Nonsurgical Cosmetic Procedures Research Articles

Addressing the Cosmetic Resident Education Gap – a Junior Cosmetic Fellowship Program

Abstract Goals/Purpose Incorporating adequate aesthetic surgery training into integrated plastic surgery programs in the United States has remained a challenge for several decades.[1-4] Specifically, residents report low confidence in performing facial cosmetic procedures compared to breast and body contouring.[1-2] This becomes increasingly relevant in the setting of heightened specialty creep and the rise in demand for cosmetic procedures overall according to the 2022 ASPS procedural statistics which show a 19% increase in cosmetic surgery procedures compared to the pre-pandemic 2019 report.[5] In a survey of 257 residents, 26.4% felt confident performing a lower blepharoplasty, 25% performing a facelift, 16.5% performing an endoscopic brow lift, and 14% performing a rhinoplasty.[2] This resident-reported difficulty with facial cosmetic procedures has shown little progress over time in reported survey data despite an increase in minimum cosmetic case numbers and length of training. A comprehensive aesthetic training also includes exposure to non-surgical interventions such as neuromodulators, injectables, non-surgical body contouring and facial rejuvenation technology. Though non-invasive fat reduction (ie. cryolypolysis) and non-surgical skin tightening (ie. radiofrequency micro-needling) have increased in demand since 2019 (77% and 22%, respectively), residents rarely have hands-on exposure to these treatment modalities.[5] Several integrated plastic surgery programs have a dedicated year of professional development or research, providing an opportunity for programs to fill this gap between cosmetic surgery training and real-world demand. Methods/Technique A junior cosmetic fellowship curriculum was created at a single institution focused on increasing confidence in performing aesthetic surgery, exposure to non-surgical cosmetic procedures, and increasing exposure to the business side of private practice. The fellowship was designed for a single resident during the professional development year of integrated plastic surgery training, completed between the third and fourth clinical years. The junior fellow spent the year within a single, multi-office private aesthetics practice in both the surgical and non-surgical setting. Over the course of the first four months (July 2023 - October 2023), the clinical experience of the Stanford junior cosmetic fellow was queried. Analysis of surgical case volume and non-surgical patient load was performed. This was then used to project surgical cases anticipated to be completed by year end. This was compared to case log minimums for graduating integrated plastic surgery residents in the United States, an essential metric of assessing resident experience and competence. Financial analysis of the non-surgical treatments by the junior fellow was performed. Using the initial four-month data, projections were also estimated to determine profitability for the practice over the course of the year-long fellowship. Results/Complications Over the span of the initial four months, the junior cosmetic fellow completed 69 cases, 58% of which were breast / body and 42% of which were focused on facial rejuvenation. It is estimated that at completion of the fellowship, this projects to 207 cases, exceeding the cosmetic ACGME program requirements for graduation. Total sales generated by the junior fellow during the first four months were as follows: $22,802, $90,257, $78,563, and $75,084 USD. Therefore, total sales by year end are estimated to be $800,118 in non-surgical treatments – demonstrating expertise of the junior fellow in non-surgical procedures and also profitability for the practice. Conclusion Increasing resident comfort with aesthetic surgical and non-surgical procedures is imperative as the demand for cosmetics continues to rise. Here we highlight the creation of a junior cosmetic fellowship, designed for programs with a year of professional development in their plastic surgery curriculum, to bridge the gap of cosmetic resident education. This junior fellowship model increases overall resident comfort in aesthetics and experience with facial procedures, a known weakness in resident training. Also, the addition of a junior fellow has shown to be financially lucrative for a practice, encouraging private practice attendings to consider this teaching model. Beyond the scope of programs with a dedicated year for professional development, this fellowship model may encourage embedded fellowships or incorporating mini-fellowships of 3-6 months in aesthetic surgery into residency programs outside of the traditional chief resident cosmetic experience.

Acceptance of Surgical and Non-surgical Cosmetic Procedures: A Cross-Sectional Study From Jazan, Saudi Arabia.

Background and objective Cosmetic surgery is a field that primarily focuses on the preservation, rebuilding, or improvement of the physical appearance of an individual through surgical and therapeutic methods. This specialization encompasses various interventions, both surgical, such as blepharoplasty, rhinoplasty, and breast augmentation, and non-surgical, including procedures such as chemical peeling, Botox injections, and dermal fillers. This study aims to assess the acceptance of cosmetic surgeries and non-surgical cosmetic procedures and the reasons for non-acceptance in a population from Jazan, Saudi Arabia. Methods This cross-sectional survey study was conducted in the general population of Jazan, Saudi Arabia, between July and August 2023. An online self-administered questionnaire was created using Google Forms and distributed through social media. The acceptance was measured using the Arabic translation of the Acceptance of Cosmetic Surgery Scale (ACSS). Results The mean cosmetic surgery acceptance score was 62.1 ± 25.9, whereas the mean non-surgical procedure acceptance score was 63.7 ± 24.5. Engaged and widowed participants had a higher mean acceptance score for cosmetic surgery, whereas divorced participants had a higher mean acceptance score for non-surgical cosmetic procedures. Higher age was associated with higher acceptance of cosmetic surgery (95% CI: 1-15), while having higher income was associated with lower acceptance (95% CI: -14 to -0.32). A higher level of parental education was associated with lower acceptance of surgical and non-surgical cosmetic procedures (95% CI: -23 to -3.5). The perceived lack of a need for cosmetic procedures was the most commonly cited reason for not accepting these procedures, while religious beliefs were the second most common reason. Conclusion Non-surgical cosmetic procedures generally had higher acceptance than cosmetic surgeries. Age, sex, marital status, income level, familial influence, and prior experience all played significant roles in shaping these attitudes. The perceived lack of a need for the procedures and religious beliefs were common reasons for not accepting cosmetic procedures.

Real-World Patient Experience With PrabotulinumtoxinA in the United Kingdom: A Single-Center Survey and Analysis of 254 Patients

Abstract Background Botulinum toxin Type A (BoNT-A) injection is the most widely performed nonsurgical cosmetic procedure in the United Kingdom. PrabotulinumtoxinA is a new BoNT-A, recently licensed in the United Kingdom, for treating moderate-to-severe glabellar lines in adults under 65. Although clinical trials have established safety and efficacy, real-world data can help clinicians translate study findings into practice and support prabotulinumtoxinA use in a more diverse patient population. Objectives To understand the real-world patient experience and patient perceptions of prabotulinumtoxinA performance for treatment of the glabellar region. Methods In this single-center survey study, a single injector administered prabotulinumtoxinA for the treatment of glabellar lines to real-world patients presenting for BoNT-A treatment. Two weeks later, patients received surveys asking about their experience through email. There were no incentives for participation. Responses returned within 5 weeks of treatment were included. Results From February to June 2023, 457 patients received prabotulinumtoxinA injections for glabellar line treatment. Survey response rate was 56% (254/457 patients). For most patients, treatment onset was 2 to 3 days following injection and peak response occurred after 7 to 10 days. Adverse effects were minimal, with 67% of patients experiencing none. Among survey respondents, 83% rated their treatment positively (5-point satisfaction scale), and 72% would choose prabotulinumtoxinA again. Conclusions These data support safety and effectiveness of prabotulinumtoxinA in a diverse, real-world population, and confirm patient satisfaction among experienced BoNT-A patients, as well as suggest a rapid time to onset and peak effect. Level of Evidence: 4

Same But Different: An 18-Month Cross-Sectional Study of Cosmetic Procedures in Patients With Skin Phototype I-III Versus IV-VI in Toronto, Canada.

Patients with darker skin phototypes self-report less facial aging than their lighter-skinned counterparts. However, the association of skin phototype with the type of cosmetic procedures received, is yet to be established in a Canadian context. To compare the pattern of nonsurgical cosmetic procedures performed on people with different Fitzpatrick SPTs. Cross-sectional study of patient encounters from October 2020-April 2022. Charts and photographs were reviewed and analyzed for age, sex, SPT, and procedure type. Participants were stratified by SPT into 2 cohorts: SPT I-III and SPT IV-VI. SPTs were collapsed into groups based on definitions of "skin of color" (SPT IV-VI) in previous literature. We analyzed 350 patients with mean age 43.4, of whom 320 (91%) were female and 30 (9%) were male. The SPT I-III cohort was older (mean age 45 vs 38.5 years, p < .0001) and more frequently underwent neuromodulator injection. The SPT IV-VI cohort more frequently underwent microneedling, platelet-rich plasma, or electrodessication. There are distinct patterns of cosmetic procedures performed. The SPT I-III cohort more commonly received procedures to manage facial aging. The SPT IV-VI cohort was younger and more commonly underwent procedures to manage hyperpigmentation.

The JCCP's response to the DHSC licensing of non-surgical cosmetic procedures first consultation paper

The JCCP has presented its response to the Government's first public consultation document with the aim of informing and determining the standard, type and content of the new practitioner licence

The Government's consultation on ‘the licensing of non-surgical cosmetic procedures in England’

A long-overdue system of regulation for aesthetic medicine is finally on the cards

Experimental inoculation of the Botox perineurally of facial nerve and followed by histological assessment for its effect on the zygomatic bone of rabbits

Background: Botox, derived from the toxin produced by Clostridium botulinum, is an attenuated toxin employed as a treatment for cervical dystonia, overactive bladder, strabismus, cerebral palsy, and non-surgical cosmetic procedures. This study aimed to explore the impact of injecting Botox around the facial nerve on the left side of rabbits, specifically focusing on the histological changes in the zygomatic bone.  Methods: Twenty-five adult rabbits of a local breed, weighing 1500-1800 gm and of both sexes, underwent a 15-day acclimation period prior to the experiment. The rabbits were randomly assigned to four groups (1st, 2nd, 3rd, and 4th). A singular intramuscular injection of Botox at a dose of 3.5 U/kg was administered to the left facial muscles. The rabbits in each group were then sacrificed at distinct time points after injection: day 10, day 15, day 30, and day 45. All rabbits survived until the end of the experiment, at which point they were euthanized with chloroform. Post-euthanasia, the rabbits' facial zygomatic bones were dissected and subjected to histological assessment. Results: The results indicated notable changes in the zygomatic bone, including prominent vacuoles within the bony matrix, cracks with cellular debris, limited osteocytes, and collagen bundles resembling woven bone. Additionally, in the day 30 group (T3), irregular bone borders and atrophied osteogenic cells were observed, while the day 45 group (T4) exhibited necrotic areas and bone fragments within the bone matrix. Conclusion: In conclusion, Botox, derived from Clostridium botulinum, serves various medical purposes. The study focused on injecting Botox around rabbits' facial nerves to assess its impact on zygomatic bones histologically. Following a controlled injection and specific time intervals, the examined bone samples exhibited distinct changes, providing insights into Botox's effects on bone morphology.

Unmasking the public health burden of facial botulinum toxin aesthetics: working towards a safer future

How can we increase education around non-surgical cosmetic procedures and the complications that arise from these treatments?

Aesthetic Surgery Training and Practice in India: A Survey.

Introduction  Aesthetic surgery is a rapidly evolving subspecialty in high demand worldwide. To be considered a fully trained plastic surgeon, all the requirements of the curriculum must be met through to successful completion, including aesthetic surgery. At present, a disparity exists between the demand and provision of aesthetic surgery training in India. This survey evaluation highlights the responses, concerns, and possible solutions regarding training and practice of cosmetic surgery in India. Methods  A meticulously crafted survey comprising of 19 questions discussing the background, training, and practice of cosmetic plastic surgery, was sent across to all accessible plastic surgeons trained or training in India. A total of 506 responses were received. The responses were analyzed and have been presented in this study. Results  The survey was completed with all participants answering all the questions. Pertinent questions regarding practice setup, percentage of aesthetic work in practice, exposure of trainees to aesthetic procedures, and merits of an aesthetic fellowship revealed a lot about aesthetic training in India. The participants also expressed their level of satisfaction with their principal plastic surgery training. Summarizing these findings, suggestions for improvements in training were made. Conclusion  Plastic surgery residency programs need to ensure that residents receive comprehensive exposure to both surgical and nonsurgical cosmetic procedures to ensure maintenance of service standards and optimum patient care. The information collected can help us formulate strategies to improvise the current cosmetic surgery training across India. Steps taken toward the same are also highlighted in the study.

Filler in the Tear Trough and Lid-Cheek Junction: A Cadaveric Evaluation of Filler Type and Manipulation Technique

Abstract Goals/Purpose The tear trough and lid-cheek junction demonstrate among the earliest and most noticeable signs of aging as a result of thin periorbital skin and loss of volume causing shadowing and darkness of the infraorbital region. Thus, rejuvenation of this area is commonly requested by patients. Soft tissue filler injections are the second most common non-surgical cosmetic procedure performed in the U.S, with over 2.6 million procedures reported in the 2020 Plastic Surgery Statistics Report. As such, there is a high demand for filler injection in the infraorbital area. However, there is currently only one FDA-approved filler for the tear trough, Juvéderm Volbella XC, although many practitioners also use Restylane-L. Interestingly, these two products differ significantly in their rheology (G’, cohesivity, and flexibility), and the Juvéderm Vycross is smooth gel while the Restylane NASHA is particulate. Despite the high demand of filler in the infraorbital area, there remains debate on injection practices and precise anatomical placement leading to several prior cadaveric examinations of the region. We herein aimed to contribute to the anatomic understanding of infraorbital filler injection via a cadaveric study using Juvéderm and Restylane products with different constitutions and manipulation techniques. Methods/Technique Institutional approval for cadaveric study was obtained. Six cadaveric cephalus specimens were used for filler injection and dissection. All fillers were dyed with food coloring. The Juvéderm products Volbella XC (tear trough, red) and Voluma XC (malar, blue) were used together in hemi-faces (Juvéderm pair), and Restylane products Restylane-L (tear trough, purple) and Restylane-LYFT (malar, green) were used together in separate sets of hemi-faces (Restylane pair). All filler injections were performed by the senior author as follows: 0.5 cc of filler was injected into the malar region in the deep fat compartment above the maxilla both medial and lateral to the infraorbital foramen. In the tear trough region, the orbit was protected with the nondominant hand and 0.3 cc of filler injected just superficial to the infraorbital rim. One hemi-face was injected with the original constitution of filler product and the other was injected with filler blended with 0.2 cc of saline. In two cadavers, after injection the hemifaces were massaged and compared to those which remained unmanipulated. All hemi-faces were then dissected from medial to lateral in the subcutaneous plane and between the superficial and deep facial fat compartments by a single author. All photographs and videography were taken by a single author. All hemi-faces were subjectively analyzed by all authors. Results/Complications All cadavers were in excellent condition, and the subcutaneous tissue, superficial fat, and deep fat compartments were dissected in clear planes. Volbella was found on the periosteum of the infraorbital rim and along the orbicularis retaining ligament (ORL) and crossed into the sub-orbicularis oculi fat (SOOF) and the subcutaneous fat while the Restylane-L did not leech into the fat and remained as a distinct mass on the rim and ORL. Voluma was found in the deep medial cheek compartment and crossed into the superficial medial cheek and superficial nasolabial compartments and subcutaneous fat. In contrast, Restylane-LYFT remained mostly within the deep medial cheek compartment without spreading into the superficial fat pads (Figure). Dilutional manipulation by blending with saline and physical manipulation by massaging both increased spread of all products within the anatomical planes. However, Restylane products appeared to remain distinctly within the anatomical planes they were injected in despite the manipulations. Conclusion This cadaveric study was successful in demonstrating the behavior of different hyaluronic acid fillers injected in the infraorbital region. Tear trough and malar region filler injections just above the periosteum resulted in precise anatomical placement along the infraorbital rim/ORL and in the deep medial cheek fat compartment, respectively. The Juvéderm products appeared to spread across anatomical planes more freely than Restylane products. This may be explained by the lower elastic modulus (G’) of the Juvéderm fillers. Manipulation of the filler product including blending and post-injection massage appeared to spread the fillers medially and laterally within the injected anatomical planes compared to unmanipulated filler. Of note, there are limitations to this study including the cadaver model as this does not allow for hydrophilic swelling of the filler nor spread and integration of the products as in live patients. The results of this study provide information about filler products commonly used in the infraorbital region and the effects of manipulation using blending or massage. Confirmation of precise anatomical placement of the fillers and improved knowledge of their behavior in situ through this cadaver study may assist clinical practitioners’ selection of rheological properties of fillers, method of constitution, and manipulation technique depending on patient-specific anatomy.

Recovery of Acute Ophthalmoplegia after Hyaluronic Acid Filler Injections to the Temples: A Case Report and Review of the Literature.

Soft tissue filler injection is the second most common nonsurgical cosmetic procedure. Despite the safety of fillers, as use has grown, so has the number of patients affected by adverse events. Ophthalmoplegia following cosmetic filler injection is a rare complication, mostly occurring after injection to the glabella, nasolabial fold, periorbital, and lateral nasal site. In all cases where ophthalmoplegia has been reported following fillers, patients have simultaneously experienced vision loss and other ocular symptoms. We report a case of isolated acute ophthalmoplegia following hyaluronic acid injection solely in the temple region. A 40-year-old woman, 3 hours after the procedure, presented to our hospital with left eye ophthalmoplegia, ptosis, and hypotropia. Treatment started with hyaluronidase, steroids, and anticoagulants. After 4 weeks, left eye ophthalmoplegia remained unchanged, and through a 10-week follow-up, all left ocular movements improved, and only mild hypotropia and ptosis persisted. This case report shows that ophthalmoplegia may also happen with temple region filler injections. We also review available prevention techniques and treatments to avoid such complications when performing soft tissue fillers for gaunt appearance correction.

The "epidemic" of nonsurgical cosmetic procedures providers in Brazil

The "epidemic" of nonsurgical cosmetic procedures providers in Brazil

Durable Suture Technique: A Simple and Versatile Nonsurgical Technique to Create/Reshape Double Eyelid in Asians

Nonincisional double-eyelid plasty, the Durable Suture Technique, is a popular nonsurgical procedure for creating double eyelids on monolids. We report cases where the Durable Suture Technique was successfully applied to other Asian cosmetic eyelid indications. A series of before-and-after photos of patients who underwent the Durable Suture Technique were shown to demonstrate that it is effective in reshaping and rejuvenating the double eyelids, as well as treating post-blepharoplasty complications. The rationale for applying the Durable Suture Technique in the above nonstandard indications was discussed. The Durable Suture Technique is a versatile, nonsurgical cosmetic eyelid enhancement procedure in Asians.

Effect of the COVID-19 Pandemic on Nonsurgical Cosmetic Procedure Interest

The COVID-19 pandemic caused many shifts in the national economy, job market, and healthcare sector, especially elective procedures such as in cosmetic plastic surgery. While there has been research in the changes in cosmetic plastic surgery since the start of the COVID-19 pandemic, there have been no study to date determining the changes in distinct sectors, such as nonsurgical plastic surgery procedures and the popular trends that may be more sensitive to changes to general public interest. The Google Trends tool was used to determine these changes in interest. Nonsurgical procedures were retrieved from the American Society of Plastic Surgery (ASPS) website, grouped into categories, such as neurotoxin, chemical peel, filler, hair removal, dermaplaning, skin laser treatment, skin tightening, and thread lift, and used as Google Trends search terms. Search term weekly data were collected from March 2018 to March 2020 and March 2020 to March 2022, divided by the start of the COVID-19 lockdown, and compared. After the start of the COVID-19 pandemic, the majority of nonsurgical procedures showed an increase in interest, with the most significant changes including neurotoxin procedures especially lip Botox, filler in the chin, cheek, jawline, tear trough, lip, and nose, skin-improving treatments, non-invasive forms of body contouring, and thread lift. Brands like Dysport, Radiesse, Restylane, Sculptra, Versa, Emsculpt, and Morpheus8 showed increased interest. Most nonsurgical procedures increased in interest after the COVID-19 lockdown, with facial and skin-improving procedures showing the most increase in interest.

SERUM SICKNESS AFTER COSMETIC ONABOTULINUMTOXIN A USE

<h3>Introduction</h3> Onabotulinumtoxin A is one of the most commonly used drugs in cosmetic medicine, and neurotoxin treatment is the most common nonsurgical cosmetic procedure in all age groups of both women and men per the most recent Aesthetic Plastic Surgery National Databank statistics. This abstract will present a case report of serum sickness believed to be the first reported of this such complication with onabotulinumtoxin A. <h3>Case Description</h3> A 46 year-old woman with an unremarkable medical history including prior onabotulinumtoxin A use in Canada was seen in Michigan, US, for injectable fillers and neurotoxins on multiple occasions. She presents with interval history of onabotulinumtoxin A treatment in Canada followed 11 days later with a visit to the ER for pyrexia, symmetric arthralgias, and abdominal swelling. Two days prior to these symptoms, she developed utricaria at the injection sites. Concern about future onabotulinumtoxin A treatments were raised. Consultation with an allergist confirmed serum sickness likely due to albumin in onabotulinumtoxin A. Skin testing was performed with protein-free neurotoxin, and no reaction was noted. She has since undergone successful neurotoxin treatment. Serum sickness did not recur. <h3>Discussion</h3> Serum sickness is a Type III hypersensitivity reaction, mediated by IgE. It is reported in the product safety insert of onabotulinumtoxin A, but has never been reported in cosmetic onabotulinumtoxin A use. Discussion of this rare but reported complication is important as onabotulinumtoxin A use for cosmetic purposes is prevalent in medical spas and non-core physician practices where this complication could be overlooked.

The Health and Care Act and the future licensing of aesthetic practitioners providing non-surgical cosmetic procedures

David Sines answers some frequently asked questions about the new licensing scheme

LB959 The influence of social media on non-surgical cosmetic dermatologic procedures: A qualitative study using survey responses

The rise of social media in recent years has changed the landscape of social interaction and profoundly impacted culture– this study aims to identify its role in influencing society’s perceptions of non-surgical dermatologic procedures. We accomplished this by conducting a cross-sectional Qualtrics survey distributed via Instagram, Facebook, GroupMe, Twitter, and email. Questions addressed frequency and type of social media use, exposure to cosmetic procedures through these platforms, and their desires to seek out cosmetic procedures.

#CosmeticsTwitter: Predicting Public Interest in Nonsurgical Cosmetic Procedures Using Twitter Data.

The utilization of social media in plastic surgery is expanding. The Twitter Academic Research Product Tract (TARPT) database provides plastic surgeons the opportunity to monitor public interest in plastic surgery procedures. Previously, TARPT was shown to be effective in tracking public interest in surgical cosmetic facial and body procedures. The authors sought to determine the ability of the TARPT tool to track and predict public interest in nonsurgical cosmetic procedures and to examine temporal public interest trends in nonsurgical cosmetic procedures. The authors employed the TARPT tool to calculate the total number of tweets containing keywords related to 15 nonsurgical cosmetic procedures from 2010 to 2020. Annual case volumes were obtained for each of the 15 procedures from annual reports provided by the American Society of Plastic Surgeons. Univariate linear regression was employed to compare tweet volumes and procedure volumes, with P < 0.05 as a threshold for significance. Univariate linear regression revealed significant positive correlations between tweet volumes and American Society of Plastic Surgeons procedure volumes for 10 search terms representing 6 nonsurgical cosmetic procedures: "xeomin," "microdermabrasion," "facial filler," "fat filler," "fat injections," "fat transfer," "hyaluronic acid filler," "hyaluronic acid injection," "HA filler," and "PRP filler." Thirty-two search terms did not demonstrate a significant relationship. The TARPT tool is an informative data source for plastic surgeons with the potential to guide marketing and advertising strategies, and monitor public interest in nonsurgical cosmetic procedures, helping surgeons respond to patients' evolving needs.

728 Chemical Burns and Eyebrow Tinting: An Unusual Case

IntroductionHere we present the case of chemical burns following professional eyebrow tinting, a phenomenon rarely described in the literature.MethodsA 50-year-old previously healthy female presented to our emergency department for evaluation and treatment of chemical burns to her eyebrows. Fifteen days prior, she underwent professional eyebrow tinting by a local esthetician. Blistering developed the following day, and progressive swelling prompted her to present to an outside hospital. There she was prescribed acyclovir, ketoconazole cream, and silver sulfadiazine, but despite these measures, her symptoms progressed, leading to her presentation to our facility. Both brows were remarkable for significant swelling with exudative crushing on the surface concerning for superficial infection of partial-thickness chemical burns. She was prescribed bacitracin, prednisone, and clindamycin and discharged with instructions to follow up in burn clinic. Six days later, both brows had developed 2x3 cm scabs, but no signs of infection were appreciated. She was instructed to apply bacitracin/polymyxin B ointment to the scabbing areas and open wounds. Forty-nine days after her tinting, both brows were noted to be completely healed with no alopecia.ResultsBurns following cosmetic procedures most commonly occur during hair lightening treatments where products frequently contain caustic chemicals such a hydrogen peroxide or persulphates leading to oxidation reactions lightening the hair. Thermal burns in hair salons have also been reported to heated hair-dressing instruments or external heat to hasten the highlighting process.The periorbital area is becoming an increasingly popular target for nonsurgical cosmetic procedures, including permanent eyelid tattooing, eyelash dying, and extensions, more recently, eyebrow tinting. Eyebrow tinting involves the application of semipermanent dyes to give the appearance of a fuller brow. There are no FDA-approved brow tinting formulations, and many contain para-phenylenediamine (PPD), a dying agent frequently associated with allergic dermatitis and less commonly chemical burns. This patient underwent brow tinting in a professional setting and still experienced a chemical burn. As the popularity of brow tinting increases, some patients will undoubtfully seek out readily available, unregulated products for self-application. The potential for dermatitis and chemical burns following eyebrow tinting will only increase.ConclusionsEyebrow tinting is not a benign cosmetic procedure, and even professional application of dyes may lead to chemical burns. We believe an increased awareness of brow tinting and its potential complications is warranted given its increasing popularity, the preponderance of unregulated products, and the potential for poor cosmetic outcomes.

Ministers to introduce licensing for non-surgical cosmetic procedures.

Ministers to introduce licensing for non-surgical cosmetic procedures.