#PRS: A Study of Plastic Surgery Trends With the Rise of Instagram

Skin Tightening Technologies in Body Contouring

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Understand the role of nonsurgical skin tightening. 2. Classify different skin tightening devices based on energy mechanism. 3. Recognize the advantages and disadvantages of various skin tightening devices. 4. Identify which skin tightening device to use depending on patient characteristics.

SUMMARY

Although surgical excision or cosmetic lift are the standard means of skin tightening, patients often desire nonsurgical options with minimal downtime. Nonsurgical skin tightening modalities vary based on energy type and delivery method. Higher energy modalities, such as laser therapy, have increased pain, downtime, and potential adverse effects. However, these offer the most dramatic results. A balance must be achieved between energy level, patient satisfaction, and safety. Devices also differ in US Food and Drug Administration approval and skin tightening location. Overall, in an ideal candidate, nonsurgical skin tightening devices offer highly satisfactory results with minimal downtime.

Analysis of the Influence of the SARS-CoV-2 (COVID-19) Pandemic on the Search for Facial Aesthetic Procedures

The SARS-CoV-2 (COVID-19) pandemic caused, in 2020, a serious and urgent health issue worldwide, establishing social distancing rules, which changed daily life in all its aspects. Work relationships and socialization became possible only through virtual networks. As a result, there has been an extreme increase in the exposure of people in general to their own image for many hours a day through cameras and video conferencing applications. This exacerbated exposure to self-image and greater criticism regarding own appearance raised hypotheses that the pandemic state generated in the population the desire to seek improvements in appearance and, consequently, would have caused an increase in searches for aesthetic procedures on the face and upper region of the chest. Therefore, this study aimed to elucidate these questions, using the virtual search trend analysis tool on the Google platform, called Google Trends. Analyzes of the main surgical and non-surgical facial aesthetic procedures carried out by dentistry professionals were done through statistical tests, tables, and observation of graphs generated by Google Trends. With the analysis of the results, a constant growth trend in searches by the public in relation to aesthetic procedures was observed, which may have been triggered by the pandemic, but is not related to it. The growth in Google searches continued after the pandemic state and some showed greater growth years after the declaration of social isolation.

Quality and Consistency of Rhinoplasty Photos on Social Media: Prevalence of Potentially Misleading Before-and-After Images

Introduction: There is significant variability in how rhinoplasty results are presented on social media. This study aims to evaluate the quality and consistency of preoperative and postoperative rhinoplasty photos on the social media platform Instagram. Methods: Instagram was queried on April 4, 2024 using the search term #rhinoplastybeforeandafter. Posts meeting our inclusion criteria were analyzed for inconsistencies in background, makeup, use of personal photo, and variations in face size between preoperative and postoperative images. Account demographics and time since surgery were also noted. Results: A total of 888 sets of before-and-after rhinoplasty photos were included, with nearly all (n = 882) posted by surgeon accounts. Of the posts analyzed, 23.7% had a ≥10% face size discrepancy, and 5.1% had a ≥10% face rotation discrepancy. Only 35.7% of posts were considered "high quality," with no significant photo discrepancies between postop and preop images and with postoperative time interval reported. Conclusion: Instagram before-and-after rhinoplasty photos evaluated in this study exhibited significant heterogeneity in quality and consistency regarding image background, image source, face size, face rotation, and brightness. Surgeons should prioritize consistency between preoperative and postoperative photos when sharing their results to minimize the potential for misleading the public.

The Top 100 Cited Articles in Male Aesthetic Surgery: A Bibliometric Analysis

BACKGROUND

In recent years, male aesthetic surgery has significantly risen in popularity, attributable to surgical technique advancements and societal changes. Research in this subject area has increased accordingly, underscoring the need to identify the most influential articles. This study evaluates the bibliometric characteristics of the top 100 most cited male aesthetic surgery articles published in the last 50 years.

METHODS

The 100 most cited articles in male aesthetic surgery from 1974 to 2024 were identified using Web of Science. We examined key trends in authorship contribution, institutional affiliation, country affiliation, citation count, journal impact factor, eigenfactor score, article influence score, and funding agency contribution.

RESULTS

As of June 2024, the top 100 articles were cited a total of 7,341 times, with individual citation counts ranging from 18 to 243. The top cited article was "A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery," published in 2004. Of the 100 articles, the top contributing authors were Dr. Joel E. Pessa (5%) and Dr. Rod J. Rohrich (4%). The top contributing organization was the University of Texas System (8%). The peak year for publications was 2008, accounting for 10% of articles. The USA contributed to 60 of 100 articles. Plastic and Reconstructive Surgery was the most prolific journal, publishing 33% of articles.

CONCLUSION

Through a historical analysis of the field's development up to its present state, our findings serve as a valuable resource for those interested in advancing their understanding of male aesthetic surgery literature.

LEVEL OF EVIDENCE V

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 .

Instagram Versus Reality: Who Are Actually Plastic Surgeons?

Background

Instagram has become one of the most powerful marketing tools available to plastic surgeons because patients have increasingly turned to online resources to find physicians. Within, we review the online presence of self-ascribed plastic surgeons in the United States to identify potential misinformation and dishonest advertising.

Methods

The Inflact database was queried for the search terms: "plastic surgeon/surgery," "plastic and reconstructive surgeon/surgery," "aesthetic surgeon/surgery," and "cosmetic surgeon/surgery." US physician account information, history of medical training, American Board of Plastic Surgery (ABPS) certification status, and posts were reviewed.

Results

In total, 1399 physicians practicing within the United States were identified. Most attended medical school in the United States (93%), a minority received integrated plastic surgery training in the United States (14%), and the majority attended general surgery residency in the United States (57%) followed by independent plastic surgery residency in the United States (50%). Altogether, 1141 individuals were explicitly listed as "plastic surgeons" on Instagram, nearly a quarter of these (325 individuals, 28%) were not certified by the ABPS, and nearly a fifth (251 individuals, 22%) received no training in plastic surgery.

Conclusions

Nearly one-third of "plastic surgeons" on Instagram are not certified through the ABPS. This is detrimental to the reputation of plastic surgery and has the potential to create broader consequences and may lead to patients mistakenly receiving care from unqualified physicians. It is paramount that plastic surgeons create a united front against such endeavors through advocacy efforts within the American Society of Plastic Surgeons.

Fantasies and Fallacies of 'Aesthetic' Instagrammers

The influence of Instagram, as a social media platform, in shaping perceptions of aesthetic surgery cannot be understated. The idea of a more "aesthetic" self cultivates a desire for cosmetic enhancements. This article underscores the profound impact of Instagram on aesthetic surgery, shedding light on both its fantasies and fallacies. Instagram, a medium for dissemination of content, often blurs the lines between fantasy and reality. Although the intent is to transfer credible information from the provider to the consumer, Instagram often contributes to the distortion of one's self-image and creates unrealistic expectations. Moreover, the glamorization of aesthetic surgery as a fast, effortless fix, often by commercially run enterprises, leads to misconceptions and impulsive decision-making. These fallacies are further compounded by the increase of misinformation and deceptive practices, presenting ethical challenges for influencers and surgeons alike. This study explores the ethical responsibilities of these "Aesthetic Instagrammers," emphasizing the necessity for transparency and ethical guidelines, while analyzing all the social media stakeholders and providing suggestions for better engagement.

Short-Term Outcomes of High-Density Porous Polyethylene Orthoses for Chin and Gonial Angle Augmentation

The high-density porous polyethylene implants are used in chin and gonial angle augmentation surgeries. These implants are valued for their biocompatibility and ease of integration with tissues, particularly in correcting retrognathia and mandibular hypoplasia. The research aimed to detail the epidemiological profile, feasibility, outcomes, and complications associated with these procedures.

METHODOLOGY

This retrospective observational study evaluated 100 patients over 18 years. Data on age, sex, aesthetic complaints, surgery types, and postoperative complications were collected and analyzed using the two-proportion z-test and descriptive statistics in RStudio 4.3.3. All patients with neuropraxia underwent neurosensory evaluation.

RESULTS

The average age was 35.92 years for males and 33.71 years for females, with a male predominance (76%). Aesthetic complaints were prevalent in 72% of patients (p < 0.01). Chin surgery was performed on 56% of patients, jaw angle surgery on 17%, and both on 39%. Complications included one case of suture dehiscence, three wound infections, and four transient cases of paresthesia, all resolving within 30 days. Overall, patient satisfaction with outcomes was high.

CONCLUSION

High-density porous polyethylene implants proved effective and safe in enhancing facial aesthetics and correcting mandibular deformities. Further research should focus on long-term outcomes to consolidate these findings.

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 .

Venture Capital's Role in Advancing Plastic Surgery

Plastic surgery sector has experienced significant growth, driven by an aging population's demand for minimally invasive procedures and technological innovation. Despite this, the role of venture capital (VC) in driving innovation within this sector remains underexplored. This study aimed to analyze the trends in VC investments in plastic surgery over the last 20 years, providing insights into the financial landscape of the sector. A retrospective cross-sectional analysis was conducted on VC investments in plastic and aesthetic surgery companies worldwide from January 1, 2003 to December 31, 2023, utilizing PitchBook (Seattle, WA). Companies were categorized into therapeutic and thematic areas, with investment trends analyzed by deal and company values, average investment size, and total capital invested. The study found 543 VC firms made 402 investments in 163 companies, totaling $1.98 billion, increasing by 15,143% over the study period, and focused on general plastic surgery and facial cosmetic procedures. Significant investments were also made in surgical software (25.3%), biotechnology and drug discovery (22.8%), and clinic and outpatient services (20.3%). Geographically, most investments were made in companies registered in Asia (45%) and North America (33.2%). VC investments have contributed to the growth and innovation in the plastic surgery sector, particularly in minimally invasive devices. The focus on general and facial cosmetic surgery aligns with market demand trends for aesthetic procedures. These findings underscore the importance of VC in shaping the future of plastic surgery and suggest the potential for strategic investments to further drive innovation.

Level of Evidence5 Diagnostic

Publication Trends in Aesthetic Breast Surgery: A Bibliometric Analysis

Background

Aesthetic breast surgery (ABS) encompasses breast augmentation, breast reduction, mastopexy, and mastopexy augmentation. This topic has seldom been assessed as a bibliometric study. This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. Bibliometrics, the quantitative analysis of publications, particularly scholarly literature, offers valuable insights into research trends and impact.

Objectives

This analysis aims to address this gap and identify trends in ABS literature to guide future research areas.

Methods

The 100 most-cited publications in ABS were identified on Web of Science (Clarivate Analytics, Philadelphia, PA), across all available journal years (from 1953 to 2024). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. The Oxford Centre for Evidence Based Medicine and levels of evidence (LOE) of each study were assessed.

Results

The 100 most-cited publications in ABS were cited by a total of 11,522 publications. Citations per publication ranged from 46 to 1211 (mean 115.2 ± 135.7), with the highest-cited study being the Pusic BREAST-Q paper (n = 1211). A majority of publications were LOE 4 (n = 30), representative of the large number of case series. The number of publications for LOE 5, 3, 2, and 1 was 12, 28, 21, and 9, respectively. The main content focus was "outcomes" in 52 publications, followed by "nonoperative management" (n = 12) and "surgical technique" (n = 12). Patient-reported outcome measures (PROMs) were used in 29 publications, and 53 publications reported aesthetic outcome measures.

Conclusions

This analysis highlights that research methodologies in ABS studies should be improved. This necessary improvement would be facilitated by vigorous, high-quality research, and the implementation of validated ABS-specific PROMs enhancing patient satisfaction, particularly in aesthetic procedures, such as BREAST-Q.

Level of Evidence 4

Ethnic rhinoplasty: Preliminary results of our technique in the pursuit of the harmonious nose

INTRODUCTION

According to the American Society of Plastic Surgery, cosmetic surgery procedures for "ethnic patients" are annually increasing. Ethnic rhinoplasty traditionally represents a difficult challenge for plastic surgeons. Herein, we describe our personal technique to ethnic rhinoplasty to achieve a harmonious nose maintaining the characteristics of individual ethnicity and identity.

MATERIALS AND METHODS

In this study, we retrospectively reviewed ethnic patients treated with rhinoplasty at our institution between January 2019 and October 2022. We described our personal rhinoplasty technique step by step. At a minimum follow-up time of six months, postoperative pictures were taken, and patients were reassessed, evaluating aspects such as global symmetry and shape and contour of the nose. Finally, patient satisfaction was investigated according to rhinoplasty outcomes evaluation (ROE) questionnaire.

RESULTS

A total of 1321 patients were included in the study. They reported a significant satisfactory aesthetic result in nasal image, as indicated by the mean postoperative ROE score (92.12). No cases of nasal contracture were recorded. None of the grafts was extruded or collapsed. Wounds healed without reported major infection.

CONCLUSION

This study demonstrated that our approach is a safe procedure that contributes to improved functional outcomes with a high patient satisfaction rate and a low rate of postoperative complication. The creation of a solid base structure, nasal skin preparation, and an integrated patient approach are key elements of this surgery.

The Use of Piezoelectric Osteotomy Instruments During a Rhinoplasty Operation in a Patient With a Cochlear Implant

A cochlear implant is a life-changing operation that significantly improves the lives of patients. Those with cochlear implants require ongoing measures to ensure the longevity of both their devices and their well-being. One concerning issue is the potential device failure due to the use of surgical instruments during procedures. In this report, we present a successful case of utilizing an ultrasonic osteotome for a primary septorhinoplasty in a 22-year-old patient who had undergone cochlear implant surgery 17 years prior. To our knowledge, this is the first recorded instance of applying a piezoelectric tool on a patient with a cochlear implant. Our findings support the safety of using a piezo osteotome in cochlear implant recipients.

Assessing the Efficacy of Hyperbaric Oxygen Therapy on Facelift Outcomes: A Case-Control Study Comparing Outcomes in Patients With and Without Hyperbaric Oxygen Therapy

Background

Wound healing remains among the most concerning complications in aesthetic surgery. The use of hyperbaric oxygen therapy (HBOT) is an accepted method of supporting wound healing.

Objectives

The aim of this study is to assess the role of HBOT in postoperative healing and complication rates following facelift surgery.

Methods

This case-control study comprised facelift patients who received HBOT and those who did not between 2019 and 2022. Data were extracted from the patients' medical records, with the primary outcomes being the presence of complications, wound-healing duration, and patient satisfaction.

Results

The authors recruited 20 female patients who underwent facelift for this study, with 9 patients in the HBOT group and 11 patients in the control group. The average number of HBOT sessions received was 7.22, and each session lasted an average of 78 ± 5 min. The duration of wound healing in the HBOT group ranged from 7 to 30 days (mean of 13.3 days), whereas the control group ranged from 6 to 90 days (mean of 36.9 days). This indicates a statistically significant shorter time to wound healing in the HBOT group compared to the control group (P < .001).

Conclusions

Future prospective randomized controlled trials with larger sample sizes and blinding are needed to further evaluate the potential benefits of HBOT in the postoperative period. Nonetheless, our findings suggest that HBOT may be a promising adjunctive therapy for patients undergoing facelift surgery.

Level of Evidence 3