Elective Cosmetic Procedures Research Articles

Examining the Potential for Koebnerization and Disease Precipitation in Cicatricial Alopecias.

The treatment of primary scarring alopecias is challenging and patients may be susceptible to koebnerization. This predisposes cicatricial alopecia patients to worsening of their disease following procedural treatments or interventions. Research and recommendations surrounding the risk for koebnerization within scarring alopecias is extremely limited. Using a comprehensive literature review, we summarized the risks of procedures in potentially koebnerizing alopecias. We evaluated the risk not only with procedural treatments, but also with common elective cosmetic procedures and potentially trauma-inducing hairstyling techniques. Although additional studies are needed to better elucidate the risks of procedural treatments within primary scarring alopecia, we believe this review of the current evidence and expert insight will benefit healthcare providers and patients alike to help guide treatments in this challenging patient population. J Drugs Dermatol. 2023;22(1):29-34. doi:10.36849/JDD.6849.

Joint Report on Terminology for Cosmetic Gynecology.

The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.

Joint Report on Terminology for Cosmetic Gynecology.

The current terminology used to describe cosmetic gynecologic procedures includes many nondescriptive, trademarked, or informal names, which contributes to substantial ambiguity about their aims and specific techniques. The development of clear, uniform descriptive terminology for cosmetic gynecology is needed for patients, researchers, and practitioners across multiple specialties. This document was developed from a collaboration of selected members from the International Urogynecological Association (IUGA) and the American Urogynecologic Society (AUGS). Wide-ranging literature reviews were performed to identify the breadth of currently used terms and tools for measuring efficacy and safety. After extensive internal review the adoption of each definition was ratified by group consensus. A terminology report for elective cosmetic gynecology procedures, anatomical classification, outcome metrics, and reporting of complications has been developed. This document seeks to provide clear descriptive guidance for patients, researchers, and practitioners across multiple specialties. This document will be subject to internal review by IUGA and AUGS to incorporate and adopt evidence-based changes in the field. A consensus-based document establishing clear terminology for cosmetic gynecology procedures has been created. Use of these terms should be encouraged to provide clarity to patients seeking these procedures and to facilitate future research to establish the safety and efficacy of these procedures.

Evaluation of Public Interest in Mohs Surgery and Other Elective Surgical Procedures During the COVID-19 Pandemic.

The reallocation of health care resources to focus on the acute care needs of COVID-19 patients leads to a delay and deferral of outpatient surgical procedures such as Mohs surgery. Planning for the resumption of regular outpatient surgical care and preparing for future surges in COVID-19 cases requires identifying surrogate markers of health care demand. United States national and state-based Google search data for "Mohs surgery" and other common elective surgical and cosmetic procedures were evaluated. These were compared with national and state-wide COVID-19 case number and death data from the Johns Hopkins University. Pearson correlation coefficients were generated to assess the association between COVID-19 cases and deaths with Google search trends. Search volume for "Mohs surgery" and other elective surgical and cosmetic procedures significantly decreased as the number of new deaths from COVID-19 increased. Statistically significant inverse correlation was noted between "Mohs surgery" search volume and new COVID-19 deaths on a national and state-based level. Search metric analysis may be used as part of a big data model to help predict health care demand during the reopening phase of the COVID-19 pandemic.

O49: EFFECT OF AFIMOXIFENE (Z-4-HYDROXYTAMOXIFEN) ON ADIPOSE-DERIVED STEM CELLS

Abstract Background Adipose-derived stem cells (ADSCs) are a promising cell source for adipose tissue engineering. Currently, novel breast reconstruction techniques using ADSCs are actively being explored. Systemic chemo- & hormonal therapy may impede tissue regeneration in breast cancer patients. However, the effect of hormonal therapy on ADSCs and their regenerative capabilities is poorly understood. Aims The current study aims to analyse the effect of Afimoxifene, an active metabolite of Tamoxifen, on proliferation and viability of ADSCs in vitro Method Lipoaspirates or adipose tissue were obtained with informed consent from breast cancer patients and healthy controls. The isolated ADSCs were subjected to single or multiple dose(s) of Z-4-Hydroxytamoxifen (12.5nM, 25nM, 50nM, 100nM and 1μM) and, analyzed on days 1, 3 and 5, using CellTitre 96 ® AQueous Cell proliferation assay. T47D and MDA-MB-231 cell lines were used as positive and negative controls, respectively. Result ADSCs were obtained from a total of 3 patients. ADSCs were isolated from a cancer patient with/without active disease at the time of sample procurement and healthy subjects opting for elective cosmetic procedures. Morphology, CFU assay and adipogenic differentiation assay were used to validate stem cell population. Afimoxifene demonstrated no statistically significant reduction in the viability or proliferation of the ADSCs, irrespective of the dose- or time-dependent exposure or cancer status (p >0.05). Conclusion Afimoxifene has no deleterious effect on viability or proliferation of human ADSCs up to 1μM concentration. Key words Adipose-derived stem cells, Afimoxifene, Breast reconstruction, Hormone therapy, Tamoxifen. Take-home message Afimoxifene has no deleterious effect on viability or proliferation of human ADSCs up to 1μM concentration

Working Out the Woes: An Analysis of the Impact of Exercise on Depression.

The purpose of this review is to examine existing research to determine whether exercise has a significant effect on improving emotional well-being and symptoms of depression. At any given time, it is estimated that greater than 15% of Americans are plagued by a depressive mood disorder (L. Andrew, 2014). Plastic surgical nurses will encounter individuals with symptoms of depression who seek elective plastic surgical and cosmetic procedures. With a broad spectrum of symptoms and presentations, both practitioners and those suffering may have difficulty identifying depression. Even after being identified, it can be quite challenging to effectively treat depressive mood disorders. The integration of exercise into the plan of care not only helps tackle one's mental health condition but also benefits any physical health concerns. The plastic surgical nurse can advocate for evidence-based practices and educate the plastic surgical patient on the benefits of physical exercise. Additional research is needed to determine the most effective amount and types of exercise to be used in clinical settings.

An Analysis of Patient-Reported Recovery Outcomes of Topical Tripeptide/Hexapeptide Formulations Utilized in a Prospective Randomized Double-Blind Split Neck and Body Study.

BackgroundPhysicians strive to improve the postsurgical experience and optimize patient-reported recovery outcome measures (PROMs) following elective cosmetic surgical procedures. Our previous pilot feasibility study demonstrated that twice daily postoperative topical body treatment with tripeptide and hexapeptide (TransFORM Body Treatment with TriHex Technology [TFB, Alastin Skincare, Inc., Carlsbad, CA]) reduced PROMs of swelling, induration, soft tissue fibrosis, and pain as well as improved visible and palpable skin quality. ObjectivesEvaluate whether adding a tripeptide/hexapeptide anhydrous gel (Regenerating Skin Nectar with TriHex Technology [RSN, Alastin Skincare, Inc., Carlsbad, CA]) pre- and post-procedure to the existing postsurgical regimen of TFB significantly improves 6 PROMs in patients undergoing neck and body contouring cosmetic surgical procedures.MethodsTen female patients underwent 15 neck and body contouring procedures and were blindly randomized to 1 of 2 topical treatment protocols (1 [TFB] and 2 [RSN/TFB]) pre- and post-procedure. Patient-reported scores of 5 skin parameters (skin discoloration, ecchymosis, edema, induration, and subcutaneous fibrous banding) and pain scores using the Visual Analog Scale were collected at 8 intervals for 12 weeks post-procedure.ResultsThe treatment side that used both topicals showed significantly reduced scores of edema, induration, and subcutaneous fibrous banding compared with the side that only used 1 topical, on days 5–7 and 10–14 (P < 0.05). All patients observed slower soft tissue recovery on the side that was treated with TFB alone and opted to break the code and use both topical treatments.ConclusionsPatients had statistically significant improved patient-reported measures of skin edema, skin induration, and subcutaneous banding on the operated side that used both topicals.Level of Evidence: 2

Nonphysician Practice of Cosmetic Dermatology: A Patient and Physician Perspective of Outcomes and Adverse Events.

Nonphysicians are expanding practice into specialty medicine. There are limited studies on patient and physician perspectives as well as safety outcomes regarding the nonphysician practice of cosmetic procedures. To identify the patient (consumer) and physician perspective on preferences, adverse events, and outcomes following cosmetic dermatology procedures performed by physicians and nonphysicians. Internet-based surveys were administered to consumers of cosmetic procedures and physician members of the American Society for Dermatologic Surgery. Descriptive statistics and graphical methods were used to assess responses. Comparisons between groups were based on contingency chi-square analyses and Fisher exact tests. Two thousand one hundred sixteen commenced the patient survey with 401 having had a cosmetic procedure performed. Fifty adverse events were reported. A higher number of burns and discoloration occurred in the nonphysician-treated group and took place more often in a spa setting. Individuals seeing nonphysicians cited motivating factors such as level of licensure (type) of nonphysician, a referral from a friend, price, and the location of the practitioner. Improper technique by the nonphysician was cited most as a reason for the adverse event. Both groups agree that more regulation should be placed on who can perform cosmetic procedures. Recall bias associated with survey data. Patients treated by nonphysicians experienced more burns and discoloration compared with physicians, and they are encountering these nonphysicians outside a traditional medical office, which are important from a patient safety and regulatory standpoint. Motivating factors for patients seeking cosmetic procedures may also factor into the choice of provider. Both patients and physicians think more regulation should be in place on who can perform cosmetic procedures. More adverse events such as burns and discolorations occurred with patients seeing nonphysicians compared with those seeing physicians. In addition, for those seeing nonphysicians, a majority of these encounters took place in spa settings. Patient safety is of utmost concern when it comes to elective cosmetic medical procedures. More adverse events and encounters occurring outside traditional medical settings when nonphysicians performed these procedures call into question the required training and oversight needed for such procedures.

Patient satisfaction and our clinical experience with 459 microfocused ultrasound treatments.

Microfocused ultrasound (MFUS) is a safe and effective method for noninvasive skin tightening. Previous clinical studies demonstrate a 60-100% patient satisfaction after MFUS. We used an anonymous online platform after MFUS to assess patient satisfaction. Patients treated with MFUS between January 2013 and 2016 were invited to complete an anonymous online survey at least 4 months post-treatment. Patients were asked to rate improvement in skin tightening as none (0%), mild (0-25%), moderate (26-50%), significant (51-75%), or dramatic (76-100%) and treatment satisfaction as disappointed, neutral, satisfied, or extremely satisfied. Between January 2013 and 2016, 253 patients received 459 MFUS treatments at our center. A total of 83 surveys were received with data. Nearly 80% of responders reported at least mild improvement, with 14.5% indicating significant improvement, 27.7% indicating moderate, 37.3% indicating mild, and 20.5% indicating none. In addition, 53.1% of responders reported being satisfied or extremely satisfied with the results. 44.6% of responders did not feel treatment results met expectations. Patient satisfaction with elective cosmetic procedures is an important indicator of success. Our current study demonstrates a high response rate, with almost 80% of responders indicating at least mild tightening with MFUS treatment. Interestingly, only 53.1% of patients reported satisfaction after treatment, a lower satisfaction rate than reported in previous non-anonymous studies and lower than patients report in our office follow-up appointments. This discrepancy may be due to gratitude bias. Anonymous surveys likely provide a more accurate assessment of patients' perceptions and will improve physician's future counseling efforts. Lasers Surg. Med. 51:495-499, 2019. © 2019 Wiley Periodicals, Inc.

Fatal Complications of Aesthetic Techniques: The Gluteal Region.

Cosmetic procedures are common and utilize many techniques to obtain aesthetically good outcomes for patient satisfaction with acceptable safety standards. Cosmetic procedures that involve the gluteal region are becoming increasingly popular as various procedures can target the gluteal region such as liposuction, tumescent liposuction, cosmetic filler injections, autologous fat transfer, depot drug delivery, and implants. Complications of cosmetic gluteal procedures can be localized or systemic with systemic complications being responsible for most deaths. These reported systemic complications include sepsis, thromboembolism, fat embolism with or without fat embolism syndrome, macroscopic fat embolism, anesthesia-related and blood volume abnormalities. We herein report 10 deaths due to elective gluteal cosmetic procedures. Autologous fat transfer (fat grafting, lipoinjection) following liposuction resulted in 8 of 10 fatal outcomes of the gluteal aesthetic procedures. A comprehensive discussion of gluteal anatomy, gluteal contouring procedures, and the approach to such cases is presented along with the autopsy findings of the reported cases.

Rapidly growing Mycobacterium infections after cosmetic surgery in medical tourists: the Bronx experience and a review of the literature

BackgroundMedical tourism is increasingly popular for elective cosmetic surgical procedures. However, medical tourism has been accompanied by reports of post-surgical infections due to rapidly growing mycobacteria (RGM). The authors’ experience working with patients with RGM infections who have returned to the USA after traveling abroad for cosmetic surgical procedures is described here. MethodsPatients who developed RGM infections after undergoing cosmetic surgeries abroad and who presented at the Montefiore Medical Center (Bronx, New York, USA) between August 2015 and June 2016 were identified. A review of patient medical records was performed. ResultsFour patients who presented with culture-proven RGM infections at the sites of recent cosmetic procedures were identified. All patients were treated with a combination of antibiotics and aggressive surgical treatment. ConclusionsThis case series of RGM infections following recent cosmetic surgeries abroad highlights the risks of medical tourism. Close monitoring of affected patients by surgical and infectious disease specialties is necessary, as aggressive surgical debridement combined with appropriate antibiotic regimens is needed to achieve cure. Given the increasing reports of post-surgical RGM infections, consultants should have a low threshold for suspecting RGM, as rapid diagnosis may accelerate the initiation of targeted treatment and minimize morbidity.

Comparative clinical efficacy of four different desensitising agents in relieving post-bleaching sensitivity

Aim: To clinically assess and compare the efficacy on hypersensitivity experienced post-bleaching as an elective cosmetic procedure using four different types of desensitizing agents at four different time intervals. Materials and Methods: 100 patients were selected using the inclusion and exclusion criteria and were randomly divided into 5 groups of 20 each. Group I – Control group (placebo), Group II – Pro-argin (Colgate Pro-Relief), group III – Novamin (Vantej), group IV – Potassium nitrate 5% and sodium monofluorophosphate (RA Thermoseal), and group V – Anti-cay (Toothmin). The respective desensitizing agent was applied to each group after the bleaching procedure was conducted for 10 minutes in two sessions. Objective and subjective scales were used to assess post-bleaching sensitivity after 24 hours and 7 days. Statistical Analysis: It was done using chi-square test, ANOVA and post-hoc Tukey’s test. Results: Using the both the scales, there was significant difference between sensitivity experienced by the control group vs all the other groups. Using the subjective scale, significant difference was found between control group and group IV initially and between control group and groups IV and V ultimately on day 14. Conclusion: The desensitizing agents used in the study show effective reduction after an in-office vital tooth bleaching. There is insignificant difference amongst the desensitizing agents using the objective scale; however, some variation is seen at different time intervals using the subjective one. Keywords: Bleaching treatments, Dentin sensitivity, Desensitizing agents, Sensitivity, Tooth bleaching, Toothpastes

Patient Satisfaction Improves With Delayed Primary Closure of Dehiscence

In 2014, nearly 15.1 million people chose to undergo elective cosmetic procedures. Cosmetic surgical procedures all involve risks, compromises, and complications. Regardless of a physician’s efforts to limit complications, spontaneous wound opening or wound dehiscence remains one of the most common to occur. Cosmetic surgery, perhaps more than any other subspecialty of medicine, walks a precarious balance of tension in effort to reduce laxity and elevate ptotic tissues. Historically, dehiscence with wound exposure more than 6.0 hours after spontaneous wound opening is managed conservatively with proper cleansing and dressing changes, with or without empiric antibiotics. Our research sought to determine whether delayed primary closure of a cosmetic wound dehiscence is a safe and viable option to improve patient care and satisfaction. A retrospective case evaluation, patients survey, and statistical evaluation revealed improved satisfaction with delayed primary closure of dehiscent wounds.

Mucormycosis following hair transplantation: a rare complication

Mucormycosis is a serious, potentially deadly fungal infection that is very rare in immuno-competent healthy patients. Mucormycosis following elective cosmetic procedures such as hair transplantation has never been reported. This case details the symptomatology, modes of diagnosis and treatment of this potentially fatal disease in a patient of hair transplantation.

Working Out the Woes

The purpose of this review is to examine existing research to determine whether exercise has a significant effect on improving emotional well-being and symptoms of depression. At any given time, it is estimated that greater than 15% of Americans are plagued by a depressive mood disorder. Plastic surgical nurses will encounter individuals with symptoms of depression who seek elective plastic surgical and cosmetic procedures. With a broad spectrum of symptoms and presentations, both practitioners and those suffering may have difficulty identifying depression. Even after being identified, it can be quite challenging to effectively treat depressive mood disorders. The integration of exercise into the plan of care not only helps tackle one's mental health condition but also benefits any physical health concerns. The plastic surgical nurse can advocate for evidence-based practices and educate the plastic surgical patient on the benefits of physical exercise. Additional research is needed to determine the most effective amount and types of exercise to be used in clinical settings.

How to Choose Between Options in Soft Tissue Fillers

The use of injectable fillers in facial plastic surgery started with injection of collagen and has seen the introduction of numerous fillers over the past few decades. These products are not only used to fill wrinkles, but also for soft tissue augmentation, reconstruction as well as to influence the aging process at a cellular level. It is imperative that the facial plastic and reconstructive surgeon be familiar with the different products available, their recommended uses, and injection techniques. Since these fillers are used predominantly for elective cosmetic procedures, there is an increased burden on the treating provider to ensure patient safety and minimize risk. We provide a review of the different classes of injectables and our recommended treatment algorithms for each.

Evaluation of wait times for patients seeking cosmetic and reconstructive breast surgery.

Patients seeking cosmetic or reconstructive procedures in plastic surgery typically face significant wait times for consultations. Little attention has been given to potential disparities in wait times between elective cosmetic and reconstructive procedures. In this initial pilot study, we audited a broad sample of plastic surgery offices within a single state for wait times in initial consultations for both breast reconstruction and breast augmentation. A sample of board-certified plastic surgeons was audited from the American Society of Plastic Surgeons (ASPS) Web site that listed both cosmetic and reconstructive breast surgery. Scripted patient telephone calls were made to 67 plastic surgery clinics within a single state on May 2012. Two calls separated by 7 days were made to each office by the same actor seeking an initial appointment for either breast reconstruction or breast augmentation. Wait times were calculated from the date of the call until the date of appointment offered. There were 72 paired calls completed on 36 plastic surgery clinics. Significant disparities in appointment wait times existed between elective cosmetic versus reconstructive procedures (P = 0.02). Mean wait times for breast reconstruction consultation (26.1 days) were significantly longer than mean consultation wait times for breast augmentation (20.9 days). Interestingly, 17.9% of offices contacted no longer perform certain procedures currently advertised on the ASPS Web site. Disparities exist in access to care between patients seeking elective breast augmentation and reconstruction after mastectomy. Patients seeking breast augmentation have more rapid access to plastic surgeons. This study did not evaluate possible explanations for the observed differences. Potential causes may include physician preference and compensation benefits for cosmetic procedures.

Successful Management of Delayed-Onset Complications from a Dermal Filler of Unknown Provenance

Introduction: A 52-year-old woman presented with delayed-onset nodules in the malar and glabellar regions approximately 16 months after undergoing facial augmentation via injection of an unknown substance in China. Medical records for the procedure were not available. The authors performed an investigative review of fillers used abroad to determine possible treatment options for the patient. After discussion with general plastic surgeons in China, a treatment plan was initiated. Materials and Methods: Computed tomography of the head with 3-dimensional reformatting was performed to characterize the nature and extent of the interventions performed. The study revealed significant amounts of a subdermal substance in the malar and glabellar regions. Results: A cycle of treatment was performed involving the injection of lidocaine, triamcinolone, and fluorouracil into the affected areas accompanied by interspersed daily massage. The regimen proved effective, and there was clear reduction in the size and inflammation of the nodules. Conclusions: The modern age of facial rejuvenation features an increasing array of soft tissue fillers available to physicians performing facial augmentation. The expansion of available filling agents and the rising costs of domestic health care have resulted in an increase in the number of patients seeking elective cosmetic procedures abroad, and patients presenting with complications from cosmetic tourism are increasingly a part of the modern aesthetic practice. Maintaining a solid awareness of current usage trends of injectable filling agents and a thorough understanding of the management options for delayed-onset nodules are essential for mitigating complications from soft tissue fillers of unknown provenance.

Safety of Cosmetic Dermatologic Procedures During Pregnancy

Safety of cosmetic procedures in pregnant women has not been extensively studied. Maternal and fetal health risks are important to consider in any procedure performed. With the increasing popularity of cosmetic procedures, dermatologic surgeons will be faced with scenarios necessitating knowledge regarding the safety of such procedures during pregnancy. Furthermore, dermatologic surgeons may inadvertently perform cosmetic procedures during the first trimester, before the patient is aware of the pregnancy. To investigate the safety of cosmetic procedures during pregnancy and the postpartum period. A literature search of PubMed and Google Scholar was conducted of all English-language articles published from 1960 through 2012. Definitive recommendations on the safety of procedures such as chemical peels, injectables, fillers, and most laser therapies during pregnancy cannot be made. The safety of onabotulinum toxin usage is well documented in the neurology literature, although isolated events of miscarriage have been reported with high doses of toxin in women with a previous history of miscarriage. Carbon dioxide laser therapy for genital condylomas has considerable evidence supporting its safety during pregnancy. There is a lack of controlled trials addressing the safety of cosmetic procedures during pregnancy and postpartum periods. It is advisable to delay elective cosmetic procedures until after the baby is born.

Keloid: A case report and review of pathophysiology and differences between keloid and hypertrophic scars

Keloids extend beyond the borders of the original wound invading normal skin. Usually appear as firm nodules, often pruritic and painful, and generally do not regress spontaneously. Most often occur on the chest, shoulders, upper back, back of the neck, and earlobes. The aim of the paper is to discuss a case of keloid, review the pathophysiology and also to highlight the differences between keloid and hypertrophic scars. A 26-year-old female complains of swelling on ear lobe since 3 years. Swelling was firm, non-tender, dumbell-shaped with central wooden stick still present, measuring 3 cm in diameter medial to the inferior part of the helix. A clinical diagnosis of keloid was given. Histopathological sections showed hyperorthokeratinized stratified squamous epithelium with deep dermal sclerosis showing large dense bundle of glassy collagen diagnostic of Keloid. Special stain like Van Gieson's was used to identify collagen bundles. The sections were also subjected to immunohistochemical markers such as α-SMA (alpha Smooth muscle actin), Desmin, and S-100. Despite decades of research, the pathophysiology of keloids remains incompletely understood. Recent studies indicate that TGF-β (Transforming growth factor beta) and PDGF (Platelet-derived growth factor) play an integral role in the formation of keloids. In future, development of selective inhibitors of TGF-β might produce new therapeutic tools with enhanced efficacy and specificity for the treatment of keloids. Patients with a previous history of keloid or other risk-factors should avoid body piercing and elective cosmetic procedures. Keloid scars should be sent for histopathology in order to avoid missing potentially malignant conditions particularly those showing unusual features.