A Google Trends Analysis of Facial Plastic Surgery Interest During the COVID-19 Pandemic.

The COVID-19 pandemic has had a multitude of effects on daily life. Aesthetic and cosmetic surgery practices have been significantly reduced in their working capacity or closed during this time. We used Google Trends to gauge the public's interest in facial plastic surgery during this pandemic, and how it has changed over the preceding months. As local shelter-in-place orders are being lifted, interest in facial plastic surgery is increasing even in the context of an ongoing national pandemic. LEVEL OF EVIDENCE V: Letter to the Editor.

Google Trends as a Resource for Informing Plastic Surgery Marketing Decisions.

BACKGROUND: Celebrities have long influenced the medical decisions of the general population. By analyzing Google search data using Google Trends, we measured the impact of highly publicized plastic surgery-related events on the interest level of the general population in specific search terms. Additionally, we investigated seasonal and geographic trends around interest in rhinoplasties, which is information that physicians and small surgical centers can use to optimize marketing decisions. METHODS: Google Trends was used to access search data histories for three separate areas of interest: Kylie Jenner and lip fillers, Joan Rivers and plastic surgery, and rhinoplasty, which were then analyzed using two-tailed, two-sample equal variance t-tests. RESULTS: The average interest level in fillers increased by 30.31 points after Kylie Jenner announced that she received Juvéderm lip injections. The interest level in plastic surgery was decreased by 21.3% the month after Joan Rivers' death. Between January 2004 and May 2017, the average interest level for rhinoplasty was significantly different in January/December (67.91 ± 20.68) and June/July (70.12 ± 18.89) from the remaining calendar months (63.58 ± 19.67). Los Angeles, New York City, and Miami showed consistently high interest levels throughout the time period, while Tulsa, OK, showed a major interest increase between 2015 to 2016 of 65 points. CONCLUSIONS: A noticeable impact was observed in both celebrity cases on search term volume, and a seasonal effect is apparent for rhinoplasty searches. As many surgeons already employ aggressive Internet marketing strategies, understanding and utilizing these trends could help optimize their investments, increase social engagement, and increase practice awareness by potential patients. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Expert Consensus on Absorbable Advanced Suspension Technology for Facial Tissue Repositioning and Volume Enhancement.

BACKGROUND: Signs of facial aging include wrinkles, loss of subcutaneous volume, decreased tone, texture, and sagging of the skin. The objective of this review is to determine whether facial suspension absorbable sutures are a safe and effective modality for facial rejuvenation.

METHOD: A group of US plastic surgeons and dermatologists who practice medical aesthetics convened to review evidence obtained from literature searches and to reach a consensus on clinical practice guidelines for the use of facial absorbable suspension sutures.

RESULTS: Currently, there are different types of lifting sutures available. Absorbable, facial suspension sutures allow for superior repositioning of tissue along a vector line together with the added benefit of volumization of the area. These benefits are for patients who have moderate facial aging and require treatment beyond the use of injectable products only.

CONCLUSIONS: Treatment with absorbable facial suspension sutures, when performed properly, is associated with minor and infrequent complications and offers a beneficial clinical alternative to traditional facial rejuvenation techniques.

J Drugs Dermatol. 2017;16(7):661-666.

[Aging prevention, new surgical techniques and future options for facial rejuvenation]. / Prévention du vieillissement, techniques chirurgicales récentes et voies d'avenir de la chirurgie du rajeunissement facial.

Prevention of aging is mainly obtained through appropriate health practices, modulated by the genetic causes of aging. Causes of facial structural aging include gravity, volume loss, contraction of the mimic muscles and obviously biological aging of tissues. Among the very numerous new surgical technique of facial rejuvenation, we could point out: for the frontal region, obviously we are focus on the endoscopic and non-endoscopic frontal lifts. But also, we should note the transcutaneous Brow Shaping which with a well defined, step by step technique is indeed a simple way to improve a possible difficult situation; concerning the mid-face lift, as the main risk is the secondary eyelid malposition, a high Smas or a temporo-malar lift can be performed. It ensures a good temporal effect but there is nearly no improvement at the mid-pupilla level. A mid-face lift is nevertheless mandatory to achieve an efficient skin removal on the mid-pupilla line. This is performed most of the time with a complete orbicularis oculi muscle opening, and only with a small lateral opening in case of the concentric malar lift, which minimize the risk of eyelid malposition. Based on a new description of the lymphatic draining of the lower lid, a new treatment of the chemosis is proposed with a corticoid injection at infero-lateral part of the malar area, in the preperiosteal plane. For the oval, the DAO section and the suspension of the middle premasseter space beyond the anterior border of the masseter where the Smas overlies the buccal fat pad, stay efficients. Regarding the neck, the suspension of the posterior border of the platysma to the Loré's fascia, the digastric corset with or without a platysma corset are advanced and valuable techniques. Lately, a new option was described using a lateral skin-platysma flap to minimize platysma bands and even more recently a neck lift with fixation of the anterior platysma to the deep cervical fascia and suspension of the lateral platysma flap.

Modified Rhytidectomy that Produces a More Natural Look: Experience with 110 Cases.

BACKGROUND: Recognition of the effects of aging on the ear and the mechanisms leading to ear deformity associated with facelift procedures aid in achieving improved aesthetic results. In 2009, the author developed a novel rhytidectomy technique to provide more natural-looking results than those achieved through other facelift procedures, which often result in facial and ear distortion/deformity. This technique is designed to optimize aesthetic outcomes by employing incisions hidden within the ear, autologous fat transfer to restore normally lost facial volume, and absorbable bidirectional sutures, all of which allow less skin removal and shorter, more concealable scars within the inside perimeter of the ear, and thus less-distorted facial contours. In this retrospective study, the author added one important modification to this previously described approach for preventing ear deformity. OBJECTIVES: The author will show that this modified rhytidectomy technique has many benefits over a traditional rhytidectomy, and it results in a natural-looking facelift. METHODS: The author modified the original technique to secure the ears in a way that prevents inferior drifting. The modified technique involves the placement of two parallel strands of 3-0 Monocryl sutures under the scalp and over the skull and running from one side of the head to the other side using a 6-inch blunt needle. The absorbable strands are passed from the inferior part of each earlobe-one in front of the ear and the other in back of the ear. The strands are tied with knots under moderate tension under each earlobe, securing the ear back in the anatomical preoperative position. This secures the bottom of the ears and prevents caudal drifting. DISCUSSION: The use of 360° round-block, inside-the-ear incisions is advantageous. These incisions have much less lymphatic derangement of the skin, because the overall cut is shorter and the skin is not cut as extensively as in other methods that use longer incisions to get rid of more excess skin in facelifts. RESULTS: This modified rhytidectomy technique has many benefits over a traditional rhytidectomy: the incisions are hidden inside the ears, so there are almost no visible external incisions, and there is no deformity of the ears and earlobes, because the ears do not drift downward. The ear canal is not distorted, there is no hairline distortion, and most importantly, it results in a natural-looking facelift without the commonly seen deformity of any noticeable pulling. CONCLUSIONS: This modified approach to rhytidectomy achieves natural looking, aesthetically pleasing results. 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 .

Advances in Face-lift Techniques, 2013-2018: A Systematic Review.

IMPORTANCE: Rhytidectomy, or face-lift surgery, is the mainstay of facial rejuvenation and is constantly evolving. There is continuous research to improve outcomes and minimize complications of this surgery. OBJECTIVE: To synthesize the updated techniques in rhytidectomy published during the past 5 years, including surgical technique, advances in anesthetic technique, minimally invasive techniques, and adjunctive procedures performed at the time of rhytidectomy. EVIDENCE REVIEW: On February 8, 2018, a literature search was performed of the PubMed and Cochrane databases using the search terms, face-lift or rhytidectomy and techniques. Articles published from February 8, 2013, to February 8, 2018, that related to techniques of facial rejuvenation in the lower one-third of the face by lifting and supporting tissue with 5 or more patients were included. Systematic reviews and primary literature were considered; narrative reviews, validation studies, and anatomic studies were eliminated. The initial search resulted in 604 articles after duplicates were removed. This was reduced to 84 articles after dual independent review screening. FINDINGS: Of the 84 articles included, 51 (61%) regarding techniques of face-lifting in the past 5 years pertained to soft-tissue techniques; 14 (17%) pertained to implants or adjunctive medications, such as tissue sealants; and 12 (14%) related to adjunctive techniques performed in addition to face-lifting, such as fat grafting, resurfacing, and liposuction. All studies found the techniques reported therein to be effective, with similar or fewer complications compared with the literature. However, according to the Oxford Centre for Evidence-Based Medicine criteria, the level of evidence of the studies was generally poor, because 45 of the studies (54%) were case series (level 4 of evidence). CONCLUSIONS AND RELEVANCE: Several new techniques have been explored for rhytidectomy or face-lift in the past 5 years, including soft-tissue techniques, introduction of implants or topical medications such as tissue sealants, and concomitant adjunctive techniques to enhance results. The overall quality of the evidence is poor, with most articles using case series with nonvalidated measures to evaluate outcomes. There is considerable room for improvement in the literature if additional studies using cohort designs and validated outcomes are performed to validate the quality of the techniques introduced during the past 5 years.

Update on minimally invasive face lift technique.

BACKGROUND: The aging face is characterized by loss of skin elasticity, fat resorption, loss of muscle tone and volume, and loss of bone volume. Restorative procedures should be based on the condition of the soft tissues and the relationship between these tissues and the existing skeletal volume and can be performed through open, endoscopic, or minimally invasive approaches. OBJECTIVE: A minimally invasive approach to the face lift is presented, updated with useful details that the author has incorporated into his clinical technique on the basis of 15 years of experience. METHODS: The minimally invasive face lift is not a mini-lift but a full face lift performed through minimal incisions located in the frontal hairline, temporal area, triangular fossae of the auricle, submentalis, and eyelids. A wide dissection was performed to liberate the parietotemporal fascia from the zygomatic arch and to pull it up in continuity with the superficial musculoaponeurotic system and the platysma as one continuous layer or composite flap. These structures were selectively secured in a higher position, restoring the contour of the face and the consistency of the soft tissues. RESULTS: The described procedures, or combinations of these procedures, were performed in 539 patients during a 9-year period. Preauricular incisions were avoided in 83% of cases. Complications were minimal and included temporary hypoesthesia of the forehead or cheek and temporary palsy of the frontotemporal branch of the facial nerve that resolved after 2 to 4 weeks. There were few problems with hematomas. CONCLUSIONS: The minimally invasive face lift technique described here can reduce morbidity, achieve more durable results, and give a greater degree of satisfaction to patients. The procedures are relatively simple and easy to carry out but require somewhat of a learning curve to achieve optimal results.

Fractional technology: a review and clinical approaches.

All of the FT devices that I have available to me work very well. Some may not be "true" FT devices and may be creating "holes" in the skin, but clinically the results seen with these devices have brought us pretty close to achieving the gold standard of ablative resurfacing. In the future, we may find FT will resurface the market of ablative resurfacing.

Current Applications of Facial Volumization with Fillers.

LEARNING OBJECTIVES: After reading this article and watching the accompanying videos, the participant should be able to: 1. Assess patients seeking facial volumization and correlate volume deficiencies anatomically. 2. Identify appropriate fillers based on rheologic properties and anatomical needs. 3. Recognize poor candidates for facial volumization. 4. Recognize and treat filler-related side effects and complications. SUMMARY: Facial volumization is widely applied for minimally invasive facial rejuvenation both as a solitary means and in conjunction with surgical correction. Appropriate facial volumization is dependent on patient characteristics, consistent longitudinal anatomical changes, and qualities of fillers available. In this article, anatomical changes seen with aging are illustrated, appropriate techniques for facial volumization are described in the setting of correct filler selection, and potential complications are addressed.

Deep plane rhytidectomy: a personal evolution.

As the rhytidectomy procedure has evolved over the years, the understanding of facial anatomy and critical examination of results have lead to the adoption and modification of the deep plane technique by the senior author. Experience with the deep plane rhytidectomy technique has shown that reliable, safe, and effective results can be achieved consistently. The aesthetic benefit has increased particularly with respect to the nasolabial fold and the jowl, while complications have been few. The historical background, evolution, and details of the technique are presented.

Current Trends in Facial Rejuvenation: An Assessment of ASPS Members' Use of Fat Grafting during Face Lifting.

BACKGROUND: Fat grafting can be used to improve the results of face lifting. The extent to which plastic surgeons use fat grafting in their face-lift practices is unknown. The goals of this study were to understand the current use of fat grafting during facial rejuvenation surgery and identify the most common techniques used. METHODS: A 28-item questionnaire was formulated for distribution to a randomized cohort of American Society of Plastic Surgeons members. Data were collected and statistically analyzed using Pearson chi-square and Fisher's exact tests. RESULTS: A total of 309 questionnaires were collected. The questionnaire revealed that 85.2 percent of respondents use fat grafting during face lifts. Currently, the most common techniques used include abdominal harvest, centrifuge processing, blunt cannula injection without pretunneling, and placing less than 0.1 cc per pass. The deep central malar, lower lid cheek junction, and nasolabial folds are the most commonly injected areas. CONCLUSIONS: Combining surgical repositioning of fat with fat grafting offers surgeons a greater degree of aesthetic control for correcting contour in the aging face. Although there is controversy regarding the best method to surgically reposition fat, there is a growing consensus that volume augmentation is preferred by most face-lift surgeons.

Advances in facial rejuvenation surgery.

There have been many important contributions to the literature on the subject of facial rejuvenation surgery. There has been a trend toward less invasive techniques that offer patients shorter recovery periods with levels of aesthetic satisfaction comparable to those of more invasive and complex procedures. Techniques reviewed in this article include midface suture meloplication, and purse-string suture suspension of the superficial musculoaponeurotic system to effect changes in the lower one third of the face. Another exciting area is the use of fibrin sealants and autologous platelet gels to enhance the adhesion of the tissue flaps at closure and reduce the amount of ecchymosis and edema in the recovery period. Their ability to decrease bruising, swelling, and lessen the frequency of complications has the potential of increasing patient satisfaction through a quicker return to normal activities.

Dermatologic surgery into the next millennium, Part III.

Face-lift procedures and blepharoplasties are performed as in-office surgeries. Either local sedation or conscious sedation is used, and the patient's vital signs are carefully monitored. To avoid complications, the patient is followed closely postoperatively. It is highly suggested that the patient receives a medical clearance prior to undergoing either of these procedures.

Dermatologic surgery into the next millennium, part II.

This is the second article in a 4-part series on dermatologic surgery. This section provides detailed information about filling agents and botulinus toxin A. The filling agents discussed here are frequently used in our office. It is emphasized that meticulous technique and patient selection predict a good cosmetic result. To select the right agent, patient safety must be a priority.

[Video-assisted endoscopic lifting: development]. / Lifting endoscopique vidéo assistée: évolution.

Now the Endoscope is used differently in video-assisted Face-lifts. Authors describe their evolution for 2 years and a half. In the beginning. It was used to correct glabellar frowns. Then, the endoscope served to elevate the forehead by a subperiosteal approach. Sometime it was combined with a subperiosteal malar dissection in an Endoscopic full face-lift. Bad results on the eyebrows and eyelids complications involved the authors to modify their strategy: By changing the dynamic of muscles: lateral section of the orbicularis occuli muscle arises the frontal muscle to definitely lift up the eyebrow: this is called the "myotomy box"; by preferring a subgaleal, retro-orbicularis dissection, under the malar fat pad and the platysma muscle in a deep plane but always above the zygomaticus major muscle, protector of the facial nerve in the buccal space; by developing new endodissectors efficient and less aggressive to spread the deep planes without damage; by an acute control of the fronto-temporal and cervico-facial deep dissection using new endoscopic valves; by treating precise damaged areas with Limited Endoscopic Face-Lifts in a same harmonious deep dissection instead of large multiplanar underminnings.