Daily Cosmetic Research Analysis
Three cosmetic-surgery–relevant studies stand out today: a surgeon survey links prior collagen biostimulators/threads to increased difficulty and complications in subsequent facelifts; a technical report introduces a pedicled deep temporalis muscle flap to enable safe reconstruction after endoscopic transorbital skull base surgery with improved cosmetic outcomes; and a subbrow blepharoplasty case series in Caucasian patients shows high satisfaction and low complication rates.
Summary
Three cosmetic-surgery–relevant studies stand out today: a surgeon survey links prior collagen biostimulators/threads to increased difficulty and complications in subsequent facelifts; a technical report introduces a pedicled deep temporalis muscle flap to enable safe reconstruction after endoscopic transorbital skull base surgery with improved cosmetic outcomes; and a subbrow blepharoplasty case series in Caucasian patients shows high satisfaction and low complication rates.
Research Themes
- Impact of biostimulators and threads on subsequent facelift surgery
- Minimally invasive skull base surgery with improved cosmetic reconstruction
- Outcomes of subbrow blepharoplasty for brow ptosis
Selected Articles
1. The Pedicled Deep Temporalis Muscle Flap in Endoscopic Transorbital Approach: How I Do It.
The authors describe a reconstruction method using a pedicled deep temporalis muscle flap to support the endoscopic transorbital skull base approach, emphasizing reduced morbidity and improved cosmetic outcomes. Both preclinical and clinical experience support feasibility and safety, suggesting broader adoption.
Impact: Introduces a practical, reconstructive solution that can expand indications for minimally invasive skull base surgery while maintaining cosmetic outcomes.
Clinical Implications: For skull base cases approached transorbitally, surgeons can consider a pedicled deep temporalis muscle flap to reinforce reconstruction, potentially reducing morbidity and optimizing cosmetic results.
Key Findings
- Endoscopic transorbital approach (TOA) can reduce morbidity and improve cosmetic outcomes compared with open techniques.
- A pedicled deep temporalis muscle flap is introduced as a novel reconstruction option tailored to TOA.
- Preclinical and clinical experience support feasibility and safety, indicating potential for broader adoption.
Methodological Strengths
- Combines preclinical and clinical implementation to demonstrate feasibility.
- Focus on reconstructive detail directly applicable to surgical practice.
Limitations
- Lack of comparative or randomized data versus alternative reconstructions.
- Unspecified sample size and limited long-term functional and cosmetic outcome data.
Future Directions: Prospective comparative studies with standardized cosmetic and functional endpoints and long-term follow-up.
Minimally invasive skull base techniques are increasingly adopted for their reduced morbidity and improved cosmetic outcomes. This study presents an endoscopic transorbital approach (TOA) for skull base surgery and introduces a novel reconstruction technique using a pedicled deep temporalis muscle flap. Preclinical and clinical results demonstrate its feasibility, safety, and potential for broader surgical use.
2. Assessment of the Possible Impacts of Collagen Biostimulators on Surgical Facelift.
In a survey of 63 facial surgeons, prior collagen biostimulators and threads were commonly perceived to delay or complicate facelift surgery, with higher reported dissection difficulty, skin irregularities, and prolonged inflammation. Many surgeons modified their approach, particularly when fibrosis was present, and procedures within 6 months of biostimulator placement were considered more challenging.
Impact: Addresses a rapidly growing clinical scenario with direct implications for safety, operative planning, and patient counseling in aesthetic surgery.
Clinical Implications: Obtain detailed histories of biostimulators/threads, anticipate fibrosis and dissection challenges, consider longer operative time, and discuss elevated complication risks. When feasible, consider delaying facelift beyond 6 months after biostimulator placement and adjust technique accordingly.
Key Findings
- 59% of surgeons believed biostimulators could delay facelift surgery.
- 84.4% reported increased complication rates; common issues included dissection difficulty (91.8%), postoperative skin irregularities (73.3%), and prolonged inflammation (57.4%).
- 50.8% observed longer operative times; 43.8% modified surgical approach, especially with fibrosis.
- Type of biostimulator influenced difficulty (97%); intraoperative recognition was highest for threads (76.6%) and CaHA (57.8%).
- Procedures performed within six months of biostimulator use were perceived as more challenging.
Methodological Strengths
- Includes a multi-specialty cohort of facial surgeons reflecting real-world practice.
- Quantifies specific operative challenges and complications with itemized frequencies.
Limitations
- Survey-based perceptions may be subject to recall and selection bias; no patient-level outcomes.
- No standardized definitions or time-to-event analyses; causality cannot be inferred.
Future Directions: Prospective registries and controlled studies to define timing, risk stratification, imaging/ultrasound mapping, and technique modifications for facelift after biostimulators.
BACKGROUND: Minimally invasive facial rejuvenation techniques, including collagen biostimulators and energy-based technologies, have gained popularity alongside surgical facelift (rhytidoplasty). While biostimulators present overall tissue remodeling (collagen, elastin, extracellular matrix), their impact on facelift surgery remains controversial due to a lack of robust scientific evidence. OBJECTIVE: To assess surgeons' perceptions on the effects of biostimulators use and facelift surgery, including surgical difficulty, complication rates, and modifications in surgical planning. METHODS: A survey was conducted with 63 facial surgeons, including plastic surgeons and otolaryngologists, evaluating their experiences with facelift procedures in patients previously treated with biostimulators. Questionnaire included patient history, preoperative assessment, surgical challenges, operative time, complications, and changes in surgical approaches. RESULTS: Most respondents (70%) performed both surgical and minimally invasive procedures, while 28% offered biostimulators through other professionals. When asked about surgery: 59% believed biostimulators could delay facelift surgery and 43.8% adjusted their surgical approach, especially in cases presenting fibrosis whereas 50.8% reported longer operative times, and 84.4% noted increased complication rates. Among complications, 91.8% reported difficulty in tissue dissection, 73.3% observed postoperative skin irregularities, and 57.4% noted prolonged inflammation. The type of biostimulator influenced surgical difficulty (97%), and intraoperative recognition was highest for threads (76.6%) and CaHA (57.8%). There was no consensus on the ideal interval between biostimulator application and surgery, but procedures performed within six months were seen as more challenging. CONCLUSION: Biostimulators may delay the need for facelift surgery but can increase intraoperative difficulty and complications. As their use expands, both cosmetic and surgical professionals must refine their techniques to ensure optimal outcomes. Also it may be considered that HCP using biostimulators and threads should advise the patients of these difficulties. Further clinical studies are needed to establish clear guidelines. 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.
3. Subbrow blepharoplasty for mild and moderate brow ptosis in Caucasians.
In 33 Caucasian patients with mild to moderate brow ptosis, subbrow blepharoplasty achieved high satisfaction (75.7% reporting significant/considerable improvement) with minimal early complications and rare visible scarring at 6 months. No sensory deficits, lagophthalmos, or significant brow descent were observed; visual field metrics improved in function-focused cases.
Impact: Provides focused outcomes data for subbrow blepharoplasty in a Western population, supporting its dual functional and cosmetic value and informing patient selection and counseling.
Clinical Implications: Subbrow blepharoplasty can be considered for Caucasian patients with brow ptosis and lateral hooding seeking functional visual field improvement and cosmetic rejuvenation, with low risk of visible scarring at 6 months when appropriately planned and executed.
Key Findings
- High patient satisfaction, with 75.7% reporting significant or considerable improvement at 6 months.
- Visual field metrics improved in cases with functional emphasis.
- Early complications were minimal (transient redness/swelling), and visible scarring at 6 months was rare.
- No cases of sensory deficits, lagophthalmos, or significant brow descent were observed.
Methodological Strengths
- Prospective assessment with standardized 6-month follow-up.
- Patient-centered outcomes including satisfaction and functional visual field metrics.
Limitations
- Single-arm case series without a comparator group and small sample size.
- Limited to Caucasian patients; generalizability to other ethnicities is uncertain.
Future Directions: Randomized or matched comparative studies versus alternative approaches (e.g., direct brow lift, upper blepharoplasty) with longer-term aesthetic and functional endpoints.
PURPOSE: This study evaluates the effectiveness and clinical outcomes of subbrow blepharoplasty for treating upper eyelid skin fold due to mainly brow ptosis and lateral hooding in Caucasian patients with mild to moderate brow ptosis. METHODS: Between 2023 and 2024, 33 patients (25 female and 8 male, aged 47 to 71) underwent subbrow skin excision to address functional and cosmetic concerns. Six months post-procedure, we assessed patient satisfaction using a Likert-type scale and documented complications, scar visibility, and nerve-related symptoms to evaluate the procedure's outcomes. RESULTS: Feedback from patients revealed a high level of satisfaction with both functional and aesthetic results. Cases that emphasized functionality showed significant improvements in visual field metrics. Early complications following surgery were minimal, primarily limited to temporary redness and swelling. By the six-month follow-up, evident scarring was rare, and there were no reported cases of sensory deficits, lagophthalmos, or significant brow descent. Evaluations using a Likert scale indicated high satisfaction levels, with 25 patients (75.7%) reporting significant or considerable improvement. CONCLUSIONS: Subbrow blepharoplasty is an effective, minimally invasive procedure for addressing brow ptosis and lateral hooding in Caucasian patients. It boasts high satisfaction rates, minimal complications, and rarely results in visible scarring. These positive outcomes demonstrate its value as a preferred surgical option for patients seeking both functional and cosmetic improvements.