Plastic Surgery Procedures Research Articles

Dilemas da geração Z: até que ponto ir à procura de padrões?

The reflective critical descriptive article aims to highlight the dilemmas of the generation that is the generation that has a ton of information in the palm of their hand in fractions of seconds, through the Internet. The following categories were listed: invasive plastic surgery procedures; generation Z, self-acceptance and image and finally mental and aesthetic health. Concluding that the search for the standard and the perfect stereotype associated with the day-to-day access to social media that do not always show the real life of the “bloggers” triggers the desire and obsession for aesthetic changes, most of the time radical and unnecessary, whose ages are between 18 and 24 years. Obviously, in most cases, the lack of confidence, insecurity and the difficulty of self-acceptance, trigger psychic disorders that lead these people to never be satisfied, and in search of diverting frustrations in most invasive surgeries that end up generating the need constant change, according to the temporary standards of beauty established by the media, but in some cases it is extremely necessary, such as bariatric surgery patients.

Preserving Nasal Tip Rotation and Projection in Open Septorhinoplasty.

Background: Open septorhinoplasty is a common facial plastic surgery procedure that requires extensive planning and knowledge to achieve predictable outcomes. Many patients want to keep their nasal tip characteristics, and the surgeon's task is to reliably meet this expectation and provide stable long-term results. Techniques used to reconstruct nasal tip support include the tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures.Methods: We assessed the 1-year reliability of tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft procedures in maintaining nasal tip rotation and projection in open septorhinoplasty. We conducted a retrospective case series review of septorhinoplasty cases between 2015 and 2019 at the Medical University of South Carolina. Cases with intention to change nasal tip rotation or projection were excluded. Two blinded reviewers analyzed standardized preoperative and 1-year postoperative photographs.Results: Fifty-seven patients fit the inclusion criteria and were included in the analysis. Mean preoperative and postoperative nasal tip rotations and projection ratios were similar (P=0.62, P=0.22, respectively). Twenty-six patients underwent a tongue-in-groove procedure, 24 had a caudal septal extension graft, and 7 had a caudal septal replacement graft with preoperative nasal tip rotations of 98.93°, 99.35°, and 96.89°, respectively (P=0.73). At 1 year, patients who received a tongue-in-groove procedure had a significant increase in nasal tip rotation to 101.24° (P=0.013), while patients who received a caudal septal extension graft had a significant decrease in nasal tip rotation to 97.25° (P=0.009). Patients who received a caudal septal replacement graft had no significant change in nasal tip rotation (P=0.117). The preoperative and postoperative projection ratios were not significantly different among the 3 techniques.Conclusion: Tongue-in-groove, caudal septal extension graft, and caudal septal replacement graft are reliable techniques for maintaining nasal tip projection in open septorhinoplasty. In our experience, when attempting to maintain preoperative nasal tip rotation, the tongue-in-groove technique resulted in a significant increase in tip rotation of 2.31°, while the caudal septal extension graft resulted in a significant decrease of 2.1° at 1 year postoperatively.

Sufentanil Sublingual Tablet Reduces Postoperative Opioid Use Following Outpatient Plastic Surgery.

BackgroundThe emphasis on better pain control with less narcotic use represents an ongoing challenge for outpatient plastic surgery procedures. Intravenous (IV) bolus opioids during surgery can lead to short-term relief, but often repeat dosing is required in the postanesthesia care unit (PACU), prolonging recovery time. The sufentanil sublingual tablet (SST) has recently shown efficacy in reducing overall opioid use and postsurgical recovery time for outpatient general surgery procedures.ObjectivesTo examine the effect of SST on PACU opioid use, adverse events, and recovery time compared with traditional IV opioid drug regimens in patients undergoing aesthetic surgical procedures.MethodsA retrospective chart review was performed on SST patients (n = 61) receiving a single 30 mcg SST 30 minutes before surgery (for short procedures) or 45 minutes before surgical extubation (longer procedures). A control group (n = 32) underwent similar surgical procedures utilizing standard IV opioid treatment without SST.ResultsControl and study groups were of similar age and sex. Procedure duration (approximately 3 hours) and intraoperative opioid administration were similar in both groups, with 92% of patients receiving SST before extubation due to the length of the case. Almost all control patients (90.6%) required rescue opioids during recovery in the PACU compared with a few SST patients (16.4%; P < 0.001), averaging 5-fold higher dosing in the control group. Recovery duration did not differ between groups as factors other than pain management and adverse events affected discharge.ConclusionsSST substantially reduced opioid administration in the PACU for patients undergoing outpatient plastic surgery procedures.Level of Evidence: 3

Glosa do Wyroku Trybunału Konstytucyjnego Republiki Kolumbii z dnia 26 kwietnia 2017 r., sygn. akt C-246/17

This paper studies the case law of the Constitutional Court of the Republic of Colombia of 26 April 2017 (Case C-246/17) which interpret the capacity of the minor to give informed consent to aesthetic medicine and plastic surgery treatments, as well as participation of such person in campaigns promoting this type of treatments. In this case, the Court first decided that the ban on aesthetic medicine and plastic surgery procedures for minors should not be applied to adolescents over 14 years of age who, due to their level of development, are able to participate together with persons having parental authority in the decision-making about the risks involved in such procedures and are able to consent to the procedure in an informed and qualified manner. The Constitutional Court also finds that the prohibition on participating in campaigns promoting cosmetic medicine clinics and the treatments carried out there, which applies to persons aged between 15 and 18, is a proportionate and effective restriction. In this way, the legislator achieves constitutionally legitimate objectives, i.e. discouraging treatments that may expose the health of a minor to unnecessary risks and reducing gender stereotypes regarding a certain canon of beauty. In assessing this ruling, the article examines the concepts of: “free development of personality”, “right to privacy”, “informed consent to medical treatment” of minors, as well as “legal moralism” and “paternalist measures”. To this end, a dogmatic method was used by reviewing the case law of the Constitutional Court of the Republic of Colombia, and the results obtained were presented through a descriptive method. In the conclusions, attention is drawn to the consistent doctrine existing in the Court’s jurisprudence relating to the concepts.

Simulation and Optimization of Reconstructive Surgery Procedures on Human Skin

Simulation and Optimization of Reconstructive Surgery Procedures on Human Skin

Forehead soft tissue trauma: Concealed by the art of plastic surgery

A 22 year old lady, who is a stage performer presented with a history of trauma to the forehead following a road traffic accident (Figure 1). The post traumatic image of her face was heartbreaking for her. Patient was taken for Plastic surgery procedure under general anaesthesia. Procedure was started using the principles of microdebridement, tissue undermining, tissue stretching and relaxation, extending the incision beyond the trauma along the Langer’s lines, layered suturing and preserving the anatomical landmarks like hairline and position of eyebrows. A trapezoid-shaped defect of size 10 cm transversely and 5 cm vertically was there after debridement (Figure 2). We could close the defect primarily without the need for skin grafting or did not leave residual raw areas for secondary healing. Finally, with patience after around 2.5 hours, we could achieve a result like this following the surgery (Figure 3). Close follow up and scar reduction measures like massage, creams and direct sunlight prevention for 1 year delivered us a good result.

Improved Vascularization and Survival of White Compared to Brown Adipose Tissue Grafts in the Dorsal Skinfold Chamber.

Fat grafting is a frequently applied procedure in plastic surgery for volume reconstruction. Moreover, the transplantation of white adipose tissue (WAT) and brown adipose tissue (BAT) increasingly gains interest in preclinical research for the treatment of obesity-related metabolic defects. Therefore, we herein directly compared the vascularization capacity and survival of WAT and BAT grafts. For this purpose, size-matched grafts isolated from the inguinal WAT pad and the interscapular BAT depot of C57BL/6N donor mice were syngeneically transplanted into the dorsal skinfold chamber of recipient animals. The vascularization and survival of the grafts were analyzed by means of intravital fluorescence microscopy, histology, and immunohistochemistry over an observation period of 14 days. WAT grafts showed an identical microvascular architecture and functional microvessel density as native WAT. In contrast, BAT grafts developed an erratic microvasculature with a significantly lower functional microvessel density when compared to native BAT. Accordingly, they also contained a markedly lower number of CD31-positive microvessels, which was associated with a massive loss of perilipin-positive adipocytes. These findings indicate that in contrast to WAT grafts, BAT grafts exhibit an impaired vascularization capacity and survival, which may be due to their higher metabolic demand. Hence, future studies should focus on the establishment of strategies to improve the engraftment of transplanted BAT.

Moriarty's sign - predictor of skin graft take.

Resurfacing wound beds with split skin graft is the most common procedure in plastic surgery. Association of more pain in the donor site than in the recipient site has been used as apredictor of successful graft take by Stark in 1962 who termed it Moriartyssign. The aim of the study was: 1) to predict the successful take of skin graft by eliciting Moriartyssign; 2) to decide the day of first graft inspection based on Moriartyssign. The authors hereby present aprospective study in 100 patients who underwent wound resurfacing with split thickness skin graft at the Department of Plastic Surgery in atertiary care center between January 2014 and June 2015. The area with more pain, absence of pain or equivocal response at the graft donor site was recorded on the visual analog scale for 10 days. In this study, 80 patients had positive Moriartyssign, 12 patients had equivocal responses and 8 patients showed anegative sign. Patients with positive Moriartyssign underwent their first graft inspection on 10th postoperative day and showed 100% graft take. Twelve patients with equivocal response underwent first graft inspection on 5th day and had 70-80% graft take. In 8 patients, with negative Moriartyssign first graft inspection done on 3rd day, the graft take was &lt; 50%. The study demonstrates that Moriartyssign is areliable clinical predictor of split thickness skin graft take and may be useful as aguide to determine the day of first graft inspection. It is an effective method even for junior members of the surgical and nursing team to monitor parameters in relation to this sign. It can be practiced in asmaller group of hospitals, too. Hence, the authors recommend to integrate this clinical assessment in routine practice.

Identifying the most attractive umbilical position – an eye tracking- and survey-based investigation

Abdominoplasty is a popular procedure in plastic surgery providing aesthetic, functional and psychological relief for patients suffering from excess abdominal tissue. Correct umbilical positioning is crucial for a successful aesthetic surgical outcome. This study aims to assess the most attractive position of the umbilicus by means of subjective and objective outcome measures. 58 Caucasian study participants with a mean age of 36.87 (15.6) years rated eight different umbilical positions. The various positions were determined based on the ratio of the distance between the xiphoid process and the umbilicus and the distance between the umbilicus and the infra-umbilical crease: 1:1, 1.25:1, 1.5:1, 1.75:1, 2:1, 2.5:1, 3:1 and 5.5:1. Semi-quantitative scoring of attractiveness based on a 5-point Likert scale and eye tracking analyses were utilized. The results revealed that the volunteers perceived as most attractive the ratio of 2:1 with 4.32 (out of possible 5.0). The ratio of 5.5:1 received the lowest rating with 1.8. The results of the objective eye tracking analyses confirmed the subjective rating as the 2:1 ratio was fixated last amongst all other displayed ratios with 1.85 s whereas the 5.5:1 ratio had the shortest interval between image display and first stable eye fixation with 0.94 s. The study confirms the concept of ‘internal representation of beauty’. Abdominoplasty procedures could rely on this easy to perform ratio by dividing the distance into thirds and using the boundary between the inferior and middle third as a clinically reliable landmark.

Association of a Statewide Opioid Legislation with Opioid Prescribing Patterns in Facial Plastic and Reconstructive Procedures.

Background: The Michigan Opioid Laws are legislation enacted between 2017 and 2018 as a strategy to combat the growing opioid crisis. Objective: To compare opioid prescription rates and morphine milligram equivalents (MMEs) of opioid prescribed to patients undergoing various facial plastic and reconstructive surgery (FPRS) procedures before, during, and after legislation enactment. Materials and Methods: This is a cross-sectional retrospective review of subjects undergoing any of 10 FPRS procedures between July 2016 and November 2019 at a tertiary care hospital with analysis of demographic factors, opioid prescription rates, and MMEs over time. Results: Of 863 patients included, 107 and 575 patients were prescribed postoperative opioids before and after opiate legislation enactment, respectively, with no difference in baseline demographics between groups. Regression analysis showed no change in MME prescribing in the year before legislation (p = 0.70), followed by a decrease of 0.13 MME per day (p = 0.00), with a subsequent stabilization of MME at a reduced rate for the remainder of the study period (p = 0.74). Conclusion: Enactment of the Michigan Opioid Laws was temporally associated with a decrease in opioid prescriptions for common facial plastic surgery procedures.

Aesthetic and Functional Abdominoplasty: Anatomical and Clinical Classification based on a 12-year Retrospective Study.

Background:Abdomen reshaping is a common plastic surgery procedure, and numerous surgical techniques have been described in the scientific literature. To standardize surgical approach, we propose our protocol that correlates patients’ anatomy with the type of procedure performed.Methods:Between 2008 and 2020, we retrospectively analyzed 582 consecutive female patients who underwent abdomen reshaping procedures, assessing anatomical features, complication rate, patient satisfaction, and surgical result, comparing them with previous reports in the literature. Aesthetic outcomes were evaluated with VAS scale (0–10).Results:Among the 582 patients recruited in the study, we performed 74 liposuctions as a single procedure, 62 mini-abdominoplasties, 28 T-inverted abdominoplasties, and 418 full-abdominoplasties. Aesthetic outcome evaluation reported a mean value of 8.2 from patients and 7.8 from surgeons. We experienced four early postoperative bleedings requiring hemostasis revision, 18 wound dehiscences, five seromas, and 24 re-interventions for aesthetic issues. We found no differences in the complication rate while comparing our data with previous reports in the literature.Conclusions:Our protocol and surgical technique have proved to be effective, safe, and reproducible, with high patient and surgeon satisfaction, low complication rate, and fast recovery time.

Plastic surgery in a trauma center: a multidisciplinary approach for polytrauma patients.

With the increasing number of polytrauma patients treated at high-level trauma centers, plastic surgery has entered the specialty of traumatology. Plastic surgeons specialize in the simultaneous surgical care of patients with facial or hand trauma and soft tissue injuries requiring microsurgery. The purpose of this study was to introduce the role of plastic surgery in a high-level trauma center. Between January 2020 and December 2020, 5,712 patients with traumatic injuries were admitted to the emergency department of a tertiary hospital. Of these 5,712 patients, 1,578 patients were hospitalized for surgical treatment and/or critical care. Among the 1,578 hospitalized trauma patients, 551 patients (35%) required at least one plastic surgery procedure. The patient variables included age, sex, etiology, the injured area, and injury characteristics. We also retrospectively investigated surgical data such as the duration of the operation, hospital stay, length of time from injury to surgery, and collaboration with other departments. The most common injury referred to plastic surgery was facial trauma (41%), followed by hand trauma (36%), and soft tissue injuries requiring microsurgery in various parts of the body other than the hand (7%). The majority of facial and hand traumas were concomitant injuries. Sixteen percent of patients underwent collaborative surgical management for polytrauma involving both plastic surgery and another department. The role of plastic surgery in multidisciplinary teams at high-level trauma centers has become increasingly important. The results of this study may help in the development of multidisciplinary trauma team strategies and future workforce planning.

Nationwide analysis of plastic and reconstructive procedural volume in the United States during the COVID-19 pandemic

IntroductionThis study aims to define the impact of the novel Coronavirus Disease 2019 (COVID-19) pandemic on the volume of common plastic and reconstructive procedures in the United States.MethodsTrinetX is a national, federated database that was utilized in surveying plastic and reconstructive procedural volumes among 53 Healthcare organizations (HCO) between March 2018 and May 2021. This timeframe was divided into pre-pandemic (March 2018 to February 2020) and pandemic periods (March 2020 to May 2021). Each period was then sub-divided into four seasons of the year and the mean monthly procedural volume per HCO was compared. A student's t-tests comparing pre-pandemic and pandemic seasonal mean procedural volumes were used for statistical analysis.ResultsA total of 366,032 patient encounters among 53 HCO were included. The average seasonal volume per HCO of all procedures reduced from 872.11 procedures during pre-pandemic seasons to 827.36 during pandemic seasons. Spring 2020 vol declined for most procedures as 15 of 24 (63%) assessed procedure categories experienced statistically significant decreases. Spring 2021 experienced rebounds with 15 of 24 (63%) assessed procedures showing statistically significant increases.ConclusionDuring the pandemic period, the average procedural volume per HCO of 14 procedure categories was significantly less than the pre-pandemic average procedural volume. Overall, an inverse relationship was observed between novel COVID-19 cases and plastic and reconstructive surgery procedure volumes in the United States.

Postoperative pain and opioid use after breast reduction with or without preoperative nerve block

Physician-prescribed opioids have been implicated as key contributing factors in the current opioid epidemic in the United States. Breast reduction mammoplasty is one of the most commonly performed procedures in plastic surgery and patients are often prescribed large amounts of postoperative opioids. Here we investigate the effects of erector spinae nerve blocks on postoperative pain, opioid consumption, and quality of life after breast reduction.Following the institutional review board (IRB) approval, a prospective cohort study of some patients undergoing breast reduction mammoplasty at Montefiore Medical Center between June and September 2019 was undertaken. The patients were stratified into two cohorts for further analysis: those who received preoperative erector spinae nerve block and those who did not. Primary outcomes measures analyzed included Likert pain scores, patient-reported outcome measures, and opioid consumption for the first five postoperative days.Forty-seven patients were enrolled in the analysis. Thirteen patients (28%) received nerve blocks, 34 (72%) did not. On average, the patients were prescribed 114.3 (±34.6) morphine equivalents postoperatively and they consumed 45% (±35.3) by the end of the first five days post-surgery. There were no significant differences between cohorts in morphine equivalents prescribed or consumed, postoperative pain scores, or patient-reported outcome measures.Following breast reduction mammoplasty, patients on average consumed < 50% of prescribed opioids, suggesting over-prescription of postoperative opioids for breast reduction recovery. Preoperative nerve block did not improve pain scores or decrease opioid consumption for the first five days after surgery.

The Impact of Obesity on Plastic Surgery Outcomes: A Systematic Review and Meta-analysis.

Obesity is a potential risk factor for complications in plastic surgeries. However, the data presented by primary studies are contradictory. The aim of this study was to summarize and clarify the divergences in the literature to provide a better understanding of the impact of obesity in different plastic surgery procedures. We conducted a systematic review and meta-analysis of the impact of obesity on plastic surgery outcomes. Searches were conducted in MEDLINE, LILACS, SciELO, Scopus, Embase, Web of Science, Opengrey.eu, and the Cochrane Database of Systematic Reviews. The primary outcomes assessed were surgical complications, medical complications, and reoperation rates. The secondary outcome assessed was patient satisfaction. Subgroup analysis was performed to investigate the impact of each BMI category on the outcomes. Ninety-three articles were included in the qualitative synthesis, and 91 were used in the meta-analysis. Obese participants were 1.62 times more likely to present any of the primary outcomes (95% CI, 1.48-1.77; P < 0.00001). The highest increase in risk among plastic surgery types was observed in cosmetic procedures (risk ratio [RR], 1.80; 95% CI, 1.43-2.32; P < 0.00001). Compared with normal-weight participants, overweight participants presented a significantly increased RR for complications (RR, 1.16; 95% CI, 1.07-1.27; P = 0.0004). Most authors found no relation between BMI and overall patient satisfaction. Obesity leads to more complications and greater incidence of reoperation compared with nonobese patients undergoing plastic surgeries. However, this effect is not evident in reconstructive surgeries in areas of the body other than the breast.

“Identification of Essential Assessment Criteria in Facial Botulinum Toxin Injections”

Facial botulinum toxin injections represent the most commonly performed aesthetic non-surgical procedures by plastic surgeons; however, post-graduate programs remain devoid of objective tools to adequately assess competence in trainees. In this study, the authors employ the Delphi methodology to establish a list of essential assessment criteria in facial botulinum toxin injections. A list of 10 suggested criteria was generated through a literature search and in consultation with an expert plastic surgeon. A panel of content experts was selected to which an online survey was administered; skills were ranked for their relevance using a 1-10 Likert scale. Recommendations for additional skills were solicited and survey rounds were repeated until consensus was achieved. The latter was a measure of panelist reliability and assessed using Cronbach α (≥0.8); skills with a rating of 7 or above were taken to be essential. The survey process was successful at achieving consensus following two rounds of survey administration. Twenty-one participants completed the first round representing a response rate of 38%. Percent agreement among the panel was 83% and Cronbach α was computed as 0.78, necessitating further rounds. The response rate in the second round was 90%; one additional skill was added; percent agreement and Cronbach α improved to 88% and 0.87, respectively. Nine assessment criteria were identified as essential in facial botulinum toxin injections; these findings provide the groundwork necessary for the development of an objective assessment tool for the more appropriate training of marginalized aesthetic procedures in plastic surgery.

Objectifying High-Definition Brazilian Buttock Lift Results Using the Buttock Assessment Tool.

The buttock is an essential feature of the female silhouette. This has led to the rise of the Brazilian butt lift as one of the most popular plastic surgery procedures in recent years. Despite this popularity, there remains no prevailing standard for the ideal buttock size and shape. In fact, a wide range of preferred sizes and shapes among the authors' patients has been observed. The authors hypothesized that age, religious affinity, and ethnic differences may demonstrate different buttock size and shape preferences. The authors designed the buttock assessment tool, which utilizes digitally altered buttock sizes and shapes to determine desired buttock shape (upper, middle, and lower pole maximum fullness) and buttock size (waist-to-hip width ratio) for both the posteroanterior and lateral views. A survey of 422 patients was completed, evaluating variation of desired buttock size and shape based on patient age, cultural, and ethnic differences. There were significant differences in buttock size and buttock shape based on age, ethnicity, and religion. Hispanics and African Americans were twice as likely as Caucasians to request lower pole fullness in the posteroanterior view. Older respondents preferred a smaller buttock in both views. African Americans preferred a larger buttock compared to Caucasians in both views. Hispanics preferred a larger buttock in only the lateral view. Muslim respondents preferred a smaller buttock in the posteroanterior view. The Brazilian buttock assessment tool has become critical to understanding and delivering prospective Brazilian butt lift patients' goals by objectifying buttock size and shapes.

TP10.1.7New Minor Surgical Set as a way to improve surgical efficiency during COVID-19 pandemic

AimsLarge number of paediatric plastic surgical procedures were identified in Evelina Hospital during COVID-19 pandemic as not requiring large conventional surgical operative sets that can contain at average 35 instruments. Large sets are more expensive, take longer preparation time due to instrument counting and as a consequence take more total operating time. Furthermore, more instruments need to be unnecessarily purchased, stored and cleaned post procedure.Simple paediatric plastic surgery procedures including nailbed repair or laceration repair require limited and largely replicating operative instrument set. We have therefore introduced Small Minor Plastic Surgical set (MS) containing only 10 instruments. We audited its effectiveness and introduced a revised version of the set as per feedback, permanently arranged into theatre operative set collection.MethodsMS set was introduced and used at senior surgeons discursion for paediatric plastic surgical procedures. Feedback was gathered from the surgeon and scrub nurse via specially designed questionnaire at post operation and theatre team debrief. Suggested alterations were implemented and New Minor Surgical (NMS) set was introduced and re-audited using revised questionnaire.Results61% of surgeons and 89% of scrub personnel thought MS set contained everything that was needed for the case. Following revision 91% of surgeons and 95% of scrub nurses thought NMS set contained all necessary equipment for the operation.ConclusionsNMS set introduced into daily surgical practice in Evelina Hospital theatres improved overall staff satisfaction when considering both surgeon and nursing staff. It provided cost- and time-effective operative set now vastly used across surgical specialities.

Effectiveness of a 1-Hour Event on Medical Students' Perceptions of Plastic and Reconstructive Surgery.

While the broad diversity of procedures is a hallmark of plastic surgery that attracts many young trainees, the extensive breadth of the specialty can lead to dramatic misunderstandings about the scope of practice of plastic surgeons by both the public and medical professionals alike.1 As the field of plastic surgery is amid a national transition toward integrated residency programs, it is important now more than ever to expose medical students to plastic surgery early in their education. Medical schools have the unique and critical task of educating future physicians on the scope of surgical subspecialties. However, plastic surgery inclusion in medical education curricula is minimal to absent at most medical schools.2,3 We therefore recruited 31 medical students to participate in a 1-hour lecture and complete prelecture and postlecture questionnaires to determine their understanding of a career in plastic surgery and plastic surgery procedures. We found that a 1-hour educational course is effective in improving medical students’ knowledge of plastic surgery procedures. Before the intervention, students associated plastic surgery most highly with cosmetic procedures and reconstructive procedures of the breast. After the intervention, there was a statistically significant increase in students correctly identifying that “bread and butter” procedures, such as free flaps, carpal tunnel releases, orbital floor fractures, and hand tendon lacerations, are frequently treated by plastic surgeons (p < 0.05) (Fig. 1). There was also a 15.2 percent increase in participants who considered plastic surgery to be a “lifesaving” field of medicine (p < 0.05). In examining perceptions of a plastic surgery career, there was a 12.1 percent increase after the lecture in choosing lifestyle as an appealing aspect of the specialty (p < 0.05), while there were no significant changes in any of the negative perceptions studied (competitiveness, lack of relatable role models, demanding training, and so on) (Fig. 2). Despite these findings, there was no associated increase in interest in pursuing plastic surgery as a career after the event.Fig. 1.: Change in correctly identifying procedures and pathologies as related to plastic surgery.Fig. 2.: Change in perceptions of plastic surgery as career.Prior studies have attempted to quantify baseline plastic surgery medical student knowledge and provide education about the specialty via emailed surveys and 1-day courses that included presentations and surgical skills practice.4,5 Some of this work, although important, took place in the United Kingdom, where medical and surgical training is structured differently than in the United States.5 This 1-day format is likely not feasible to be incorporated into the already-dense U.S. medical school curriculum. Our study demonstrates the importance of establishing surgical subspecialty education early in medical school, especially given the trend toward integrated training programs. The lecture event provided adequate education about the procedures involved in plastic surgery, which will be valuable for all future physicians with regard to making appropriate referrals and consultations. However, a 1-hour event may fall short in recruiting medical students to plastic surgery careers. In our anecdotal experience, many plastic surgery departments or divisions host little more than an annual medical student interest group lecture in an effort to attract students to our field. To achieve this goal will likely require surgical subspecialties to be more inventive and creative in how they engage students and introduce them to their fields. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

"Zoom Dysmorphia": A New Diagnosis in the COVID-19 Pandemic Era?

The coronavirus disease of 2019 pandemic, widely referred to as COVID-19 (SARS-CoV-2), has dramatically changed the global status quo, as it has serious implications both individually and socially. Governmental guidelines have enforced quarantine as a means of social distancing to get control of viral spread. Social isolation results in stress, acne, hair loss, depression, alcohol/substance abuse, and an increase of youth considering suicide in the United States.1 In an effort to sustain existing social connections, people are extensively using digital platforms such as Zoom (Zoom Technologies, Inc., San Jose, Calif.). Real-time web camera communication prevents the use of photo-editing tools. As a result, people have an increased awareness of physical features they perceived as flawed. This exaggerated self-criticism creates a form of body dysmorphia, similar to body dysmorphic disorder, leading to dissatisfaction and a desire to seek cosmetic surgery.2 Body dysmorphic disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (300.7, F45.22). It is associated with obsession over minimal, inconspicuous, or inexistent imperfections in one’s appearance. This extreme preoccupation may lead to significant psychological distress, functional impairment in social, occupational, or other areas of life, and even suicidal tendencies. Patients diagnosed as having the disorder are commonly unhappy with the postoperative results from the aesthetic interventions they pursue.3 Stay-at-home orders, being surrounded by mirrors, isolation, and spending prolonged time on social media and on web camera act as triggers for a full-blown body dysmorphic disorder exacerbation. In 2019, 72 percent of the American Academy of Facial Plastic and Reconstructive Surgery members reported seeing patients seeking cosmetic procedures to improve their selfies. The exponential increase in Zoom and virtual meetings has led to a high demand for cosmetic surgery.4 A survey is indicated to assess the extent of plastic surgery procedures performed in response to “Zoom dysmorphia.” During consultations, plastic surgeons should make surgical candidates aware that the camera often distorts facial features due to technical aspects (i.e., focal length).5 Also, they should take preoperative photographs of the patients, in order to address objective findings, so that patients have realistic expectations. DISCLOSURE The authors have no financial interest in any of the products or devices mentioned in this article.