Developing Consensus-Based Guidelines for Case Reporting in Aesthetic Medicine: Enhancing Transparency and Standardization

A Systematic Review to Explore the Role of Industry and Regulators on Minimally Invasive Aesthetics Education: A Tale of Two Cities

INTRODUCTION

The aesthetic medicine industry has seen significant growth due to technological advancements and increasing demand for minimally invasive procedures. This sector's influence on educational institutions is profound, often shaping curricula to align with industry standards. However, this focus can sometimes narrow educational scope, potentially compromising the broader intellectual and ethical development of medical professionals.

METHODS

This study employs a comprehensive literature review to examine the influence of the aesthetic medicine industry on medical education. A systematic search was conducted across academic databases including PubMed, Google Scholar, and ScienceDirect, focusing on articles published between January 2003 and December 2023. Inclusion criteria encompassed studies examining the impact of industry on medical education, financial relationships, ethical implications, and student outcomes.

RESULTS

Out of 279 studies identified, 21 met the inclusion criteria. The analysis highlighted themes such as the need for a balanced curriculum integrating both theoretical and practical training, the impact of financial incentives on educational integrity, and the importance of ethical guidelines. The literature underscores the necessity for standardised curricula and enhanced regulatory oversight to ensure comprehensive and unbiased education.

CONCLUSION

The aesthetic medicine industry's significant influence on medical education necessitates a balanced approach that integrates industry advancements with ethical and comprehensive educational practices. Addressing these challenges requires collaboration between academic institutions and industry partners, alongside stringent regulatory oversight. By ensuring educational integrity and fostering holistic training, the field can produce well-rounded professionals capable of ethical and effective practice in aesthetic medicine.

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 .

A Systematic Review on the Effectiveness and Safety of Combining Biostimulators with Botulinum Toxin, Dermal Fillers, and Energy-Based Devices

INTRODUCTION

Aesthetic medicine has evolved towards minimally invasive procedures, with biostimulators like Poly-L-Lactic Acid (PLLA), Calcium Hydroxylapatite (CaHA), and Polycaprolactone (PCL) gaining attention for their role in collagen induction, improving skin texture, elasticity, and volume. Combining these agents with other treatments-such as botulinum toxin, dermal fillers, and energy-based devices (e.g. laser and radiofrequency therapies)-is hypothesised to provide enhanced aesthetic outcomes. However, studies on the efficacy and safety of these combinations remain sparse and methodologically varied, posing challenges in establishing definitive recommendations.

METHODS

This systematic review adhered to PRISMA guidelines, involving a thorough literature search across PubMed, MEDLINE, Embase, and Cochrane databases. The search included terms related to biostimulators and combination treatments. Studies meeting inclusion criteria reported clinical outcomes of combined biostimulator treatments, including effectiveness, safety, patient satisfaction, and adverse effects. Key parameters extracted included treatment area, combination protocols, and outcomes. Data synthesis used a narrative approach due to variability in methodologies, treatment protocols, and outcome metrics.

RESULTS

Out of 1,237 studies initially identified, 29 met the inclusion criteria. These studies included various combinations of biostimulators with botulinum toxin, dermal fillers, and energy-based devices, with sample sizes ranging from 10 to 350 subjects. Treatments combining CaHA or PLLA with energy-based modalities like high-intensity focused ultrasound (HIFU), fractional lasers, and microneedling demonstrated notable improvements in skin texture, elasticity, and contouring, particularly in areas with ageing signs. Adverse events included erythema, bruising, and nodules in 15-30% of cases, with rare but severe complications such as granulomas and vascular occlusions. Management protocols for these events involved corticosteroids, hyaluronidase, or surgical intervention. The review also found a lack of molecular understanding of the synergistic mechanisms.

CONCLUSION

The review underscores the potential benefits of combined treatments in aesthetic outcomes, though limitations like heterogeneous methodologies, small sample sizes, and inconsistent protocols impact the reliability of findings. Current literature lacks a molecular understanding of the mechanisms underlying these combinations, limiting insights into the longevity and safety of results. Future studies with standardised protocols, objective outcome measures, and detailed molecular analyses are essential for developing evidence-based recommendations for combining biostimulators with other treatments in aesthetic practice.

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 .

Ultrasound-Assisted Chin Liposuction under Local Anesthesia: An Effective Tool for Facial Slimming in Indian Population

An aesthetically pleasing neck is an important component of a youthful appearance of the face. It is frequently targeted by many surgical and nonsurgical methods to achieve the best results. Today, patients are looking for a minimally invasive option that gives permanent results and has a quick recovery. Therefore, ultrasound-assisted liposuction of the chin and jawline has become an important part of the cosmetic surgeon's armamentarium. The objective of this article is to describe the technique, mechanism of action, and most common complications and to establish ultrasound-assisted face liposuction under local anesthesia as an effective method to achieve facial slimming especially in the Indian population.

"Filler-Associated Acute Stroke Syndrome": Classification, Predictive Modelling of Hyaluronidase Efficacy, and Updated Case Review on Neurological and Visual Complications

INTRODUCTION

The rising use of soft tissue fillers for aesthetic procedures has seen an increase in complications, including vascular occlusions and neurological symptoms that resemble stroke. This study synthesizes information on central nervous system (CNS) complications post-filler injections and evaluates the effectiveness of hyaluronidase (HYAL) treatment.

METHODS

A thorough search of multiple databases, including PubMed, EMBASE, Scopus, Web of Science, Google Scholar, and Cochrane, focused on publications from January 2014 to January 2024. Criteria for inclusion covered reviews and case reports that documented CNS complications related to soft tissue fillers. Advanced statistical and computational techniques, including logistic regression, machine learning, and Bayesian analysis, were utilized to dissect the factors influencing therapeutic outcomes.

RESULTS

The analysis integrated findings from 20 reviews and systematic analyses, with 379 cases reported since 2018. Hyaluronic acid (HA) was the most commonly used filler, particularly in nasal region injections. The average age of patients was 38, with a notable increase in case reports in 2020. Initial presentation data revealed that 60.9% of patients experienced no light perception, while ptosis and ophthalmoplegia were present in 54.3 and 42.7% of cases, respectively. The statistical and machine learning analyses did not establish a significant linkage between the HYAL dosage and patient recovery; however, the injection site emerged as a critical determinant.

CONCLUSION

The study concludes that HYAL treatment, while vital for managing complications, varies in effectiveness based on the injection site and the timing of administration. The non-Newtonian characteristics of HA fillers may also affect the incidence of complications. The findings advocate for tailored treatment strategies incorporating individual patient variables, emphasizing prompt and precise intervention to mitigate the adverse effects of soft tissue fillers.

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 .

Embracing Spectrum: Celebrating LGBTQIA+ Journeys in Aesthetic Medicine: A Kaleidoscope of Identity

PURPOSE

This synaptic systemised review critically examines the provision of aesthetic medical care to LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more) individuals, assessing both the clinical practices and the educational frameworks that guide interactions with LGBTQIA+ patients in aesthetic settings.

METHODS

Following PRISMA-S guidelines, a comprehensive review was conducted, initially identifying 159 potentially relevant articles. Upon stringent full-text review, 33 studies met the inclusion criteria and were subject to an in-depth thematic analysis. The scope encompassed qualitative studies, quantitative analyses, and a cross section of interdisciplinary research, predominantly from Western settings.

RESULTS

The analysis distilled four principal themes: the imperative of identity affirmation in aesthetic interventions, substantial barriers to inclusive and empathetic care, the critical need for patient empowerment, and the existing deficiencies within medical education regarding LGBTQIA+ care. These themes highlight a complex interplay between the clinical aspirations of LGBTQIA+ individuals and the current capacity of aesthetic medicine to cater to this diversity.

CONCLUSIONS

There is a pressing need for a paradigmatic shift towards more inclusive, competent, and sensitive aesthetic medical care for LGBTQIA+ patients. It underscores the necessity of reform in medical education and advocates for policy changes that promote a more equitable healthcare environment. This research serves as a call to action, emphasizing the ethical imperative to integrate comprehensive LGBTQIA+ care competencies into aesthetic medicine curricula and practice.

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.