Invasive Cosmetic Treatments Research Articles

Online Interest in Minimally Invasive Cosmetic Treatments Outpaces Surgical Procedures: A Google Trends Analysis.

Online Interest in Minimally Invasive Cosmetic Treatments Outpaces Surgical Procedures: A Google Trends Analysis.

The smile and emotional expression: practical application of a lip and perioral assessment scale

Background: Lip enhancement continues to be one of the most frequently requested minimally invasive cosmetic treatments. Balancing anatomical considerations and objective measurements with individuals’ differences in aesthetics preferences can present unique challenges. Objectives: Identify key characteristics that contribute to lip and perioral aesthetics and providing practical insights into the real-world use of the recently published Lip and Perioral Assessment Scale. Methods: This work comprised four stages. The establishment of an International multidisciplinary collaborative group of eight experts to discuss current clinical practices with respect to lip and perioral enhancement. A practitioner survey to assess the experiences, perceptions, and opinions of a wider group of clinicians (N=40). A hybrid focus group, chaired by two of the experts, to establish considerations best practice approaches to patient assessment in the Asia-Pacific Region. Practical application of a Lip and Perioral Assessment Scale. Results: Consensus opinion from experienced injectors in the Asia Pacific Region supports the need to consider a wide variety of factors contributing to smile anatomy and aesthetics. Best practices approaches encompass (1) accounting for underlying structures, soft tissues and the impact of aging on smile anatomy, (2) understanding the relative contributions of the teeth and gingiva, lip proportions and skin quality to smile aesthetics and (3) the value of a systematic approach to patient assessment. Conclusions: Clear communication between patients and injectors is vital to establish achievable goals and realistic expectations. Systematic assessment that accounts for a wider array of variables than lip volume may facilitate a more individually tailored approach.

Preparing for a Crowded Cosmetic Market: A Resident Training Model for Minimally Invasive Cosmetic Treatments.

Patient demand for nonsurgical and minimally invasive cosmetic treatments has increased in recent years, resulting in a growing market that is particularly vulnerable to specialty creep. Despite this growing demand, nonsurgical cosmetic training for plastic surgery residents is often inconsistent and challenging. To ensure the continued safe and effective delivery of nonsurgical cosmetic care by board-certified plastic surgeons, it is critical to implement standardized training models for plastic surgery residents. In this Special Topic article, the authors describe their experience with a resident-run clinic training model that incorporates graduated autonomy, volunteer patient recruitment, and grant-based industry support that has been successfully implemented at their institution for the past 6 years. The article provides a framework for a resident educational model and addresses common obstacles in resident cosmetic training. The authors also provide recommendations for patient recruitment, optimizing clinic workflow, and the management of patient complications.

COVID-19 Pandemic: Evaluation of Socio-Economic Impact on Aesthetic Plastic Surgery Providers

BackgroundIn many countries, the worldwide spread of COVID-19 has led to a near total stop of non-urgent, elective surgeries across all specialties during the first wave’s peak of the pandemic. For providers of aesthetic surgery procedures or minimal invasive cosmetic treatments, this led to a huge socio-economic impact worldwide. In order to evaluate valid clinical management strategies for future pandemic events and to overcome the challenges imposed by the current pandemic, it is paramount to analyse the socio-economic effects caused by the COVID-19 crisis.MethodsAn online survey comprising 18 questions was sent out five times by e-mail to all members of the International Society of Aesthetic Plastic Surgery (ISAPS) between June and August 2020. The data set was statistically analyzed and grouped into an overall group and into subgroups of countries with high (n = 251) vs. low (n = 440) gross domestic product per capita (GDP p.c.) and five defined world regions (Europe (n = 214); North America (NA; n = 97); South America (SA; n = 206); Asia and Oceania (Asia + OC; n = 99); Africa and Middle East (Africa + ME; n = 75)).ResultsA total of 691 recipients completed the survey. The majority of the participants experienced severe operating restrictions resulting in a major drop of income from surgical patients. Low GDP p.c. countries experienced a bigger negative economic impact with less aesthetic (non-) surgical procedures, whereas the high GDP p.c. subgroup was less affected by the COVID-19 crisis. Most of the survey participants had already adopted the ISAPS guidelines for patient (pre-) appointment screening and clinical/patient-flow management. For surgical and non-surgical aesthetic procedures, in the high GDP p.c. subgroup more basic-level PPE (surgical mask) was used, whereas the low GDP p.c. subgroup relied more on advanced-level PPE (N-95 respirator mask or higher). Comparing the different world regions, Europe and Africa used more basic-level PPE.ConclusionsMeasurable differences in the socio-economic impact and in the adaptation of safety protocols between high and low GDP p.c. subgroups and between different world regions were present. Since the COVID-19 pandemic is an international crisis, aligned, expedient and universal actions should be taken.Level of evidence VThis 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 Table of Contents or online Instructions to Authors www.springer.com/00266.Supplementary InformationThe online version of this article (10.1007/s00266-021-02130-9) contains supplementary material, which is available to authorized users.

The Aging neck-A Case base treatment algorithm.

Effective nonsurgical treatments for the aging face are widely accepted and utilized. Although changes in the aging neck, often patients to seek esthetic rejuvenation protocols are neither well defined nor well designed. Increasingly, patients desire less invasive cosmetic treatments with less morbidity and downtime. A significant challenge exists in managing expectations and educating patients about the pros and cons of a surgical approach compared to the plethora of nonsurgical options. When equipped with state of the art information and technique, using a multi-modality nonsurgical approach, surprisingly outstanding results may be obtained. In this paper, we aim to revisit the neck's anatomy and then demonstrate current nonsurgical techniques in managing actual cases. To achieve that, we have utilized an intuitive four-point grading scale to guide both physician and patient regarding appropriate treatment combinations. The proposed four-point scale was applied to six patients and their treatment plan was described in detail. Skin laxity is not the only factor that comes into play when assessing the neck. careful analysis of the neck and face hold the key for treatment choice and execution.

ASPEKTY PRAWNE ZABIEGÓW KOSMETYCZNYCH WYKONYWANYCH PRZEZ KOSMETOLOGA

This article is devoted to the legal aspects of cosmetic procedures performed by a cosmetolo-gist. Firstly it describes the terms of reference of professional cosmetologists. Next, attention was paid to the legal aspect of cosmetologist profession, and it was proposed to put it among the medical profession. Then the author tries to answer the question whether, on the basis of existing legislation, invasive cosmetic treatments performed by a cosmetologist are legal. Laser treatment trainings have also been assessed. In the end criminal and civil liabilities on the field cosmetic treatments have been considered. The author, basing on all elements of the subject, presents currently practised solutions. These considerations are also a review of the positions of doctrine and juris-prudence in the discussed area.

A 5-Year Study of Aesthetic Surgery Providers in Southern California

INTRODUCTION: Over the last decade, there has been a surge in the number of non-plastic surgeons performing aesthetic procedures. This has raised concerns regarding issues of patient safety and competition between plastic surgeons and non-surgically trained providers. To better elucidate plastic surgeons’ presence in the medical aesthetic field, this study examined the trend of providers who offer minimally invasive and invasive cosmetic treatments in the Southern California region. METHODS: A 70,860 square mile area encompassing the Los Angeles and San Diego megalopolis was studied. Providers of minimally invasive aesthetic procedures in the Southern California area were catalogued using the sales from the manufacturers of hyaluronic acid fillers. Liposuction treatments were used as a marker of invasive aesthetic procedures; corresponding providers of liposuction were compiled from various websites and internet search engines. The board certification and training background of each provider was detailed. A five-year trend was studied using data comparisons from August 2009 and August 2014. RESULTS: From 2009 to 2014, the number of providers offering minimally invasive injectables increased from 2,472 to 3,362 (a 36.0% increase) (Figure 1). Of these, plastic surgery providers comprised 29.1% of the providers in 2009 and 26.8% in 2014. Non-plastic surgeon providers increased by 40.5%, comprising 70.8% in 2009 to 73.2% of providers in 2014. In this 5-year period, dermatologists composed the second largest group of providers of cosmetic injectables (20.5% in 2014) and primary care physicians composed the third largest group (19.9% in 2014). The number of providers practicing liposuction increased from 1,160 to 1,324 (a 14.1% increase) during this study period. Non-plastic surgery-trained providers increased by 38.9%, surpassing the growth of plastic surgery providers (2.5%). Plastic surgeons comprised 68.1% of liposuction providers in 2009 and 61.2% in 2014. The number of non-surgical providers increased from a prevalence of 12.6% in 2009 to 17.1% in 2014 (a 55.5% increase).Figure 1: Providers of minimally invasive procedures.Providers of minimally invasive procedures increased by 36% during the 5-year study period with growth in all 3 groups of providers. Although there was an overall 25% increase of plastic surgeons providing minimally invasive procedures, this group made up 29% of providers in 2009, but decreased to 26% of the providers in 2014. Plastic surgeons made up a smaller composition of the total number of practitioners. In contrast, the 51% increase in the overall number of non-core physicians was statistically significant and composition of providers increased from 34% to 38%. Providers of invasive aesthetic procedures increased by 14% during the 5-year study period. There was a 2.5% increase of plastic surgeons providing these operations, who made up 68% of providers in 2009, which decreased to 61% in 2014. Plastic surgeons now comprised a smaller percentage of the providers (Figure 2).Figure 2: Providers of invasive aesthetic procedures.In contrast, the 55% increase in the number of practitioners not trained in surgery was statistically significant and their composition of providers increased from 11% to 16%. Providers of non-plastic surgery specialties, especially those with no surgical training, now make up a larger percentage. CONCLUSIONS: This study revealed a substantial number and steady growth of non-plastic surgeons performing both minimally invasive and invasive aesthetic procedures. The significant growth in non-plastic surgeon providers may suggest that using injectables opens the gateway to practicing more invasive procedures. Plastic surgeons must continue to educate patients that board certification in plastic surgery is critical, especially when they are seeking invasive treatments. For all these reasons, the unification of plastic surgeons is of utmost importance. A lack of strong front-line resistance against infiltration tactics has the potential for plastic surgeons to lose footing in their own specialty.

Safety and Efficacy of Microfocused Ultrasound in Tightening of Lax Elbow Skin.

With the increased popularity of minimally invasive cosmetic treatments, this study evaluates the efficacy and safety of microfocused ultrasound with visualization (MFU-V) for tightening lax skin above the elbow. Subjects were treated bilaterally above the elbows with MFU-V using transducers with different focal depths. Photographs were taken before treatment and at 90- and 180-day follow-ups. Masked observer ratings and physician and subject global aesthetic improvement scales (PGAIS and SGAIS) were completed at follow-ups. Safety, based on adverse event (AE) incidence, was assessed. Masked blinded assessment was completed at 90 days; 56% showed aesthetic improvement. Overall improvement in SGAIS was 83% and 81% at 90 and 180 days, respectively. The overall improvement in PGAIS was 94% at both 90 and 180 days. Patient satisfaction questionnaires showed that 83% noticed improvements in elbow characteristics at 90 days, with 81% still indicating improvement at 180 days. No serious AEs or treatment-related AEs were reported. This pilot study suggests that MFU-V is a safe and promising nonsurgical option for the treatment of skin laxity above the elbow. Based on the positive results of this study, a larger trial is warranted together with testing different treatment densities to optimize this noninvasive approach.

Long-term efficacy, safety and durability of Juvéderm® XC

Over the last decade, there has been increasing interest in minimally invasive cosmetic treatments, especially for facial rejuvenation. Next to botulinum toxin injection, the injection of soft tissue fillers is the second most frequent minimally invasive procedure performed in the USA. Hyaluronic acid (HA) is the most commonly used dermal filler. One of patients’ main concerns about filler injections pertains to pain and discomfort. Topical anesthetics, nerve blocks, and/or the incorporation of lidocaine to the filler have been applied in order to reduce distress and pain. Despite nerve blocks being an effective form of anesthesia, they may distort the area to be treated, as well as lengthen and complicate the procedure. Studies have shown that the incorporation of lidocaine to HA fillers significantly reduces pain and discomfort. Yet, one of the dilemmas about the addition of lidocaine solution to HA fillers is the possible alteration of the physical characteristics of the product by negatively impacting the efficacy and/or duration of the filler. The concern is that the addition of lidocaine could dilute the product, creating less correction per mL, changing the product’s viscosity and consequently the “lifting” ability. Also, this dilution could reduce the product’s duration. There may be a difference between a physician adding an aqueous solution into a lidocaine-free version of HA and the pre-incorporated lidocaine version of HA. An aqueous solution might dilute the product, while the pre-incorporated powder lidocaine appears to avoid this problem. Juvéderm® XC is manufactured with powder lidocaine 0.3%; it is associated with significantly less injection pain than Juvéderm® and other lidocaine-free versions of HA. Studies have shown that lidocaine enhances treatment comfort and optimizes the injection experience while maintaining a similar safety and effectiveness profile. Regarding the longevity, further study is necessary to determine if there is any difference in durability.

Soft-tissue augmentation with hyaluronic acid and calcium hydroxyl apatite fillers

Soft-tissue augmentation with hyaluronic acid and calcium hydroxyl apatite are among the most widely used minimally invasive cosmetic treatments for the correction of contour deficiencies and wrinkles of the face without the risk, recovery time, and expense of a major surgery. Training and experience in the art and science of fillers is essential for the successful creation of a more youthful and natural appearance. An understanding of the different products, the injection techniques, the indications, and the potential complications of each filler are paramount to success.

Who Is Providing Aesthetic Surgery? A Detailed Examination of the Geographic Distribution and Training Backgrounds of Cosmetic Practitioners in Southern California

In recent years, there has been a significant increase in the number of non-plastic surgeons performing cosmetic procedures. This has the potential to have an impact on the plastic surgery practitioner by increasing competition and bringing into question the assurance of patient safety. In this study, a demographic analysis was performed of providers of invasive and minimally invasive cosmetic treatments in the Southern California region. Providers of minimally invasive aesthetic procedures were catalogued using the sales lists from the manufacturers of the hyaluronic acid fillers Juvéderm and Restylane. The data set was further analyzed to enumerate the providers of surgical treatments, with a focus on the provision of liposuction. Data were analyzed using Environmental Systems Research Institute ArcGIS to focus on the Southern California area. Physician board certification and training background were detailed exhaustively. In the 45,238-square mile area encompassing the San Diego/Los Angeles megalopolis, there are 1867 cosmetic practitioners offering hyaluronic acid injections. Of this number, 495 are trained in plastic surgery. In the same geographic region, there are 834 individuals offering liposuction. Practitioners are concentrated in downtown Los Angeles and San Diego, where the potential patient-to-provider ratios are 1088:1 and 1185:1, respectively. Interestingly, primary care physicians comprise the third largest group providing hyaluronic acid fillers and the fourth largest group of liposuction providers. The authors' data demonstrate that there are numerous non-plastic surgeons performing cosmetic procedures, especially in the field of minimally invasive therapies. In addition, there is a growing contingent of non-surgery-trained individuals providing surgical cosmetic treatments, especially liposuction.

High-Volume Calcium Hydroxylapatite Filler to the Lower One-Third of the Face

High-Volume Calcium Hydroxylapatite Filler to the Lower One-Third of the Face