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Following the advent of glucagon-like peptide-1 receptor agonists (GLP-1RAs), subsequent unintended effects such as accelerated facial aging and altered skin health have been noted. This review delves deeper into the causative underlying mechanisms and provides insights into the intricate relationship between GLP-1RAs, adipose tissue, and premature facial aging, thereby highlighting the need for a nuanced understanding of their effects on facial alterations and skin health. Studies exploring the potential effects of GLP-1RAs on facial alterations and offering insights into the possible underlying mechanisms, causes, and clinical implications were included. The accelerated facial aging and altered skin health observed in GLP-1RA patients appears to be multifactorial, involving loss of dermal and subcutaneous white adipose tissue, and altered proliferation and differentiation of adipose-derived stem cells (ADSCs), and impacts on the production and secretion of hormonal and metabolic factors. These changes compromise the structural integrity and barrier function of the skin and may lead to diminished facial muscle mass, further exacerbating the appearance of aging. The insights presented call for a paradigm shift in the clinical management of facial changes induced by GLP-1RAs, with a focus on treatment strategies aimed at targeting ADSC stimulation. These include autologous fat transfers to reintroduce cells rich in ADSCs for rejuvenation, composite fat grafting combining autologous fat with/without stromal vascular fraction, and the strategic use of soft tissue fillers for volume restoration and biostimulation. This review highlights the potential role of GLP-1RAs in modulating adipose tissue dynamics, thereby contributing to accelerated aging through metabolic, structural, and hormonal pathways. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

Cellulite in the proximal lower extremities is a reported concern among many adult females. The unsightly appearance of cellulite leads many affected individuals to seek treatment by trained specialists. The objective of this review is to provide the reader with an update on new and innovative therapies for cellulite including various treatment combinations to maximize therapeutic outcomes, and strategies for minimizing adverse events. The availability of new technologies and the results from recent clinical trials provide additional tools and data to consider when creating treatment plans for cellulite patients. This update to previous treatment recommendations is based on the most recent developments in cellulite management including the personal experiences of the authors with an emphasis on injectable enzymes, acoustic subcision, targeted verifiable subcision, and biostimulators. Formal clinical studies are warranted to compare various treatment modalities and further investigate combination regimens. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]

Background: The popularity of social media appears to be increasing the acceptance of cosmetic treatments, prompting more consumers to seek cosmetic treatments. As the estimated prevalence of acne vulgaris among adult women may be as high as 54%, acne is commonly observed among patients presenting for cosmetic treatments. Concomitant treatment of acne in the aesthetic patient population will improve overall clinical outcomes. Aims: The goal of this work was to deliver a high‐quality ethical and evidence‐based educational program to physicians and adjunctive health care providers to advance patient care. Methods: This paper is based on a webcam presentation with roundtable discussion by several notable experts in their field. Results: A range of topical medications, injectable products, chemical peels, and energy‐based devices are available for treating acne vulgaris. In most instances, these are compatible with rejuvenation procedures in the aesthetic patient. Conclusion: The growth of social media is raising awareness of aesthetic procedures and appears to be increasing the number of patients seeking aesthetic treatment. Educating patients about the importance of treating acne vulgaris can improve overall treatment outcomes. In most instances, the presence of acne is not a barrier to aesthetic care. [ABSTRACT FROM AUTHOR]

Background: Collagenase clostridium histolyticum‐aaes (CCH‐aaes) is approved in the United States for moderate‐to‐severe cellulite in the buttocks of adult women. Aim: Interim analysis to evaluate efficacy/safety of CCH‐aaes in the treatment of thigh cellulite. Methods: Data were analyzed from a phase 3, open‐label study (REAL). Women with mild‐to‐moderate cellulite on both thighs (Clinician Reported Photonumeric Cellulite Severity Scale score, 2 or 3) received ≤0.84 mg (volume, 18 ml) of CCH‐aaes subcutaneously, in up to 12 dimples per posterolateral thigh, in up to 3 treatment sessions (Days 1, 22, and 43). Follow‐up was on Day 90 (interim cutoff). A subset of women participated in the concurrent study (PIXELS), which included high‐definition photography and 3D‐image scanning of treatment areas. Results: Twenty‐two women (44 thighs) were included in the interim analysis (mean age, 42.3 years; thighs with mild cellulite, 68.2%). Investigators reported high percentages of responders (score of "improved" or better on Investigator Global Aesthetic Improvement Scale) at Day 90 for either thigh (86.4%; primary endpoint) or both thighs (72.7%). Patient‐reported bother due to cellulite was reduced at Day 90; mean change was 15.3 points (85.5% reduction) in BODY‐Q Appraisal of Cellulite Scale total score (possible range, 11–44). In PIXELS analysis, Day 90 3D‐image scans showed improvement from baseline in skin roughness in some of the treated thigh areas. The most commonly reported adverse events were injection‐site bruising and pain (95.5% and 50.0% of patients, respectively). Conclusions: CCH‐aaes treatment of mild‐to‐moderate thigh cellulite was effective and generally well tolerated, with markedly reduced cellulite‐related bother. [ABSTRACT FROM AUTHOR]

Background: The nose is a central visual feature of the face leading many patients wishing to improve their facial esthetic appearance to undergo rhinoplasty. Increasingly more patients are seeking non‐surgical alternatives such as hyaluronic acid filler injections. These treatments have the ability to profoundly impact patients' esthetic appearance and first impressions. Objective: To evaluate the effects of hyaluronic acid filler injection in non‐surgical nasal augmentation on first impressions, quality of life, and to evaluate treatment efficacy in reducing the height of the nasal dorsal convexity. Methods: Ten female subjects underwent small‐particle hyaluronic acid filler injection into the nasal soft tissues. Photographs of the subjects were taken at baseline and post‐treatment after achieving an optimal correction result. Patients reported satisfaction with outcomes using a validated patient‐reported outcome measurement tool. Blinded evaluators were used to assess first impressions across specifically defined categories using the baseline and post‐treatment photographs. The height of the pre and post‐injection nasal dorsal convexity was compared. Results: All patients experienced a statistically significant reduction in the height of their dorsal nasal convexity. There was significant improvement in patient‐reported outcomes based on all measures of the FACE‐Q scale. A total of 224 evaluators completed blinded assessments of first impressions. Mean first impressions in all eight categories, along with overall first impression score showed statistically significant improvement following treatment. Conclusion: Hyaluronic acid filler injections for non‐surgical nasal reshaping are a safe and effective method to improve perceived first impressions and to improve patient‐reported self‐esteem and esthetic satisfaction with their nose. [ABSTRACT FROM AUTHOR]

Abstract Objective: To compare the efficacy and safety of 2 doses of botulinum toxin type A in the treatment of dermatochalasis. Methods: Forty patients with mild to moderate dermatochalasis were [...]

Background: PrabotulinumtoxinA is a 900-kDa botulinum toxin type A produced by Clostridium botulinum.Objectives: The authors sought to investigate the safety of prabotulinumtoxinA for treatment of glabellar lines.Methods: This was a multicenter, open-label, repeat-dose, 1-year phase II safety study. Adults with moderate to severe glabellar lines at maximum frown, as independently assessed by both investigator and patient on the validated 4-point photonumeric Glabellar Line Scale (0 = no lines, 1 = mild, 2 = moderate, 3 = severe), were enrolled. On day 0, patients received an initial treatment (IT) of 20 U prabotulinumtoxinA (4 U/0.1 mL final vacuum-dried formulation injected into 5 glabellar sites). On and after day 90, patients received a repeat treatment (RT) if their Glabellar Line Scale score was ≥2 at maximum frown by investigator assessment. Safety outcomes were evaluated throughout the study.Results: The 570 study patients received a median total dose of 60 U, that is, 3 treatments. Sixty-one patients (10.7%) experienced adverse events (AEs) assessed as possibly study drug related; 6.5% experienced study drug-related AEs after the IT. With each RT, progressively lower percentages of patients experienced study drug-related AEs. Eight patients (1.4%) experienced study drug-related AEs of special interest: 5 experienced eyelid ptosis (0.9%), 3 eyebrow ptosis (0.5%), 1 blepharospasm (0.2%), and 1 blurred vision (0.2%). Seven patients (1.2%) experienced serious AEs, but none were study drug related. A total of 4060 serum samples were tested for antibotulinum toxin antibodies; no seroconversion was observed.Conclusions: The safety of RTs of 20 U of prabotulinumtoxinA for moderate to severe glabellar lines was confirmed in this second phase II study based on a broad range of outcomes.Level Of Evidence:2: [ABSTRACT FROM AUTHOR]

Background: The emergence of Coronavirus disease of 2019 (COVID-19), quickly became one of the most severe disease outbreaks in modern history. This caused many aesthetic practices around the country to close temporarily and led to a unique time period to evaluate the impact neurotoxin has in the setting of an ongoing pandemic.Objectives: To examine whether the administration of onabotulinumtoxinA (BOTOX Cosmetic, Allergan plc, Coolock, Ireland), in regular users, synergistically amplifies the elevation in mood/happiness, self-satisfaction with appearance and overall satisfaction, in the context of the ongoing pandemic.Methods: A randomized single-blind cross-over study was designed to evaluate the impact of neurotoxin treatment in the upper third of the face on mood, self-satisfaction with appearance, and overall satisfaction. The placebo group crossed over to treatment after 1 month. Surveys evaluating patient happiness, self-satisfaction with appearance and overall efficacy were completed among both groups, and again to the placebo group again following crossover to treatment.Results: Forty-five subjects were enrolled with 30 in the treatment and 15 in the control/cross-over group. The placebo group demonstrated no change in happiness or self-satisfaction in appearance until cross-over to the treatment group. Both groups, once receiving, onabotulinumtoxinA reported increased happiness, self-satisfaction with appearance and overall treatment satisfaction.Conclusions: OnabotulinumtoxinA treatment to the upper face in the midst of the COVID-19 pandemic was found to increase patient happiness, self-satisfaction with appearance, and overall treatment satisfaction. [ABSTRACT FROM AUTHOR]

Since there is no universal standard of beauty, each aesthetic provider's definition may shape his/her practice of aesthetic procedures. Beauty and attractiveness are commonly defined by both mathematical and cultural influences and are shaped by our surroundings and what is most familiar to us. Therefore, we thoroughly explored the literature to better elucidate these variables and biases that affect the perception of beauty, in order to better provide appropriate and customized aesthetic procedures that preserve each individuals' own unique beauty. Understanding how each provider's own bias and aesthetic preferences differs from that of his/her patients may go a long way to improving communication in the consultation process and patient satisfaction with the outcomes achieved. We know that clinicians many times superimpose their biases onto their patients, so it is important that each practitioner accounts for bias in aesthetic medicine when consulting with patients and colleagues. [ABSTRACT FROM AUTHOR]