A Prospective Evaluation of Female External Genitalia Sensitivity to Pressure following Labia Minora Reduction and Clitoral Hood Reduction.

BACKGROUND: Little research has been conducted into the effects of labiaplasty on sensitivity of external genitalia. This study aimed to determine the effect of labia minora and clitoral hood reduction using the edge resection technique on external genitalia sensitivity. METHODS: Female subjects electing to undergo labia minora and clitoral hood reduction were enrolled. Subjects underwent sensitivity testing using monofilaments at five locations (one at the clitoral hood and four labial with each labium measured 0.5 cm from the leading edge and 1.5 cm distal to the hymen) at baseline; 2 weeks; and 3, 6, and 12 months postoperatively. Self-evaluations using the Sexual Function Questionnaire were performed at baseline and 3, 6, and 12 months postoperatively. RESULTS: Thirty-seven subjects undergoing labia minora and clitoral hood reduction were enrolled. Subjects experienced a median increase in sensitivity at month 6 of 0.118 mN at the 0.5-cm right labial location (p = 0.027) and 0.059 mN at the 0.5-cm left labial location (p = 0.046) compared with baseline. No change in sensitivity was demonstrated at the clitoral hood or either of the 1.5-cm labial locations. At 6 months, an increase in the number of sexual relations was observed in 44.1 percent of subjects (p = 0.011), an improvement in orgasm frequency was exhibited by 35.3 percent of subjects (p = 0.013), and an increase in orgasm strength was observed in 35.3 percent of subjects (p = 0.006). CONCLUSION: Labia minora and clitoral hood reduction as performed by the trim/edge resection method does not result in diminished sensitivity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Plastic surgery trends parallel Playboy magazine: the pudenda preoccupation.

BACKGROUND: Aesthetic vulvovaginal procedures are being performed with increased frequency. Many experts have suggested that the growing demand for these procedures relates to the availability and revealing nature of nude images on the Internet and in other media. OBJECTIVES: The authors examined chronologically organized nude photographs from a popular magazine and objectively measured the position of the vulva relative to the center of focus to observe trends for the past 6 decades. METHODS: Playboy magazine centerfold photographs from 1954 to 2013 were analyzed and categorized. The positions of the vaginal area (V-line) and the breast area (N-line) were measured in relation to the horizontal midline of the photograph. Images also were assessed for degree of grooming and exposure of the breast and pubic areas, as well as visibility of the pudendal cleft, labia majora, and labia minora. RESULTS: Four hundred ninety images met inclusion criteria for the analysis. Full exposure of the V-line increased from 0 instances in the 1950s to 78.6% of images from 2010 through 2013 (P<.001). Moreover, the V-line position became 41.0% closer to the photographic midline (P=.045). CONCLUSIONS: The results demonstrate a trend toward increased visibility and prominence of the female genitalia as the focal point of popular nude photographs.

Minimally invasive neck lifts: have they replaced neck lift surgery?

The aging neck is accompanied by an increase in submental fat, platysmal banding, and redundant dyspigmented skin. Creating a more acute cervicomental angle, distinct mandibular border, homogeneous skin tone, and smoother texture helps to achieve a more youthful appearance. The aesthetic provider's armamentarium has long had surgical techniques in the highest regard, but a new wave of minimally invasive procedures looks to offer a nonsurgical approach to cervicomental rejuvenation. Selecting the appropriate procedure for appropriate patients that will effectively meet their aesthetic goals and expectations is the core of successful neck rejuvenation.

Restylane persisting in lower eyelids for 5 years.

The authors report the case of a 58-year-old woman presenting with "puffiness" in her lower eyelids persisting for approximately 5 years. While dark, puffy eyelid circles following hyaluronic acid placement periorbitally are not uncommon, what is so unusual in our case is that it was noted 5 years after treatment with Restylane. It has been our experience that hyaluronic acid within periorbital tissues can result in a negative cosmetic outcome that can persist for years after the treatment.

A new treatment regimen for rosacea: onabotulinumtoxinA.

Rosacea is a cutaneous condition with several clinical subtypes that are commonly seen in daily medical practice. There are many different treatment modalities for each of the physical findings associated with this disease, and all have varying results. As the use of onabotulinumtoxinA rises, its benefit in the treatment of a growing number of medical diseases increases. The authors report anecdotal evidence of patients with rosacea experiencing improved symptoms of erythema and flushing after treatment with intradermal, microdroplets of onabotulinumtoxinA. There were no adverse events reported for any of the treatments. The mechanism of action through a likely neurogenic component to vascular dysfunction, inflammation, and hypersebaceous activity is reviewed.

Management of impending necrosis associated with soft tissue filler injections.

BACKGROUND: As the number of soft tissue filler injections increases, the number of adverse events associated with injection may rise. Impending necrosis represents a serious complication that, if not treated correctly and timely, may have grave consequences. OBJECTIVE: We describe a protocol utilizing hyaluronidase, nitroglycerin paste, aspirin, antacid and a topical oxygen therapy that may be used to treat impending necrosis subsequent to injection with soft tissue fillers. CONCLUSION: We have successfully treated nine post-filler injection adverse events involving impending necrosis or necrosis following both hyaluronic acid and calcium hydroxylapatite injections using our protocol.

A phase 2, double-blind, randomized, placebo-controlled trial of a novel nutritional supplement product to promote healthy skin.

BACKGROUND: Despite an abundance of nutritional supplements, very few well-controlled trials have assessed their beneficial effect on the skin, such as hydration, antioxidant levels, texture or appearance. The objective of the following placebo-controlled, double-blind study was to determine the effects of the Skin Health Experimental Product (SHEP) on skin health. METHODS: The study enrolled healthy men and women aged 30 years or older. Subjects were randomized to receive a twice-daily regimen of SHEP or placebo. The effects SHEP had on overall skin appearance and health were assessed by measuring improvements in: (1) skin hydration using a closed-aperture transepidermal water-loss moisture meter and a vapometer; (2) skin texture using silicon profilometry; (3) skin carotenoid concentration using Raman spectrometry; and (4) reported self-image assessments using the Global Aesthetic Improvement Scale (GAIS). RESULTS: SHEP-treated subjects demonstrated a significant reduction in fine lines compared to the placebo-treated group. Raman spectroscopy showed that SHEP increased carotenoids at some measurement sites. Based on the GAIS, SHEP-treated subjects were three times more likely to perceive an improvement in their appearance compared to placebo-treated subjects (P>0.049). CONCLUSION: The orally-administered SHEP nutritional supplement improves skin texture, carotenoid levels in specific areas of the hand, and improves patients' perception of skin health.

Soft tissue fillers and biofilms.

The purpose of this study was to review the clinical course of reported hypersensitivity reactions associated with use of soft tissue fillers and the response of these reactions to treatment. In this comprehensive literature review, we identified ~40 published reports that together reported numerous adverse reactions associated with use of nonpermanent soft tissue fillers; however, very few of these reactions were consistent with type I immediate or type IV delayed hypersensitivity reactions. Based on their clinical course and response to treatment, most reported hypersensitivity reactions are likely due to an infectious process. Although there are no confirmed reports of biofilm reactions associated with nonpermanent fillers, the possibility of bacterial contaminants should be considered in acute or chronic inflammatory reactions associated with use of nonpermanent soft tissue fillers. Early treatment with antibiotics is recommended.

The endonasal lateral crural underlay and sandwich grafts.

BACKGROUND: Previously, the problem created by overly convex, wide, and robust lower lateral cartilages (LLC) required an external or endonasal approach with delivery. Although this method has proven invaluable, it may not be indicated in all patients with large tips, specifically those with overly convex LLC or with thin skin and robust LLC. OBJECTIVE: The authors present the results of their straightforward technique for narrowing the bulbous tip through an endonasal nondelivery approach that reinforces the nasal airway while at the same time preventing alar notching, lateral crus recurvature, and bossa formation. METHODS: From August 2008 to February 2010, 29 patients underwent endonasal lateral crural underlay and sandwich graft with the authors' technique. All patients had medium to thin skin and prominent, bulbous, symmetric LLC. Three of the patients presented for secondary rhinoplasty. The authors identified no specific contraindications for this procedure. All patients who remained for follow-up were given a questionnaire that analyzed their nasal tip satisfaction on a five-point categorical scale at seven separate points of follow-up. RESULTS: Among the 27 patients who remained for follow-up, the results were highly satisfactory, mostly satisfactory, or satisfactory in 25 of the 27 cases (as indicated by patient survey). The two remaining patients requested a thinner nasal tip. No significant complications were noted. CONCLUSIONS: The lateral lower crural underlay sandwich graft is an adjunct to the traditional endonasal approach, further enhancing and expanding the possible outcomes. It appears to equal the predictability and stability identified with traditional tip-narrowing techniques in the external approach but with less operative time, less surgical dissection, and presumably less edema, thereby allowing us to better meet our patients' demands.

A double-blind, randomized, placebo-controlled health-outcomes survey of the effect of botulinum toxin type a injections on quality of life and self-esteem.

BACKGROUND: Although studies show that botulinum toxin type A (BoNTA) can positively influence one's first impression, little research has been conducted to measure the effect that BoNTA has on mental well-being. OBJECTIVE: To determine the effects that BoNTA injections for the treatment of facial wrinkles had on quality of life (QOL) and self-esteem. METHODS AND MATERIALS: One hundred participants received treatment with BoNTA or placebo saline in this double-blind randomized placebo-controlled survey. All participants completed a health outcomes survey consisting of Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form and Heatherton and Polivy State Self-Esteem measurements before injection and 2 weeks and 3 months after injection. RESULTS: Statistically significant improvements (p<.05) in participants treated with BoNTA were observed in answers to QOL questions regarding physical health, mood, household activities, overall life satisfaction, body satisfaction, self-consciousness, intellect, self-worth, appearance, comprehension, weight satisfaction, attractiveness, and sense of well-being. Increases in overall self-esteem and appearance-, social-, and performance-related self-esteem were observed in participants treated with BoNTA. CONCLUSION: Our findings showed that BoNTA injections result in improvements in QOL and self-esteem. In addition, BoNTA-naïve participants demonstrate greater improvements in QOL and self-esteem than participants previously exposed to BoNTA. Moreover, BoNTA-familiar participants demonstrated sustained improvement in QOL and self-esteem relative to BoNTA-naïve participants, even when injected with placebo.

Retailicine, somewhere between retail and medicine.

In the increasingly competitive market of aesthetic surgery and the unstable predicament of the current economy, managing a successful aesthetic practice becomes ever more difficult. This article introduces the concept of Retailicine, combining essential elements of retail with the core principles of medicine. This new concept stresses the importance of the customer (patient) and provides tips to help manage the aesthetic practice. Through incorporating the techniques mentioned in this article, the aesthetic physician can ensure a successful practice despite current economic uncertainty.

Blinded evaluation of the effects of hyaluronic acid filler injections on first impressions.

BACKGROUND: Facial appearance has profound influence on the first impression that is projected to others. OBJECTIVE: To determine the effects that complete correction of the nasolabial folds (NLFs) with hyaluronic acid (HA) filler has on the first impression one makes. METHODS: Twenty-two subjects received injections of HA filler into the NLFs. Photographs of the face in a relaxed pose were taken at baseline, optimal correction visit, and 4 weeks after optimal correction. Three hundred four blinded evaluators completed a survey rating first impression on various measures of success for each photo. In total, 5,776 first impressions were recorded, totaling 46,208 individual assessments of first impression. RESULTS: Our findings indicate a significant improvement in mean first impression in the categories of dating success, attractiveness, financial success, relationship success, athletic success, and overall first impression at the optimal correction visit. At 4 weeks after the optimal correction visit, significance was observed in all categories measured: social skills, academic performance, dating success, occupational success, attractiveness, financial success, relationship success, athletic success, and overall first impression. CONCLUSION: Full correction of the NLFs with HA filler significantly and positively influences the first impression an individual projects.

Strategies to grow your practice in a struggling economy.

Creating a successful aesthetic medicine practice in times of economic uncertainty is a daunting challenge. This article introduces the concept of Retailicine, combining inherent edicts of medicine with the best practices in business, so today's aesthetic physician can develop strategies for success in any economy. Through the efficient use of marketing strategies catered to aesthetic medicine, aesthetic practices can thrive. Emphasizing the patient's experience, effectively using the Internet, and an ego-devoid introspective analysis of the flaws of one's practice are essential for any successful aesthetic physician to grow and be prosperous despite any shortfalls in the economy.

Soft tissue fillers in the nose.

Using soft tissue fillers to correct postrhinoplasty deformities in the nose is appealing. Fillers are minimally invasive and can potentially help patients who are concerned with the financial expense, anesthetic risk, or downtime generally associated with a surgical intervention. A variety of filler materials are currently available and have been used for facial soft tissue augmentation. Of these, hyaluronic acid (HA) derivatives, calcium hydroxylapatite gel (CaHA), and silicone have most frequently been used for treating nasal deformities. While effective, silicone is known to cause severe granulomatous reactions in some patients and should be avoided. HA and CaHA are likely safer, but still may occasionally lead to complications such as infection, thinning of the skin envelope, and necrosis. Nasal injection technique must include sub-SMAS placement to eliminate visible or palpable nodularity. Restricting the use of fillers to the nasal dorsum and sidewalls minimizes complications because more adverse events occur after injections to the nasal tip and alae. We believe that HA and CaHA are acceptable for the treatment of postrhinoplasty deformities in carefully selected patients; however, patients who are treated must be followed closely for complications. The use of any soft tissue filler in the nose should always be approached with great caution and with a thorough consideration of a patient's individual circumstances.