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da Prato EB, Cartier H, Margara A, Molina B, Tateo A, Grimolizzi F, Spagnolo AG. The ethical foundations of patient-centered care in aesthetic medicine. Philos Ethics Humanit Med 2024; 19:1. [PMID: 38317236 PMCID: PMC10845625 DOI: 10.1186/s13010-024-00151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
This article addresses some critical aspects of the relationship between aesthetic medicine (AM) and ethics and proposes a possible deontological ethical line to pursue based on current practices. The role of AM has always been controversial and suffers from unclear practical and moral boundaries, even within academic settings, since it aims to improve the appearance of individuals, not to cure a disease. Today, it is essential and pertinent to discuss these issues, as AM specialists are dealing with a growing and increasingly demanding patient population that has undergone profound evolution in recent years. Current challenges within the field of AM include a lack of global uniformity concerning the education of AM specialists, an increasing number of physicians practicing AM with diverse training backgrounds, the spread of AM being practiced outside of medical practice or hospital settings, and the influence of social media where the success is modelled and dictated by the identification of a youthful appearance). By the field of action enriched by technologies that aim not only at enhancement per se but also at the preservation and regeneration of tissues, it is necessary to establish an active multidisciplinary discussion on the definition of shared ethical limits. This discussion would allow AM to fully reclaim its identity as a specialty that aims to improve patient well-being whilst maintaining respect for patient aesthetic harmony, the expertise of specialists who practice AM, the essential role of safety, and awareness of the importance of a confidential doctor-patient relationship.
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Affiliation(s)
| | | | | | | | - Antonello Tateo
- Private Practice, Pavia, Italy
- Private Practice, Milan, Italy
| | | | - Antonio Gioacchino Spagnolo
- Institute of Bioethics and Medical Humanities, Faculty Member, Catholic University of the Sacred Heart, Rome, Italy
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Alahmadi S, Hakimi AA, Tripathi N, Tripuraneni P, Chu E, Reilly MJ. Do-It-Yourself Filler Self-Injection on YouTube: A Dangerous Online Trend. Aesthet Surg J 2023; 43:NP1101-NP1102. [PMID: 37682869 DOI: 10.1093/asj/sjad293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
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Mella J, Oyer S. Nonsurgical rhinoplasty: prevention and management of associated complications. Curr Opin Otolaryngol Head Neck Surg 2022; 30:241-248. [PMID: 35906976 DOI: 10.1097/moo.0000000000000818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Nonsurgical rhinoplasty (NSR) continues to grow in demand and popularity. Consequently, there has been a rise in the number of reported complications. This review will summarize and discuss the current evidence for the prevention and management of adverse events related to NSR with a specific emphasis on practical clinical applications. The review is based on recent systematic reviews and multidisciplinary expert consensus recommendations. RECENT FINDINGS First, NSR has overall favorable outcomes with rare complications. Second, vascular compromise is a rare event, but the number of reported severe complications is rising. Third, providers should be intimately familiar with preventive measures, early signs and symptoms, and appropriate management algorithms of all possible complications. Fourth, having a readily available 'toolbox' of recommended therapies may improve timely management of emergent complications. SUMMARY The number of complications associated with NSR is expected to rise congruent with the increased demand for the procedure. Although NSR has a favorable safety profile, complications can occur in the best of hands even when using appropriate risk reduction strategies. Early detection and appropriate treatment of known complications may eliminate or minimize sequelae and allow providers to continue to safely perform NSR.
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Affiliation(s)
- Jeffrey Mella
- University of Virginia, Department of Otolaryngology, Head and Neck Surgery, Facial Cosmetic and Reconstructive Surgery, Charlottesville, Virginia, USA
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Kern JA, Kollipara R, Hoss E, Boen M, Wu DC, Groff W, Goldman MP. Serious Adverse Events With Injectable Fillers: Retrospective Analysis of 7,659 Patient Outcomes. Dermatol Surg 2022; 48:551-555. [PMID: 35170541 DOI: 10.1097/dss.0000000000003409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In total, 2.7 million injectable filler treatments were performed in 2019 in the United States. Although generally considered to be a safe treatment modality, adverse events may occur in rare situations. OBJECTIVE Analyze serious adverse events from injectable filler treatments, including infections, cutaneous necrosis, blindness, or delayed-onset nodule formation, spanning 11 years for 3 board-certified dermatologists and review their incidence, management, and outcomes. MATERIALS AND METHODS A retrospective analysis was performed of injectable filler treatments spanning 11 years at a multipractitioner outpatient clinic. Serious adverse events were identified, and treatment measures were documented. A literature search was performed to determine recent trends and outcomes for comparison. RESULTS Between January 2009 and August 2020, 18,013 mL of injectable filler was administered to 7,659 patients. Of the 18,013 mL administered, 74.1% comprised hyaluronic acid derivatives, 19.19% poly-l-lactic acid, and 6.71% calcium hydroxylapatite. Four serious adverse events were identified. Three events were delayed-onset skin nodule formation. One adverse event was related to vascular compromise and subsequent cutaneous necrosis. After appropriate treatment, all adverse events resolved without significant long-term sequelae. CONCLUSION Serious adverse events associated with injectable fillers, when performed by board-certified dermatologists, are extremely rare and can be successfully managed with appropriate treatment.
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Affiliation(s)
- Jessica A Kern
- University of California, San Diego School of Medicine, San Diego, California
| | | | - Elika Hoss
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
| | - Monica Boen
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - Douglas C Wu
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - William Groff
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
| | - Mitchel P Goldman
- Cosmetic Laser Dermatology, A West Dermatology Company, San Diego, California
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Sharpe A, O'Keefe M, Windsor K, Theobald J, Feldman R. Hemolysis after subcutaneous deoxycholic acid overdose. Am J Emerg Med 2021; 52:268.e1-268.e2. [PMID: 34456101 DOI: 10.1016/j.ajem.2021.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/07/2021] [Indexed: 11/26/2022] Open
Abstract
This report describes a case of hemolysis in a patient injecting deoxycholic acid and benzyl alcohol for aesthetic benefit without medical supervision. The concentration and dose injected by the patient resulted in a 10-fold overdose of deoxycholic acid in comparison to the FDA-recommended dosing for the approved indication. Providers should be aware of medically unsupervised use of DCA and other injectables and the potential risks associated with this practice.
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Affiliation(s)
- Abigail Sharpe
- Wisconsin Poison Control Center, 999 N 92nd Street, Suite 600, Wauwatosa, WI 53226, United States of America.
| | - Mary O'Keefe
- Wisconsin Poison Control Center, 999 N 92nd Street, Suite 600, Wauwatosa, WI 53226, United States of America
| | - Katie Windsor
- Concordia University Wisconsin School of Pharmacy; 12800 N Lake Shore Drive, Mequon, WI, 53097, United States of America
| | - Jillian Theobald
- Wisconsin Poison Control Center, 999 N 92nd Street, Suite 600, Wauwatosa, WI 53226, United States of America
| | - Ryan Feldman
- Wisconsin Poison Control Center, 999 N 92nd Street, Suite 600, Wauwatosa, WI 53226, United States of America
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Affiliation(s)
- Sooyie Choi
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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'How to Botox' on YouTube: Influence and Beauty Procedures in the Era of User-Generated Content. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084359. [PMID: 33924004 PMCID: PMC8072976 DOI: 10.3390/ijerph18084359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/08/2021] [Accepted: 04/17/2021] [Indexed: 11/16/2022]
Abstract
The current media environment is complex and has important effects on all aspects of life, including beauty and health. In this sense, YouTube has become one of the main contexts for the dissemination of tutorials and content related to medical procedures such as the application of Botox. Thus, the present study constitutes the first exploratory analysis of YouTube videos in Spanish related to this procedure. A preliminary analysis of 221 YouTube videos yielded a final sample of the 50 most viewed videos within this genre. The analysis was carried out through a quantitative content analysis assessing the popularity of the videos, contact and emotive strategies by the creator, the credibility conveyed, and the characteristics of information about the procedure itself. Results suggest that these influencers align with mainstream Internet celebrity culture in practices that aim at increasing their following and views, as well as calls for subscriptions and visits to other platforms and profiles. Moreover, they include different strategies to establish their credibility but emphasize personal experience. The positive portrayal of the procedure, including positive emotions and content that highlights the benefits, is interesting and supports the commercial nature of much of the content.
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Nonhealing Right Lower Leg Ulcer: Answer. Am J Dermatopathol 2021; 43:77. [PMID: 33337626 DOI: 10.1097/dad.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tamashunas NL, Forootan N, Simmons E, Ezaldein HH, Wong C. Evaluation of the sale of unregulated dermal fillers on e‐commerce websites. Int J Dermatol 2020; 59:e433-e434. [DOI: 10.1111/ijd.14979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Nazilla Forootan
- School of Medicine Case Western Reserve University Cleveland OH USA
| | - Elanee Simmons
- School of Medicine Case Western Reserve University Cleveland OH USA
| | - Harib H. Ezaldein
- Department of Dermatology University Hospitals Cleveland Medical Center Cleveland OH USA
| | - Christina Wong
- Department of Dermatology University Hospitals Cleveland Medical Center Cleveland OH USA
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Rauso R, Nicoletti GF, Zerbinati N, Lo Giudice G, Fragola R, Tartaro G. Complications Following Self-Administration of Hyaluronic Acid Fillers: Literature Review. Clin Cosmet Investig Dermatol 2020; 13:767-771. [PMID: 33116740 PMCID: PMC7569170 DOI: 10.2147/ccid.s276959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022]
Abstract
The purpose of the present study is to review published literature regarding complications following self-administration of hyaluronic acid (HA) filler. The following keywords were searched in Pubmed and Cochrane database: filler AND self injection, hyaluronic acid AND self injection; filler AND self administration; hyaluronic acid AND self administration. Two authors performed title and abstract eligibility assessment independently. Gray literature and all articles cited in the included papers were also screened and their reference lists were examined to identify other potentially pertinent studies. Non-English papers were excluded. A total of 4 complications following self injection of HA were identified. Conversely, after performing a general search through the Google Internet search engine, with the item “self-injection of hyaluronic acid filler”, there were 604,000 hits. The number of articles reporting complications after the self administration of HA is few. Despite that internet searches on the same topic shows that self-administration of HA fillers is a widely discussed phenomenon in several on-line forums. The present review suggests that complications after self-injection of HA are an under-reported phenomenon.
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Affiliation(s)
- Raffaele Rauso
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialists, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Giovanni Francesco Nicoletti
- Plastic Surgery Unit, Multidisciplinary Department of Medicine, Surgery and Odontological Sciences, "Luigi Vanvitelli" University Hospital, Naples, Italy
| | - Nicola Zerbinati
- Dermatology, Department of Medicine and Surgery, "Insubria" University Hospital, Varese, Italy
| | - Giorgio Lo Giudice
- Maxillo-Facial Surgery, Department of Neurosciences, Reproductive and Odontological Sciences, "Federico II" University Hospital, Naples, Italy
| | - Romolo Fragola
- Oral and Maxillofacial Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialists, University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
| | - Gianpaolo Tartaro
- Maxillo-Facial Surgery Unit, Multidisciplinary Department of Medicine, Surgery and Odontological Sciences, "Luigi Vanvitelli" University Hospital, Naples, Italy
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Zein M, Tie-Shue R, Pirakitikulr N, Lee WW. Complications after cosmetic periocular filler: prevention and management. ACTA ACUST UNITED AC 2020; 7. [PMID: 33102629 PMCID: PMC7583139 DOI: 10.20517/2347-9264.2020.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Soft tissue fillers are a mainstay in contemporary, minimally invasive facial rejuvenation procedures owing to timely results and minimal recovery period. Although associated with a low complication rate, soft tissue fillers are not without risk. Complications range from mild superficial skin irregularities to granuloma formation to vascular occlusion leading to skin necrosis or even blindness. Fillers vary in composition, elasticity, hydrophilicity and duration of effect that is tailored to specific cosmetic indications. Selecting the right product for the desired effect can cut down on unwanted outcomes. Severe adverse events can be avoided with safe injection technique, early recognition of symptoms and a thorough knowledge of the local anatomy. This review outlines several complications all providers should recognize and discusses strategies for their prevention and management.
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Affiliation(s)
- Mike Zein
- Mcknight Vision Research Center, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
| | - Ryan Tie-Shue
- Department of Biomedical Research, Yale University, New Haven, CT 06520, USA
| | - Nathan Pirakitikulr
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
| | - Wendy W Lee
- Division of Oculofacial Plastic and Reconstructive Surgery, Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, FL 33136, USA
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Facial Sclerosing Lipogranuloma After Self-Injection of Homemade Tissue Filler: An Alarming New Practice. Dermatol Surg 2020; 46:711-713. [PMID: 30908364 DOI: 10.1097/dss.0000000000001904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li Y, Galimberti F, Morrison B. Online availability of neurotoxin and injectable cosmetics. J Am Acad Dermatol 2020; 84:1200-1202. [PMID: 32948343 DOI: 10.1016/j.jaad.2020.01.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/27/2019] [Accepted: 01/14/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Yumeng Li
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida.
| | - Fabrizio Galimberti
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
| | - Brian Morrison
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, Florida
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Steroid Madness- has the dark side of anabolic-androgenic steroids (AAS) been over-stated? ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.peh.2019.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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