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Background Hematomas are consistently cited as the most common complication of facelift surgery, with reported incidence rates ranging from 1% to 9% despite preventative measures. A self-assembling RADA16 peptide solution (PuraSinus, 3-D Matrix, Newton, MA) designed to aid in wound healing, adhesion prevention, and bleeding control has demonstrated hemostatic control of intra- and postoperative bleeding associated with various surgical procedures, including nasal and sinus surgery. Objectives To report surgical experience using novel application of RADA16 hemostatic agent in facelift procedures. Methods Through exploring incorporation of RADA16 hemostatic agent into standard of care, 15 higher-risk facelift patients were treated intraoperatively between December 2020 and July 2021. Postoperative follow-up was on post-procedure day 1 and 3 and at approximately one week. During follow-up, potential complications were assessed subjectively, including hematoma, swelling, and bruising; postoperative observations recorded; and photographs taken. Results Among facelift patients receiving intraoperative RADA16 hemostatic agent there were no hematomas or protracted ecchymosis events. The only significant complication was one patient admitted for intravenous hydration due to post-operative nausea and vomiting. All patients had minimal bruising or a dramatic absence of bruising and experienced no hemorrhage or hematoma. Through surgical experience, technique for RADA16 hemostatic agent placement was optimized and procedural details are provided. Conclusions Intraoperative administration of topical RADA16 hemostatic agent appears to deter acute hematoma and hemorrhage formation and early experience suggests that RADA16 hemostatic agent may also attenuate post-operative bruising in facelift patients. These observations warrant further investigation in a larger randomized controlled study. Level of Evidence: 4

Background Multiple intrinsic and extrinsic factors influence aging and lead to visible changes in the skin, including dryness, fine lines and wrinkles, loss of elasticity, surface roughness, uneven pigmentation, and loss of luminosity. Although it is well established that a single combination of topicals can address multiple signs of skin aging, it is common for patients’ at-home skin treatment routines to include multiple different topicals with different active ingredients. The layering of active ingredients can cause skin irritation, and lead to noncompliance with a consistent routine. Further, multiple active ingredients may exacerbate irritation from in-office aesthetic treatments. Objectives To assess the long-term efficacy, safety, tolerability, and patient adherence to a Stackable Treatment topical routine consisting of 4 complementary topical formulations. Methods This study examined a daily topical routine (Stackable Treatment routine) consisting of 4 topical formulas with different active ingredients, and evaluated the routine's safety, tolerability, and efficacy in a composite of in-office treatment patients who applied the routine for a minimum of 1 year. Results Of the 14 patients, 0 experienced adverse reactions. Improvements to multiple skin parameters were observed, including improvements to skin hydration, surface texture, pigmentation, vasculature, and the appearance of scars. The majority of patients continue to use the Stackable Treatment routine after the study's conclusion. Conclusions The combination of low incidence of irritation, high patient satisfaction, and overall efficacy of the routine indicates the Stackable Treatment routine may be well suited as a foundational skin care regimen that can complement in-office aesthetic treatments. Level of Evidence: 4

Background While retinol is known to reduce the appearance of fine lines and wrinkles, it is associated with irritating effects. However, when combined with water soluble cannabidiol (CBD; CR Topical), CBD may act to reduce oxidative stress and inflammation, mitigating irritation from retinol and further improving the skin’s appearance through independent anti-aging mechanisms. Objectives To assess the efficacy and tolerability of CR-Topical for improving facial skin. Methods In this prospective, single-center pilot study, 9 female patients and one male patient aged 20 to 53 years who presented with facial skin imperfections (visible pores, dehydration, roughness, and/or static/dynamic wrinkles) applied CR-Topical to the entire face once daily for 42 days. Outcomes were measured on days 1, 21, and 42 using the Global Ranking Scale (GRS) with Comprehensive Skin Analysis by the patient and senior investigator as well as by a blinded reviewer (board-certified plastic surgeon). Dynamic videos and static imagery were taken before and after treatment, and patient satisfaction surveys were completed. Results Global improvement across all 13 domains was observed, with the greatest mean differences for visible pores (2.0; 95% CI, 1.5-2.5), dehydration (2.0; 95% CI, 1.4-2.6), surface roughness (1.8; 95% CI, 1.2-2.4), static wrinkles (1.8; 95% CI, 1.1-2.5), and dynamic wrinkles (1.6; 95% CI, 0.8-2.3). Patient satisfaction (100%) and willingness to recommend the product to others (90%) were high, and tolerability of CR-Topical was excellent. Conclusions CR-Topical is effective at improving global skin quality, including static and dynamic wrinkles. This study also used 4-dimensional analysis in the evaluation, a novel and developing method. Level of Evidence: 4

Background Absorbable suspension sutures are the only nonsurgical modality approved for tissue repositioning. Objectives To quantitate patient perceptions of treatment at 24 months and determine the impact of age and prior surgical procedures on perceptions of efficacy, treatment longevity, and overall satisfaction. In addition, the authors sought to describe the impact of treatment with absorbable suspension sutures on the likelihood a patient will undergo future surgical procedures. Methods The first 100 treated patients who underwent treatment with absorbable suspension sutures, by the senior author, were critically evaluated. Subjects completed surveys 24 months following initial treatment. Results Of the initial 100 patients, complete records were available for 80 patients (age 39–86). Eighteen (22.5%) received a second treatment with absorbable suspension sutures and average time to second treatment was 23.4 months (range 13–37 months). Overall satisfaction was affected by age, 100% of patients ≤ 50 vs. 60% of patients > 50 (P = 0.026). Prior surgery appeared to be a factor in patient perception of efficacy: 82.6% of patients with no prior surgery indicated that absorbable suspension sutures were effective vs. 45.5% of patients with a prior surgical procedure (P = 0.0286). Just under one third of pretreatment surgical patients underwent surgery following treatment while 25% of surgery naïve patients went on to have surgery. Importantly, satisfaction with the initial procedure does not preclude later surgery. Conclusions Treatment with absorbable suspension sutures is associated with high satisfaction through 24 months and does deter patients from surgery. The combination of lift and volumization results in 4-dimensional rejuvenation that includes rejuvenation of dynamic expression. Level of Evidence: 4

Background For aesthetic treatment with botulinum neurotoxin type A (BoNTA), interest in maximizing treatment duration and efficacy has prompted study of doses higher than those used in registration studies. As data emerge, it is important that physicians understand how to apply study findings to their own practice so that patient demand is satisfied. Objectives To bring together leading experts in neuromodulators for a roundtable discussion on the implications of high-dose BoNTA studies for patient care. Methods The authors reviewed and discussed recent data from high-dose BoNTA studies for abobotulinum toxin A, incobotulinum toxin A, and Oonobotulinumtoxin A. Results Discussion focused on the challenges of data interpretation and extrapolation of study findings for real-world patient care. The authors participated in a candid discussion of whether the observed improvements in treatment duration and patient satisfaction warrant treatment with high-dose regimens delivered as high-concentration injections. Safety was also discussed, as well as economic considerations for both practices and patients. Of note, for BoNTA products, the registration dose, when administered in a smaller total volume, appears to give rise to more durable results than those observed in pivotal trials, implicating product concentration as an important consideration. Importantly, at higher doses, extended duration of effect does not appear to be at the expense of natural-looking results. Conclusions While the authors provide considerations for the development of individual clinical practice, there is no one-size-fits-all recommendation. It may be that “high-dose” BoNTA is in reality the optimal dose; however, important economic considerations may prevent rapid uptake for all patients.

Innovative strategies for artfully blending aesthetic techniques to maximize results The Art of Combining Surgical and Nonsurgical Techniques in Aesthetic Medicine by Julius W. Few Jr. reflects multidisciplinary contributions from renowned practitioners in plastic surgery, dermatology, oculoplastics, and facial plastic surgery. This is the first book to specifically discuss minimally-invasive aesthetic techniques for the face and body and how to strategically combine them, both with and without surgery. The text is rooted in evidence-based scientific principles and sound clinical applications, with the goal of helping aesthetic practitioners attain more favorable and longer-lasting results. Fifteen comprehensive chapters reflect the visionary beliefs of top experts in cosmetic medicine. Each topic is discussed by clinicians who have developed innovative approaches that will revolutionize the field. The book lays a solid foundation with opening chapters on concepts of beauty and nonsurgical facial rejuvenation in traditional surgical candidates. Subsequent chapters discuss innovative, combined approaches for both the face and body. Key Features * Blending and sequencing of techniques, and diverse skin type considerations * A wide array of modalities — from noninvasive devices, microneedling and platelet-rich plasma, and light- and energy-based therapies — to surgical interventions * Practical, real-life case studies throughout * More than 200 detailed photos and colorful illustrations detail anatomy and approaches * Technical videos available online demonstrate techniques in depth * Special emphasis on how to avoid and treat complications This must-have resource masterfully guides novice and veteran clinicians alike on the thoughtful use of combined state-of-the-art techniques to achieve optimal outcomes. It will help plastic surgeons, facial plastic surgeons, dermatologists, and dermatologic surgeons reduce recovery time and enhance results in their patients.

IntroductionThe use of neuromodulators has grown substantially in our society, particularly in the temporary treatment of brow ptosis. This study revisits the use of the transpalpebral browpexy for upper face and brow rejuvenation in the context of what has been learned from neuromodulators.MethodsA retrospective review of 97 subjects was conducted who had transpalpebral browpexy performed for lateral brow ptosis. Qualitative degree of brow elevation after the procedure was determined by examining before and after photographs for each patient.ResultsOut of 97 patients, 95 (98%) experienced aesthetically optimal brow elevation for their respective gender. Two patients required surgical revision, both of which experienced extenuating circumstances. Two patients experienced edema and one patient experienced periodic eruptions of chalazia along the upper eyelid.ConclusionTranspalpebral browpexy is a reliable, minimally invasive surgical procedure that effectively emulates the results of neuromodulator injections for a much longer period of time. While it cannot replace traditional brow-lifting techniques, transpalpebral browpexy does have solid indications with proven long-lasting results, which can be effective in a significant portion of patients with brow ptosis.Level of Evidence IVThis 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.

Background Aesthetic medicine has traditionally relied on clinical scales for the objective assessment of baseline appearance and treatment outcomes. However, the scales focus on limited aesthetic areas mostly and subjective interpretation inherent in these scales can lead to variability, which undermines standardization efforts. Objective The consensus meeting aimed to establish guidelines for AI application in aesthetic medicine. Materials and Methods In February 2024, the AI Consensus Group, comprising international experts in various specialties, convened to deliberate on AI in aesthetic medicine. The methodology included a pre‐consensus survey and an iterative consensus process during the meeting. Results AI's implementation in Aesthetic Medicine has achieved full consensus for enhancing patient assessment and consultation, ensuring standardized care. AI's role in preventing overcorrection is recognized, alongside the need for validated objective facial assessments. Emphasis is placed on comprehensive facial aesthetic evaluations using indices such as the Facial Aesthetic Index (FAI), Facial Youth Index (FYI), and Skin Quality Index (SQI). These evaluations are to be gender‐specific and exclude makeup‐covered skin at baseline. Age and gender, as well as patients' ancestral roots, are to be considered integral to the AI assessment process, underlining the move towards personalized, precise treatments. Conclusion The consensus meeting established that AI will significantly improve aesthetic medicine by standardizing patient assessments and consultations, with a strong endorsement for preventing overcorrection and advocating for validated, objective facial assessments. Utilizing indices such as the FAI, FYI, and SQI allows for gender‐specific, age adjusted evaluations and insists on a makeup‐free baseline for accuracy.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are widely used for Type 2 diabetes and weight management but may adversely affect skin quality, resulting in dermal thinning, decreased elasticity, and accelerated aging—a phenomenon referred to as “GLP-1 Face.” A novel topical serum, GLPSGLT (Aforé LLC), was developed to counteract these effects using a proprietary blend of a bioavailable retinoic acid derivative, peptides, and botanical agents to support keratinocyte function and dermal repair. The authors of the study aim to evaluate the safety and efficacy of GLPSGLT serum in improving facial skin quality in patients undergoing GLP-1 RA or SGLT-2 therapy. In this split-face, double-blind pilot study, 7 female patients (median age 55) on stable GLP-1 RA/SGLT-2 therapy applied GLPSGLT serum to one side of the face and placebo to the other, twice daily for 6 weeks. Assessments at baseline, Day 21, and Day 42 included the Global Ranking Scale (GRS), standardized photography reviewed by a blinded physician, and a 26-item patient-satisfaction questionnaire. Treated sides showed statistically significant improvements across all 13 GRS domains vs placebo (P < .0001), particularly in hydration, surface roughness, pigmentation, vasculature, visible pores, and static wrinkles. The blinded reviewer correctly identified the treated side in all cases. Patients reported greater satisfaction with skin texture, firmness, radiance, and hydration. No adverse events were reported. GLPSGLT serum significantly improved skin quality in GLP-1 RA/SGLT-2-treated patients and was well-tolerated, warranting further investigation in larger, histologically assessed cohorts. Level of Evidence: 4 (Therapeutic)

Background Aging, influenced by intrinsic and extrinsic factors, leads to visible skin changes such as dryness, surface roughness, and loss of luminosity. Proper skin care can mitigate some of these effects, with topical combination products offering support through complementary mechanisms. Objectives To test efficacy and safety of GSYBS-7 (Goop Beauty Youth-Boost Peptide Serum; Goop Inc., Santa Monica, CA), a topical postbiotic and botanical combination serum, used twice daily on facial skin for 6 weeks. Methods In this 19-patient pilot study, the primary efficacy measure was improvement on the Global Ranking Scale (GRS) at 42 days. A 12-point patient satisfaction survey and the serum's effect on healing after ablative laser treatment served as secondary and exploratory measures, respectively. Results Statistically significant improvements in all GRS domains were observed as early as day 7 with ongoing improvement up to day 42. A >1-point improvement was observed for dehydration (1.8; 95% CI, 1.5-2.2), visible pores (1.6; 95% CI, 1.3-2.0), surface roughness (1.6; 95% CI, 1.3-1.9), imbalance (1.3; 95% CI, .9-1.7), static wrinkles (1.3; 95% CI, .9-1.6), pigmentation (1.3; 95% CI, 1.0-1.5), and vasculature (1.2; 95% CI, .8-1.5). Independent photographic review and patient satisfaction surveys corroborated these findings. At day 42, 94.4% of patients were very satisfied with the results, and 88.9% would recommend GSYBS-7 to family and friends. No adverse events were reported, and 100% of patients indicated that GSYBS-7 was gentle enough for everyday use. Conclusions GSYBS-7 appears to be an effective and well-tolerated combination topical for the management of age-related and environment-induced skin changes. Level of Evidence: 4