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Choi K, Kang D, Kang E, Kim S, Lee W, Cho J. Development and Validation of the Facial Line Distress Scale for Lateral Canthal Lines: FINE-LCL. Facial Plast Surg Aesthet Med 2024; 26:517-522. [PMID: 38569158 DOI: 10.1089/fpsam.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background: Currently available patient-reported outcome measures (PROM) have limited ability to assess unique issues related to lateral canthal lines (LCL). This study aimed to develop a PROM to assess the severity and psychosocial impact of LCL in afflicted patients. Methods: We conducted a cross-sectional survey at a tertiary hospital and two local clinics in Korea. Exploratory factor analysis was conducted to identify the underlying factor structure of the Facial Line Distress Scale for LCL (FINE-LCL), and the internal consistency and test-retest reliability were also examined. Results: We developed a questionnaire comprising 20 items in four domains. Coefficient alphas ranged from 0.94 to 0.97 for subdomains and 0.97 for the total questionnaire. The test-retest intraclass correlation coefficient ranged from 0.77 to 0.90. The FINE-LCL was moderately correlated with the appearance appraisal score and body image. Analysis of the accuracy of the FINE-LCL score in predicting severe LCL was characterized by an area under the curve of 0.79. Conclusions: FINE-LCL is a reliable, valid, and comprehensive PROM for the assessment of the severity of LCL and their associated distress.
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Affiliation(s)
- Kyeongrok Choi
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Danbee Kang
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Eunjee Kang
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Sooyeon Kim
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | | | - Juhee Cho
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
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Kang E, Kang D, Kim S, Choi K, Lee W, Cho J. Development and Validation of Facial Line Distress Scale for Forehead Lines: FINE-FL. Aesthet Surg J 2024; 44:NP225-NP232. [PMID: 37934866 DOI: 10.1093/asj/sjad340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Forehead lines (FL) are one of the main signs of aging. Traditional tools to measure FL have limited ability to evaluate the multidimensional impact of these lines on appearance, confidence, and psychological and social relationships. OBJECTIVES We developed and validated the Facial Line Distress Scale-Forehead Lines (FINE-FL) to evaluate the severity and psychosocial distress associated with FL. METHODS We conducted a cross-sectional survey for FINE-FL psychometric validation at a tertiary hospital and 2 local clinics in Korea. First, a preliminary item pool for the FINE-FL was developed through a qualitative interview based on literature reviews and expert consultations. Second, cognitive interviews and a pilot test were conducted to evaluate comprehension, ease of response, acceptability of terminology, phrasing, and response options. FINE-FL consisted of 26 items. In this study, exploratory factor analysis was conducted to identify the underlying factor structure of the FINE-FL, and internal consistency and test-retest reliability were also examined. RESULTS We found 21 items in 4 domains. The model fit was good. Coefficient αs ranged from 0.89 to 0.95 for subdomains and 0.96 for the total. The FINE-FL was moderately correlated with the appearance appraisal score. On the test-retest, the range of the intraclass correlation coefficient was 0.65 to 0.79. CONCLUSIONS FINE-FL is a reliable, valid, and comprehensive patient-reported outcome measure for assessing FL severity and distress. This will be helpful in determining a patient's eligibility for inclusion in a study and measuring primary or secondary effectiveness endpoints for forehead line treatment.
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Pequeno ALV, Bagatin E. Dermatological ultrasound in assessing skin aging. Front Med (Lausanne) 2024; 11:1353605. [PMID: 38410749 PMCID: PMC10895009 DOI: 10.3389/fmed.2024.1353605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/08/2024] [Indexed: 02/28/2024] Open
Abstract
Ultrasonography (US) has emerged as a pivotal tool in Dermatology since its inaugural use in 1979. Its evolution encompasses technological advancements, higher frequencies, and diverse applications in clinical, surgical, and research aspects. The discussion centers on its crucial role in assessing skin aging through various parameters such as skin thickness, subepidermal low echogenicity band (SLEB) characterization, and echogenicity assessment. This analysis can help guide interventions in a more personalized manner for each patient and assess the effectiveness of cosmetics and procedures. Despite its widespread utility, challenges persist, including discrepancies in research outcomes, operator dependence, inability to detect minute lesions, and measurement variations throughout the day. Combining US with complementary methodologies is advocated for a better understanding of skin aging in vivo. The cost-effectiveness and non-invasiveness of the US emphasize its promising future in dermatology, but ongoing research remains imperative to enhance its accuracy and expand its applications.
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Affiliation(s)
| | - Ediléia Bagatin
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, Brazil
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Boonipat T, Hebel NSD, Shapiro D, Stotland MA. Impact of Surgical Rejuvenation on Visual Processing and Character Attribution of Faces. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5038. [PMID: 37731729 PMCID: PMC10508498 DOI: 10.1097/gox.0000000000005038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/09/2023] [Indexed: 09/22/2023]
Abstract
Background This study considers observers' reflexive responses to the rejuvenated face, and how instinctive responses relate to subjective judgment. We investigated observers' reflexive perception of faces both pre and post surgical intervention during the early stages of visual processing. Subjective character attribution for all test images was also assessed by the same observers. Method Forty frontal facial images of 20 patients portraying the pre- and postoperative high superficial musculoaponeurotic system facelift along with variable concomitant procedures were studied. Nineteen lookzone regions were mapped post hoc onto each image. Forty observers examined the images, whereas an eye-tracking camera recorded their eye movements. Visual fixation data were recorded and analyzed. Observers also rated each image on the basis of five elemental positive character attributes. Results A statistically coherent but nonsignificant (P > 0.05) trend was identified with the surgical intervention resulting in greater attention being paid to the central triangle region of the face with reduction in attention to the facial periphery. Facial rejuvenation significantly increased the subjective character ratings of all five positively valenced attributes tested. Average age estimate of the photos decreased significantly from 54 to 48.6 years (true average age of 57.4 years). Conclusions We provide data illustrating both reflexive and subjective responses to facial rejuvenation. Observers reported a more favorable impression of the treated faces and evaluated them as being younger than their true age. A trend was detected for increased visual fixation of the central facial region following rejuvenation. Interpretation of these findings and indication for further research is provided.
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Affiliation(s)
- Thanapoom Boonipat
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | | | - Daniel Shapiro
- From the Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Mitchell A. Stotland
- Department of Surgery, Weill-Cornell Medical College- Doha, Qatar
- Division of Plastic, Craniofacial, and Hand Surgery, Sidra Medicine, Doha, Qatar
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5
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Wang X, Chen X, Zhao Q, Zhou Z, Wu S, Chen Y, Wang X, Huang X, Long X. Patient-Specific Implants for Correction of Midfacial Aging. J Craniofac Surg 2023; 34:1784-1788. [PMID: 36991544 DOI: 10.1097/scs.0000000000009269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/03/2022] [Indexed: 03/31/2023] Open
Abstract
The nasolabial folds (NLFs) may be shallowed with the use of nostril base augmentation. This study aimed to design and customize patient-specific implants (PSIs) with computer-aided design/computer-aided manufacturing (CAD/CAM) to correct NLF deepening caused by midfacial aging. The patient's head computed tomography data obtained and were used for reconstruction. The PSIs were customized by CAD/CAM techniques, which were implanted into a nasal base for shallow NLFs caused by midfacial aging. Preoperative and postoperative photos and a wrinkle severity rating scale were used to evaluate the changes in NLFs. Also, the global esthetic improvement scale was used to investigate the surgical satisfaction of patients. Eleven patients (22 NLFs) received PSIs in the nasal base (22 implants). The customized PSI matched well with premaxilla, reducing the difficulty of operation. After 3 to 12 months of follow-up, PSI was stable without foreign body reaction or inflammatory reaction. Postoperative wrinkle severity rating scale scores showed that NLF severity was reduced in all patients, with a significant esthetic improvement compared with preoperatively ( P < 0.01). The global esthetic improvement scale showed an extremely satisfied improved NLF in 27.27% of patients, much improved in 63.63%, and improved in 9.90% (2/22), and none reported change or poor NLF. Patient satisfaction with their midface appearance differed significantly before and after surgery ( P < 0.01). Individualized PSI designed with high precision and matching degree by CAD and prepared using CAM could be applied to overcome the limitations of noncustomized implants.
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Affiliation(s)
- Xin Wang
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to the Zhejiang University School of Medicine
| | - Xiaoping Chen
- Department of Plastic Surgery, Hangzhou Time Medical Cosmetic Surgery Hospital, Hangzhou, Zhejiang, China
| | - Qiming Zhao
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to the Zhejiang University School of Medicine
| | - Zhuying Zhou
- Department of Plastic Surgery, Hangzhou Time Medical Cosmetic Surgery Hospital, Hangzhou, Zhejiang, China
| | - Sihan Wu
- Department of Plastic Surgery, Hangzhou Time Medical Cosmetic Surgery Hospital, Hangzhou, Zhejiang, China
| | - Yue Chen
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to the Zhejiang University School of Medicine
| | - Xiaowei Wang
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to the Zhejiang University School of Medicine
| | - Xiaoxiang Huang
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to the Zhejiang University School of Medicine
| | - Xiaohui Long
- Department of Plastic Surgery, Zhejiang Hospital Affiliated to the Zhejiang University School of Medicine
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Man-Lok L, Chang CC, Huang YH. The Composition of Antiaging Scales for Facial Rejuvenation: Assessed with Artificial Intelligence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5117. [PMID: 37465287 PMCID: PMC10351931 DOI: 10.1097/gox.0000000000005117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/30/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Lio Man-Lok
- From the Department of General Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Chang-Cheng Chang
- Department of Plastic Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Yung-Hsueh Huang
- Department of Dermatology, 20 Skin Clinic, Taichung City, Taiwan
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Jung G, Kim S, Lee J, Yoo S. Deep learning-based optical approach for skin analysis of melanin and hemoglobin distribution. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:035001. [PMID: 36992693 PMCID: PMC10042298 DOI: 10.1117/1.jbo.28.3.035001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/06/2023] [Indexed: 06/19/2023]
Abstract
SIGNIFICANCE Melanin and hemoglobin have been measured as important diagnostic indicators of facial skin conditions for aesthetic and diagnostic purposes. Commercial clinical equipment provides reliable analysis results, but it has several drawbacks: exclusive to the acquisition system, expensive, and computationally intensive. AIM We propose an approach to alleviate those drawbacks using a deep learning model trained to solve the forward problem of light-tissue interactions. The model is structurally extensible for various light sources and cameras and maintains the input image resolution for medical applications. APPROACH A facial image is divided into multiple patches and decomposed into melanin, hemoglobin, shading, and specular maps. The outputs are reconstructed into a facial image by solving the forward problem over skin areas. As learning progresses, the difference between the reconstructed image and input image is reduced, resulting in the melanin and hemoglobin maps becoming closer to their distribution of the input image. RESULTS The proposed approach was evaluated on 30 subjects using the professional clinical system, VISIA VAESTRO. The correlation coefficients for melanin and hemoglobin were found to be 0.932 and 0.857, respectively. Additionally, this approach was applied to simulated images with varying amounts of melanin and hemoglobin. CONCLUSION The proposed approach showed high correlation with the clinical system for analyzing melanin and hemoglobin distribution, indicating its potential for accurate diagnosis. Further calibration studies using clinical equipment can enhance its diagnostic ability. The structurally extensible model makes it a promising tool for various image acquisition conditions.
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Affiliation(s)
- Geunho Jung
- Lulu-lab, AI R&D Center, Seoul, Republic of Korea
| | - Semin Kim
- Lulu-lab, AI R&D Center, Seoul, Republic of Korea
| | - Jongha Lee
- Lulu-lab, AI R&D Center, Seoul, Republic of Korea
| | - Sangwook Yoo
- Lulu-lab, AI R&D Center, Seoul, Republic of Korea
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8
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Lio ML, Chang CC, Chuang ADC, Tsai LC, Chen CC. Quantified Facial Rejuvenation Utilizing High Intense Focus Ultrasound with Multiple Penetrative Depths. Clin Cosmet Investig Dermatol 2022; 15:489-496. [PMID: 35368623 PMCID: PMC8968221 DOI: 10.2147/ccid.s350556] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022]
Abstract
Background Multiple penetration depths of high-intensity focused ultrasound (HIFU) treatment for facial rejuvenation have not been quantified. Methods We enrolled 12 participants (n=24) to undergo one session of HIFU rejuvenation between January 1, 2019, and January 10, 2020. We used a 2-, 4.5-, and 6-mm focal depth transducer on the upper and middle face. We evaluated efficacy on days 60 and 90 by using our specific assessment system. Results The average eyebrow peak and pupil-eyebrow peak angles significantly increased by 2° (p < 0.0005) and decreased by 1° (p < 0.0001), respectively, at day 90. The shortened eyebrow-iris length indicated that the forehead tissues had lifted and moved medially to the central face. Supraorbital tissues were also vertically elevated, marked by the eyebrow-orbital (p = 0.0016) and vertical palpebral fissure lengths (p = 0.0052), which both exhibited a 0.8-cm elevation. For the midface, the increased canthus-oral-nasal angle (p = 0.5881) and decreased tragus-oral length (p = 0.5881) indicated that laxity had been corrected through lifted oral commissure, though the data were not statistically significant. No serious side effects were observed. Conclusion HIFU treatment with multiple depths quantitatively improved both upper-facial rejuvenation and midface rejuvenation after a single session.
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Affiliation(s)
- Man-Lok Lio
- Department of General Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Chang-Cheng Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Cosmeceutics and Graduate Institute of Cosmeceutics, China Medical University, Taichung, Taiwan.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan, Taiwan
| | - Andy Deng-Chi Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Li-Cheng Tsai
- Department of Dermatology, China Medical College Hospital, Taichung, Taiwan
| | - Chien-Chou Chen
- Department of Dermatology, Joe Chen Beauty Skin Clinic, Taichung City, Taiwan
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Lee DH, Suh YJ, Kim DH, Lee SJ, Shin MK. Objective assessment of facial laxity changes after monopolar radiofrequency treatment by using moiré topography. J COSMET LASER THER 2022; 23:170-175. [PMID: 35243964 DOI: 10.1080/14764172.2022.2048671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Radiofrequency (RF) has been widely used as a noninvasive technique for skin tightening and rejuvenation. Moiré is a type of interference pattern corresponding to the shape of the face. We aimed to objectively evaluate the effect of RF on facial skin laxity using moiré. Ten subjects participated and were treated with a monopolar RF on the face. Clinical photographs and moiré images were obtained at the baseline and after treatment. The periorbital angle from the upper third of the face, zygomatic length ratio (L1/L2), angle from the middle third, perioral perpendicular length, and angle from the lower third were analyzed. After one session of RF treatment, the mean zygomatic length ratio (L1/L2) from the middle third of the face significantly increased in the 4th week (by 49.68%, P = .047). The L1/L2 ratio increased to nearly one, which were not significant after 8 weeks. The mean perioral perpendicular length decreased to 282.25 ± 84.069 pixels (px) after 4 weeks, and to 281.38 ± 76.03 px after 24 weeks; these differences were statistically significant. The parameters of zygomatic length ratio and perioral perpendicular length extracted from illuminated moiré images can be useful for objectively assessing various facial tightening treatments in clinical settings.
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Affiliation(s)
- Dong Hye Lee
- Department of Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Republic of Korea
| | - Ye-Jin Suh
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | | | - Sang Jun Lee
- Department of Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Republic of Korea
| | - Min Kyung Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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10
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Zhang C, Wang J. Additional Thoughts on Artificial Intelligence Evaluation of Facelift Surgery. Aesthet Surg J 2022; 42:NP188-NP189. [PMID: 34679160 DOI: 10.1093/asj/sjab374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chang Zhang
- Head and Neck Plastic and Cosmetic Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaqi Wang
- Head and Neck Plastic and Cosmetic Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Quinlan DJ, Ghanem AM, Hassan H. Topical growth factors and home-based microneedling for facial skin rejuvenation. J Cosmet Dermatol 2021; 21:3469-3478. [PMID: 34951101 DOI: 10.1111/jocd.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cosmeceutical products are an important therapeutic option for facial rejuvenation. Of these, topical application of growth factors has been shown to increase dermal collagen synthesis, improve skin texture, and reduce fine lines and wrinkles. Limited data exist for the use of growth factors in combination with microneedling. OBJECTIVE This prospective, single-center, uncontrolled study evaluated the efficacy of topical growth factor treatment in conjunction with transdermal delivery of growth factors via home-based microneedling for facial skin rejuvenation. PATIENTS/METHODS Eleven healthy female individuals aged 33-61 years, with mild-moderate facial wrinkling were included in the study. Over 3 months, participants received twice-daily application of a topical recombinant human growth factor preparation (SkinGenuity® Regenerative and Reparative Serums) along with twice-weekly transdermal delivery of growth factors using a home-based microneedling (0.2 mm) device. Objective skin analysis (VISIA® ) and a subjective patient-reported outcome (FACE-Q® ) assessment measuring satisfaction with appearance were performed at baseline and after 3 months. RESULTS Objective skin analysis showed a significant improvement in skin texture (17.6%, p < 0.001), wrinkles (17.3%, p < 0.001), red areas (12.4%, p =0.004), and brown spots (6.0%, p =0.03) at 3 months follow-up. FACE-Q scales showed a significant improvement from baseline, including satisfaction with skin, facial appearance, nasolabial folds, cheeks, and lower face/jawline (all p ≤ 0.02). Numerical improvement in adverse effects related to skin was also observed (p = 0.07). No serious adverse effects were reported. CONCLUSIONS Three months of twice-daily topical growth factor treatment in conjunction with transdermal delivery of growth factors via microneedling improved skin analysis parameters and participant-reported outcome measures, indicative of facial skin rejuvenation.
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Affiliation(s)
- Daniel J Quinlan
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ali M Ghanem
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Haidar Hassan
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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12
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Outcome Measurement of Beauty and Attractiveness of Facial Aesthetic Rejuvenation Surgery. J Craniofac Surg 2021; 32:2091-2096. [PMID: 34320578 DOI: 10.1097/scs.0000000000007821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Aesthetic plastic surgery is a most unusual and unique subspecialty. Unlike other medical and surgical specialties driven primarily by objective medical diagnosis and outcome, aesthetic surgery is patient driven; it represents a special exercise in professional competence by adapting objective medical standards to a mostly subjective field. Given the subjectivity of facial beauty and of the projected aesthetic intervention outcome, in addition to be able to determine beauty of the final result as precisely and objectively as possible, it is also essential to be able to assess patient's satisfaction. However, lack of standardized facial measurements and clear definition of aesthetic outcome and beauty are still major obstacles preventing real change in the consultation dynamics to help better serve patients' expectations. Because of the tremendous increase in demand for all types of facial aesthetic procedures, an objective understanding of aesthetics and beauty is becoming of utmost importance. Recognition of the importance of science and evidence-based medicine is long overdue in our specialty. This study aims at identifying the most recently available evidence-based measures to quantitatively assess beauty and measure outcome of rhytidoplasty that can be useful in everyday aesthetic practice.
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13
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Gibstein AR, Chen K, Nakfoor B, Lu SM, Cheng R, Thorne CH, Bradley JP. Facelift Surgery Turns Back the Clock: Artificial Intelligence and Patient Satisfaction Quantitate Value of Procedure Type and Specific Techniques. Aesthet Surg J 2021; 41:987-999. [PMID: 33217756 DOI: 10.1093/asj/sjaa238] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patients desire facelifting procedures to look younger, refreshed, and attractive. Unfortunately, there are few objective studies assessing the success of types of facelift procedures and ancillary techniques. OBJECTIVES The authors sought to utilize convolutional neural network algorithms alongside patient-reported FACE-Q outcomes to evaluate perceived age reduction and patient satisfaction following various facelift techniques. METHODS Standardized preoperative and postoperative (1-year) images of patients who underwent facelift procedures were analyzed by 4 neural networks to estimate age reduction after surgery (n = 105). FACE-Q surveys were employed to measure patient-reported facial aesthetic outcome. We compared (1) facelift procedure type: skin-only vs superficial musculoaponeurotic system (SMAS)-plication, vs SMAS-ectomy; and (2) ancillary techniques: fat grafting (malar) vs no fat grafting. Outcomes were based on complications, estimated age-reduction, and patient satisfaction. RESULTS The neural network preoperative age accuracy score demonstrated that all neural networks were accurate in identifying our patients' ages (mean score = 100.4). SMAS-ectomy and SMAS-plication had significantly greater age-reduction (5.85 and 5.35 years, respectively) compared with skin-only (2.95 years, P < 0.05). Fat grafting compared to no fat grafting demonstrated 2.1 more years of age reduction. Facelift procedure type did not affect FACE-Q scores; however, patients who underwent fat grafting had a higher satisfaction with outcome (78.1 ± 8 vs 69 ± 6, P < 0.05) and decision to have the procedure (83.0 ± 6 vs 72 ± 9, P < 0.05). CONCLUSIONS Artificial intelligence algorithms can reliably estimate the reduction in apparent age after facelift surgery. Facelift technique, like SMAS-ectomy or SMAS-plication, and specific technique, like fat grafting, were found to enhance facelifting outcomes and patient satisfaction.
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Affiliation(s)
| | - Kevin Chen
- Division of Plastic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, USA
| | | | - Stephen M Lu
- Division of Plastic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, USA
| | | | - Charles H Thorne
- Division of Plastic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, USA
- Department of Plastic Surgery, Lenox Hill Hospital, New York City, NY, USA
| | - James P Bradley
- Division of Plastic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, USA
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14
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de Maio M, Chatrath V, Hart S, Hoo AJS, Marchac A, Sykianakis D, Lee ILI. Multi-Dimensional Aesthetic Scan Assessment (MD ASA™): Initial experience with a novel consultation, facial assessment, and treatment planning tool. J Cosmet Dermatol 2021; 20:2069-2082. [PMID: 33977669 DOI: 10.1111/jocd.14216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comprehensive patient assessment and planning are central to esthetic treatment with injectables. MD ASA™ (Multi-Dimensional Aesthetic Scan Assessment) is a novel tool developed for this purpose. AIMS To describe the MD ASA technique and present its preliminary application. METHODS MD ASA breaks down the face into five hierarchies (H1-H5). H1 shifts patients' focus from "distractions" (individual lines and folds) toward the overall messages their face portrays, based on eight Emotional Attributes: four negative (tired, sad, angry, and saggy); four positive (youthful, attractive, contoured, and feminine/masculine). Three priority Emotional Attributes are selected for each patient. This is followed by a process of narrowing down through facial thirds (H2), periorbital and perioral dynamics (H3), facial units (H4), and subunits (H5), to arrive at a final assessment. Based on the key facial signs identified, this can be translated into MD Codes equations and thus a treatment formula. A retrospective analysis was performed based on 12 female patients injected by expert clinicians at an educational event. All patients were selected for, and treated using, a single MD Codes formula derived from a common MD ASA work-up. RESULTS There were substantial differences between patients and clinicians in their views of which anatomical areas needed treatment-but good alignment on priority Emotional Attributes. Patients were treated only for three negative Emotional Attributes, but improvements were observed across all eight attributes. CONCLUSIONS MD ASA provides a practical method for translating facial messages into actionable injectable treatment plans and facilitates greater patient-clinician alignment. Prospective studies are warranted.
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Affiliation(s)
| | | | | | | | | | | | - Izzy Lung I Lee
- Shang-Ho Aesthetic Medical Clinic, Kaohsiung City, Taiwan ROC
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15
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Abstract
BACKGROUND Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions. OBJECTIVE The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck. PATIENTS, METHODS AND MATERIALS PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations. RESULTS These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency. CONCLUSION The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.
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Affiliation(s)
- Payal Shah
- Both authors are affiliated with The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
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16
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Wollina U, Goldman A. Long lasting facial rejuvenation by repeated placement of calcium hydroxylapatite in elderly women. Dermatol Ther 2020; 33:e14183. [DOI: 10.1111/dth.14183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/20/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology Städtisches Klinikum Dresden Dresden Germany
| | - Alberto Goldman
- Department of Plastic Surgery Clinica Goldman Porto Alegre Rio Grande do Sul Brazil
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17
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Gama JT, Rossetto LA, Brito NB, Veiga DF, Ferreira LM. Cross-cultural validation of the FACE-Q Satisfaction with Facial Appearance Overall Scale (FACE-Q SFAOS) in Brazilian rhytidoplasty patients. Clinics (Sao Paulo) 2020; 75:e1568. [PMID: 32756818 PMCID: PMC7384204 DOI: 10.6061/clinics/2020/e1568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/14/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aimed to culturally validate the FACE-Q - Satisfaction with Facial Appearance Overall Scale (Face-Q SFAOS) in a population of Brazilian rhytidoplasty patients. METHOD Authorization for the translation and validation of the questionnaire was obtained from the FACE-Q SFAOS distribution rights holders. The FACE-Q SFAOS was translated and then back-translated. For cultural validation, a total of 57 women were selected 5 to 8 months after undergoing rhytidoplasty. Twenty of them participated in the cultural adaptation, 30 participated in the reproducibility analysis, and 57 participated in the construct validation. RESULTS The analysis identified two factors (general appearance and face geometry) that exhibited excellent internal consistency. The total satisfaction score, which comprised nine items, also presented excellent internal consistency. Good reproducibility was found for Overall Appearance, Geometry and Total. There was a difference in the satisfaction means (total and factors) between procedure locations; patients undergoing frontal, upper eyelid and lower eyelid procedures were less satisfied than those who did not undergo such procedures. Satisfaction was higher with geometry than with overall face appearance. CONCLUSION The FACE-Q SFAOS was adapted to the cultural context of Brazilian rhytidoplasty patients and was reproducible, and the scale exhibited face, content and construct validity.
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Affiliation(s)
- José Teixeira Gama
- Programa de Pos-graduacao em Cirurgia Translacional Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Luís Antônio Rossetto
- Programa de Pos-graduacao em Cirurgia Translacional Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Nathalya Botelho Brito
- Programa de Pos-graduacao em Cirurgia Translacional Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Daniela Francescato Veiga
- Programa de Pos-graduacao em Cirurgia Translacional Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | - Lydia Masako Ferreira
- Programa de Pos-graduacao em Cirurgia Translacional Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
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18
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Dayan S, Rivkin A, Sykes JM, Teller CF, Weinkle SH, Shumate GT, Gallagher CJ. Aesthetic Treatment Positively Impacts Social Perception: Analysis of Subjects From the HARMONY Study. Aesthet Surg J 2019; 39:1380-1389. [PMID: 30239596 DOI: 10.1093/asj/sjy239] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of facial aesthetic treatments not only enhances physical appearance but also psychological well-being. Accordingly, patient-reported outcomes are increasingly utilized as an important measure of treatment success. Observer-reported outcomes are a relevant yet often overlooked measure of treatment benefit. OBJECTIVES The authors aimed to evaluate the impact of panfacial aesthetic treatment on the perception of an individual in a variety of social contexts. METHODS A total 2000 men and women (aged 18-65 years) participated in an online study designed to capture the blinded observer's social perception of pretreatment and posttreatment patients who received panfacial aesthetic treatment in the HARMONY study. Perceptions relevant to character traits, age, attractiveness, and social status were evaluated. Observers were divided into 2 groups. Single image respondents (n = 1500) viewed 6 single, randomized patient images (3 pretreatment, 3 posttreatment), and paired image respondents (n = 500) viewed 6 pretreatment and posttreatment image pairs. RESULTS Single image respondents reported significantly (P < 0.05) higher levels of agreement that posttreatment subjects appeared to possess more positive character traits (eg, healthy and approachable), were more socially adept, younger, more attractive, more successful at attracting others, and possessed a higher social status. Paired image respondents also reported a higher level of agreement for posttreatment images being aligned with positive character traits, representative of a younger and more attractive individual, and one with a higher social status. CONCLUSIONS The results suggest that the positive impact of minimally invasive panfacial treatment extends beyond enhancing physical appearance and highlights the importance of social perception and observer-reported outcomes in aesthetic medicine.
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Affiliation(s)
- Steven Dayan
- Department of Otolaryngology, University of Illinois, Chicago, IL
| | | | - Jonathan M Sykes
- Facial Plastic and Reconstructive Surgery, UC Davis Medical Group, Sacramento, CA
| | | | - Susan H Weinkle
- Affiliate Clinical Professor of Dermatology, University of South Florida, Tampa, FL
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Zhou RR, Wu HL, Zhang XD, Ye LL, Shao HJ, Song XH, Song ML, Zheng SS. Efficacy and Safety of Botulinum Toxin Type A Injection in Patients with Bilateral Trapezius Hypertrophy. Aesthetic Plast Surg 2018; 42:1664-1671. [PMID: 30206648 DOI: 10.1007/s00266-018-1201-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate aesthetic outcomes in patients with bilateral trapezius hypertrophy treated by botulinum toxin type A (BTxA) injection for aesthetic reconstruction of the upper trapezius. METHODS From May 2015 to May 2016, 30 women with a short neck shape resulting from bilateral trapezius hypertrophy were treated with botulinum toxin type A (BTxA) injection at the most affected area of the upper trapezius. Pre- and postoperative values of SACDF (irregularly shaped area of the four points A, C, D, and F) and SACDE (irregularly shaped area of the four points A, C, D, and E), responses to patients' and doctors' Global Aesthetic Improvement Scale (GAIS) questionnaires for neck aesthetic assessment, as well as reported adverse events, were recorded and analyzed. RESULTS Duration of follow-up ranged from 4 to 12 months. Subjects experienced non-severe adverse events and complete recovery after a single BTxA injection. In patients' GAIS questionnaires, "very much improved" accounted for 53%, "much improved" accounted for 13%, and "improved" accounted for 27%. In doctors' GAIS questionnaires, "very much improved" accounted for 27%, "much improved" accounted for 33%, "improved" accounted for 33%, and "no change" accounted for 7%. The overall degree of improvement was high. Statistically significant differences were observed with respect to the "very much improved" response to GAIS questionnaires between patients and doctors (P = 0.035). CONCLUSION A single injection of BTxA for aesthetic reconstruction of the upper trapezius is safe and effective in patients with bilateral trapezius hypertrophy. LEVEL OF EVIDENCE IV This 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 .
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Affiliation(s)
- Rong-Rong Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
- Department of Burn and Plastic Surgery, PLA 117 Hospital, Hangzhou, 310013, China
| | - Hui-Ling Wu
- Department of Plastic and Cosmetic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China
| | - Xu-Dong Zhang
- Department of Burn and Plastic Surgery, PLA 117 Hospital, Hangzhou, 310013, China
| | - Li-Li Ye
- Department of Burn and Plastic Surgery, PLA 117 Hospital, Hangzhou, 310013, China
| | - Hui-Jun Shao
- Department of Burn and Plastic Surgery, PLA 117 Hospital, Hangzhou, 310013, China
| | - Xin-Hui Song
- College of Computer Science, Zhejiang University, Hangzhou, 310013, China
| | - Ming-Li Song
- College of Computer Science, Zhejiang University, Hangzhou, 310013, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China.
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