Do Google Trends Correlate with the Number of Facial Plastic Surgery Procedures Performed in the United States?

INTRODUCTION: Cosmetic facial surgical procedures have become increasingly popular. Previous studies have shown an association between Internet searches for and volume of these procedures being performed. There is a paucity of data on the correlation between Google Trends search volumes and actual number of facial plastic surgery procedures performed. METHODS: Google Trends, a tool that collects and analyzes the results from Google, was used to identify the average search volumes of popular facial plastic surgery procedures between 2004 and 2020. The identified search terms were correlated with the actual number of facial plastic surgery procedures done as reported by the American Society of Plastic Surgeons. A Spearman's rank correlation coefficient was completed to determine correlation between the two variables. RESULTS: There were very weak to moderate correlations between relative search volume (RSV), the ratio of a query's search volume to the sum of the total search volume over a given time period, of procedures with the number of procedures performed in the same or following year. Of the six terms (blepharoplasty, cheek implant, neck lift, mentoplasty, rhinoplasty, rhytidectomy) evaluated, correlation of RSV and number of procedures completed in the same year and the following year showed very weak to moderate correlations. The associated searches for the terms were related to specifics of a procedure including cost, before and after photos, different terms for a given procedure, or other related procedures. CONCLUSION: This study showed that RSV for common cosmetic plastic surgery procedures did not significantly correlate with the number of procedures performed annually in the United States. More research is needed to further understand the use of Google Trends in gauging patient interest in a procedure and understanding what patients seek to learn about a procedure.

Delayed Granulomas as a Complication Secondary to Lip Augmentation with Dermal Fillers: A Systematic Review.

Introduction Lip augmentation with dermal filler is rising in popularity. There are generally minimal side effects that are mild and transient. However, long-term complications may occur and include lumps, bumps, nodules, or granulomas. To better understand this uncommon but challenging outcome, we aim to perform a thorough systematic review of the published literature related to nodule or granuloma formation after cosmetic soft tissue augmentation of the lips. Methods A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in April 2021 and included PubMed, ScienceDirect, Embase, Google Scholar, and Cochrane databases. The Medical Subject Headings (MeSH) terms used included the following terms: "lip filler," "hyaluronic acid," "lip injection," "lip augmentation," "silicone," "poly-L-lactic acid," "calcium hydroxyapatite," "polymethylmethacrylate," "complications," "reaction," "granuloma," and "nodule." All studies were reviewed by two independent reviewers. Any discrepancies were resolved by a third reviewer. Results The initial search for filler-related nodules or granulomas yielded 2,954 articles and 28 were included in the final analysis containing 66 individual cases of lip nodules. All but one patient was female. The mean age was 50 years. Nodules presented on average 35.2 months or 2.9 years after initial treatment. Thirty-seven nodules underwent histological analysis, the majority of which identified the presence of a foreign-body granuloma. Silicone was the most reported filler used followed by hyaluronic acid. Most cases resolved following multiple treatments including oral antibiotics or steroids followed by surgical excision. Conclusion Understanding the sequelae of lip augmentation with filler products allows clinicians to provide safe and effective treatment. Nodules that present months to years following dermal treatment may represent a foreign-body granuloma. A combination of oral antibiotics, intralesional or oral steroids, and surgical excision successfully treated the majority of cases in our study.

Delayed Complications following Dermal Filler for Tear Trough Augmentation: A Systematic Review.

Tear trough deformity is a popular target for the treatment with filler injections. The side effects are generally mild and transient. However, delayed complications may occur. We aim to perform a thorough systematic review of the published literature related to delayed complications after tear trough filler injections. A search of published literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in June 2021 and included PubMed, ScienceDirect, and Embase databases. The Medical Subject Headings (MeSH) terms used included the following terms: delayed complications, nodules, granulomas, swelling, discoloration, dermal filler, hyaluronic acid (HA), polyacrylamide, calcium hydroxyapatite (CaHA), poly-L-lactic acid (PLLA), eyelid, periorbital, periocular, and tear trough. Twenty-eight articles consisting of 52 individual cases were included in the final analysis. 98% (51/52) of patients were female and had an average age of 48.3 years. HA was the most reported product (71.2%, 37/52), followed by PLLA (4/52, 7.7%), and CaHA (4/52, 7.7%). The most common delayed complication with any dermal filler was swelling (42.3%, 22/52) followed by lumps or nodules (25.0%, 13/52). Xanthelasma-like reaction (17.3%, 9/52), migration (7.7%, 4/52), discoloration (3%, 3/52) also occurred. The average time of onset of any complication was 16.8 months with xanthelasma-like reaction appearing soonest (mean: 10 months) and discoloration appearing latest (mean: 52 months). Most swelling cases were caused by HA. Semi-permanent fillers such as PMMA and synthetic fillers such as PLLA were more likely to be associated with lumps and nodules than other complications. It is important that clinicians who perform tear trough augmentation with dermal fillers have a thorough understanding of the risks of the procedure to diagnose and manage them promptly as well as provide patients with accurate information regarding the potential adverse effects.

Perspectives on Advance Care Planning for Patients with Hematologic Malignancy: An International Clinician Questionnaire.

Rationale: Critical illness is common in patients with hematologic malignancy (HM). Advance care planning (ACP) can allow these patients to express their care preferences before life-threatening illnesses. Objectives: To evaluate physicians' perspectives surrounding ACP in patients with HM. Methods: We administered a survey to intensivists and hematologic oncologists who care for patients with HM across Canada and the United Kingdom. Potential respondents were identified from institutions that have a hematologic-oncology program. The survey was disseminated electronically. Results: A total of 111 physicians completed the survey, with a response rate of 19% (39% across those who opened the e-mail); 52% of respondents were intensivists, and 48% of respondents were hematologic oncologists. Of the responses, 15.5% of physicians reported that ACP happens routinely at their institution, whereas 8.3% of physicians stated that code status is routinely discussed. ACP discussions were most commonly reported at the onset of critical illness (84.3% of respondents), during disease recurrence (52.9% of respondents), or during the transition to a strictly palliative approach (54.9% of respondents). Commonly cited barriers to ACP centered on physicians' concern about the reaction of the patient or family. Conclusions: This study emphasizes the need for earlier and more frequent ACP discussions in this high-risk population with a variety of barriers identified.

Pigmented solar (actinic) keratosis: an underrecognized collision lesion.

BACKGROUND: The lack of well-established diagnostic criteria for pigmented solar (actinic) keratosis (PSK) along with its poorly understood etiopathogenesis has contributed to underrecognition. OBJECTIVE: The clinical, dermatoscopic, and histopathologic features of PSK and the cause of the pigmentation are elucidated. METHODS: In all, 167 histologic specimens, 22 clinical images, and 17 dermatoscopic images of PSK were reviewed. In 38 cases, Melan-A-stained sections were available for analysis. RESULTS: The majority of the lesions were located on the head and neck (84%). A separate pigmented lesion was adjacent to or admixed within PSK in 138 (83%) of the cases indicating that PSK represents a collision between a nonpigmented solar keratosis and a pigmented lesion. Solar lentigo (72%) was the most commonly associated pigmented lesion followed by seborrheic keratosis and melanoma. PSK was suspected clinically in 17% of the cases. There were no significant differences in the quality and quantity of the melanocytes between pigmented and nonpigmented solar keratosis. LIMITATIONS: This was a single-center retrospective study. The sample sizes were small for the clinical and dermatoscopic images and Melan-A stains. CONCLUSION: In the majority of the cases, a collision between a nonpigmented solar keratosis and a separate coexistent pigmented lesion, primarily a solar lentigo, accounts for the pigmentation in PSK rather than from any fundamental changes in the quantity or quality of the melanocytes. The collision phenomenon accounts for the spectrum of the clinical and dermatoscopic features observed in PSK and its underrecognition.

Porokeratosis ptychotropica: a clinically distinct variant of porokeratosis.

Porokeratosis represents a spectrum of clinical disease. Multiple variants have been described including porokeratosis ptychotropica, a rare subtype. The clinical presentation of porokeratosis ptychotropica frequently resembles an inflammatory perianal disease. We report a patient with porokeratosis ptychotropica with coexistent disseminated superficial actinic porokeratosis. We review the current literature on porokeratosis ptychotropica including the clinical presentation, histopathology, cause, and pathogenesis of this rare variant of porokeratosis.

Pseudoxanthoma elasticum is a recessive disease characterized by compound heterozygosity.

Pseudoxanthoma elasticum (PXE) is caused by mutations in the ABCC6 gene. Historically, PXE has been suggested to be inherited either in an autosomal dominant or autosomal recessive manner. To determine the exact mode of inheritance of PXE and to address the question of phenotypic expression in mutation carriers, we identified seven pedigrees with affected individuals in two different generations and sequenced the entire coding region of ABCC6 in affected individuals, presumed carriers with a limited phenotype and unaffected family members. Two allelic mutations were identified in each individual with unambiguous diagnosis of PXE, as well as in those with only minimal clinical signs suggestive of PXE but with positive skin biopsy. Missense mutations were frequently detected in the latter cases. In conclusion, PXE is inherited in an autosomal recessive manner and presence of disease in two generations is due to pseudodominance.