Cosmetic Surgery Practice Research Articles

Pursuing beauty: socio-cultural and labor-economic determinants of cosmetic surgery consideration among female college students in China.

Cosmetic surgery has a profound impact on health and other aspects. As a means of enhancing physical attractiveness, it is increasingly being considered by female college students in China. However, current knowledge about the determinants of cosmetic surgery consideration among Chinese female college students still needs to be improved due to the lack of systematic perspectives and large-scale representative data sets. This study aimed to contribute to the literature in these two aspects. We framed cosmetic surgery consideration as a function of two broad sets of determinants: socio-cultural and labor-economic. We used data from a large, nationally representative sample of female college students in China (N = 6658, mean age = 20.3years). In terms of socio-cultural oriented factors, we found that family socioeconomic status, peers' cosmetic surgery practices, and media exposure were positively associated with the likelihood of considering cosmetic surgery. In terms of labor-economic oriented factors, we found that self-rated physical appearance, higher grades, and expected income after graduation were positively associated with a higher likelihood of considering cosmetic surgery. These findings suggest that the decision-making process for cosmetic surgery among Chinese female college students goes beyond personal factors and is significantly influenced by structural factors.

A 7-Year Retrospective Analysis of Hymenoplasty: Profiles From a Specialized Gynecological Cosmetic Surgery Practice.

Hymenoplasty-surgical reconstruction of the hymen-is on the rise in Turkey, reflecting the enduring importance of virginity which is rooted in sociocultural and religious beliefs. Demographic factors shape women's decisions regarding this procedure. The aim of this investigation was to delve into the multifaceted perceptions around virginity and hymenoplasty in Turkey, examining the impact of sociocultural and religious beliefs on women's decisions. The study also explored demographic influences, offering insights into the societal and cultural backdrop of hymenoplasty. A 7-year retrospective analysis of 4259 patient records (2015-2022) at a private clinic was conducted, and statistical tools were used to meticulously analyze data on demographics and shared decision-making dynamics. In the examined cohort (83.3%), the choice of permanent hymenoplasty was prevalent among individuals aged 14 to 49 years, with 58.6% being engaged and seeking the procedure a week before marriage. Notably, 91.0% were accompanied by friends during consultations, and a minority disclosed a history of childbirth or experience of forced intercourse. An increasing trend in first-time and post-assault hymenoplasty procedures was observed in 2021. Geographically, the majority of individuals resided in Istanbul, but represented all Turkish regions. Additional procedures such as vaginoplasty were common, with mostly successful postprocedural outcomes and minor complications. This study highlighted the enduring social importance of virginity in Turkey, emphasizing hymenoplasty as a coping strategy for psychological and societal challenges. The study calls for comprehensive patient support and societal progress in respecting women's bodily autonomy, urging a shift away from the cultural fixation on virginity.

Scope of practice regulation in medicine: balancing patient safety, access to care and professional autonomy.

Scope of practice regulation in medicine is crucial for ensuring patient safety, access to care and professional autonomy. This paper explores the impact of scope of practice regulation on healthcare delivery, professional responsibilities and patient outcomes. It discusses the variability in standards for safe practice, the challenges in defining boundaries between medical specialties and the recent controversies in cosmetic surgery practice. The paper also examines the potential benefits and drawbacks of rigorous scope of practice regulations, including their impact on clinical innovation, flexibility and access to care. Furthermore, it delves into the implications of defensive medicine and the consequences of restrictive regulations on patient care. The author proposes implementing a proactive, national, artificial intelligence-powered, real-time outcome monitoring system to address these challenges. This system aims to cover every patient undergoing a surgical procedure and could be gradually extended to non-surgical conditions, benefiting all key stakeholders in the health system. The paper emphasises the need for a balanced approach to scope of practice regulation to avoid stifling clinical innovation and professional autonomy, while ensuring patient safety and professional accountability.

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.

A Study on the Ramifications of Silicon as a Semiconductor Being Used Heavily In the Practice of Cosmetic Surgery

A Study on the Ramifications of Silicon as a Semiconductor Being Used Heavily In the Practice of Cosmetic Surgery

Effect of Truth-in-Advertising Laws on Who Is Advertising Cosmetic Surgery Practices on Social Media.

Effect of Truth-in-Advertising Laws on Who Is Advertising Cosmetic Surgery Practices on Social Media.

Cosmetic surgery procedures accessed by Nigerian women at a single private cosmetic surgery practice: A retrospective review.

Little is known about the cosmetic surgery procedures sought by Nigerian women. Aim: We sought to report the proportion of cosmetic surgery procedures accessed by Nigerian women and determine any associations between the demographics and cosmetic procedures accessed. A retrospective review was conducted between January 2020 and July 2021 of all cosmetic surgery procedures at a single private cosmetic surgery practice. Data were analyzed using means, Mann-Whitney U-test, chi square test, and Fisher's exact test as appropriate. The statistical significance was set at P ≤ 0.05. Of the 392 consultations for cosmetic procedures, 245 (62.5%) patients accessed cosmetic surgery. Most were women (239 (97.6%)) and single (178 (72.7%)). The median age of the patients at surgery was 29.0 years (IQR 26-33), the median weight was 78.8 kg (IQR 71.4-88.8), and the median body mass index (BMI) was 28.1 (IQR 25.7-32.3). Liposuction was the procedure accessed by nearly all the patients (224 (91.4%)). Next to this was bilateral buttock augmentation (199 (81.2%)). Other cosmetic procedures such as tummy tuck, facial cosmetic surgery, umbilicoplasty, and labiaplasty each constituted less than three percent of the patients. The abdomen (224 (91.4%)), back (219 (89.4%)), and arms (79 (32.2%)) were the most common regions of the body sought for liposuction, while the calves (2 (0.8%)) were the least. Liposuction of the arms was associated with the BMI (p < 0.003). Liposuction and bilateral buttock augmentation are the most common cosmetic surgery procedures accessed by this cohort of Nigerian women.

Analysis of In Vivo Skin Anisotropy Using Elastic Wave Measurements and Bayesian Modelling

In vivo skin exhibits viscoelastic, hyper-elastic and non-linear characteristics. It is under a constant state of non-equibiaxial tension in its natural configuration and is reinforced with oriented collagen fibers, which gives rise to anisotropic behaviour. Understanding the complex mechanical behaviour of skin has relevance across many sectors including pharmaceuticals, cosmetics and surgery. However, there is a dearth of quality data characterizing the anisotropy of human skin in vivo. The data available in the literature is usually confined to limited population groups and/or limited angular resolution. Here, we used the speed of elastic waves travelling through the skin to obtain measurements from 78 volunteers ranging in age from 3 to 93 years old. Using a Bayesian framework allowed us to analyse the effect that age, gender and level of skin tension have on the skin anisotropy and stiffness. First, we propose a new measurement of anisotropy based on the eccentricity of angular data and conclude that it is a more robust measurement when compared to the classic “anisotropic ratio”. Our analysis then concluded that in vivo skin anisotropy increases logarithmically with age, while the skin stiffness increases linearly along the direction of Langer Lines. We also concluded that the gender does not significantly affect the level of skin anisotropy, but it does affect the overall stiffness, with males having stiffer skin on average. Finally, we found that the level of skin tension significantly affects both the anisotropy and stiffness measurements employed here. This indicates that elastic wave measurements may have promising applications in the determination of in vivo skin tension. In contrast to earlier studies, these results represent a comprehensive assessment of the variation of skin anisotropy with age and gender using a sizeable dataset and robust modern statistical analysis. This data has implications for the planning of surgical procedures and questions the adoption of universal cosmetic surgery practices for very young or elderly patients.

Offering No-Cost Cosmetic Revisions: The Experience of an Academic Cosmetic Surgery Program.

The financial principles of a no-cost revision policy and their implications for revision rates are not well understood. Therefore, the primary objective of this retrospective study is to report our no-cost revision rates and, secondarily, to survey the cosmetic revision policies of other cosmetic surgery practices and detail the financial principles underpinning no-cost revisions. All aesthetic surgeries and no-cost revisions performed by the plastic surgeons, oculoplastic surgeons, and facial plastic and reconstructive surgeons at our academic outpatient cosmetic surgery center from January 1, 2016 to June 30, 2022 were identified using procedural codes. Data on the number of surgeries, number of revisions, operative minutes, and time intervals between initial and revision surgeries were collected. A survey was administered to assess the revision policies of similar cosmetic surgery practices. A total of 1491 aesthetic surgeries and minimally invasive procedures were included, and 125 revision procedures were performed (8.4%). Thigh lifts (3, 13.6%), rhinoplasties or septoplasties (25, 15.8%), and otoplasties (3, 27.3%) had the highest revision rates. Three practices (15%) offered cosmetic revisions at no cost, 9 (45%) did not apply a surgeon's fee, 5 (25%) evaluated fees on a case-by-case basis, 1 (5%) offered revisions with an insurance policy, and 2 (10%) cosmetic surgery practices did not offer revisions at a reduced rate. Despite offering revisions at no cost, our revision rates are reasonable for an academic cosmetic surgery practice. The revision policies offered to patients on the private market are varied, but most surveyed practices offer revisions at either a reduced rate or no cost.

Shopping on Social Media for a Cosmetic Surgeon? The Impact that Truth in Advertising Laws Have Had on Who Is Behind the Most Popular Social Media Accounts That Are Advertising Cosmetic Surgery Practices

Shopping on Social Media for a Cosmetic Surgeon? The Impact that Truth in Advertising Laws Have Had on Who Is Behind the Most Popular Social Media Accounts That Are Advertising Cosmetic Surgery Practices

Efficacy of Medical Weight Loss in the Cosmetic Surgery Practice

Introduction: Weight loss is an achievement desired by many in our current society. Those who struggle to obtain their desired result with diet and exercise regimens are interested in other options. Although bariatric surgery is undeniably the surest way to achieve dramatic weight loss results, many patients are ineligible for the procedure or are uneasy regarding the surgery and desire an alternative. Thus, medical weight loss is a suitable option for many of these patients. Materials and Methods: We postulated that cosmetic patients undergoing medical weight loss would be more aggressive toward losing weight, which would synergistically result in a more significant degree of weight loss compared with noncosmetic, control patients. Results: Our retrospective study revealed no statistically significant difference in the weight loss achieved by each group. Conclusion: We concluded that medical weight loss does not act synergistically with a desire to improve one’s cosmesis; however, as both groups lost weight efficaciously, it can be concluded that medical weight loss can be used as an effective tool in a cosmetic practice for eligible patients.

Are Delayed Dermal Filler Granulomas More Common Since COVID-19?

PurposeGranuloma and delayed inflammatory reaction to hyaluronic acid (HA) facial esthetic fillers occurs rarely. More recently, these reactions have been reported with increasing frequency and have been associated with COVID-19 infection. The purpose of the study is to determine if delayed filler granulomas are more common after the start of the COVID-19 pandemic.MethdosA retrospective cohort study including of all patients treated with dermal filler at 4 offices of a single cosmetic surgery practice between August 1st, 2018 and October 31st, 2021 was performed. The primary outcome variable was granuloma formation. The primary predictor variable was time period, either pre-COVID (8/1/18-2/29/20) or post-COVID (3/1/20-10/31/21). Other study variables recorded were age, amounts of dermal fillers used, and types of dermal filler used. Data was analyzed using chi-squared, t-tests and logistic regression.ResultsOver the study period, 3,255 patients receiving 8,067 syringes of filler over 6,800 sessions were reviewed. The average patient age was 46.8 ± 13.7 years and 2,583 sessions were performed in the pre-COVID time period and 4,217 sessions in the post-COVID time period. There were 11 granulomas in 9 subjects receiving filler in the post-COVID time period and 0 granulomas in the pre-COVID time period (0.3% vs 0.0%, respectively, p = 0.009). Juvederm Vollure was used in 64% of patients who developed granulomas, but only accounted for 26% of filler administrations in the post-COVID time period and 28% in the cohort overall (p=0.02).ConclusionGranuloma formation is a rare complication of HA filler injection that appears to be occurring with more frequency following the COVID-19 pandemic. Practitioners who administer dermal fillers should be aware of this complication and its apparent increased incidence

Commentary on: The Macrotextured Implant Recall: Breast Implant-Associated Anaplastic Large Cell Lymphoma Risk Aversion in Cosmetic and Reconstructive Plastic Surgery Practices.

Commentary on: The Macrotextured Implant Recall: Breast Implant-Associated Anaplastic Large Cell Lymphoma Risk Aversion in Cosmetic and Reconstructive Plastic Surgery Practices.

Concepts in Hip Implant Body Contouring: Patient Evaluation &amp; Implant Fabrication

Introduction: One of the most requested aesthetic procedures is body contouring using liposuction. Adjunctive procedures using fat grafting can provide enhancement in most body areas, commonly used in both gluteal and hip augmentation. Performing processing and enrichment to optimize fat transfer survival can avoid the use of body implants. When there is insufficient fat for the desired degree of augmentation, silastic implant placement is an alternative treatment. Much has been written in the medical cosmetic literature regarding gluteal and breast implants, but nothing in terms of hip silastic implants. Material and Methods: Hip implant patient selection, the body frame analysis, associated enhancing body contouring procedures, implant design and fabrication, and implant surgical placement are analyzed. In 3 different cosmetic surgery practices, methods of patient analysis and the process of creating a custom hip implant is presented. Techniques and protocols in the use of fat grafting in association with both gluteal and hip implants are elucidated. Results: The minimally manipulating fat maneuvers to increase fat survival are detailed. This paper defines the process of planning, designing, and fabricating a custom hip implant with significant patient input. By definition, patient-specific or custom implants can be any shape, size, and projection. The patient and surgeon provide the implant fabrication company a paper tracing of the surface area of the proposed implant along with the maximum projection. Engineering creates a 2-dimensional drawing using a computational software for intelligent system design or CAD. The implants are fabricated with input from the surgeon on silastic durometer, implant alterations to lower weight and enhance ease of folding for placement, and shape. Caveats and pitfalls in surgical planning, implant design, fabrication, and surgical placement are identified. Discussion: Body contouring using ultrasound liposuction may provide the desired aesthetic result. When augmentation is requested, fat transfer is the preferred initial procedure. If there is an insufficient volume of fat to augment both the buttocks and hip area, hip fat grafting is preferred to avoid a hip alloplastic implant. The reason for this treatment recommendation is to avoid the hip implant with a higher risk profile. Once the indication for the hip implant is confirmed, usually because of either inadequate presence of fat or a desired maximum hip projection that cannot be attained by fat grafting alone, the body shape analysis is finalized. Conclusion: Custom silastic hip implants are designed, fabricated, and surgically placed to provide the patient desired cosmetic hip augmentation.

Cosmetic Surgery Regulation in Australia: Who Is to Be Protected—Surgeons or Patients?

The practice of cosmetic surgery is of immense interest across the western world. In Australia, its regulation is currently the subject of three separate administrative processes, all due to report by mid-2022. Cosmetic surgery is typically dealt with at a superficial level by the media and sometimes misrepresented by medical commentators. This article details relevant issues for consideration and in relation to their complexities, which may be of interest to readers in other jurisdictions such as the United States.

The Macrotextured Implant Recall: Breast Implant-Associated-Anaplastic Large Cell Lymphoma Risk Aversion in Cosmetic and Reconstructive Plastic Surgery Practices.

The recall of Allergan Biocell (Irvine, CA) devices due to the association between anaplastic large cell lymphoma (ALCL) and macrotextured breast implants means that plastic surgeons are faced with the challenge of caring for patients with these implants in situ. Cosmetic and reconstructive surgeons have been contacting affected patients to encourage them to follow up and discuss the most appropriate risk-reduction strategies. The aim of this study was to evaluate patient concerns about the risk of breast implant-associated ALCL (BIA-ALCL) and to compare management differences between cosmetic and reconstructive patients. A retrospective review was performed of 432 patients with macrotextured implants who presented to clinic after being contacted (121 reconstructive and 311 cosmetic). These records were analyzed for their presenting concerns, surgery wait times, and management plans. Statistical analysis was performed to compare the cohorts, and odds ratios (ORs) were computed to determine the association between patient concerns and their choice of management. After consultation, 59.5% of the reconstructive cohort and 49.5% of the cosmetic cohort scheduled implant removal or exchange. The reconstructive population had a higher rate of ALCL concern (62.7%); however, both cohorts had a significant OR, demonstrating an expressed fear of ALCL likely contributed to their subsequent clinical management (OR cosmetic, 1.66; OR reconstructive, 2.17). Although the risk of ALCL appears to be more concerning to the reconstructive population, both cohorts were equally motivated to have their implants removed. Informing patients about their ALCL risk is crucial to ensure a patient-supported risk reduction plan.

Patterns in Academic Cosmetic Surgery Practice: Population Differences and Procedure Preferences.

Although growth in cosmetic surgery remains constant in the private setting, academic cosmetic surgery practices are often underdeveloped. Our study aims to determine which patient populations access academic cosmetic surgery services. The 2018 Health Care Utilization Project Nationwide Ambulatory Surgery Sample database was used for data analysis. Encounters for the following American Society of Plastic Surgery top 5 procedures for 2020 were selected: blepharoplasty, breast augmentation, liposuction, rhinoplasty, and rhytidectomy. Patient encounter data were collected because it relates to median income, geographic location, and primary payer status. The 2018 Nationwide Ambulatory Surgery Sample data set contained 44,078 encounters at academic surgical centers for the procedures listed previously. Low-income patients account for 13.7% of academic cosmetic surgery encounters compared with 37.9% for high-income patients. Breast augmentation rates are higher among low-income patients (20.5% vs 17.2%, P < 0.001), and high-income patients undergo rhytidectomy more frequently (5.7% vs 3.0%, P < 0.001). In the academic setting, patients from large metropolitan areas encompass the majority of cosmetic encounters (71.0%), and these patients are more likely to proceed with rhinoplasty, rhytidectomy, and liposuction procedures (P < 0.001). Patients from smaller metropolitan areas undergo blepharoplasty more frequently compared with those from larger metropolitan areas (56.4% vs 41.8%, P < 0.001). Self-pay and privately insured patients comprise the majority of academic cosmetic surgery encounters (40.8% and 29.9%, respectively). Eighty-eight percent of Medicare patients within this cohort underwent blepharoplasty, whereas self-pay patients accessed breast augmentation, liposuction, and rhytidectomy more often than other insured patients. Income status, patient location, and primary payer status play an important role in academic cosmetic surgery access rates and procedure preferences. Academic cosmetic practices can use these insights to tailor their services to the populations they serve.

The Application of Medical Tattooing in Cosmetic Breast Surgery.

Historically, medical tattooing has mainly been applied to correct or simulate the nipple areola complex among breast cancer survivors postmastectomy. Our purpose was to extend the application of medical tattooing to other cosmetic breast surgeries in a complimentary fashion and to improve aesthetic outcomes through scar blending, areola extension, and/or decorative appliques. Two case studies in which medical tattooing was applied following breast augmentation or reduction are presented. Our clinical procedures are described, including assessment, treatment planning, equipment, inks, and considerations for topical anesthesia. The two cases illustrate the range of applications of medical tattooing in cosmetic breast surgery from minor touch-up, to using elaborate decorative appliques for camouflage. Preoperative photographs, and postoperative patient photographs illustrating good aesthetic outcomes are presented. The field of medical tattooing is effective and is expanding rapidly but needs professional direction. We suggest plastic and cosmetic surgery practices develop active and intentional relationships with professional tattoo artists. Professional medical organizations should lead the development of medical tattoo assistant training and credentialling. Priorities for future research are described.

Patient Understanding of Provider Credentials and Selection of Plastic Surgery Providers.

Many physicians who are not board-certified plastic surgeons have started performing aesthetic procedures, leading to unsafe practices that jeopardize patients' health. Patients of a cosmetic and reconstructive private plastic surgery practice were asked to complete a survey that assessed their understanding of plastic surgeon credentials and advertising practices, and what influences their choice of a plastic surgeon. Eighty-five patients completed the survey, with 37.2% reporting prior aesthetic surgery; 84.9% were unaware of the lack of legal regulations governing the advertising practices of physicians. When asked if a doctor can perform surgery to improve their appearance without being a board-certified plastic surgeon, 22.1% responded "yes," 50% responded "no," and 27.9% responded "I don't know;" 98.8% reported a sense of comfort knowing their provider is board-certified in plastic surgery. When asked what factors help them decide if a surgeon is knowledgeable and trustworthy, the overwhelming majority reported referral from patients and providers as the most important factor, followed by online ratings and reviews. When deciding whether to recommend a plastic surgeon, personal experience was the most important factor. When deciding who should perform their cosmetic procedure, the most important factor was experience, followed by plastic surgery board certification. Current physician advertising practices lack strict guidelines and are often misleading. Patients would benefit from more thorough education on these practices. Of the various plastic surgeon assessment factors, most patients rely heavily on feedback obtained from patients and providers.

Guidelines to starting a cosmetic surgery practice

Cosmetic surgery includes operations and all other invasive medical procedures where the primary aim is the change, the restoration, normalisation or improvement of the appearance, the function and wellbeing at the request of an individual.