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Introduction: The global aesthetic medicine industry is rapidly expanding, with conferences serving as crucial platforms for knowledge exchange and collaboration. However, concerns have emerged about the increasing prioritisation of commercial content over scientifically rigorous presentations. This study critically evaluates the balance between commercial and scientific content at aesthetic medicine conferences, utilising artificial intelligence (AI) tools to analyse the impact of industry sponsorship and live procedural demonstrations on educational value., Method: Using the Punctuated Equilibrium Framework (PEF), AI-driven content analysis, social network analysis (SNA), and sentiment analysis were applied to evaluate conference data, including programs, sponsorship details, speaker affiliations, and attendee engagement metrics. The study analysed global and regional aesthetic medicine conferences from 2014 to 2024, identifying patterns and punctuated shifts in the balance between scientific and commercially driven content., Results: AI-based analysis of 487 conferences, comprising over 28,000 sessions and 2 million social media posts, revealed an increasing trend towards commercially focused content, particularly in industry-sponsored events. Approximately 44% of sessions were commercially oriented, with significant spikes during product launches. Academic and clinical speakers were more prevalent in scientific conferences, while industry-affiliated speakers dominated commercial sessions. Social media sentiment, analysed using AI tools, reflected high engagement with procedural demonstrations but also highlighted concerns about educational quality., Conclusion: While industry-driven sessions garnered higher immediate engagement, they reduced long-term cognitive retention and compromised the educational integrity of conferences. The use of AI in this study enabled a deeper understanding of content trends and their effects. Aesthetic medicine conferences must recalibrate the balance between commercial interests and scientific rigour to ensure sustainable professional development and patient safety., Evidence Level: IV., Competing Interests: Conflict of Interest Statement and Financial Disclosure Statement: Dr Rahman worked as a consultant and speaker for Allergan Aesthetics an Abbvie company (Irvine, CA); Karim Sayed is a consultant to, speaker for, and has received honoraria from L’oréal/Skinceuticals, Teoxane, Lutronic Cynosure and Allergan, an AbbVie Company; Dr Rao is a speaker for Allergan aesthetics an Abbvie Company (Irvine, CA); Dr Rao, Dr Ioannidis, is a speaker for Allergan aesthetics an Abbvie Company (Irvine, CA; Dr Philipp-Dormston reports being a clinical trial investigator, scientific advisor, and/or speaker for Allergan Aesthetics an Abbvie company (Irvine, CA), Galderma (Lausanne, Switzerland), Merz Pharmaceuticals GmbH and Evolus. He is also Senior President of the German Society for Botulinum and Filler Treatment (DGBT); Dr Carruthers has been a consultant and researcher for Alastin, Appiell, Allergan Aesthetics, an AbbVie Company, Avari, Bonti (now with Allergan/AbbVie), Evolus, Fount Bio, In Mode, Jeune Aesthetics, Merz, and Revance Biopharma and also own shares in Galderma. She is an author and editor for Elsevier and “Up to Date” Neuromodulators and Fillers, as well as an assistant editor for Dermatologic Surgery; Dr Webb, Dr Garcia , Dr Yu and Dr Wang has nothing to disclose., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Introduction: The aesthetic medicine industry has seen significant growth due to technological advancements and increasing demand for minimally invasive procedures. This sector's influence on educational institutions is profound, often shaping curricula to align with industry standards. However, this focus can sometimes narrow educational scope, potentially compromising the broader intellectual and ethical development of medical professionals., Methods: This study employs a comprehensive literature review to examine the influence of the aesthetic medicine industry on medical education. A systematic search was conducted across academic databases including PubMed, Google Scholar, and ScienceDirect, focusing on articles published between January 2003 and December 2023. Inclusion criteria encompassed studies examining the impact of industry on medical education, financial relationships, ethical implications, and student outcomes., Results: Out of 279 studies identified, 21 met the inclusion criteria. The analysis highlighted themes such as the need for a balanced curriculum integrating both theoretical and practical training, the impact of financial incentives on educational integrity, and the importance of ethical guidelines. The literature underscores the necessity for standardised curricula and enhanced regulatory oversight to ensure comprehensive and unbiased education., Conclusion: The aesthetic medicine industry's significant influence on medical education necessitates a balanced approach that integrates industry advancements with ethical and comprehensive educational practices. Addressing these challenges requires collaboration between academic institutions and industry partners, alongside stringent regulatory oversight. By ensuring educational integrity and fostering holistic training, the field can produce well-rounded professionals capable of ethical and effective practice in aesthetic medicine., 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 ., Competing Interests: Declarations Conflict of interest Authors declare no conflict of interest in relation to this manuscript. Outside the work, Dr Rahman, Rao, Dr Garcia, Dr Ioannidis is a speaker for Allergan aesthetics an Abbvie Company (Irvine, CA); Dr Philipp-Dormston reports being a clinical trial investigator, scientific advisor, and/or speaker for Allergan Aesthetics an Abbvie Company (Irvine, CA), Galderma (Lausanne, Switzerland), and Merz Pharmaceuticals GmbH; , Dr Sayed is a speaker for Allergan aesthetics an Abbvie Company (Irvine, CA); Dr Carruthers is a consultant and investigator for Allergan Aesthetics, an Abbvie Company, Merz Pharmaceuticals GmbH, Solstice Neurosciences, and Revance, Inc ; Dr Mosahebi served a consultant and speaker for Allergan Aesthetics an Abbvie Company (Irvine, CA), Merz Pharmaceuticals GmbH; Dr Webb has nothing to declare. Ethical Approval This article does not contain any studies with human participants or animals performed by any of the authors Informed Consent For this type of study informed consent is not required, (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction: The study investigates the impact of social media reviews and brand identity on consumer preferences in the non-surgical aesthetics products across different generations. It highlights the evolving landscape of aesthetic medicine and surgery, driven by technological advancements and a cultural shift towards individual well-being. The research aims to explore the interplay between generational preferences, the influence of social media, and the role of brand identity in shaping consumer decisions., Methods: A cross-sectional study design was employed, with a sample size of > 5000 participants stratified across various generational cohorts. The study utilized an online questionnaire to capture both quantitative and qualitative insights into consumer behaviour, with statistical analysis performed to identify patterns and relationships., Results: Analysis of 5850 responses revealed distinct generational preferences and behaviours. Social media engagement varied significantly across generations, with younger cohorts placing a higher emphasis on online reviews. The study also found that brand identity's influence is diminishing in decision-making processes, with consumers increasingly relying on peer reviews and social media content., Conclusion: The findings highlight a pivotal shift in the non-surgical aesthetics consumer market, emphasizing the growing importance of social media and peer reviews over traditional brand identities. Importantly, the study underscores the critical need for integrating patient safety and evidence-based practice within marketing strategies. As consumer preferences evolve towards valuing transparency and authenticity, non-surgical aesthetics providers must prioritize these elements, ensuring that their services are not only appealing but also grounded in safety and scientific validity., 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 .", Competing Interests: Declarations. Conflict of interest: The authors declare no conflicts of interest to disclose in relation to this manuscript. Human and Animal Resources: This article contains no studies with human participants or animals performed by any of the authors. Informed Consent: For this type of study, informed consent is not required., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction: Social media platforms significantly influence public perception and individual behaviour, particularly regarding aesthetic enhancements. Instagram, TikTok, Douyin, Kuaishou, X, Sina Weibo, and VK showcase content related to various aesthetic procedures, shaping societal norms around beauty and self-image. Despite the prevalence of this content, understanding its psychological impact and societal attitudes remains underexplore., Methods: We analysed over 14.9 million social media posts related to aesthetic enhancements from seven platforms, collected between January 2019 and January 2024. Data collection utilized platform-specific APIs and web scraping, focusing on relevant keywords and hashtags. Posts were cleaned, normalized, and translated. Sentiment analysis used VADER and machine learning models (logistic regression, SVM, random forest, and BERT). Psychological factors were identified using latent Dirichlet allocation (LDA) and Bayesian modelling., Results: Initial VADER analysis categorized sentiments as 45% positive, 30% neutral, and 25% negative, with an 85% accuracy. The BERT-based model improved accuracy to 92%. Positive sentiments peaked during Summer, neutral sentiments were highest in April, and negative sentiments remained stable. Psychological analysis revealed a strong positive correlation between self-esteem and positive sentiments, while societal pressure was negatively correlated. Younger users and females exhibited significant variations in sentiment and psychological factors., Conclusion: This study provides a comprehensive analysis of aesthetic enhancement discourse on social media, revealing seasonal and demographic sentiment variations and profound psychological impacts. These insights are crucial for practitioners in the aesthetic industry and mental health professionals to tailor strategies and support mechanisms. The study emphasizes the need for responsible messaging and realistic beauty representations to mitigate negative psychological effects., 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction: Botulinum toxin A (BoNT-A), derived from Clostridium botulinum, is widely used in medical and aesthetic treatments. Its clinical application extends from managing chronic conditions like cervical dystonia and migraine to reducing facial wrinkles. Despite its efficacy, a significant challenge associated with BoNT-A therapy is immunogenicity, where the immune system produces neutralising antibodies (NAbs) against BoNT-A, reducing its effectiveness over time. This issue is critical for patients requiring repeated treatments. The study aims to compare FDA-approved BoNT-A products, examining the factors influencing NAbs development using advanced machine learning techniques., Method: This research analysed data from randomised controlled trials (RCTs) involving five main BoNT-A products. The study selected trials based on detailed immunogenic responses to these treatments, particularly for glabellar lines. Machine learning models, including logistic regression, random forest classifiers, and Bayesian logistic regression, were employed to assess how treatment specifics and BoNT-A product types affect the development of NAbs., Results: Analysis of 14 studies with 8,190 participants revealed that dosage and treatment frequency are key factors influencing the risk of NAbs development. Among BoNT-A products, IncobotulinumtoxinA shows the lowest, and AbobotulinumtoxinA the highest likelihood of inducing NAbs. The study's machine learning and logistic regression findings indicated that treatment planning must consider these variables to minimise immunogenicity., Conclusion: The study underscores the importance of understanding BoNT-A immunogenicity in clinical practice. By identifying the main predictors of NAbs development and differentiating the immunogenic potential of BoNT-A products, the research provides insights for clinicians in optimising treatment strategies. It highlights the need for careful treatment customisation to reduce immunogenic risks, advocating for further research into the mechanisms of BoNT-A immunogenicity., Competing Interests: Conflict of Interest Statement: Dr Rahman worked as a consultant and speaker for Allergan Aesthetics an Abbvie company (Irvine, CA); Dr Carruthers has been a consultant and researcher for Alastin, Appiell, Allergan Aesthetics, an AbbVie Company, Avari, Bonti (now with Allergan/AbbVie), Evolus, Fount Bio, In Mode, Jeune Aesthetics, Merz, and Revance Biopharma and also own shares in Galderma. She is an author and editor for Elsevier and “Up to Date” Neuromodulators and Fillers, as well as an assistant editor for Dermatologic Surgery. Dr Rao is a speaker for Allergan aesthetics an Abbvie Company (Irvine, CA); Dr Philipp-Dormston reports being a clinical trial investigator, scientific advisor, and/or speaker for Allergan Aesthetics an Abbvie company (Irvine, CA), Galderma (Lausanne, Switzerland), Merz Pharmaceuticals GmbH and Evolus. He is also Senior President of the German Society for Botulinum and Filler Treatment (DGBT) Dr Webb and Dr Yu has nothing to disclose., (Copyright © 2024 by the American Society of Plastic Surgeons.)

Background: Botulinum toxin A (BoNT-A) is widely used in treating dystonia and spasticity to managing chronic migraine and cosmetic applications. However, its immunogenic potential presents challenges, such as the development of neutralizing antibodies that lead to diminished therapeutic efficacy over time, known as secondary nonresponse., Objective: This review aims to bridge the knowledge gap regarding the immunogenic mechanisms of BoNT-A and to explore effective management strategies to mitigate these immune responses., Materials and Methods: The authors conducted a systematic search in databases including PubMed, Embase, and Web of Science, using keywords related to BoNT-A's immunogenicity. The selection process refined 157 initial articles down to 23 relevant studies, which underwent analysis to investigate the underlying mechanisms of immunogenicity and the factors influencing it., Results: The analysis revealed that both the neurotoxin component and the neurotoxin-associated proteins could elicit an immune response. However, only antibodies against the core toxin influence therapeutic outcomes. Various patient-specific factors such as genetic predispositions and prior immune experiences, along with treatment-related factors such as dosage and frequency, play crucial roles in shaping these responses., Conclusion: Understanding the specific immunogenic triggers and responses to BoNT-A is critical for optimizing treatment protocols and improving patient outcomes., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction: The rising use of soft tissue fillers for aesthetic procedures has seen an increase in complications, including vascular occlusions and neurological symptoms that resemble stroke. This study synthesizes information on central nervous system (CNS) complications post-filler injections and evaluates the effectiveness of hyaluronidase (HYAL) treatment., Methods: A thorough search of multiple databases, including PubMed, EMBASE, Scopus, Web of Science, Google Scholar, and Cochrane, focused on publications from January 2014 to January 2024. Criteria for inclusion covered reviews and case reports that documented CNS complications related to soft tissue fillers. Advanced statistical and computational techniques, including logistic regression, machine learning, and Bayesian analysis, were utilized to dissect the factors influencing therapeutic outcomes., Results: The analysis integrated findings from 20 reviews and systematic analyses, with 379 cases reported since 2018. Hyaluronic acid (HA) was the most commonly used filler, particularly in nasal region injections. The average age of patients was 38, with a notable increase in case reports in 2020. Initial presentation data revealed that 60.9% of patients experienced no light perception, while ptosis and ophthalmoplegia were present in 54.3 and 42.7% of cases, respectively. The statistical and machine learning analyses did not establish a significant linkage between the HYAL dosage and patient recovery; however, the injection site emerged as a critical determinant., Conclusion: The study concludes that HYAL treatment, while vital for managing complications, varies in effectiveness based on the injection site and the timing of administration. The non-Newtonian characteristics of HA fillers may also affect the incidence of complications. The findings advocate for tailored treatment strategies incorporating individual patient variables, emphasizing prompt and precise intervention to mitigate the adverse effects of soft tissue fillers., 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Regenerative aesthetics claims to enhance cosmetic outcomes through advanced biological interventions like Stem cell and Exosome therapy, Polydeoxyribonucleotide (PDRN), Photobiomodulation, bioactive peptides and treatment for cellular senescence yet lacks substantial scientific and regulatory validation., Objective: To evaluate the scientific and clinical foundations of regenerative medicine techniques in non-surgical aesthetics and assess the legitimacy of regenerative aesthetics as a medical specialty., Methods: A systematic review was conducted according to PRISMA guidelines, searching databases including PubMed, Scopus, and Web of Science for studies published in the last ten years. We included 19 studies, comprising 14 randomized controlled trials (RCTs) and 5 prospective studies, focusing on interventions that purportedly use regenerative medicine principles in aesthetic applications., Results: The review highlights a prevalent gap in molecular and clinical evidence supporting the efficacy and safety of regenerative aesthetics. Despite the robust design of the included RCTs and prospective studies, there remains a significant lack of consistent, high-quality evidence proving the effectiveness of these interventions. Issues such as inadequate reporting, unclear molecular mechanisms, and absence of long-term safety data were common., Conclusion: The field of regenerative aesthetics lacks the necessary scientific rigour and regulatory compliance to be recognized as a legitimate medical specialty. This review underscores the need for stringent scientific validation and regulatory oversight to ensure patient safety and treatment efficacy before these techniques can be recommended for clinical use., Level of Evidence Ii: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Aesthetic medicine has evolved significantly, accommodating diverse demographics and motivations influenced by societal shifts and technological advancements. The IMPACT (integrative multigenerational psychological analysis for cosmetic treatment) study refines patient archetypes, integrating psychological theories to tailor treatments, especially for younger demographics and LGBTQIA + communities., Methods: This cross-sectional study utilized a comprehensive, validated survey with a Cronbach's alpha of 0.89 and a Content Validity Index (CVI) of 0.92, distributed across a globally diverse, generationally stratified sample. Techniques like regression analysis, ANOVA, Bayesian modelling, and factor analysis were employed to analyse the data, focusing on developing nuanced patient archetypes., Results: Among 5645 participants, 5340 complete responses highlighted significant generational differences in aesthetic preferences. Millennials showed a strong preference for non-invasive procedures (β = 0.65, p < 0.001). ANOVA results confirmed significant variances across generations [F (3, 5118) = 157.6, p < 0.001], with post-hoc analyses delineating specific inter-group differences. Bayesian modelling provided insights into the probability of non-invasive preferences among younger cohorts at over 92% certainty. Factor analysis revealed key dimensions such as 'Generational Influence' and 'Technological Adoption,' which helped in defining archetypes including Dynamic Self-Identity, Digital Native, Stability Seeker, Classic Conservatism, and Holistic Health, collectively explaining up to 78% of the variance in responses., Conclusion: The IMPACT study underscores the influence of generational identity and digital exposure on aesthetic preferences, advocating for personalized, archetype-based treatment approaches. This aligns with enhancing patient satisfaction and treatment outcomes, promoting an adaptive aesthetic medicine practice that meets the evolving needs of modern patients., 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Understanding the multifaceted nature of attractiveness (A), which encompasses physical beauty (PB), genuineness (GEN), self-confidence (SC), and prior experience (RE), is crucial for various domains, including psychology and clinical aesthetics. Previous studies have often isolated specific elements, failing to capture their intricate interplay. This study aims to develop a comprehensive equation for attractiveness using computational neuroaesthetics., Method: The study began with a pilot study involving 250 participants (50 experts and 200 laypersons) who prerated 500 facial images on a Likert scale for traits such as physical beauty, genuineness, self-confidence, and perceived prior experience. Following the pilot, the main study recruited 11,780 participants through diverse media channels to rate a new set of 1,000 facial images. Advanced computational techniques, including multiple linear regression and Bayesian hierarchical modelling, were employed to analyse the data and formulate an attractiveness equation., Results: The analysis identified genuineness as the most significant factor, followed by physical beauty, self-confidence, and prior experience. The proposed equation for attractiveness, refined through Bayesian modelling, is: A = β 0 + ( β 1 · PB + β 2 · GEN + β 3 · SC + β 4 · PE ) + ϵ A = 1.82 + ( 0.34 · PB + 0.44 · GEN + 0.26 · SC + 0.16 · PE ) + ϵ (β 0 is the intercept; β 1 , β 2 , β 3 , β 4 are the coefficients for each factor; and ϵ is the error term) CONCLUSION: The findings underscore the paramount importance of psychological traits in attractiveness assessments, suggesting a shift from purely physical enhancements to holistic interventions in clinical settings. This model provides a robust framework for understanding attractiveness and has potential applications in psychology, marketing, and AI., 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Botulinum toxin A (BTxA) has gained popularity as a nonsurgical aesthetic treatment for skin rejuvenation. However, previous studies on intradermal BTxA have shown inconsistent results. This systematic review and meta-analysis with trial sequential analysis aimed to assess the efficacy and safety of intradermal BTxA for facial rejuvenation., Methods: Following PRISMA guidelines, a comprehensive search was conducted in various databases from January 2008 to March 2023. Outcome measures included sebum production, pore size, skin hydration, skin texture, erythema index, facial wrinkles, and facelift. Eligible studies included human-based clinical trials and prospective cohort studies published in English, focusing on healthy populations requiring facial rejuvenation. Two authors independently screened the titles and abstracts, followed by a full-text review to determine study eligibility. Data extraction and quality assessment were performed by two authors using predefined criteria., Results: Ten studies met the inclusion criteria, including five randomized controlled trials and five prospective cohort studies with 153 participants. Studies revealed positive effects of intradermal BTxA on various outcome measures related to facial rejuvenation. These effects included improvements in sebum production, pore size, erythema index, facial wrinkles, skin texture and elasticity, and overall facelift but not skin hydration. All failed to reach the required information size in the trial sequential analysis., Conclusions: Findings suggest positive outcomes in multiple attributes of skin quality and facial rejuvenation. However, more high-quality research is needed to establish definitive conclusions. These findings contribute to the evidence base for nonsurgical aesthetic treatments, emphasizing the importance of ongoing research in this field., Competing Interests: Dr. Rahman worked as a consultant and speaker for Allergan Aesthetics (Irvine, Calif.); Dr. Rao, Dr. Garcia, Dr. Ioannidis, Dr. Kefalas, Dr. Kajaija, Dr. Friederich, and Dr. Parikh are speakers for Allergan aesthetics an Abbvie Company (Irvine, Calif.); Dr. Philipp-Dormston reports being a clinical trial investigator, scientific advisor, and/or speaker for Allergan Aesthetics an Abbvie Company (Irvine, Calif.), Galderma (Lausanne, Switzerland), and Merz Pharmaceuticals GmbH; Dr. Almeida has been a consultant to Allergan Inc. and Merz, and participated in clinical trials for Allergan and Galderma. Dr. J. Carruthers is a consultant and investigator for Allergan Aesthetics, an Abbvie Company, Merz Pharmaceuticals GmbH, Solstice Neurosciences, and Revance, Inc. Dr. A. Carruthers is a consultant for and has received research grants from Allergan Aesthetics an Abbvie Company (Irvine, Calif.), Merz Pharmaceuticals GmbH, and Revance, Inc; Dr. Mosahebi served a consultant and speaker for Allergan Aesthetics an Abbvie Company (Irvine, Calif.), Merz Pharmaceuticals GmbH; Dr. Wu is a speaker and consultant for Allergan Aesthetics an Abbvie Company, Merz Pharmaceuticals GmbH; Dr. Goodman is a speaker, investigator, and consultant for Allergan Aesthetics an Abbvie Company. (Irvine, Calif.) and Galderma (Lausanne, Switzerland). All the other authors have no financial interest to declare in relation to the content of this article., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Background: Platelet-rich plasma (PRP) is widely used in various medical and surgical specialties for its regenerative properties, including aesthetics (facial rejuvenation, hair restoration, and skin tightening) and orthopedics (treatment of tendinitis and osteoarthritis). However, the inconsistent literature on PRP's efficacy and safety leads to critical knowledge gaps. This systematic review evaluates quality control measures in PRP preparation and application and explores the regulatory environment governing its clinical use. Methods: Following PRISMA guidelines, a comprehensive search was conducted across multiple databases, including PubMed, EMBASE, and Web of Science, for studies published from January 2020 to April 2024. The review included randomized controlled trials (RCTs) involving human participants undergoing PRP treatment for aesthetic or regenerative purposes. Key parameters such as the PRP preparation methods, platelet concentration, and quality control measures were analyzed. The study protocol was registered with PROSPERO (ID: CRD42024557669). Results: Out of 75 RCTs involving 5726 patients, the review identified significant variability in PRP preparation methods and application techniques, including differences in centrifugation protocols and platelet concentration levels. A new evidence-based scoring system, the William-Eqram Scoring System for PRP Quality Reporting (WESS-PQR), was proposed to address these inconsistencies. Correlation analysis revealed a strong positive correlation (r = 0.79) between proper temperature control during preparation and PRP efficacy. Initial platelet count assessment showed a moderate positive correlation (r = 0.57) with efficacy. Conclusions: Standardized PRP preparation protocols and robust regulatory frameworks are urgently needed to ensure the safety and efficacy of PRP treatments. The proposed WESS-PQR scoring system can serve as a valuable tool for clinicians and researchers, promoting consistency and reliability in PRP applications.

Purpose: This synaptic systemised review critically examines the provision of aesthetic medical care to LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more) individuals, assessing both the clinical practices and the educational frameworks that guide interactions with LGBTQIA+ patients in aesthetic settings., Methods: Following PRISMA-S guidelines, a comprehensive review was conducted, initially identifying 159 potentially relevant articles. Upon stringent full-text review, 33 studies met the inclusion criteria and were subject to an in-depth thematic analysis. The scope encompassed qualitative studies, quantitative analyses, and a cross section of interdisciplinary research, predominantly from Western settings., Results: The analysis distilled four principal themes: the imperative of identity affirmation in aesthetic interventions, substantial barriers to inclusive and empathetic care, the critical need for patient empowerment, and the existing deficiencies within medical education regarding LGBTQIA+ care. These themes highlight a complex interplay between the clinical aspirations of LGBTQIA+ individuals and the current capacity of aesthetic medicine to cater to this diversity., Conclusions: There is a pressing need for a paradigmatic shift towards more inclusive, competent, and sensitive aesthetic medical care for LGBTQIA+ patients. It underscores the necessity of reform in medical education and advocates for policy changes that promote a more equitable healthcare environment. This research serves as a call to action, emphasizing the ethical imperative to integrate comprehensive LGBTQIA+ care competencies into aesthetic medicine curricula and practice., 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., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Introduction: Exosomes, diminutive extracellular vesicles, are integral to intercellular communication, harbouring potential for applications in regenerative medicine and aesthetic interventions. The field, however, grapples with the complexities of harmonising exosome characterisation protocols and safeguarding therapeutic integrity., Methodology: In this scholarly overview, systematic adherence to the Cochrane Collaboration and Preferred Reporting Items for Overviews of Reviews guidelines was observed, scrutinising the congruence of exosome-related therapies with the Minimal Information for Studies of Extracellular Vesicles standards delineated by the International Society for Extracellular Vesicles, alongside criteria set forth by the International Society for Cell Therapy and the International Society for Stem Cell Research. A meticulous search strategy spanning databases such as PubMed, Scopus, Web of Science, EMBASE, and Cochrane database was employed to encapsulate studies pertinent to the isolation, characterisation, and functional assessment of exosomes., Results: The initial search yielded 225 articles, of which 17 systematic reviews were selected based on predefined criteria, encompassing 556 primary studies. Notwithstanding the acknowledged therapeutic promise of exosome modalities, the synthesis illuminated a prevalent deficiency in adherence to established reporting and experimental benchmarks, notably in exosome source characterisation and bioactive constituent delineation. A critical appraisal employing the AMSTAR-2 tool underscored a pervasive shortfall in methodological rigour., Conclusion: This review accentuates the imperative for stringent methodological standardisation within exosome research to fortify the validity and reproducibility of empirical findings. Amidst the burgeoning therapeutic optimism, the discipline must rectify methodological disparities and comply with regulatory mandates, ensuring the ethically sound and scientifically robust advancement of exosome-based therapeutic modalities., 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

The aim of this study was to identify the anatomical feature of retaining ligament and fat compartment on the lower eyelid and infraorbital region using a histological method, and to investigate clear definitions for them which could be used generally in the clinical area. Eighteen specimens from eight fresh Korean cadavers were stained with Masson trichrome or hematoxylin and eosin. The ligamentous and fascial fibrous tissue were clearly identified. The ligamentous fibrous tissue which traversed in the superficial and deep fat layer was skin ligament and orbicularis retaining ligament (ORL). The fascial fibrous tissue enclosed the orbicularis oculi muscle (OOc) and circumferencial adipose tissue. Based on the ligamentous and fascial structure, three fat compartments, septal, suborbicularis oculi and infraorbital fat compartment, could be identified. The OOc attached to orbital rim and dermis by ORL and skin ligament, and the muscle fascicle and fat fascicle provided the connection point to the ORL and skin ligament as enclosing all muscle and fat tissue. The combination of the force made by the skin ligament in the lower eyelid and ORL may decide the level and form of the infraorbital grooves.

Background: The aim of this study was to elucidate the anatomical structures of supporting system of the infraorbital area., Materials and Methods: Forty-four hemifaces from eleven Korean and eleven Thai cadavers were used to dissect the infraorbital area. Based on the dissection and previous histologic results, they were analyzed., Results: The orbicularis oculi muscle (OOc) had two portions (palpebral and orbital portion) and four subparts (pretarsal, preseptal, prezygomatic, and premaxillary part). The elliptical muscle fiber of OOc was supported by circumferential connective tissue including skin ligament, orbicularis retaining ligament, zygomatic ligament, and zygomatic cutaneous ligament. The vertical muscle fiber, the tear trough muscle fiber, and medial muscular band directly attached to the skin., Conclusion: Full of subcutaneous tissue in the tear trough groove, strong attachment to the bone by tear trough ligament and to the skin by tear trough muscle fiber would multiply result in the tear trough on the face., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Clinical case reporting plays a vital role in sharing detailed patient narratives, providing insights into rare conditions, innovative treatments, and unexpected outcomes. However, existing reporting guidelines in aesthetic medicine fail to capture the specific nuances of procedures and outcomes in this field. The authors' objectives were to develop comprehensive guidelines for Case REporting in Aesthetic Medicine (CREAM). The study employed a 3-phase consensus process, including a literature review, expert interviews, and a consensus meeting. A diverse group of 10 expert participants (plastic surgeons, dermatologists, noncore specialists, evidence-based medicine expert, and research scientist) in Phase I and 30 experienced aesthetic practitioners in Phase II contributed to the research. Statistical analysis was conducted to assess agreement levels among participants and explore associations and variations within the data. The participants represented various specialties, genders, LGBTQ+ identities, and ethnic backgrounds. The research resulted in the development of the CREAM guidelines, consisting of a 16-item checklist. The guidelines covered essential aspects of case reporting, such as patient and practice information, procedure details, clinical assessment and outcomes, adverse events, and ethical considerations. Statistical analysis indicated a high level of consensus among participants, as well as significant associations between checklist items. CREAM guidelines represent a step toward enhancing transparency and standardization in case reporting in aesthetic medicine. Adhering to these guidelines will allow authors to contribute to a robust evidence base, prioritize patient safety, and drive advancements aesthetic medicine., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Aesthetic Society.)

Purpose: The aim of this research was to create a novel and low-cost TP prostate biopsy simulator that has face, content and construct validity with high educational value., Methods: This research developed a trans perineal prostate (TP) biopsy simulator using 3D-printed moulds and tissue-mimicking materials. Important regions (anterior, mid, and posterior zones) were coded with different colours. Ultrasound visible abnormal lesions were embedded in the prostate phantom. Expert and novice participants in TP biopsies were recruited. Essential skills were identified through the consensus of six experts. These skills were assessed through tasks performed by participants. This included the accuracy and timing of systematic and target biopsies. Immediate feedback was determined by the colour of the biopsy cores taken. A survey was distributed to evaluate its realism and educational value., Results: The material cost of one simulator was £7.50. This simulator was proven to have face, content, and construct validity. There was a significant difference (p = 0.02) in the accuracy of systematic biopsies between both experts and novices. Significant difference was also observed (p = 0.01), in accurately identifying target lesion on ultrasound between both groups. Participants rated the overall realism of the simulator 4.57/5 (range 3-5). 100% of the experts agreed that introducing this simulator to training will be beneficial. 85.7% of the participants strongly agree that the simulator improved their confidence in TP biopsies., Conclusion: There is value in integrating this proof-of-concept TP prostate biopsy simulator into training. It has highly rated educational value and has face, content, and construct validity., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Onabotulinumtoxin A (Onabot A) was the first treatment to be approved for aesthetic indications, namely glabellar lines (GLs), crow's feet lines (CFLs), and forehead lines (FHLs), with a cumulative dose of 64 U., Objectives: The aim of this study was to conduct a meta-analysis to combine the available data for approved doses for GLs, CFLs, and FHLs to explore the effect and duration of simultaneous treatment with Onabot A., Methods: PubMed/MEDLINE, Embase, and other national clinical trial registries were searched for randomized controlled trials from January 2010 to July 2022. The meta-analysis, trial sequential analysis, and investigator-assessed time to return to nonresponder status in GLs, CFLs, and FHLs following Onabot A were plotted to elicit a cumulative dose-adjusted response curve based on Kaplan-Meier analysis with a log-rank test., Results: Fourteen randomized controlled trials were eligible for quantitative analysis. A total of 8369 subjects were recruited across the trials. The meta-analysis results show that Onabot A is very effective in reducing moderate to severe GLs, CFLs, and FHLs. The cumulative Z-curve for GLs, CFLs, and FHLs also exceeds the required information size (RIS). Kaplan-Meier analysis with a log-rank test demonstrated that simultaneous treatment of GLs, CFLs, and FHLs requires 182 days (95% CI = 179, 215 days) (P < 0.00002) to return to nonresponder status., Conclusions: Treatment of the upper facial expression lines with Onabot A is effective, and the approved cumulative dose of 64 U gives longer-lasting effects., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Objective structured practical examination (OSPE) has proven a reliable assessment tool in many specialities. Therefore, we aimed to construct an OSPE tool that could assess the clinical facial anatomy knowledge of non-surgical aesthetic practitioners in a simulated environment., Approach: Ten subject matter experts identified the themes individually with significant experience in teaching non-surgical aesthetic practitioners. A consensus is then reached following extensive discussion to determine the final themes. After blueprinting, 25 stations were created comprising a single best answer with a clinical vignette and either a dissected Cephalus or a high-resolution picture of a dissected Cephalus or a skull and a full-face photograph of a patient. Finally, concurrent and construct validity were assessed for individual questions. Twenty-five novices and 25 experts participated in the OSPE pilot. Each cycle lasted 45 minutes (90 seconds per station; 25 clinical and five rest stations). Internal reliability was measured by Cronbach's alpha. In addition, the novices and experts group scores were compared, employing an independent t-test., Evaluation: The mean item difficulty of the 25 questions was 0.65. There was a significant difference in the scores for experts (M = 48.56, SD = 1.003), novices (M = 33.60, SD = 3.18) and conditions; t (48) = 22.38, p = 0.000. These results suggest the construct validity and confirm the robustness of the OSPE set-up to accomplish the learning outcomes., Implication: We successfully designed and validated OSPE as an assessment tool to examine non-surgical aesthetic practitioners' clinical facial anatomy knowledge. We envisage using OSPE in our future programmes and encourage programme directors to integrate it into the postgraduate curriculum in non-surgical aesthetics., (© 2022 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Aspiration prior to hyaluronic acid filler injection is often taught as a safety maneuver to minimize the risk of intravascular injection; however, the validity of this technique in aesthetic practice is being increasingly challenged. One key assumption underpinning the validity of the aspiration test is that the needle tip does not move during the aspiration and subsequent injection of filler., Objectives: The aim of this study was to visualize and measure needle tip movement in real time during aspiration and injection of filler. Secondary objectives were to assess the impact of injector experience and double-handed versus single-handed aspiration technique in maintaining stability of the syringe., Methods: Under real-time ultrasound visualization, 3 injectors with different levels of experience injected hyaluronic acid filler into pork belly tissue utilizing both double-handed and single-handed aspiration techniques. Needle tip movements were recorded and measured by means of ultrasound and video., Results: The aspiration maneuver is in all cases associated with retrograde movement of the needle tip, ranging from 1.1 to 5.3 mm (mean, 2.9 mm), whereas injection leads to anterograde movement ranging from 0.6 to 4.1 mm (mean, 1.9 mm). Double-handed aspiration is associated with less needle tip movement than single-handed aspiration (P = 0.037). Greater experience is also associated less movement of the needle tip (P < 0.0001)., Conclusions: In all cases, the aspiration and injecting maneuver is associated with micromovements of the needle tip, of a magnitude consistently significant relative to the typical size of facial vessels. Although needle tip movement is only a single factor limiting the usefulness of the aspiration test, the results of this study suggest that it is not advisable to rely only on aspiration as a method to prevent intravascular injection., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Non-surgical aesthetics is a rapidly growing healthcare domain and lacks pedagogically sound education and training programs. The trainee physicians often participate in short courses which are outside of the scope of an existing postgraduate training program to acquire the necessary knowledge and procedural skills. However, such training programs lack values and interests that shape critical thinking and holistic decision-making, often referred to as professional identity., Objectives: This systematic review aims to analyze current trends in non-surgical aesthetic clinical education to form knowledge, skills, and professional identity., Methods: A detailed literature search was conducted in electronic databases-PubMed, Cochrane, Centre for Reviews and Dissemination, and Google Scholar-for relevant studies published between January 2010 and December 2020, with an update in September 2021., Results: Fifty-five articles were identified through electronic searches, among which 40 were selected following a review of the abstracts. Sixteen articles were identified as the best evidence for the detailed and iterative review based on their relevance and fit to the inclusion criteria. Unfortunately, none of the included studies designed their questionnaire based on the Kirkpatrick Model, which is best known for analyzing and evaluating the results of training and educational programs., Conclusions: This systematic review provides valuable insight into graduate professional identity formation and graduates' readiness for independent clinical practice. Therefore, particular consideration should be given to incorporating these triggers when developing evidence-based postgraduate curricula for non-surgical aesthetics., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Botulinum toxin A (BoNT-A) injections are a popular non-surgical procedure for facial rejuvenation. Its increase in popularity and utilization is met with limited regulations, potentially posing a significant risk to patient safety and public health., Objectives: The authors sought to assess the safety profile of cosmetic glabellar and forehead BoNT-A injections and evaluate BoNT-A type on complication rate., Methods: A systematic search of MEDLINE and EMBASE was performed for studies reporting complications after cosmetic BoNT-A in the glabellar or in the forehead region in the glabellar or in the forehead region. A random effects meta-analysis was carried out to assess complication rate. Where there were sufficient randomized-controlled trials, a network meta-analysis was performed., Results: Of 556 identified articles, 24 were included in the final quantitative analysis, with 4268 BoNT-A injection sessions and 1234 placebos. Frequently observed treatment-related complications in the BoNT-A intervention group included headache, local skin reactions, and facial neuromuscular symptoms. The overall BoNT-A complication rate was 16%. The odds ratio of developing complications from abobotulinum toxin injections compared with placebo was 1.62 (1.15, 2.27; P > 0.05) and that from onabotulinum toxin injections compared with placebo was 1.34 (0.52, 3.48; P > 0.05). In 30% of the studies, the injectors were doctors, whereas the training status of the practitioner was not reported in the remaining 70%., Conclusions: Cosmetic BoNT-A injections in the glabellar and forehead region appear to be safe, and most complications are mild and transient. Nevertheless, the literature demonstrates heterogeneous reporting of complications and a lack of consistency of the definition of treatment-related complications., (© 2022 The Aesthetic Society.)

Background: The desire for portraying a young and beautiful face and body is driving people to seek aesthetic treatment and accelerating the exponential growth of nonsurgical aesthetic (NSA) procedures. Unfortunately, despite impressive advances, NSA is yet to have a formal clinical education program., Objectives: This study aimed to identify the content and structure of an evidence-based postgraduate curriculum in NSA., Methods: The Delphi questionnaire was developed after a comprehensive literature review and a focus group discussion. The questionnaire was emailed to 40 experts and 20 trainee physicians worldwide through the online survey platform and was asked to assign a rating on a 4-point Likert scale. A "1" represents a strong disagreement about integrating a topic in the NSA curriculum, and a "4" indicates a firm agreement. A pre-fixed percentage agreement of 80% and Cronbach's α = 0.90 was established to represent a consensus for the current study., Results: The response rate for the Delphi study was 90.0%, 88.8%, and 90% in the first, second, and third rounds, respectively. The experts and trainee physicians agreed with all the proposed topics (≥80%) and considered them critical for the proposed NSA curriculum. The mean score for each was ≥ 3, and Cronbach's α value for the Delphi was 0.94, confirming internal consistency and reliability., Conclusions: The consensus demonstrates significant advances toward developing an evidence-based curriculum for a postgraduate program in NSA, which is essential to support the growing demand for trained aesthetic physicians., (© 2022 The Aesthetic Society.)

Background: Botulinum toxin type A has been used to treat a wide array of neurologic, medical, and aesthetic indications. Several factors contribute to the formation of neutralizing antibodies, such as shorter intervals of treatment, higher dosage, amounts of antigenic proteins, serotypes, and storage of formulations., Method: This overview followed the Cochrane guideline for overview reviews. The AMSTAR-2 (revised version of A Measurement Tool to Assess Systematic Reviews) tool was used for the critical appraisal of the selected systematic reviews., Results: Five systematic reviews consisting of 203 studies (17,815 patients) were included, and their AMSTAR-2 scores were low to critically poor. There was high heterogeneity between the studies. Across the clinical indications, neutralizing antibody prevalence was significantly higher in dystonia, spasticity, and urologic conditions, and nil to insignificant in hyperhidrosis and aesthetic indications. The overall rate for the neutralizing antibody formation across three different formulations, abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA, was 1 to 2.1 percent, with no significant difference between them., Results: Although there is debate on the prevalence rate across the different botulinum toxin type A formulations in individual systematic reviews, the overall frequency of the development of neutralizing antibodies and the immunogenicity of abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA remain low to insignificant., Conclusions: Properly designed comparative trials are required to explore the difference in the prevalence of neutralizing antibodies across the commercially available botulinum toxin type A products. Such studies should also examine the relevance of neutralizing antibody titer to clinical responsiveness and nonresponse., (Copyright © 2022 by the American Society of Plastic Surgeons.)

Botulinum toxins (BoNT) are complex biological products. Each licensed BoNT type A (BoNTA) has its own individual characteristics resulting into different attributes, some of them being of clinical relevance. Besides profound anatomical knowledge and understanding of esthetic principles, the responsible injecting physician should be aware of those pharmaceutical and clinical properties. Especially against the background of new BoNTA formulations receiving approval by the authorities, a critical and dedicated discussion on the individual characteristics should take place, and the potential relevance on the treatment outcome should be taken into consideration., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Aesthetic physicians rely on certain anecdotal beliefs regarding the safe practice of filler injections. These include a presumed safety advantage of bolus injection after a negative aspiration., Objectives: The authors sought to review and summarize the published literature on inadvertent intravascular injection of hyaluronic acid and to investigate whether the technique of aspiration confers any safety to the practitioner and the patient., Methods: Pertinent literature was analyzed and the current understanding of the safety of negative and positive aspiration outlined., Results: The available studies demonstrate that aspiration cannot be relied on and should not be employed as a safety measure. It is safer to adopt injection techniques that avoid injecting an intravascular volume with embolic potential than utilize an unreliable test to permit a risky injection., Conclusions: To prevent intravascular injection, understanding "injection anatomy" and injection plane and techniques such as slow, low-pressure injection are important safety measures. Assurance of safety when delivering a bolus after negative aspiration does not appear to be borne out by the available literature. If there is any doubt about the sensitivity or reliability of a negative aspiration, there is no role for its utilization. Achieving a positive aspiration would just defer the risk to the next injection location where a negative aspiration would then be relied on., (© 2021 The Aesthetic Society.)

Background: The purpose was to evaluate the role and impact of the rhinoplasty outcome evaluation (ROE) in rhinoplasty., Objectives: To systematically review the ability of ROE to assess rhinoplasty outcome in the very recent surgical approaches., Data Sources: Searching MESH terms "rhinoplasty" and "rhinoplasty and ROE" on PubMed, Scopus, Embase, Google Scholar, and other major literature databases., Study Eligibility Criteria: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses model was adopted for eligibility criteria., Participants and Interventions: A first large screening on 1,660 papers allowed the final retrieval of 896 reports, of which only 101 were eligible for all the inclusion criteria, which allowed finally to select a group of 12 reports published in the time range 2018-2021., Study Appraisal and Synthesis Methods: Meta-regression with Durbin-Watson test, checking of meta-analysis bias with Rosenthal's estimator, and heterogeneity through the I 2 statistics were performed. The analysis included a Mantel-Haenszel test and associated or meta-analysis., Results: Twelve eligible and qualified papers were included in the meta-analysis, out of 1,263 patients, from 1,660 papers. ROE confirmed previous reports about its ability to discriminate preoperative from postoperative outcome (50/100), as from the different rhinoplasty approaches, a value very close to the functional Nasal Obstruction Symptom Evaluation scale. This study strengthens the role of ROE in the evaluation of rhinoplasty outcomes encouraging further research to improve ROE scale on different cultural habits and geographical areas., Limitations: The main limitations were due to the weak inclusion and exclusion criteria, methodological flaws with the statistical analysis, and poor data synthesis and evaluation in many papers about ROE., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Annals of Maxillofacial Surgery.)

Background: Botulinum toxin A (BTX-A) is commonly employed as a neuromodulator in several neurological diseases and aesthetic indications. Formation of neutralizing antibodies (NAbs) after BTX-A injections may be responsible for treatment failure., Objectives: The authors sought to quantify the prevalence of NAbs following treatment with Abobotulinumtoxin A, Incobotulinumtoxin A, and Onabotulinumtoxin A for therapeutic indications., Methods: An electronic systematic search (2000-2020) of PubMed, Scopus, Web of Science, and Embase was conducted. Original studies reporting prevalence of NAbs were included. Data analysis was carried out through open meta-analysis softwares., Results: Forty-three studies involving 8833 patients were included in this meta-analysis. The incidence of NAbs was 1.8% (summary estimate = 0.018, 95% CI [0.012, 0.023]); a meta-regression analysis revealed that BTX-A duration was significantly associated with increased incidence of NAbs (P = 0.007). Patients with dystonia had the highest incidence (7.4%) of NAbs against BTX-A (summary estimate = 0.074, 95% CI = [0.045, 0.103], I2 = 93.%, P < 0.00) followed by patients with spasticity (6.7%) and urological indications (6.2%). Abobotulinumtoxin A was associated with the highest incidence of NAbs (7.4%) (summary estimate = 0.074, 95% CI = [0.053, 0.096], I2 = 97.24%, P < 0.00) by the Incobotulinumtoxin A and Onabotulinumtoxin A 0.3% (summary estimate <0.003%, 95% CI = [-0.001, 0.007], P < 0.003)., Conclusions: Although the overall incidence of NAbs following BTX-A injections is relatively low, patients with secondary nonresponse to BTX-A with no apparent causes should be investigated for NAbs. A consensus needs to be developed for the optimal management of such patients., (© 2021 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)

Background: Botulinum toxin injection is the most commonly performed minimally invasive aesthetic procedure in men. Despite various recommendations by experts on the use of onabotulinumtoxin type A in the literature, distinct guidelines for its use in males and females do not exist., Objectives: The aim of this study was to delineate safe and effective doses for the use of onabotulinumtoxin type A in males for correction of upper facial expression lines., Methods: PubMed (MEDLINE), Embase, the Cochrane database, and Google Scholar were searched from 2002 to 2019 inclusive. Three researchers independently assessed trials for inclusion, extracted data, checked for accuracy, and assessed the evidence with AGREE II., Results: Average dosing recommended for the treatment of upper face expression lines was specific to glabellar frown lines, crow's feet, and horizontal forehead lines. Changing trends and gender variation was noted in each of the studies. Six of the 11 recommendations suggest the need to alter dosing in male patients, although do not give separate recommendations., Conclusions: There is an urgent need for up-to-date recommendations for the use of onabotulinumtoxin type A in upper face expression lines of male patients., (© 2021 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)

Background: In-depth understanding of facial anatomy is the foundation of clinical education and practices. Lately, anatomy education has undergone many changes due to the adoption of integrated medical curriculums. The time allocated to anatomy teaching on occasion been shortened to allow more time for clinical education. Innovation in visual technology such as virtual reality (VR), augmented reality (AR) and mixed reality (MR) has added a new dimension to anatomy education. The authors present a mixed reality virtual face model to facilitate complex anatomy teaching using Microsoft HoloLens in various educational settings., Materials and Methods: Close-range photogrammetry technique was utilised to construct a virtual face using a dissected fresh-frozen cephalus. Scanning was undertaken using DSLR cameras, capable of capturing ten frames per second, in ten different angles on the dissected side and four for the undissected side. The images of the entire cephalous were also separately captured in twenty different angles. These images were processed using software to reconstruct the three-dimensional virtual face., Result: The virtual face using a mixed reality platform was able to demonstrate individual layers of the face and relevant clinically significant structures clearly with interactive labelling. Face and the content validity by 12 experts (plastic surgeons and dermatologists) demonstrated strong inter-rater reliability expressed as interclass correlation coefficient., Conclusion: An immersive experience by using Microsoft HoloLens provides an accurate 3D perception of the face to enhance anatomy learning. This can be utilised in undergraduate, postgraduate and continued medical education as an additional teaching tool in the constraints of cadaveric dissection., 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 .

Background: Botulinum toxin A (botulinum toxin A) was found to provide a wide variety of therapeutic and aesthetic benefits as one of the most potent toxins in the world. Injectable remedies, including soft tissue fillers and botulinum toxin, have become very common in wrinkling and face rejuvenation management. While these methods of treatment are relatively safe, serious side effects can occur. In this review, the complications of BoNTA are highlighted., Methods: A literature research considered published journal articles (clinical trials or scientific reviews). Electronic databases (PubMed, Scopus, Science Direct) were searched using key terms, and for identification of additional relevant studies, reference lists have also been examined. Only articles published in English were included in this review with a time restriction from 2000 to 2020., Results: There are various injection-related adverse effects associated (AE) with botulinum toxins such as erythema, oedema, pain, ptosis of eyelid or brow and ecchymosis. The overall majority of adverse events identified are mild and temporary., Conclusion: As the use of toxins becomes increasingly more common, adverse events can be expected to increase as well. The practitioners need to be aware of such AEs, and the patients should be informed of these before undertaking such procedures., 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 .

Background: Standardizing training and education in nonsurgical facial aesthetic procedures during residency training has long been challenging because majority of the procedures are performed outside the usual teaching hospital settings. Several areas of refinement have been suggested and an increased need for more hands-on training identified in the available literature. Despite the growing demand for nonsurgical facial aesthetics (NSFA), it is yet to be fully integrated into standard postgraduate medical or surgical curriculum., Objectives: The objective of this study was to explore the current state and the need for medical education and training of aesthetic clinicians across specialties in a formal postgraduate curriculum., Methods: A mixed-method, cross-sectional, online research was conducted among physicians involved in training and practicing NSFA between July 2018 and December 2018. Focus group discussion was conducted to ensure the face and content validity of the survey items., Results: The total responses collected in the trainer's group was 179 and 496 in the trainee's group. The majority of trainers (95%) and trainees (93.8%) across specialties expressed their opinion for the need of a standard postgraduate course in NSFA. Moreover, more than 55% of them felt that 12 months, with a work-based, blended learning approach, would be most suitable for training and education., Conclusions: The survey results have underlined the need for specialized training in NSFA to enable clinicians to pursue independent practice with confidence. The authors recommend the inclusion of evidence-based postgraduate programs on NSFA in higher academic institutions as per their educational curriculum., (© 2020 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)

Background: Both age-related and congenital volume deficiencies may be addressed through the injection of hyaluronic acid (HA) fillers. Deep injection provides structural support, more superficial fat-tissue injection mediates contouring, and superficial intradermal use of HA filler and/or onabotulinumtoxinA may be used for refinement., Aims: To evaluate the clinical efficacy, patient satisfaction, and safety of the MD Codes approach as a proposed standardized methodology for full-face rejuvenation., Methods: This was a retrospective, single-center study of 250 consecutive adult patients undergoing full-face rejuvenation with HA fillers (Vycross) and onabotulinumtoxinA based on the MD Codes approach., Results: The mean age was 39.4 ± 11.6 years, and 80.4% were female. All patients were treated with HA filler in the midface; 89.6% were also treated in the upper face, and 63.2% in the lower face. The mean number of syringes used was 14 ± 4 (range 4-25), with more syringes typically required in older versus younger patients. All patients received onabotulinumtoxinA treatment. Mean FACE-Q Appearance-Related Psychosocial Distress score decreased from 54.3 ± 9.3 pretreatment to 36.1 ± 8.9 at 3 months post-treatment (P < .05). The most common complications were bruising (35.2%), transient soft-tissue edema (14.0%), and prolonged periorbital edema (3.6%)., Conclusions: Full-face rejuvenation based on the MD Codes approach provides significant esthetic improvements, with no major safety issues observed., (© 2020 Wiley Periodicals, LLC.)

Background: The novel coronavirus (COVID-19) pandemic is expected to last for an extended time, making strict safety precautions for office procedures unavoidable. The lockdown is going to be lifted in many areas, and strict guidelines detailing the infection control measures for aesthetic clinics are going to be of particular importance., Methods: A virtual meeting was conducted with the members (n = 12) of the European Academy of Facial Plastic Surgery Focus Group to outline the safety protocol for the nonsurgical facial aesthetic procedures for aesthetic practices in order to protect the clinic staff and the patients from SARS-CoV-2 infection. The data analysis was undertaken by thematic and iterative approach., Results: Consensus guidelines for nonsurgical facial aesthetic procedures based on current knowledge are provided for three levels: precautions before visiting the clinic, precautions during the clinic visit, and precautions after the clinic visit., Conclusions: Sound infection control measures are mandatory for nonsurgical aesthetic practices all around the world. These may vary from country to country, but this logical approach can be customized according to the respective country laws and guidelines., (© 2020 Wiley Periodicals, LLC.)

Background: With the increase in the use of soft-tissue fillers worldwide, there has been a rise in the serious adverse events such as vascular compromise and blindness. This article aims to review the role of fillers in causing blindness and the association between hyaluronic acid (HA) filler and blindness., Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to report this review., Results: A total of 190 cases of blindness due to soft-tissue fillers were identified, of which 90 (47%) cases were attributed to autologous fat alone, and 53 (28%) cases were caused by HA. The rest of the cases were attributed to collagen, calcium hydroxylapatite, and other fillers., Conclusions: Autologous fat was the most common filler associated with blindness despite HA fillers being the most commonly used across the globe. However, the blindness caused by other soft-tissue fillers like collagen and calcium hydroxylapatite was represented. It was also evident through the review that the treatment of HA-related blindness was likely to have better outcomes compared with other fillers due to hyaluronidase use.

Background: An understanding of facial anatomy is crucial for the safe practice of nonsurgical facial esthetic procedures. Contextual learning, aided with instructional design, enhances the trainees' overall learning experience and retention, and makes a positive impact on the performance of procedural skills. The present study aimed to develop a teaching approach based on Bloom's taxonomy involving cognitive, affective, and psychomotor learning domains., Materials and Methods: The practicability of Assess & Aware, Demonstrate, Decode, Act & Accomplish, Perform, Teach & Test (ADDAPT), a new approach to teaching applied facial anatomy and procedural skills to esthetic physicians in a large group setting, was evaluated in this study. Study participants were from two cohorts (n=124) who underwent 2 days of applied anatomy training in Singapore. Pre- and post-course multiple choice questions and objective structured practical examination were conducted to measure the effectiveness and applicability of the teaching model. Expert raters, table demonstrators, and participants rated the steps involved in the ADDAPT model on an 11-point Likert scale., Results: Pre- and post-course evaluation mean scores for multiple choice questions were 17.32 (SD ±3.36) and 22.61 (SD ±1.77) and for objective structured practical examination were 24.53 (SD ±4.63) and 43.57 (SD ±5.35), respectively ( P <0.001). Inter-rater agreement, expressed as the intraclass correlation coefficient, was 0.91 (95% CI: 0.62-0.98) for expert raters and 0.90 (95% CI: 0.78-0.97) for table demonstrators, which reflects the real strength of sound educational practice. The trainees well accepted the model and found the sessions intellectually stimulating. Trainees' feedback stated that the learning experience was enhanced by the repeated observation and constructive feedback provided by the tutors., Conclusion: The ADDAPT model is practical to instruct a large group of trainees in clinical anatomy and procedural skill training. This approach to instructional design may be feasible and transferable to other areas of psychomotor skill training in medical education., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The recent rapid growth in dermal filler use, in conjunction with inadequate product and injector control, has heralded a concerning increase in filler complications. The 10-point plan has been developed to minimize complications through careful preconsideration of causative factors, categorized as patient, product, and procedure related. Patient-related factors include history, which involves a preprocedural consultation with careful elucidation of skin conditions, systemic disease, medications, and previous cosmetic procedures. Other exclusion criteria include autoimmune diseases and multiple allergies. The temporal proximity of dental or routine medical procedures is discouraged. Insightful patient assessment, with the consideration of ethnicity, gender, and generational needs, is of paramount importance. Specified informed consent is vital due to the concerning increase in vascular complications, which carry the risk for skin compromise and loss of vision. Informed consent should be signed for both adverse events and their treatment. Product-related factors include reversibility, which is a powerful advantage when using hyaluronic acid (HA) products. Complications from nonreversible or minimally degradable products, especially when layered over vital structures, are more difficult to control. Product characteristics such as HA concentration and proprietary cross-linking should be understood in the context of ideal depth, placement, and expected duration. Product layering over late or minimally degradable fillers is discouraged, while layering of HA of over the same brand, or even across brands, seems to be feasible. Procedural factors such as photographic documentation, procedural planning, aseptic technique, and anatomical and technical knowledge are of pivotal importance. A final section is dedicated to algorithms and protocols for the management and treatment of complications such as hypersensitivity, vascular events, infection, and late-onset nodules. The 10-point plan is a systematic, effective strategy aimed at reducing the risk of dermal filler complications., Competing Interests: Disclosure The authors report no conflicts of interest in this work.