Aesthetic considerations for treating the North American multi-ethnic patient: Thriving in diversity international roundtable series

A Review of Neuromodulators and Energy-Based Devices for Optimizing Nasal Appearance

Importance: The demand for less invasive nasal procedures has been increasing, highlighting a gap in research on alternatives beyond fillers. This review explores the potential of neuromodulators and energy-based devices for nonsurgical rhinoplasty. Observations: Both botulinum toxin and energy-based devices used independently or alongside fillers have been studied for nasal shape adjustments. Neuromodulator injection of the depressor septi nasi can reduce nasal tip droop, which can reduce the appearance of a plunged nose. Treatment of the dilator naris can minimize alar flaring, giving the appearance of a thinner nasal tip. These methods primarily reported patient-reported outcomes. Energy-based devices have been used to address nasal skin quality and shape contouring, including resurfacing devices for rhinophyma with improvement in both physician and patient-reported outcomes. The 1470 nm laser achieved nasal reshaping after two sessions. Radiofrequency microneedling was notable for volumetric reduction in the nose (excluding nasal tip), confirmed by 3D imaging, lasting about 12 months. Conclusions and Relevance: The use of neuromodulators and energy-based devices may offer promising results for nasal reshaping. However, there is a need for further comparison studies using both objective measures such as 3D photography and physician and patient-reported outcomes, prior to establishing best practices for these techniques.

Differential preferences in breast aesthetics by self-identified demographics assessed on a national survey

There is a paucity of literature examining how preferences differ amongst various demographic groups. This study aimed to assess how perceptions of the ideal breast differ between respondents stratified by self-identified demographic factors. A cohort of 25 patients from the senior surgeon's practice presenting for breast surgery was assembled. Pre-operative anteroposterior photographs of these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents' impressions of 'breast attractiveness'. Respondents were asked to rate breasts on a Likert scale. Survey responses were analysed for differences in breast aesthetic preferences by sex, gender, sexual orientation, and race. Males rated all breasts higher on the Likert scale for attractiveness than females (2.8 vs 2.5, p < 0.001). Despite this discrepancy, ratings amongst male and female respondents were highly correlated with one another (R = 0.940; p < 0.0001). Considering sexual orientation, individuals attracted to women provided significantly higher attractiveness ratings to all breasts compared to individuals attracted to men only (2.8 vs 2.5, p < 0.001). White or Caucasian individuals ascribed significantly higher breast attractiveness ratings than Asian individuals (2.7 vs 2.2, p < 0.001), but not Black or African American individuals (2.7 vs 2.4, p = 0.23). Despite these racial discrepancies in mean breast attractiveness, ratings amongst the three groups were highly correlated. In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by demographic factors. These findings merit further investigation to understand these trends and observations.

A Review of Aesthetic Considerations for Treating the Transgender Patient

BACKGROUND

As gender diversity becomes increasingly embraced by society, and despite growing recognition of the unique needs of transgender patients, the literature remains devoid of guidelines for gender affirming facial feminization or masculinization techniques.

OBJECTIVE

The authors seek to identify and discuss target feminine and masculine facial features, as well as an armamentarium of surgical and nonsurgical strategies to effectively address and achieve them in the transgender population.

METHODS

A search of the National Library of Medicine database (PubMed) was undertaken to identify the existing literature on gender-affirming facial feminization and masculinization techniques.

RESULTS

The importance of assessing proportional relationships between the bitemporal, bizygomatic, and bigonial distances is discussed; ideal masculine faces possess a rectangular face shape, with ratios for these 3 areas tending toward 1:1:1. Conversely, the ideal female face is heart shaped with projection at the zygoma and a tapered jawline. Strategic positioning of the cheek apex serves as an anchor in sculpting a distinctly masculine or feminine face. Other considerations include the enhancement of skin quality and implications of hormonal therapy.

CONCLUSION

The aesthetic considerations provided in this study can serve as a valuable guidance for aesthetic physicians seeking to deliver optimal care for their transitioning patients.

Cross-cultural perspectives on patient expectations in cosmetic dermatology: A comparative analysis across countries and ethnicities

Patient expectations in cosmetic dermatology exhibit significant variations across countries, cultures, and ethnicities, thereby reflecting individual desires, concerns, and goals. While some individuals seek aesthetic enhancements, others prioritize addressing specific skin conditions within the context of beauty norms in their respective countries. The provision of personalized and culturally sensitive care plays a crucial role in meeting these diverse expectations. Skin characteristics and concerns differ among ethnicities, influencing treatment preferences. For instance, individuals with darker skin tones may prioritize the treatment of pigmentation disorders, whereas those with lighter skin tones may focus on achieving a fair complexion. Furthermore, differences in facial anatomy among various ethnicities necessitate tailored treatment approaches. This commentary aims to contribute to the effective understanding and management of patient expectations, ultimately leading to satisfactory outcomes. Additional research and regional studies are required to further deepen our understanding of patient expectations in cosmetic dermatology and enable the delivery of improved and culturally appropriate care on a global scale.