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Aesthetic Plastic Surgery in Asians: Principles and Techniques is the culmination of a monumental effort by well-known experts in the field, Dr Lee L.Q. Pu and his six coeditors. The magnitude of this undertaking is astounding since it involves 90 contributors from multiple Asian countries. This beautiful two-volume set is very timely since the popularity of aesthetic plastic surgery in Asia is skyrocketing with no limit in sight. The two volumes consist of 74 chapters under 10 major sections and also include four chapters on breast reconstruction. In Asia, breast reconstruction is usually considered cosmetic in nature. The set also includes three DVDs and a complimentary eBook version. The quality of writing and editing is excellent. This by itself is a testament to Dr Pu and his coeditors since many of the authors come from countries where English is not their first language. Many chapters include remarks on pertinent differences between Asian and Caucasian anatomy. High quality artwork and images run throughout the book along with clear tables and algorithms. Each chapter ends with a bulleted list titled “Pearls for Success.” In an age when information is instantly accessible by digital media, and with Asia awakening to the popularity of aesthetic plastic surgery, it might seem daunting to try and capture the essence of Asian aesthetic surgery in a book form. Previous books on this subject have been more limited in scope, with many chapters written by only a handful of authors. This book nicely covers all of the pertinent aesthetic procedures in Asians. There is an interesting chapter on “Scar Management for Asian Cosmetic Surgery Patients,” which includes a summary of available treatments and a discussion of anatomic regions which are at higher risk for heavy scarring. Since skin hyperpigmentation is more problematic in Asians and other darker complected races, it is appropriate that this book includes a chapter on this topic. The chapter nicely reviews the differential diagnoses of various epidermal and dermal-pigmented lesions but would be more complete if it also included a paragraph or two on the use of a Wood's lamp as a diagnostic tool for pigmented skin lesions. Although most Western plastic surgeons don't treat acne on a regular basis, “Treatment for Acne and Acne Scars” provides an excellent discussion of the pathophysiology and treatment of these troublesome entities. Liquid silicone is still available in Asia as a soft tissue filler and its use is discussed along with others fillers for facial rejuvenation. Other chapters reflect similar differences between Asia and the West regarding the popularity of various techniques. For instance, thread-lifting was prevalent for a period of time in the United States but has now fallen in popularity. The chapter on “Facial Rejuvenation with Thread Lift” will have a wider audience in Asia. Another stark difference in practice between Asia and the United States is the use of acellular dermal matrices (ADM). The chapter “Breast Reconstruction with Implant” makes no mention of ADM, even for patients with recurrent severe capsular contractures or patients with prior radiation. Perhaps ADM is not widely used in Asia at the present time, but this is likely to change in the next decade or so. As expected, there is some overlap among various chapters. For instance, a chapter titled “Total Facial Rejuvenation with Microautologous Fat Transplantation” follows “Fat Grafting for Facial Contouring.” In a similar vein, “Botulinum Toxin A Injections for Facial Rejuvenation and Shaping” is followed by “Botulinum Toxin A Injections for Facial Contouring.” Many chapters have excellent discussions of complications and their management, while other chapters are either devoid of such discussions or mention complications only in a cursory manner. As an example, Asian surgeons commonly use alloplastic materials for dorsal nasal augmentation, while Western surgeons shy away from using such materials in the nose because of their known associated complications (implant deviation, palpability, infection, extrusion, capsular contractures, etc.). The chapter “Alloplastic Implants for Rhinoplasty” would be more complete if the above complications were properly addressed. DVDs as a complimentary learning tool are very popular, especially in surgery books which are procedure-oriented. The DVDs in this book set contain a number of very good videos. Unfortunately, only seventeen of the sixty procedure-oriented chapters have associated videos. The complimentary eBook version is a very nice addition since it allows the reader to not only access the book's contents online but also offline via a smartphone or tablet. As far as I am aware, this book represents the most comprehensive treatment of this subject matter to date. I thoroughly enjoyed going through each chapter because the flow was smooth, and the material was presented in a very clear manner. For an undertaking of this magnitude, I congratulate Dr Pu and his coeditors for a job well done. They have succeeded in capturing the essence of aesthetic plastic surgery in Asians today. I highly recommend this work to plastic surgeons of all levels who are interested in aesthetic surgery as it applies to Asians. To purchase: https://www.crcpress.com/Aesthetic-Plastic-Surgery-in-Asians-Principles-and-Techniques-Two-Volume/Pu-Chen-Li-Wu-Park-Takayanagi-Wei/9781482240870. Dr Ishii is an unpaid member of the Kybella (Allergan, Irvine, CA) faculty. The author received no financial support for the research, authorship, and publication of this article.
Aesthetic plastic surgery has been long practiced for primarily psychological rather than physical benefit to patients. However, evaluation of the psychological impact of aesthetic plastic surgery has often been of limited methodological rigor in both study design and appropriate measurement. This study is intended to evaluate the psychological impact of aesthetic surgery on patients seeking such intervention in regard to concerns about breasts, nose or upper limbs using standardised psychometric instruments. Participants were recruited through the Plastic Surgery Unit (Patients) and general surgery, ENT surgery and Maxillo-facial surgery (Comparisons) at a UK General Hospital. Outcome measures included the Crown-Crisp Experiential Inventory anxiety scale, Beck Depression Inventory and Derriford Appearance Scale-24, a valid and reliable measure of distress and dysfunction in relation to self-consciousness of appearance. Data were collected pre-operatively (T1) and 3 months post-operatively (T2) for both groups. Longitudinal appearance adjustment for the plastic surgery group was also assessed at 12 months (T3). Both groups were less depressed and anxious post-operatively. The improvement in anxiety was significantly greater in the plastic surgery group. Body site specific appearance distress was significantly improved for the plastics group only, and the level of improvement was related to the body site affected.
Postoperative pain management is crucial for aesthetic plastic surgery procedures. Poorly controlled postoperative pain results in negative physiologic effects and can affect length of stay and patient satisfaction. In light of the growing opioid epidemic, plastic surgeons must be keenly familiar with opioid-sparing multimodal analgesia regimens to optimize postoperative pain control. Methods: A review study based on multimodal analgesia was conducted. Results: We present an overview of pain management strategies pertaining to aesthetic plastic surgery and offer a multimodal analgesia model for outpatient aesthetic surgery practices. Conclusion: This review article presents an evidence-based approach to multimodal pain management for aesthetic plastic surgery.
BACKGROUND: Recent evidence suggests tranexamic acid (TXA) may improve outcomes in aesthetic surgery patients. OBJECTIVES: This systematic review aimed to investigate the impact of TXA use in aesthetic plastic surgery on bleeding and aesthetic outcomes. METHODS: A systematic literature search was conducted to identify studies evaluating TXA use in aesthetic plastic surgery. The primary outcome of interest was perioperative bleeding, reported as total blood loss (TBL), ecchymosis, and hematoma formation. Meta-analyses analyzing TBL and postoperative hematoma were performed. RESULTS: Of 287 identified articles, 14 studies evaluating TXA use in rhinoplasty (6), rhytidectomy (3), liposuction (3), reduction mammaplasty (1), and blepharoplasty (1) were included for analysis. Of 820 total patients, 446 (54.4%) received TXA. Meta-analysis demonstrated TXA is associated with 26.3 mL average blood loss reduction (95% CI, -40.0 to -12.7 mL; P < 0.001) and suggested a trend toward decreased odds of postoperative hematoma with TXA use (odds ratio, 0.280; 95% CI, 0.076-1.029; P = 0.055). Heterogeneity among reporting of other outcomes precluded meta-analysis; however, 5 of 7 studies found significantly decreased postoperative ecchymosis levels within 7 days of surgery, 3 studies found statistically significant reductions in postoperative drain output, and 1 study reported significantly improved surgical site quality for patients who received TXA (P = 0.001). CONCLUSIONS: TXA is associated with decreased blood loss and a trend toward decreased hematoma formation in aesthetic plastic surgery. Its use has the potential to increase patient satisfaction with postoperative recovery and decrease costs associated with complications, including hematoma evacuation.
Quality of life (QoL) is an important outcome in plastic surgery. However, authors use different scales to address this subject, making it difficult to compare the outcomes. To address this discrepancy, the aim of this study was to perform a systematic review and a random effect meta-analysis. METHODS: The search was made in two electronic databases (LILACS and PUBMED) using Mesh and non-Mesh terms related to aesthetic plastic surgery and QoL. We performed qualitative and quantitative analyses of the gathered data. We calculated a random effect meta-analysis with Der Simonian and Laird as variance estimator to compare pre- and postoperative QoL standardized mean difference. To check if there is difference between aesthetic surgeries, we compared reduction mammoplasty to other aesthetic surgeries. RESULTS: Of 1,715 identified, 20 studies were included in the qualitative analysis and 16 went through quantitative analysis. The random effect of all aesthetic surgeries shows that QoL improved after surgery. Reduction mammoplasty has improved QoL more than other procedures in social functioning and physical functioning domains. CONCLUSIONS: Aesthetic plastic surgery increases QoL. Reduction mammoplasty seems to have better improvement compared with other aesthetic surgeries.
Despite an increasing surge of exosome use throughout the aesthetic arena, a paucity of published exosome-based literature exists. Exosomes are membrane-bound extracellular vesicles derived from various cell types, exerting effects via intercellular communication and regulation of several signaling pathways. The purpose of this review was to summarize published articles elucidating mechanisms and potential applications, report available products and clinical techniques, and prompt further investigation of this emerging treatment within the plastic surgery community. Methods: A literature review was performed using PubMed with keywords exosomes, secretomes, extracellular vesicles, plastic surgery, skin rejuvenation, scar revision, hair growth, body contouring, and breast augmentation. Publications from 2010 to 2021 were analyzed for relevance and level of evidence. A Google search identified exosome distributors, where manufacturing/procurement details, price, efficacy, and clinical indications for use were obtained by direct contact and summarized in table format. Results: Exosomes are currently derived from bone marrow, placental, adipose, and umbilical cord tissue. Laboratory-based exosome studies demonstrate enhanced outcomes in skin rejuvenation, scar revision, hair restoration, and fat graft survival on the macro and micro levels. Clinical studies are limited to anecdotal results. Prices vary considerably from $60 to nearly $5000 based on company, source tissue, and exosome concentration. No exosome-based products are currently Food and Drug Administration-approved. Conclusions: Administered alone or as an adjunct, current reports show promise in several areas of aesthetic plastic surgery. However, ongoing investigation is warranted to further delineate concentration, application, safety profile, and overall outcome efficacy.
BACKGROUND: Tranexamic acid (TXA) can reduce intra- and postoperative bleeding as well as minimizing postoperative swelling and ecchymosis. It can be administered both intravenously and topically during surgery with minimal side effects. OBJECTIVES: To assess the evidence of TXA use in aesthetic surgery and to complete a survey of current practice of full British Association of Aesthetic Plastic Surgeons members. METHODS: The authors performed a literature review and online survey of full British Association of Aesthetic Plastic Surgeons members. RESULTS: There is an increased indication of TXA utilization in aesthetic surgery. It provides multiple surgeon and patient benefits. CONCLUSIONS: TXA is a useful adjunct in aesthetic surgery.
BACKGROUND: What do patients want when looking for an aesthetic surgeon? When faced with attributes like reputation, years in practice, testimonials, photos, and pricing, which is more valuable? Moreover, are attributes procedure-specific? Currently, inadequate evidence exists on which attributes are most important to patients, and to our knowledge, none on procedure-specific preferences. OBJECTIVES: First, to determine the most important attributes to breast augmentation, combined breast/abdominal surgery, and facelift patients using conjoint analysis. Second, to test the conjoint using an internet crowdsourcing service (Amazon Mechanical Turk [MTurk]). METHODS: Anonymous university members were asked, via mass electronic survey, to pick a surgeon for facelift surgery based on five attributes. Attribute importance and preference was calculated. Once pre-tested, the facelift, breast augmentation and combined breast/abdominal surgery surveys were administered worldwide to MTurk. RESULTS: The university facelift cohort valued testimonials (33.9%) as the most important, followed by photos (31.6%), reputation (18.2%), pricing (14.4%), and practice years (1.9%). MTurk breast augmentation participants valued photos (35.3%), then testimonials (33.9%), reputation (15.7%), pricing (12.2%), and practice years (3%). MTurk combined breast/abdominal surgery and facelift participants valued testimonials (38.3% and 38.1%, respectively), then photos (27.9%, 29.4%), reputation (17.5%, 15.8%), pricing (13.9%, 13.9%), practice years (2.4%, 2.8%). CONCLUSIONS: Breast augmentation patients placed higher importance on photos; combined breast/abdominal surgery and facelift patients valued testimonials. Conjoint analysis has had limited application in plastic surgery. To our knowledge, internet crowdsourcing is a novel participant recruitment method in plastic surgery. Its unique benefits include broad, diverse and anonymous participant pools, low-cost, rapid data collection, and high completion rate.
BACKGROUND: A critical issue for aesthetic surgeons may be whether some patients have psychiatric conditions that contraindicate cosmetic procedures. OBJECTIVE: This study reports on the results of an e-mail survey of American Society for Aesthetic Plastic Surgery (ASAPS) members about their awareness of and experiences with body dysmorphic disorder (BDD). METHODS: In August 2001, all active ASAPS members with e-mail addresses listed in the ASAPS membership registry were e-mailed the "2001 Body Image Survey." Participants were given until August 31 to complete the 8-question survey. The responses were compiled by an independent research firm. RESULTS: Two hundred sixty-five ASAPS members responded to the survey. Respondents indicated that they believed 2% of patients seen for an initial cosmetic surgery consultation suffer from BDD. Eighty-four percent indicated that they have refused to operate on persons with BDD. Eighty-four percent indicated that they had operated on a patient whom they believed was appropriate for surgery, only to realize after operation that the patient had BDD. Eighty-two percent of these surgeons believed that these patients had a poor postoperative outcome. However, only 30% of respondents indicated that they believed BDD was always a contraindication to cosmetic surgery. CONCLUSIONS: The estimated rate of BDD reported by participants in the survey is consistent with the rate of occurrence in the general population but lower than the rate reported for cosmetic surgery patients in other studies. This suggests that although most surgeons are aware that BDD exists among their patients, they may underestimate the rate at which it occurs. (Aesthetic Surg J 2002;22:531-535.).
The evolution of barbed suture technologies and their application in the field of plastic surgery is now in its third decade. Much has been learned along the way. Initial excitement was often followed by disappointment as we learned more about the limited longevity of minimally invasive procedures and complications arising from various suture designs of the past. Some of the early designs, developed primarily for use in aesthetic facial procedures, included free-floating, bidirectionally barbed, nonabsorbable sutures; unidirectional barbed, nonabsorbable sutures; anchored, bidirectional, nonabsorbable double-threaded sutures; and a technology combining a nonabsorbable knotted thread and absorbable cones. More recently, a new, absorbable, unidirectional barbed suture design has become available. However, it should be noted that very limited data are available for any of the modified suture designs used in this field, and much of what has been published is based on the experience of a single user. The author has used the bidirectionally barbed Quill Knotless Tissue-Closure Device (Angiotech Pharmaceuticals, Inc, Vancouver, British Columbia, Canada), the most common barbed suture in both facial and other aesthetic plastic surgery procedures, with considerable success in various open aesthetic facial procedures, including suspension of the brow and midface, platysmaplasty, and lateral neck suspension. It is the author's experience that completion of 1 to 2 cases with this technology is sufficient to achieve competency in the closure techniques discussed in this article and that time savings can be realized using this device in various breast and body contouring procedures, including mastopexy, reduction mammoplasty, abdominoplasty, bodylift, and brachioplasty.
of This Year's Dataset The total number of surgical procedures grew 2.9% from 2022 to 2023 and has increased 10.2% from 2019 to 2023. Liposuction, Breast Augmentation, Tummy Tuck, Breast Lift, and Eyelid Surgery have consistently remained the most common procedures.
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BACKGROUND: The emergence of new technologies necessitates a study of current trends in liposuction and other methods for fat removal. OBJECTIVE: The American Society for Aesthetic Plastic Surgery (ASAPS) conducted a survey of its members to gain valuable information from Board-certified plastic surgeons about their experience with new technologies for fat removal and managing complications after liposuction. METHODS: The ASAPS Current Trends in Liposuction Survey was emailed to 1713 ASAPS members. Data were tabulated and examined to determine current trends in liposuction and other fat removal techniques performed by ASAPS members. RESULTS: The response rate for the survey was 28.7% (n = 492). Most ASAPS respondents reported performing between 50 and 100 liposuction procedures annually. Most plastic surgeons currently employ or have previous experience with suction-assisted lipectomy/liposuction (SAL), ultrasound-assisted liposuction (UAL), and power-assisted liposuction, but fewer reported experience with laser-assisted liposuction (LAL), mesotherapy, or external, noninvasive devices. SAL was the preferred method of fat removal for 51.4%. UAL, LAL, and SAL were most commonly associated with complications. Only 10.5% of ASAPS members employ LAL; 38% have treated a patient with complications secondary to LAL. CONCLUSIONS: Valuable information about current trends in liposuction and other fat removal techniques has been gained from this survey. Although many studies have been published that review issues related to safety, morbidity, aesthetics, and recovery after different methods of fat removal, more prospective studies with standardized objective outcome measures comparing these techniques, particularly newer modalities, are needed to continue improving safety-related standards of care.
The authors report on the possibility of carrying out combined procedures for aesthetic surgery. They pinpoint the conditions necessary for the success of these techniques: surgeon, surgical team, anesthesiologist, and patient should fulfill some requirements that are indispensable. Preoperative and postoperative technical details are presented together with the methodology used for the most important associated procedures. The advantages of these techniques are a more complete patient satisfaction owing to the simultaneous correction of her or his multiple aesthetic problems, decreased hospitalization length and costs (if compared with multistaged surgical corrections), and decreased doctor and patient time investment. No important difference as far as general clinical complications or the aesthetic results were noticed after these procedures. The importance of a qualified team approach is underlined as a condition sine qua non. Otherwise, these techniques would be extremely difficult and risky. Data on personal experience are given, and finally, the authors emphasize the fact that combined procedures for aesthetic surgery are only a possibility that can be performed when all the basic principles and conditions are strictly respected, not a treatment of choice.
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Aesthetic Plastic Surgery National Databank Statistics 2020 Aesthetic Surgery Journal, Volume 41, Issue Supplement_2, June 2021, Pages 1–16, https://doi.org/10.1093/asj/sjab178 Published: 21 April 2021
BACKGROUND: Analysis of Internet search patterns is rapidly transforming the study of human behavior. Google's data, accessed through Google Trends, have proven extremely insightful in several fields of medical research. Despite its adoption in other fields of medicine, Google Trends has not yet been explored in the field of plastic surgery. METHODS: The number of cosmetic surgery procedures from 2005 through 2016 was obtained from the American Society of Plastic Surgeons annual reports. Using Google Trends, the most commonly used keywords describing each procedure were determined, and data regarding search interest over time, interest across geographic area, and Related Queries were obtained. The number of procedures performed annually was compared to relative search volume from the corresponding year and the year prior to determine correlation. RESULTS: Of the 22 procedures evaluated, the annual number of eight procedures correlated with Internet search volume in the corresponding year, and six procedures correlated with the Internet searches performed in the year prior. Florida and New York were the states with the most searches for these procedures. Related Queries suggested that several factors, such as operative techniques, notable individuals undergoing procedures, and cost, variably drove correlations for different procedures. CONCLUSIONS: Google Trends is a powerful tool that can be used to better understand patient interest in, questions about, and decisions regarding cosmetic surgery procedures. These findings warrant action by aesthetic surgeons to increase interest, address misinformation, and help patients fill the gaps of information missed by Internet searches.
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Aesthetic plastic surgery has received wide public attention in the past few years. Expectations of patients regarding results have been exaggerated; the real place and medical importance of the procedures are still not clear because of a lack of more objective evidence. This study discusses the difficulties encountered related to the scientific evaluation of the aesthetic operations and proposes alternatives for assessment. A frequently performed procedure, reduction mammaplasty, is presented as an example, with its specific evaluation.