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Background: Botulinum toxin has been in use since the 1970s. Over the last few years, the indications for botulinum toxin use have extended for cosmetic and noncosmetic applications. Three preparations of botulinum toxin type A and one preparation of botulinum toxin type B are commercially available and approved for use in the United States by the United States Food and Drug Administration.Objective: To review the most recent literature on all commercially available botulinum toxins in the United States, their indications, Food and Drug Administration approvals, and handling (reconstitution, storage, and dilution).Methods: A literature review (not Cochrane type analysis) using several databases (PubMed, MEDLINE, textbooks, Food and Drug Administration homepage, and manufacturer information) was performed.Conclusion: Several different preparations of botulinum toxins exist worldwide, none of which are identical or interchangeable. Manufacturer recommendations on all available botulinum neurotoxins advise the use of unpreserved saline for reconstitution. Side effects are mostly mild and always self-limited. More serious complications are associated with higher doses, improper injection techniques, and occur in patients with underlying comorbidities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Excess submental fat (SMF) can cause submental fullness resulting in negative perceptions of individuals. However, the impact of SMF on perceptions of social traits has not been well studied. OBJECTIVE: To characterize the impact of SMF on external value judgments in adults in the United States. METHODS: Respondents completed an online survey in which they reacted to statements about individuals with varying grades of SMF. Attributes were rated on a scale from 0 to 100 with higher scores for more positive attributes. RESULTS: Similar proportions of respondents (N = 1996) indicated that women and men with double chins were less attractive than those without (91% and 90%, respectively). A double chin was more likely to be noticed on a woman than on a man (78% of respondents). With increasing SMF, individuals were perceived as significantly less likeable, intelligent, happy, active, and easygoing. Those with greater amounts of SMF were rated as significantly less attractive than those with less SMF. For all attributes, male respondents rated all individuals lower than female respondents did. CONCLUSION: Results from this study provide further evidence of negative perceptions of individuals with SMF. Aesthetics of the submental area, especially SMF, likely impact the overall assessment of attractiveness and social attributes. [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: 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]

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., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Importance: The demand for less invasive nasal procedures has been increasing, highlighting a gap in research on alternatives beyond fillers. This review explores the potential of neuromodulators and energy-based devices for nonsurgical rhinoplasty. Observations: Both botulinum toxin and energy-based devices used independently or alongside fillers have been studied for nasal shape adjustments. Neuromodulator injection of the depressor septi nasi can reduce nasal tip droop, which can reduce the appearance of a plunged nose. Treatment of the dilator naris can minimize alar flaring, giving the appearance of a thinner nasal tip. These methods primarily reported patient-reported outcomes. Energy-based devices have been used to address nasal skin quality and shape contouring, including resurfacing devices for rhinophyma with improvement in both physician and patient-reported outcomes. The 1470 nm laser achieved nasal reshaping after two sessions. Radiofrequency microneedling was notable for volumetric reduction in the nose (excluding nasal tip), confirmed by 3D imaging, lasting about 12 months. Conclusions and Relevance: The use of neuromodulators and energy-based devices may offer promising results for nasal reshaping. However, there is a need for further comparison studies using both objective measures such as 3D photography and physician and patient-reported outcomes, prior to establishing best practices for these techniques.

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., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

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., (© 2022 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Social media has become a rising popular online medium for facilitating the exchange of information and ideas for the purpose of education and networking, especially in the realm of plastic surgeon. It is important for facial plastic surgeons in private practice to recognize the influence of and engagement in social media, particularly among younger adults given the ongoing movement of cosmetic patients seeking facial rejuvenation treatments at an earlier age. This article discusses the most recent trends in social media and facial plastic surgery as well as the benefits and challenges of social media in private practice., Competing Interests: Disclosure The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this article., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Blind individuals have demonstrated the ability to detect danger and facial expressions without conscious awareness of visual stimuli. These embodied sensations are believed to be the result of primitive neural networks refined by evolutionary adaptations. We postulate that similar embodied sensations may have evolved to allow blind individuals to perceive beauty., Objective: To determine whether the visually blind can detect physical beauty., Patients and Methods: This observational study consisted of 8 blind and 10 nonblind test subjects and 6 models that were categorized into predetermined beauty categories. Test subjects were individually asked to rate 6 models on a 1 to 10 numerical beauty scale. This process was repeated in both groups while blindfolded (masked). All groups' mean model beauty scores underwent multivariate and univariate analysis., Results: All groups rated preselected (greater than 8) more beautiful models, higher except for the masked, nonblind group. Intraclass correlation was good in the blind raters with a score of 0.751, whereas poor in the nonblind masked raters with a score of 0.458., Conclusion: This is the first pilot study demonstrating with supporting evidence that blind individuals can detect beauty and supports that beauty may rely on primal forms of messaging that are subconsciously appreciated.