Body Image, Personality Traits, and Quality of Life in Botulinum Toxin A and Dermal Filler Patients

Investigation of Appearance Anxiety Levels and Influencing Factors in Patients Undergoing Minimally Invasive Facial Cosmetic Procedures

OBJECTIVE

This study aimed to investigate appearance anxiety and its influencing factors in patients undergoing minimally invasive facial cosmetic procedures.

METHODS

A convenience sampling method was used to select 351 patients who attended the outpatient clinic of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January to August 2023. Patients completed self-administered and social appearance anxiety questionnaires before treatment.

RESULTS

The mean appearance anxiety score was 2.49±0.85, indicating a moderate level of anxiety. Significant differences in appearance anxiety levels were observed based on age (p = 0.010), gender (p = 0.026), marital status (p = 0.032), number of children (p = 0.019), facial wrinkle removal procedures (p = 0.023), self-pleasure (p = 0.043), and special attention to the treatment area (p = 0.042). Multiple linear regression analysis identified facial wrinkle removal (p = 0.018), facial depression filling (p = 0.049), and special attention to the treatment area (p = 0.034) as significant factors.

CONCLUSION

Younger populations are more likely to seek improved appearance for better opportunities. The uncertainty of treatment outcomes may also increase social appearance anxiety in patients. Patients can reduce this anxiety by increasing their self-efficacy and self-confidence.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluation of people's satisfaction with botulinum toxin injection for facial rejuvenation based on age

BACKGROUND

Botulinum toxin type A injections are widely used for facial rejuvenation; however, research on people's satisfaction based on age is limited. This study assessed patient satisfaction with botulinum toxin injections for forehead, glabella, and periorbital wrinkles in Birjand, Iran.

PATIENTS AND METHODS

The current study examined 150 people aged 18 to 70 who requested botulinum toxin type A injection in the forehead, glabellar, and periorbital area in 2022, who visited the plastic surgery clinic and the authors' offices in Birjand City. To check patients' satisfaction, Facial Lines Treatment Satisfaction (FTS) Questionnaire was used. One month after botulinum toxin type A injection, this questionnaire was completed by the clients. Also, the brand type of botulinum toxin, age, gender of the clients, frequency of visits, and complications were collected in the relevant checklist.

RESULTS

The average age of participants was 38.8 ± 8.29 years with 73.3% being female. Masport botulinum toxin (MasoonDarou Pharmaceutical Company, I.R. Iran) was the most frequently used botulinum toxin brand at 66.7%. The average satisfaction score with the result of botulinum toxin injection in the forehead/glabella and periorbital area, in the age group under 30 years and 30-40 years, was significantly higher than in the age group over 50 years. The same indicators in the age group under 30 years old were significantly higher than in the 30-40 age group (p < 0.05). Furthermore, brand selection and the number of visits (first-time vs. second-time clients) demonstrated varied outcomes in satisfaction. There was a total of 62.7% side effects postinjection, with varying degrees of severity.

Evaluation of the Effect of Platelet-Rich Fibrin Matrix in the Correction of Periorbital Wrinkles: An Experimental Clinical Trial

INTRODUCTION

Skin rejuvenation techniques have gained substantial popularity due to increased life expectancy over recent years. Platelet-rich fibrin matrix (PRFM) is the new generation of platelet aggregate products that have surfaced in recent years to treat skin aging.

OBJECTIVES

We intend to use PRF to correct periorbital wrinkles in 15 volunteers and evaluate its effectiveness in this study.

METHODS

To evaluate the efficacy of PRFM intervention, eight men and women over the age of thirty entered our study. Blood samples were taken and were immediately centrifuged at 700rpm for 5 minutes. PRFM was extracted from the plasma and injected at the sub-dermis site in periorbital areas. The initial severity of periorbital wrinkles was determined by Visioface 1000D, and obtained data were delivered to the statistical unit for statistical analysis. Scoring and evaluation were based on tissue volume and depth and were measured before and twelve weeks after injection. Adverse effects were also taken into consideration.

RESULTS

The results demonstrated noticeable improvement in deep, fine, and small wrinkles, periocular hyperpigmentation, and overall skin freshness of the injection site. The subjects had swelling in the injection site for up to one day after the injection, which resolved without complications.

CONCLUSIONS

PRFM was observed to have potential in skin rejuvenation, demonstrating promising outcomes in terms of safety and long-term effects in improving skin condition.

Quality of Life, Body Image and Personality Traits Among Women Receiving Botulinum Toxin Type a for Cosmetic Purposes

BACKGROUND

The demand for minimally invasive cosmetic procedures has rampantly increased in recent decades. The aim of this study was to evaluate the body image, personality traits and quality of life (QoL) in women consuming botulinum toxin type A for cosmetic purposes.

METHODS

This case-control study was conducted on 89 participants referring to outpatient dermatology clinics in Mashhad from 2019 to 2021. All participants completed a checklist of demographic and clinical characteristics, as well as three other questionnaires, including the World-Health-Organization Quality of Life-Short Form, Big 5 Inventory-10 (BFI-10) and Yale-Brown Obsessive-Compulsive Scale modified for body dysmorphic disorder (Y-BOCS-BDD). A control group of 101 sex and age-matched people from the general population also completed the questionnaires online.

RESULTS

All participants were females, and most of them in the case group were 31-50 years old (n = 68, 77.1%). Among the case group, QoL was reported higher in all domains; however, this was only significant in 'physical' (P = 0.003) and 'psychological' (P = 0.036) aspects. After considering the confounding factors, the case group was able to significantly predict increased QoL in the 'physical' (P = 0.019) and 'environmental' (P = 0.015) domains. In terms of BFI-10 scores, conscientiousness was notably higher among the case group (P < 0.001), while the control group scored slightly but significantly higher than the case group in neuroticism (P = 0.019). The control group scored significantly higher in Y-BOCS-BDD (P < 0.001).

CONCLUSIONS

In clients receiving botulinum toxin injection for cosmetic purposes, QoL was higher than in the control group. No signs of body dysmorphia or pathological personality traits were found in these individuals.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ocular Complications Post-Cosmetic Periocular Hyaluronic Acid Injections: A Systematic Review

BACKGROUND

With the global rise in the use of hyaluronic acid (HA) fillers as a minimally invasive cosmetic procedure, significant adverse effects such as vascular compromise and blindness have become common. Hence, we present the first systematic review aimed to investigate ocular complications secondary to a facial HA injection and to understand the presentation, cause, management, and outcome of these complications.

METHODS

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A systematic search was performed in July 2021 for published literature using the PubMed, MEDLINE, and Cochrane databases. The following terms were used: facial fillers, facial injections, hyaluronic acid, blindness, ophthalmoplegia, diplopia, ptosis, ophthalmic artery occlusion, posterior ciliary artery occlusion, and ocular ischemic syndrome.

RESULTS

A total of 2496 publications were searched, and 34 articles published between January 2000 and July 2021 were included. Twenty-seven case reports and seven case series were evaluated. The nose was the most common site of injection (n = 25; 40.67%). Ocular pain was the most common initial symptom of ocular complications (n = 13, 22.41 %). The most common complication was vision loss (n = 17, 50%). The majority of patients received hyaluronidase, aspirin, and steroids. Regarding the outcome, 15 (45.45%) of the published studies showed no improvement in complications even after management.

CONCLUSION

HA is gaining popularity in cosmetic applications. Post-HA ocular complications nearly always have an immediate onset. Proper knowledge of potential adverse events is crucial for clinicians to attempt to decrease complications and improve outcomes.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Prevalence and associated factors of minimally invasive facial cosmetic surgery in Chinese college students

BACKGROUND

Minimally invasive facial cosmetic surgery (MIFCS) is becoming more and more popular and acceptable in Chinese young people, and it influences people in many aspects. However, there is little research on the associations between MIFCS and psychopathology in Chinese college students. The purpose of this study was to identify the prevalence of MIFCS and its associated factors among Chinese college students.

METHODS

A cross-sectional design was applied in this study. A total of 8089 students completed an online questionnaire on demographic data, depressive symptoms (Self-Rating Depression Scale), anxiety symptoms (Self-Rating Anxiety Scale) and MIFCS. Logistic regression was used to identify independent factors associated with MIFCS.

RESULTS

The prevalence of MIFCS in Chinese college students was 2.7% (221/8098). Students with MIFCS were more likely to be from urban areas, from a single child household, experience depression or anxiety and have a history of smoking (all p < 0.05). They were also less likely to be right-handed or have a good relationship with father or mother (all p < 0.05). Binary logistic regression showed that older age (OR,1.162; 95%CI [1.061,1.273]), female sex (OR,1.837; 95%CI [1.352, 2.497]), community (urban) (OR,0.601; 95%CI [0.441,0.818]), right-handedness (OR,0.668; 95%CI [0.454,0.985]), depressive symptoms (OR, 4.708; 95%CI [1.690,13.112]), family income (30,000-70,000 yuan per year) (OR,0.572; 95%CI [0.403,0.812]) and smoking (OR,1.571; 95%CI [1.09,2.423]) were independently associated with MIFCS.

CONCLUSIONS

Minimally invasive facial cosmetic surgery (MIFCS) is very common in Chinese college students, indicating the importance of paying attention to MIFCS. This study provides valuable evidence for college counselors and doctors in the cosmetic department to provide better and healthier services to students who undergo MIFCS, especially those with depressive symptoms.

Body dysmorphic disorder and personality in breast augmentation: The big-five personality traits and BDD symptoms

BACKGROUND

Breast augmentation is one of the most performed cosmetic surgeries in the world. Personality traits predict the presence of psychological and social factors that may affect the patient satisfaction with a cosmetic surgical procedure and may be risk factors for body dysmorphic disorder. The aim of this study was to assess symptoms of body dysmorphic disorder in patients undergoing breast augmentation and identify their personality traits.

METHODS

Thirty-six women with hypoplasia of the breast (Sacchini index < 9 cm), a mean age of 28.1 years (SD = 6.2), body mass index ≤ 25 kg/m², and no history of breast surgery or breast-associated conditions were included in this prospective study.The Brazilian versions of the Structured Clinical Interview (SCID-I), Big Five Inventory (IGFP-5), and Body Dysmorphic Symptoms Scale (BDSS) were applied preoperatively and at 2 and 4 months after breast augmentation.

RESULTS

Personality traits were associated with symptoms of body dysmorphic disorder. A significant decrease (p< 0.001) in IGFP-5 scores on the Conscientiousness dimension, symptoms of body dysmorphic disorder (BDSS scores), and the number of patients with body dysmorphic disorder (SCID-I) were observed among different time points. In the study population, breast augmentation decreased the symptoms of body dysmorphic disorder, psychosocial impairment, and mean scores on Conscientiousness.

CONCLUSION

Personality traits varied in intensity and overlapped over time, and were associated with core symptoms of body dysmorphic disorder and the onset of body dissatisfaction.

Botulinum toxin for the management of depression: An updated review of the evidence and meta-analysis

Botulinum toxin (BTX) treatment of glabellar frown lines is one of the most common procedures in aesthetic medicine. In addition to its cosmetic effect, the neurotoxin has been shown to have a positive influence on mood and affect. Several randomized clinical trials (RCTs) have examined the effect of botulinum toxin on the treatment of depression. Combining the results of the five RCTs in a random effects meta-analysis revealed that patients treated with BTX showed a more intense improvement of depressive symptoms in comparison to subjects that received placebo injections (d = 0.98). Despite methodological limitations, the results of this study emphasize the effectiveness of BTX in the treatment of depression and therefore pave the way for its use in the field of psychiatry.

Worry during the initial height of the COVID-19 crisis in an Italian sample

In the earliest months of 2020, the COVID-19 emergency reached a pandemic status of international concern. In this situation, people tended to think more about current difficulties and their negative consequences due to the fear of infection and changed daily life during quarantine. The aim of this study was to explore the severity of worry in relation to individual characteristics and emotions during COVID-19 outbreak in the Italian people. Socio-demographic questions and standardized self-report questionnaires were administered online. Results highlighted a moderate level of worry, anxiety and distress. People with higher perceptions of COVID-19 severity exhibited higher levels of worry in contrast to those who perceived a greater control over the possibility of infection. Multiple regression analysis indicated that coping styles, emotion regulation strategies and personality traits significantly contributed to explain the variance in worry scores. Findings supported that cognitive reappraisal, emotion-focused coping and extraversion were protective factors for worry, while expressive suppression, dysfunctional and problem-focused coping, and neuroticism were related to high worry. However, neuroticism and dysfunctional coping were particularly important predictors of worry. This paper also considers possible psychological interventions that might be implemented in order to deal with mental health issues emanating from the COVID-19 pandemic.

A Correlative Study Between Personality Traits and the Preference of Site Selection in Cosmetic Treatment

Background: Cosmetic treatment was closely associated with beauty seekers' psychological well-being. Patients who seek cosmetic surgery often show anxiety. Nevertheless, not much is known regarding how personality traits relate to the selection of body parts that receive cosmetic treatment. Aims: This study aims to investigate the correlation between personality traits and various selection sites for cosmetic treatment via Eysenck Personality Questionnaire (EPQ). Methods: A cross-sectional approach was adopted to randomly recruited patients from a general hospital planning to undergo cosmetic treatments. All respondents completed the EPQ and provided their demographic information. The EPQ involves four scales: the extraversion (E), neuroticism (N), psychoticism (P), and lying scales (L). Psychological scales were evaluated to verify that people who selected different body sites for cosmetic intervention possessed different personality portraits. Results: A total of 426 patients with an average age of 32.14 ± 8.06 were enrolled. Among them, 384 were females, accounting for more than 90% of patients. Five treatment sites were analyzed, including the body, eye, face contour, nose, and skin. Comparatively, patients with neuroticism were more likely to undergo and demand rhinoplasty (OR 1.15, 95% CI 1.07-1.24, P < 0.001). Face contour treatment was commonly associated with extraversion (OR 1.05, 95% CI 1.00-1.11, P = 0.044), psychoticism (OR 1.13, CI 1.03-1.25, P = 0.013), and neuroticism (OR 1.05, CI 1.01-1.10, P = 0.019). Conclusions: This novel study attempted to determine the personality profiles of beauty seekers. The corresponding assessments may provide references for clinical treatment options and enhance postoperative satisfaction for both practitioners and patients.

Advanced Techniques for the Use of Neurotoxins in Non-Surgical Facial Rejuvenation

BACKGROUND

Neurotoxins initially were used to treat hyperfunctional rhytids of the face, but now have been expanded to improve facial shaping, correct facial asymmetry and even improve skin texture and tone.

METHODS

The clinical approach to non-surgical facial rejuvenation is approached into four anatomical regions: the upper face, midface, lower face and neck.

RESULTS

The key muscles of the upper face include frontalis, orbicularis oculi, corrugator supercilii, procerus, depressor supercilii and temporalis. The muscles in the midface to be discussed include the levator labii superioris, levator labii superioris alaeque nasi, depressor anguli oris, depressor septi nasi and nasalis. Treatment of the lower face focuses on the orbicularis oris, mentalis, depressor anguli oris and masseter muscles. Finally, treatment of the neck region will be reviewed with emphasis on platysmal bands and necklace lines as well as the Nefertiti lift.

CONCLUSIONS

Non-surgical facial rejuvenation using neurotoxins should be performed safely and effectively in order to avoid and treat complications.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Innovative approach to aesthetical medicine services quality assessment

Recently, both doctors and patients pay particular attention to aesthetic medical services quality and efficacy of aesthetic adjustment implemented. It is essential to ensure research, analysis, and improving of botulinum toxin therapy quality and provide patients' orientation on the adjustment schedule, which includes long-term observation period, in order to accomplish the expected goals and increase degree of satisfaction. Injections of medication such as botulinum A toxin are highly demanded in many types of aesthetic treatment. However, practically, sufficient cosmetological effect may not always be achieved, and moreover, complications are possible. This article presents an attempt to evaluate botulinum toxin therapy efficacy using computer program, with calculation of integral quality factor (IQF) and plotting injection modeling visual diagram in long-term observation period. In 3 selected clinical examples, aggregate IQF figure makes: in case of static forehead wrinkles 91.67%, for dynamic forehead wrinkles 76.67%; in case of static eyebrow wrinkles 96.67%, for dynamic eyebrow wrinkles 85%; as applied to static wrinkles of the outer corned of the eye 91.67%, whereas applied to dynamic wrinkles of the outer corner of the eye 73.33%. Although the benchmark is thought to be 100% of remodeling result, the procedures outcome still meets patients' expectations. At the same time, present approach demands further discussion and collection for the purpose of development of procedural basis for aesthetic services quality assessment and interpretation of findings.

The effect of breast augmentation surgery on quality of life, satisfaction, and marital life in married women using BREAST-Q as a validation tool

Introduction:

The results of previous studies show that breast augmentation surgery is effective in improving women's satisfaction and the quality of life. The type of surgical survey tool can be effective in validating the results. The BREAST-Q is a strong and valid questionnaire that has not been performed nationwide as a breast augmentation's survey tool on the quality of life indicators. Therefore, in this study, the effect of breast augmentation surgery on quality of life, satisfaction, and marital life was assessed in married women using BREAST-Q as a validation tool.

Materials and Methods:

This prospective study was performed on 60 married women who underwent breast augmentation surgery from April 2014 to April 2015. Participants were asked to complete the BREAST-Q questionnaires before and 6 weeks after surgery. Statistical analysis was performed using t-test. The level of significance was considered 0.05.

Results:

The results of patients filling out the BREAST-Q questionnaires showed that breast augmentation surgery improved the three variables of satisfaction with breasts, psychosocial well-being, and sexual well-being significantly (P < 0.001). The mean values of the significance of change index also show that a significant improvement is achieved in all three variables up to 100%.

Conclusion:

The results of this study show that in addition to the direct relationship between breast augmentation surgery and quality of life improvement, satisfaction, and marital relationships, using the BREAST-Q questionnaire can be a tool for physicians to assess the psychometric effects of the breast surgery.

Neurotoxin Impurities: A Review of Threats to Efficacy

Recently launched esthetic botulinum toxin serotype A (BoNT/A) products include Nabota/Jeuveau, Meditoxin/Neuronox, and Botulax, which contain nontoxic accessory proteins and excipients. Clinical evidence supporting these formulations, including their purity and potential immunogenicity or their link to treatment failures, is limited. Any nonhuman protein, including nontoxin accessory proteins, can initiate immune reactions, especially if administered repeatedly, yet the issue of BoNT/A-induced immunogenicity is widely contested. However, there have been multiple reports of treatment failures and observations of BoNT/A-induced neutralizing antibodies. Compared with the purified formulation in Xeomin, these recently launched toxins contain higher total neurotoxin quantities, much of which is inactive and exposes patients to potentially immunogenic nontoxin proteins or inactive neurotoxins that increase their risk of developing treatment failure. Well-established products [especially abobotulinumtoxinA (Dysport), onabotulinumtoxinA (Botox) and Xeomin] are accompanied by comprehensive and long-ranging clinical evidence on safety and efficacy in esthetic facial indications, which still remains undisclosed for many of the recently introduced toxins. Clinicians need this information as patients will require repeated BoNT treatments and may be unnecessarily but cumulatively exposed to potential immunogens. To underscore the need for caution and further evidence, we review some of the issues surrounding BoNT/A-induced immunogenicity and antibody-induced treatment failures and argue that using highly purified toxins that do not negatively impact patient outcomes is a prudent clinical decision.

Neuroticism Level and Life Satisfaction in Women Undergoing Breast Augmentation Surgery (a Preliminary Report)

Background

The aim of the present study was to verify the relationship between the level of neuroticism and selected aspects of life satisfaction in women undergoing breast augmentation surgery.

Methods

The study group included 109 women, aged 18–46 years, who completed the self-developed survey measuring selected psychological traits before and after (1 year) surgery. Four questions in this survey were related to the level of neuroticism and two pertained to the self-assessment of leading character traits and the level of life satisfaction. Three questions made up the lie scale.

Results

The studied women were constant in their truthfulness. No statistically significant difference in the level of neuroticism before and after surgery was noticed. However, an increase in the subjective life satisfaction after surgery was highly significant (p < 0.001). Statistically significant negative correlations of neuroticism level with the self-assessment of positive character traits (r_s = − 0.236; p = 0.013) and life satisfaction (r_s = − 0.277; p = 0.004) were found before surgery. Also, a significant positive correlation was observed between neuroticism and the change in life satisfaction 1 year after surgery (r_s = 0.302; p = 0.001).

Conclusions

Breast augmentation surgery did not affect neuroticism level, which proves that constitutional personality traits in women undergoing such operations are not significantly influenced by a surgical intervention. However, neuroticism may play the role of a modulator of the psychological changes in women after breast augmentation (e.g., an increased postsurgical life satisfaction). The preliminary results obtained in our study should be confirmed on a larger sample size in the future.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Influence of Expectancy Level and Personal Characteristics on Placebo Effects: Psychological Underpinnings

Placebo effects benefit a wide range of clinical practice, which can be profoundly influenced by expectancy level and personal characteristics. However, research on the issue of whether these factors independently or interdependently affect the placebo effects is still in its infancy. Here, we adopted a 3-day between-subject placebo analgesia paradigm (2-day conditioning and 1-day test) to investigate the influence of expectancy levels (i.e., No, Low, and High) and personal characteristics (i.e., gender, dispositional optimism, and anxiety state) on placebo effects in 120 healthy participants (60 females). Our results showed that the reduction of pain intensity in the test phase was influenced by the interaction between expectancy and gender, as mainly reflected by greater reductions of pain intensity in females at Low expectancy level than females at No/High expectancy levels, and greater reductions of pain intensity in males than in females at High expectancy level. Additionally, the reduction of pain unpleasantness was not only modulated by the interaction between expectancy and gender, but also by the interaction between expectancy and dispositional optimism, as well as the interaction between expectancy and anxiety state. Specifically, participants who were more optimistic in Low expectancy group, or those who were less anxious in High expectancy group showed greater reductions of pain unpleasantness. To sum up, we emphasized on regulating the expectancy level individually based on the assessment of personal characteristics to maximize placebo effects in clinical conditions.