Search

Purpose Advances in medical technology coupled with rapid growth of web-based mass media and social networking services have considerably increased public access to cosmetic surgery. In South Korea, in particular, the number of people undergoing cosmetic surgery has been rapidly increasing, and studies related to cosmetic surgery have markedly increased. We report an integrative review of studies examining the relationship between cosmetic surgery and self-esteem in Korea. We aimed to identify relevant variables and determine their overall effect sizes. Methods This study was designed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two researchers separately performed the literature search, selected 16 papers based on the inclusion and exclusion criteria, and analyzed them. Results Of the 16 papers on cosmetic surgery and self-esteem, 5 (33.3%) involved both men and women, and the remaining 11 (66.7%) involved only women. The respondents included teenagers and adults. The total number of respondents was 6296, with an average of 393.5 per paper. Most studies (n = 13, 81.3%) used the Rosenberg Self-Esteem Scale. Self-esteem was correlated with variables grouped into the following six categories: appearance management intention, cosmetic surgery intention, sociocultural attitude, body satisfaction, BMI, and stress. The effect sizes from the meta-analysis with correlation coefficients were 0.157, − 0.118, 0.023, 0.175, − 0.045, and − 0.085. Conclusions Among the relevant variables categorized in this study, sociocultural attitude, BMI, and stress showed weak effect sizes, and the appearance management intention, cosmetic surgery intention, and body satisfaction categories showed intermediate effect sizes. The results of this study are expected to serve as a concrete basis for the development of strategies to minimize the adverse effects of the ever-growing cosmetic surgery industry. This information can help elucidate the psychologic characteristics of individuals seeking cosmetic surgery and contribute to optimal medical outcomes. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background The perception of an attractive face is largely subjective. The purpose of this paper is to provide an insight and a practical approach to facial contouring management with hyaluronic acid (HA) implants and botulinum toxin A. Methods This study is presenting the clinical experience of the authors regarding facial contouring. After a careful medical history, patients underwent an exhaustive aesthetic assessment that includes photographs and videos. Realistic treatment goals were discussed and agreed with the patient. Comprehensive treatment strategies for facial contouring, including HA implants and/or botulinum toxin A injections, were selected according to the patient needs. Results Based on the MD codes®, developed by Mauricio de Maio, these treatment strategies have been adapted to six different basic categories of facial shapes, namely round, square, triangular, inverted triangle, rectangle, oval and oblong faces. The incidence of complications was low and, in all the cases, was mild (edema, erythema and local ecchymosis), of limited duration, and was resolved without sequela. Conclusions The current article presented the personal experiences of the authors on a specific subject, and this fact should be considered when interpreting data from this paper. As other aesthetic treatments, facial contouring should be focused on the patient needs and to select a specific aesthetic approach according to different facial shapes. Finally, it is essential to have a good understanding of the potential associated complications, because it will help the specialist to take the necessary precautions to prevent them, and if they ever arise, to be able to deal with them effectively. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The global pandemic of coronavirus 2019, or COVID-19, has undeniably impacted all facets of healthcare, affecting both its function and provision. Due to the cessation of all non-emergent surgical cases in the USA and worldwide, the professional lives and practices of many physicians have been negatively affected. However, among different physicians and specifically plastic surgeons, cosmetic/aesthetic plastic surgeons have been disproportionately affected by the COVID-19 pandemic as the majority of their cases are semi-elective and elective. The ability to perform semi-elective and elective cases is dependent on state and local authorities’ regulations, and it is currently uncertain when the ban, if ever, will be completely lifted. Financial constraints on patients and their future inability to pay for these procedures due to the COVID-19-related economic recession are things to consider. Overall, the goal of this unprecedented time for cosmetic/aesthetic plastic surgeons is for their medical practices to survive, to conserve cash flow although income is low to none, and to maintain their personal finances. In this paper, the authors review the financial impacts of the current COVID-19 pandemic on the practices of cosmetic plastic surgeons in the USA and worldwide, along with some potential approaches to maintain their practices and financial livelihoods. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background Patients often seek guidance from the aesthetic practitioners regarding treatments to enhance their ‘beauty’. Is there a science behind the art of assessment and if so is it measurable? Through the centuries, this question has challenged scholars, artists and surgeons. Aims and Objectives This study aims to undertake a review of the evidence behind quantitative facial measurements in assessing beauty to help the practitioner in everyday aesthetic practice. Methods A Medline, Embase search for beauty, facial features and quantitative analysis was undertaken. Selection Criteria Inclusion criteria were studies on adults, and exclusions included studies undertaken for dental, cleft lip, oncology, burns or reconstructive surgeries. The abstracts and papers were appraised, and further studies excluded that were considered inappropriate. The data were extracted using a standardised table. The final dataset was appraised in accordance with the PRISMA checklist and Holland and Rees’ critique tools. Results Of the 1253 studies screened, 1139 were excluded from abstracts and a further 70 excluded from full text articles. The remaining 44 were assessed qualitatively and quantitatively. It became evident that the datasets were not comparable. Nevertheless, common themes were obvious, and these were summarised. Conclusion Despite measures of the beauty of individual components to the sum of all the parts, such as symmetry and the golden ratio, we are yet far from establishing what truly constitutes quantitative beauty. Perhaps beauty is truly in the ‘eyes of the beholder’ (and perhaps in the eyes of the subject too). Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background The aim of this paper is to analyze the aesthetic characteristics of the human females’ gaze using anthropometry and to present an artistic model to represent it: “The Frame Concept.” In this model, the eye fissure represents a painting, and the most peripheral shadows around it represent the frame of this painting. The narrower the frame, the more aesthetically pleasing and youthful the gaze appears. Materials and Method This study included a literature review of the features that make the gaze appear attractive. Photographs of models with attractive gazes were examined, and old photographs of patients were compared to recent photographs. The frame ratio was defined by anthropometric measurements of modern portraits of twenty consecutive Miss World winners. The concept was then validated for age and attractiveness across centuries by analysis of modern female photographs and works of art acknowledged for portraying beautiful young and older women in classical paintings. Results The frame height inversely correlated with attractiveness in modern female portrait photographs. The eye fissure frame ratio of modern idealized female portraits was similar to that of beautiful female portraits idealized by classical artists. In contrast, the eye fissure frames of classical artists’ mothers’ portraits were significantly wider than those of beautiful younger women. Conclusion The Frame Concept is a valid artistic tool that provides an understanding of both the aesthetic and aging characteristics of the female periorbital region, enabling the practitioner to plan appropriate aesthetic interventions. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A3 online Instructions to Authors. www.springer.com/00266.

After surgery, the plastic surgeon is very often questioned about how to maintain the result and more frequently how to slow down the aging process. However, this type of knowledge is not commonly delivered during medical education or at least needs an update. This review could be used as a guide to help plastic surgeons to manage these frequent postoperative consultations. The aim of this literature review was to focus discussion on specific positive factors, identified to have a significant impact on human longevity. A literature review was performed using the automated computerized PubMed search, with the keywords “human longevity.” Only papers written in the English language were included. References were screened to identify further relevant articles. Experimental studies based on microorganisms and animals, works published in non-indexed journals, case reports, letters, and viewpoints were excluded. One hundred and twenty-four articles reporting factors influencing human longevity were analyzed for data extraction. A total of 59 articles reporting only positive factors were included. Fourteen factors seemed to have a positive impact on longevity: caloric restriction, active effort and sports, happiness, vitamins, vegetarian or Mediterranean diet, oriental practices, socioeconomic status, genetics, sexual activity, sleep, moderate wine consumption, religion, and education. While some factors with a positive impact on longevity are clearly identified and should be integrated in the postoperative process, further studies are still needed to be able to slow down the aging process. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The article stresses the need to consider the psychological significance of craniofacial deformities and their correction. The paper reviews some basic concepts of identily and self-image, particularly as they apply to the face and specifically in patients suffering facial disfigurement. The psychological problems of the repair of the disfigurement are also discussed. The continuity of body-image, self-concept and identity is presented. People with craniofacial deformities have a need to reorganize body-image and correction of the deformity requires another reorganization. A change in selfimage coincident with a change physically requires time and may require psychotherapy. The severity of the handicap of a facial disfigurement is presented. The importance of the significance of the deformity and the influence of social forces are outlined as determinates of the emotional impact. The “loss” is dealt with by such defense mechanisms as denial and undoing, both pathologic defenses which frequently break down. After reconstructive surgery, personality change does not occur simultaneous with physical change. The repair, potentially, can produce a depression related to the loss of the old identity, as well as a psychosis. Frequently, fantasied expectations of the patient can lead to much difficulty. The repair may also confront the patient with new sensory experiences. Acceptance of the change in identity is more readily accomplished by the young as opposed to the old. Problems of facial disfigurement and the work involved psychologically as a consequence of the repair of the disfigurement are illustrated in a case presentation of prognathous mandible. The need for the patient to receive proper support and help in integrating the new facial image and the need to concretize expectations for the patient, preoperatively, are stressed since these are often grossly unrealistic.

Many significant advances and refinements in breast augmentation have been realized over the past 15 years including improvements in technique, better implant selection processes, and perhaps most importantly, availability of better implants. Concordant with the elevation of this most basic of aesthetic breast procedures is the level of sophistication required to perform the procedure successfully. Gone are the days where a plastic surgery ‘‘hobbyist’’ could generate the types of results demanded by the current patient clientele, and with good reason. The previous model of one operation fits all simply does not reflect the wide variety of patient presentations seen currently. In fact, one of the most difficult aspects of the breast augmentation procedure relates to the handling of the small but significant asymmetries presented by nearly every breast augmentation patient. Clearly, this is an operation that can and should be performed only by those with the training and skills to carry out the procedure in a way that maximizes the aesthetic result and minimizes the potential complications. It is with this in mind that the survey reported by Heden and colleagues is noteworthy because it underscores the need for well-trained and highly qualified plastic surgeons to bring the same level of expertise to the consultation process as they do to the procedure. Clearly, for the modern patient, a simple 10-min consultation designed to say hello, get a quick photograph, choose an implant, and schedule the surgery is woefully inadequate. In this advanced information age, patients will be much better informed and aware of the various options available to them. If the patient senses in any way that her need for information or her desires for the surgical outcome are being sacrificed for the sake of time, she will most likely seek treatment elsewhere. To build an optimal level of trust with the patient, the entire consultation process must be crafted to meet the needs of each individual. To this end, the recommendations noted in the paper by Heden and colleagues merit careful consideration. From the time the patient contacts the office, the process of trust building must begin. This process includes knowledgeable front desk personnel, a caring nursing staff, helpful billers and schedulers, and sufficient individual time with the surgeon for a healthy doctor– patient relationship to be built. This time is optimally spent developing a history, performing an exam, going through an organized implant selection process, and taking photographs. The implant selection process must include an examination of the breast with regard to the base diameter, the soft tissue thickness medially and laterally, the breast height, and laxity of the soft tissue framework. After these factors have been determined, the patient’s desires regarding her size is established by a series of questions, and the projection of the implant is determined. This entire process is explained to the patient so she can play a significant role in the final implant selection, thus significantly minimizing postoperative discontent over implant choice. It is entirely appropriate to use well-trained ancillary staff to assist in the education process, but the overall impression must be that the physician is in charge and looking out for the best interest of the patient. In this fashion, a level of trust is built with the patient that will keep her in the physician’s office through to the successful completion of the procedure and beyond. Heden and colleagues are to be congratulated for summarizing these important concepts. D. C. Hammond (&) Center for Breast and Body Contouring, 4070 Lake Drive, Suite 202, Grand Rapids, MI 49546, USA e-mail: cbbc@dennischammond.com