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Patient demand for procedures has increased in the evolving landscape of cosmetic dermatology. This has been fueled, in part, by social media and the growing normalization of cosmetic enhancements, developments that have led some patients to have potentially unrealistic expectations and place undue pressure on dermatologists to meet these often unrealistic demands. This pressure is exacerbated further by patients who are seen as difficult, demanding, and time-consuming and who may require extensive counseling. Physicians may adopt dynamic or differential pricing strategies to offset the additional time and effort that these patients require. We discuss the ethical concerns surrounding these pricing strategies in the cosmetic sphere, highlight the importance of transparency in pricing, and offer suggestions to promote clarity and fairness in cosmetic dermatology practices., Competing Interests: Declaration of competing interest All authors declare that they have no commercial or other associations that might pose a conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: To evaluate trends in botulinum toxin (BTX) industry payments to physicians. Methods: Cross-sectional analysis of nonroyalty, BTX-specific payments made by Allergan (Botox), Ipsen (Dysport), and Merz (Xeomin) to physicians using the 2016-2020 Open Payments Database. Results: Between 2016 and 2020, >$27 million in payments was made for BTX-related activities to dermatologists, neurologists, ophthalmologists, otolaryngologists, and plastic surgeons, with payments ranging from $3.9 million in 2016 to $8.7 million in 2019. 21.7% was paid to dermatologists, 57.5% to neurologists, 5.9% to ophthalmologists, 5.7% to otolaryngologists, and 9.1% to plastic surgeons. Conclusions: Growing amounts are being paid to physicians for BTX-related activities-both medical and aesthetic. Despite the variety of indications for BTX within otolaryngology, otolaryngology payments were overshadowed by other specialties, which may reflect greater BTX utilization in those specialties.

Background: Direct-to-consumer (DTC) advertising is a prominent type of health care communication., Objective: This study aims to determine the impact of DTC advertisements on consumer opinion., Methods: A total of 203 participants were recruited from dermatology clinics at an urban academic center. Participants viewed 2 cosmetically oriented DTC advertisements, and prequestionnaires and postquestionnaires were administered to assess consumer opinion., Results: Postquestionnaire data highlight a 18.8% and 24.6% increase in participants reporting using commercials as an information source (p < .001) and seeking out additional medical knowledge (p < .001), respectively. After watching the advertisements, there was a 14.4% increase in participants who believed advertisements facilitate better discussions between patients and physicians (p < .001) and a 33% increase in patients reporting they would discuss the procedures with their doctors (p < .001). Of the participants, 60% believed the advertisements did not provide enough information about the possible risks of the product and 39.4% believed a physician was not required to perform cosmetic procedures., Conclusion: Direct-to-consumer advertisements instill meaningful information to patients and promote patient-physician communication. They also seem to exaggerate the benefits while making the procedures seem simple and without risks, suggesting trained medical professionals are not needed for administration., (Copyright © 2021 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: The COVID-19 pandemic has transformed the delivery of medical and surgical services globally. Subsequently, all elective and aesthetic procedures have been cancelled or deferred in accordance with government-mandated quarantine measures. The Cosmetic Surgery Governance Forum (CSGF) is a network of aesthetic plastic surgery consultants which has enabled a sharing of expertise during challenging times. We conducted a cross-sectional survey to assess the impact of the COVID-19 pandemic on aesthetic plastic surgeons and their practice in the UK., Methods: On 15 June 2020, 131 respondents from the CSGF and wider aesthetic plastic surgeons in the UK were invited to respond to an online survey. An anonymised questionnaire was created using SmartSurvey TM and distributed at the end of the quarantine period. Questions regarding their current scope of practice, willingness to recommence face-to-face consultations, financial loss and psychological impact were asked., Results: A total of 101 Consultant Plastic surgeons (76%) completed the questionnaire. If strict protocols and adequate personal protective equipment were available, 50-55% of respondents would consider offering non-surgical treatments as soon as the private clinic was open. Furthermore, 51% would consider procedures under general anaesthetic, whilst 89% of respondents would offer local anaesthetic only in the initial phase. Moreover, 66% reported experiencing a psychological impact and 100% of respondents reported a significant financial impact., Conclusions: This survey aims to give an account of the current state (May-July 2020) of aesthetic plastic surgery in the UK. There is ongoing uncertainty and deliberation regarding the timing and organisational changes required for aesthetic practice to restart., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Recent changes to the plastic surgery residency training requirements along with a general call for expanded education in cosmetic surgery have encouraged many institutions to incorporate resident aesthetic clinics into their curricula. Although the safety and satisfaction rates of resident aesthetic clinics have been well-studied, their financial viability has not. This study reviews the financial viability of the resident aesthetic clinic at the authors' institution through a cost analysis., Methods: Billing data were analyzed for all patient visits to the resident aesthetic clinic of the authors' institution during calendar year 2018. Data were extracted, including type and anatomical location of each procedure, charges collected, and supplies used. A financial analysis was performed based on fixed and variable costs and gross revenue., Results: A total of 100 unique patients were seen in the clinic over a 1-year period, resulting in 53 operations. This included 15 face, four breast, and 34 body contouring procedures. In addition, 160 cosmetic injections were performed. The gross revenue was $69,955 and the net revenue was $36,600., Conclusions: The resident aesthetic clinic at the authors' institution proved to be financially viable. The authors encourage other institutions to more closely examine the financial state of their resident aesthetic clinics as well. Furthermore, the authors hope that this analysis demonstrates to other programs that, with certain practice models, cost should not be a barrier to initiating and maintaining this valuable training tool., (Copyright © 2021 by the American Society of Plastic Surgeons.)

Background: Patients use social media to find information about cosmetic procedures, yet dermatologists historically lack a social media presence. Misleading information from nonexperts is potentially harmful., Objective: To identify the top influencers posting about nonsurgical cosmetic procedures on Instagram, verify their credentials, and analyze their content to empower dermatologists to effectively join the online conversation, combat harmful misinformation, and preserve the expertise and influence of board-certified dermatologists., Methods and Materials: Using the Klear marketing platform, Instagram influencers with more than 50,000 followers were identified. Influence rating, top posts, and other metrics were extracted using proprietary algorithms., Results: Ninety nine influencers were identified. Of the top 10, 70% were board-certified plastic surgeons. Physicians not board-certified in a core cosmetic specialty had the highest influencer rating and number of followers. The most popular posts were of before and after photographs and personal posts., Conclusion: Dermatologists may be able to increase their Instagram footprint by posting frequently, especially of before and after and personal photographs, using hashtags, Instagram live and Instagram television, and Instagram stories. It is important for the dermatology community to find a way to ethically navigate social media to have a seat at the table and meet patients where they are., (Copyright © 2021 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background: Coronavirus 2019 (COVID-19) disease has rapidly spread worldwide with a multitude effects on daily life. Since the transmission risk increases with close contact, some cosmetic procedures are considered high risk and majority of them had to be postponed or canceled in private dermatocosmetology clinics especially during the heavy period of the outbreak., Aims: We aimed to document the medical and socioeconomic problems emerged in dermatocosmetology clinics in Turkey caused by COVID-19 pandemic and to discuss the management strategies taken by dermatologists., Patients/methods: This survey research was conducted with 100 dermatologists who work in private dermatocosmetology clinics. The survey included 38 questions about office re-arrangements including patient admission and office environment, safety precautions taken for cosmetic procedures, management of clinic staff, and financial impact of the pandemic., Results: A remarkable decrease in major cosmetic interest was reported in private clinics; meanwhile, there was an increase in applicants for noncosmetic dermatological complaints. The most avoided cosmetic procedures were application of skin care devices, lasers, chemical peeling, and thread lifting, while botulinum toxin injection was the most performed procedure. Nearly half of the participants had severe financial damage. Of the participants, 55% reported that they worked anxiously during this period and 60% believed that they managed the early period of the pandemic successfully., Conclusion: Private dermatocosmetology clinics have to work in a totally different period that they have never experienced before. The pandemic has had serious impacts on both medical and socioeconomic issues which had to be managed carefully., (© 2020 Wiley Periodicals LLC.)

The facial plastic surgeon faces increasing competition in the aesthetic world for both surgical and nonsurgical services. Incorporating nonsurgical options in practice, such as "liquid facelifts," aesthetic services, and products, increases both patient satisfaction and office revenue stream. A successful nonsurgical practice can be built with minimal expense by focusing on the most critical and popular options to offer patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The rapidly increasing number of COVID-19-infected patients and evidence of human-to-human transmission even within the asymptomatic incubation period prompted the attention of the entire world. The field of dermatology and procedural dermatology is not exempt from this global issue. We cannot deny the fact that this situation will have a lasting impact on the health-seeking behaviors of our patients. It is necessary for dermatologists and dermatologic surgeons to be aware of the potential risks and precautions when re-emerging their practices after COVID-19., (© 2020 Wiley Periodicals, LLC.)

Objective(s): To characterize procedural trends in facial plastic and reconstructive surgery procedures in relation to the United States economy., Methods: Retrospective cohort study examining annual procedure rates were determined from the American Society of Plastic Surgeons (ASPS) National Clearinghouse of Plastic Surgery Procedural Statistics from January 1 2007 to December 30, 2017. Procedures were compared to economic activity of the United States as measured by gross domestic product (GDP) were compared using Kolmogorov-Smirnov goodness of fit testing and piecewise multivariate regression modeling., Results: Annual trends in procedural rates showed an overall decrease in the rates of rhinoplasty (284,960 to 218,924), blepharoplasty (240,660 to 209,571), and otoplasty (28,571 to 23,433) from 2007 to 2017. Total cosmetic surgery remained fairly stable, while minimally invasive cosmetic surgery increased in frequency over the study period. On piecewise regression analysis, rhinoplasty (P = .02), rhytidectomy (P = .007), invasive cosmetic surgery (P < .001) were significantly associated with GDP, whereas otoplasty (P = .98) and reconstructive surgery (P = .11) were not associated with GDP., Conclusion: Cosmetic plastic surgery procedures show a greater correlation to GDP than reconstructive procedures. Trends in plastic surgery cases over the last decade show a decreasing number of rhinoplasty, otoplasty, and blepharoplasty, with stabilization in the last few years. An increasing number of reconstructive cases are found., Level of Evidence: 4 Laryngoscope, 130:632-636, 2020., (© 2019 The American Laryngological, Rhinological and Otological Society, Inc.)

Recently, stem cells in aesthetics have attracted increased attention, especially as they have become a popular trend that is being mass-marketed to consumers on the Internet and social media. Unfortunately, studies have shown this marketing to be misleading as it portrays many purported benefits of stem cells that have yet to be proven in the limited studies that are available. It is important for clinicians to understand the evidence and marketing behind any new trends, especially in the fast-paced world of aesthetics, where treatments often outpace current medical understanding. As clinicians, we have bioethical and professional obligations to educate ourselves on current trends, ensure adequate patient safety, and advocate for continued consumer education.

Background: The utility of Google Trends (GT) in analyzing worldwide and regional patient interest for plastic surgery procedures is becoming invaluable to plastic surgery practices. GT data may offer practical information to plastic surgeons pertaining to seasonal and geographic trends in interest in facial cosmetic procedures., Objectives: The authors sought to analyze geographic and temporal trends between GT search volumes and US surgery volumes using univariate analysis., Methods: The "related queries" feature of GT generated potential search terms. GT data were compiled for cheek implants, mentoplasty, otoplasty, blepharoplasty, rhytidectomy, forehead lift, hair transplantation, lip augmentation, lip reduction, platysmaplasty, and rhinoplasty from January 2004 to December 2017. Annual volumes for respective procedures were obtained from annual statistics reports of the American Society of Plastic Surgeons (ASPS) from 2006 to 2017 and American Society of Aesthetic Plastic Surgery (ASAPS) from 2004 to 2017., Results: Geographical and temporal variations in search volume were detected during the study. Search volume trends that correlated significantly with both ASPS and ASAPS surgery volume trends were: "eyelid plastic surgery" (ASPS R2 = 0.336, P = 0.048; ASAPS R2 = 0.661, P = 0.001); "facelift" (ASPS R2 = 0.767, P ≤ 0.001; ASAPS R2 = 0.767, P = 0.001); "lip injections" (ASPS R2 = 0.539, P = 0.007; ASAPS R2 = 0.461, P = 0.044); and "rhinoplasty surgery" (ASPS R2 = 0.797, P ≤ 0.001; ASAPS R2 = 0.441, P = 0.01). Several search terms demonstrated no significant relationships or were significant with only one database., Conclusions: GT may provide a high utility for informing plastic surgeons about the interest expressed by our patient population regarding certain cosmetic search terms and procedures. GT may represent a convenient tool for optimizing marketing and advertising decisions., (© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Background: Among the growing aesthetic patient population, Hispanic/Latinos represent the largest proportion of non-Caucasians patients. While treatment of Caucasian facial aging patterns are well documented, far less information describes the aesthetic needs of the Hispanic/Latino patient. Objective: An online study was designed to survey facial aesthetic concerns, treatment priorities, and future treatment considerations among a US-based population of Hispanic/Latino American women. Materials and Methods: A total of 401 participants ages 30 to 65 years reported their attitudes toward facial aging, current facial conditions, most bothersome facial areas, areas most/least likely to be treated first, awareness of treatment options and their consideration rates, and motives and barriers that factor into consideration of injectable treatments. Results: Most participants wanted to look good for their age and treatment interests reflected predominant conditions: facial wrinkles, periorbital signs of aging, and uneven skin tone. Most bothersome facial areas included the submental area, periorbital area, and forehead, which were also among the areas most-likely to treat first. The majority of participants would consider injectables. Cost and safety/side effects were cited as frequent concerns. Conclusion: An understanding of the facial aesthetic concerns and treatment priorities specific to Hispanic/Latino women will enhance the practitioner’s patient-centric treatment approach. J Drugs Dermatol. 2019;18(7):623-632.

The article defines the main trends of the market of medical anti-aging services and prospects of aesthetic medicine. The paper presents the data of research on the impact of contextual advertising in social networks on the decision of patients of middle and retirement age on the use of anti-aging cosmetology and treatment for the provision of cosmetic services of an aesthetic nature. The article presents the analysis of the main options of Internet advertising of a medical nature for anti-aging subjects, in addition, describes the methodology that is developed for commercial medical organizations, and analysis of anti-aging medical procedures in the aspect of aesthetic medicine and the search for the necessary information on anti-aging medicine in social networks. The article draws an important conclusion that an important factor affecting the medical market of aesthetic medicine services is the decrease in consumer activity and solvency of the population, which requires a revision of the price and assortment policy of clinics. The article demonstrates the results of obtaining valuable data on popular requests and effective advertising sources, conversion into circulation from different advertising channels and from different devices, the activity of consumers of medical aesthetic services during the week and day. Special attention was paid to the advertising of anti-aging aesthetic medicine in social networks.

Background: As facial aesthetic procedures have become more widely accepted, the racial and ethnic diversity of aesthetic patient populations has increased. Asian Americans represent a growing segment of this population and have specific aesthetic concerns that should be differentiated from the broader Caucasian population. Objective: An online study was designed to survey facial aesthetic concerns, treatment priorities, and future treatment considerations among a US-based population of Asian American women. Materials and Methods: A total of 403 participants ages 30 to 65 years reported perspectives on facial aging, current facial conditions, most bothersome facial areas, most/least likely to be treated first, awareness of treatment options and consideration rates, and motives/barriers impacting the consideration rate of injectable treatments. Results: Treatment interests reflected predominant issues; uneven skin tone, wrinkles, and sun damage. Most bothersome facial areas included the periorbital area, forehead, and submental area, and also among areas designated as most likely to treat first. The majority of participants would consider injectables. However, safety/side effects, cost, and concerns about not looking natural were primary barriers. Conclusion: Understanding the aesthetic concerns and priorities specific to Asian American women may help guide treatment plans more aligned with the goals and expectations of this patient population. J Drugs Dermatol. 2019;18(7):633-641.

Background: Although treatments to address cosmetic concerns are common, patients' self-reported motives for considering such procedures have not been systematically explored., Objective: To develop a framework of categories to describe patients' self-reported motivations for undergoing minimally invasive cosmetic procedures., Methods: Face-to-face, semistructured patient interviews were conducted with adult participants who had undergone or were considering minimally invasive cosmetic dermatologic procedures. A qualitative constant comparative approach was used to analyze interview transcripts, yielding themes and subthemes., Results: A total of 30 interviews were completed. Most patient-reported motivations for cosmetic procedures could be subsumed under 8 general categories (themes): (1) mental and emotional health, (2) cosmetic appearance, (3) physical health, (4) work and/or school success, (5) social well-being, (6) cost and/or convenience, (7) procedural perceptions, and (8) timing of treatment. Many individual motivations in these categories were unrelated to desire for physical beauty. In particular, participants wanted to avoid being self-conscious, enhance confidence, reduce the time and expense required to conceal physical imperfections, and be perceived as capable at work., Limitations: Only English-speaking patients in the United States were interviewed., Conclusion: Patient-reported motivations for cosmetic procedures mostly pertained to physical and psychosocial well-being. Indeed, a desire for improved cosmetic appearance was only 1 of the 8 themes revealed through the patient interviews., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Caustic products are used as affordable alternatives to laser removal of tattoos., Objective: Describe a series of patients with sequels after tattoo removal by caustic products., Methods: 11 patients with complications referred from 2013 to 2017 were studied. Objective findings, sequels, corrective treatments, cost and psychological aspects were obtained. Numeric Rating Scale (NRS, score 10 extremely dissatisfied) was used to describe patient satisfaction with tattoos before and after removal., Results: Scarring and residual tattoo pigments were detected in all patients. Chronic itching (73%), redness (73%) and swelling (64%) were frequent. Patients were less satisfied with their tattoo after removal attempts; Average NRS prior to removal was 7.5 (range 5-10), and afterwards 8.9 (range 4.5-10), t test non-significant. Removal was performed by medical professionals (82%) and cosmetologists (18%), involving the marketed injection brands Tatt2Away and Rejuvi. Ten patients had corrections eg. laser, plastic surgery or cover-up tattoos. Private expense for corrections was mean 1.953 EUR, not including consultations provided by the Hospital., Conclusion: Tattoo removal by caustic products can cause severe and chronic sequels with dissatisfaction despite therapeutic interventions to correct disfiguring changes. Removal by caustic products is freely permitted. Products are obscured and liability and consumer protection is unacceptable; limitation is needed., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The medical tourism industry, and in particular cosmetic tourism for breast augmentation, is becoming an increasingly popular global phenomenon. The objective of this study is to determine the extent of medical literature and the patient risk profiles associated with cosmetic tourism for breast augmentation both locally and abroad., Data Sources: OVID MEDLINE, OVID Embase, Cochrane Central and Proquest electronic databases., Methods: The search was conducted through to April 2017. Studies pertaining entirely or partly to cosmetic tourism for breast augmentation were considered for inclusion. Exclusion criteria included non-English articles, studies relating to non-cosmetic or non-implant breast augmentation, and studies that did not separately report on findings associated with breast augmentation abroad., Results: We identified 17 observational studies. Common destinations included Europe, South America and South East Asia. Infectious complications were common. Wound dehiscence and aesthetic dissatisfaction also featured. Catastrophic outcomes such as sepsis, intubation and ventilation, radical bilateral mastectomy, irreversible hypoxic brain injury and death were also reported. There were expectations that home country health systems would treat complications and provide non-medically indicated revision procedures. The burden on home country health systems was evident from a public health perspective., Conclusion: Determining the extent of cosmetic tourism for breast augmentation, including outcomes and complications, will help to inform Australian patients who this seek procedure abroad. Furthermore, it will aid in better understanding the health system implications and may help to guide future research and public health interventions both locally and internationally., (© 2017 Royal Australasian College of Surgeons.)

Background: Cosmetic tourism has become increasingly popular despite many associated risks. The economic impact of atypical mycobacterial infections in cosmetic tourism is poorly defined in the literature. We sought to investigate the costs and clinical course of patients with these infections., Methods: A retrospective review of all patients managed by the Plastic Surgery Division at Columbia University Medical Center from 2013 to 2014 with atypical mycobacterial surgical site infections after cosmetic surgery outside the United States was performed. Data including patient demographics, procedure costs, clinical course, impact on daily life, and costs associated with complications were collected using hospital billing information, patient questionnaires, telephone interviews, and clinical charts. Cost analysis was done to identify the personal and societal costs of these complications., Results: Data from 10 patients were collected and analyzed. Management of mycobacterial infections cost an average of $98,835.09 in medical charges. The indirect cost of these infections was $24,401 with a mean return to work time of 6.7 months. Total patient savings from cosmetic tourism was $3419. The total cost of a mycobacterial infection was greater than $123,236.47. Although the incidence of mycobacterial infection abroad is unknown, the potential cost of an infection alone outweighs the financial benefits of cosmetic tourism if the risk exceeds 2.77%., Conclusions: Atypical mycobacterial infections as a result of cosmetic tourism come at considerable cost to patients and the health care system. When our results are taken into consideration with other risks of cosmetic tourism, the financial risks likely far outweigh the benefits.

Background: The appearance of aging skin is a common complaint among dermatology patients. There is an expanding market for anti-aging therapies, but little information is available regarding which patients utilize these treatments and patient preferences regarding treatment., Aims: To describe the patient population utilizing anti-aging therapies, assess patient familiarity with treatment options, and learn where treatment information is most often obtained., Patients/methods: Three hundred patients were surveyed in the University of Michigan General Dermatology Clinic., Results: Fifty-three percent of the general dermatology patient population has used an anti-aging treatment in the past; 66% reported interest in the future use. Interest is high among all genders, ages, and incomes. Most subjects obtained treatment information from magazines, but subjects were more likely to pursue treatment if information was obtained from a dermatologist., Conclusion: Demographics of anti-aging therapy are changing, and a wide variety of patients pursue treatment. Patients are largely unfamiliar with most treatment options and are more likely to pursue treatment after receiving treatment information from a dermatologist. The information presented in this study is helpful to both dermatologists and marketers of anti-aging products., (© 2017 Wiley Periodicals, Inc.)

Background: Medical tourism has witnessed significant growth in recent years. The emerging trend towards international travel for cosmetic surgical interventions has not previously been reviewed. The current review aims to critically address the scale and impact of cosmetic surgical tourism and to delineate the complication profile of this form of medical tourism., Methods: Articles published in the English language on the PubMed database that were relevant to surgical tourism and the complications of elective surgical procedures abroad were examined. Reference lists of articles identified were further scrutinized. The search terms used included combinations of 'surgery abroad', 'cosmetic surgery abroad', 'cosmetic surgery tourism', 'cosmetic surgery complications' and 'aesthetic tourism'., Results: This article critically reviews the epidemiology of cosmetic surgical tourism and its associated economic factors. Surgical complications of selected procedures, including perioperative complications, are described. The implications for travel medicine practice are considered and recommendations for further research are proposed., Conclusion: This narrative literature review focuses on the issues affecting travellers who obtain cosmetic surgical treatment overseas. There is a lack of focus in the travel medicine literature on the non-surgery-related morbidity of this special group of travellers. Original research exploring the motivation and pre-travel preparation, including the psychological counselling, of cosmetic surgical tourists is indicated.

Background: Plastic surgeons are rapidly integrating social media into their practices and recent articles on the subject have exploded in the literature. Although social media is being evaluated as a tool, few have actually been able to quantify the impact of social media on a practice., Objectives: To quantify the return on investment for social media in a plastic surgery practice., Methods: The ideal method for this type of study is a new practice, without preexisting clients and with a broad approach to marketing to examine the effects of multiple marketing tools. In this study, we profile a start-up plastic surgery practice in Beverly Hills, Los Angeles., Results: In this study, we report practice demographics as well as one year of income, broken down by the referral source for each patient. The dollar amount returned was reported for several social media resources and other internet-based marketing tools., Conclusions: Social media has a relatively high return on investment, and to date this is the first study to transparently quantify the value of social media in plastic surgery.

In their article "Importing Injectables" in the September 2014 issue of the Journal of Drugs in Dermatology, Dr. Kenneth Beer and Karen Rothschild highlighted the possible harm to patients and practitioners from the use of unapproved botulinum toxin products - eg, Botox, Dysport, Xeomin, and Myobloc - and other cosmetic prescription drug products purchased from foreign or unlicensed suppliers.1 In the intervening years, the accuracy of their critique has been repeatedly demonstrated, as the dangers to patients' health, as well as to cosmetic practitioners' liberty, has only increased.

Background: Centrifugation (Cf) is a common method of fat processing but may be time consuming, especially when processing large volumes., Objectives: To determine the effects on fat grafting time, volume efficiency, reoperations, and complication rates of Cf vs an autologous fat processing system (Rv) that incorporates fat harvesting and processing in a single unit., Methods: We performed a retrospective cohort study of consecutive patients who underwent autologous fat grafting during reconstructive breast surgery with Rv or Cf. Endpoints measured were volume of fat harvested (lipoaspirate) and volume injected after processing, time to complete processing, reoperations, and complications. A budget impact model was used to estimate cost of Rv vs Cf., Results: Ninety-eight patients underwent fat grafting with Rv, and 96 patients received Cf. Mean volumes of lipoaspirate (506.0 vs 126.1 mL) and fat injected (177.3 vs 79.2 mL) were significantly higher (P < .0001) in the Rv vs Cf group, respectively. Mean time to complete fat grafting was significantly shorter in the Rv vs Cf group (34.6 vs 90.1 minutes, respectively; P < .0001). Proportions of patients with nodule and cyst formation and/or who received reoperations were significantly less in the Rv vs Cf group. Based on these outcomes and an assumed per minute operating room cost, an average per patient cost savings of $2,870.08 was estimated with Rv vs Cf., Conclusions: Compared to Cf, the Rv fat processing system allowed for a larger volume of fat to be processed for injection and decreased operative time in these patients, potentially translating to cost savings. LEVEL OF EVIDENCE 3., (© 2016 The American Society for Aesthetic Plastic Surgery, Inc.)

Patients often come to medical aesthetic offices with hopes to fully correct lost facial volume and achieve a natural appearance. Unfortunately, the cost per syringe of dermal filler can be a barrier to desired outcomes. Many aesthetic practitioners do the best they can with the amount of product the patient can afford, often falling short of the "wow" effect for the patient. This article describes what one office implemented to solve the conundrum of affordability while still allowing offices to cover its own financial realities. This tool can help patients achieve beautiful, natural, and affordable outcomes while helping offices advance in manufacturer's tiers, improve word-of-mouth advertising, and increase job satisfaction.

Background: This article is a review of the literature and the authors' experience in managing patients seeking facial and nonfacial rejuvenation procedures with budgetary constraints., Objective: To provide readers with an approach to the cosmetic patient with financial limitations., Methods and Materials: This article is written from a review of the literature and the authors' experience., Results: The readers should learn how to better manage a patient with financial limitations seeking cosmetic procedures., Conclusion: Because patients seeking cosmetic procedures are often faced with budgetary constraints, it is important for the cosmetic physician to educate patients about available treatment options and their costs. Giving patients realistic expectations and tailoring treatment plans to the patient's primary goals and financial limitations can help maximize overall patient satisfaction.

Plastic surgeons are sometimes hesitant to provide their pricing information online, due to several concerns. However, if implemented right, price transparency can be used as a lead generation tool that provides consumers with the pricing information they want and gives the physician the consumer's contact information for follow-up. This study took place during the author's first year in private practice in a new city. An interactive price transparency platform (ie, cost estimator) was integrated into his website, allowing consumers to submit a "wishlist" of procedures to check pricing on these procedures of interest. However, the consumer must submit their contact information to receive the desired breakdown of costs that are tailored based on the author's medical fees. During that first year, without any advertising expenditure, the author's website received 412 wishlists from 208 unique consumers. Consumers (17.8%) that submitted a wishlist came in for a consultation and 62% of those booked a procedure. The average value of a booked procedure was over US $4000 and cumulatively, all of the leads from this one lead source in that first year generated over US $92,000 in revenue. When compared with non-price-aware patients, price-aware patients were 41% more likely to book a procedure. Price transparency led to greater efficiency and reduced consultations that ended in "sticker shock." When prudently integrated into a medical practice, price transparency can be a great lead generation source for patients that are (1) paying out of pocket for medically necessary services due to a high-deductible health plan or (2) paying for services not typically covered by insurance, such as cosmetic services.

Background: The quest for beauty has been a constant theme in human history since the earliest civilizations. The QUEST Observatory, an online observational study, investigated how women continue the pursuit of beauty in the 21st century by examining women's perceptions of facial attractiveness and the strategies they adopt to combat the effects of time on their faces., Aims: To investigate women's attitudes toward beauty, aging, and the place of minimally invasive cosmetic procedures and anti-aging skincare., Patients/methods: An in-depth questionnaire was developed by experts in dermatology, esthetic medicine, and social anthropology as the basis for this online, observational study. A nationally representative sample of 1000 French women aged between 25 and 70 years took part in the study., Results: The main criteria for beauty were identified as a natural look, self-confidence, and attractive skin. A woman is considered to be at the peak of beauty in her mid-thirties just before early signs of facial aging begin to appear. Approximately 50% of women contemplate cosmetic procedures, but less than 10% go ahead. Confidence in the practitioner and good postprocedure follow-up are as influential as efficacy, safety, and cost in decisions about cosmetic procedures., Conclusions: The QUEST Observatory sheds valuable light on factors that affect women's choices regarding strategies for anti-aging and cosmetic procedures. These findings will help esthetic practitioners to better understand their patients and to meet their expectations., (© 2015 Wiley Periodicals, Inc.)

Background: There are an estimated 700,000 or more transgender people in the United States, however their dermatologic needs are not fully established in the medical literature. Unique needs relate to hormone therapy, prior surgeries, and other aspects of physical transitioning., Objectives: By examining attitudes and practices of transgender individuals, we aimed to identify areas for which dermatologists could contribute to their physical transformation., Methods: This cross-sectional study used an anonymous online survey, distributed via lesbian, gay, bisexual, and transgender organizations; social media; and at targeted locations and events., Results: A total of 327 people completed the survey (63% men, 29% women, 9% other). Most transgender women indicated that their face was most imperative to have changed, whereas men noted their chest, in turn influencing procedures. Of women's facial procedures, hair removal predominated, followed by surgery then injectables, mostly performed by plastic surgeons. Hormone-induced facial effects varied, usually taking over 2 years for maximal effect. When choosing procedures, money was the major barrier and good aesthetic outcome the primary concern. Participants did not think that facial procedures necessitate the currently accepted prerequisites for chest and genital surgery., Limitations: This study has limited size and convenience sampling., Conclusion: Dermatologists could contribute to the physical transformation of transgender patients through noninvasive procedures., (Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Postacne scarring is disfiguring, both physically as well as psychologically. Over the past two decades, multiple modalities for treatment of acne scars have emerged and microneedling with dermaroller is one of them., Objective: To evaluate the efficacy and safety of microneedling treatment for atrophic facial acne scars., Material and Methods: Thirty-six patients (female--26, male--10) of postacne atrophic facial scars underwent five sittings of dermaroller under topical anesthesia at monthly intervals. Objective evaluation of improvement was performed by recording the acne scar assessment score at baseline and thereafter at every visit. Pre- and posttreatment photographs were compared, and improvement was graded on quartile score. Final assessment was performed 1 month after the last sitting. Patients were asked to grade the improvement in acne scars on visual analog scale (VAS, 0-10 point scale) at the end of study., Results: Of 36 patients, 30 completed the study. The age group ranged from 18 to 40 years, and all patients had skin phototype IV or V. There was a statistically significant decrease in mean acne scar assessment score from 11.73 ± 3.12 at baseline to 6.5 ± 2.71 after five sittings of dermaroller. Investigators' assessment based on photographic evaluation showed 50-75% improvement in majority of patients. The results on visual analog scale (VAS) analysis showed "good response" in 22 patients and "excellent response" in four patients, at the end of study. The procedure was well tolerated by most of the patients, and chief complications noted were postinflammatory hyperpigmentation in five patients and tram-trek scarring in two patients., Conclusion: Microneedling with dermaroller is a simple and cheap, means of treatment modality for acne scars remodulation with little downtime, satisfactory results and peculiar side effects in Asian skin type., (© 2014 Wiley Periodicals, Inc.)

Background: Stem cells are attractive candidates for the development of novel therapies, targeting indications that involve functional restoration of defective tissue. Although most stem cell therapies are new and highly experimental, there are clinics around the world that exploit vulnerable patients with the hope of offering supposed stem cell therapies, many of which operate without credible scientific merit, oversight, or other patient protection., Methods: The authors review the potential and the drawbacks of incorporation of stem cells in cosmetic procedures. A review of U.S. Food and Drug Administration-approved indications and ongoing clinical trials with adipose stem cells is provided. Furthermore, a "snapshot" analysis of Web sites using the search terms "stem cell therapy" or "stem cell treatment" or "stem cell facelift" was performed., Results: Despite the protective net cast by regulatory agencies such as the U.S. Food and Drug Administration and professional societies such as the American Society of Plastic Surgeons, the authors are witnessing worrying advertisements for procedures such as stem cell face lifts, stem cell breast augmentations, and even stem cell vaginal rejuvenation. The marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence in the majority of cases., Conclusions: Stem cells offer tremendous potential, but the marketplace is saturated with unsubstantiated and sometimes fraudulent claims that may place patients at risk. With plastic surgeons at the forefront of stem cell-based regenerative medicine, it is critically important that they provide an example of a rigorous approach to research, data collection, and advertising of stem cell therapies.