Cosmetic Surgery Patients Research Articles

Assessing the Effectiveness of a Short Form Screening Tool (COPs) for Body Dysmorphic Disorder in Cosmetic Surgery Patients: A Study of Pre- and Post-Operative Outcomes.

Recent regulatory changes in Australian cosmetic surgery necessitate preoperative screening for body dysmorphic disorder (BDD). This study, which focuses on patient outcomes, evaluates the COPs tool's efficacy and examines its implications on patients undergoing cosmetic procedures. A total of 189 patients were included: 78 underwent Medicare-classified "cosmetic" surgeries, and 111 underwent "medically necessary" procedures. Patients completed the COPs assessment pre- and post-operatively, with a score >40 indicating BDD susceptibility. Results show no significant pre- to post-operative change in COPs scores across different surgical procedures (body, breast, facial, and mixed) in both "cosmetic" (p = 0.2-0.4) and "itemised" groups (p = 0.15-0.33). However, overall, there was a marked reduction in COPs scores post-operatively (p < 0.001), indicating improved self-perception. Specifically, 91% of patients initially BDD-prone showed scores < 40 post-operatively. Conversely, 3.8% of initially low-scoring patients developed BDD-prone scores post-operatively. Comparison between cosmetic and itemised groups revealed higher preoperative COPs scores in the itemised group (p = 0.006), though post-operative scores did not differ significantly (p = 0.33). Incidences of post-operative BDD-prone scores or scores < 40 did not differ between groups (p = 0.61). Complication rates and the need for revision surgery were similar between groups. These findings suggest two plausible interpretations: First, preoperative screening with the COPs tool may positively influence self-perception related to BDD among cosmetic surgery patients, potentially serving as a therapeutic adjunct for those at risk. Second, while screening tools are beneficial, they may have limitations in predicting post-operative outcomes related to BDD development. Further research should explore these dynamics to refine screening practices and optimise patient outcomes in cosmetic surgery contexts. Level of Evidence III 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 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.

Screening for Body Dysmorphic Disorder in Plastic Surgery Patients.

The Australian medical board, the Australian Health Practitioner Regulation Agency (AHPRA) has recently introduced new regulations mandating providers of cosmetic surgery undertake a clinical screen for body dysmorphic disorder (BDD) in all potential cosmetic surgery patients. The assessment must be conducted by the surgeon using a validated psychological screening tool. The aims of this paper are to discuss the key clinical characteristics of BDD before reviewing currently validated screening tools that would meet this new regulatory requirement, and which may be most applicable to a busy plastic surgery practice. A literature search identified 1164 titles, of which 229 titles were retrieved for abstract screening. Six studies were identified that validated BDD screening tools in a setting relevant to cosmetic plastic surgery. Six validated screening were identified: BDD Questionnaire (BDDQ), BDD Questionnaire Dermatology Version (BDDQ-DV), BDD Questionnaire Aesthetic Surgery (BDDQ-AS), Cosmetic Procedure Screening Questionnaire (COPS), Body Dysmorphia Symptom Scale (BDSS) and the BDD Screening Test (BDD-ST). Our group practice has chosen to adopt the BDDQ-AS to meet the AHPRA regulator requirement for BDD screening based on its robust validation and ease of use in clinical practice, consisting of a seven-item self-report questionnaire that can be reliably completed in 1-2 minutes in most cases. Of the six screening tools for body dysmorphic disorder available for use in clinical practice that have been validated in a cosmetic population setting, we have chosen to use the BDD Questionnaire Aesthetic Surgery (BDDQ-AS). To date all available validated screening tools are based on the DSM-IV, and further work to develop a validated screening tool based on the revised definition of BDD in the DSM-V is recommended, with a particular focus on items relating to repetitive physical or mental behaviours. 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 Dysmorphic Concern Questionnaire: Is It Possible to Predict a Satisfactory Result After Cosmetic Eyelid Surgery?

As oculofacial surgeons performing esthetic surgery, the most valuable result is a satisfied patient. It can be extremely frustrating to have an unhappy patient with, what we believe is, a satisfactory result. Therefore, the ability to predict satisfaction is of extreme importance. We studied our cosmetic eyelid surgery patients to try to find factors that can predict satisfaction. We retrospectively studied 454 consecutive patients, who underwent any combination of 7 cosmetic surgical procedures. Patients answered the Dysmorphic Concern Questionnaire (DCQ) before surgery. We studied age, gender, type and number of procedures performed, DCQ score, presence of complications, and history of previous fillers. At the 3-month follow-up visit, patients were given an outcome report survey to graduate their surgical results on a scale from 1 to 5. Results were evaluated using a model of binary logistic regression in which the outcome variable was divided into 2 groups. Three hundred eighty-six patients (85%) were female and the median age was 54.8 years old. The median for the number of procedures was 2 (range, 1-5). Two hundred two of the 454 patients (44.5%) had a history of fillers. Twenty-five patients had complications. DCQ score was significantly lower in the satisfied group (median score, 3) versus the unsatisfied group (median, 6), p = 0.007. In the multiple binary logistical model, the variables age, male gender, DCQ, presence of complications, and upper eyelid blepharoplasty resulted as significant. We found a significant positive association with upper lid blepharoplasty and a negative association with increasing age, male gender, occurrence of complications, and DCQ score, as predictors of patient satisfaction. We routinely administer the DCQ to all cosmetic patients: It is a brief, sensitive, and specific screening instrument for body dysmorphic disorder.

The heart of it all: Body dysmorphic disorder in cosmetic surgery

Body Dysmorphic Disorder (BDD) represents a prevalent mental health condition characterized by distress arising from self-perceived physical imperfections. BDD serves as a contraindication to aesthetic surgery. Recognizing BDD holds paramount importance for plastic surgeons, as it is instrumental in averting the exacerbation of this condition while ensuring appropriate referrals. This study aimed to investigate the prevalence of BDD in cosmetic surgery patients and to pinpoint key characteristics associated with BDD. This information provides plastic surgeons with specific factors to consider during preoperative evaluations. We employed TriNetX database to identify patients with BDD who underwent cosmetic surgery identified by Current Procedural Terminology codes. Demographics and patient characteristics were identified using the International Classification of Diseases 10 codes. We calculated odds ratios (OR) by using chi-squared tests to assess risk factors among patients with BDD. Of 226,374 patients who underwent plastic surgery between August 2002 and August 2022, fewer than 0.1% were diagnosed with BDD. Of the BDD patients, 52.1% were diagnosed after cosmetic surgery. Compared with the control group, BDD patients were more likely to undergo rhinoplasty (OR=1.784, p=0.004) and nonlocalized lipectomy (OR=1.448, p=0.021) and less likely to undergo blepharoplasty (OR=0.451, p=0.002). Findings indicated a strong association between BDD patients undergoing cosmetic procedures and comorbid psychiatric conditions such as depression (OR=4.279, p<0.05), anxiety (OR=5.490, p <0.05), and Attention-Deficit Hyperactivity Disorder (OR=3.993, p<0.05). These findings underscore the ongoing significance of BDD in the context of cosmetic surgery, potentially indicating a lower surgery rate among BDD patients compared with previous estimates. Nevertheless, avenues for further improvement persist. Our data affirm the noteworthy occurrence of postsurgery BDD development, thereby highlighting the ongoing necessity for psychiatric evaluation in surgical patients.

Does autologous fat grafting serve the need for reconstructive surgery in oral cancer patients? A prospective evaluation in cosmetic surgery patients.

The prevalence of cancer is growing daily. Oral cancer, which is primarily triggered by tobacco use, can have detrimental effects on facial appearance. Despite significant advances in the molecular underpinnings of cancer, surgery, chemotherapy and radiotherapy have become standard cancer treatment methods. These treatments remove the tumor but can significantly alter patient's appearance, which can impact their physical and mental wellbeing. The soft tissue augmentation technique of autologous fat grafting (AFG), commonly referred to as lipofilling, is frequently used in cosmetic and reconstructive surgery to promote facial rejuvenation and body form remodeling. The advantages of AFG include its biocompatibility, low immunogenicity and allergenicity, as well as its capability to heal wounds. To explore the advantages of and patient satisfaction with the AFG technique as a potential facial restoration procedure in oral cancer patients. We examined the effects of facial AFG in cosmetic surgery patients and investigated the prevalence of postoperative problems. Patient satisfaction and potential complications after autologous fat filling in different areas of the facial space were investigated using clinical evaluations, patient-reported outcomes and photographic assessments. All of the patients were satisfied with the results in terms of improved facial shape, skin glossiness, skin elasticity, ptosis, and facial expressions. More than 80% of the patients and surgeons reported overall satisfaction. Based on these findings, we hypothesize that the AFG approach may be beneficial as a reconstructive therapy for patients with oral cancer following treatment. This technique will improve the patient's physical appearance, confidence and mental wellbeing.

Preparing Patients for Cosmetic Surgery and Aesthetic Procedures: Ensuring an Optimal Nutritional Status for Successful Results.

Aesthetic and cosmetic medical practices have attracted considerable consumer attention globally. However, possible complications vary and range from mild, self-resolving ecchymoses or edema to more persistent complications. The aim of this review is to identify the nutritional deficits or excesses associated with the major complications of reconstructive surgery, aesthetic surgery, and mini-invasive aesthetic procedures. An additional goal is to provide a bundle of actions for professionals working in the industry in order to reduce the risks of aesthetic procedures and improve the clinical outcomes. Granulomas, hypertrophic scars and keloids, seromas, infections and xerosis, hyperpigmentation, petechiae, livedo reticularis, slower wound healing, and other poor outcomes are frequently associated with nutritional deficiencies. Nutritional status can markedly affect wound healing and tissue repair following surgical interventions, as well as the outcomes of aesthetic and cosmetic medical practices. Professionals working in this industry, therefore, need to consider the nutritional aspects of their patients to obtain the best results.

The Influence of Personality on Health Complaints and Quality of Life in Women With Breast Implants.

A causal relation between systemic symptoms and breast implants has not been established. Psychological factors, such as personality and psychological distress, are strongly associated with the development of medically unexplained symptoms. It can be hypothesized that psychological factors may be related to the development of breast implant illness (BII). This study was conducted to evaluate the correlation between self-reported health complaints, health- and breast-related quality of life (QoL), and personality, in women with cosmetic breast implants. Women who attended the plastic surgery outpatient clinic of Maastricht University Medical Center between October 2020 and October 2021 for reasons related to their implants and women recruited for a BII study at the Center during this period were invited to participate in this study. Only women who underwent cosmetic breast augmentation were eligible. Participants completed a physical complaints score form and the BREAST-Q, SF-36, and EPQ-RSS questionnaires via an online survey. In total, 201 women completed the questionnaires. Extroversion and social desirability were predominant personality traits in women with breast implants, followed by neuroticism. Relatively high levels of neuroticism were found compared with normative data. Neuroticism correlated significantly with health status and breast-related QoL. Physical and mental health-related QoL had the strongest correlations with neuroticism (β = -3.94, β = -4.86, P < 0.001). Personality can play a role in the development of complaints. High levels of neuroticism are seen in cosmetic surgery patients and are negatively correlated with subjective health and patient-reported outcomes in women with breast implants. Therefore, neuroticism may be a factor in the development of BII.

High Morbidity of Mycobacterial Infections Following Cosmetic Surgery Tourism

Background Medical tourism is an increasingly popular practice among cosmetic surgery patients. These procedures place patients at risk of infection by rapidly growing Mycobacterium. Rapidly growing Mycobacterium (RGM) is a relatively rare infection within developed nations. Management options vary, although all pose significant morbidity to patients. We present 2 cases treated at our institution and a comprehensive literature review of RGM infection in patients who have undergone cosmetic surgery in developing nations, analyzing its associated morbidity. Methods This is a review of institutional records for patients with RGM infections after cosmetic surgery tourism was performed. A comprehensive literature search was conducted to identify reports of similar cases. Individual treatment courses were reviewed and descriptive statistics performed for management and associated morbidities. Results Two patients underwent abdominoplasty in a developing nation and later presented to our institution with mycobacterial infection. They underwent a combined 7 procedures, received a combined 3 years of antibiotic therapy, and accounted for 1 line-associated deep venous thrombosis and line-associated bacteremia. Thirty-five similar cases were identified by literature review. Patients underwent an average of 2.4 surgical procedures and received antibiotics for an average of 8.7 months. At least half of the patients (51%) required medication adjustment due to adverse effects or expense. Further morbidities encountered were financial hardship, psychological distress, and scar hypersensitivity. Conclusion Patients who undergo cosmetic surgery as medical tourists are placed at risk of infection by rapidly growing mycobacterial species. Management is highly morbid, and they are often left with extensive surgical scarring and unanticipated additional out-of-pocket expense.

The Racial Representation of Cosmetic Surgery Patients and Physicians on Social Media.

Aggregated data show that Black patients undergo disproportionately lower rates of cosmetic surgery than their Caucasian counterparts. Similarly, laboratory findings indicate that social media representation is lower among Black patients for breast reconstruction surgery, and it is expected that this could be the case in cosmetic surgery as well. The aim of this study was to explore the social media representation of Black patients and physicians in the 5 most common cosmetic surgery procedures: rhinoplasty, blepharoplasty, abdominoplasty, breast augmentation, and liposuction. Data were collected from RealSelf (Seattle, WA), the most popular social media site for sharing cosmetic surgery outcomes. The skin tone of 1000 images of patients in each of the top 5 cosmetic surgeries was assessed according to the Fitzpatrick scale, a commonly utilized skin tone range. Additionally, the Fitzpatrick scores of 72 providers who posted photographs within each surgical category were collected. Black patients and providers are underrepresented in rhinoplasty, blepharoplasty, breast augmentation, and liposuction compared with the general population (defined by the US Census Bureau), but were proportionately represented in abdominoplasty. Additionally, it was found that patients most often matched Fitzpatrick scores when both had scores of 2, whereas patients with a score of 5 and 6 rarely matched their provider's score. The underrepresentation of Black patients and providers in social media for cosmetic surgery may well discourage Black patients from pursuing cosmetic surgeries. Therefore, it is essential to properly represent patients to encourage patients interested in considering cosmetic surgery.

Dynamic identities and self-perception of aging: The case of Turkish cosmetic surgery patients

Drawing on the idea that aging is a physical and a psychosocial process, this study aimed to understand self-perceived aging by focusing on the cultural and experiential perspective presented by Turkish women. The social and interactive aspects were reflected in their self-perceptions of aging, which did not necessarily entail physical degradation or health problems. This study focused on patients who underwent anti-aging operations, and cosmetic surgery was revealed to be a convenient and quick way to eliminate the physical signs of aging. By analyzing 31 in-depth interviews with patients of ages ranging from 21 to 75, three interpretations of aging were identified and discussed. Past-oriented women wanted to return to “good old times,” present-oriented women wanted to balance their inner and outer selves, and future-oriented women desired a total transformation in their lives. This study contributes to our understanding of self-perceived aging and presents findings from patients who did not necessarily conceptualize their selves as moving forward in time. Successful aging may be possible by means of past, present, or future selves, and “success” in aging is socio-culturally interpreted by these women in addition to more objective definitions of well-being and medical norms.

Psychosocial issues and body dysmorphic disorder in aesthetics: Review and debate

Body dysmorphic disorder (BDD) is a serious and debilitating psychiatric condition that disproportionately presents in dermatologic and cosmetic surgery patients. BDD is currently underrecognized in cosmetic medical settings and is thought to be underdiagnosed by behavioral health professionals. The significant comorbidities associated with this disorder, as well as potential harm done to both patient and physician, raise ethical and medicolegal concerns regarding its treatment. Although cosmetic interventions have historically been discouraged in BDD, recent studies have provided controversial evidence of benefit in certain cohorts. The rise of “snapchat dysmorphia” and the proposed explanatory phenomenon of perception drift have generated further debate around the de novo development or unmasking of BDD. We critically review and summarize existing debates around the treatment of BDD in cosmetic medicine. We provide guidance for screening, clinical interviewing, and the provision of psychoeducation in cases of suspected BDD.

Body dysmorphic disorder and self-esteem: a meta-analysis

ObjectiveBody dysmorphic disorder (BDD) is associated with low self-esteem. The aim of this meta-analysis was to examine the strength of the cross-sectional relationship between BDD symptom severity and global self-esteem in individuals with BDD, mentally healthy controls, community or student samples, and cosmetic surgery patients. Moreover, the role of depressive symptom severity in this relationship and other moderating factors were investigated.MethodsA keyword-based literature search was performed to identify studies in which BDD symptoms and global self-esteem were assessed. Random effects meta-analysis of Fisher’s z-transformed correlations and partial correlations controlling for the influence of depressive symptom severity was conducted. In addition to meta-analysis of the observed effects, we corrected the individual correlations for variance restrictions to address varying ranges of BDD symptom severity across samples.ResultsTwenty-five studies with a total of 6278 participants were included. A moderately negative relationship between BDD symptom severity and global self-esteem was found (r = −.42, CI = [−.48, −.35] for uncorrected correlations, r = −.45, CI = [−.51, −.39] for artifact-corrected correlations). A meta-analysis of partial correlations revealed that depressive symptom severity could partly account for the aforementioned relationship (pr = −.20, CI = [−.25, −.15] for uncorrected partial correlations, pr = −.23, CI = [−.28, −.17] for artifact-corrected partial correlations). The sample type (e.g., individuals with BDD, mentally healthy controls, or community samples) and diagnosis of BDD appeared to moderate the relationship only before artifact correction of effect sizes, whereas all moderators were non-significant in the meta-analysis of artifact-corrected correlations.ConclusionsThe findings demonstrate that low self-esteem is an important hallmark of BDD beyond the influence of depressive symptoms. It appears that negative evaluation in BDD is not limited to appearance but also extends to other domains of the self. Altogether, our findings emphasize the importance of addressing self-esteem and corresponding core beliefs in prevention and treatment of BDD.

Does Surgeon Gender Matter for Aesthetic Patients?

Plastic surgery patients have expectations for an ideal practice to visit. However, patients' preferences regarding their plastic surgeon are still being described. The aim of this study was to investigate if elective cosmetic plastic surgery patients exhibit gender preference in their plastic surgeon when making online inquiries. A retrospective, single-practice review of all online inquiries for elective plastic surgery and nonsurgical injectable treatment from June 2019 to June 2020 was performed. The study was based on a private practice located in Houston, TX. The practice surgeons were a married couple, 1 female and 1 male, with identical training, age, and post-residency experience. Patients submitted an online inquiry for their procedure of interest and surgeon preference via the practice website. The private practice received 873 online inquiries during the year-long study period. The majority of patients were female, 855 (97.9%), and the remaining 18 (2.1%) were male. Of the female patients, 476 (55.7%) preferred a female surgeon and 138 (16.1%) preferred a male surgeon; 241 (28.2%) female patients expressed no surgeon preference. Regardless of surgeon preference, the majority of procedures inquired about were breast and body contouring. This cohort of female patients prefers the female surgeon for breast procedures or multiple procedures involving the breast, and the male surgeon for injectable procedures and facial procedures. There is no preference for the male or female surgeon for body procedures. Female plastic surgery patients may be influenced by surgeon gender in choosing their surgeon, depending on their surgery of interest.

Demographic and Cultural Differences in the Acceptance and Pursuit of Cosmetic Surgery: A Systematic Literature Review.

Background:Worldwide, the numbers of cosmetic procedures continue to climb. However, cosmetic surgery (CS) continues to be plagued by negative stigmatization. This study reviews the literature to identify how attitudes toward CS vary by sex, age, race, culture, and nationality, and aims to determine how other factors like media exposure interact with demographics to influence how well CS is accepted.Methods:A PRISMA-guided systematic review of the literature was conducted to identify all English-language papers reporting on CS or plastic surgery acceptance, attitudes, or stigmatization, specifically examining for data on age, sex, race/ethnicity, culture, and media influence.Results:In total, 1515 abstracts were reviewed, of which 94 were deemed pertinent enough to warrant a full-text review. Among the potential demographic predictors of CS acceptance, the one with the most supportive data is sex, with women comprising roughly 90% of all CS patients in virtually all populations studied and consistently exhibiting greater CS knowledge and acceptance. Culturally, the pursuit of beauty through CS is a universal phenomenon, although different countries, races, and cultures differ in how willingly CS is embraced, and in the aesthetic goals of those choosing to have it. In countries with culturally diverse societies like the United States, non-Hispanic Whites continue to predominate among CS patients, but the number of CS patients of other races is rising disproportionately. In this trend, social media is playing a major role.Conclusion:Healthcare practitioners performing cosmetic procedures need to consider demographic and cultural differences of the patients in order to enhance their understanding of their patients’ aesthetic goals and expectations.

Structural injustice and the Requirements of Beauty

Structural injustice and the Requirements of Beauty

Mexico's medical tourism healthcare service quality: a content analysis of international patients' online testimonials

This research analyses medical tourists' perceptions of Mexico's medical tourism healthcare service quality. A content analysis of international cosmetic surgery patients' online testimonials from a medical tourism facilitator's website shows that medical tourists have distinct perceptions of Mexico's medical tourism healthcare service quality, with the HEALTHQUAL dimensions safety and empathy being mentioned most frequently. Healthcare service quality perceptions varied depending on the testimonial format (handwritten versus typed), whether a post-procedure photo was included with the testimonial, gender, type of cosmetic surgery procedure received, whether hospital satisfaction was explicitly expressed by medical tourists and if medical staff were referred to in the testimonials. Marketing communication implications of the results are discussed, including using safety and empathy cues to reduce the perceived risk and uncertainty associated with traveling abroad for medical care. Future research ideas are also submitted.

Intraoral labial frenulectomy with periosteal release: a simple approach to enhance immediate surgical outcome and long-term stability of the cosmetic rhinoplasty

Purpose Nasal tension tip and restrained upper lip during function are common findings in the preoperative evaluation of the facial cosmetic surgery patient. Many structures contribute to these findings, and most of them are related to the upper labial frenulum (ULF). The ULF is an intraoral structure that has many intricacies in terms of function and cosmetic implications. Commonly described as merely soft tissue that attaches the upper lip to the maxillary gingiva, the ULF includes several structures that are directly related to the outcome of the nasomaxillary cosmetic surgery. The ULF is composed of connective tissue of the attached and free gingival mucosae, the depressor nasi septi muscle, a ligament that is a continuation of the nasal SMAS (superficial musculoaponeurotic system) and the periosteal extension of the superior midline gingiva into the palatal area; in some instances, it is so tenuous that it creates a diastema. Methods This prospective study included 37 patients who underwent intraoral labial frenulectomy with periosteal release (ILFPR) in conjunction with cosmetic rhinoplasty. Clinical and photographic evaluations, including millimetric and VAS (visual analogue scale) scores comparing pictures in 3 time intervals; preoperative (T1), intraoperative (T2) and longest postoperative follow-up (T3). Evaluation criteria included (1) nasal tension tip while smiling; (2) upper lip restraint; (3) overall outcome, and (4) long-term stability. The intraoral labial frenulectomy surgical technique includes (1) transection of the vertical component of the ULF deep down to the nasal spine; (2) subperiosteal release of the muscle and ligaments attached; (3) subperiosteal release of the vestibular and palatal gingiva, if prominent; and (4) suture using 4-0 chromic gut. Results This study found a significant difference, with higher VAS scores for patients who underwent ILFPR. These patients showed significant decreased tension on the nasal tip; and lip lengthening was performed, when needed, after ILFPR. Conclusions The results of this study showed that the ILFPR is a successful surgical technique that releases the nasal tension tip and restraining lip, producing more natural and long-lasting results when performed in conjunction with cosmetic rhinoplasty. Lip lengthening can also be achieved with this surgical technique.

Underrepresentation of Racial Minorities in Breast Surgery Literature: A Call for Increased Diversity and Inclusion.

In this study, the extent of racial diversity in images of breast-related plastic surgery published literature was investigated to better understand disparities that exist in breast surgery. The lack of racial diversity in images of skin color in surgery literature can perpetuate implicit bias and stereotypes. Implicit bias can affect the way patients are evaluated, diagnosed, and treated. The visual aspects of plastic surgery make a lack of diversity in imagery especially impactful on patient care and outcomes. Published medical images and graphics depicting human skin were analyzed across 4 major plastic surgery journals. Up to 4 years were chosen a priori to evaluate from each journal and represented the initial year of color image publication, the year of study initiation (2016), and representative years for a given decade (2000 and 2010). Images and graphics were tabulated, rated by Fitzpatrick scale and categorized into "White" or "non-White." Data were evaluated with pair-wise and linear regression statistics. Of the 2774 images and 353 graphics that met inclusion criteria, only 184 (8.18%) images and 9 graphics (6.34%) depicted non-White skin. Temporal analysis showed that there is an increased diversity of images published since 2010 with 0% of images being non-White before and 7.3% to 10.3% after 2010. International and multi-national authors tended to publish more non-White images. There is insufficient racial diversity visually represented in the breast-related plastic surgery literature with a small degree of progress made towards more equitable imagery over time. Increasing awareness of image content, and the need for equitable visual representation may allow for improved racial diversity in surgical literature.

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