Non-surgical Facial Aesthetics Research Articles

An Evidence-based Pathway for Body Dysmorphic Disorder in Facial Aesthetics.

Aesthetic procedures should be avoided in patients with body dysmorphic disorder (BDD) since they can negatively impact mental health and lead to further aesthetic dissatisfaction. There are no evidence-based patient pathways for BDD in facial aesthetics which can result in the failure to identify patients with BDD, leading to unsuitable treatments and suboptimal patient care. We aim to construct the first evidence-based patient pathway for BDD in surgical and nonsurgical facial aesthetics. A systematic review was performed and articles that discussed screening or patient pathways for BDD in field of facial aesthetics were included. We extracted relevant information from each article on screening tools and pathways for BDD. Data were synthesized by summarizing the data under column headings into a structured narrative and into new tables. Based on this synthesis, a practical pathway for BDD was constructed. Forty articles fulfilled the criteria for inclusion. Twenty-eight BDD screening tools were discussed in the included articles, and we provide an overview of these tools. Thirty-one articles discussed patient pathways for BDD, and we synthesized this information into a structured narrative. Combining these findings, we present an evidence-based patient pathway for BDD for patients presenting for facial aesthetic treatments. This systematic review has resulted in the first, evidence-based, patient pathway for BDD in surgical and nonsurgical facial aesthetics. This practical pathway can be used by aesthetic clinicians to identify patients with potential BDD and provide clear guidance for managing cases where BDD is suspected. It will help reduce the number of facial aesthetic procedures performed on patients with BDD, safeguard patient mental well-being, and prevent further aesthetic dissatisfaction.

50. Attitudes and perceptions of medical and dental students on the implementation of non-surgical facial aesthetics in their curricula

50. Attitudes and perceptions of medical and dental students on the implementation of non-surgical facial aesthetics in their curricula

What are the factors influencing the uptake of non-surgical facial aesthetic treatments in adults? A systematic review

Awareness of the patient motivational factors that predispose them to an emotionally healthy treatment outcome is a critical part of the patient assessment. However, this area is lacking in research and poorly understood. The growing popularity, availability and acceptance of facial aesthetics procedures amongst the general population highlight the need for clinicians to understand the patient motivational factors to improve treatment overall, particularly on a psychological level. The aim of this paper is therefore to identify the characteristics and motivational factors of patients seeking non-surgical facial aesthetics treatments; while not all patients seeking treatments are at psychological risk, how this knowledge benefits clinical practice on an emotional level is also discussed. To conduct this study, medical literature was searched and 39 studies were assessed for eligibility. Based on given criteria, six studies were selected for review. The included studies revealed that interested patients were mostly educated women over the age of 30 with a history of receiving facial aesthetics treatments, seeking improved self-confidence as their main treatment outcome. These patients were more likely to have a satisfactory post-treatment result with lower tendencies of psychological risk.

Attitudes and perceptions of medical and dental students on the implementation of non-surgical facial aesthetics in their curricula

There is an accelerated demand for non-surgical facial aesthetics (NSFA) encompassing the use of botulinum toxin and dermal fillers. Healthcare professionals may either treat NSFA-related complications in the public sector or practise in the private sector. Currently, there is no standardised undergraduate teaching in the UK to educate healthcare professionals on NSFA. The aim of our study was to compare medical and dental undergraduate students’ perceptions and awareness of NSFA, and to understand its role if implemented in each curriculum in the UK. An online questionnaire was devised and distributed via social media platforms to medical and dental students across the UK. Student responses were anonymised and collated as quantitative data, and subsequently analysed. Of the 146 respondents, 89% had no previous teaching on NSFA. Ninety-three per cent of medics and 75% of dentists agreed or strongly agreed that non-surgical aestheticians require dental or medical knowledge to deliver NSFA, and 66% of medics and 75% of dentists agreed or strongly agreed that NSFA should be incorporated into the undergraduate curriculum. Only 7% of medics and 8% of dentists were aware of the steps required to practise NSFA. Incoming doctors and dentists are showing interest in the field yet have no formal teaching in the area. Requiring healthcare professionals to have some baseline understanding of NSFA and its associated complications means that implementing formal education on the subject in the medical and dental curricula is an important consideration.

Can we support second degree students by incorporating non-surgical facial aesthetics into undergraduate dentistry during the first degree?

Non-surgical facial aesthetics (NSFA) are cosmetic procedures intended to reduce signs of ageing and provide facial rejuvenation. There is currently no recommendation for NSFA to be included in the undergraduate dental curriculum globally. This study aims to gain the views of final year dental students about pursuing a career in NSFA. An online survey was completed by 114 final year dental students across two English Universities. A total of 67% (77/114) of students would pursue a career in NSFA. A total of 76% (87/114) and 75% (86/114) of students were not aware of the complications associated with the administration of dermal fillers and Botox injections, respectively. Most students considered NSFA upon graduation. NSFA provides a transferable skillset and useful anatomical knowledge. Incorporation of NSFA in undergraduate education could financially support oral and maxillofacial surgery (OMFS) trainees within their second degree. This may in turn promote retention within the speciality with high financial costs associated with OMFS training.

Working whilst studying: a survey of medically-qualified dental students

Medically-qualified junior trainees who are interested in oral and maxillofacial surgery (OMFS) are faced with the challenging decision to undertake the minimum three years required to obtain a Bachelor of Dental Surgery (BDS) with its associated expenses and loss of income from full-time employment, or to follow a different career path. Trainees have reported duration of training and financial factors, such as cost of attaining additional qualifications and loss of income, as common reasons for loss of interest in OMFS. This survey of students enrolled on King’s College London’s three-year BDS dentistry entry programme for medical graduates (DPMG)shows that most studentsundertake paid part-time work in various settings and specialties alongside their studies. The average number of hours worked by students whilst studying is reported to be 27.0/week. Students report a wide range of incomes from various sources including secondary-care shifts in the NHS and private sector, as well as non-secondary-care activities such as non-surgical facial aesthetics. Direct correlation is noted between the number of hours worked and earnings, with comparable potential income in OMFS and non-OMFS specialties. Participants working in OMFS report greater educational and training value compared with non-OMFS work.

Background and complications of dermal fillers: the increasing use of non-surgical facial aesthetics in dental practice

There has been a noticeable increase in the number of patients who present to oral and maxillofacial surgery (OMFS) departments for treatment of post-operative complications of dermal fillers and botulinum toxin. These complications are more likely when the treatments are performed by untrained persons or self-administered by patients. Occasionally, these adverse outcomes cannot be avoided, even when products are administered by medically trained professionals. This review includes two cases and discusses some of the key issues surrounding these products so that patients can be informed of the benefits and risks with these types of non-surgical aesthetic procedures and, where possible, reduce the risk of complications occurring. CPD/Clinical Relevance: Appropriate knowledge of facial anatomy and different types of dermal fillers is necessary to reduce the risk of complications associated with injection of these products.

Non-surgical facial aesthetics: Should this be incorporated into medical education?

BackgroundNon-Surgical Facial Aesthetics (NSFA) encompasses a range of minimally invasive procedures. Complications associated with NSFA often present to local Emergency Departments. There is no representation of NSFA in the undergraduate curriculum. Medical students appear to have little to no exposure to NSFA during their training.The main aims of this study were to gain an insight into the views of final year medical students in pursuing a career in NSFA and assessing their understanding of NSFA competence and complications of common procedures. Methodology: An online survey was completed by 148 medical students across two English Universities. 106/148 (71.6%) of students were from University A and 42/148 (28.4%) were from University B. Results47.6% (70/148) of medical students would consider pursuing a career in NSFA after graduating from medical school. 76.3% (87/148) and 80.7% (92/148) of students were not aware of the complications associated with the administration of dermal fillers and Botox injections respectively. Most medical students felt a single day training program in NSFA was sufficient to administer non-surgical rhinoplasty 67.8% (99/148) dermal fillers 67.1% (98/148) and Botox injections 68.5% (100/148). ConclusionDespite a large proportion of medical students considering a career in NSFA the majority were unaware of the common complications. Incorporation of NSFA into undergraduate curriculum should improve enhance patient safety, effective management of complications and augment future learning and career progression. This may be achieved by through signposting, student-selected components and as part of structured head and neck teaching.

Knowledge and practice of faculty members of dental colleges in Saudi Arabia on non-surgical facial aesthetics (botox & dermal fillers)

Background: Botulinum toxin (BTX) and dermal fillers (DF) are some of the most popular aesthetic interventions used nowadays. This study aimed to evaluate the knowledge and opinions of the use of BTX and DF in aesthetic and therapeutic dental treatment by dental faculty members of different dental colleges in Saudi Arabia. Methodology: In the current study, 245 questionnaires were distributed to faculty members of Saudi dental colleges to assess their knowledge of non-surgical facial aesthetic (NSFA) procedures. The questionnaire consisted of questions about the indications and side effects of botulinum toxin and dermal filler types. Results: Among the participants, 35.5% knew about the therapeutic uses of BTX, 88.6% thought that wrinkle reduction was the most common indication of BTX. Among the participants, 80% chose lip augmentation as the most common indication of dermal fillers, whereas 40.8% of participants thought that allergic reaction was more commonly seen with BTX; however, 36% thought that asymmetry was more associated with dermal fillers. A statistically significant difference was observed across genders about the indications and side effects of BTX (p ≤ 0.05). Conclusion: It was found that faculty members in Saudi Arabia had limited knowledge about NSFA source, dosage, side effects, and applications. Female faculty members of Saudi dental colleges have a significantly better knowledge about NSFA types and indications.

Response to "Structured Education and Training in Nonsurgical Facial Aesthetics".

Response to "Structured Education and Training in Nonsurgical Facial Aesthetics".

Commentary on: Global Need-Assessment for a Postgraduate Program on Non-Surgical Facial Aesthetics.

Commentary on: Global Need-Assessment for a Postgraduate Program on Non-Surgical Facial Aesthetics.

Structured Education and Training in Nonsurgical Facial Aesthetics.

Structured Education and Training in Nonsurgical Facial Aesthetics.

Global Needs-Assessment for a Postgraduate Program on Nonsurgical Facial Aesthetics.

Standardizing training and education in nonsurgical facial aesthetic procedures during residency training has long been challenging because majority of the procedures are performed outside the usual teaching hospital settings. Several areas of refinement have been suggested and an increased need for more hands-on training identified in the available literature. Despite the growing demand for nonsurgical facial aesthetics (NSFA), it is yet to be fully integrated into standard postgraduate medical or surgical curriculum. The objective of this study was to explore the current state and the need for medical education and training of aesthetic clinicians across specialties in a formal postgraduate curriculum. A mixed-method, cross-sectional, online research was conducted among physicians involved in training and practicing NSFA between July 2018 and December 2018. Focus group discussion was conducted to ensure the face and content validity of the survey items. The total responses collected in the trainer's group was 179 and 496 in the trainee's group. The majority of trainers (95%) and trainees (93.8%) across specialties expressed their opinion for the need of a standard postgraduate course in NSFA. Moreover, more than 55% of them felt that 12 months, with a work-based, blended learning approach, would be most suitable for training and education. The survey results have underlined the need for specialized training in NSFA to enable clinicians to pursue independent practice with confidence. The authors recommend the inclusion of evidence-based postgraduate programs on NSFA in higher academic institutions as per their educational curriculum.

HYALURONIC ACID DERMAL FILLERS IN THE MANAGEMENT OF RECURRENT ANGULAR CHEILITIS: A CASE REPORT

Angular cheilitis (AC) is a common oral pathology characterized by erythema, fissures, and crusting at 1 or both labial commissures. Pain and itchiness typically accompany these lesions. The objective is to report conservative treatment based on the use of dermal fillers for a case of recurrent AC. This is a case report of an 80-year-old patient with a history of recurrent AC that was not resolved with a conventional approach. The patient presented deep and irregular Y-shaped wrinkles by the union of the nasolabial fold with the labial commissure, which is why we chose to perform a mesh lift injection from the mentolabial sulcus with a 28-gauge needle. The hyaluronic acid worked as a suspender to maintain the elevated position of the perioral tissues. This case illustrates the potential of nonsurgical facial aesthetics (NSFAs), aside from achieving aesthetic goals, for treating this common pathology among elderly.

Development of "Core Syllabus" for Facial Anatomy Teaching to Aesthetic Physicians: A Delphi Consensus.

Background:A detailed understanding of facial anatomy, specifically the vascular framework, is crucial for delivering safe nonsurgical aesthetic procedures. To date, there is no core document based on consensus for the teaching of facial anatomy to aesthetic physicians exists. The aim of this study was to ascertain the most critical anatomical structures for avoiding disastrous complications during nonsurgical aesthetic procedures.Methods:After a detailed literature review, Delphi questionnaire was developed listing 154 anatomical structures of the face and neck for consensus review. Thirty-five international experts in surgical and nonsurgical facial aesthetics were invited to complete an online survey designed to rank the relevance of each anatomical element on a Likert scale from 1 (not at all important) to 4 (very important) or 5 (no opinion). Consensus for items included in the core syllabus was predefined as achieving a Cronbach’s α ≥ 0.90 and an agreement score of ≥ 80%.Results:Thirty-four international experts (97.14%) completed the iterative online Delphi survey. The consensus among the specialists polled was achieved after 1 round of the survey (Cronbach’s α = 0.94). The expert panel reached an agreement score of ≥ 80% on 137 of the 154 anatomical structures listed.Conclusion:The outcome of this Delphi study represents an essential first step in systematizing an evidence-based facial anatomy “Core Syllabus” for the teaching of aesthetic physicians and practitioners. This “Core Syllabus” will act as a blueprint for the educators while crafting a program.

Dynamic Relaxers of the Face.

Dynamics of the facial aesthetics is changing rapidly as we treat more and more faces. Our understanding of the molecule at hand and its various applications only expands as our learnings progress. Perception and expectation of the end goal to beauty itself are evolving, and therefore newer ways of analyzing, understanding, and delivering of any aesthetic drug have to evolve continuously. Botulinum toxin is one of the wonders in the aesthetic world, which led the entire focus of the medical fraternity into nonsurgical facial aesthetics. Botulinum toxin was and is still the best tool for relaxing lateral canthal lines and glabellar frown lines. However, it has evolved further to now impart changes/enhancements in skin texture and luminosity, enhancement in facial shape, and reduction in glandular activity of sebaceous, sweat, and salivary glands, therefore leading to a lot more aesthetic application while it still remains as the line eraser.

Can UK undergraduate dental programmes provide training in non-surgical facial aesthetics?

Aim Recently, more and more dentists have found themselves engaging in the delivery of non-surgical facial aesthetics (NSFA) as part of their regular practice routine. NSFA is a growing field in aesthetic medicine that is practised by a range of clinicians including doctors, dentists and registered prescriber nurses and is an industry estimated to be worth over £3 billion in the UK alone. In the past few years, several public scandals in aesthetic medicine have prompted reactions by several bodies including the Government and Royal Colleges. With Health Education England (HEE) having recently released standards in education, it is clear that a shift in attitude towards training is imminent. With a large volume of dentists making up this NSFA workforce it is reasonable to consider the stance of undergraduate training and the relevance of the existing knowledge within dentistry in the context of the HEE standards.Method All dental schools in the UK were contacted to establish the range of subjects taught within the curriculum, with particular reference to those relevant to NSFA. The two largest aesthetic pharmacies were contacted regarding numbers of registered dentists they serve.Results Twelve out of 16 dental schools responded. Two-thirds of responding dental schools do not cover NSFA in their curricula. However, many dental schools cover related subjects including: facial anatomy/material science/neuromuscular junction physiology (100%), anatomy of the aging face (66%), pharmacology of botulinum toxin (25%) and ethical-legal implications of aesthetic dentistry/NSFA (50%/42% respectively).Conclusion Dentists are well placed to deliver NSFA given their background in relevant subjects and surgical training. With the emergence and growth of such a large multi-disciplinary field it is crucial that dentistry is not left behind. Just as most dental schools have embraced the evolution of cosmetic dentistry and implantology, it would be prudent to consider that training standards around NSFA are reflected in both undergraduate curricula and appropriate post-graduate clinical training for dentistry.

Hurdles in the pursuit of youth. A case series investigating adverse reactions associated with dermal fillers: where is the onus of care?

Introduction: The non-surgical facial aesthetics industry accounts for 75% of the total UK cosmetic procedures market, according to the DoH. People are more inclined towards minimally invasive methods of facial rejuvenation to circumvent traditional surgery and its perceived complications. The complications that can arise using dermal fillers, however, can be equally distressing and debilitating for patients.

Non-surgical aesthetic nasal enhancement: indications, contraindications and anatomy

The non-surgical facial aesthetics arena is rapidly evolving and there has been a high demand over recent years for the correction of mild-to-moderate external nasal deformities. The minimally invasive rhinoplasty combines the adjuvant use of botulinum toxin type A and dermal fillers to rectify or improve a range of perceived or actual nasal defects (e.g. drooping tip, depressed areas). The procedure takes place in an outpatient setting and involves virtually no discomfort, little associated downtime, and is considered very safe and efficient, yielding high patient satisfaction rates. This article will explore the history of the procedure, describe the ideal nasal proportions, outline the anatomy of the external nose and cover the indications and contraindications for the procedure. A second article will look at the products used and provide readers with a treatment protocol. Both articles are reflective of the author's experience.

Advances in non-surgical facial aesthetics

Botulinum toxin (BoNT) to facilitate 'muscle relaxation', in combination with a 'light' filler for 'dermal treatment' and a 'heavy' filler for 'lifting capacity'.