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Latest Medical News


Comparison of Myelin-Associated Glycoprotein and Vincristine for Nerve Inhibition in a Transgenic Thy1-Gfp Rat Model

Key Points

Question  What is the neuroinhibitory potential of myelin-associated glycoprotein in comparison with vincristine, as measured via quantification of fluorescent intensity of the facial nerve after an axotomy injury?

Findings  In this laboratory experiment on 12 rats transgenic for the Thy-1 Gfp gene, myelin-associated glycoprotein significantly reduced fluorescent intensity in comparison with saline at weeks 3, 4, and 5 after an initial injury. Myelin-associated glycoprotein demonstrated similar intensity results as vincristine at weeks 4 and 5.

Meaning  These findings suggest that myelin-associated glycoprotein may have potential as a specific neuroinhibitor for patients with lower facial asymmetry after facial nerve injury.

Importance  Aberrant synkinetic movement after facial nerve injury can lead to prominent facial asymmetry and resultant psychological distress. The current practices of neuroinhibition to promote greater facial symmetry are often temporary in nature and require repeated procedures.

Objective  To determine whether myelin-associated glycoprotein (MAG), a specific neuroinhibitor, can prevent neuroregeneration with efficacy comparable with that of vincristine, a well-established neurotoxin.

Design, Setting, and Participants  Rats transgenic for Thy-1 cell surface antigen–green fluorescent protein (Thy1-Gfp) were randomized into 3 groups. Each rat received bilateral crush axotomy injuries to the buccal and marginal mandibular branches of the facial nerves. The animals received intraneural injection of saline, MAG, or vincristine.

Main Outcomes and Measures  The animals were imaged via fluorescent microscopy at weeks 1, 3, 4, and 5 after surgery. Quantitative fluorescent data were generated as mean intensities of nerve segments proximal and distal to the axotomy site. Electrophysiological analysis, via measurement of compound muscle action potentials, was performed at weeks 0, 3, 4, and 5 after surgery.

Results  A total of 12 rats were included in the study. Administration of MAG significantly reduced fluorescent intensity of the distal nerve in comparison with the control group at week 3 (mean [SD], MAG group: 94 [11] intensity units vs control group: 130 [11] intensity units; P < .001), week 4 (MAG group: 81 [19] intensity units vs control group: 103 [9] intensity units; P = .004), and week 5 (MAG group: 76 [10] intensity units vs control group: 94 [10] intensity units; P < .001). In addition, rats treated with MAG had greater fluorescent intensity than those treated with vincristine at week 3 (mean [SD], MAG group: 94 [11] intensity units vs vincristine group: 76 [6] intensity units; P = .03), although there was no significant difference for weeks 4 and 5. At week 5, both MAG and vincristine demonstrated lower distal nerve to proximal nerve intensity ratios than the control group (control group, 0.94; vs MAG group, 0.82; P = .01; vs vincristine group; 0.77; P < .001). There was no significant difference in amplitude between the experimental groups at week 5 of electrophysiological testing.

Conclusions and Relevance  Lower facial asymmetry and synkinesis are common persistent concerns to patients after facial nerve injury. Using the Thy1-Gfp rat, this study demonstrates effective inhibition of neuroregeneration via intraneural application of MAG in a crush axotomy model, comparable with results with vincristine. By potentially avoiding systemic toxic effects of vincristine, MAG demonstrates potential as an inhibitor of neural regeneration for patients with synkinesis.

Level of Evidence  NA.

Original Article

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Three popular options for male body contouring

three popular options for male body contouring

Time affects everyone. With age, the skin and tissues on the face and body stretch, descend and lose their elasticity. This can adversely affect your facial and body contour. For men, in particular, this shows up on the abdomen, chest and the neck/jaw juncture. As plastic surgeons, it is our job to come up with new, safer and better ways to address our patients’ needs. There have been huge advancements of late in terms of nonsurgical modalities for reducing fat and tightening skin. This 1-2 combination has made it possible to treat many of the male face and body contouring issues without having to resort to surgery. This is a huge plus for men who have less tolerance for downtime.

Sometimes, however, surgery is going to be the best option. Whenever considering any type of aesthetic procedure, it is important that you be assessed in person by a board-certified plastic surgeon. You want to see someone who not only offers the full range of nonsurgical and surgical options, but who also has the experience and training to deliver a safe, natural-looking result. The internet has made patients more aware of the many male face and body contouring options, but a procedure is only effective if it is the right match for your individual anatomy and needs. Bottom line: what worked for your friend may not work for you.

Male body contouring options for treating the abdomen

The abdomen is probably the single greatest area of concern for most men. Many men want to have a taut, flat abdomen with visible abdominal muscles, also known as the “six-pack.” With age, however, some men tend to develop a gut no matter how hard they exercise or how well they eat which can hide that taunt abdomen. The fat on the outside of the abdominal wall—the extra-abdominal fat—is treatable. On the nonsurgical side, the two most popular fat reduction techniques are:

Both work by destroying the fat cells in the treatment area either through cold or heat. Once destroyed, these cells are then eliminated through your body’s own lymphatic and metabolic systems. CoolSculping® and SculpSure® are both fast, effective and versatile. However, they each require multiple treatments, spaced 6-8 weeks apart, in order to deliver optimum results. The goal for each treatment is to reduce the targeted fat by about 20%.

Liposuction, on the other hand, is a more aggressive surgical procedure and can be more effective. Most plastic surgeons agree that liposuction is the gold standard when it comes to male abdomen and flank body contouring. It allows the surgeon to literally re-sculpt your torso. Laser technology can also be used as an adjunct body contouring modality. In the right patient, it can even reveal the 6 pack abs that are covered by the extra-abdominal fat. Liposuction does require downtime, typically about a week, and you will need to wear a compression garment to ensure the best results and skin contour.

Gynecomastia options for a flatter chest

The second most popular area for men when it comes to body contouring is the chest. Gynecomastia is a fullness in the chest caused by an excess in glandular tissue, fat or a combination of the two. Incredibly common, there are a number of different ways to treat gynecomastia. The right procedure is going to depend on the underlying cause. In patients whose fullness is solely the result of too much fat, liposuction is the most common form of treatment. Sculpting and reducing the fat may lead to a trimmer and more masculine chest. Liposuction of the chest can be done safely under local anesthesia with minimal downtime and recovery.

Most men who are afflicted with gynecomastia, however, have excess glandular tissue in addition to fat. The gland must be surgically removed in order to deliver the kind of flat, smooth chest that men desire. There are a few different incision options. The right one is going to depend on the amount of breast tissue that needs to be removed. Although the idea of scars on the chest sounds frightening, ideally, the incision can be camouflaged in the border between the darker skin of the nipple and the lighter skin on the chest. Men who have excess, loose skin in addition to gland and fat might need surgical removal and adjustment of the skin as well.

Aesthetic procedures for a crisp jawline

A crisp jawline is a youthful-looking jawline. Unfortunately, some men aren’t born this way and some lose this definition with age. The area under the chin is a prime spot for excess fat in men. Whether you wear a tie or not, a buildup of fat at the neck/chin juncture can make you feel dumpy and overweight when you are not. Thankfully, this focused area of fat accumulation is treated well with noninvasive body contouring devices such as CoolSculpting® and SculpSure®. Furthermore, there is an injectable, Kybella®, that was specifically designed to decrease the submental fat beneath the chin. In patients with a severe amount of extra fat, liposuction is probably going to be the best option.

Assuming that your skin has enough elasticity or “bounce back,” these can all be stand-alone procedures. However, older men or men who have loose or lax neck skin may need to combine a fat reducing modality with a skin tightening procedure such as ThermiRF. The latter uses radiofrequency energy to heat up the tissue in the treatment area. This creates a controlled injury to the neck skin. The body’s natural response to any injury is to produce more collagen and elastin. As the foundations of youthful-looking skin, more collagen and elastin results in smoother, tighter, more lifted looking skin.

So, if you would like a face or body contour with a bit more tone, schedule a consultation with a board-certified plastic surgeon in your area to discuss which options might be right for you. It’s not just about looking better. Getting rid of pockets of excess fat may make you feel more vital, confident and in charge.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

Original Article

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Save a Life Makes Final Round in Challenge

Wolters Kluwer Health

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Is There a Selfie Epidemic?

Chen et al1 should be commended for this novel study, which attempts to directly relate the current landscape of social media to the acceptance of cosmetic surgery. Their findings that social media investment had a positive effect on the consideration of surgery corroborates the rising trend noticed among facial plastic surgeons.2 The discussion provided on the negative effect of social media and, more specifically, selfies highlights the need to better understand the underlying motives and characteristics of our patients.

Original Article

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A new minimally invasive treatment to get you ready for the holidays

minimally invasive procedures to get you ready for the holidays

Now that the holidays are quickly upon us, how do we look great at the holiday party on very short notice? Luckily, there are several new aesthetic options that don’t require surgery or significant downtime.

PDO threads are synthetic absorbable surgical sutures that are used to enhance the appearance of the area treated. Although most commonly used in the face, PDO threads have also been successfully used in the extremities and the abdomen. PDO stands for polydioxanone, a material that induces collagen production around the thread. The thread can increase collagen production by up to 100% in the area treated.

How do PDO threads work?

When barbed threads are used in the face, they can lift the skin in the cheeks, jowls and marionette lines. The contour of the face is improved while, at the same time, stimulating long-term collagen production. In addition, PDO threads can be used to give lip fullness as well as reduce wrinkles in the perioral area.

The procedure takes less than one hour and is done under local anesthesia. Bruising and swelling can occur, but usually, patients can apply makeup and return to work the next day. If desired, thread lifts can be added to enhance surgical procedures such as a neck lift or facelift. They can also be combined with dermal fillers or neurotoxin treatments.

What results can you expect PDO threads?

For those patients do not want to undergo surgery, PDO threads offer an excellent alternative. The results last 12-24 months, but they are instantaneous and require minimal downtime. The best candidates for thread lifts are those who have early signs of aging. Patients with heavy tissues and advanced aging signs are probably better off with more traditional facial plastic surgery.

As with any aesthetic procedure, proper patient selection is key. If the patient is well informed and has appropriate expectations, PDO threads can yield a quick, natural-appearing rejuvenation. For the plastic surgeon, PDO threads represent another arrow in the ever-expanding quiver of choices that we can offer our patients.

So add a little Botox, some filler and a PDO lift and you can be at the company holiday party with no sign of surgery and without having missed a single day of work!

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

Original Article

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Best Rhinoplasty Surgeons Miami

Miami’s Best Rhinoplasty Surgeon

Who is the best doctor in Miami to see about a nose job?

Best Surgeon

Dr. Kim Patrick Murray, MD – Rhinoplasty / Nose Job – Miami, FL

A definitive answer to who can claim the title is elusive as many doctors have claimed to be on their websites.  A look at Yelp may help:

Yelp Best Rhinoplasty Doctor

By their account its a race between contenders Andres Bustillo, MD, FACS who has more reviews but a lower overall rating then Kim Patrick Murray, MD who has a higher rating but needs more reviews.  Hopefully more patients of each doctor will rate in the future, until then it is too close to call, even for Yelp.

Beyond Yelp’s scientific determination one might look to Best of Miami 2019 for a clue.  Unfortunately they only have “Best Doctor” and their winning lacks the specialty were seeking of Rhinoplasty.
“The best way to evaluate a rhinoplasty surgeon is to view before and after photos. Results are what matter.” Dr Murray’s website notes.

Rhinoplasty

Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The motivation for rhinoplasty may be to change the appearance of the nose, improve breathing or both.

The upper portion of the structure of the nose is bone, and the lower portion is cartilage. Rhinoplasty can change bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve.

When planning rhinoplasty, your surgeon will consider your other facial features, the skin on your nose and what you would like to change. If you’re a candidate for surgery, your surgeon will develop a customized plan for you.

Sometimes part or all of a rhinoplasty is covered by insurance.

Rhinoplasty can change the size, shape or proportions of your nose. It may be done to repair deformities from an injury, correct a birth defect or improve some breathing difficulties.

Risks

As with any major surgery, rhinoplasty carries risks such as:

  • Bleeding
  • Infection
  • An adverse reaction to the anesthesia

Other possible risks specific to rhinoplasty include but are not limited to:

  • Difficulty breathing through your nose
  • Permanent numbness in and around your nose
  • The possibility of an uneven-looking nose
  • Pain, discoloration or swelling that may persist
  • Scarring
  • A hole in the septum (septal perforation)
  • A need for additional surgery

Talk to your doctor about how these risks apply to you.

How you prepare

Before scheduling rhinoplasty, you must meet with your surgeon to discuss important factors that determine whether the surgery is likely to work well for you. This meeting generally includes:

  • Your medical history. The most important question your doctor will ask you is about your motivation for surgery and your goals. Your doctor will also ask questions about your medical history — including a history of nasal obstruction, surgeries and any medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.
  • A physical exam. Your doctor will conduct a complete physical examination, including any laboratory tests, such as blood tests. He or she also will examine your facial features and the inside and outside of your nose.The physical exam helps your doctor determine what changes need to be made and how your physical features, such as the thickness of your skin or the strength of the cartilage at the end of your nose, may affect your results. The physical exam is also critical for determining the impact of rhinoplasty on your breathing.
  • Photographs. Someone from your doctor’s office will take photographs of your nose from different angles. Your surgeon may use computer software to manipulate the photos to show you what kinds of results are possible. Your doctor will use these photos for before-and-after assessments, reference during surgery and long-term reviews. Most importantly, the photos permit a specific discussion about the goals of surgery.
  • A discussion of your expectations. You and your doctor should talk about your motivations and expectations. He or she will explain what rhinoplasty can and can’t do for you and what your results might be. It’s normal to feel a little self-conscious discussing your appearance, but it’s very important that you’re open with your surgeon about your desires and goals for surgery.If you have a small chin, your surgeon may speak with you about performing a surgery to augment your chin. This is because a small chin will create the illusion of a larger nose. It’s not required to have chin surgery in those circumstances, but it may better balance the facial profile.

Once the surgery is scheduled, you’ll need to arrange for someone to drive you home if you’re having an outpatient surgery.

For the first few days after anesthesia, you may have memory lapses, slowed reaction time and impaired judgment. So arrange for a family member or friend to stay with you a night or two to help with personal care tasks as you recover from surgery.

Food and medications

Avoid medications containing aspirin or ibuprofen (Advil, Motrin IB, others) for two weeks before and after surgery. These medications may increase bleeding. Take only those medications approved or prescribed by your surgeon. Also avoid herbal remedies and over-the-counter supplements.

If you smoke, stop smoking. Smoking slows the healing process after surgery and may make you more likely to get an infection.

What you can expect

Rhinoplasty does not have an ordered series of steps. Each surgery is unique and customized for the specific anatomy and goals of the person having the surgery.

During the surgery

Rhinoplasty requires local anesthesia with sedation or general anesthesia, depending on how complex your surgery is and what your surgeon prefers. Discuss with your doctor before surgery which type of anesthesia is most appropriate for you.

  • Local anesthesia with sedation. This type of anesthesia is usually used in an outpatient setting. It’s limited to a specific area of your body. Your doctor injects a pain-numbing medication into your nasal tissues and sedates you with medication injected through an intravenous (IV) line. This makes you groggy but not fully asleep.
  • General anesthesia. You receive the drug (anesthetic) by inhaling it or through a small tube (IV line) placed in a vein in your hand, neck or chest. General anesthesia affects your entire body and causes you to be unconscious during surgery. General anesthesia requires a breathing tube.

Rhinoplasty may be done inside your nose or through a small external cut (incision) at the base of your nose, between your nostrils. Your surgeon will likely readjust the bone and cartilage underneath your skin.

Your surgeon can change the shape of your nasal bones or cartilage in several ways, depending on how much needs to be removed or added, your nose’s structure, and available materials. For small changes, the surgeon may use cartilage taken from deeper inside your nose or from your ear. For larger changes, the surgeon can use cartilage from your rib, implants or bone from other parts of your body. After these changes are made, the surgeon places the nose’s skin and tissue back and stitches the incisions in your nose.

If the wall between the two sides of the nose (septum) is bent or crooked (deviated), the surgeon can also correct it to improve breathing.

After the surgery, you’ll be in a recovery room, where the staff monitors your return to wakefulness. You might leave later that day or, if you have other health issues, you might stay overnight.

After the surgery

After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery.

In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It’s usually in place for about one week.

Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a “drip pad” — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don’t place the drip pad tight against your nose.

To further lower the chances of bleeding and swelling, your doctor may ask that you follow precautions for several weeks after surgery. Your doctor may ask you to:

  • Avoid strenuous activities such as aerobics and jogging.
  • Take baths instead of showers while you have bandages on your nose.
  • Not blow your nose.
  • Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause you to strain, putting pressure on the surgery site.
  • Avoid extreme facial expressions, such as smiling or laughing.
  • Brush your teeth gently to limit movement of your upper lip.
  • Wear clothes that fasten in the front. Don’t pull clothing, such as shirts or sweaters, over your head.

In addition, don’t rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pressure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed.

Use SPF 30 sunscreen when you’re outside, especially on your nose. Too much sun may cause permanent irregular discoloration in your nose’s skin.

Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodium will help the swelling go away faster. Don’t put anything such as ice or cold packs on your nose after surgery.

Your nose changes throughout your life whether you have surgery or not. For this reason, it’s difficult to say when you have obtained your “final result.” However, most of the swelling is gone within a year.

Results

Very slight changes to the structure of your nose — often measured in millimeters — can make a large difference in how your nose looks. Most of the time, an experienced surgeon can get results both of you are satisfied with. But in some cases, the slight changes aren’t enough, and you and your surgeon might decide to do a second surgery for further changes. If this is the case, you must wait at least a year for the follow-up surgery, because your nose can go through changes during this time.

Frequently Asked Questions

How is rhinoplasty different from septoplasty?

Rhinoplasty is a surgery to change the shape of the nose. Because both breathing and the nose’s shape are interrelated, a rhinoplasty may sometimes be performed not only to change the way the nose looks but also to improve breathing through the nose.

Septoplasty is a surgery to improve breathing by straightening the wall inside the nose that divides the nasal passages into a right and a left side (nasal septum). When the septum is crooked, it can make it harder to breathe through the nose. A septoplasty is often combined with a rhinoplasty.

Is rhinoplasty a simple operation?

No. Rhinoplasty is a challenging operation. This is due to several factors. First, the nose is a complicated 3D shape that is in the middle of the face. Changes made during rhinoplasty are often very small. But these changes can make a major difference in the way the nose looks and functions. Because these changes are small, so is the margin for error.

Swelling and the placement of local anesthetic in the skin distort the nose during surgery, hiding many of the subtle changes made. Rhinoplasty also doesn’t have a standard plan or set order of steps. Doctors tailor each operation to the needs of the patient.

Will I need to stay in the hospital?

Nearly everyone who has rhinoplasty is able to safely leave the hospital the same day after surgery. In rare cases, you may stay in the hospital for one night if you’re having a hard time with nausea or have other health problems that need to be monitored.

How long is the recovery period?

Plan to take a week off from work, school or other obligations. You will feel progressively better each day during the first week. One week after surgery, people usually feel like they are themselves again.

After surgery, there will be some swelling. The swelling can take many months to resolve, although most people stop noticing it after a couple of months. People are usually back to performing most activities after a week and resuming all activities after two to four weeks.

Are there risks?

All surgeries have risks. Fortunately, rhinoplasty risks are small and complications are rare. Your doctor will talk to you about the surgery’s risks and benefits in detail before the operation.

Does insurance pay for a rhinoplasty?

Sometimes insurance pays for a rhinoplasty, but it depends on the insurance policy. Before scheduling surgery, your doctor’s office will help you get prior written authorization from your insurance company. Although this isn’t a guarantee of coverage, it’s the only way to confirm that rhinoplasty is a covered benefit. Sometimes insurance will pay for a part of a nasal surgery, but not other parts. In these cases, you can contact the business office to get a quote for the operation.

How much does rhinoplasty cost?

The cost of a rhinoplasty depends on several factors, including the complexity of the surgery, the surgeon’s training and experience, and geography. At Mayo Clinic, the cost of surgery will be the same regardless of which surgeon you choose.

Can I see what my nose might look like after surgery?

Yes. Before your consultation, your doctor will take standardized photographs of multiple views of your face. These photos can be manipulated to give you an idea of what your nose might look like after surgery.

Is rhinoplasty painful?

Not for most people. One day after surgery, most people rate their pain between 0 and 4 out of 10.

Will you pack my nose?

No. Packing can be very uncomfortable. But you’ll likely have some soft splints in your nose. These splints have a hole in them to make it possible to breathe through them, at least for a few days. Doctors easily remove these splints at the one-week visit.

How long will I be bruised?

Bruising is uncommon. If you do have some minor bruising, it usually lasts a week or so.

What should I look for in a surgeon?

Plastic surgeons, facial plastic surgeons or otolaryngologists (ENT) perform most rhinoplasties. Training and board certification in one of these specialties is a good starting point. You’ll likely want a surgeon who often performs rhinoplasty.

You’ll likely want a surgeon with a good reputation among patients and other doctors. If your surgeon has published many papers in medical literature related to rhinoplasty and is invited to speak at educational conferences, that is usually one sign that their peers recognize expertise in rhinoplasty.

Make sure that your surgery will be performed in an accredited surgical facility or hospital. You likely should also feel comfortable with your surgeon. Look for a surgeon who can explain to you in understandable terms what is going to happen during your surgery.

Miami Rhinoplasty

Source

Association Between Social Media and Photograph Editing Use, Self-esteem, and Cosmetic Surgery Acceptance

Key Points

Question  Does an association exist between the use of social media and photograph editing applications, self-esteem, and attitudes toward cosmetic surgery?

Findings  In this survey study of 252 participants, increased investment in the use of social media platforms was associated with increased consideration of cosmetic surgery. Participants who reported using specific applications, such as YouTube, Tinder, and Snapchat photograph filters, had an increased acceptance of cosmetic surgery; use of other applications, including WhatsApp and Photoshop, was associated with significantly lower self-esteem scores.

Meaning  These findings suggest that perceptions of cosmetic surgery may vary based on social media and photograph editing application use.

Importance  Social media platforms and photograph (photo) editing applications are increasingly popular sources of inspiration for individuals interested in cosmetic surgery. However, the specific associations between social media and photo editing application use and perceptions of cosmetic surgery remain unknown.

Objective  To assess whether self-esteem and the use of social media and photo editing applications are associated with cosmetic surgery attitudes.

Design, Setting, and Participants  A population-based survey study was conducted from July 1 to September 19, 2018. The web-based survey was administered through online platforms to 252 participants.

Main Outcomes and Measures  Each participant’s self-esteem was measured using the Rosenberg Self-esteem Scale (scores range from 0-30; higher scores indicate higher self-esteem) and the Contingencies of Self-worth Scale (scores range from 1-7; higher scores indicate higher self-worth). Cosmetic surgery attitude was measured using the Acceptance of Cosmetic Surgery Scale (scores range from 1-7; higher scores indicate higher acceptance of cosmetic surgery). Unpaired, 2-tailed t tests were used to assess the significance of self-esteem and cosmetic surgery attitude score differences among users of various social media and photo editing applications. Structural equation modeling was used to assess the association between social media investment and cosmetic surgery attitudes.

Results  Of the 252 participants, 184 (73.0%) were women, 134 (53.2%) reported themselves to be white, and the mean age was 24.7 (range, 18-55) years. Scores on the Rosenberg Self-esteem Scale from users and nonusers across applications were compared, with lower self-esteem scores noted in participants who reported using YouTube (difference in scores, −1.56; 95% CI, −3.01 to −0.10), WhatsApp (difference in scores, −1.47; 95% CI, −2.78 to −0.17), VSCO (difference in scores, −3.20; 95% CI, −4.98 to −1.42), and Photoshop (difference in scores, −2.92; 95% CI, −5.65 to −0.19). Comparison of self-esteem scores for participants who reported using other social media and photo editing applications yielded no significant differences. Social media investment had a positive association with consideration of cosmetic surgery (R, 0.35; 95% CI, 0.04-0.66). A higher overall score on the Acceptance of Cosmetic Surgery Scale was noted in users of Tinder (difference in means, 0.79; 95% CI, 0.34-1.23), Snapchat (difference in means, 0.39; 95% CI, 0.07 to 0.71), and/or Snapchat photo filters (difference in means, 0.44; 95% CI, 0.16-0.72). Increased consideration of cosmetic surgery but not overall acceptance of surgery was noted in users of VSCO (difference in means, 0.84; 95% CI, 0.32-1.35) and Instagram photo filters (difference in means, 0.38; 95% CI, 0.01-0.76) compared with nonusers.

Conclusions and Relevance  This study’s findings suggest that the use of certain social media and photo editing applications may be associated with increased acceptance of cosmetic surgery. These findings can help guide future patient-physician discussions regarding cosmetic surgery perceptions, which vary by social media or photo editing application use.

Level of Evidence  NA.

Original Article

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What’s so special about Retin-A?

what's so special about retin-A

Retin-A, or Tretinoin, is a form of vitamin A that was developed at the University of Pennsylvania in the 1960s. One of the most successful patents of all time, it revolutionized topical skin care and still has great utility today.

To understand how Retin-A works, it helps to understand the effects of aging on the skin. The most superficial cells—the keratinocytes of the epidermis—tend to become more adhesive and hang around longer. This leaves the skin looking dryer and rougher. The epidermal cells at the base also do not replicate as quickly, so the lifespan of these cells in the outer layer is much longer—and it shows. The pigmentation can become irregular and mottled because of this.

The deeper layer of cells, called the dermis, and the collagen bundles become thinner and disordered, allowing for creases and fine wrinkles to more easily show the muscular activity from below.

How does Retin-A work?

Retin-A is a topical medicine available by prescription only that is applied sparingly to the facial skin, sparing the eyelids and the corners of the nose and lips. It works at the cellular level and takes several months to see the full effect. In many ways, Retin-A can be thought of as reversing the outwards signs of aging on the skin.

The earliest effect of Retin-A is that the outer layer of keratinocytes start shedding off, leaving the skin fresher, smoother and more evenly pigmented. The next effect seen is that the epidermal cells start to replicate faster causing the skin to look and feel softer, more robust and healthier. Finally, the collagen bundles in the dermis will thicken and organize, causing the appearance of fine lines and wrinkles to lessen with time.

Retin-A improves the cosmetic appearance of the skin, but it also helps treat some functional problems of the skin such as acne and precancerous conditions, such as actinic keratoses.

How is Retin-A used for beauty treatments?

Typical treatment regimens include a period of tapering up. The topical product is applied sparingly 2-3 nights per week for several weeks and then the frequency is gradually increased until a nightly regimen is attained. A cream or gel delivery system is chosen based on the skin’s underlying dry or oily predisposition and the concentration can be increased over time.

Common side effects are raw itchy burning skin, generally from more aggressive application in the early phase of exposure. Often taking a break for a few days before continuing the medication at a slower ramp-up will remedy this. Sensitive areas like the corners of the nose, eyelids, lips and corners of the lips should not be treated. Patients should avoid exposure to the sun following Retin-A treatments. The use during pregnancy should also be avoided.

Pretreatment with Retin-A is extremely helpful prior to moderate to deep chemical peel, laser treatments, dermabrasion or facelifting to hasten healing and help prevent scarring or dyspigmentation. Retin-A is certainly a useful addition to any beauty regimen.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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Pedicled Fat Transposition vs Free-Fat Grafting

To the Editor We read with interest the description by Kim et al1 of their lower blepharoplasty technique using autologous fat grafting. We recognize their excellent surgical results, but respectfully dissent against the authors’ claims of the technique’s superior safety relative to lower blepharoplasty with fat transposition.

Recognition of how an aging face changes, including maxillary retrusion and midfacial volume loss,2 has heightened the appreciation of facial volume and its preservation.3 The authors report that fat transposition increases eyelid retraction risk, which is unsubstantiated in the literature4 and by our anecdotal experience. Disruption of the middle lamella is necessary during any transconjunctival approach. Septal manipulation could cause postoperative retraction; however, anterior lamellar shortening, orbicularis oculi trauma, and uncorrected lateral canthal tendon laxity are likely the primary contributors. Lower blepharoplasty carries a low risk of motility disturbance from inferior oblique disruption. Meticulous surgical dissection with release of the muscle and supporting pulleys during fat pedicle development prevents tethering.

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How long does Botox last?

how long does Botox last?

Let’s start with what Botox is. Botox is the brand name for Onobotulinumtoxin A, a neurotoxin derived from Clostridium botulinum. There are currently four different types that are FDA-approved for cosmetic facial wrinkles. These include Botox, Xeomin, Dysport and now Jeuveau.

They all work by blocking a signal from the nerve to the targeted muscle that prevents it from contracting. By preventing the contraction of these specific muscles, there is less action or pull on the skin and a decrease in the formation of wrinkles. While all of these products have the same end result, they differ slightly in their onset, duration of action and discomfort.

When to use each product is dependent on several things. Sometimes, it is the surgeon’s or injector’s preference. In other instances, a patient may have had experience with different products and have found that one works better than the other in them personally. In either case, all of these products are safe and effective in the right hands.

What to expect during your procedure

Finally, the real question. Oftentimes, at the time of your injection, your injector will discuss with you your goals and, after an examination, will be able to assess if those goals can be achieved with the use of neurotoxin. If it can, it’s your lucky day!

Your face will be cleansed and the areas that are to be injected, possibly marked with a removable eyeliner/marker. You might have a numbing cream applied or be given ice packs to help with any discomfort. Once you are ready, the injections will be performed in various areas to target the desired muscles.

You might have a few small bumps in the skin at the actual injection site but these will be gone by the time you leave the office. You might also have some mild bruising which will resolve in 24-48 hours. Finally, you will be given instructions on what to do and what not to do in the next 24 hours. This is can vary from injector to injector.

Onset

Neurotoxins generally take effect in 3-5 days but it is common to not see your full and final results for 7-10 days. I, personally, always tell my patients to wait a full 2 weeks after their Botox injection and, at that point if they need a touch-up, we will take care of it. It takes this long because it takes time for the toxin to block off those nerve impulses to the muscles. It is not immediate.

Duration

Well, don’t we wish Botox lasted forever? Unfortunately, it doesn’t. Eventually, the action of the neurotoxin will wear off and the nerves will again be able to send those signals to the muscles to start working or contracting. In general, Botox lasts 3-4 months.

There will certainly be patients in which in lasts longer, in that 4-6 month range, or shorter, in that 2-month range. It is also common for first-timers to notice that it may not last as long initially but may last longer after the second treatment. Everyone has a unique experience and results may vary.

Hopefully, this helps answer any questions you have about Botox or other neurotoxins. For any further questions, consult with your local board-certified plastic surgeon or use the ASPS Ask A Surgeon tool.

The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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