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Reconstruction of facial contours with facial implants are procedures done simultaneously with orthognatic surgery or as an isolated procedure in order to get a good facial esthetics and patient satisfaction better. The results of bioimplants are good with few complications, If they applied properly. In this study, two cases whose facial contours are supported by ‘porous polyethylene implants' were presented.

Objective: Review aesthetic concerns of the lower face and neck and provide expert guidance on evaluation and treatment. Methods: Twelve international experts participated in an advisory board on lower face and neck aesthetic treatment. They completed a premeeting survey and met twice, reviewing responses and discussing patient evaluation and treatment strategies. They developed decision tree algorithms on patient assessment and treatment planning and sequencing, using clinical cases as a reference. Results: Treatment concerns include neck and lower face skin laxity, structural bone deficiency, insufficient or excess volume, submental fat, jowls, platysma bands, and masseter muscle prominence. Advisors agreed that the lower face and neck may be the most challenging areas to assess and treat; treatment goals include lower facial contour and overall facial harmony/balance. Advisors recommended first ruling out a surgical approach, then determining whether midface treatment is needed to support the lower face, and lastly evaluating the lower face for significant submental fat, excess or insufficient volume, and structural bone deficiency. To treat the lower face and neck, an anatomical layer approach, moving from deep to superficial layers, beginning with structural support, was recommended. Assessment and treatment decision trees were based on this approach. Conclusion: The lower face and neck are important but underrecognized areas of aesthetic concern. This article provides expert guidance and a suggested algorithm for assessment and treatment aimed at achieving satisfying and harmonious facial aesthetic results. [ABSTRACT FROM AUTHOR]

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Although the cancellation of elective procedures due to the COVID-19 outbreak has been a vital precaution, it has resulted in the suspension of aesthetic procedures and surgeries worldwide. Consequently, this postponement and other factors might have a negative impact on patients planning to undergo aesthetic procedures. Understanding the changes in patient motivation and perception in comparison to the prepandemic period is imperative for proper adjustment of plastic surgery clinics. A prospective questionnaire study was conducted on patients with cancelled aesthetic surgeries or procedures to determine the effects that coronavirus disease 2019 (COVID-19) had on patient motivation regarding cosmetic surgery and procedures and to establish a relationship between patient characteristics and the overall effect of pandemia on the perception of cosmetic surgery. Although most patients felt angry or frustrated due to the cancellation of their surgeries or procedures, the majority accepted that it was a necessary precaution. Patients with a history of previous minimally invasive procedures had a significantly higher ratio of acceptance for cancellations, whereas single patients were more likely to want to have their treatments done if the decision were left up to them. A subset of patients considered undergoing additional cosmetic procedures in the setting of self-isolation, and all patients stated that they would reschedule once the pandemia was under control. Patients with established motivation for plastic surgery and minimally invasive procedures ultimately plan to resume their normal treatments alongside others after the pandemia subsides. Plastic surgeons must actively communicate with their patient population during this time to properly educate, embrace, and direct them under scientific guidelines. [ABSTRACT FROM AUTHOR]

Background: Treatment of a sunken appearance of the temporal region using injectable fillers is a popular procedure. The temporal fossa has very complex anatomy due to multiple vessels running in the different tissue layers. A severe complication in the form of non-thrombotic pulmonary embolism (NTPE) can occur as a result of an inadvertent injection in the middle temporal vein (MTV) while performing temporal fossa filler procedures. Therefore, in-depth knowledge and understanding of the MTV anatomy are essential for successful and safer injectable procedures of the temporal fossa. Objectives: While there have been many studies to describe the arteries in this region, there is limited information about the location and course of the middle temporal vein. This literature review is aimed at providing detailed information about the course, depth, and size of the MTV to help aesthetic practitioners in performing safer temporal fossa filler injections. This information is imperative to delineate the 'venous danger zone' in the temple region. Methods: The preferred reporting items for systematic reviews and meta-analyses guidelines were used for this review. A literature search was performed to find the articles providing details about the MTV anatomy and the measurements related to its course and size. Results: A review of the literature showed that the MTV displays a consistent course and depth in the temporal region, with high variability in its diameter. The middle temporal vein width varied between 0.5 and 9.1 mm in various studies. The middle temporal vein receives many subfascial tributaries from the surface of the temporalis muscle, and for most of its course runs in the fat pad enclosed between superficial and deep layers of the deep temporal fascia. A 'venous danger zone,' in the interfascial planes of the temporal fossa, which contain the main part of the MTV and its tributaries, has been proposed in this paper. Conclusions: The temporal fossa filler procedures need great caution, and knowledge of the depth and course of the MTV is essential for avoiding NTPE. 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 online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background: Factors that motivate the treatment goals and expectations of the aesthetic patient reflect evolving social, cultural, and commercial influences. The aesthetic practitioner may often be faced with the challenge of first decoding the underlying motives that drive the patient to pursue their specific goals. The challenge for clinicians is further compounded by an increase in patient diversity with respect to race, ethnicity, age, and gender. Aims: Simplify the path to patient interpretation with identification of primary patient archetypes. Methods: The "Going Beyond Beauty" (GBB) initiative, consisting of 27 market research projects, was conducted to survey the primary goals and motives for seeking treatment aesthetic treatment. The results were stratified into predominant patient archetypes using segmentation analysis and then validated through online surveys, 1‐to‐1 interviews, and focus groups conducted with patients. An advisory board of internationally based aesthetic clinicians integrated the data with their own insights to further characterize each archetype. Results: Data from over 54 000 participants in 17 different countries were distilled into four distinct patient archetypes based on motivating factors, aesthetic goals, initial treatment requests, and treatment opportunities and challenges. These archetypes were named Beautification, Positive Aging, Transformation, and Correction. Conclusion: The clinician's ability to recognize these four primary archetypes may provide a useful frame of reference to understand patient motives better, anticipate and manage their expectations, and provide the appropriate treatment guidance that best serves the long‐term goals of their patients. [ABSTRACT FROM AUTHOR]

Background: Although the excision of the buccal fat pad has become very popular for achieving a slimmer midface, not all patients are good candidates for this procedure. Unfortunately, studies that provide guidelines by emphasizing volumetric and technical details are limited.Objectives: The study compared preoperative and postoperative volumetric data to identify the amount of tissue that can safely be removed and important technical concepts involved in lower cheek contouring with buccal fat pad excision.Methods: Patients complaining of cheek fullness were evaluated to determine if they were good candidates for the procedure. Eligible patients were screened with transbuccal ultrasound to determine tissue volumes and anatomical details. Intraoperative and postoperative, 6th-month volume measurements were undertaken and residual tissues and vascular pedicles reevaluated.Results: Ultrasound imaging showed that the mean preoperative volume of the fat pads was 11.67 ± 1.44 mL, and the mean postoperative volume was 8.58 ± 1.07 mL. The mean volume of the excised tissues was 2.74 ± 0.69 mL. Postoperative buccal fat pad volume values correlated with the reported average in the literature for the same age group.Conclusions: Buccal fat pad removal is an effective technique for refining the facial silhouette that should be reserved for patients with increased buccal fat pad volume. Removal of only the excessive portion of the fat pad is important because this structure provides significant volume in the midface that can be difficult to restore once aging affects the surrounding soft and bony tissue.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]

Background: Lip augmentation procedures have increased drastically in the last years as patients seek to enhance the shape and size of their lips with dermal fillers. One of the main concerns faced with these procedures is the pain inflicted through injections. On the other hand, many different techniques have been introduced for the reduction of pain while performing office-based minimal invasive procedures.Objectives: This study aims to determine the analgesic effect of vibration anesthesia during lip augmentation procedures and to evaluate its overall effect on the comfort of patients.Methods: A split-lip study was designed in a randomized fashion for 25 lip augmentation patients who received hyaluronic acid fillers with or without with a concurrent vibration stimulus on either half of their lips. Patients were asked to score the pain that they felt during lip injections on a scale from 0 to 10 (0 being no pain and 10 being the worst pain ever felt) for either lip half. The pain scores were then analyzed for significance.Results: The overall pain score on the vibration-assisted side was 3.82 ± 1.73 while the pain score for the side with no vibration was 5.6 ± 1.76 (P < 0.001). Twenty-three patients (92%) felt less pain with the addition of vibration while, interestingly, 2 patients (8%) stated that they felt an increase in pain levels on the vibration-treated side.Conclusions: Vibration devices can be a safe and effective tool for lowering pain levels in patients undergoing lip augmentation with hyaluronic acid fillers.Level of Evidence: 2. [ABSTRACT FROM AUTHOR]

Background: Photography standardization is paramount for appropriate critical analysis of aesthetic surgery outcomes. Therefore, the authors designed a study to evaluate the influence of different variables in photos of patients with indications for undergoing facial rejuvenation. Methods: This blinded prospective study was conducted by the Section of Plastic Surgery in the Hospital das Clínicas at the Federal University of Paraná. In the study, 29 patients had their photos taken in two separate settings. Photo 1, termed “preoperative” (Pre), was obtained according to the same pattern for all patients. Photo 2, termed “postoperative” (Post), was acquired on the same day using different variables to manipulate the photo outcome. No surgery was actually performed. Both photos (Pre and Post) were sent to five experienced Brazilian plastic surgeons, who provided a score for photo 2 that varied from −10 to +10 compared with photo 1. Results: The photos were examined by 119 plastic surgeons. No significant improvement was observed in most of the groups, except for the group that used a flash for the Post photography ( p = 0.035). Almost half of the scores (45.37 %) were above zero. The highest score was found to be ten for two photographs of the makeup group. A score of zero was assigned to 54.62 % of the photos, which means no changes occurred between the Pre and Post photos. Conclusion: Inadequate photographic technique can change assessments of photos in a meaningful way. All the factors evaluated had a positive impact, but the only statistically significant variable was the use of a flash in the Post group. Level of Evidence II: 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 . [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the effects of preoperative subcutaneous platelet-rich plasma and fibrin glue administration on skin flap survival. Methods: One week before surgery; saline, platelet-rich plasma, fibrin glue, and thrombin solutions were applied under rat skin flap areas in Groups I, II, III, and IV, respectively. Unipedicled epigastric flaps were elevated in the first three groups but could not be elevated in Group IV because of preoperative abdominal skin necrosis. Necrotic area measurements, microangiography, and histological and immunohistochemical evaluations were performed. Results: Platelet-rich plasma reduced the percentage of necrotic area when compared to other groups. Histologically and microangiographically an increased number of arterioles were observed in the platelet-rich plasma group. Thrombin (when used alone) caused abdominal skin necrosis. Increased expression of VEGF and PDGF was found in all platelet-rich plasma-treated flaps. There was no significant difference between groups with respect to TGF-β3 staining intensity. Conclusion: In this study preoperative administration of platelet-rich plasma mimicked the pharmacological delay effect and enhanced flap survival. Individual use of thrombin was found to be unsuitable in flap surgery. Level of Evidence I: 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 . [ABSTRACT FROM AUTHOR]

Intrigued by developments in aesthetic surgery and minimally invasive applications, and an accompanying increase in demand for these procedures, this study attempts to understand patients' decision-making processes by employing the affect-behavior-cognition (ABC) model. Affect stands for the feelings, whereas behavior stands for patient behavior towards the surgery and the physician, and the cognition stands for related thoughts. The assumption in this paper is that patients with different physical, social, and psychological 'needs' have different orientations towards the specific service and toward the physician. Qualitative data collection methods are employed to understand underlying thoughts and feelings. Interviews are conducted with 30 different individuals. Results indicate three groups of patients who follow different processes, specifically CAB (patients with physical problems), CBA (patients without major health concerns), and ABC (patients of minimally invasive procedures). The study also points out, with a conclusive analytical framework, that these patients can be treated as patient-consumers in order for a mutually satisfying, doctor-patient relationship. [ABSTRACT FROM AUTHOR]

The aim of this study was to emphasize the importance of preoperative surgical planning using 3D skull models in craniosynostosis surgery. By using 3D polymethyl methacrylate skull models manufactured using 3D tomography images, the authors previously showed that after fronto-parietal osteotomy, instead of fixing the fronto-parietal bone flap without rotation, angled advancement with horizontal osteotomy provides maximum increase in intracranial volume, in a bilateral coronal craniosynostosis model. After changing the operation technique using data gathered from previous studies, we reviewed two bilateral craniosynostosis patients operated with the new technique and compared it with two patients that were operated with the old technique. Comparing cranial indexes (CI), significant improvement was detected in both groups. The decrease in CI in the second group was slightly better than the first group. In the comparison of intracranial volume (ICV), there was an increase in ICV values in both groups. The percentage of increase between two groups was similar. The morphological outcome was satisfactory in all patients. There were no major or minor complications and morbidity. Current multislice tomography technology and stereolithographic procedures provide an excellent surgical simulation model to find new techniques and predict the outcome. These models should be used in all complex and syndromic craniosynostosis for both better results and reducing the operative time and associated blood loss. [ABSTRACT FROM AUTHOR]

Prominent ear deformity is a common congenital ear deformity. Prominent ear deformity includes components such as valgus of concha, failure of scaphal folding, conchal hypertrophy, and prominent lobule. The deformity and the elastic properties of the ear cartilage determine the method of surgical correction in each case. Concha-mastoid suture, conchal excision, and posterior auricular muscle excision are different treatment options for mild to severe cases of conchal hypertrophy and valgus deformity. In this article we present a method of conchal excision, combined with a posterior auricular muscle flap, to repair severe conchal hypertrophy or valgus deformity. Six patients (11 ears) were operated on using this method. The results obtained were satisfactory. Postoperative results at 6 months were satisfactory in all patients. The smoothness and the natural appearance of the conchal bowls were notable in all patients. In contrast to the early methods of utilizing the posterior auricular muscle by transposing to the scapha or excising, its usage as a muscle flap for conchal hypertrophy and valgus deformity may be a promising option for the future. [ABSTRACT FROM AUTHOR]