Search

Introduction: First impressions are lasting, consequential and defined as the immediate judgment made of another from zero acquaintance. Multiple studies have reported the benefits of cosmetic make-up. We set out to investigate the psychosocial and aesthetic effects of cosmetic make-up in order to better understand why women wear it., Materials and Methods: Twenty-seven women were recruited in order to examine the effects of cosmetic make-up on first impressions. The photographs of individual subjects wearing the control cosmetics, their own make-up, and no make-up were randomly assigned to three binders (A, B, and C). Three hundred evaluators participated (100 evaluators per book) and completed a 10-point First Impression Scale for each of the 27 photos in their binder., Results: Statistical analysis of the collected data was conducted in SPSS using two-tailed t-tests to determine the statistical significance of the differences between first impressions of Own Make-up vs No Make-up, No Make-up vs Control Make-up, and Own Makeup vs Control Make-up. There was a significant difference in improvement in all pairings across all 8 categories in the First Impressions questionnaire particularly in perceived age between own make-up, no make-up, control make-up (41, 42, 38; P<0.001)., Discussion: Our study evaluated the first impressions, age perception, self-esteem, and the quality of life impact that cosmetic makeup has on women's appearance and confidence. Subjects wearing cosmetic make-up appeared 4 years younger than those wearing no make-up. And the control cosmetic make-up subjects on average projected a 37% better first impression than subjects wearing no make-up. We objectively quantified and qualified the benefits of applying cosmetic make-up. Make-up can reduce the perceived age, improve the first impression projected and increase the self-esteem of those who apply it.

Anxiety is an under recognized and major obstacle among patients seeking cosmetic procedures. The ability to alleviate it may be essential for achieving high patient satisfaction and better outcomes. Key initiators leading to anxiety include the fear of appearing unnatural and the fear of pain. Pain perception can be mitigated or augmented by psychological factors. Based on patient expectations, they may experience diminished pain perception through the placebo effect or catastrophized pain due to previous painful experiences. It is also important to recognize the influence of religion, cultural, ethnic, and gender bias on pain perception. In recent years, the aesthetic medical community has responded to patient demand for more minimally invasive procedures with more natural appearing result, resulting in a dramatic increase in the number of cosmetic procedures performed each year. Achieving pain and anxiety-free aesthetic medicine will likely result in a pronounced increase in the demand for cosmetic treatments., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Adverse reactions and unintended effects can occasionally occur with toxins for cosmetic use, even although they generally have an outstanding safety profile. As the use of fillers becomes increasingly more common, adverse events can be expected to increase as well. This article discusses complication avoidance, addressing appropriate training and proper injection techniques, along with patient selection and patient considerations. In addition to complications, avoidance or amelioration of common adverse events is discussed., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The aging neck is accompanied by an increase in submental fat, platysmal banding, and redundant dyspigmented skin. Creating a more acute cervicomental angle, distinct mandibular border, homogeneous skin tone, and smoother texture helps to achieve a more youthful appearance. The aesthetic provider's armamentarium has long had surgical techniques in the highest regard, but a new wave of minimally invasive procedures looks to offer a nonsurgical approach to cervicomental rejuvenation. Selecting the appropriate procedure for appropriate patients that will effectively meet their aesthetic goals and expectations is the core of successful neck rejuvenation., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Hyaluronic acid (HA) is the most frequently injected filler for soft tissue augmentation in the United States., Objective: To systematically review published evidence for aesthetic use of small- and large-gel-particle HA., Methods and Materials: Clinical data on anatomic area, level of evidence, patient population, trial design, endpoints, efficacy, and safety were extracted from PubMed., Results: Fifty-three primary clinical reports were analyzed. The highest-quality efficacy evidence was for the nasolabial folds (NLFs), with 10 randomized, blind, split-face, comparative trials. Several randomized, blind trials supported treatment of the glabella, lips, and hands. Lower-level evidence (from studies with nonrandomized, open-label, or retrospective designs) was recorded for the nasojugal folds (tear troughs), upper eyelids, nose, infraorbital hollows, oral commissures, marionette lines, perioral rhytides, temples, and cheeks. Common adverse events (AEs) across anatomic areas were pain, bruising, swelling, and redness. Serious AEs were uncommon (8 events in 8 patients of 4,605 total patients) and were considered to be unrelated (7 events) or probably unrelated (1 event) to treatment., Conclusion: The efficacy and safety of small- and large-gel-particle HA are well established for NLFs; evidence for the glabella, lips, and hands is more limited. Preliminary reports in other anatomic regions suggest efficacy without major complications., (© 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Background: The effect of perceived facial blanching with neurotoxin therapy has been described in the literature and has been used to treat the undesirable facial flushing of Frey's syndrome. Patients rarely report it as a complication after cosmetic injection, but it can be distressing., Objectives: To elucidate the proposed mechanism(s) of this unusual vasculocutaneous phenomenon, we reviewed normal physiologic responses to heat stress and the role of cholinergic neurotransmission in modulating cutaneous vascular tone in the context of the literature., Materials/methods: We report a case of a 32-year-old woman who complained of white patches on her forehead at sites of abobotulinumtoxinA injections administered 2 weeks before presentation., Results: Acetylcholine is a primary mediator of cutaneous vasodilatation; certain co-transmitters modulate its effect. Chemical denervation by botulinum toxin (BoNT) appears to interfere with these normal signaling pathways and can provide symptomatic relief to patients with undesirable facial flushing. Conversely, it may create an unwanted cosmetic effect in patients who desire isolated muscle paresis., Conclusions: Skin sites injected with BoNT type A may not experience the expected decrease in cutaneous vessel tone associated with higher body temperature. The exact mechanism remains unclear., (© 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Rosacea is a cutaneous condition with several clinical subtypes that are commonly seen in daily medical practice. There are many different treatment modalities for each of the physical findings associated with this disease, and all have varying results. As the use of onabotulinumtoxinA rises, its benefit in the treatment of a growing number of medical diseases increases. The authors report anecdotal evidence of patients with rosacea experiencing improved symptoms of erythema and flushing after treatment with intradermal, microdroplets of onabotulinumtoxinA. There were no adverse events reported for any of the treatments. The mechanism of action through a likely neurogenic component to vascular dysfunction, inflammation, and hypersebaceous activity is reviewed.

Background: Few dosing data on onabotulinumtoxinA to treat hyperdynamic perioral lines (POLs) are available. Studying onabotulinumtoxinA in controlled settings is beneficial to treating a hyperfunctional orbicularis oris., Objective: To compare the dose-response relationship of two doses of onabotulinumtoxinA in hyperdynamic POLs., Methods: Female subjects (N = 60) received injections of onabotulinumtoxinA at four sites totaling 7.5 U or 12.0 U. Subjects returned at weeks 2, 4, 8, 12, 16, and 20. POL severity and total lip satisfaction (TLS) were assessed at all visits., Results: Investigator-assessed POL severity was reduced through week 20 for 12.0 U (p < .01). POL reduction for 7.5 U persisted until week 16 (p < .05). Responder rates did not differ until week 12 (12.0 U, 77%; 7.5 U, 36%; p = .003). Subject-assessed TLS was improved (p < .05) at all time points for both groups except at week 20 (12.0 U; p = .06). Most adverse events (AEs) were mild to moderate in severity and typical for onabotulinumtoxinA treatment in the lips, and the incidence was dose-dependent., Conclusion: OnabotulinumtoxinA provides significant reductions in POL severity and high levels of subject satisfaction. Lack of dose response and fewer AEs suggest that treatment of hyperdynamic POLs with 7.5 U appears adequate for up to 16 weeks., (© 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Background: Despite an abundance of nutritional supplements, very few well-controlled trials have assessed their beneficial effect on the skin, such as hydration, antioxidant levels, texture or appearance. The objective of the following placebo-controlled, double-blind study was to determine the effects of the Skin Health Experimental Product (SHEP) on skin health., Methods: The study enrolled healthy men and women aged 30 years or older. Subjects were randomized to receive a twice-daily regimen of SHEP or placebo. The effects SHEP had on overall skin appearance and health were assessed by measuring improvements in: (1) skin hydration using a closed-aperture transepidermal water-loss moisture meter and a vapometer; (2) skin texture using silicon profilometry; (3) skin carotenoid concentration using Raman spectrometry; and (4) reported self-image assessments using the Global Aesthetic Improvement Scale (GAIS)., Results: SHEP-treated subjects demonstrated a significant reduction in fine lines compared to the placebo-treated group. Raman spectroscopy showed that SHEP increased carotenoids at some measurement sites. Based on the GAIS, SHEP-treated subjects were three times more likely to perceive an improvement in their appearance compared to placebo-treated subjects (P>0.049)., Conclusion: The orally-administered SHEP nutritional supplement improves skin texture, carotenoid levels in specific areas of the hand, and improves patients' perception of skin health.

Background: As the number of soft tissue filler injections increases, the number of adverse events associated with injection may rise. Impending necrosis represents a serious complication that, if not treated correctly and timely, may have grave consequences., Objective: We describe a protocol utilizing hyaluronidase, nitroglycerin paste, aspirin, antacid and a topical oxygen therapy that may be used to treat impending necrosis subsequent to injection with soft tissue fillers., Conclusion: We have successfully treated nine post-filler injection adverse events involving impending necrosis or necrosis following both hyaluronic acid and calcium hydroxylapatite injections using our protocol.

Background: An 18-month persistence study reported nasolabial fold (NLF) improvements using a small gel-particle hyaluronic acid (SGP-HA) dermal filler lasted up to 18 months after one retreatment., Objective: [corrected] To evaluate the efficacy and persistence of SGP-HA for the correction of NLFs for up to 36 months., Methods & Materials: Subjects completing the 18-month persistence study were permitted to enroll in an 18-month extension trial. Most required second retreatments to achieve optimal correction of their NLFs. Subjects were followed for up to 36 months after their initial treatment. The primary efficacy measure was a 1-point improvement from baseline Wrinkle Severity Rating Scale (WSRS) score as determined by a blinded evaluator at different time points., Results: The study enrolled 52 subjects. Forty subjects required a second retreatment for optimum NLF correction. Mean retreatment volume was less than 50% of the initial treatment volume. Twenty-six subjects completed the study. Blinded assessments revealed that 94% to 100% of subjects maintained WSRS scores of 1 point or more higher than baseline throughout the study., Conclusions: Participants in the 18-month extension of an 18-month SGP-HA persistence study continued to demonstrate improvement of NLFs up to 36 months after a second retreatment. The mean volume of SGP-HA required for optimum NLF correction decreased substantially with each retreatment. Subjects reported no treatment-related adverse events after the second retreatment., (© 2011 by the American Society for Dermatologic Surgery, Inc.)

The purpose of this study was to review the clinical course of reported hypersensitivity reactions associated with use of soft tissue fillers and the response of these reactions to treatment. In this comprehensive literature review, we identified ~40 published reports that together reported numerous adverse reactions associated with use of nonpermanent soft tissue fillers; however, very few of these reactions were consistent with type I immediate or type IV delayed hypersensitivity reactions. Based on their clinical course and response to treatment, most reported hypersensitivity reactions are likely due to an infectious process. Although there are no confirmed reports of biofilm reactions associated with nonpermanent fillers, the possibility of bacterial contaminants should be considered in acute or chronic inflammatory reactions associated with use of nonpermanent soft tissue fillers. Early treatment with antibiotics is recommended., (© Thieme Medical Publishers.)

In the increasingly competitive market of aesthetic surgery and the unstable predicament of the current economy, managing a successful aesthetic practice becomes ever more difficult. This article introduces the concept of Retailicine, combining essential elements of retail with the core principles of medicine. This new concept stresses the importance of the customer (patient) and provides tips to help manage the aesthetic practice. Through incorporating the techniques mentioned in this article, the aesthetic physician can ensure a successful practice despite current economic uncertainty., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Creating a successful aesthetic medicine practice in times of economic uncertainty is a daunting challenge. This article introduces the concept of Retailicine, combining inherent edicts of medicine with the best practices in business, so today's aesthetic physician can develop strategies for success in any economy. Through the efficient use of marketing strategies catered to aesthetic medicine, aesthetic practices can thrive. Emphasizing the patient's experience, effectively using the Internet, and an ego-devoid introspective analysis of the flaws of one's practice are essential for any successful aesthetic physician to grow and be prosperous despite any shortfalls in the economy., (Thieme Medical Publishers.)

Using soft tissue fillers to correct postrhinoplasty deformities in the nose is appealing. Fillers are minimally invasive and can potentially help patients who are concerned with the financial expense, anesthetic risk, or downtime generally associated with a surgical intervention. A variety of filler materials are currently available and have been used for facial soft tissue augmentation. Of these, hyaluronic acid (HA) derivatives, calcium hydroxylapatite gel (CaHA), and silicone have most frequently been used for treating nasal deformities. While effective, silicone is known to cause severe granulomatous reactions in some patients and should be avoided. HA and CaHA are likely safer, but still may occasionally lead to complications such as infection, thinning of the skin envelope, and necrosis. Nasal injection technique must include sub-SMAS placement to eliminate visible or palpable nodularity. Restricting the use of fillers to the nasal dorsum and sidewalls minimizes complications because more adverse events occur after injections to the nasal tip and alae. We believe that HA and CaHA are acceptable for the treatment of postrhinoplasty deformities in carefully selected patients; however, patients who are treated must be followed closely for complications. The use of any soft tissue filler in the nose should always be approached with great caution and with a thorough consideration of a patient's individual circumstances.

Over the last decade, there has been a shift in the way aesthetic surgeons approach facial rejuvenation. With recognition of the value of volume enhancement in achieving a more youthful appearance, as well as the ease of office procedures offering minimal downtime and predictable results, there has been a concomitant explosion in the soft tissue filler market. Given the vast array of filler products currently available, the decision of which facial filler to use in specific situations can be complicated and confusing. A physician's selection of facial filler(s) should be based on a solid understanding of the various filler products, appropriate patient selection, and the physician's proficiency in injection techniques. We present a review of the most widely used fillers, offering guidance on patient selection and effective injection techniques.

Botulinum toxin type A (BTX-A) has been used for years with excellent results for upper facial cosmetic applications. Because of this success, the use of BOX-A for facial aesthetics has expanded to the lower facial and neck regions. BTX-A, especially when used in combination with fillers, has generally proven to be safe and efficacious in these areas. For optimal results, however, several issues must be taken into considerations, including dosing differences versus upper facial applications, the specific type of botulinum toxin used and the importance of precise placement and injection technique. In this article, the authors present their experience with BTX-A in the lower face and neck, and compare and contrast their current practices with those reported by others.

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 randomly assigned to receive 1 of 2 doses of botulinum toxin type A in the lateral infrabrow--4 U/brow or 6 U/brow--and followed up for 20 weeks., Results: Investigator assessment showed the proportion of responders (> or = 1 grade improvement in severity of dermatochalasis on a scale of none, mild, moderate, or severe) at week 2 was 32% with 4 U and 47% with 6 U. Compared with the lower dose group, the higher dose group also reported a greater degree of improvement, significantly higher ratings for feelings of attractiveness and feelings of satisfaction with appearance, and a higher incidence of satisfaction., Conclusion: Single-site injection of botulinum toxin type A in the lateral infrabrow can offer effective treatment for mild to moderate upper eyelid dermatochalasis.