A Google Trends Analysis of Facial Plastic Surgery Interest During the COVID-19 Pandemic.

The COVID-19 pandemic has had a multitude of effects on daily life. Aesthetic and cosmetic surgery practices have been significantly reduced in their working capacity or closed during this time. We used Google Trends to gauge the public's interest in facial plastic surgery during this pandemic, and how it has changed over the preceding months. As local shelter-in-place orders are being lifted, interest in facial plastic surgery is increasing even in the context of an ongoing national pandemic. LEVEL OF EVIDENCE V: Letter to the Editor.

Advances in Face-lift Techniques, 2013-2018: A Systematic Review.

IMPORTANCE: Rhytidectomy, or face-lift surgery, is the mainstay of facial rejuvenation and is constantly evolving. There is continuous research to improve outcomes and minimize complications of this surgery. OBJECTIVE: To synthesize the updated techniques in rhytidectomy published during the past 5 years, including surgical technique, advances in anesthetic technique, minimally invasive techniques, and adjunctive procedures performed at the time of rhytidectomy. EVIDENCE REVIEW: On February 8, 2018, a literature search was performed of the PubMed and Cochrane databases using the search terms, face-lift or rhytidectomy and techniques. Articles published from February 8, 2013, to February 8, 2018, that related to techniques of facial rejuvenation in the lower one-third of the face by lifting and supporting tissue with 5 or more patients were included. Systematic reviews and primary literature were considered; narrative reviews, validation studies, and anatomic studies were eliminated. The initial search resulted in 604 articles after duplicates were removed. This was reduced to 84 articles after dual independent review screening. FINDINGS: Of the 84 articles included, 51 (61%) regarding techniques of face-lifting in the past 5 years pertained to soft-tissue techniques; 14 (17%) pertained to implants or adjunctive medications, such as tissue sealants; and 12 (14%) related to adjunctive techniques performed in addition to face-lifting, such as fat grafting, resurfacing, and liposuction. All studies found the techniques reported therein to be effective, with similar or fewer complications compared with the literature. However, according to the Oxford Centre for Evidence-Based Medicine criteria, the level of evidence of the studies was generally poor, because 45 of the studies (54%) were case series (level 4 of evidence). CONCLUSIONS AND RELEVANCE: Several new techniques have been explored for rhytidectomy or face-lift in the past 5 years, including soft-tissue techniques, introduction of implants or topical medications such as tissue sealants, and concomitant adjunctive techniques to enhance results. The overall quality of the evidence is poor, with most articles using case series with nonvalidated measures to evaluate outcomes. There is considerable room for improvement in the literature if additional studies using cohort designs and validated outcomes are performed to validate the quality of the techniques introduced during the past 5 years.

Google Trends as a Resource for Informing Plastic Surgery Marketing Decisions.

BACKGROUND: Celebrities have long influenced the medical decisions of the general population. By analyzing Google search data using Google Trends, we measured the impact of highly publicized plastic surgery-related events on the interest level of the general population in specific search terms. Additionally, we investigated seasonal and geographic trends around interest in rhinoplasties, which is information that physicians and small surgical centers can use to optimize marketing decisions. METHODS: Google Trends was used to access search data histories for three separate areas of interest: Kylie Jenner and lip fillers, Joan Rivers and plastic surgery, and rhinoplasty, which were then analyzed using two-tailed, two-sample equal variance t-tests. RESULTS: The average interest level in fillers increased by 30.31 points after Kylie Jenner announced that she received Juvéderm lip injections. The interest level in plastic surgery was decreased by 21.3% the month after Joan Rivers' death. Between January 2004 and May 2017, the average interest level for rhinoplasty was significantly different in January/December (67.91 ± 20.68) and June/July (70.12 ± 18.89) from the remaining calendar months (63.58 ± 19.67). Los Angeles, New York City, and Miami showed consistently high interest levels throughout the time period, while Tulsa, OK, showed a major interest increase between 2015 to 2016 of 65 points. CONCLUSIONS: A noticeable impact was observed in both celebrity cases on search term volume, and a seasonal effect is apparent for rhinoplasty searches. As many surgeons already employ aggressive Internet marketing strategies, understanding and utilizing these trends could help optimize their investments, increase social engagement, and increase practice awareness by potential patients. 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 .

[Aging prevention, new surgical techniques and future options for facial rejuvenation]. / Prévention du vieillissement, techniques chirurgicales récentes et voies d'avenir de la chirurgie du rajeunissement facial.

Prevention of aging is mainly obtained through appropriate health practices, modulated by the genetic causes of aging. Causes of facial structural aging include gravity, volume loss, contraction of the mimic muscles and obviously biological aging of tissues. Among the very numerous new surgical technique of facial rejuvenation, we could point out: for the frontal region, obviously we are focus on the endoscopic and non-endoscopic frontal lifts. But also, we should note the transcutaneous Brow Shaping which with a well defined, step by step technique is indeed a simple way to improve a possible difficult situation; concerning the mid-face lift, as the main risk is the secondary eyelid malposition, a high Smas or a temporo-malar lift can be performed. It ensures a good temporal effect but there is nearly no improvement at the mid-pupilla level. A mid-face lift is nevertheless mandatory to achieve an efficient skin removal on the mid-pupilla line. This is performed most of the time with a complete orbicularis oculi muscle opening, and only with a small lateral opening in case of the concentric malar lift, which minimize the risk of eyelid malposition. Based on a new description of the lymphatic draining of the lower lid, a new treatment of the chemosis is proposed with a corticoid injection at infero-lateral part of the malar area, in the preperiosteal plane. For the oval, the DAO section and the suspension of the middle premasseter space beyond the anterior border of the masseter where the Smas overlies the buccal fat pad, stay efficients. Regarding the neck, the suspension of the posterior border of the platysma to the Loré's fascia, the digastric corset with or without a platysma corset are advanced and valuable techniques. Lately, a new option was described using a lateral skin-platysma flap to minimize platysma bands and even more recently a neck lift with fixation of the anterior platysma to the deep cervical fascia and suspension of the lateral platysma flap.

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Expert Consensus on Absorbable Advanced Suspension Technology for Facial Tissue Repositioning and Volume Enhancement.

BACKGROUND: Signs of facial aging include wrinkles, loss of subcutaneous volume, decreased tone, texture, and sagging of the skin. The objective of this review is to determine whether facial suspension absorbable sutures are a safe and effective modality for facial rejuvenation.

METHOD: A group of US plastic surgeons and dermatologists who practice medical aesthetics convened to review evidence obtained from literature searches and to reach a consensus on clinical practice guidelines for the use of facial absorbable suspension sutures.

RESULTS: Currently, there are different types of lifting sutures available. Absorbable, facial suspension sutures allow for superior repositioning of tissue along a vector line together with the added benefit of volumization of the area. These benefits are for patients who have moderate facial aging and require treatment beyond the use of injectable products only.

CONCLUSIONS: Treatment with absorbable facial suspension sutures, when performed properly, is associated with minor and infrequent complications and offers a beneficial clinical alternative to traditional facial rejuvenation techniques.

J Drugs Dermatol. 2017;16(7):661-666.

Modified Rhytidectomy that Produces a More Natural Look: Experience with 110 Cases.

BACKGROUND: Recognition of the effects of aging on the ear and the mechanisms leading to ear deformity associated with facelift procedures aid in achieving improved aesthetic results. In 2009, the author developed a novel rhytidectomy technique to provide more natural-looking results than those achieved through other facelift procedures, which often result in facial and ear distortion/deformity. This technique is designed to optimize aesthetic outcomes by employing incisions hidden within the ear, autologous fat transfer to restore normally lost facial volume, and absorbable bidirectional sutures, all of which allow less skin removal and shorter, more concealable scars within the inside perimeter of the ear, and thus less-distorted facial contours. In this retrospective study, the author added one important modification to this previously described approach for preventing ear deformity. OBJECTIVES: The author will show that this modified rhytidectomy technique has many benefits over a traditional rhytidectomy, and it results in a natural-looking facelift. METHODS: The author modified the original technique to secure the ears in a way that prevents inferior drifting. The modified technique involves the placement of two parallel strands of 3-0 Monocryl sutures under the scalp and over the skull and running from one side of the head to the other side using a 6-inch blunt needle. The absorbable strands are passed from the inferior part of each earlobe-one in front of the ear and the other in back of the ear. The strands are tied with knots under moderate tension under each earlobe, securing the ear back in the anatomical preoperative position. This secures the bottom of the ears and prevents caudal drifting. DISCUSSION: The use of 360° round-block, inside-the-ear incisions is advantageous. These incisions have much less lymphatic derangement of the skin, because the overall cut is shorter and the skin is not cut as extensively as in other methods that use longer incisions to get rid of more excess skin in facelifts. RESULTS: This modified rhytidectomy technique has many benefits over a traditional rhytidectomy: the incisions are hidden inside the ears, so there are almost no visible external incisions, and there is no deformity of the ears and earlobes, because the ears do not drift downward. The ear canal is not distorted, there is no hairline distortion, and most importantly, it results in a natural-looking facelift without the commonly seen deformity of any noticeable pulling. CONCLUSIONS: This modified approach to rhytidectomy achieves natural looking, aesthetically pleasing results. LEVEL OF EVIDENCE III: 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 .

Current Applications of Facial Volumization with Fillers.

LEARNING OBJECTIVES: After reading this article and watching the accompanying videos, the participant should be able to: 1. Assess patients seeking facial volumization and correlate volume deficiencies anatomically. 2. Identify appropriate fillers based on rheologic properties and anatomical needs. 3. Recognize poor candidates for facial volumization. 4. Recognize and treat filler-related side effects and complications. SUMMARY: Facial volumization is widely applied for minimally invasive facial rejuvenation both as a solitary means and in conjunction with surgical correction. Appropriate facial volumization is dependent on patient characteristics, consistent longitudinal anatomical changes, and qualities of fillers available. In this article, anatomical changes seen with aging are illustrated, appropriate techniques for facial volumization are described in the setting of correct filler selection, and potential complications are addressed.

Current Trends in Facial Rejuvenation: An Assessment of ASPS Members' Use of Fat Grafting during Face Lifting.

BACKGROUND: Fat grafting can be used to improve the results of face lifting. The extent to which plastic surgeons use fat grafting in their face-lift practices is unknown. The goals of this study were to understand the current use of fat grafting during facial rejuvenation surgery and identify the most common techniques used. METHODS: A 28-item questionnaire was formulated for distribution to a randomized cohort of American Society of Plastic Surgeons members. Data were collected and statistically analyzed using Pearson chi-square and Fisher's exact tests. RESULTS: A total of 309 questionnaires were collected. The questionnaire revealed that 85.2 percent of respondents use fat grafting during face lifts. Currently, the most common techniques used include abdominal harvest, centrifuge processing, blunt cannula injection without pretunneling, and placing less than 0.1 cc per pass. The deep central malar, lower lid cheek junction, and nasolabial folds are the most commonly injected areas. CONCLUSIONS: Combining surgical repositioning of fat with fat grafting offers surgeons a greater degree of aesthetic control for correcting contour in the aging face. Although there is controversy regarding the best method to surgically reposition fat, there is a growing consensus that volume augmentation is preferred by most face-lift surgeons.

Midface lift: panel discussion.

UNLABELLED: What is the most efficient dissection plane to perform midface lift? What is the best incision/approach (preauricular, transtemporal, transoral)? Why? What specific technique do you use? Why? What is the best method/substance for adding volume to midface lifting? In approaching the midface, how do you see the relationship of blepharoplasty versus fillers versus midface lifting? ANALYSIS: How has your procedure or approach evolved over the past 5 years? What have you learned, first-person experience, in doing this procedure?

Facelift: panel discussion, controversies, and techniques.

This article is a panel discussion with questions and answers on face-lift technique.

Updating the concepts on neck lift and lower third of the face.

BACKGROUND: When planning a face lift, the surgeon must keep in mind that signs of aging vary depending on the patient's age, skin quality, bony structure, and muscle tone. The deformities must be evaluated individually to determine the best treatment. METHODS: The purpose of this article is to discuss the surgical and philosophical aspects of the treatment of the lower third of the face and neck, based on the authors' experience of 40 years. A review of 1500 patients who were operated on in a private clinic and in the Hospital of the Rio de Janeiro State University was conducted to evaluate the different aspects of deformities and their treatments. RESULTS: In the majority of patients, the authors open the neck and treat the platysma muscle. Subplatysmal fat is removed with care, only in the midline. The authors do not perform any procedures on the submandibular glands or the digastric muscles. The authors do perform superficial musculoaponeurotic system (SMAS) dissection and SMASectomy in the majority of cases, with plication only in thin patients. Many procedures have been described for facial rejuvenation. Most of them aim for a good aesthetic result with a short recovery period. In the authors' experience, the best results are accomplished in a young patient with thin skin. CONCLUSION: Although the surgeon selects treatments for patients based on their deformities, it must be kept in mind that treatments must be selected to satisfy the patient's needs and preferences.