Facial Aesthetic Priorities and Concerns: A Physician and Patient Perception Global Survey.

BACKGROUND: Minimally invasive and noninvasive facial aesthetic treatments are increasingly popular, and a greater understanding of patient perspectives on facial aesthetic priorities is needed. OBJECTIVES: The authors surveyed facial aesthetic concerns, desires, and treatment goals of aesthetically conscious men and women, and physicians, in 18 countries. METHODS: This was a global, internet-based survey on desired appearance and experiences with, or interest in, facial aesthetic treatments. Eligible respondents were aesthetically conscious adults (21-75 years). Eligible aesthetic physicians were required to see ≥30 patients per month for aesthetic reasons, have 2 to 30 years of experience in clinical practice, and spend ≥70% of their time in direct patient care. RESULTS: A total of 14,584 aesthetically conscious adults (mean age, 41 years; 70% women) and 1315 aesthetic physicians (mean age, 45 years; 68% men) completed the survey. Most respondents (68%) reported that aesthetic procedures should be sought in their 30s to 40s; physicians recommended patients seek treatment earlier. Respondents expressed greatest concern over crow's feet lines, forehead lines, facial skin issues, hair-related concerns, and under-eye bags or dark circles; in contrast, physicians tended to underestimate concerns about under-eye bags or dark circles, mid-face volume deficits, and skin quality. Although both physicians and respondents cited cost as a major barrier to seeking aesthetic treatments, respondents also emphasized safety, fear of injections or procedure-related pain, and concern about unnatural-looking outcomes. CONCLUSIONS: This global survey provides valuable insight into facial aesthetic concerns and perspectives that may be implemented in patient education and consultations to improve patient satisfaction following aesthetic treatments.

#Botox 101: Subgroup Analysis of Twitter's Top 101 Neurotoxin Influencers.

BACKGROUND: Recent studies demonstrate that board-certified plastic surgeons and dermatologists are underrepresented in posting public-directed marketing content about botulinum toxin A on YouTube. However, educational content and peer-to-peer social media influence regarding the topic of neurotoxins has not been studied. Twitter is a social media platform that has emerged as a unique network for public education and for the exchange of ideas among physicians. OBJECTIVE: The purpose of this study is to identify Twitter's top social media influencers on #botox, to describe their characteristics and to relate their social media influence to academic influence. METHODS: Twitter influence scores for the topic search #botox were collected in January 2019 with Right Relevance software. #Botox was the only neurotoxin term with sufficient activity to generate an influencer list. The user accounts associated with top influencers were connected to individual names, identification as a plastic surgeon or dermatologist, board certification status, location, and academic h-index. RESULTS: The top 101 Twitter influencers on #botox are presented. Seventy-five percent of influencers are physically located in the United States. Academic h-index of #botox social media influencers ranged from 0 to 62 (mean, 8.6). CONCLUSION: This study shows that the top #botox social media influencers on Twitter and primarily board-certified or eligible plastic surgeons located in the United States. This study also elucidates the influencer network within which other plastic surgeons and dermatologists can interact to augment their own influence within the social media network. This is the first study to describe social media influencers in this way.

Topicals in skin rejuvenation: prescription topicals.

With the recent proliferation of over the counter cosmeceuticals, prescription topical skin treatments have the cache of being evidence-based and not being available outside the setting of a patient-physician interaction. In the setting of facial rejuvenation, patient demand for prescription topical skin treatments falls into three main roles: (1) stimulation of collagen production; (2) improvement of dyspigmentation; and (3) amelioration of adult acne.

Future directions in facial rejuvenation.

Future directions in the advancement and refinement of facial rejuvenation techniques represent a response to patient demand for higher aesthetic impact with less procedural downtime and with minimal scarring as evidence of previous surgery. With surgical procedures, the trend of innovation in response to demand has been toward more minimally invasive approaches that have the predictability and durability of results of more traditional approaches. With nonsurgical procedures, there have been new developments in achieving more significant aesthetic improvements with less downtime and less invasively.

Diffuse fasciitis with eosinophilia developing after local irradiation for breast cancer.

This case describes a patient who developed diffuse fasciitis with eosinophilia (DFE) after an exaggerated local response to radiation following excision of a lymph node-negative breast cancer. Our patient's fasciitis was diffuse, involving both upper and lower extremities and the trunk at sites distant from the irradiation and tumor site. The fasciitis progressed after curative excision of the breast cancer rather than concurrently with active breast cancer and persisted despite therapy; there was no tumor reoccurrence. With three published cases linking localized eosinophilic fasciitis with breast cancer, and with the literature suggesting that DFE commonly presents after a traumatic trigger, the possibility that radiation therapy for breast cancer could be one such trigger is an important insight for clinicians treating the many patients who undergo breast cancer treatment each year.