Minimally Invasive Facial Cosmetic Procedures

The access and invasiveness-based classification of medical procedures to clarify non-invasive from different forms of minimally invasive and open surgery

BACKGROUND

The rapid development of less invasive and traumatic medical procedures has resulted in a mixture of terms used to describe them, without any agreed definition for each. This is confusing to both medical professionals and patients and can lead to unrealistic patient expectations. The aim of this article is to show the current confused nomenclature and to suggest a new, simple classification based on access and invasiveness (AI) that can be applied to any medical procedure.

METHODS

We performed an online search for definitions for 'non-invasive', 'non-surgical', 'minimally invasive', 'minimal access', 'pinhole' and 'keyhole'. We then searched peer-reviewed medical papers (PRMPs) and patient facing websites (PFWs) for the following index procedures, to see which of the original 6 terms were used to describe them: transvaginal ultrasound, sclerotherapy for leg veins, botulinum toxin injections, dermal fillers, endovenous thermal ablation and laparoscopic gall bladder removal.

RESULTS

We found a wide variety of definitions for each of the initial terms. In both PRMPs and PFWs, there were a variety of terms used for each index procedure (i.e.: transvaginal ultrasound, injections of sclerotherapy, botulinum toxin or dermal fillers being both 'non-invasive' and 'minimally invasive') showing confusion in the classification of procedures. We suggested the 'AI classification' based on access (A - none, B - natural orifice or C - penetrating an epithelial surface) and invasiveness (1 - none, 2 - surface damage, 3 - needle = <21G, 4 - cannula >21G but not a surgical trocar, 5 - surgical trocars or small incisions and 6 - incisions).

CONCLUSION

The current confusion of terms used for procedures that are less invasive than the open surgical alternatives leads to confusion and possible false patient expectations. We have proposed an AI classification that can be applied easily to any procedure, giving a uniform classification for medical professionals and patients to understand.

Twelve Steps to Optimize Scar Outcomes in External Rhinoplasty

A well-healed scar extends beyond a mere superficial concern, reflecting the precision and care underlying the surgery. This study addresses the lack of recent literature on the complete closure technique for external rhinoplasty scars, emphasizing its potential impact on patient satisfaction and overall aesthetic quality. The main purpose of this article was to introduce and assess the efficacy of a novel closing suture technique for external rhinoplasty and emphasize on 12 specific steps for wound closure. A cohort of 104 patients who underwent external rhinoplasty utilizing the proposed closing suture technique were evaluated. Standardized photographic documentation and scar assessment were performed using the Vancouver-Manchester scale, considering notching, skin level differences, pigmentation, and overall appearance. The surgical approach involved a combination of vertical mattress and interrupted simple sutures, creating an effective closure framework. Analysis revealed an absence of poor scars, with 83.6% classified as good. Note that 65.5% of the good scars achieved a perfect 6-point score. While one moderate scar scored 3 points, the majority demonstrated optimal outcomes. Clinical photographs further illustrated the technique's success, showcasing imperceptible scars and reinforcing the efficacy of the complete closure approach. Our study introduces and assesses the efficacy of the complete closure technique for external rhinoplasty scars. The approach consistently yields positive outcomes, with an emphasis on almost imperceptible scars. While not achieving a 100% imperceptible scar rate, this study underscores the need for ongoing research to refine techniques and enhance patient satisfaction in external rhinoplasty. The proposed technique contributes significantly to scar management practices and encourages further exploration within the evolving landscape of rhinoplasty.

An Innovative Treatment Using Calcium Hydroxyapatite for Non-Surgical Facial Rejuvenation: The Vectorial-Lift Technique

BACKGROUND

The facial aging process entails alterations in the volume, shape, and texture of all skin layers over time. Calcium hydroxyapatite (CaHA) is a well-established safe skin filler with unique properties to resolve some skin alterations by stimulating neocollagenesis. The vectoral-lift (V-lift) technique targets the global repositioning of facial structures by addressing distinct anatomical injection planes. It includes deep facial augmentation with Radiesse PlusTM to retain ligament restructuring and superficial subcutaneous enhancement with diluted Radiesse DuoTM. Herein, we present cases that illustrate the use of this approach.

METHODS

This pilot study enrolled 36 participants (33 women and three men; ages 37-68 years) in a Brazilian clinical setting, and all patients underwent a single treatment. Photographs were taken at rest, in frontal and oblique views, before injection, and 90 days after treatment.

RESULTS

Treatment resulted in elevation of the upper and middle face, notable improvements in the infraorbital hollow, and adjustment of the mean facial volume.

CONCLUSIONS

The V-lift technique is a three-dimensional pan-facial treatment that relies on ligament support and face vectoring to obtain a lifting effect and facial contour restoration. It encompasses deep facial augmentation involving the use of Radiesse PlusTM for restructuring and retaining ligaments and Radiesse DuoTM for superficial subcutaneous enhancement. This approach targets a global repositioning of the facial structures by addressing distinct anatomical injection planes. It achieves a repositioning of the overall facial anatomy without requiring a substantial volumetric expansion.

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 .

Successful treatment of rare adverse event after radiofrequency microneedle on Fitzpatrick skin type IV : a case report

Radiofrequency microneedle (RFM) is relatively safe to use for all skin types but there is still possibility of adverse events. Tram-track scarring or uniform papular eruptions is a rarely reported adverse event, but it is challenging to manage. We report a case of successful treatment of tram track scarring post RFM using a combination of light emitting diodes 640 nm and a salicylic acid peel and home treatment with a combination of azelaic acid and retinoic acid. There is still no standard therapy to treat this case. The results of clinical observations showed the lesions completely recovered in 6 months.

Facial flow line and its effect on dental midline deviation on a female subject in an Asian population - A cross-sectional study

INTRODUCTION

This study aims to understand the relationship between midline deviations and the inherent asymmetry that can be observed in a human face.

MATERIALS AND METHODS

A cross-sectional study was conducted using a frontal smile photograph of a female which was altered on Adobe Photoshop software version 23.0 into eight different photographs by deviating the dental midlines by 2 mm, 4 mm, and 6 mm towards and away from the facial flow line (FFL). 4 mm of chin deviation was incorporated in all the pictures except for the first picture in which the midline and chin were kept symmetric. Orthodontic residents evaluated those photographs on an interrupted visual analogue scale (VAS) with 0 being the least attractive and 10 being the most. Simple linear regression was applied to observe factors associated with VAS score.

RESULTS

Highest score was observed for picture with midline and chin on (MLCon) with a score of 9.4 ± 0.7, followed by picture with midline on and chin deviated (MLon) 8.7 ± 0.8. The deviations towards green zone received higher scores in comparison to deviations towards red zone. Linear regression revealed highly statistically significant differences between the constant and the rest of the pictures.

CONCLUSIONS

The formation of green and red zones by the FFL influences the perception of midline deviation as judged by orthodontic residents. Midline when deviated towards the green zone, was judged to be more aesthetic than when shifted towards the red zones.

Equipping your facial plastic clinic for office-based procedures

Office-based procedures can be a fulfilling part of the facial plastic practice with the right tools, personnel, and preparation. Equipping the clinic for office-based procedures has several unique considerations that ultimately impact its success. It is important to strategize preemptively regarding what treatments will be offered and the respective equipment that will allow the safe, cost-effective, and high-quality delivery of those treatments. Most procedures in the office-based setting are cosmetic in nature and there are often overlapping treatment modalities that target similar outcomes. Patient selection and counseling is a crucial step in preparing for office-based procedures in the effort to maximize patient satisfaction. Nearly all the most common facial plastic procedures can be delivered in the office-based based setting under local anesthesia and moderate sedation, depending on the expertise of the surgeon. To enable these and other categories of treatments, there are certain expensive pieces of technology that one might consider for their office-based practice and other fundamental supplies that are necessary for almost all practices. Though the initial investment in equipment can be costly, this article also discusses more affordable alternatives or third-party sales of devices and equipment. The field of facial plastic surgery is very dynamic and having both peer and mentorship networks is invaluable in navigating some of the financial decisions discussed herein. This article also briefly covers personnel, training, and accreditation considerations.

Non-Surgical Management of the Gingival Smile with Botulinum Toxin A-A Systematic Review and Meta-Analysis

Currently, concern about facial attractiveness is increasing, and this fact has led to orthodontics in adult patients being an increasingly demanded treatment, and with it, multi-disciplinary work. When it is caused by a vertical excess of the maxilla, the ideal solution is orthognathic surgery. However, in borderline cases and when the cause is hyperactivity of the upper lip levator muscle complex, alternative conservative solutions can be considered, such as the application of botulinum toxin A (BTX-A). Botulinum toxin is a protein produced by a bacterium and causes a reduction in the force of muscle contraction. The multi-factorial nature of the smile requires an individualized diagnosis in each patient, since there are multiple ways to treat the gummy smile (orthognathic surgery, gingivoplasty, orthodontic intrusion). In recent years, interest has grown in the simplest techniques that allow the patient to quickly return to their usual routine, such as lip replacement. However, this procedure shows recurrences in the first 6-8 post-operative weeks. The main objective of this systematic review and meta-analysis is to analyze the effectiveness of BTX-A in the treatment of gummy smile in the short term, to study its stability, and to evaluate potential complications. A thorough search of the PubMed, Scopus, Embase, Web of Science, and Cochrane databases and a grey literature search were conducted. The inclusion criteria were studies with a sample size greater than or equal to 10 patients with gingival exposure greater than 2 mm in smile, treated with BTX-A infiltration. Those patients whose exclusive etiology of their gummy smile was related to altered passive eruption, gingival thickening, or overeruption of upper incisors were excluded. In the qualitative analysis, the mean pre-treatment gingival exposure ranged between 3.5 and 7.2 mm, reaching a reduction of up to 6 mm after infiltration with botulinum toxin at 12 weeks. Although multiple muscles are involved in the facial expression, the muscles par excellence selected for blockade with BTX-A were levator labii superioris, levator labii superioris ala nasalis, and zygomaticus minor, infiltrating from 1.25 to 7.5 units per side. In the quantitative analysis, the difference in mean reduction between both groups was -2.51 mm at two weeks and -2.24 mm at three months. The benefit of BTX-A in terms of improvement of gummy smile is demonstrated, as a significant reduction in gummy smile is estimated by BTX-A therapy two weeks after its application. Its results gradually decrease over time, however, they stay satisfactory without returning to their initial values after 12 weeks.

Effectiveness of Topical Conditioned Medium of Stem Cells in Facial Skin Nonsurgical Resurfacing Modalities for Antiaging: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Facial skin nonsurgical resurfacing modalities, including laser, chemical peeling, and microneedling, have become common due to increasing public concern about skin aging. The potential effect of stem cell conditioned medium (CM) for antiaging has been reported in recent years, and such medium may be able to improve the efficacy of resurfacing modalities. This study investigated the efficacy of topical CM combined with resurfacing in comparison with resurfacing alone. We searched the PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs). We used the Cochrane risk-of-bias tool (version 2) to assess the risk of bias of the included studies and Review Manager (version 5.4) for data analysis. Means and standard deviations of outcomes, namely wrinkle, pigmentation, pore, and overall improvement, were extracted. After screening, we included five RCTs in the analysis, four of which were quantitatively analyzed. The result revealed that stem cell CM significantly reduced wrinkles (P = 0.0006), pigmentation (P = 0.004), and pores (P = 0.01) and improved overall skin condition (P < 0.0001). In summary, we suggest that stem cell CM is a safe treatment that can enhance the efficacy of facial skin nonsurgical resurfacing modalities.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 .

Application of Nonsurgical Modalities in Improving Facial Aging

Objective. This review aims to summarize different kinds of applications of minimally invasive surgery in improving facial aging to provide a comprehensive and accurate introduction on the issue of esthetic treatment of facial skin. Overview. In the twentieth century, facial rejuvenation has become a new beauty trend. Facial cosmetology has entered a period of antiaging and rejuvenation therapies and microplastic surgery. The pursuit of beauty has promoted the development of minimally invasive plastic surgery. This review introduces the possible causes of facial aging and its related topics with a focus on facial injectable drugs, such as botulinum toxin, main filler materials (hyaluronic acid, calcium hydroxyapatite, poly L-lactic acid, collagen, autologous fat, and polymethyl methacrylate), and some current antiwrinkle technologies, such as thread lift and radiofrequency rhytidectomy. Conclusions. Despite the difference in mechanisms of action, each technique can address facial aging involving the loss of collagen, displacement and enlargement of fat, and muscle relaxation. Combinations of these treatments can provide patients with reasonable, comprehensive, and personalized treatment plans.

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.

Puzzle Facelift: A non-surgical, whole treatment for facial modelling and rejuvenation

The assessment of correct anatomy of face and the evaluation of the dynamic interplay between anatomy and function, in order to get an overall improvement, is a leading topic in aesthetic surgery and has increased its impact in the recent years. A non-surgical impact technique reduces both post-treatment discomfort and the overall cost. Obtaining the simultaneous correction in forehead, nose, lips and chin means obtaining an overall improvement in face view. Likewise, the high predictability of the procedure and the absence of alloplastic implant, bone re-absorption and scars have to be considered in non-surgical aesthetic medicine. In conclusion, a single-session of profile correction using HA filler should be proposed to patient, every time the aesthetic practitioner sees a coexistence of forehead, nose lips and chin defects.

The MICRO-Lift: A Ligaments-Based Anatomic Technique for Lower Face and Neck Rejuvenation Using Bipolar Radiofrequency

BACKGROUND

The aim of this paper is to present the results of a new technique for lower face and neck rejuvenation named the MICRO-lift (Minimally Invasive, Combined Radiofrequency, Outpatient lift). This technique is based on a bipolar radiofrequency treatment applied to specific ligamentous areas.

METHODS

Inclusion criteria were patients with skin laxity of the neck and jowls, with or without fat accumulation. Patients who presented platysma sag and alteration of subplatysmal structures were excluded from the study. The distribution of the energy was adapted to the ligament anatomy, differentiating three areas based on the energy concentration. In all patients, sex, age at surgery, type of anesthesia, radiofrequency parameters and complications were registered. In all cases, standard photographs and satisfaction interviews were conducted preoperatively and postoperatively. Satisfaction evaluation was also assessed.

RESULTS

Sixty-five patients underwent MICRO-lift technique for the lower face and neck. All patients in our series were female. There were no major complications. Minor complications included transient paralysis of the marginal mandibular (4,6%), infection of the submental incision that required incisional drainage (3,1%), and deep skin burn in the neck (1,5%). Fifty-nine patients were satisfied a year after the treatment (90,8%).

CONCLUSIONS

The MICRO-lift can produce outstanding and satisfying improvements in cervicofacial appearance. This new approach offers a predictable strategy to achieve the desired aesthetic results, making this procedure more reliable and reproducible for both novel and experienced surgeons with bipolar radiofrequency.

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 .

Efficacy and Safety of Topical Dexpanthenol-Containing Spray and Cream in the Recovery of the Skin Integrity Compared with Petroleum Jelly after Dermatologic Aesthetic Procedures

Moisturizers are commonly prescribed after laser and chemical peel aesthetic procedures, but the evidence regarding their efficacy and safety of such use is scarce. We conducted four single-blind, three-week, controlled studies to evaluate the efficacy and safety of topical Dexpanthenol-containing products (Bepantol® spray and Bepantol® cream) using petroleum jelly as a positive control. Skin recovery was assessed after four aesthetic procedures: (1) non-ablative facial laser resurfacing, (2) laser depilation on the external genital and inguinal regions, (3) chemical peel on the external genital and inguinal regions, and (4) ablative facial laser resurfacing. Efficacy was assessed through transepidermal water loss (TEWL) combined with clinical assessment of the skin by the investigators and the participants. In studies (1) and (4), the erythema intensity was evaluated by measuring dermal temperature with a thermal imaging camera. Safety was assessed through adverse event reporting and acceptability through a questionnaire. Dexpanthenol-containing products significantly decreased TEWL and dermal temperature, therefore maintaining skin integrity, promoting its recovery, and reducing erythema. No statistical differences with the positive control were observed. In addition, Dexpanthenol-containing products were well appreciated by the participants from a sensory perspective. These findings suggest that these Dexpanthenol-containing products are adequate for post-procedural care in aesthetic dermatology.

Ultrasound assessment of tissue integration of the crosslinked hyaluronic acid filler VYC-25L in facial lower-third aesthetic treatment: A prospective multicenter study

BACKGROUND

Dermal fillers have become an integral part of any aesthetic physician's intervention.

AIMS

To assess, by means of ultrasounds, the tissue integration of the hyaluronic acid (HA) dermal filler VYC-25L in chin and jaw.

METHODS

Prospective, noncomparative, open-label, and multicenter study conducted on healthy subjects, with age comprised between 30 and 60 years old, who attended to the clinic to perform a facial rejuvenation treatment of the lower third of the face. VYC-25L was injected using a 27G needle (supraperiosteal bolus, from 0.2 to 0.3 mL per bolus) in the chin and with canula (retrograde threads, from 0.4 to 0.6 mL) in the jaw. Ultrasound examinations (UE) were performed at each study center by the same experienced observer at baseline, immediately after injection, 48 hours, and 30 days after treatment.

RESULTS

Thirty patients (10 per center) were included in the study. At baseline, UE found a characteristic heterogeneous pattern of subcutaneous cellular tissue, with alternation of soft anechoic and hyperechoic images. The UE, performed immediately after treatment, showed a poorly defined globular ultrasound pattern, with anechoic images indicative of liquid content. Forty-eight hours after treatment, UE are still showing a globular pattern, with well-defined anechoic areas. Thirty days after treatment, a thickening of the subcutaneous cellular tissue was observed in all the evaluated zones, with a total integration of the HA into the tissue.

CONCLUSION

VYC-25L might represent a significant advance in volumization/restoration of the lower face. Its biointegration was total at day 30 and practically complete at 48 hours of treatment.

Review of Plastic Surgery Biomaterials and Current Progress in Their 3D Manufacturing Technology

Plastic surgery is a broad field, including maxillofacial surgery, skin flaps and grafts, liposuction and body contouring, breast surgery, and facial cosmetic procedures. Due to the requirements of plastic surgery for the biological safety of materials, biomaterials are widely used because of its superior biocompatibility and biodegradability. Currently, there are many kinds of biomaterials clinically used in plastic surgery and their applications are diverse. Moreover, with the rise of three-dimensional printing technology in recent years, the macroscopically more precise and personalized bio-scaffolding materials with microporous structure have made good progress, which is thought to bring new development to biomaterials. Therefore, in this paper, we reviewed the plastic surgery biomaterials and current progress in their 3D manufacturing technology.