Facial Cosmetic Procedures Research Articles

Effects of lavender olfactory input on cosmetic procedures

To evaluate the effects of the aroma of essential oil of lavender against placebo on subjects' pain perceptions and levels of anxiety when undergoing elective cosmetic facial injections of botulinum toxin type A (BOTOX(®) COSMETIC) for the correction of glabellar wrinkles. Subjects (N=30) who had not previously received any cosmetic facial injections were randomized to essential oil of lavender aroma exposure or to placebo during elective cosmetic facial injections of BOTOX(®) (12 U) for the correction of glabellar wrinkles. Evaluations of subjects' pain perceptions and levels of anxiety assessed by the Spielberger State-Trait Anxiety Inventory, heart rate (HR), and blood pressure (BP) measurements were taken at baseline, before, and after injections. Subjects exposed to essential lavender oil showed a significant reduction in HR after the injection as compared to the pre-injection HR. Subjects exposed to the placebo did not show any significant difference in BP or HR between pre-injection and postinjection. Although essential oil of lavender did not have an effect on the subjects' perception of pain during a facial injection, subjects showed significant increases in parasympathetic activity when exposed to the lavender aroma. Lavender aromatherapy has the potential to ease anxiety in patients undergoing minimally invasive facial cosmetic procedures.

Malar Augmentation Assessed by Magnetic Resonance Imaging in Patients after Face Lift and Fat Injection

Restoration of cheek volume is recognized as an important part of facial rejuvenation. However, there are no previous studies that have determined whether any soft-tissue technique is effective for achieving lasting malar augmentation. This study prospectively evaluated a subset of five patients who had deep-plane face lifts with fat injection, and other facial cosmetic procedures. The mean volumes of fat injected were 9.1 cc (range, 4 to 12 cc) into the right cheek and 8.5 cc (range, 4 to 11.5 cc) into the left cheek. Magnetic resonance imaging scans were obtained before surgery and at intervals after surgery up to 6 months (and 1 year in one patient) for a total of 22 studies. Axial, coronal, and sagittal images, T1- and T2-weighted, were obtained. Thickness of the malar fat pads was measured. Malar thicknesses showed significant increases at the time of the 1-month follow-up appointments (p < 0.01). This increase was maintained at the next follow-up appointment (p < 0.01). There was no significant difference in thickness between the first postoperative appointment and the second postoperative appointment. The T1- and T2-weighted images revealed that the increase was attributable to tissue with fat density, not fluid. The average increase in malar projection was 0.66 cm for the right cheek and 0.60 cm for the left cheek. Fat injection at the time of face-lift surgery produces an increase in malar volume that is still present up to 6 months after surgery. This study confirms the rationale for injecting fat at the time of face-lift surgery.

Outcome Analysis in 93 Facial Rejuvenation Patients Treated with a Deep-Plane Face Lift

This prospective study assessed outcomes in patients undergoing a deep-plane face lift and other simultaneous facial cosmetic procedures. It is the first prospective outcome study to assess and compare these patients and provide data on patient satisfaction and quality of life—the most important determinants of surgical success. From 2002 to 2007, in-person interviews were conducted with 93 patients who attended a follow-up appointment at least 1 month after surgery from a total of 122 consecutive patients treated with a deep-plane face lift and other facial rejuvenation procedures (response rate, 76 percent). Questions were asked in six categories: patient data, indications, recovery, results, complications, and psychological effects. Responses were analyzed in four groups: face lift alone; face lift and blepharoplasties; face lift and forehead lift; and face lift, blepharoplasties, and endoscopic forehead lift. The average subjective reduction in apparent age was 11.9 years (range, 0 to 27.5 years). Seventy-seven patients (82.8 percent) reported an improvement in self-esteem, and 64 patients (69.6 percent) reported an improved quality of life. There was no significant correlation between result rating and procedure groups, age, gender, smoking history, previous face lift, body mass index, or the occurrence of a complication. Despite a significant recovery period, patient satisfaction was high, with 96.7 percent of patients reporting a more youthful appearance after surgery. Scar dissatisfaction was rare (2.2 percent). With proper patient preparation and education, facial rejuvenation effectively meets patient expectations. These findings support the recommendation of surgical facial rejuvenation to patients who wish to look younger.

An open-label trial examining the efficacy and safety of a pre- and postprocedure topical five-product system (Clinique Medical Optimizing Regimen) specifically formulated to complement laser/light-based facial cosmetic procedures

Background: Specialized skin care regimens may help to minimize adverse events (AEs) following non-ablative facial procedures. Methods: A 14-week, open-label, three-center study evaluated the efficacy and safety of a topical five-product system (Clinique Medical Optimizing Regimen; Allergan, Inc., Irvine, CA, USA) for minimizing localized AEs during two 6-week procedure cycles with fractionated laser (FL) or intense pulsed light (IPL). The skin care regimen consisted of a 2-week preprocedure phase, a 1-week postprocedure phase, and a 3-week maintenance phase. Investigators and patients rated the presence and severity of erythema, itching, stinging/burning, edema, pain, pruritus, swelling, crusts/erosion, and photodamage. Results: Two days after the FL/IPL treatment (IPL: n = 27; FL: n = 21), most assessments, including erythema, were near baseline values; at 4 weeks postprocedure, all investigator scores were comparable to baseline. Patients missed work or avoided social situations a mean of only 0.8 days. Mean subject ratings for itching, stinging/burning, pain, swelling, and redness for 2 weeks postprocedure were ‘none’ to ‘mild’. Treatment-related AEs (acne, facial rash) occurred in four patients. All investigators stated they would recommend this topical over-the-counter regimen again in conjunction with non-ablative FL/IPL treatments. Conclusions: This topical five-product skin care system was safe and effective in conjunction with non-ablative FL/IPL procedures.

The use of botulinum toxin type A in cosmetic facial procedures

Over the past decade, facial cosmetic procedures have become more commonplace in dentistry and oral and maxillofacial surgery. An increasing number of patients seek minimal invasive procedures. One of the most requested procedures is treatment with botulinum toxin type A (BoNTA). Treatment of dynamic rhytids and lines with BoNTA is effective and produces high rates of improvement with rapid onset and long duration of action (longer than 4 months for some patients) compared with placebo. This paper considers the history and pharmacology of this neurotoxin, and focusses on the literature concerning the treatment of different facial areas with BoNTA. It also presents clinical guidelines on the treatment of glabellar lines, the frontalis muscle, peri-orbital lines, gummy smile and masseter muscle hypertrophy. Knowledge about the mechanisms of action and the ability to use BoNTA as an adjunctive treatment are mandatory for those working in the field of cosmetic facial surgery.

Poster 03: Identification of Body Dysmorphic Disorder in Adult Patients Seeking Orthognathic and Facial Cosmetic Surgery From Oral and Maxillofacial Surgeons

Statement of the Problem: Traditionally, Oral and Maxillofacial Surgeons have aided orthodontists in alignment of teeth by performing orthognathic surgery to correct misalignment of the jaws due to dentofacial deformities. While studies indicate that 90% of individuals who undergo orthognathic surgery are satisfied with their outcome and 80% would choose to do it again given the same circumstances and outcomes, approximately 10-15% of individuals are dissatisfied regardless of outcomes. These patients have typically been referred to as being “high maintenance” and dismissed. However, it is plausible that some of these individuals suffer from body dysmorphic disorder (BDD). No assessment tool is currently in place to screen patients seeking orthognathic surgery for BDD. Furthermore, as oral and maxillofacial surgeons expand the scope of their practice to include more cosmetic facial surgery, it will be important to screen this population of patients in order to identify individuals that have BDD. The purpose of the present study was to identify adult patients with BDD seeking orthognathic or facial cosmetic surgery procedures by utilizing a well documented, “user friendly” BDD screening tool, the BDD Questionnaire (BDDQ).

Use of temporalis fascial for facial augmentation

Background and Objectives: Facial augmentation is one of the popular facial cosmetic procedures. Many materials have been used for this purpose but all of them have some drawbacks. We have tried to use temporalis fascia that we think will cover some of the common complications and problems. The aim of this study was to introduce a predictable and stable material for augmentation

Pulsed-Dye Laser for Treating Ecchymoses After Facial Cosmetic Procedures

Pulsed-Dye Laser for Treating Ecchymoses After Facial Cosmetic Procedures

Pulsed-Dye Laser for Treating Ecchymoses After Facial Cosmetic Procedures

To assess the safety and efficacy of a 595-nm pulsed-dye laser in the treatment of ecchymoses after facial cosmetic procedures. Twenty consecutive patients with ecchymoses after facial cosmetic procedures underwent treatment with the pulsed-dye laser. A 10-mm spot size was used, with pulse duration of 6 milliseconds, fluence of 6 J/cm(2), and cryogen spray for 30 milliseconds with a 20-millisecond delay. The ecchymotic area was outlined; the lateral half was treated on postoperative day 5 or 6 and the medial half on postoperative day 7 to 10. Clinical photographs were obtained before and after each treatment. Three blinded independent observers evaluated the photographs and graded the ecchymoses on a scale of 0 to 3, with 3 indicating severe ecchymosis. The most common procedures associated with ecchymoses are cervicofacial rhytidectomy, facial lipocontouring, thread lift, and minimally invasive subperiosteal midface-lift. Pulsed-dye laser treatment resulted in a 63% mean improvement in ecchymosis scores within 48 to 72 hours. The only adverse effects were mild edema and discomfort. Maximal efficacy of the laser treatment was observed when it was performed between 5 and 10 days postoperatively. Patient satisfaction was universally high. Treatment with the pulsed-dye laser is safe and effective for expeditious resolution of postoperative ecchymoses after facial cosmetic procedures. It has the potential for wider application in treating postoperative ecchymoses on other areas of the body and after trauma.

Preventing and Managing Dry Eyes after Periorbital Surgery: A Retrospective Review

Dry eye syndrome is a common sequela associated with periorbital surgery. As more patients seek periorbital rejuvenation, understanding the pathophysiology, diagnosis, and treatment of this condition perioperatively is essential for managing patient expectations and maximizing outcomes. A retrospective review of charts for 202 consecutive patients (180 women and 22 men) who underwent upper and/or lower blepharoplasty was performed. Additional facial cosmetic procedures were performed in 91 percent of patients. Data were collected identifying associated risk factors and the incidence of persistent dry eye symptoms. Key elements of perioperative care are described and algorithms for detection of those at risk, prevention, and management are outlined. Dry eyes persisting longer than 2 weeks after surgery were noted in 22 patients (10.9 percent) and longer than 2 months in only four patients (2 percent). In most cases, dry eyes resolved with conservative management, including artificial tears, lubrication, topical and systemic steroids, and night taping. One patient (0.5 percent of all studied patients) eventually needed surgical correction of lower eyelid retraction after failure of the punctate plug. Persistent chemosis occurred in 15 patients (68.2 percent) who had symptomatic dry eyes (p < 0.01). Recognizing and addressing risk factors before surgery and an algorithmic approach to prevention and management of patients undergoing periorbital surgery are essential for minimizing the occurrence of dry eye syndrome.

Injectable Calcium Hydroxylapatite for Correction of Nasal Bridge Deformities

Minimally invasive procedures for aesthetic surgery have become widely popular, and facial soft tissue augmentation is one of the most common procedures. Various kinds of fillers have been used, and recently the use of calcium hydroxylapatite was extended to cosmetic facial procedures. This article presents the authors' experience with primary and secondary nasal bridge correction using calcium hydroxylapatite (Radiesse). This preliminary prospective study investigated the use of commercially available calcium hydroxylapatite (Radiesse) for correction of nasal bridge deformities. Calcium hydroxylapatite was injected on the plane of the periosteum in a retrograde fashion using a linear, threading, fanning, or crosshatching technique. The patients were followed for several months, with the outcome and side effects assessed both subjectively and objectively. Patients showed a persistence of benefit up to 1 year during the follow-up period, with pleasing long-term results. Calcium hydroxylapatite (Radiesse) is a useful injectable filler for correction of nasal bridge deformities. Further efficacy studies seem justified.

A Validated Hand Grading Scale

Following the popularity of facial cosmetic procedures to reverse the signs of aging, cosmetic procedures that rejuvenate the hand are being sought. Irregular surface pigmentation, prominence of superficial veins and tendons, thinning of the dermis, and loss of subcutaneous fat typically characterize aging of the hand. To develop the Hand Grading Scale for objective quantification of the severity of hand aging and to establish the reliability of this photonumeric scale for clinical research and practice. The Hand Grading Scale is a 5-point photonumeric rating scale that was developed to objectively quantify the severity of aging of the hand. Nine experts rated photographs of 35 subjects, twice, with regard to the aspect "hand aging" in comparison with morphed images. Inter- and intrarater variability was assessed by computing intraclass correlation coefficients. The agreement between the experts was considerably high. Bubble plots (bivariate scatter plots) demonstrated linearity in judgment by the experts. The 5-point photonumeric scale generated spans the severity of hand aging for which patients most commonly seek correction. The scale is well stratified for consistent rating.

A Validated Hand Grading Scale

BACKGROUND Following the popularity of facial cosmetic procedures to reverse the signs of aging, cosmetic procedures that rejuvenate the hand are being sought. Irregular surface pigmentation, prominence of superficial veins and tendons, thinning of the dermis, and loss of subcutaneous fat typically characterize aging of the hand. OBJECTIVES To develop the Hand Grading Scale for objective quantification of the severity of hand aging and to establish the reliability of this photonumeric scale for clinical research and practice. MATERIALS AND METHODS The Hand Grading Scale is a 5-point photonumeric rating scale that was developed to objectively quantify the severity of aging of the hand. Nine experts rated photographs of 35 subjects, twice, with regard to the aspect “hand aging” in comparison with morphed images. Inter- and intrarater variability was assessed by computing intraclass correlation coefficients. RESULTS The agreement between the experts was considerably high. Bubble plots (bivariate scatter plots) demonstrated linearity in judgment by the experts. CONCLUSION The 5-point photonumeric scale generated spans the severity of hand aging for which patients most commonly seek correction. The scale is well stratified for consistent rating.

Non-aesthetic use of botulinum toxin

Introduction: Botulinum toxin A injection has recently been reported to account for a significant increase in the number of facial cosmetic procedure performed in the UK. Apart from the well publicised facial aesthetic use, botulinum toxin injection for non-aesthetic reason in the face and mouth regions is also growing. We report a series of non-aesthetic cases in which botulinum toxin injection have been helpful.

Psychological Considerations in Revision Rhinoplasty

Revision rhinoplasty is a unique challenge. In addition to the technical considerations that are inherently more difficult than those of primary cases, the surgeon must also be mindful of the psychological considerations that revision rhinoplasty presents. These patients are by definition unhappy with their prior rhinoplasty experience, and this perception of a suboptimal result is both legitimate and real, even if the surgeon is not in agreement. Tantamount to any intraoperative technique, the preoperative ability of the surgeon to sift through the myriad psychological and psychosocial issues is critical to achieving satisfactory outcomes for both patient and surgeon. Reasons for dissatisfaction with a primary surgery, reasons for seeking revision surgery, and the psychological profiles of revision rhinoplasty patients can differ from those related to other facial cosmetic procedures. This article attempts to provide the reader with a better understanding of the complex interplay of these issues and with this understanding help the reader to distinguish one who is a favorable surgical candidate from one who is best left unrevised.

Midface lift technique with use of a biodegradable device for tissue elevation and fixation

Aesthetic surgeons have become increasingly aware that elevation of the midface is a significant component of facial rejuvenation. However, adequate fixation remains a problem in midface lift procedures, regardless of the approach. The purpose of this study was to evaluate the efficacy and ease of application of the Endotine midface device (Coapt Systems, Palo Alto, CA), as well as patient and surgeon satisfaction with the results of treatment. The Endotine device consists of a polylactide polymer that incorporates 5 tines, each 4.5 mm long, to distribute tension over a wide area, maximizing fixation strength and holding power. After the cheek tissue is engaged, upward tension is applied to the anchoring leash, which is then sutured to the deep temporal fascia. Between October 2003 and October 2004, 31 patients underwent Endotine fixation for midface lift. The patient group comprised 7 men and 24 women ranging in age from 40 to 65 years (mean age, 49.25 years). Four patients had midface lifts as the sole procedure, and 27 had adjunctive facial cosmetic procedures. Results evaluated included ease of use/difficulty of insertion, postsurgical pain, adequacy and stability of fixation, side effects and complications, and patient and surgeon satisfaction. All patients were judged to have satisfactory cheek elevation and enhanced contour without evidence of recurrent midface ptosis or loss of elevation/fixation. There were no postoperative complications of infection, hematoma, or dehiscence. In a subset of 11 patients, "pain in the treated area" averaged 2.7 (0 = no pain, 10 = extreme pain) at one month follow-up. Surgeon satisfaction with the fixation result averaged 4.9 (1 = very dissatisfied, 5 = very satisfied) at one month follow-up. Patient self-assessment of aesthetic outcome averaged 3.8 (1 = worse than baseline, 4 = dramatic improvement from baseline) at one month follow-up, and patient satisfaction assessment averaged 3.9 (1 = very dissatisfied, 4 = very satisfied) at one month follow-up. The midface Endotine device provided rapid, secure fixation in our small patient study group without complications, and eliminated the complicated and awkward suture techniques that have been an impediment to midface surgery. Larger clinical studies are in progress.

The Minimal Approach: An Innovation in Facial Cosmetic Procedures

Plastic surgery is a rapidly growing field, particularly the use of less invasive procedures such as biodegradable dermal fillers and botulinum toxin. Aging is a complex process involving two important factors: volume loss throughout the face, and repetitive muscle movements that cause wrinkles and folds. Dermal fillers work by providing support for facial structures, whereas botulinum toxin reduces the mimetic effects. In combination, these products can be used effectively to reshape and rejuvenate the face and neck. Dermal fillers can be used throughout the face to raise the eyebrows, fill the tear trough, reshape the nose, lift the nose tip, fill nasolabial folds and oral comissures, fill the cheeks, raise the cheekbones, reshape the jaw line, and rejuvenate the neck area. This "minimal approach" offers a faster, less painful, and less costly alternative or complement to surgical facelifts. A variety of biodegradable injectable products are currently available, the most common of which are collagen- or hyaluronic acid-based. Using these products in combination takes advantage of their hydrophobic and hydrophilic properties and can provide better and longer-lasting results. The addition of botulinum toxin can further extend the duration of results by reducing the mimetic stress that can break down the polymers. With regular maintenance treatments, the minimal approach using dermal fillers and botulinum toxin can give patients a "whole new look" with a fast and relatively painless lunchtime procedure.

The "pinch and slide" blepharoplasty: safe and predictable aesthetic results.

Blepharoplasty is one of the most common facial cosmetic surgical procedures. When done properly, this relatively simple operation can result in a dramatic improvement for the patient with relatively little downtime. However, when it is performed improperly, the results can be crippling for the patient and often difficult for the surgeon to correct. Standard treatments for upper eyelid dermatochalasis include surgical excision of skin, muscle, and fat. Several techniques have been described for removing some or all of these components, depending on the patients' anatomic requirements. In particular, the "pinch" technique can be used to remove either the upper eyelid skin alone or a combination of skin, muscle, and fat. While this technique is not new, its appearance in the literature is sparse. We demonstrate herein how a modified version of the pinch technique can be used to remove the central orbital fat pad by "sliding" the pad through the medial fat pad incision. This procedure maintains the integrity of the central orbital septum and the delicate structures that lie beneath.

The aging face in patients of color: minimally invasive surgical facial rejuvenation-a targeted approach.

We are in the midst of exciting times from a demographic standpoint as the population of darker-skinned people grows exponentially in the United States. Although there is a growing demand for facial cosmetic procedures amongst people of color, the total number of individuals undergoing surgical facial rejuvenation is dwarfed by the current Caucasian market. In order to provide optimal options for facial rejuvenation, cosmetic surgeons must have an underlying appreciation for the dynamic interplay among ethnicity, facial morphology, and the progression of aging. The purpose of the present article is to outline the minimally invasive surgical options for facial rejuvenation best suited for the patient of color. Although the population of individuals with darker-pigmented skin is quite vast, the present paper will focus on individuals of African descent, with whom the author has the most experience. Preferred surgical techniques include blepharoplasty, autologous facial fat transplantation, percutaneous cheek lift, and submental liposuction. Cutaneous surgeons familiar with soft-tissue surgery and facial anatomy should feel comfortable performing these techniques.

Aesthetic Eyelid Ptosis Correction: A Review of Technique and Cases

Upper eyelid ptosis can present both functional and aesthetic problems. Because proper correction of ptosis can be difficult to achieve, numerous surgical procedures have been developed. Plication of levator aponeurosis can be combined with aesthetic blepharoplasty and facial rejuvenation procedures to successfully address ptosis. The authors assessed the effectiveness of levator aponeurosis plication for correction of acquired upper eyelid ptosis in patients presenting for concomitant cosmetic facial procedures. The medical records of 74 consecutive patients (68 women and six men) who had upper eyelid ptosis correction in conjunction with cosmetic facial procedures from January of 1994 to January of 2000 were reviewed. During this period, 400 endoscopic forehead lifts and 479 face lifts were performed. The correction was performed through an external upper blepharoplasty approach removing an ellipse of skin and orbicularis muscle. Once the orbital septum was opened, a plication of the levator aponeurosis was accomplished by one or more horizontal mattress sutures of 6-0 clear nylon (with the first bite placed at or just medial to the vertical level of the pupil). The average follow-up period was 14 months. Long-term correction of the ptosis was excellent. The complications were minor, with the most common occurrence being asymmetry. Revisions were performed on only four patients. Correction of ptosis can be performed safely and effectively in conjunction with periorbital and facial rejuvenation. The technique described is simple, reliable, and reproducible.