetic plastic surgery practice.

The characteristics of private plastic surgery practice in developing country: An epidemiological study.

Background:With the rise in working-age population, there has been notable economic growth in Indonesia. Along with it, there is an increase in expenditure for non-food items such as health-care service, without exception to plastic surgery practice. Aesthetic plastic surgery practice has gained its popularity in several other developing countries such as Brazil, Russia, India and China. Epidemiology report of private plastic surgery practice in Jakarta, the capital of Indonesia, will provide the evidence of increasing need for aesthetic plastic surgery practices as the basis for further improvement.Methods:This is a single-centre descriptive cross-sectional study with a total sampling method which included all patients registered at a private plastic surgery clinic between January 2008 and December 2016.Results:There were 1457 medical procedures. The majority (93.4%) of patients were female. More than 80% were surgical procedures, the most common ones were breast implant and blepharoplasty with the latter being similarly popular in both gender. The majority of the patients fell into 20–45-year-old group. Patients <20-year-old had undergone a more minor surgical procedure such as skin tumour and nevus excision or scar treatment while patients >45-year-old had more procedures with rejuvenation purpose.Conclusion:The epidemiology of private plastic surgery practice in an urban area of developing country resembles those in either developed or developing countries with a similar socio-demographic profile. This data can be further utilised for a more focused private plastic surgery practice improvement. The limitation however is that, the study is based on a single centre data.