JOLT: A Noninvasive Solution for the Correction of the Jowl.

Background: Sagging and loss of elasticity of the facial skin and tissues leads to jowling and an aged appearance. Jowling is a common reason for aesthetic surgical consultations. Methods: Prospective open-label study of the JOLT (jowl lifting) technique using hyaluronic acid (HA) fillers in healthy women 40-65 years of age with Fitzpatrick skin phototypes II-IV (n = 8). To be eligible, patients had jowling grade 2-3 on the jowl appearance scale as assessed by both the physician and patient. Treatment was administered at the baseline visit and consisted of an average of 6 mL of HA filler, 3 mL per side. Efficacy was assessed at baseline, week 4, and week 12. Assessment measures included the jawline rating scale (JRS) and a five-point global aesthetic improvement scale performed by two independent observers. Success was defined as an improvement of 1-2 grades on JRS. Results: The mean JRS was improved from 2.75 at baseline to 1.53 at 90 days, which was considered a significant improvement. Mean global aesthetic improvement scale scores at 90 days were 1.44 ±â€…0.66 (range 1-3), indicating a "very much improved" appearance compared with baseline on both investigator and subject ratings. The procedure was well tolerated by all patients. Injection-related side effects (bruising and localized swelling) resolved spontaneously within 1 week of treatment. No other adverse events were reported. Conclusions: The JOLT technique effectively uses HA fillers to lift and tighten the lower face/neck and camouflage the remaining jowl, diminishing marionette lines, defining the mandibular border, and improving jowl sagging.

Simplifying the injector's armamentarium: An international consensus regarding the use of gel science to differentiate hyaluronic acid fillers and guide treatment recommendations.

BACKGROUND: The Restylane portfolio of soft tissue fillers spans a wide range of indications, due in part to their complementary manufacturing technologies [non-animal stabilized hyaluronic acid (NASHA) and Optimal Balance Technology (OBT/XpresHAn)]. Using an array of products, injectors can achieve a holistic, natural looking effect for their patients. However, with a wide range of products it may be difficult to choose an optimal combination. AIM: Simplify and align global use recommendations for NASHA versus OBT products. METHODS: Two pre-meeting surveys were completed by 11 key opinion leaders with international representation, with the goal of collecting information regarding their current injection practices for various anatomical regions of the face (i.e., temporal region, forehead, tear trough, lateral zygoma, anteromedial cheek, nose, pyriform aperture, nasolabial fold, perioral area, lips, labiomental crease, marionette lines, chin, and jawline). The data collected from these surveys was subsequently discussed in a consensus group meeting involving 11 voting members and 3 nonvoting members. RESULTS: Top product recommendations were identified for each anatomical area, along with secondary and tertiary recommendations that can also be used under defined circumstances. Recommendations were provided based on a consideration of elements such as patient features (e.g., skin thickness, bone structure), the desired aesthetic outcome, experience of the injector, and the preferred injection technique. CONCLUSION: A majority consensus regarding the top NASHA versus OBT product choice for each anatomical region of the face was reached. These recommendations represent international agreement regarding the use of Restylane products.

Turn Your AART into a HIT Using a Complete Range of Aesthetic Injectables: Methodology for Combining Products to Maximise Patient Outcomes.

Purpose: Optimizing outcomes of aesthetic treatments with injectable products usually requires a consideration of the entire face to ensure balance, along with combination treatments that align with the patient's goals. To help injectors, a method of assessing the patient and developing an individualized, holistic treatment plan was developed. This methodology is termed Assessment, Anatomy, Range, and Treatment (AART™) and Holistic Individualized Treatments (HITs™). This article aims to describe and evaluate the novel and systematic AART-HIT™ methodology. Methods: The AART-HIT™ methodology, including its associated diagnostic tool the Facial Assessment Scale (FAS™), were developed to aid injectors in completing a patient assessment in which the entire face is evaluated, the relevant anatomy is considered, the science behind the available range of products is understood, and the treatment plan is individualised for the patient. Specifically, the HITs™ are methodologic tools for practitioners to perform a standardized, full facial assessment and to create an individualized treatment approach to holistically address a patient's aesthetic concerns. The use of this methodology in clinical practice was assessed via a survey, deployed to twenty-eight clinicians. Results: Over 85% of participants agreed that the AART-HIT™ methodology was adequate for their needs. Additionally, 100% of participants agreed that the temporal sequencing of HITs™ and the FAS™ diagnostic tool was useful in clinical practice. Furthermore, over 70% of participants agreed that the anatomical locations identified in each HIT™ were sufficient, while over 80% responded that the HITs™ adequately represented the range of products. Finally, over 85% of participants agreed that the HITs™ covered different ethnic skin types and various patient ages and, over 80% of participants responded that they would not add additional elements to any of the 5 HITs™. Conclusion: The AART-HIT™ methodology, including the FAS™ were comprehensive enough for clinical use in providing a personalised treatment plan for individual patients.

Artificial Intelligence Versus Expert Plastic Surgeon: Comparative Study Shows ChatGPT "Wins" Rhinoplasty Consultations: Should We Be Worried?

Introduction: Large language models, such as ChatGPT, hold tremendous promise to bridge gaps in patient education and enhance the decision-making resources available online for patients seeking nasal surgery. Objective: To compare the performance of ChatGPT in answering preoperative and postoperative patient questions related to septorhinoplasty. Methods: Two sets of responses were collected for the questions: one from an expert rhinoplasty surgeon with over two decades of experience, and the other from ChatGPT-3.5. Seven expert rhinoplasty surgeons, blinded to the source of responses, independently assessed the responses using a 5-point Likert scale in four performance areas: empathy, accuracy, completeness, and overall quality. Results: ChatGPT outperformed physician responses in three of the four performance areas, earning significantly higher ratings in accuracy, completeness, and overall quality (p < 0.001). In addition, ChatGPT was overwhelmingly preferred over physician responses (p < 0.001), with evaluators favoring ChatGPT in 80.95% of instances. Conclusions: ChatGPT has demonstrated its remarkable ability to deliver accurate, complete, and high-quality responses to preoperative and postoperative patient questions. Although certain improvements are warranted, this artificial intelligence tool has shown its potential to effectively counsel and educate prospective septorhinoplasty patients at a level comparable with or exceeding that of an expert surgeon.

Cannula versus needle in medical rhinoplasty: the nose knows.

The use of hyaluronic acid (HA) fillers has become a popular alternative for nose remodeling, although poor understanding of the nasal anatomy has resulted in adverse events and generated some controversy. Among them, is the question of where and when to use cannulas vs needles. Through multiple cadaver dissections, clinical experience and the review of medical literature the authors conclude the use of needle over cannula is preferred, assuring a correct injection plane lying fully against the bone or cartilage. Although blunt in nature, cannulas may lead to difficulty in determining with precision the exact depth of product placement and contribute to more dissection of adjacent structures. Thorough knowledge of the highly variable nasal anatomy, including vessel depth location is of outmost importance in avoiding adverse events. Good patient selection is critical where most noses for augmentation rhinoplasty and some reduction rhinoplasty candidates where the goal is to camouflage the dorsal hump are amenable to medical rhinoplasty, unless there is reduced skin elasticity of nasal soft tissues or distortion of anatomy from surgery or trauma. Appropriate product selection is important for effective results. The authors suggest fillers with low cohesivity and high lifting capacity. Finally, we suggest a technique referred as Rhinosculpting base in the use the use of three conceptual elements: facial analysis, light reflection, and use of HA gel as a cartilage graft, in combination with the detailed injection technique presented in this article, which ensures a safer and satisfying treatment outcome.

Evaluación diagnóstica en la sinusitis maxilar crónica / Diagnostic evaluation of chronic maxillary sinusitis

La exploración endoscópica rígida de nariz y senos paranasales, complementada con un estudio tomográfico, juega un papel primordial en el diagnóstico de enfermedad nasosinusal. Se estudiaron 50 pacientes con sintomatología nasosinusal crónica a los que se les realizó un cuestionario estandarizado, rinoscopía anterior, endoscopía rígida, radiografías simples, tomografía (TC) y cirugía. Los resultados revelaron que la endoscopía identificó patología en 21 pacientes sin hallazgos patológicos a la exploración física. Asimismo, la TC identificó patología en 27 pacientes con imágenes de normalidad en las radiografías simples. La endoscopía rígida resultó ser un estudio con una alta sensibilidad y especificidad. En cambio, la TC tiene poca especificidad y por lo tanto una clara tendencia a sobre diagnosticar enfermedad nasosinusal. Se sugiere la utilización de la endoscopía rígida de manera rutinaria en pacientes con sintomatología nasosinusal crónica y el solicitar TC únicamente cuando la endoscopía halla demostrado patología y exista necesidad de conocer su extensión y relación anatómica. Esto hará que el diagnóstico de esta enfermedad se haga de una manera más efectiva tomando en cuenta el costo beneficio de los diferentes estudios.

Angioleiomioma en cavidad nasal: reporte de un caso / Angioleiomioma in nasal cavity: report of a case

Se presenta el caso de un paciente femenino de 44 años de edad con datos clínicos de obstrucción nasal izquierda intermitente no progresiva de 6 meses de evolución. Presentaba tumoración en cavidad nasal izquierda. Se realiza biopsia excisional y doce meses después la paciente se encuentra asintomática y sin recurrencia tumoral.