Nose Tip Elongation and Elevation: A Novel Filler Injection Technique

Background Filler injection for nose tip improvement remains a difficult subject due to efficacy and safety issues. Objectives To better the techniques and safety for nose tip improvement with a filler. Methods Patients seeking nose tip improvement were recruited regardless of their pre-treatment conditions. A hyaluronic acid filler is injected through the skin behind the nose tip into the potential septal space. To achieve tip elevation, the filler is retro injected from the anterior nasal spine, stopping at the mid-level of medial crura. To elongate the nose, the filler is deposited just in front of the caudal septal cartilage. The tip extends in the sagittal plane, causing the nose tip to move either caudally (tip elongation) or anteriorly (tip elevation), or both, as directed by the surgeon. Results Depending on the patients, the nose could be elongated by 2 to 6mm, and the tip could be elevated by 2 to 8 mm. Additionally, stronger columellar support, finer tip structures, and improved nasolabial angle are observed. Interestingly, the upper lip appears shorter. The nostril shapes and the alar widths are also improved. A total of 1288 cases are reported. Only two patients expressed dissatisfaction. Conclusions This technique is easy and safe to perform and, the results are natural and comparable to those from rhinoplasty surgeries. Further, this report of filler nose lengthening may be the first large series in the world. Finally, this technique works well in all populations.

Incidence and Preoperative Risk Factors for Major Complications After Capsulectomy: Analysis of 3,048 Patients

Background While there are many indications for periprosthetic breast capsulectomy, heightened public attention surrounding breast implant illness has resulted in increased rates of capsulectomy. Objectives This study aims to identify the incidence of major complications and risk factors associated with capsulectomy. Methods Using a prospectively enrolled cosmetic surgery insurance database, CosmetAssure (Birmingham, AL, USA), patients undergoing capsulectomy between January 2, 2017 and July 31, 2019 were identified. Outcomes measured included the occurrence of and risk factors for major complication(s) necessitating an emergency department visit, hospitalization, or reoperation within 45 postoperative days. Results Among 76,128 patients evaluated, 3048 (4.0%) underwent capsulectomy. There was a significant increase in number of capsulectomies following January 6, 2019 (2.7/day vs 5.2/day, p<0.05). Capsulectomy patients had more likely to have any complication and specifically hematoma than those undergoing breast implant removal or replacement without capsulectomy (2.8% vs 1.9% and 1.6% vs 0.9%, respectively, p<0.05). Eighty-four (2.8%) developed at least one complication. The most common complications included hematoma (1.6%) followed by infection (0.5%). ASA class III/IV was an independent risk factor for any complication and BMI ≥30 and office-based surgical suites were risk factors for infection. Conclusions There is a growing number of capsulectomies being performed. The most common major complication is hematoma. Patients undergoing capsulectomy confer a higher complication rate compared to those undergoing breast implant removal or replacement without capsulectomy. Patients should be counseled regarding the potential for major complications.

Observer Gaze Patterns of Patient Photos Pre- and Post-Facial Feminization

Background Human interaction begins with the visual evaluation of others, and this often centers on the face. Objective measurement of this evaluation gives clues to social perception. Objectives The objective was to use eye-tracking technology to evaluate if there are scanpath differences when observers view faces of men, women, and transgender women pre- and post-facial feminization surgery (FFS) including when assigning tasks assessing femininity, attractiveness, and likability. Methods Undergraduate psychology students were prospectively recruited as observers at a single institution. Using eye-tracking technology, they were presented frontal images of prototypical male, prototypical female, and pre- and post-FFS face photos in a random order and then with prompting to assess femininity, attractiveness, and likability. Results Twenty-seven observers performed the tasks. Participants focused their attention more on the central triangle of post-operative and prototypical female images and forehead of pre-operative and prototypical male images. Higher femininity ratings were associated with longer proportional fixations to the central triangle and lower proportional fixations to the forehead. Conclusions This preliminary study implies the scanpath for viewing a post-FFS face is closer to that for viewing a prototypical female than a prototypical male based on differences viewing the forehead and brow versus the central triangle.

PAIIN (Precise Analgesic Instructions Improve Narcotic Usage): A Randomized Trial

Background Given the ongoing battle with opioid abuse and over-use in the United States new strategies are consistently being implemented in an attempt to reduce opioid use and over prescribing. Objectives The purpose of this study was to determine if a more regulated explicit pain management instruction plan could reduce the number of opioids taken. Methods Blinded randomized prospective study comparing a total of 110 (Group A=55, Group B=55) women undergoing elective outpatient bilateral breast reduction surgery by two different plastic surgeons. Patients were randomly divided into either Group A (control) that received general pain management instructions or Group B (experimental) that received explicit pain management instructions from the surgeons and nurses. Participants were asked to record the number of times they treated their pain with each separate modality. They were also asked to record their average daily pain scale for the days that they were treating their pain. Results Patients in group B took on average 1.5 oxycodone while patients in group A took on average 5.7 oxycodone (p<0.01). Thirty-four patients in group B took no oxycodone. Patients in group B also had statistically significant lower subjective pain scores. Conclusions Based on these results it appears that standardizing how patients are instructed to treat their pain post-operatively may reduce the number of narcotics needed, thus reducing the number of narcotics prescribed without compromising pain control.

Three-Dimensional Arterial Distribution Over the Midline of the Nasal Bone

Background A comprehensive understanding of arterial variations around the midline of the nose is of great importance for the safety of filler injection. Objectives The aim of the study was to clearly define the 3D location of the arteries along the midline of the nasal bone. Methods The arterial structures overlapping the nasal bone along the midline were observed in seventy-nine cadavers. Results The present study found that 0~3 named arteries per nose segment could be identified. All of the arterial structures were located in or above the superficial musculoaponeurotic system (SMAS) layer overlapping the nasal bone. The probability of encountering named arteries at five defined points, P1-P5, was 5/79 (6.3%), 4/79 (5.1%), 1/79 (1.3%), 6/79 (7.6%) and 9/79 (11.4%), respectively. The depth of the main arterial trunk was 1.2 ± 0.4 mm, 1.6 ± 0.6 mm, 1.8 ± 0 mm, 1.0 ± 0.4 mm, 0.9 ± 0.5 mm below the skin at P1-P5, respectively. Conclusions We confirmed that sub-SMAS injection along the midline through a needle is anatomically reliable and that a technique with one entry point through the rhinion via a cannula can easily keep the needle sufficiently deep for safe nasal filler injection.

Tissue Stromal Vascular Fraction Improves Early Scar Healing: A Prospective Randomized Multicenter Clinical Trial

Background Wound healing and scar formation depends on a plethora of factors. Given the impact of abnormal scar formation, interventions aimed to improve scar formation would be most advantageous. Tissue stromal vascular fraction (tSVF) of adipose tissue is composed of a heterogenous mixture of cells embedded in extracellular matrix. It contains growth factors and cytokines involved in wound healing processes, eg, parenchymal proliferation, inflammation, angiogenesis, and matrix remodeling. Objectives In this study, we hypothesized that tSVF reduces post-surgical scar formation. Methods This prospective, double-blind, placebo-controlled, randomized trial was conducted between 2016 and 2020. Forty mammoplasty patients were enrolled and followed for 1 year. At the end of the mammoplasty procedure, all patients received tSVF in the lateral 5 cm of the horizontal scar of one breast and a placebo injection in the contralateral breast to serve as an intra-patient control. Primary outcome was scar quality using the patient and observer scar assessment scale (POSAS). Secondary outcomes were obtained with photograph evaluation and histological analysis of scar tissue samples. Results Thirty-four of 40 patients completed follow-up. Six months postoperatively, injection of tSVF had significantly improved postoperative scar appearance as assessed by POSAS questionnaire (observer and patient questionnaire). No difference was observed at 12 months postoperatively. No improvement was seen based on the evaluation of photographs and histological analysis of postoperative scars between both groups. Conclusions Injection of tSVF resulted in improved wound healing and reduced scar formation at 6 months postoperative, without any noticeable advantageous effects seen at 12 months.

#PlasticsTwitter: The Use of Twitter Data s a Tool for Evaluating Public Interest in Cosmetic Surgery Procedures

Background Plastic surgeons are increasingly turning to social media to market their services. The newly released Twitter Academic Research Product Track (TARPT) database provides free, customizable analysis of keywords that are included in tweets on the Twitter platform. The TARPT tool may provide valuable insight into public interest in cosmetic surgery procedures. Objectives To determine TARPT’s utility in tracking and predicting public interest in cosmetic surgery procedures and to examine temporal trends in tweets related to cosmetic facial and body procedures. Methods The TARPT tool was used to calculate total number of tweets containing keywords related to 10 facial cosmetic procedures and 7 cosmetic body procedures from 2010 to 2020. Annual volumes for respective procedures were obtained from annual statistics reports of the American Society of Plastic Surgeons (ASPS) from 2010 to 2020. Univariate linear regression was used to compare tweet volumes and procedure volumes, taking P < 0.05 as the cutoff for significance. Results Variations in tweet volume were observed. Univariate linear regression analysis demonstrated statistically significant positive correlations between tweet volumes and ASPS procedure volumes for 7 search terms: “eyelid lift”, “facelift”, “lip injections”, “mastopexy”, “butt lift”, “butt implants”, and “liposuction”. Many procedure-related keywords were not significant, demonstrating the importance of careful selection of Twitter search terms. Conclusions The TARPT database represents a promising novel source of information for plastic surgeons, which the potential to inform marketing and advertising decisions for emerging trends in plastic surgery interest before these patterns become apparent in surgical or clinical volumes.