Evolution and Trends of Facial Plastic Surgery and Facial Aesthetic Procedures in India: From Awakening to Revival.

Facial aesthetic surgery is an emerging branch worldwide. India, a torchbearer country in facial plastic surgery, has seen tremendous growth in medical technology, resources, and clientele over the past century. This study aims to study past practices and current trends in facial plastic surgery and aesthetic procedures in India by individually addressing commonly performed nonsurgical procedures (Botox, Kybella [Allergan, Irvine, CA], fillers, threads, micro-focused ultrasound, and nonsurgical hair restoration), and surgical procedures (rhinoplasty, blepharoplasty, hair transplant, and facelift). It also aims to further elaborate on the scope of facial aesthetics and make recommendations on prospects in the field. A structured scoping review and a subsequent evidence-based synthesis were done following an extensive literature search on various databases such as PubMed (National Institutes of Health, Bethesda, MD), LILACS (Latin American and Caribbean Center on Health Sciences Information, São Paulo, Brazil), MEDLINE (National Library of Medicine, Bethesda, MD), EMBASE (Elsevier, Amsterdam, the Netherlands), and Cochrane (Wiley, Hoboken, NJ). The initial search yielded 703 articles, out of which 20 were found to be relevant to the present study and discussed. It was found that there is an upward trend in the growth of facial plastic surgery in India, and a gradual shift in patient attitude toward nonsurgical aesthetic procedures was seen. This article affirms the growth of facial aesthetic surgery in India by highlighting the recent development and trends in the practices of surgeons. It also addresses the shortcomings in the current administration and makes recommendations to fill the existing loopholes in plastic surgery.

Determinants of the influence and experiences of cosmetic and aesthetics profiling on interpersonal relationships among Indian patients.

BACKGROUND: The notion of facial beauty is a fast-expanding field in many different disciplines. The determinants and the nature of inter-personal relationships remain a controversial issue. Here, we tackle such questions proposing a novel experimental approach by analyzing first-hand experiences and quality of life among Indian patients, who underwent cosmetic procedures and the subsequent impact of these aesthetic treatments on interpersonal relationships. METHODS: The data collection tool consisted of questions pertaining to the relations between the human face and facial image, relations between the race and facial image and interpersonal relationships and facial image. The tool consisted of 27 questions that were descriptive and closed ended without alternate choices. RESULTS: The study gauged the perception of an ideal facial image among both genders also highlighting the multifaceted nature of a persons' beauty and how its perception is affected by peers, society, and race. CONCLUSION: Though there was a gender-based difference found in the opinions on facial image, majority of the people experienced an ameliorated experience in their relationships with family and peers.

Multidimensional Indicators as Enablers on Perception of Facial Beauty and Appearance among Indian Population: A Descriptive Cross-Sectional Study.

Background: Facial appearance has been a flagbearer of "beauty" since time immemorial. Perception of beauty is highly influenced by cultural, interpersonal, and intra-personal variations. Objectives: This study aimed to assess the perception of facial beauty and appearance through multidimensional influencing indicators among the Indian population, and to determine whether the physically attractive person possesses more personal and socially desirable traits than the comparatively less attractive individual. Materials and Methods: A study population of 474 with equal male and female population of Indian origin was selected. Their perception was assessed based on the prevalidated, self-administered questionnaire using a tool with five major multidimensional indicators. Six images were selected, three each of male and female subjects, and labeled as A, B, and C, in descending order of attractiveness. The multidimensional influencing indicator tool was self-administered to the participants and the responses were recorded individually. Results: Photograph A scored the highest out of the three grading scales in both males and females. Conclusion: The most attractive photograph, in both males and females, was deemed to be associated with higher scores of attractiveness and success.

Robotic (super) microsurgery: Feasibility of a new master-slave platform in an in vivo animal model and future directions.

Advanced microsurgical procedures are currently limited by human precision and manual dexterity. The potential of robotics in microsurgery is highlighted, including a general overview of applications of robotic assistance in microsurgery and its introduction in different surgical specialties. A new robotic platform especially designed for (super) microsurgery is presented. Results of an in vivo animal study underline its feasibility and encourage further development toward clinical studies. Future directions of robotic microsurgery are proposed.

Arginine improves microcirculation in the free transverse rectus abdominis myocutaneous flap after breast reconstruction: a randomized, double-blind clinical trial.

BACKGROUND: Partial flap loss is caused by the incapability of the vascular pedicle to provide sufficient microvascular perfusion in distal segments of the flap in addition to the reperfusion injury that occurs in the whole flap after free tissue transfer. In experimental studies, the amino acid arginine reduces reperfusion injury and improves microvascular perfusion. The purpose of this clinical study was to explore the effect of arginine in free flap surgery. METHODS: In this randomized, double blind, placebo-controlled trial, 20 patients with unilateral breast reconstruction using the free transverse rectus abdominis myocutaneous flap were included. Patient and flap data were recorded. Patients received a continuous intravenous infusion of arginine or the control amino acid alanine for 5 days. Microcirculation was recorded in the flap in a standardized fashion using laser Doppler flowmetry (Perimed). RESULTS: Zone IV microcirculatory blood flow postoperatively was higher in the arginine group than in the alanine control group (p = 0.04). CONCLUSION: The authors' study shows beneficial effects of intravenous therapy with arginine to improve microcirculation in the free transverse rectus abdominis myocutaneous flap.

Intravenous arginine and human skin graft donor site healing: a randomized controlled trial.

BACKGROUND AND AIMS: Studies evaluating the effect of arginine supplementation in human wound healing are inhomogeneous with conflicting results. This study aims to clarify the role of arginine supplementation in the healing of human skin graft donor sites. METHODS: 35 subjects undergoing skin autografting were randomly assigned to receive intravenous arginine (n = 16) or placebo (n = 19) for 5 days in a dose of 30 g of arginine or an isovolumetric amount of placebo (25.2g of alanine). Wound healing was evaluated at the donor sites by objectifying angiogenesis, reepithelialization and neutrophil influx. Plasma amino acid concentrations were measured to evaluate our intervention. RESULTS: The two groups were comparable in age, morbidity and nutritional, metabolic and inflammatory state. Plasma arginine and alanine levels increased significantly upon supplementation in the two groups, respectively. No differences were found between the arginine supplementation group and the placebo group in the studied parameters. Placebo vs. arginine; mean ± SD: neutrophil influx on day 2: 6.67 ± 3.0 vs. 6.57 ± 3.3, p = 0.66; angiogenesis on day 10: 8.0 ± 2.8 vs. 8.9 ± 3.1; reepithelialization in % on day 10: 81 ± 8.5 vs. 85 ± 7.1. CONCLUSION: Intravenous arginine supplementation does not improve angiogenesis, reepithelialization or neutrophil influx in healing of human skin graft donor sites.

Oral arginine supplementation and the effect on skin graft donor sites: a randomized clinical pilot study.

Although arginine has been shown to improve healing in rodents and in small induced wounds in healthy volunteers, little is known about the effects of arginine supplementation on healing of clinically relevant surgical wounds. We studied 18 patients in a double-blind randomized pilot study (12 men, 6 women), who underwent skin transplantation as part of reconstructive surgery. Patients were randomly assigned to receive arginine (n = 8) or placebo (n = 10) supplementation as an enteral dose of 36.2 g of l-arginine-HCl or an isocaloric amount of placebo (51.2 g alanine), respectively. Wound healing was evaluated at the donor sites of skin grafts by measuring angiogenesis, reepithelialization, and neutrophil count. Arginine metabolism was studied by measuring plasma and wound fluid amino acid concentrations. Our results show that none of these parameters were significantly different between the oral arginine supplementation group and the placebo group. In conclusion, enteral arginine supplementation does not improve wound healing of skin donor sites.

A study of perfusion of the distal free-TRAM flap using laser Doppler flowmetry.

The aim of this study was to characterise microcirculatory changes in the distal part of a flap and to evaluate whether measurement of the microcirculation may predict flap complications (FC). In this prospective study, 30 patients undergoing a delayed breast reconstruction were included. Perioperative data were recorded and with the laser Doppler flowmetry (LDF; Perimed) blood flow was recorded in the central part (zone I) and the distal part (zone IV) of the flap. A lower blood flow was observed in zone IV of patients with flap complications compared to patients without flap complications (P=0.013). In addition, LDF demonstrated different flow trends in zone I compared to zone IV indicating a delayed opening of the choke vessels connecting the angiosomes in the distal part of the flap. The LDF has proven to be a useful investigative tool to monitor microcirculatory changes. In future studies it will be used to evaluate interventions aimed at decreasing distal ischaemia and reducing flap complications.

Risk factors and blood flow in the free transverse rectus abdominis (TRAM) flap: smoking and high flap weight impair the free TRAM flap microcirculation.

Mastectomy patients may have significant psychologic-related problems. Breast reconstruction provides in these cases substantial benefits in restoring body image and health-related quality of live. Autologous free tissue transfer is the treatment of choice due to excellent outcome. The purpose of this study was to elucidate the effect of the risk factors on the microcirculation and clinical outcome. In this prospective study, 21 patients with a free transverse rectus abdominis (TRAM) flap breast reconstruction were included. Patient demographics and flap characteristics were recorded. Blood flow was recorded in the central part (zone I) and the distal part (zone IV) of the flap with the laser Doppler flowmetry (LDF; Perimed). In this study, increased flap complications were seen in smokers when compared with nonsmokers (P < 0.000). LDF was higher in the older patient population (P = 0.008) in zone IV. Smoking, especially in combination with a high flap weight (HFW), revealed lower blood-flow values (P = 0.020) in zone IV. Other possible influencing risk factors such as a HFW and history of radio- and chemotherapy did not alter the microcirculation. Patients with smoking and a HFW did also show decreased blood flow but also more severe flap complications.Smoking, especially in patients with a HFW, impairs the free TRAM flap microcirculation in zone IV. In our opinion, these patients can still be included for reconstruction. However, extra care has to be taken during flap design to minimize disturbed wound healing.