Identifying Levels of Competency in Aesthetic Medicine:A Questionnaire-based Study

Background: In 2022, the US experienced a significant increase in demand for minimally invasive aesthetic procedures, underscoring its rising acceptance amid an unregulated educational environment for practitioners. The absence of standardized educational pathways and quality control in aesthetic medicine, primarily provided by nonacademic institutions, highlights a critical need for establishing educational standards to ensure practitioner competence and patient safety. Objectives: The aim of this study was to identify levels of competency for the aesthetic practitioner and necessary achievement milestones during the educational path from novice to expert injector. Methods: A total of n = 386 international study participants responded to an online questionnaire regarding their experience in aesthetic medicine practice. The questionnaire comprised 58 questions focusing on professional data, the perceived difficulty of injection, and risk for the occurrence of adverse events for specific facial regions in soft tissue filler and toxin injections. Results: Regardless of medical specialty and experience level, averages of 3.85 (1.8) years, 786.4 (2628) filler injections and 549.9 (1543) toxin injections were estimated to progress from novice to advanced injector, while averages of 6.10 (3.7) years, 1842.2 (4793) filler injections, and 1308.5 (3363) toxin injections were estimated to advance from advanced to expert injector. The nose and the perioral region have been ranked as the facial regions where it is most difficult to achieve a perfect aesthetic outcome and with the greatest risk for the occurrence of adverse events for filler and toxin injections, respectively. Conclusions: In this study we establish an educational framework in aesthetic medicine by defining the progression from novice to competent and expert injector levels, suggesting 4 years of practice and over 790 filler and 550 neuromodulator injections for competence, and at least 6 years with 1840 filler and 1310 neuromodulator injections for expertise. We also identify critical facial regions for targeted treatments by different expertise levels.</p

Investigating the Clinical Merit of Contraction Patterns for Glabellar Neuromodulator Injections—A Clinical Retrospective Investigation Following the 3-Point Glabellar Injection Technique

Background: Since the introduction of glabellar contraction patterns as a guide for neuromodulator treatments, feedback regarding its clinical utility has been mixed. Recent studies have cast doubt on the value of such contraction-pattern-driven treatment paradigms.Objective: The aim of this retrospective study is to evaluate the clinical outcome of identical glabellar injections independent of glabellar contraction pattern types. Methods: Forty-two Brazilian, multi-ethnic, consecutive patients with moderate to very severe glabellar lines were included in this retrospective analysis. The same 3-point glabellar injection technique was utilized, administering a total of 37.5 sU (=15 IU) to the procerus and corrugator supercilii muscles. Glabellar severity was assessed at 20 and 90 days after the initial treatment. Results: Across the entire study sample, a highly statistically significant improvement was observed at all investigated follow-up time points (p &lt; 0.001). When comparing the treatment outcome across the five different glabellar contraction patterns, there was no statistically significant difference detected at either 20 days follow-up (p = 0.373) or 90 days follow-up (p = 0.311). Multivariate analyses confirmed that neither age, BMI, Fitzpatrick skin type, nor glabellar contraction patterns statistically influenced the outcome at 90 days (all p &gt; 0.05). Conclusion: The results of this retrospective analysis revealed that in the sample investigated, no statistically significant differences were detected between patients with different glabellar contraction patterns at any of the conducted follow-up visits when the same glabellar injection technique with the same amount of toxin units was administered.</p

The Influence of Image Exposure Duration on Facial Perception—Why It Matters

Background: First impressions from faces, thought to serve an adaptive evolutionary role, vary by age and gender. Understanding gaze patterns is key to uncovering how these impressions form. Understanding facial gaze during brief (1 s) and longer (8 s) exposures helps identify key facial areas and behaviors, providing insights for better aesthetic assessment for non-invasive and surgical procedures to enhance outcomes and satisfaction. Aims: To evaluate whether we perceive faces differently depending on the gaze duration.Methods: The number of stable eye fixations (total fixation count) of n = 55 observers (34 females, 21 males) in seven facial regions of four visual stimulus images (young and old male and female) was analyzed using eye-tracking technology. The four visual stimulus images were presented to the observers twice in a randomized order with exposure times of 1 and 8 s. Results: Regardless of age or sex of the face, fixation rankings followed similar patterns, with slight shifts between 1 and 8-s exposures. Age- and sex-specific analyses revealed gaze pattern differences. Conclusion: A consistent facial scanning pattern, starting with central features (periorbital, nose, perioral) and expanding to cheeks, forehead, chin, and jawline, was observed regardless of the inspection time. However, longer image exposure shifts focus to regions more crucial for facial expressions, such as the perioral and forehead areas. This effect is especially visible for mature faces in which increased exposure time makes observer focus on the areas where age-related changes are most visible (i.e., perioral) and, on the other hand, possible to be corrected with injections.</p

Prediction of post-operative necrosis after mastectomy: A pilot study utilizing optical diffusion imaging spectroscopy

<p>Abstract</p> <p>Introduction</p> <p>Flap necrosis and epidermolysis occurs in 18-30% of all mastectomies. Complications may be prevented by intra-operative detection of ischemia. Currently, no technique enables quantitative valuation of mastectomy skin perfusion. Optical Diffusion Imaging Spectroscopy (ViOptix T.Ox Tissue Oximeter) measures the ratio of oxyhemoglobin to deoxyhemoglobin over a 1 × 1 cm area to obtain a non-invasive measurement of perfusion (StO₂).</p> <p>Methods</p> <p>This study evaluates the ability of ViOptix T.Ox Tissue Oximeter to predict mastectomy flap necrosis. StO₂measurements were taken at five points before and at completion of dissection in 10 patients. Data collected included: demographics, tumor size, flap length/thickness, co-morbidities, procedure length, and wound complications.</p> <p>Results</p> <p>One patient experienced mastectomy skin flap necrosis. Five patients underwent immediate reconstruction, including the patient with necrosis. Statistically significant factors contributing to necrosis included reduction in medial flap StO₂(p = 0.0189), reduction in inferior flap StO₂(p = 0.003), and flap length (p = 0.009).</p> <p>Conclusion</p> <p>StO₂reductions may be utilized to identify impaired perfusion in mastectomy skin flaps.</p