The Importance of Patient Mindset: Cosmetic Injectable Patient Experience Exploratory Study-Part 1

Improving Neck and Jawline Aesthetics With OnabotulinumtoxinA by Minimizing Platysma Muscle Contraction Effects: Efficacy and Safety Results in a Phase 3 Randomized, Placebo-Controlled Study

BACKGROUND

Platysma prominence (PP) describes the noticeable appearance of the platysma muscle upon contraction, causing a less defined jawline contour and vertical neck bands.

OBJECTIVES

The objective of this study was to assess the safety and efficacy of onabotulinumtoxinA for improvement of PP in adults.

METHODS

Participants with moderate to severe (Grade 3 to 4) PP at maximum contraction received onabotulinumtoxinA or placebo on Day 1 and were monitored for 120 days. OnabotulinumtoxinA dosage (26, 31, or 36 U) was customized based on baseline PP severity on each side of the neck.

RESULTS

Efficacy analyses were conducted in the intent-to-treat (ITT) population (all randomized participants), and modified ITT population (mITT; psychosocially impacted by PP appearance). Results from ITT and mITT populations were comparable. As assessed by investigators, 76.7% of onabotulinumtoxinA mITT participants achieved ≥1-grade improvement vs 21.2% in the placebo group, and 41.0% vs 2.2% (P < .0001) achieved ≥2-grade improvement at Day 14. As assessed by participants, 79.9% of onabotulinumtoxinA mITT participants vs 21.8% in the placebo group and 40.8% vs 3.9% (P < .0001) achieved ≥1- or ≥2-grade improvement, respectively, at Day 14. OnabotulinumtoxinA responder rates remained higher than placebo through Day 120, gradually declining over time. OnabotulinumtoxinA participants reported significantly higher satisfaction with treatment effect, less bother from jawline and vertical neck bands, and lower psychosocial impact from PP than placebo at Day 14 (P < .0001). OnabotulinumtoxinA effectively improved self-perceived jawline definition and was well tolerated.

CONCLUSIONS

OnabotulinumtoxinA was well tolerated and effective at improving moderate to severe PP, including neck bands and jawline definition.

LEVEL OF EVIDENCE: 1 (THERAPEUTIC)

Understanding clinical meaningfulness when targeting the depressor anguli oris muscle (DAO) with neuromodulators: a clinical prospective interventional study

BACKGROUND

Neuromodulator injections in the US increased by 24% from 2021 to 2022. This rise is attributed to new products and growing acceptance of minimally invasive aesthetic treatments. Recent studies emphasize the importance of facial anatomy for precision and, consequently, a higher efficacy of neuromodulator treatments. This study aims to evaluate the clinical efficacy of a novel previously proposed injection technique targeting the depressor anguli oris (DAO) muscle to improve oral commissure position. This clinical, prospective study included 34 volunteers from the Shinobu Clinic, São Paulo, Brazil. Patients received 3 units of onabotulinumtoxinA per side, injected mid-distance between the oral commissure and jawline, following the labiomandibular sulcus (LMS). Standardized photographs and assessments using the Oral Commissure Severity Scale (OCSS) and Global Aesthetic Improvement Scale (GAIS) were conducted before and 30 days post-treatment. Statistical analyses included t-tests, Wilcoxon Signed Rank test, and generalized linear models. The average increase in commissural height was 5.22% (p < 0.001). OCSS ratings improved significantly from baseline (clinician: 1.21 to 0.72, p < 0.001; patient: 0.93 to 0.69, p < 0.001). However, GAIS scores indicated no significant change (patient: 0.32, observer: 0.38; p = 0.491). The proposed injection technique improves perioral aesthetics objectively and subjectively. However, the lack of significant change in GAIS scores suggests that perceived improvements may not be clinically meaningful to patients. Future studies should focus on patient-centered evaluation methods to better assess aesthetic outcomes.

Searching for Signs of Plastic Surgery on the Face: Tracking the Eyes of Where Observers Look

Background: Objective measurement of where observers direct their attention to faces when searching for signs of facial plastic surgery (FPS) is currently lacking. Objective: To compare where laypersons direct their attention on facial photographs using eye-tracking software when they are asked to (1) search for signs of aesthetic facial surgery or (2) allowed to gaze without direction (free-gaze). Methods: Naïve observers either free-gazed or examined faces for signs of FPS (FPS-prompted) for 10 s per face while their gaze was recorded by an eye-tracking system. Faces had no known history or signs/stigmata of FPS and were selected from the FACES and CFD databases with a diverse demographic distribution. Gaze times in nine facial subregions were analyzed using mixed-effects linear regression. Results: In FPS-prompted observers (n = 50, mean age 32.7 ± 11.3 years, 23/50 (46%) female), the nose, mouth, cheeks, and forehead experienced the most substantial increases (p < 0.001) and a high percentage of overall gaze time (17.9%, 12.5%, 12.0%, 9.6%, respectively) compared to free-gazing observers [n = 57, 35.5 ± 13.9 years, 31/57 (54%) female]. Conclusions: Observers direct attention differently on a face when searching for signs of plastic surgery with increased attention on the nose, mouth, cheeks, and forehead.

A 360° Approach to Patient Care in Aesthetic Facial Rejuvenation

Background

Aesthetic medicine has traditionally focused on addressing perceived problem areas, with lack of long-term planning and engagement.

Objectives

This article describes a patient-centric model for nonsurgical aesthetic medical practice, termed the 360° approach to facial aesthetic rejuvenation.

Methods

The 360° approach was divided into 4 foundational pillars. Medical literature, the authors' clinical experiences, and results from patient satisfaction surveys were used to support the approach.

Results

Pillar 1 describes the development of a complete understanding of the patient, based on the use of active listening principles, to characterize the patient's current aesthetic concerns, lifestyle, medical and treatment history, treatment goals, attitude toward aesthetic treatment, and financial resources. Pillar 2 involves conducting a comprehensive facial assessment in contrast to a feature-specific assessment, considering multiple facial tissues and structures and their interrelationships, thus helping to prevent the unanticipated consequences of narrowly focused treatment. Pillar 3 describes leveraging all available treatments and techniques in the development of an initial treatment plan arising from the facial assessment. Pillar 4 adds a time dimension to treatment planning, working toward the goal of a long-term modifiable treatment timeline, with full patient support and involvement; this is designed to facilitate a durable, sustained relationship between the patient and aesthetic healthcare professional (HCP).

Conclusions

Although implementation involves substantial commitment and time, the patient-oriented focus of the 360° approach can help achieve optimal patient outcomes and the development of enduring patient-HCP relationships.

Level of Evidence 5

How Nutrition and Supplements Impact Aesthetic Outcomes

Nutraceuticals, nutritional supplements, and the diet industry often provide misleading information, make faulty promises, and may also support profit over consumer safety. Furthermore, the U.S. Food and Drug Administration regulates dietary supplements as a food, not as a drug. As health care providers, we must be aware of current trends in supplements and nutrition programs so that we can screen our patients for contraindications to aesthetic treatments and educate and promote specific supplements/programs that are safe and evidence-based. Oxidative stress, chronic inflammation, and increased glycation can accelerate the aging process. The combination of an anti-inflammatory diet and pharmaceutical-grade nutritional supplements can impact the multiple forces involved in skin aging and help balance skin homeostasis. Using specific nutritional interventions and supplements can help repair damaged skin, improve skin health, and reduce skin senescence. Aesthetic providers can enhance healing and clinical results by educating patients and providing high-quality supplements that promote good aesthetic outcomes.