Facial Plastic Surgery Practice Research Articles

Minimally Invasive Otoplasty.

Minimally invasive otoplasty (MIO) is an elegant and well-proven technique for correcting protruding ears as the most frequent form of first-degree auricular dysplasia. It is well suited for the majority of patients with prominauris who regularly present to a facial plastic surgery practice. Although there are several variations of the MIO, all MIO techniques differ from traditional otoplasty techniques in that they avoid a large retroauricular skin incision and excision. This distinction considerably diminishes the risk of hypertrophic scars and keloids. The best elements of traditional otoplastic techniques can be utilized with much smaller incisions, respectively, even without incisions at all and with new surgical instruments to achieve an effective and precise surgical result. The MIO technique described herein enables all steps of cartilage work through the small retroauricular skin incision that Kaye already suggested in the very first publications of a closed otoplasty technique 1967.

The Future of Visual Documentation? Assessing the Use of Videography in Facial Plastic Surgery.

Recent technological advancements in the field of portable electronics have facilitated the use of videography as a form of visual documentation in facial plastic surgery. Currently, the degree of video adoption and perceptions relating to its use in plastic surgery are not known. This study aimed to evaluate the current use, perceptions, and barriers regarding the adoption of video in the clinical practice of facial plastic surgery. A cross-sectional study of all American Academy of Facial Plastic and Reconstructive Surgery members was conducted through an e-mail-disseminated 24-item online survey. A total of 164 surgeons responded to the survey. Nearly all surgeons reported routinely employing photography for the documentation and marketing of surgical results. Fewer than 25% of respondents acknowledged using video to document surgical outcomes. Younger surgeons (<10 years in practice) and those in academic practices were significantly more likely to adopt videography (32 vs. 17%, p = 0.042 and 38 vs. 18%, p = 0.027, respectively). Most surgeons regarded video as the superior visual documentation format for dynamic facial expression and as being more difficult to deceptively manipulate. Most frequently cited barriers to adoption included time-consuming capture, file editing/storage requirements, and lack of clear standards. Videography holds favorable potential as the future format of visual documentation in facial plastic surgery due to its ability to capture the full range of dynamic facial expression. Establishing standards and setup guidelines for video capture will be essential in increasing its adoption.

Practicing functional nasal surgery in the non-urban setting: experience from a single center

Nasal airway obstruction is a prevalent chief complaint in the contemporary facial plastic surgery practice. Studies report an asymmetric distribution of plastic surgeons across the United States with a disproportionately high concentration of surgeons practicing in urban areas. The lack of elective specialist care creates unique challenges for these patients who may need to travel and dedicate time to reach a nasal surgery expert. We conducted a retrospective chart review to report our experience from practicing functional nasal surgery in such a non-urban setting in the United States. A total of 103 patients underwent functional nasal surgery (FNS) between May 2015 and August 2021 including septoplasty, inferior turbinate reduction, septorhinoplasty and nasal valve procedures. We present the epidemiological characteristics, surgical techniques used and postoperative complications and illuminate the unique characteristics of practicing FNS in the non-urban setting.

Radiological examination of cranial, ear-nose-throat, and maxillofacial system findings of Dyke-Davidoff-Masson syndrome in 28 patients

ObjectivesIt was aimed to detail the intracranial and ear–nose–throat-maxillofacial (ENT-MF) system findings of Dyke–Davidoff–Masson Syndrome (DDMS), and to examine the association in a larger sample according to current literature. Patients and methodsThe study was designed retrospectively. Cranial magnetic resonance (MRI) and computed tomography (CT) Imaging records of patients were re-examined. Outcome parameters were identified as patients' demographics, the emergence of the central nervous system (CNS) pathologies, the asymmetric pneumatization of the skull bones, and ENT-MF system presentation. The correlation of the cranial and ENT-MF system findings was evaluated with Spearmen correlation analysis. ResultsRadiological images of 28 patients were examined. The number of men was 21 (75.0%) and the number of females was 7 (25.0%). The mean age of the patients was 23.6 ± 10.6 (min. 1, max. 44). DDMS involvement detected on the right side in 15 (53.6%) of the patients. Cerebral atrophy (n = 28, 100%), lateral ventricular dilatation (n = 26, 96.3%) and corpus callosum damage (n = 19, 67.9%) were most frequent findings respectively. Cerebellar atrophy (n = 4, 14.3) and venous sinus dominance (n = 4, 14.3) were the rarest pathologies. Facial asymmetry (n = 15, 53.6%) and frontal sinus hyperpneumatization (n = 15, 53.6%) were the most frequent findings in the ENT-MF system. Increased calvarial thickness showed a high positive correlation with facial asymmetry and frontal sinus hyperpneumatization (p = 0.002, r = 0.571 and 0.024, r = 0.424, respectively). ConclusionDDMS may occur with different radiological findings depending on the level of cerebral damage. Facial asymmetry often accompanies the disease and it should be considered in clinical practice of facial plastic and maxillofacial surgery.

Conversion Rate of Web-based Versus Non-web-based Patient Referral Sources in a Facial Plastic Surgery Practice.

To compare the conversion rate (number of procedures/referrals) of web-based and non-web-based referrals to a facial plastic surgery practice (2012-2019). Data on demographics, referral source, patient's concern, and their facial procedures were recorded. Web-based referral sources include website and Instagram. Non-web-based counterparts were the word-of-mouth, medical professionals, and others (TV, radio, printed media). Patient concerns were either cosmetic or noncosmetic (functional). Patients who underwent facial cosmetic surgery and injections (botulinum toxin A, filler, fat) were categorized in the cosmetic procedure group. Patients with functional procedures with or without facial injections were categorized in the noncosmetic procedure group. The conversion rate was defined as the ratio of the number of referrals with different facial procedures to the total number of referrals. Included were 19,965 patients, majority of whom (63.3%) had cosmetic concern. Total, cosmetic, and noncosmetic conversion rates were 30.1%, 27.7%, and 2.4% for the web-based and 24.1%, 19.8%, and 4.3% for the non-web-based referrals, respectively (0.3 < p < 0.4). Cosmetic conversion rate grew from 6.7% in referrals ≤20 to more than 23% in >20 years of age (p = 0.03). It was also significantly (p < 0.001) higher in the referrals with cosmetic (28.3%) than noncosmetic (12.1%) concern. Gender and year of practice did not have a significant effect on the conversion rates. Conversion rates were not significantly different between the web-based and non-web-based referrals. A significantly higher cosmetic conversion rate was observed for the referrals with cosmetic concern and older than 20 years.

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 .

Online Ratings of Facial Plastic Surgeons: Worthwhile Additions to Conventional Patient Experience Surveys.

Background: Physician review websites are now commonly used by patients. However, in facial plastic surgery, the trends and content in these websites are not well studied. We examined online reviews for U.S. facial plastic surgeons, and compared comment content with the most commonly used patient experience survey, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) administered by Press Ganey. Methods: A retrospective mixed method study was employed to quantitatively compare online ratings and comments of 100 randomly selected U.S. facial plastic surgeons on vitals.com, healthgrades.com, google.com and zocdoc.com. Qualitative content analysis was utilized to categorize themes present in 957 patient-generated (unverified) comments, and compare these with CAHPS survey questions and themes. Results: The physician review websites had favorable ratings of facial plastic surgeons with 84.55% five-star reviews on Healthgrades and 78.40% on Vitals. These ratings were similar across surgeon age (p = 0.44), gender (p = 0.85), and geographic region (p = 0.29). Of sites examined, Healthgrades and Vitals were most frequently used. Analysis of patient comments identified themes aligning with CAHPS content (e.g., physician interactions, efficiency, and recommendation likelihood), as well as additional themes such as patient's outcome perception (55.28% of comments) and finances (86% of negatively rated reviews). Conclusions: These exploratory results suggest that facial plastic surgeons are generally rated positively online, and the comments left on these websites provide additional feedback that is not currently included in CAHPS surveys. In evaluating the patient experience with facial plastic surgery practices, these websites may prove to be useful.

Recovery of Elective Facial Plastic Surgery in the Post-Coronavirus Disease 2019 Era: Recommendations from the European Academy of Facial Plastic Surgery Task Force.

The impact of the COVID-19 pandemic has resulted in widespread disruption to routine surgical services across the globe. As the peak of the initial pandemic passes, surgeons will increasingly resume elective work to address the backlog. Whilst urgent cases such as cancer work will be prioritized, the safe resumption of facial plastic surgery will remain an ongoing challenge; particularly if there are secondary waves of infection. Rhinoplasty and nasal reconstructive surgery in particular poses a unique challenge to address due to the due to the potential for aerosolizing the virus. A task force of facial plastic surgeons from the European Academy of Facial Plastic Surgery has collaborated to create this document detailing recommendations for resuming a safe facial plastic surgery practice. These include the need to embrace telemedicine, advice on surgical prioritization, planning of clinical area flow plans, advice on pre-/peri- and postoperative care as well as recommendations on training for residents and well-being for surgeons. The recommendations have been made in line with the best available evidence in the literature and are applicable to facial plastic surgery colleagues from around the world in order to resume a safe practice.

Level of Evidence in Facial Plastic Surgery Research: A Procedure-Level Analysis.

As evidence-based medicine has taken hold across medical specialties, the level of evidence within the facial plastic surgery literature has risen, but remains weak in comparison. There has not yet been a systematic, critical appraisal of the relative strength of evidence among subsets of the practice of facial plastic surgery. The current study is a systematic review, designed to evaluate the level of evidence observed in the facial plastic surgery literature. Five journals were queried using facial plastic surgery terms for four selected years over a 10-year period. Following screening, articles were assigned to a category regarding subject matter, assessed for the presence of various methodological traits, and evaluated for overall level of evidence. Comparisons were made in regard to level of evidence across the breadth of facial plastic surgery subject matter. A total of 826 articles were included for final review. Studies on operative facial rejuvenation and rhinoplasty had significantly fewer authors on average than studies on cancer reconstruction or craniofacial topics. Craniofacial studies demonstrated higher levels of evidence relative to all other categories, with the exception of facial paralysis and facial trauma studies, from which there was no significant difference. In general, reconstructive studies had significantly more authors and higher levels of evidence than did articles with an aesthetic focus. Level of evidence in facial plastic surgery remains relatively weak overall. Reconstructive and particularly craniofacial studies demonstrate higher mean level of evidence, relative to other subsets of facial plastic surgery. 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 evolving roles of computer-based technology and smartphone applications in facial plastic surgery

This article aims to provide a comprehensive review of the established and emerging applications of various computer-based technologies and smartphone applications in the field of facial plastic surgery. Computer-based technologies and smartphone applications have widespread utility across various domains of facial plastic surgery; these include preoperative consultation, surgical planning, intraoperative navigation, custom implant creation, postoperative assessment, physician productivity, communication, and education. Smartphone applications are being utilized for assessment of patients such as those with facial paralysis. Three-dimensional (3D) imaging and 3D printing has influenced preoperative counseling, surgical planning, and execution. The incorporation of intraoperative navigation has the potential to improve the accuracy and precision of facial reconstruction. Current advances in computer-based technology have made a significant impact on the practice of facial plastic and reconstructive surgery. These technological advances have influenced how we counsel patients, perform procedures, assess outcomes, and learn new techniques.

Neurotoxins.

Botulinum toxin is integral to the practice of facial plastic surgery. Since it was approved by the U.S. Food and Drug Administration for the temporary improvement of glabellar rhytids in 2002, botulinum toxin has achieved a growing number of off-label clinical applications. These include the management of facial rhytids, brow ptosis, excessive gingival display, masseteric hypertrophy, platysmal banding, facial nerve paralysis, hypertrophic scars, and keloids. Many forms of botulinum toxin have been developed, and their safety and efficacy have been thoroughly established. This article will review the aesthetic and functional uses of botulinum toxin as it relates to the field of facial plastic and reconstructive surgery. In addition, the authors will discuss the suggested quantity of units per injection site based on onabotulinumtoxinA.

Facial Plastic Surgery Faculty Turnover: Survey of Academic Facial Plastic Surgeons and Department Chairs.

Introduction The turnover and inability to consistently retain academic facial plastic surgeons is an issue that many academic departments of otolaryngology face. In addition to the financial costs of staff turnover and gaps in patient care, insufficient exposure of residents to key surgical procedures is a significant problem for residency programs. Objective To identify the most important reasons that lead faculty members to leave an academic facial plastic surgery (FPS) practice as well as features that may be associated with retention of FPS faculty. Methods Members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and the Association of Academic Departments of Otolaryngology (AADO) were administered an anonymous, online survey. For both groups, we evaluated demographic factors, reasons for choosing academic careers, contributors to faculty turnover, as well as strategies for retention. The frequency of the responses was analyzed. Results A total of 11.3% (135/1,200) of facial plastic surgery faculty responded to the faculty survey, with 59.1% (68/115) of current, academic surgeons participating, and a total of 16.7% (20/120) of department chairs responded to the chairs' survey. If a faculty member had left/was to leave, more control over practice was the most common reason between the two respondent groups. Of the five most important ways to increase faculty retention, more control over practice was the number one reason. Conclusion Chairs and facial plastic surgery faculty should strive to agree upon the amount of control over the academic practice to lead to higher retention, better patient care, and continued resident education.

Novel Use of a Volumizing Hyaluronic Acid Filler for Treatment of Infraorbital Hollows.

Hyaluronic acid filler can be safely used as a soft-tissue filler for correction of infraorbital hollowing. It has a high overall patient satisfaction profile among patients. To report safety and patient satisfaction outcomes of Juvéderm Voluma XC for correction of infraorbital hollows. This was a retrospective observational study performed at a private ambulatory facial plastic and reconstructive surgery practice. Participants were all patients 21 to 85 years old who presented to our practice and underwent Juvéderm Voluma XC treatment for correction of infraorbital hollows as a singular intervention from February 2016 to March 2017. Injection of Juvéderm Voluma XC to the tear trough, nasojugal fold, and/or palpebromalar groove. Primary outcome measures include the number of recorded short- and long-term adverse events, need for additional treatment, and patient questionnaire FACE-Q scores. A total of 202 eyes were treated in 101 patients with a mean follow-up of 12 months. Patients were principally female (90 [89%]) with an average age of 54 years (range, 21-85 years). Most patients (99) had Fitzpatrick grade 1 to 4 skin type (98%) and had an infraorbital hollows score of 2 to 4 (89 [88%]). The average initial treatment volume was 1 mL with 18 patients (18%) requiring additional treatment within 3 months. The average time until additional treatment was 35.7 days. Adverse effects include bruising (in 10 [10%], contour irregularities (2 [2%]), swelling (3 [3%]), and Tyndall effect (1 [1%]). Hyaluronidase was required in 3 patients (3%). Forty-one patients completed the FACE-Q Satisfaction With Eyes survey, and 42 patients completed the FACE-Q Satisfaction With Decision survey (41% and 42%). Overall mean (SD) patient satisfaction (based on FACE-Q scores) was 71.1% (27.3) and 65.6% (31.3), respectively. Juvéderm Voluma XC has a high patient satisfaction profile and an acceptable safety profile for the correction of infraorbital hollowing. 4.

Introducing Hair Transplantation into a Facial Plastic Surgery Practice.

Hair restoration can be an integral addition to the facial plastic surgery practice. As surgeons dedicated to reconstructive and aesthetic surgery of the head and neck, hair restoration is a natural complement to a facial plastic surgeon's practice. This article presents the keys to adding and starting hair restoration to one's facial plastic surgery practice.

Modification of Chin Projection and Aesthetics With OnabotulinumtoxinA Injection.

Because of the soft-tissue envelope and the dimensional complexity of the muscular contraction of the mentalis muscle, the projection and shape of the chin is not determined by only the bony projection. In a subset of patients with a seemingly underprojected chin, a hyperactive, high-riding mentalis muscle contributes to a blunted chin contour. To evaluate the use of onabotulinumtoxinA (botulinum toxin A) for improving chin aesthetics in patients with an underprojected bony chin and a high-riding hyperactive mentalis muscle. This case series and photographic analysis included 11 patients presenting with an underprojected bony chin and a high-riding hyperactive mentalis muscle at a private facial plastic surgery practice from August 25, 2006, to November 10, 2012. Data were analyzed from November 13, 2012, to April 9, 2013. Injection with 12 to 15 U of onabotulinumtoxinA into the mentalis muscle. Photographic analysis of the vertical and horizontal positions of the pogonion relative to fixed facial points before and after injection. A patient satisfaction scale was also used to assess improvement in overall chin aesthetic. Eleven patients (3 men and 8 women; mean [SD] age, 46.3 [16.4] years) participated in the study, including 2 who had undergone prior chin implantation. The vertical position of the pogonion was more inferior after injection in 10 of 11 patients (mean [SD] vertical position, 1.36 [0.18] preinjection and 1.44 [0.18] postinjection; P = .005). Although the horizontal position of the pogonion changed in all patients, this change was not statistically significant (mean [SD] horizontal position, 0.11 [0.13] preinjection and 0.14 [0.13] postinjection; P = .32). All patients experienced improvement in their overall chin aesthetic and a subjective decrease in chin tension. Chin contour was improved, with soft-tissue volume overall displaced more inferiorly with a rounded rather than blunted appearance. No adverse effects were reported after injection. OnabotulinumtoxinA is effective at improving chin aesthetics by altering the position of the pogonion. In this first photographic analysis to date of the influence of onabotulinumtoxinA treatment, patients demonstrated a measurable change in the position of the pogonion, in addition to improvements to the chin contour on profile. This nonsurgical mentoplasty may be used as an independent procedure or as an adjunct to optimize traditional chin augmentation in carefully selected patients. 4.

Association Between Patient Value Systems and Physician and Practice Attributes Available Online.

The relative value of facial plastic surgeon personal and practice attributes is relevant to the broader health care system because of increasing out-of-pocket expenses to patients. To determine the relative value of specific facial plastic surgeon personal and practice attributes available online from the perspective of patients. This study consisted of an electronic survey sent to patients by email using choice-based conjoint analysis; surveys were sent between December 2015 and March 2016. Participants had agreed to join email registries to be sent email surveys and promotions at 3 private facial plastic and reconstructive surgery practices. The following surgeon personal and practice attributes and levels were compared: (1) outcome transparency (above average, average, not available); (2) surgical training affiliations (US News and World Reports rankings); (3) online rating site scores (2 [poor], 3, or 4 [excellent] stars); and (4) price ($1×, $2×, and $3× [× = $1500; average cost was set at $2×]). The relative importance of outcome transparency, surgical training affiliations, online rating scores, and price to prospective patients. Overall, 291 patients participated for a completion rate of 68%. Outcome transparency was the most valued attribute (attribute utility range = 141; attribute importance = 35.2%). Price was the least valued attribute (attribute utility range = 58.59; attribute importance = 15.1%). Assuming top-tier affiliations and 4-star ratings, share of market (SOM) was 75.5% for surgeons with above-average outcome transparency priced at $3× compared with those surgeons with no outcomes available priced at $1×. Holding price constant at $2×, surgeons with middle-tier affiliations and 2-star online ratings but above average outcomes achieved 48.4% SOM when compared with those surgeons with top-tier affiliations and 4-star online ratings without available outcomes. Facial plastic surgery patients most value surgeons who publish outcomes. Moreover, they are willing to discount poor rating scores and lower-ranked institutional affiliations when outcome transparency is high. This study demonstrates that outcome transparency is crucial in facial plastic surgery markets. NA.

Minimally Invasive Aesthetic Procedures: An Update on a Decade-Old Prediction.

AbstractIn 2007, the senior author (G.S.K.) published a commentary on the importance of incorporating minimally invasive aesthetic procedures into facial plastic surgery practices and training programs. The now decade-old prediction suggested that failing to perform minimally invasive aesthetic procedures placed facial plastic surgeons at risk of practice “phase out.” By not providing the most current options that patients' desire, we may lose patients to outside providers willing to perform those procedures. The aim of this article is to provide an update on this perspective by putting forth the results of the most up-to-date data on practice patterns with regard to minimally invasive aesthetic procedures.

Prevalence of Body Dysmorphic Disorder and Surgeon Diagnostic Accuracy in Facial Plastic and Oculoplastic Surgery Clinics.

Body dysmorphic disorder (BDD) is a relative contraindication for facial plastic surgery, but formal screening is not common in practice. The prevalence of BDD in patients seeking facial plastic surgery is not well documented. To establish the prevalence of BDD across facial plastic and oculoplastic surgery practice settings, and estimate the ability of surgeons to screen for BDD. This multicenter prospective study recruited a cohort of 597 patients who presented to academic and private facial plastic and oculoplastic surgery practices from March 2015 to February 2016. All patients were screened for BDD using the Body Dysmorphic Disorder Questionnaire (BDDQ). After each clinical encounter, surgeons independently evaluated the likelihood that a participating patient had BDD. Validated instruments were used to assess satisfaction with facial appearance including the FACE-Q, Blepharoplasty Outcomes Evaluation (BOE), Facelift Outcomes Evaluation (FOE), Rhinoplasty Outcomes Evaluation (ROE), and Skin Rejuvenation Outcomes Evaluation (SROE). Across participating practices (9 surgeons, 3 sites), a total of 597 patients were screened for BDD: 342 patients from site 1 (mean [SD] age, 44.2 [16.5] years); 158 patients, site 2 (mean [SD] age, 46.0 [16.2] years), site 3, 97 patients (mean [SD] age, 56.3 [15.5] years). Overall, 58 patients [9.7%] screened positive for BDD by the BDDQ instrument, while only 16 of 402 patients [4.0%] were clinically suspected of BDD by surgeons. A higher percentage of patients presenting for cosmetic surgery (37 of 283 patients [13.1%]) compared with those presenting for reconstructive surgery (21 of 314 patients [6.7%]) screened positive on the BDDQ (odds ratio, 2.10; 95% CI, 1.20-3.68; P = .01). Surgeons were only able to correctly identify 2 of 43 patients (4.7%) who screened positive for BDD on the BDDQ, and the positive likelihood ratio was only 1.19 (95% CI, 0.28-5.07). Patients screening positive for BDD by the BDDQ had lower satisfaction with their appearance as measured by the FACE-Q, ROE, BOE, SROE, and FOE. Body dysmorphic disorder is a relatively common condition across facial plastic and oculoplastic surgery practice settings. Patients who screen positive on the BDDQ have lower satisfaction with their facial appearance at baseline. Surgeons have a poor ability to screen for patients with BDD when compared with validated screening instruments such as the BDDQ. Routine implementation of validated BDD screening instruments may improve patient care. NA.

The Effects of an Antistick Phospholipid Solution on Bipolar Electrocautery Efficacy in Rhytidectomy

Ensuring adequate intraoperative hemostasis is crucial in avoiding serious complications of rhytidectomy surgery such as hematoma formation and skin flap necrosis. Charring of bipolar electrocautery arms can lead to ineffective hemostasis, frequent wiping to ensure hemostatic efficacy and prolonged operative time. We investigate the impact of a commercially available antistick coating solution (Electro Lube) on intraoperative wiping frequency of bipolar electrocautery arms and operative time for rhytidectomy procedures. Fifty patients undergoing rhytidectomy were prospectively enrolled in a randomized, split-face study. All patients enrolled were seen and evaluated in a private facial plastic and reconstructive surgery practice, and were operated on by a single surgeon in either an accredited ambulatory surgical center under deep, intravenous sedation or in a monitored office setting under light, oral sedation. Electro Lube was utilized to coat bipolar electrocautery arms for one side of the rhytidectomy procedure on each patient, letting the contralateral side serve as control. Total number of wipes to clean the cauterizing arms of the bipolar cautery per procedure was counted, and operative time, from skin incision to skin trimming, was measured. Total wipe count in the intervention group (n = 50) was 13 (0.26 wipes/procedure) versus 47 in the control group (n = 50) (0.94 wipes/procedure), a difference that was found to be statistically significant ( P = .0013). Average operative time in the intervention group was 27.52 minutes versus 28.35 minutes in the control group. This difference was also found to be statistically significant ( P = .043). The use of Electro Lube to coat bipolar electrocautery arms may have clinical utility to simplify and reduce intraoperative wiping and shorten operative time in rhytidectomy procedures and other cosmetic or reconstructive procedures where frequent use of bipolar electrocautery to maintain intraoperative hemostasis is crucial.

Correction of Age-Related Midface Volume Loss With Low-Volume Hyaluronic Acid Filler.

The pivotal approval trial for a smooth, highly cohesive, viscous, 20-mg/mL hyaluronic acid filler demonstrated sustained aesthetic improvement, with a mean injection volume of 6.65 mL. In daily practice, however, it is not often practical or necessary to use large injection volumes to achieve the desired cosmetic outcome. To assess the efficacy, longevity, and patient satisfaction associated with correction of age-related midface volume loss using the low volumes of hyaluronic acid filler more commonly used in day-to-day practice. A 2-center, retrospective cohort study examined medical records of 61 healthy patients who underwent treatment for facial volume loss with hyaluronic acid filler from November 1, 2013, through April 31, 2014. Follow-up visits were conducted at 1, 3, 6, and 12 months after the procedure. Data were pooled from a private facial plastic surgery practice in Weston, Florida, and a private cosmetic dermatology practice in San Diego, California. Patients were treated with hyaluronic acid filler according to the investigator's usual practices. The main outcome measure was patient-graded Global Aesthetic Improvement Scale scores at 1, 3, 6, and 12 months after treatment. Scores range from 1 to 5; 1 indicates very much improved and 5, worse. A total of 61 consecutive, healthy adult patients (mean [SD] age, 57.4 [12.8] years) with mild to severe facial volume loss were enrolled in the study. A total of 46 patients (75%) were white, 3 (5%) were black/African American, 9 (15%) were Hispanic/Latino, 1 (2%) was Asian/Pacific Islander, and 2 (3%) were other. Three patients (5%) were male, and 58 (95%) were female. Mean initial treatment volume was 1.6 mL. At follow-up, 29 patients (48%) elected to have a touch-up treatment; mean total touch-up volume was 1.4 mL. The patient-graded Global Aesthetic Improvement Scale scores at 1, 3, 6, and 12 months after treatment demonstrated that 73% (41 of 56) to 89% (24 of 27) of the study patients reported being very much or moderately improved. Most patients were rated by investigators on the Global Aesthetic Improvement Scale as very much or moderately improved at the 12-month follow-up. At 12 months after the procedure, 43 of 51 patients (84%) reported satisfaction with their outcome. At all time points, most patients would elect to undergo the procedure again (range, 17 [68%] to 61 [100%]). Adverse events were mild, and all resolved spontaneously within 14 days. At the 2-year follow-up, there were no reports of delayed adverse events. Midface volumization using the low volumes of hyaluronic acid filler more commonly used in daily clinical practice is effective and well tolerated. 3.