Non-surgical Aesthetic Treatments Research Articles

"The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medspa Directorship and Practitioner Trends in Florida".

The rapid proliferation of medical spas in the US has raised concerns over the continued shift of non-surgical aesthetic treatments away from traditional core specialty integration and supervision, potentially affecting the surgical treatment guidance and education of cosmetic surgery patients. This study aimed to assess the current trends in the growth of independent medspa facilities as well as practitioner supervision, licensing, and specialization in the state of Florida. A comprehensive, statewide survey of all independent medspas in Florida, by municipality, employing Google and Yellow Pages search engines. Information gathered included the number of locations, business stakeholders, and director/practitioner licensing and certification obtained from the Florida Division of Corporations/Department of Health databases and respective medical boards. A total of 1,038 medspas were identified, revealing a 100% increase in number relative to 2021 estimates. Non-physician practitioners represented 84% of medspa providers, with core specialty medical director supervision present in only 22% of facilities and a large proportion of directors lacking specialty training (77%) or board certification (42%). Additionally, 25% of medspas appeared to disregard state guidelines pertaining to medical directorship, autonomous non-physician practice, and numerical/geographic restrictions on directorship, with 96% of facilities lacking licensing/registration with Florida's Agency for Health Care Administration. Medspa growth in Florida has been explosive, with continued departure from core supervision, increasingly limited specialty training/integration, and non-adherence to state guidelines. Enhanced regulation and integrated non-physician practitioner training are likely necessary to ensure patient safety and the cohesive practice of aesthetic medicine and surgery.

Multimodal Analyses of the Aging Forehead and Their Clinical Implications.

Recent research has indicated that in the upper face a delicate arrangement exists between the muscles of facial expression and the skin. This arrangement allows for immediate transmission of movements following muscle contraction, resulting in skin movements and skin rhytid formation. To investigate age-related changes of the biomechanical unit formed by facial muscles, their connective tissue envelope, and the skin of the upper face. A total of 76 Caucasian volunteers (30 males, 46 females) with a mean age of 42.2 years (SD 18.6) and a mean body mass index of 24.58 kg/m2 (SD 3.7) were investigated. Three upper facial regions were analyzed for skin firmness and elasticity with cutometric assessment, vertical and horizontal skin vector displacement using 3-dimensional imaging, and muscle activity with surface-derived electromyography. Study participants of older age (>42.2 years), when compared with younger participants (≤42.2 years), showed increased skin firmness, at 0.20 mm vs 0.30 mm (P < .001); decreased skin elasticity at 53.2% vs 69.0% (P < .001); increased vertical (not horizontal) skin mobility at 3.56 mm vs 1.35 mm (P < .001); and decreased surface-derived electromyography (sEMG) signal of the frontalis muscle with 174 µV vs 309 µV (P = .039). This study reveals that age-related changes occur in each component of the biomechanical unit formed by facial muscles, connective tissue envelope, and skin in the upper face. Knowledge and understanding of such changes can allow for more targeted and individualized surgical and nonsurgical aesthetic treatments.

Introduction of the Lip Classification of Tubercles: A Novel Approach to Minimally Invasive Aesthetic Lip Treatments.

Lip enhancement procedures involving dermal fillers are one of the most sought after nonsurgical aesthetic treatments. However, current trends are associated with unnatural results and involve increased risks of complications and compromise to normal function. It appears that lips may be classified according to the presentation of their tubercles and this may be used to guide minimally invasive techniques which aim to preserve individual lip shapes and normal function. To test the reliability of a classification system based on lip tubercle morphology, named the Lip Classification of Tubercles (LCT). To test the reliability of the LCT, a total of 214 high-definition photographs of patients' lips with no previous histories of lip treatments were classified independently by 4 experienced aesthetic practitioners on 2 separate occasions 3 months apart; the second followed a more detailed explanation of the classification. When inter-rater reliability was calculated for the first attempt, the results were 36% and 43% for upper and lower lips, respectively. The second attempt following an education process resulted in 79% for both lips. When 1 practitioner was considered the standard, the average score for the remaining 3 showed some individual variation but improved significantly from 58% to 85%. The LCT is a reliable way to classify lip types based on the morphology of tubercles.

49. Is it time for OMFS to bring non-surgical aesthetics into the training syllabus?

The number of non-surgical aesthetic treatments being carried out in the UK and globally continues to rise. Despite reports from both Government (The ‘Keogh’ Report 2013) and Parliament (The APPG BAW 2021), such treatments can legally still be performed by anyone, regardless of qualifications or experience. OMF Surgeons are frequently tasked with managing the complications of non-surgical aesthetics treatment.

A qualitative study exploring the application of psychosocial screening to identify psychological conditions in non-surgical aesthetic patients

This study explores medical aesthetic practitioners' initial and ongoing application of psychosocial screening, to identify existing or emerging psychological disorders or conditions in non-surgical aesthetic patients. The increased demand for non-surgical aesthetic treatments correlates with the rise of patients who present with existing or evolving psychosocial problems or issues. Therefore, patients must be appropriately and adequately assessed, to identify those vulnerable individuals who are not suitable for treatment or whose treatments may exacerbate underlying psychological conditions. Identification can support signposting to trained professionals to ensure appropriate holistic care. Moreover, the study explores which validated screening tools have been adopted into practice, and routes for guiding patients should concerns arise.

Complications Following Non-Surgical Aesthetic Treatments in HIV+ Patients Receiving Antiretroviral Therapy: A 12-Years Experience

Since the advent of HIV antiretroviral therapies at the end of the 20th century, the morbidity and mortality rates associated with HIV infection have decreased dramatically. Unfortunately, these benefits are associated with substantial morphologic changes in the body, such as abnormal fat distribution with peripheral lipohypertrophy and facial lipoatrophy. Facial wasting is considered the major stigma for HIV–infected people and may result in reduced antiretroviral adherence. Patients suffering from the stigmata of HIV infection can benefit from non-surgical aesthetic treatments performed with fillers or lipolytic agents that provide a quick and reliable service for facial rejuvenation, with high patient satisfaction and a low risk of complications. In the present paper, a retrospective analysis of complications following non-surgical aesthetic treatments (calcium hydroxyapatite-based filler, hyaluronic acid filler, polyacrylamide hydrogel filler and dehoxycholic acid injections), in a cohort of 116 consecutive HIV+ patients, treated over a period of 12 years, was performed. With the exception of the tardive swelling reported after calcium hydroxyapatite injections, complications were recorded just after polyacrylamide hydrogel treatment as small, palpable, nonvisible nodules or aseptic abscess. Our experience is consistent with those already published in the literature and the complication rate seems to be comparable to non-infected patients.

A Path to Resume Aesthetic Care: Executive Summary of Project AesCert Guidance Supplement-Practical Considerations for Aesthetic Medicine Professionals Supporting Clinic Preparedness in Response to the SARS-CoV-2 Outbreak.

A Path to Resume Aesthetic Care: Executive Summary of Project AesCert Guidance Supplement-Practical Considerations for Aesthetic Medicine Professionals Supporting Clinic Preparedness in Response to the SARS-CoV-2 Outbreak.

A PATH TO RESUME AESTHETIC CARE EXECUTIVE SUMMARY OF PROJECT AesCert™ GUIDANCE SUPPLEMENT: PRACTICAL CONSIDERATIONS FOR AESTHETIC MEDICINE PROFESSIONALS SUPPORTING CLINIC PREPAREDNESS IN RESPONSE TO THE SARS-CoV-2 OUTBREAK.

This Project AesCert™ Guidance Supplement ("Guidance Supplement") was developed in partnership with a multi-disciplinary panel of board-certified physician and doctoral experts in the fields of Infectious Disease, Immunology, Public Health Policy, Dermatology, Facial Plastic Surgery and Plastic Surgery. The Guidance Supplement is intended to provide aesthetic medicine physicians and their staffs with a practical guide to safety considerations to support clinic preparedness for patients seeking non-surgical aesthetic treatments and procedures following the return-to-work phase of the COVID-19 pandemic, once such activity is permitted by applicable law. Many federal, state and local governmental authorities, public health agencies and professional medical societies have promulgated COVID-19 orders and advisories applicable to health care practitioners. The Guidance Supplement is intended to provide aesthetic physicians and their staffs with an additional set of practical considerations for delivering aesthetic care safely and generally conducting business responsibly in the new world of COVID-19. Aesthetic providers will face new and unique challenges as government stay-at-home orders and related commercial limitations are eased, and the U.S. economy reopens and healthcare systems transition from providing only urgent and other essential treatment to resuming routine care and elective procedures and services. The medical aesthetic specialties will therefore wish to resume practice in order to ensure high quality, expert care is available, and importantly to help promote patients' positive self-image and sense of well-being following a lengthy and stressful period of quarantine. In a number of areas, this Guidance Supplement exceeds traditional aesthetic office safety precautions, recognizing reduced tolerance in an elective treatment environment for any risk associated with COVID-19's highly variable presentation and unpredictable course. The disease has placed a disturbing number of young, otherwise healthy patients in extremis with severe respiratory and renal failure, stroke, pericarditis, neurologic deficits and other suddenly life-threatening complications, in addition to its pernicious effects on those with pre-existing morbidities and advanced age. Accordingly, the Guidance Supplement seeks to establish an elevated safety profile for providing patient care while reducing, to the greatest extent reasonably possible, the risk of infectious processes to both patients and providers. While the Guidance Supplement cannot foreclose the risk of infection, nor serve to establish or modify any standards of care, it does offer actionable risk-mitigation considerations for general office comportment and for certain non-surgical procedures typically performed in aesthetic medical settings. It is axiomatic that all such considerations are necessarily subject to the ultimate judgment of each individual healthcare professional based on patient situation, procedure details, office environment, staffing constraints, equipment and testing availability, and local legal status and public health conditions.

Consideration of the ‘cooling off period’ as part of the consent process

Kate Kelso, in conjunction with Tracey Bell Education and ICE Postgraduate Dental Institute, provides an insight into the cooling off period and what the guidance regarding this suggests in regard to non-surgical aesthetic treatments

Two multinational, observational surveys investigating perceptions of beauty and attitudes and experiences relating to aesthetic medical procedures.

BackgroundData on opinions and experiences of aesthetic medical procedures outside the United States and Western Europe are scarce.AimsThis study aimed to survey users and non‐users of aesthetic procedures in countries where this information is less readily available, to understand attitudes and perceptions relating to beauty.Patients/MethodsTwo independent internet‐based observational surveys were conducted. Survey 1: individuals from Colombia, Lebanon, Malaysia, Russia and Turkey who were ‘users’ or ‘non‐users’ of aesthetic medical procedures. Survey 2: individuals from Colombia, Russia, Thailand, Turkey and the United Arab Emirates who were ‘users’ of non‐surgical aesthetic treatments.ResultsSurveys 1 and 2 were completed by 300 and 160 individuals, respectively, most of whom were female (94.0% and 99%). Overall, respondents rated the eyes and smile as the most pleasing male and female facial features. Most participants (mean 82.6%; range 75%‐100%) believed maintaining a healthy lifestyle was important for ageing gracefully, and over one‐third (36.0%; 28%‐47%) believed men age more gracefully than women. The emphasis respondents placed on the importance of physical attributes vs inner feelings, internal beauty and self‐confidence varied between countries. Users were often more positive about aesthetic medical procedure outcomes than non‐users. Adequate information, good physician communication (including managing treatment expectations), treatment recommendations based on patient need and good aftercare improved treatment satisfaction.ConclusionsThe eyes and smile were key features of attractiveness, but maintaining a healthy lifestyle was consistently considered an important factor for ageing gracefully. Ensuring patients are well informed was a major determinant of treatment satisfaction.

Ideals of Facial Beauty Amongst the Chinese Population: Results from a Large National Survey.

Surgical and non-surgical aesthetic treatments are very popular throughout Asia and in particular in China. With the globalisation and immigration of Chinese people to other countries where many seek treatment from Western-trained doctors, it is important to understand the ideals of beauty amongst Chinese people so as to achieve optimal results. We conducted an online survey to understand the preference of Han Chinese laypersons for facial shape, profile (straight, convex, concave), jaw angle and shape, and shape of the chin, nose, and lips. In addition, the participants were asked about their educational level, geographic location, likelihood to have cosmetic surgery, preference for surgical or non-surgical cosmetic procedures and whether ''being beautiful'' would affect their daily life. A total of 1417 responses were collected from 599 male and 818 female participants, the majority of them who were 25-35 years old (58.93%). The responses showed that the majority of participants preferred an oval face shape, with a smoothly tapered jaw angle for both men and women, round and pointy chin for both genders, straight to concave nose profile and full lips with well-defined cupid's bow. Most responders indicated they were not willing to undergo cosmetic surgery; however, when given a choice between surgical and non-surgical cosmetic procedures, 82.22% of the participants preferred non-surgical procedures. The majority of respondents (83%) thought that being beautiful has an effect on daily life and improves quality of life.Level of Evidence V 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 .

Ideals of Facial Beauty Amongst the Chinese Population: Results from a Large National Survey

Surgical and non-surgical aesthetic treatments are very popular throughout Asia and in particular in China. With the globalisation and immigration of Chinese people to other countries where many seek treatment from Western-trained doctors, it is important to understand the ideals of beauty amongst Chinese people so as to achieve optimal results. We conducted an online survey to understand the preference of Han Chinese laypersons for facial shape, profile (straight, convex, concave), jaw angle and shape, and shape of the chin, nose, and lips. In addition, the participants were asked about their educational level, geographic location, likelihood to have cosmetic surgery, preference for surgical or non-surgical cosmetic procedures and whether “being beautiful” would affect their daily life. A total of 1417 responses were collected from 599 male and 818 female participants, the majority of them who were 25–35 years old (58.93%). The responses showed that the majority of participants preferred an oval face shape, with a smoothly tapered jaw angle for both men and women, round and pointy chin for both genders, straight to concave nose profile and full lips with well-defined cupid’s bow. Most responders indicated they were not willing to undergo cosmetic surgery; however, when given a choice between surgical and non-surgical cosmetic procedures, 82.22% of the participants preferred non-surgical procedures. The majority of respondents (83%) thought that being beautiful has an effect on daily life and improves quality of life.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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Exploring skin anatomy, function and site-specific treatment options

The skin is the external surface covering the human body and the immediate interface to its surrounding environment. It acts as a protective barrier from infection, injury, light and heat. To aid consultation and enable correct assessment of the skin, aesthetic practitioners need to possess an in-depth understanding of skin anatomy and function, and skin changes due to lifestyle, age, gender and disease. Having this base of knowledge ensures that aesthetic practitioners can both prescribe and provide the most appropriate treatments. This article explores skin anatomy and function, offering a brief overview of non-surgical aesthetic treatments in relation to the areas discussed. It is hoped that the information in this paper will increase aesthetic practitioners' understanding of anatomy and function in relation to the treatments they perform. It also aims to encourage practitioners to carry out further self-directed reading to enhance their existing knowledge about the effects of the treatments offered in their clinics.

Why are we reinventing the wheel in medical aesthetics?

Non-surgical aesthetic treatments have advanced rapidly over the past decade, evidenced by the reduced uptake of surgical procedures. Aarti Narayan-Denning reiterates the need for emphasising the medical nature of this ever-evolving clinical area of practice, and for recognising it as an emerging specialty rather than demoting it to the status of a commodity to be traded

Cosmetic injection of botulinum toxin: practical considerations and accuracy

Botulinum toxin type A injections are among the most popular non-surgical aesthetic treatments worldwide and so minimising the risks of associated complications is an important consideration. Clinicians should keep up to date with new insights into facial anatomy and the latest publications, says Anna Baker, who explores options for ensuring administration will be as accurate as possible

Safety and Early Satisfaction Assessment of Patients Seeking Nonsurgical Rhinoplasty with Filler.

Background:Nonsurgical aesthetic treatments are usually preferred by patients because their effects are visible immediately after the treatment and patients can return to their normal activities on the same day. Although many studies have indicated safety and efficacy of filler injection to improve facial appearance, it is not absolutely confirmed for nose reshaping.Objectives:To assess the safety and early satisfaction of 52 consecutive patients underwent nonsurgical rhinoplasty with an injection of a 20-mg/mL smooth, cohesive, and viscous hyaluronic acid (HA) filler.Materials and Methods:Fifty-two consecutive healthy patients, dissatisfied with the appearance of their nose, were treated with HA injections between November 2014 and November 2016. Complications and side effects were documented. Aesthetic outcomes were scored subjectively on a scale of 1–4 represented by four emoticons.Results:Among patients, 96.15% affirmed to be “very satisfied” at the end of the procedure (50 patients over 52 treated). No major complications and side effects occurred.Conclusions:Outcomes of this study, with the limitation of a non-comparative open-label study, show that surgical remodeling of the nose, with the use of a 20-mg/mL smooth, cohesive, and viscous HA filler, is a safe and predictable technique, with a high degree of satisfaction for the patients.

Is it time to update our dermal filler terminology for the modern consumer?

Even though dermal fillers are one of the fastest growing categories of non-surgical aesthetic treatments, Leslie Fletcher believes there is still a huge population of people that are fearful of what the results would look like on them. Catering to their reasonable fears of looking ‘too full’ or ‘too different’, it would stand to reason to update our terminology to address the desires of these prospective patients

Rejuvenation of the Aging Arm

The aging arm is characterized by increased dyspigmentation, a proliferation of ectactic blood vessels, excessive adiposity, excessive skin laxity, and actinic keratosis. A variety of laser, energy, and surgical techniques can be used to improve these features. The objective of this article is to describe the treatment modalities that have proven efficacious in rejuvenating the aging arm and combination therapies that have the potential to optimize patient outcomes while maintaining safety and tolerability. A Medline search was performed on nonsurgical aesthetic combination treatments because it relates to arm rejuvenation, and results are summarized. Practical applications for these combination treatments are also discussed. Although there is significant evidence supporting the effective use of nonsurgical treatments for arm rejuvenation, little in the literature was found on the safety and efficacy of combining such procedures and devices. However, in the authors' clinical experience, combining arm rejuvenation techniques can be done safely and often result in optimal outcomes. Arm rejuvenation can be safely and effectively achieved with combination nonsurgical aesthetic treatments.

Antiaging - a scientific topic or just a social trend?

The number of nonsurgical anti-aging procedures have increased in recent years. Reasons for this trend are various: The World Wide Web distributes an immense amount of information throughout the world within seconds, which in turn generates a great demand on information. Active and aggressive medias, which were almost absent 50 years ago, have made our society ambitious; the perception of which is attractive, desirable, and sexy gets globalized. In addition, our lifestyle has changed with the fast-growing offer of leisure activities. Wrinkles, fat deposits, and sun-damaged skin do not fit into our neat society. The increasing demand for aesthetic treatments has prompted many physicians without any knowledge in aesthetic medicine to offer various nonsurgical aesthetic treatments with the danger that aesthetic dermatology stands to lose its scientific relevance. Evidence-based medicine should be applied not only in medical procedures but also in aesthetic dermatology.