The American Journal of Cosmetic Surgery

The form and size of the female gluteal region have always symbolized beauty and sexuality. There is a remarkable increase in the number of patients seeking gluteoplasty worldwide. Gluteoplasty may be achieved by silicone implant insertion or autologous fat transfer, in addition to other ancillary procedures including liposuction. Careful patient selection and evaluation are needed to assure good results. The aim of the study was to evaluate the use of silicone implants, autologous fat transfer, and liposuction in gluteoplasty. A total of 22 patients underwent gluteoplasty. Intramuscular gluteal implant insertion was employed in 8 patients, whereas autologous fat transfer was employed in 14 patients. The average patient satisfaction (on a scale from 1 to 5) following implant gluteoplasty was 4.25 for the overall aesthetic outcome, whereas the average patient satisfaction following autologous fat transfer gluteoplasty was 4.79 for the overall aesthetic outcome. Both gluteoplasties with silicone implants or fat transfer achieved favorable results, with very good to excellent patients’ satisfaction after both procedures, with slightly better satisfaction following autologous fat transfer. Our results are comparable with before published results, with favorable outcomes regarding complications. Liposuction is an important addition that positively affects the aesthetic result. Gluteoplasty using silicone implants or fat transfer, in addition to ancillary liposuction, achieved favorable results, with very good to excellent patients’ satisfaction. However, a larger scale study is needed to statistically approve or disapprove to this trend.

Dermal fillers are widely used in Medical and Surgical Cosmetic practices. Temporary and semipermanent fillers are more commonly used for a wide variety of reasons; however, permanent fillers represent an excellent option in properly selected patients. The aim of this study is to evaluate the off-label use of Silikon 1000 (S1000) as a permanent filler analyzing safety, durability, and patient satisfaction. This was a retrospective chart review of prospectively collected data. The study included 25 patients who underwent S1000 injection in 32 treatment areas. The following parameters were assessed: age, gender, weight, height, body mass index (BMI), number of treatments, duration of treatments, follow-up, complications, and interventions. Patients who had other fillers injected into the same area within 1 year before or after the S1000 injection were excluded from the study. In all, 32 treatment areas in 25 patients (21 females, 4 males) were included in the study. Five female patients received S1000 in more than one area. Treatment areas included the following: nose (n = 4), lips (n = 16), glabella (n = 4), nasolabial folds (n = 3), scars (acne or others) (n = 2), orbital rim (n = 2), and perioral (n = 1). Extrusion of silicone, migration, cosmetic deformity, hematoma, seroma, and infection were considered as inclusive criteria for injection complications. None of the patients developed any complications along the course of follow-up that ranged from 8-38 months; therefore, no intervention or surgery was needed to treat any adverse outcomes. All patients reported high satisfaction with the cosmetic results. Off-label use of highly purified polydimethylsiloxane as dermal filler is safe and durable. Being conservative is key to optimize outcomes and avoid complications. Proper approach involves injection of small doses using microdroplet technique to augment the tissue gradually over sessions at 1-2 months apart. Complications as silicone migration and irregularities can be largely avoided by following proper techniques and understanding the unique mechanism of action of S1000 compared with traditional fillers.

Several past studies have suggested there are benefits to using botulinum neurotoxin type A (BoNTA) for improving the aesthetic appearance of established scars. This article describes a study on the prophylactic use of BoNTA for controlling scar formations as they occur. It is based on a small, double-blinded, controlled group of patients having just undergone a facelift procedure. The results suggest that the use of BoNTA just after surgery yield both quantitative and qualitative aesthetic benefits, and the data provide some guidance on optimal doses.

Since Eugene Holländer performed the first rhytidectomy in 1901, face-lift surgery has dramatically transformed over 100+ years. Our objective was to assess conceptual themes and content evolution in the published rhytidectomy literature. A bibliometric rhytidectomy analysis was performed on English-language literature between the period of 1951 and 2017. Analyses included most productive authors, countries, journals, most-cited articles, and keywords. K-means clustering was used to discern trends in topics. A total of 1927 rhytidectomy abstracts were mined from the Scopus® bibliographic database over the period of 1951-2017. These abstracts originated from 500 different source publications and 3744 different authors. The annual growth rate of rhytidectomy literature is 6.87 articles/year. The most productive countries were the United States (856 publications), France (107 publications), and Brazil (67 publications). Between-country collaborations were rare. From 1995-2015, the recent literature centered on younger adults, surgical approaches, and complications. Older literature investigated surgical techniques, facial skin, aging, and lipectomy. Two distinct concept clusters were discovered: (1) surgical outcomes and techniques/approaches, and (2) study design. Bibliometric analyses are useful in understanding intellectual structure, gaps, and opportunities for knowledge advancement. The recent rhytidectomy literature is focused on new techniques/approaches, complications, and younger adults and is dominated by US-based clinicians.

Facial cosmetic surgery is rapidly being incorporated into the contemporary oral and maxillofacial surgery (OMS) practice. The Commission on Dental Accreditation (CODA), the accreditation body for American Oral and Maxillofacial Surgery residencies, mandates a minimum requirement in 4 major categories. Facial cosmetic surgery procedures are included in the “Facial Cosmetic and Reconstruction” category. This requirement stipulates that each graduating resident must complete at least 20 facial cosmetic and/or facial reconstructive procedures. We hypothesized that some OMS programs meet and exceed the minimum graduation requirement set forth by the CODA in the facial cosmetic and reconstruction category solely with cosmetic procedures. We also speculated that some OMS programs surpassed the minimal graduation requirements of medical specialties most commonly associated with performing facial cosmetic procedures. Finally, the research was intended to investigate whether there was a difference, in terms of cosmetic surgery experience, between 4-year OMS certificate programs and OMS programs with an incorporated medical degree (dual degree or 6-year program). Surveys were sent to all 102 CODA-accredited OMS programs. These data were analyzed to evaluate the total number of facial cosmetic procedures completed at each institution over a 5-year period and the average number of facial cosmetic surgery procedures per chief resident. In addition, a comparison was made between single and dual degree programs. Finally, these numbers were compared with medical residencies/fellowship accredited by the Accreditation Council for Graduate Medical Education (ACGME). Twenty-two of 102 programs returned the survey. Over the 5-year period (2011-2016), accredited OMS programs completed an average of 211 facial cosmetic procedures ranging from zero procedures to 1073. Genioplasties and rhinoplasties were the most common facial cosmetic surgery procedures tallied. Four-year OMS programs completed 20.3 procedures per chief resident while dual degree programs completed 9.7 cases on average. OMS programs with the largest volume of cases reached and exceeded many of the minimum procedure requirements set forth by plastic and reconstructive surgery residency programs and American Academy of Cosmetic Surgery Fellowships. With the vast differences among training requirements, it is challenging to assess what is a reasonable number of procedures to ensure a surgeon is comfortable and, more importantly, competent and proficient. When compared with the variability of requirements from medical specialties that commonly perform facial cosmetic procedures, the data support that comprehensive experience in facial cosmetic surgery is attainable within American Oral and Maxillofacial Surgery Residencies.