Using artificial intelligence to analyze emotion and facial action units following facial rejuvenation surgery.

INTRODUCTION: There remains a lack of standards in facial rejuvenation procedures, which may be attributed to the subjective measures used to determine surgical outcomes and success. The aim of this study was to evaluate the use of machine learning technology, i.e. FaceReader™, to objectively measure facial rejuvenation surgery outcomes. METHODS: Using a retrospective study design, we enrolled a cohort of patients undergoing high SMAS facelift with/without additional procedures during a one-year interval. The predictor variable was surgery done (pre- vs. postoperative). The outcome variables were 28 facial action units, happiness, and sadness emotions, detected by FaceReader™. Appropriate statistics were calculated at α = 0.05. RESULTS: The sample comprised of 15 patients (11 females, 15 Caucasians, mean age of 55.7 years). There was an average increase in detected happy emotion from 1.03% to 13.17% (p>0.01). Conversely, the average angry emotion detected decreased from 14.66% to 0.63% (p<0.05). There were no other distinct action unit patterns across the operation. CONCLUSION: Despite a small sample size, the results of this study suggest that FaceReader™ can be used as an objective outcome assessment tool in patients undergoing high SMAS facelift with/without its adjuncts.

Is There a Rejuvenating Effect of (Grand)Childcare? A Longitudinal Study on German Data.

OBJECTIVES: Provision of grandchild care has been found to be associated with a youthful subjective age. Yet, previous studies on this topic were cross-sectional and ignored the increasing proportions of older people growing old without the opportunity to become a grandparent. This study investigates the effects of childcare to grandchildren and to other children on subjective age using panel data. METHODS: We exploit the longitudinal nature of data from the German Ageing Survey (DEAS) to examine the association between grandparental childcare and care to other children with subjective age, using fixed-effects regression analyses on a sample of 50-85 years old individuals (men: N = 11,151; n = 3,984; women: N = 10,687; n = 3,746, where N is the number of observations and n is the number of individuals). RESULTS: The results from cross-sectional analyses show a "rejuvenating effect" of provision of both types of childcare in later life, especially for women. However, longitudinal analyses find very small and statistically insignificant effects. DISCUSSION: We show for the first time that both grandchild care and childcare outside the grandparent-grandchild relationship are associated with a youthful subjective age for older people. However, these associations are likely due to selection effects, that is, unobserved characteristics of people that make them more likely to engage in childcare and are also associated with subjective age. Our results warn against causal interpretation of associations found in previous studies, but also open up new research questions on the role played by childcare other than to grandchildren.

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.

Facial Rejuvenation with Concentrated Lipograft-A 12 Month Follow-Up Study.

Lipofilling is a popular technique to treat volume loss in aging patients. The isolated adipose tissue is composed of adipocytes and stromal vascular fraction cells, which include adipose-derived stem cells (ASC). We hypothesize that the patient's wrinkle severity scale (WSS) and patient's satisfaction on the global aesthetic improvement scale (GAIS) can be improved after using concentrated lipoaspirate. Fourteen patients (54 years ± 11.09 years) with volume loss in the midface area underwent waterjet-assisted liposuction (Human Med AG, Schwerin, Germany). Fat was centrifuged in an ACP Double Syringe (Arthrex GmbH, Munich, Germany) using Rotofix 32A centrifuge (Andreas Hettich, GmbH & Co.KG, Tuttlingen, Germany). Homogenization was performed using the double syringe and a 1.4 mm female-female luerlock connector. After a second centrifugation, patients received periorbital (PO) and nasolabial (NL) lipografting. ASC count was performed after enzymatical digestion. Vitality of cells was assessed using a resazurin assay. During long-term follow up (12 months, n = 10), we found a high patient's satisfaction (GAIS 1+/-0.52) and a good improvement of the WSS during short- and long-term follow-up. The ASC count of processed lipoaspirate was 2.1-fold higher than of unprocessed lipoaspirate (p < 0.001). The difference of ASC in sedimented and simply centrifuged lipoaspirate was also significant (p < 0.05). Facial rejuvenation with concentrated fat graft offers good results concerning objective aesthetic outcome and patient's satisfaction.

Subjective Evaluation of the Results of Injectable Hyaluronic Acid Fillers for the Face.

BACKGROUND: Skin ageing is a physiological process, progressive and irreversible. Hyaluronic acid injection treatments are used to correct the signs of skin ageing. MATERIAL AND METHODS: Hyaluronic acid was implanted in the area of the cheek and the forehead aesthetic units in 57 women, aged 35-55 years. Apart from the clinical observation, self-assessment of the therapeutic results was conducted. The "My skin" questionnaire was used for subjective evaluation of the treatment results. RESULTS: Mean wrinkle score in the pre-menopausal group changed after the treatment, from 3.2±0.6 to 1.1±0.3 and from 3.2±0.6 to 0.8±0.6 for the forehead and the cheek esthetic units, respectively. In the post-menopausal group, the score decreased from 3.8±0.4 to 1.7± 0.7 and from 3.2±0.617 to 0.8± 0.6 for the forehead and the cheek esthetic units, respectively. The changes were age-dependent. Improved appearance of the facial skin - higher satisfaction with skin tone and scent - was reported after hyaluronic acid injections. Higher subjective perception of improvement corresponded to older age, irrespectively of the menopausal status. Correlations between age and the effect of the treatment on maintaining proper skin hydration as well as between improved appearance of the forehead area and feelings of autonomy and well-being were found. CONCLUSION: Hyaluronic acid injections significantly improved the subjective perception and overall assessment of the scent and appearance of the facial skin.

Resistance and acceptance: Ambivalent attitudes toward the aging body and antiaging practices among older Korean migrants living in New Zealand.

Using intersectionality as a conceptual framework, this study investigated how older Korean women living in New Zealand perceived their aging bodies, antiaging practices and/or products, and how they used such products. Thematic analysis identified three themes: tension between acceptance of the aging body as an inevitable process and transformation of the aging body into a healthy body, juggling between abstinence and use of antiaging products and practices, and redefining natural aging. The findings challenge binary interpretations between "acceptance" of and "resistance" to the experiences of the aging process and the use of antiaging practices.

Understanding and treating different patient archetypes in aesthetic medicine.

BACKGROUND: Factors that motivate the treatment goals and expectations of the aesthetic patient reflect evolving social, cultural, and commercial influences. The aesthetic practitioner may often be faced with the challenge of first decoding the underlying motives that drive the patient to pursue their specific goals. The challenge for clinicians is further compounded by an increase in patient diversity with respect to race, ethnicity, age, and gender. AIMS: Simplify the path to patient interpretation with identification of primary patient archetypes. METHODS: The "Going Beyond Beauty" (GBB) initiative, consisting of 27 market research projects, was conducted to survey the primary goals and motives for seeking treatment aesthetic treatment. The results were stratified into predominant patient archetypes using segmentation analysis and then validated through online surveys, 1-to-1 interviews, and focus groups conducted with patients. An advisory board of internationally based aesthetic clinicians integrated the data with their own insights to further characterize each archetype. RESULTS: Data from over 54 000 participants in 17 different countries were distilled into four distinct patient archetypes based on motivating factors, aesthetic goals, initial treatment requests, and treatment opportunities and challenges. These archetypes were named Beautification, Positive Aging, Transformation, and Correction. CONCLUSION: The clinician's ability to recognize these four primary archetypes may provide a useful frame of reference to understand patient motives better, anticipate and manage their expectations, and provide the appropriate treatment guidance that best serves the long-term goals of their patients.

Injeção de agregados plaquetários no rejuvenescimento facial: uma revisão sistemática / Injection of platelet aggregates in facial rejuvenation: a systematic review

Introdução: Essa revisão sistemática foi conduzida para avaliar se a associação da aplicação da injeção de agregados plaquetários quando comparada a outras terapias faciais favorece no rejuvenescimento facial em pacientes adultos. Métodos: A pesquisa buscou ensaios clínicos randomizados que compararam uso de técnicas de rejuvenescimento facial isoladas com as mesmas técnicas aliadas à injeção de agregados plaquetários. A busca foi realizada em bases de dados indexadas e literatura cinzenta. A ferramenta de risco de viés da "Cochrane Collaboration" foi aplicada para a avaliação da qualidade dos estudos. Resultados: Foram identificados 7137 artigos. Apenas quatro estudos permaneceram na síntese qualitativa, e os demais foram considerados com risco indefinido de viés nos domínios chaves. Conclusão: Existem poucos estudos na literatura que comparam o uso de agregados plaquetários em rejuvenescimento facial e os que estão disponíveis têm risco de viés "indefinido" ou "alto". Há necessidade de realizar mais estudos clínicos bem delineados que comparem o uso de injeção de agregados plaquetários associados ou não às técnicas de rejuvenescimento facial.

Introduction: This systematic review was conducted to assess whether the use of a platelet aggregate injection with or without associated facial rejuvenation techniques favors facial rejuvenation in adult patients. Methods: Randomized clinical trials that compared the use of techniques for facial rejuvenation alone with the same techniques coupled with the injection of platelet aggregates were searched. The search was performed in indexed databases and in the gray literature. The Cochrane Collaboration bias risk tool was applied to assess the quality of the studies. Results: In total, 7137 articles were identified. Only four studies remained in the qualitative synthesis, and the others were considered as having undefined bias risk in the key domains. Conclusion: There are few studies in the literature that compare the use of platelet aggregates in facial rejuvenation and those that are available have a risk of "undefined" or "high" bias. There is a need for more well-designed clinical studies comparing the use of platelet aggregate injection with or without associated facial rejuvenation techniques.

Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip Plasty in Asians.

BACKGROUND: The objective of this study was to illustrate a novel technique for lifting of the aging upper lip with nasal tip plasty in Asians. With this procedure, a shortening of the philtrum, an increase of the vermilion, and a natural and nicer mouth can be obtained, with increase of the tip of the nose simultaneously. METHODS: Thirty patients were the subjects of this study. Incisions were made bilaterally beginning at the alar fold, entering nostrils, and rising medially on the skin below the lower margin of the medial crura. Excess skin of the philtrum was eliminated in two separate pieces and the muscle was suspended to the base of the nose with interrupted stitches. RESULTS: All patients expressed a high degree of satisfaction. The average ratio between the L1 reference line and the height of the upper lip measurement preoperatively was 0.43 ± 0.05. This ratio was improved postoperatively to an average of 0.32 ± 0.05. The nasolabial angle was 91.31 ± 4.19 degrees before surgery and 105.62 ± 5.04 degrees after surgery. The angle of the upper lip was 48.97 ± 2.41 degrees before surgery and 38.21 ± 3.34 degrees after surgery. CONCLUSIONS: Lip lift is an effective tool for correcting a natural tendency of the upper lip to cover the upper teeth during aging. There is a dramatic improvement in the patient's facial aesthetic appearance during smiling and at rest. The authors strongly recommend this technique as part of the surgical procedure to achieve a youthful face. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Assessment of the Impact of Perioral Rejuvenation With Hyaluronic Acid Filler on Projected First Impressions and Mood Perceptions.

BACKGROUND: Small-particle hyaluronic acid filler is approved for lip augmentation and correction of perioral rhytides. Treatment with this product may improve facial aesthetics, projected first impression, and self-perception of mood. OBJECTIVE: To determine the effect of perioral rejuvenation with hyaluronic acid on patient perception of mood and projected first impression. MATERIALS AND METHODS: Seventeen subjects underwent perioral rejuvenation treatment with small-particle hyaluronic acid filler. Each subject underwent photography and completed 2 surveys measuring self-perception of mood before treatment and after achieving an optimal cosmetic result. Aesthetic improvement with treatment was assessed using the Global Aesthetic Improvement Scale and the Oral Commissure Severity and Perioral Line Severity scales. Seventeen hundred blinded evaluators rated pre-treatment and post-treatment photographs of the subjects using a First Impressions Questionnaire. RESULTS: Perioral filler treatment significantly improved pre-treatment and post-treatment scores for happiness within the Happiness Measures Scale. This treatment was found to significantly improve projected first impression across all categories. CONCLUSION: Small-particle hyaluronic acid filler treatment for perioral rejuvenation is an effective method for improving physical appearance as well as first impressions. Larger studies are necessary to verify whether perioral rejuvenation with hyaluronic acid offers enhanced self-perception of mood.

Knowledge and attitude of women on genital cosmetic surgery at University College Hospital, Ibadan, Nigeria.

BACKGROUND: Female genital cosmetic surgery (FGCS) is performed in other to restore or enhance the female genitalia. MATERIALS AND METHODS: This is a cross-sectional study assessing the knowledge and attitude of 310 women attending gynaecology clinic towards FGCS at University College Hospital, Ibadan, Nigeria. Data were analysed using SPSS 20. RESULTS: Mean age of respondents was 33.28 ± 7.68 years. Majority were married (76.1%) in monogamous family (87.7%) and almost half (49.7%) were multipara. About 56.1% had vaginal delivery of which 84.5% had perineal tear or/and episiotomy. Overall, 27.7% had heard about FGCS and 84.2% had positive attitude towards the procedure. Respondents' age, marital status and occupation were associated with their knowledge and attitude to FGCS. Women with skilled occupation were more likely to have the knowledge and positive attitude to FGCS. CONCLUSION: The knowledge of FGCS was low; however, majority had positive attitude towards it because of its associated sexual and psychological satisfaction.

Quality of life before and after cosmetic procedures on the face: A cross-sectional study in a public service.

BACKGROUND: Quality of life can be impaired by health conditions that modify body appearance. AIMS: The objective of this cross-sectional study was to evaluate the quality of life of patients before and after free-of-charge esthetic dermatological treatments offered in a philanthropic Dermatological Clinic for nonpathological conditions, such as anti-aging procedures. METHODS: All consecutive patients admitted between March and November 2016 were recruited. All esthetic treatments in this study were simple procedures applied in one session only, on the face, neck, arms, and upper chest, with a consult visit scheduled four weeks later for clinical evaluation. The WHOQOL-BREF instrument was used before and one month after the procedure. RESULTS: WHOQOL-BREF scores increased significantly after treatment (P < 0.001) in all the domains. CONCLUSION: Patients undergoing simple dermatological treatments applied by specialists report overall and specific domain improvements in quality of life, according to the World Health Organization instrument, regardless of the type of procedure.

Vaginal Rejuvenation: A Review of Female Genital Cosmetic Surgery.

IMPORTANCE: Female genital cosmetic surgery (FGCS) is a growing area within the field of gynecology with an increasing number of patients asking providers about these services. OBJECTIVE: This review aims to increase the knowledge surrounding the types of FGCS performed, the outcomes and complications of these procedures, and the controversy surrounding FCGS. EVIDENCE ACQUISITION: This study is a review of the most recent peer-reviewed articles and review articles as well as guidelines and recommendations of the American College of Obstetrics and Gynecology. RESULTS: Female genital cosmetic surgery is a broad term that encompasses multiple procedures including labiaplasty, vaginoplasty, clitoral hoodectomy, hymenectomy, labia majora augmentation, and G-spot amplification. Minimal data exist regarding the long-term outcomes and complications associated with these procedures. There is also a paucity of literature comparing FGCS to less invasive alternatives. Significant controversy exists regarding FGCS, given the known variation in female genitalia, lack of safety data, and concern for proprietary conflict with these procedures. CONCLUSIONS AND RELEVANCE: Cosmetic gynecology surgery has become more popular in recent years, with few studies assessing the long-term benefits and harms of these treatments. Gynecologists should be aware of the lack of evidence supporting the effectiveness of FGCS in light of the growing marketing efforts and patient demand for these procedures.

Brazilian Consensus Recommendation on the Use of Polymethylmethacrylate Filler in Facial and Corporal Aesthetics.

BACKGROUND: Considering that aesthetic benefits can be obtained with the use of permanent filling materials, this work focuses on the development of a consensus regarding the facial and corporal use of polymethylmethacrylate (PMMA) filler in Brazil. METHODS: A questionnaire regarding PMMA treatment, which included items on the main indication, application site, volume of product applied, criteria for selection of the material, complications, contraindications, and individual professional experience, was distributed to the Expert Group members. In addition, the responses were summarized, constituting the starting point for the debate regarding the use of PMMA-based fillers on The First Brazilian PMMA Symposium to create a guideline to be followed in PMMA facial and corporal treatments. RESULTS: This survey involved 87,371 cases. PMMA treatment is recommended for restorative and aesthetic purposes in facial and corporal cases, particularly for facial balance. PMMA 30% filler is recommended in specific facial sites (nose, mentum, mandible angle, zygomatic arc, and malar). PMMA filler is contraindicated in other sites (lips) regardless of concentration. With regard to facial treatment, the juxtaperiostal is the application plane most recommended. For PMMA corporal application, intramuscular is the application plane most indicated, while intradermal and justadermal planes are contraindicated. The submuscular plane application is relative to PMMA filler concentration. The experts also inquired regarding the amount of PMMA recommended in each corporal site (50 mL in the calf, 100-150 mL in the gluteal region). CONCLUSION: These recommendations provide a guideline for physicians, supporting them to perform safe and efficacious treatment with PMMA fillers. LEVEL OF EVIDENCE V: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Elimination of Aesthetic Deformations of the Midface Area Our Experience.

INTRODUCTION: The aesthetic manifestations of the aging process in the cheekbone, cheek and infraorbital areas are especially concerning for patients, so rejuvenating interventions in these areas are most in demand. OBJECTIVE: To introduce the experience of our clinic for aesthetic manipulation using Aptos (anti-ptosis) thread lifting methods in the midface area. METHODS: Among the surgical interventions that we used were Aptos thread lifting methods both in combination with lower blepharoplasty, and without it. At the same time, special attention was paid to the individual approach, trying to minimize invasiveness and, most importantly, trying to achieve the effect of moving subcutaneous soft tissues to a new, more advantageous position from an aesthetic point of view, with their fixation to dense structures. RESULTS: The results of application of the presented methods to lift the cheek-zygomatic and infraorbital regions using Aptos methods were studied. In the overwhelming majority of cases, the results satisfied both surgeons and patients. CONCLUSIONS: Aptos methods for lifting the midface soft tissues, which we used, are quite effective for rejuvenating the aging face. LEVEL OF EVIDENCE IV: 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 .

Concentric Malar Lift in the Management of Lower Eyelid Rejuvenation or Retraction: A Clinical Retrospective Study on 342 Cases, 13 Years After the First Publication.

BACKGROUND: Lower eyelid rejuvenation can, unfortunately, induce scleral show even if the lower eyelid procedure is limited. This study was designed to assess the effectiveness and reliability of the concentric malar lift technique in two scenarios: the first, in rejuvenation of the mid-face and, the second, in reconstructive surgery for correction of congenital or acquired eyelids malposition. METHODS: The concentric malar lift technique was first published by Le Louarn (Aesthet Plast Surg 28(6):359-372, 2004). This retrospective study was carried out by analyzing data on patients operated on between January 2010 and January 2016. Patients operated on before 2010 were excluded because barbed thread sutures were not used in the first version of the technique. Patients after January 2016 were excluded to ensure adequate follow-up, and so 342 patients are included in the study. A total of 256 cases (75%) were for aesthetic mid-face lifting, and 86 cases (25%) were reconstructive surgeries for lower eyelid retraction. A spacer graft was used in 30 of these reconstructive cases (35%). The mean follow-up time was 13.6 months. All the concentric malar lifting procedures included strengthening the lateral canthus, which is a key element of the procedure. RESULTS: None of the patients developed secondary eyelid malposition, and all the cases of lower eyelid retraction displayed marked improvement both functionally and aesthetically. Two patients experienced loss of sensitivity of part in the infra-orbital nerve distribution for 4 months after the procedure. CONCLUSION: The concentric malar lift procedure enables the recruitment of a significant amount of skin into the lower eyelid: between 10 and 30 mm. It ensures better rejuvenation of the mid-face with minimal risk of lower eyelid malposition. In reconstruction of the lower eyelid lid, the concentric malar lift is able to reduce the need for skin grafting and a skin flap reducing the risks of visible scarring. LEVEL OF EVIDENCE IV: 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 .

Ritidoplastia com tunelização associada a lipoaspiração e descolamento reduzido / Rhytidectomy with tunneling combined with liposuction and reduced detachment

Introdução: Várias técnicas de rejuvenescimento facial buscam encontrar resultados satisfatórios com mínimas complicações. Com a introdução da lipoaspiração, a cirurgia da face teve um grande benefício na região cervical. O objetivo deste estudo é demonstrar a técnica de tunelização associada a lipoaspiração prévia e descolamento reduzido da face e plicatura do SMAS/ platisma para tratamento do envelhecimento facial. Métodos: Foram analisados retrospectivamente os resultados obtidos com 129 pacientes operados entre 2005 e 2015, com a tática cirúrgica proposta, aqui demonstrada. Resultados: Os pacientes apresentaram boa satisfação com a tática cirúrgica utilizada, baixo índice de complicações e retorno rápido ao trabalho. Conclusões: A ritidoplastia com tunelização associada a lipoaspiração e descolamento seletivo é efetiva, com boa mobilidade e segurança do retalho cutâneo suprajacente, reprodutível, sendo uma opção no tratamento do envelhecimento facial.

Introduction: Multiple facial rejuvenation techniques have been used to obtain satisfactory results with minimal complications. With the introduction of liposuction for facial surgery, treatment of the cervical region has improved. This study aimed to describe a technique using preceding liposuction combined with reduced detachment and plication of the superficial muscular aponeurotic system/platysma for treatment of facial aging. Methods: We retrospectively analyzed the results in 129 patients who underwent surgery between 2005 and 2015. Results: The patients reported satisfaction with the surgical technique, a low complication rate, and early return to work. Conclusions: Rhytidectomy with tunneling combined with liposuction and selective detachment is effective, with good mobility of the overlying skin flap; the technique is safe and reproducible, and is an option for the treatment of facial aging.