"The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medspa Directorship and Practitioner Trends in Florida".

BACKGROUND: The rapid proliferation of medical spas in the US has raised concerns over the continued shift of non-surgical aesthetic treatments away from traditional core specialty integration and supervision, potentially affecting the surgical treatment guidance and education of cosmetic surgery patients. This study aimed to assess the current trends in the growth of independent medspa facilities as well as practitioner supervision, licensing, and specialization in the state of Florida. METHODS: A comprehensive, statewide survey of all independent medspas in Florida, by municipality, employing Google and Yellow Pages search engines. Information gathered included the number of locations, business stakeholders, and director/practitioner licensing and certification obtained from the Florida Division of Corporations/Department of Health databases and respective medical boards. RESULTS: A total of 1,038 medspas were identified, revealing a 100% increase in number relative to 2021 estimates. Non-physician practitioners represented 84% of medspa providers, with core specialty medical director supervision present in only 22% of facilities and a large proportion of directors lacking specialty training (77%) or board certification (42%). Additionally, 25% of medspas appeared to disregard state guidelines pertaining to medical directorship, autonomous non-physician practice, and numerical/geographic restrictions on directorship, with 96% of facilities lacking licensing/registration with Florida's Agency for Health Care Administration. CONCLUSIONS: Medspa growth in Florida has been explosive, with continued departure from core supervision, increasingly limited specialty training/integration, and non-adherence to state guidelines. Enhanced regulation and integrated non-physician practitioner training are likely necessary to ensure patient safety and the cohesive practice of aesthetic medicine and surgery.

Cosmetic Filler-Induced Vascular Occlusion: A Rising Threat Presenting to Emergency Departments.

Vascular emergencies from cosmetic filler-induced vascular occlusion represent an iatrogenic etiology that poses a threat to patients, with sequelae that range from disfiguring skin necrosis to blindness and stroke. As cosmetic fillers continue to grow in popularity, the importance of early identification, triaging, and management of these rare but potentially disabling injuries has motivated efforts to educate the public and professional audiences. In this practice review article, we outline components of acute care pertaining to these injuries based on evolving practice guidelines and best evidence recommendations.

Needle Microcores: Can They Pose an Occlusive Threat with Nonparticulate Injections?

SUMMARY: The incidence of vascular occlusion injuries has risen substantially along with the increasing popularity of cosmetic injectables. Among these occurrences, instances of soft-tissue ischemic events following the injection of nonparticulate solutions, such as botulinum, represent an enigmatic etiology that has yet to be fully understood. One hypothesized mechanism of injury underlying these events relates to the accidental capture and intravascular ejection of needle microcores, defined as submillimeter tissue fragments trapped by the beveled lumen of a needle during conventional injections. To test this hypothesis, the authors conducted a cytologic evaluation of dermal remnants incidentally captured by 31-G tuberculin needles following repeated injections into postrhytidectomy skin fragments. Their findings revealed the presence of dermal tissue microcores ranging from 100 to 275 µm in diameter with an overall microcoring incidence of 0.7%. These findings confirm the ability of ultrafine needles, commonly used in botulinum injections, to produce tissue microcores that may serve as causative agents of vascular occlusion with nonparticulate solutions. Awareness of this mechanism of injury may be of benefit in the early recognition and management of these rare occurrences. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

#TheUglyTruth? A Qualitative Evaluation of Outcomes Photography on Instagram: Introducing the SEPIA Scoring System.

Photographs of cosmetic treatment outcomes on social media are prone to bias and misrepresentation from nonadherence to established photographic standards. However, there is currently insufficient information regarding which norms are most-commonly violated, precluding quality improvement efforts. Methods: A qualitative study of cosmetic treatment photographs published on Instagram was undertaken in accordance with the Guidelines for Reporting Reliability and Agreement Studies using a newly proposed Standards for the Evaluation of Photographs In Aesthetics (SEPIA) nine-point photograph scoring system and grading scale. Results: A total of 510 posts encompassing 2020 clinical photographs published by 102 practitioner accounts on Instagram were audited for photographic quality. The average score was 4 out of 9 (medium quality), with approximately 40% of posts scoring in the low-quality range. Zoom, lighting, timing, and presentation of multiple views were the standards most-commonly disregarded. Plastic and Reconstructive Surgery specialty and subspecialty (PRSS) practitioners scored higher (4.5/9 versus 3.1/9, P = 0.002) and had fewer low-quality posts (22% versus 54%, P = 0.001) than non-PRSS providers. Low-quality photographs were most often seen with rhinoplasty (30% versus 7%, P < 0.00001) and lip filler (60% versus 33%, P = 0.0001) compared with surgical and nonsurgical treatments, respectively, due to a higher incidence of immediate photographs and selfies. Conclusions: Before and after photographs of surgical and nonsurgical cosmetic treatment outcomes on social media are frequently of substandard quality. This study outlines specific items frequently neglected in outcomes photography to assist practitioners in maximizing adherence to established standards of photography online.