'Magic cosmetic fillers': Appearance-enhancement effects on self-face recognition.

People naturally exhibit a self-serving bias which can be observed in their tendency to judge their own physical attractiveness more favourably than that of others. Despite this positive self-perception, minimally invasive cosmetic injectable procedures for facial rejuvenation and enhancement are becoming increasingly common. It remains unclear, however, whether recognizing an altered version of one's own face, enhanced cosmetically, correlates with a positive view of cosmetic surgery and excessive preoccupations about physical characteristics perceived as defects (body dysmorphic concerns). In this study, 30 healthy female participants, aged 18-24 years (Mage = 21.1 years, SD = 1.6), engaged in a face recognition task during which their faces were digitally morphed with that of gender-matched unfamiliar women who had undergone cosmetic enhancements, specifically lip and cheek fillers. The duration of exposure to these modified faces varied with short (500 msec) and long (2000 msec) viewing periods. Participants were asked to identify whether the digital morphs represented themselves or the other woman. Self-reports regarding acceptance of cosmetic surgery and dysmorphic concerns were collected. Participants PSE indicated a tendency towards self-bias under short presentation times, shifting towards the other as presentation times lengthened. Interestingly, this effect was associated with greater acceptance of cosmetic surgery and higher body dysmorphic concerns. This study underscores the importance of understanding how perceptions of others' physical appearances can influence self-recognition and attitudes towards cosmetic surgery, which may have both positive and potentially harmful implications.

A Systematic Review on the Reinforcement Loop in Aesthetic Medicine and Surgery: The Interplay of Social Media, Self-Perception, and Repeat Procedures.

INTRODUCTION: This systematic review delves into the impact of social media on self-perception and the escalating interest in clinical aesthetic procedures, proposing that social media significantly influences beauty standards and increases demand for aesthetic enhancements. METHOD: Following PRISMA guidelines, a mixed-method analysis of 34 articles was conducted, sourced from various databases, focusing on social media's psychological effects on clinical aesthetics decisions. The studies encompassed a broad spectrum, including qualitative, quantitative, and mixed methodologies, reflecting diverse geographical and cultural perspectives. RESULTS: The quantitative analysis demonstrated a strong positive correlation between social media usage and the consideration of aesthetic procedures (r=0.45, p<0.001), indicating a significant impact. Specific findings included a large effect size (Cohen's d=0.8) for the relationship between time spent on social media and the desire for aesthetic enhancements. Individuals spending more than 3 hours per day on social media platforms were twice as likely to consider aesthetic procedures compared to those with less usage, with a 95% confidence interval indicating robustness in these findings. CONCLUSION: Confirming the reinforcing effect of social media on aesthetic decision-making, this study highlights the complex interplay between digital media exposure, altered self-perception, and the increased inclination towards aesthetic procedures. It suggests a critical need for practitioners to carefully navigate the digital influence on patient's desires, reinforcing the significance of understanding psychological motivations and societal pressures in clinical aesthetics. This comprehensive analysis offers pivotal insights for clinical practice and ongoing research into social media's role in contemporary beauty standards. 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 .

The influence of social media on public attitudes and behaviors towards cosmetic dermatologic procedures and skin care practices: A study in Saudi Arabia.

BACKGROUND: Social media has fostered a landscape where trends, ideals, and beauty standards have significantly proliferated. Images of flawless skin, sculpted features, and curated aesthetics inundate user feeds, potentially shaping their self-perceptions and aspirations. The rise of influencers, dermatologist social media engagement, and beauty campaigns sharing skincare routines and product recommendations wield substantial influence over individual appearance-related decisions. AIMS: The main aim of this study is to determine the pattern of behavior in using social media to seek dermatological procedures and skin care routine. METHODS: We conducted a nationwide, online cross-sectional study targeting the general Saudi population. Our survey aimed to understand participant social media behaviors and gather insights into skincare products, cosmetic procedures, and makeup habits. RESULTS: Gender-related differences emerged in seeking skincare advice. Females preferred dermatologists on social media (p < 0.001) and beauty influencers (p < 0.001), whereas men leaned towards pharmacists (p < 0.001). Women displayed stronger engagement with dermatologist social media reputation regarding non-cosmetic concerns (p < 0.001), education (p < 0.001), and social media impact on cosmetic decisions (p = 0.001). They frequently sought dermatologists on social media before appointments (p = 0.001), whereas men emphasized dermatologists' fame (p = 0.024). Common cosmetic barriers included high costs (62.5%), complications (40.3%), and trust issues (40.2%). Women underwent various cosmetic procedures (p < 0.05), influenced by social media in their decisions and skincare routines. CONCLUSIONS: Our study reveals significant gender-based disparities in seeking skincare advice. Women rely on social media, clinics, friends, and beauty influencers, whereas men prefer pharmacists. Additionally, women depend on dermatologists' social media reputation and conduct thorough pre-appointment research. Their heightened social media engagement links to skincare practices and influences cosmetic procedure considerations based on age and usage frequency.

Sociocultural pressures and engagement with cosmetic products and procedures in adult women.

Previous studies have shown that cosmetic procedures and products that perpetuate Western hegemonic beauty standards among women have become increasingly popular, and pressures from sociocultural agents to utilize them are significant. However, little work has documented the relationship between perceived sociocultural pressures and use of cosmetic procedures and products among a larger age range of adult women. A community sample of 308 women aged 18-66, mean (SD) age of 35.7 (9.7), reported on the cosmetic procedures they had considered or used, as well as perceived pressures from the media, peers, romantic partners, and health and beauty professionals. Findings revealed that, among those investigated, the most frequently utilized products and procedures were supplements and hair removal. However, a significant minority reported considering more invasive procedures, including cosmetic surgery. Media was the predominant source of pressure, while partners were the least frequently endorsed. While pressure from professionals and peers had small-to-moderate associations with utilization of cosmetic products and procedures, pressure from partners had the largest association with their use. This work frames important future directions for examining the impact of sociocultural pressures on women's willingness to utilize cosmetic products and procedures that are sometimes underregulated and risky for physical and mental health.

LetibotulinumtoxinA Attenuates the Psychological Burden of Glabellar Lines and Is Associated With High Subject Satisfaction in Phase 3 Clinical Trials.

BACKGROUND: Hyperfunctional glabellar frown lines can transmit facial miscues that adversely affect emotional communication, increase perceptions of age, and diminish self-esteem. OBJECTIVE: To evaluate the efficacy of letibotulinumtoxinA in mitigating the negative psychological impact associated with moderate to severe glabellar lines and to assess subject satisfaction with treatment outcome in the BLESS phase 3 clinical trials. MATERIALS AND METHODS: Baseline and posttreatment assessments were made using validated subject-administered instruments: Modified Skindex-16 Glabellar Line Quality of Life (GL-QoL) Scale, Facial Assessment and Cosmetic Evaluation Questionnaire (FACE-Q) Appraisal of Lines Between Eyebrows Scale, FACE-Q Age Appraisal Visual Analog Scale, and FACE-Q Satisfaction with Outcome Scale. An integrated analysis using pooled BLESS data was conducted on these secondary end points. RESULTS: Among enrolled and treated subjects ( N = 1,272), 85.5% had moderate to severe psychological impact at baseline. LetibotulinumtoxinA subjects experienced significant improvements compared with placebo on all measures. Mean improvement to Week 4 for the Modified Skindex-16 GL-QoL Scale overall score was -33.84 for letibotulinumtoxinA subjects compared with -1.37 for placebo subjects ( p < .001). Attenuation of psychological burden was highly correlated with improvement in glabellar line severity ( p < .0001). CONCLUSION: LetibotulinumtoxinA significantly improved the psychosocial burden associated with glabellar lines across all trials. Treated subjects experienced improved quality of life, younger perceived age, and satisfaction with treatment outcome.

The SKIN-Q: An Innovative Patient-Reported Outcome Measure for Evaluating Minimally Invasive Skin Treatments for the Face and Body.

Background: As the aesthetics field continues to innovate, it is important that outcomes are carefully evaluated. Objectives: To develop item libraries to measure how skin looks and feels from the patient perspective, that is, SKIN-Q. Methods: Concept elicitation interviews were conducted and data were used to draft the SKIN-Q, which was refined with patient and expert feedback. An online sample (i.e., Prolific) provided field-test data. Results: We conducted 26 qualitative interviews (88% women; 65% ≥ 40 years of age). A draft of the SKIN-Q item libraries were formed and revised with input from 12 experts, 11 patients, and 174 online participants who provided 180 survey responses. The psychometric sample of 657 participants (82% women; 36% aged ≥40 years) provided 713 completed surveys (facial, n = 595; body, n = 118). After removing 14 items, the psychometric analysis provided evidence of reliability (≥0.85) and validity for a 20-item set that measures how skin feels and a 46-item set that measures how skin looks. Short-form scales were tested to provide examples for how to utilize the item sets. Conclusion: The SKIN-Q represents an innovative way to measure satisfaction with skin (face and body) in the context of minimally invasive treatments.

An Evidence-based Pathway for Body Dysmorphic Disorder in Facial Aesthetics.

Aesthetic procedures should be avoided in patients with body dysmorphic disorder (BDD) since they can negatively impact mental health and lead to further aesthetic dissatisfaction. There are no evidence-based patient pathways for BDD in facial aesthetics which can result in the failure to identify patients with BDD, leading to unsuitable treatments and suboptimal patient care. We aim to construct the first evidence-based patient pathway for BDD in surgical and nonsurgical facial aesthetics. A systematic review was performed and articles that discussed screening or patient pathways for BDD in field of facial aesthetics were included. We extracted relevant information from each article on screening tools and pathways for BDD. Data were synthesized by summarizing the data under column headings into a structured narrative and into new tables. Based on this synthesis, a practical pathway for BDD was constructed. Forty articles fulfilled the criteria for inclusion. Twenty-eight BDD screening tools were discussed in the included articles, and we provide an overview of these tools. Thirty-one articles discussed patient pathways for BDD, and we synthesized this information into a structured narrative. Combining these findings, we present an evidence-based patient pathway for BDD for patients presenting for facial aesthetic treatments. This systematic review has resulted in the first, evidence-based, patient pathway for BDD in surgical and nonsurgical facial aesthetics. This practical pathway can be used by aesthetic clinicians to identify patients with potential BDD and provide clear guidance for managing cases where BDD is suspected. It will help reduce the number of facial aesthetic procedures performed on patients with BDD, safeguard patient mental well-being, and prevent further aesthetic dissatisfaction.

Minimally invasive cosmetic procedures for mothers of brides: Strategies and considerations.

The pivotal role of the bride's mothers in wedding celebrations is an effective motivation to seek cosmetic therapies, making them frequent patients in a dermatologists' offices. Addressing their aesthetic concerns contributes to their holistic well-being, but faces an intricate relationship between time availability, financial factors, and the critical emotional context. This article underscores the varying behavioral patterns of mothers of brides when seeking aesthetic treatments, providing tailored strategies for effective communication and decision-making, based on individual personalities. Additionally, this paper presents a specific timeline for the implementation of these interventions, including neuromodulators, collagen stimulators, and fillers. Understanding the unique traits and expectations of this particular population can lead to improved patient satisfaction, enhanced outcomes, and an overall positive experience.

Redefining Beauty: A Qualitative Study Exploring Adult Women's Motivations for Lip Filler Resulting in Anatomical Distortion.

BACKGROUND: Lip filler enhancement has fast become one of the most popular minimally invasive cosmetic procedures. Motivations for "overtreatment" with lip fillers are poorly understood. OBJECTIVES: The aim of this study was to explore female motivations for and experiences of procedures that achieve an aesthetic of distorted lip anatomy. METHODS: Twenty-four females who had undergone lip filler procedures resulting in strikingly distorted lip anatomy, determined by the Harris classification of filler spread, took part in semistructured interviews about their motivations, experiences, and perceptions related to lip fillers. A qualitative thematic analysis was carried out. RESULTS: Four major themes are discussed: (1) the normalization of lip fillers, (2) perceptual drift which is mediated by exposure to repetitive images of larger lips on social media, (3) perceived financial and social benefits of larger lips, and (4) the relation between mental health and seeking repeated lip filler procedures. CONCLUSIONS: Motivations for seeking lip fillers vary, but most subjects described social media impacting perceived aesthetic norms. A process of perceptual drift occurs whereby mental schema encoding expectations of "natural" facial anatomy can adapt through repeated exposure to enhanced images. The results can inform aesthetic practitioners and policymakers seeking to understand and support those seeking minimally invasive cosmetic procedures.

High Patient Satisfaction for up to 6 Months With OnabotulinumtoxinA Treatment for Upper Facial Lines.

BACKGROUND: OnabotulinumtoxinA safety and efficacy are well established for upper facial lines (UFL), including forehead lines (FHL), glabellar lines (GL), and crow's feet lines (CFL). OBJECTIVE: To investigate the association of onabotulinumtoxinA efficacy with patient-reported psychological impacts and satisfaction in UFL. MATERIALS AND METHODS: A pooled analysis of data from 4 pivotal Phase 3 trials (onabotulinumtoxinA vs placebo in FHL ± GL, FHL + GL ± CFL, CFL, and CFL + GL for ≤180 days) evaluated investigator-assessed ≥1-grade severity improvement on the Allergan Facial Wrinkle Scale at Day 30 (responders). Facial Line Outcomes (FLO-11) Questionnaire, Facial Line Satisfaction Questionnaire (FLSQ), and Subject Assessment of Satisfaction of Appearance (SASA) were used to evaluate responder appearance-related psychological impacts and satisfaction. RESULTS: OnabotulinumtoxinA patients, by primary study focus (FHL, GL, or CFL), totaled 921, 921, and 833, respectively; 786 patients received placebo. Most patients were female, White, and aged 45 to 50 years (median). Through 150 days, >42% FHL, >43% GL, and ≥32% CFL patients were onabotulinumtoxinA responders. Responders reported improvements in appearance-related psychological impacts (FLO-11) and high satisfaction (FLSQ and SASA), sustained through ≥150 days. CONCLUSION: A ≥1-grade improvement with onabotulinumtoxinA is a clinically meaningful outcome in UFL, associated with long-lasting improved patient-reported psychological impacts and high satisfaction.

Dermal Filler Injections in Patients With Autoimmune and Inflammatory Rheumatic Diseases-The Patients' Perspective.

BACKGROUND: Injecting dermal fillers in patients with autoimmune inflammatory rheumatic diseases (AIIRDs) is controversial. OBJECTIVE: To evaluate the attitudes of patients with AIIRDs regarding the use of dermal fillers and the side effects of those who underwent them. METHODS: Patients with AIIRDs who attended a rheumatology outpatient clinic between 2016 and 2018 filled in a questionnaire about their attitudes toward dermal filler injections. The questionnaire evaluated information received from professionals and the factors that influenced their decision of whether or not to undergo the procedures. RESULTS: Overall, 194 patients with AIIRDs (mean age 56.5 ± 14.0, 99% women) responded. Forty-two of them had previously undergone the injections and intended to repeat them (Group A), 37 had not received filler injections but intended to do so (Group B), and 114 who had never undergone them did not intend to undergo them. The major motivation for undergoing filler injections was social. Patients treated with dermal fillers refrained from informing their rheumatologist about their injections. They were, however, highly satisfied with the procedure and reported negligible side effects. CONCLUSION: The use of dermal fillers was apparently safe and well received by patients with AIIRDs. Physicians' recommendations to refrain from injecting them with dermal fillers should be reconsidered and evaluated in clinical studies.

Impact of Direct-to-Consumer Advertising of Cosmetic Procedures on Consumers.

BACKGROUND: Direct-to-consumer (DTC) advertising is a prominent type of health care communication. OBJECTIVE: This study aims to determine the impact of DTC advertisements on consumer opinion. METHODS: A total of 203 participants were recruited from dermatology clinics at an urban academic center. Participants viewed 2 cosmetically oriented DTC advertisements, and prequestionnaires and postquestionnaires were administered to assess consumer opinion. RESULTS: Postquestionnaire data highlight a 18.8% and 24.6% increase in participants reporting using commercials as an information source (p < .001) and seeking out additional medical knowledge (p < .001), respectively. After watching the advertisements, there was a 14.4% increase in participants who believed advertisements facilitate better discussions between patients and physicians (p < .001) and a 33% increase in patients reporting they would discuss the procedures with their doctors (p < .001). Of the participants, 60% believed the advertisements did not provide enough information about the possible risks of the product and 39.4% believed a physician was not required to perform cosmetic procedures. CONCLUSION: Direct-to-consumer advertisements instill meaningful information to patients and promote patient-physician communication. They also seem to exaggerate the benefits while making the procedures seem simple and without risks, suggesting trained medical professionals are not needed for administration.

Providing Optimal Rejuvenation to the Jawline and Perioral Area Using Neuromodulators and Hyaluronic Acid Dermal Fillers.

Including the jawline in aesthetic assessment has become increasingly popular when using both surgical and nonsurgical techniques. Facial aging processes include bone resorption, fat pad atrophy, and a breakdown of the quality of collagen and elastin in the skin. To provide optimal treatment of the jawline using nonsurgical techniques, it is important to consider all of these aspects before planning treatment. Men and women have different facial aging processes and ideal facial ratios that must be respected. The objective of this article is to discuss the use of botulinum toxin A and hyaluronic acid filler injectable treatments, deoxycholic acid injectable treatments, and cryolipolysis treatments and explain how these treatments can be utilized for optimal rejuvenation of the jawline and perioral area.

What Women Want: Women's Perspectives on Male Cosmetic Procedures.

BACKGROUND: The rate of growth for male cosmetic treatments has slowed in the past 5 years. There is limited data on why men may not seek cosmetic treatments. OBJECTIVE: To evaluate women's perspectives on male cosmetic treatments. METHODS: Heterosexual female patients (single (n = 64); in a relationship/married (IR/M) (n = 136)) completed an online survey. RESULTS: 87.5% of single and 36.03% of IR/M women reported that men are bothered by signs of aging (p < .0001). However, both single and IR/M women reported that men are interested in (single: 77.78%, IR/M: 65.44%) and will benefit (single: 93.55%, IR/M: 67.31%) from cosmetic procedures. Both groups of women (single: 93.75%, IR/M: 83.82%, p < .0530) indicated, however, that men are reluctant to seek cosmetic treatments. Societal stigma/perception of masculinity was the number one cited reason (single: 87.1.75%, IR/M: 73.02%, p < .0264). However, 87.5% of single and 94.86% of IR/M women (p = .0659) reported that male cosmetic treatments will not affect their perceptions of masculinity. Furthermore, 95% of women (single: 95.31%, IR/M: 95.59%, p = .9292) reported that they will support their partners from pursuing cosmetic treatments. CONCLUSION: Women strongly believe that men can benefit from cosmetic treatments, do not believe cosmetic treatments affect masculinity, and are overwhelmingly supportive of male cosmetic treatments.

Dermatologists' Perceptions and Confidence in Cosmetic Care for Male Patients.

BACKGROUND: Despite a growing interest in nonsurgical cosmetic procedures in men, the utilization of aesthetic treatments remains comparatively low, suggesting the presence of barriers to care. OBJECTIVE: To describe barriers to cosmetic intervention for male patients from the perspective of dermatologists. MATERIALS AND METHODS: An anonymous, online survey was distributed through a listserv made available by the American Academy of Dermatology. RESULTS: Dermatologist respondents perceived a low utilization of cosmetic services in male patients (5%) and a lack of opportunity (72.3%) to provide such services. Respondents also perceived a lack of sufficient education/training (40.9%), experience (20.5%), and a lack of evidence in the field (20.5%) for dermatologists as potential barriers to cosmetic care for male patients. Presence of targeted messaging and in-office educational materials for male patients was found to be associated with increased utilization of cosmetic treatments by male patients (p = .012, p = .012, respectively). Dermatologists reported strong confidence in delivering various noninvasive cosmetic treatments to male patients. CONCLUSION: Despite dermatologists' reported confidence in performing cosmetic procedures in men, many perceive insufficient education/training and experience with this population which may create barriers to cosmetic care for male patients. Increasing educational materials and targeted messaging to male patients may decrease barriers for patients to receive desired cosmetic care.

Assessing Unrealistic Expectations in Clients Undertaking Minor Cosmetic Procedures: The Development of the Aesthetic Procedure Expectations Scale.

Objective: To develop and validate a novel patient-reported measure to assess internally and externally driven expectations for change after a cosmetic procedure, termed the aesthetic procedure expectations (ASPECT) scale. Method: In total, 186 adults recruited from nonsurgical cosmetic clinics in Melbourne, Australia, accessed an online survey (150 completed; 81% response rate) including the novel ASPECT questionnaire, demographics, and measures of psychological distress. Results: The final sample included 141 women and 5 men with a mean age of 44.78 years (standard deviation = 11.68) with <10% missing data. Results supported a two-factor ASPECT scale measuring intrinsic and extrinsic expectations, with high internal consistency and convergent validity. Heightened extrinsic and intrinsic expectations were both associated with individuals who were emotionally distressed, younger, and had previously undertaken more cosmetic procedures. Cutoff scores for the ASPECT subscales are proposed to aid cosmetic practitioners in identifying clients requiring further assessment. Conclusions: The ASPECT scale may provide a reliable and useful clinical tool for cosmetic practitioners to assess unrealistic expectations and determine which clients may require more in-depth consultation before undergoing surgical or nonsurgical cosmetic treatment.

Observer-Reported Outcomes and Cosmetic Procedures: A Systematic Review.

BACKGROUND: Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions. OBJECTIVE: The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck. PATIENTS, METHODS AND MATERIALS: PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations. RESULTS: These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency. CONCLUSION: The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.