Scientific Abstract Presentations: Aesthetic Session 2 Friday, October 10 Fri, Oct 10 5:00-6:00 p.m. CDT

Purpose: Facial skin aging is influenced by intrinsic and extrinsic factors, but the neck, which undergoes distinct aging processes, has been comparatively understudied. This study investigates how aging risk factors influence objective neck skin characteristics in adults over 50, using the DermaLab Combo system for a detailed biomechanical analysis.

Methods: Thirty-six adults (mean age 64.3) completed a survey assessing demographic, lifestyle, and medical risk factors. Lifetime stress levels were evaluated using the Life Change Index Scale, and satisfaction with neck appearance was measured with the FACE-Q-Appraisal of the Neck scale. Neck skin properties, including melanin, erythema, transepidermal water loss (TEWL), viscoelasticity (VE), Young's modulus of elasticity (E), and retraction time, were measured using the DermaLab Combo. Univariate and multivariate analyses adjusted for age and ethnicity.

Results: Males had significantly higher erythema levels (P≤0.01), greater TEWL (P=0.08), and lower skin elasticity (E) (P=0.01) than females. Ethnicity was the strongest predictor of melanin levels, with Black participants exhibiting significantly higher melanin levels than White and Hispanic participants (P≤0.01), as well as higher erythema levels (P≤0.01). Obesity (BMI≥30) was associated with higher melanin levels (P=0.03), lower VE (P=0.02), lower elasticity (P=0.04), and longer retraction time (P=0.02) compared to those with BMI<25. Diabetes and metabolic syndrome were linked to higher melanin (P≤0.01), higher erythema (P=0.05), lower VE (P=0.03), and lower elasticity (P=0.02). Higher stress levels correlated with increased melanin (P=0.03). Sunscreen use (SPF>30) was associated with higher VE (P=0.03) and greater elasticity (P=0.05). Smoking history was linked to prolonged retraction time (P=0.01), suggesting impaired biomechanical recovery. Tanning bed use was associated with lower melanin (P≤0.01) and lower erythema (P≤0.01). Participants spending ≥4 days/week in direct sunlight had significantly higher FACE-Q scores (P=0.01). A greater increase in BMI from age 18 was associated with decreased erythema (P≤0.01) and lower TEWL (P=0.01).

Conclusions: This study provides objective evidence linking aging risk factors to neck skin biomechanical properties. Obesity and smoking were associated with reduced elasticity and prolonged retraction time, while sunscreen use was linked to improved viscoelasticity and elasticity. The observed correlations between melanin, obesity, stress, and diabetes/metabolic syndrome suggest potential racial disparities in health risk factors, which warrant further investigation. These findings emphasize the importance of lifestyle modifications and photoprotection in mitigating neck skin aging and optimizing aesthetic surgical outcomes.

INTRODUCTION: HIV-associated lipodystrophy, a condition characterized by abnormal fat redistribution, is a common co-morbidity in patients undergoing highly active antiretroviral therapy. Facial fat loss, a hallmark of this condition, can significantly impact a patient's physical appearance and quality of life. As a result, facial fat grafting has emerged as a key therapeutic approach to restore volume and enhance facial aesthetics in individuals with HIV-related facial fat loss. This study aimed to identify the most effective facial fat process technique for facial fat grafting in these patients, with focuses on safety, physician assessment, and patient satisfaction.

METHODS: A systematic review and meta-analysis were performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review protocol was registered with PROSPERO. The study included English-language articles published from 2002-2024 that provided extractable data on autologous fat processing and patient satisfaction following surgical intervention for facial fat grafting in patients with HIV lipodystrophy. Meta-analysis was performed using a random-effects model.

RESULTS: The systematic review identified 5,270 articles, of which 73 were selected for full-text review and 10 were deemed eligible. The total population consisted of 903 patients, with a mean age of 41.4 years (95% CI: 30.68–52.12). The mean fat graft volume was 9.96 mL (95% CI: -30.16–50.09). The site of harvest was predominantly the abdomen (77.8%), followed by the cervical lump (11.1%) and triceps (11.1%). The distribution of specific graft sites was as follows: 71.4% of patients had grafts at the Malar site, 14.3% at the Temporal site, 7.1% at the Zygomatic site, and 7.1% at the Nasolabial sulcus site. The analysis of both physician and patient satisfaction ratings based on fat process techniques (centrifugation vs. decantation) showed no significant difference, with physician satisfaction yielding a p-value of 0.67 and patient satisfaction a p-value of 0.55.

CONCLUSION: The choice of fat process technique, whether centrifugation or decantation, does not significantly affect satisfaction ratings from either physicians or patients. Despite variations in harvest sites and graft locations, the results indicate that both techniques yield comparable satisfaction outcomes. This suggests that factors beyond the fat processing method, such as harvest and graft site, may play a more pivotal role in determining patient satisfaction, physician satisfaction, and fat retention, particularly in the context of HIV lipodystrophy.

Purpose: Dermal fillers have become an increasingly popular non-surgical option for aesthetic enhancement, with nearly three million procedures performed annually. The growing demand has contributed to a lucrative market; however, variations in provider training and expertise have led to inconsistencies in patient safety and an increased risk of medical malpractice. This study aims to analyze malpractice cases related to dermal filler to gain a deeper understanding of the associated risks and challenges.

Methods: The Westlaw legal database was searched for medical malpractice final jury verdicts or settlements related to dermal fillers. The names of all currently available fillers were also individually queried. Litigant demographics and credentials, type of filler, allegations for malpractice, complications, case outcomes, and award payments were analyzed. Board certification in an aesthetic specialty was defined as plastic surgery, otolaryngologist (ENT), dermatology, or oculoplastics, while all other specialties were categorized as non-aesthetic.

Results: Analysis of 22 cases revealed that four defendants (18.2%) were non-medical professionals, while the remaining 18 were physicians, two of whom (11.1%) were not board certified in an aesthetic specialty . Plastic surgeons (n=8) were the most commonly named defendants, followed by dermatologists (n=4) and ENT specialists (n=4). Silicone was the most frequently cited filler (n=4), followed by Juvederm, Radiesse, Restylane, and Sculptra (all n=3). Negligence and lack of informed consent were the most common allegations, with scarring, disfigurement, and granuloma formation as prevalent complications. A majority of case outcomes favored the defendant (72.7%), while 22.7% resulted in plaintiff verdicts and one (4.5%) in a settlement. The average payout for plaintiff verdicts was $501,267.81 (range: $20,707.00–$1,160,000.00), while the settlement resulted in a payment of $425,000.00. Cases involving non-physician injectors or non-aesthetic board certified physicians (OR=14.00, p=0.022), as well as claims involving battery (OR=8.67, p=0.045) and fraud (OR=15.00, p=0.040), were significantly more likely to result in legal payments to the plaintiff. Additionally, plastic surgeons were more frequently named in claims related to inadequate post-injection care (p = 0.008) and loss of consortium (p = 0.036), where a plaintiff's partner claims the injury adversely affected their relationship.

Conclusion: Medical malpractice cases involving dermal fillers mainly favored defendants. Most defendants were aesthetic specialized physicians, though some lacked medical licenses or board certification in aesthetic specialties. Cases involving unqualified injectors or allegations of battery or fraud had higher odds of plaintiff verdicts or settlements. Providers should remain vigilant in postoperative care and maintain strong patient relationships to mitigate potential litigation risks in cosmetic injectable procedures.

Purpose: With the growing social acceptance of cosmetic enhancements, injectable treatments have surged in popularity. Manhattan has become a major hub, hosting numerous medspas and injectors. However, aesthetic injections are medical procedures that carry risks and require qualified providers. This study examines top web search results in Manhattan to assess injector credentials and practices.

Methods: Aesthetic injectors and clinics were identified using two online methods. First, providers were located through the "Find a Provider" feature on the official websites of dermal filler brands, including Bellafill, Juvederm, Radiesse, Restylane, RHA, Belotero, and Sculptra, with search parameters set to Manhattan, New York, and within a 5-mile radius. The second method involved a Google search using the query "filler in Manhattan," in which the first five pages of search results were reviewed. Duplicates across both methods were counted only once. Each clinic's website was analyzed for practice ownership, injector credentials, board certification, and presence of an on-site physician.

Results: Out of 219 clinics analyzed, 167 (75.3%) were owned or founded by medical doctors, 38 (17.4%) by non-physician healthcare providers (e.g., dentists, DNPs, NPs, PAs, and RNs), and 13 (5.48%) by non-medical professionals such as estheticians and business owners. Twenty one clinics indicated having a Medical Director, two of whom were DNPs. Among the 19 physician Medical Directors, 10 (52.63%) were not board-certified in an aesthetic specialty, defined as plastic surgery, ENT/facial plastics, oculoplastic, or dermatology. Out of 166 clinics that had physician injectors available, 142 (64.8%) were board certified in an aesthetic field. Clinics founded by non-physicians were significantly less likely to have an on-site physician (p < 0.001), and when present, these physicians were more likely to not be board-certified in aesthetic specialties (p < 0.001). Furthermore, physicians certified in non-aesthetic fields were significantly less likely to display their credentials online (p < 0.001).

Conclusions: Our review of the top online results for aesthetic injectors in Manhattan reveals a wide variation in provider qualifications. Although most clinics are physician-owned, a notable number were founded by non-physicians that often lacked on-site doctor or employed non-aesthetic board certified specialists with limited credential transparency. These findings potentiate the need for greater regulatory oversight and consumer education in cosmetic injections.

BACKGROUND: Major depression has been associated with significantly increased likelihood of postoperative complications, expected length of stay, and/or hospital readmission in females.(1) This study aims to investigate the impact of major depression on facial cosmetic surgery outcomes using data from the National Inpatient Sample (NIS), assessing variables such as age, complications, length of stay, and hospital charges.

METHODS: A retrospective cohort design was employed, analysing inpatient data from 2016–2020. Patients with major depression undergoing facial cosmetic surgeries were compared to a control group without depression. Standard statistical tests were used to assess the outcomes.

RESULTS: The study cohort included 352 patients who underwent facial cosmetic surgeries, comprising 321 control patients (91.2%) and 31 depression patients (8.8%). The median age differed significantly between the groups, with controls having a median age of 61.67 years compared to 53.42 years for depressed patients (p < 0.001). There was a higher prevalence of hypertension among depressed patients (29% vs 13.4%) (p < 0.05). No significant disparities were observed in the overall in-hospital outcomes following facial cosmetic surgeries.

CONCLUSIONS: In conclusion, our study demonstrates that facial cosmetic surgery outcomes are comparable between patients with and without major depression, suggesting these procedures are safe when depression is well-managed, and expectations are realistic.

REFERENCES: 1. Geoffrion R, Koenig NA, Zheng M, Sinclair N, Brotto LA, Lee T, Larouche M. Preoperative Depression and Anxiety Impact on Inpatient Surgery Outcomes: A Prospective Cohort Study. Ann Surg Open. 2021 Mar 16;2(1):49. https://doi.org/10.1097/AS9.0000000000000049

Purpose: Eyelid ptosis is a condition characterized by the drooping of the upper eyelid, which can significantly impact a patient's vision and health-related quality of life. (1) Surgical intervention is commonly required to restore normal eyelid position and improve visual outcomes. (2) One such corrective measure is levator shortening, which involves advancing the levator muscle to improve upper eyelid position above the pupil. (3) The aim of this prospective study is to evaluate the effectiveness of levator shortening in correcting upper eyelid ptosis. This will be achieved by assessing various eyelid parameters at different stages of the surgical process, including preoperative, intraoperative, and post-operative measurements.

Methods: This study was conducted as a prospective, single-institution, single-surgeon study. The patient cohort consisted of individuals undergoing bilateral levator advancement for upper eyelid ptosis. The study period extended from February 2015 to November 2024. The eyelid parameters collected included Marginal Reflex Distance-1 (MRD-1), eyelid aperture (EA), mid-pupil to upper lid crease distance (MPC), and levator shortening (LS). Measurement techniques included the use of a ruler for MRD-1, EA, and MPC preoperatively and postoperatively, and the use of calipers for intraoperative LS measurement. All measurements were collected in millimeters.

Results: A total of 40 patients (80 eyes) were included in the study, comprising 30 females and 10 males, with an average age of 65.55 ± 11.34 years. The mean operative time was 3.20 ± 1.48 hours, and the average follow-up period was 53.91 ± 53.33 days. Among the procedures, 12 cases were combined with a blepharoplasty, 11 with a brow lift, and 8 with other procedures. Of the 40 cases, 39 were performed as a primary procedure, while one was a secondary procedure. No revisions were required postoperatively.

A total of 139 preoperative and 150 postoperative measurements were analyzed. Postoperatively, all patients had increased MRD-1, aperture, and mid pupil to crease distance. An average levator shortening of 4.71 ± 1.26 mm resulted in a mean MRD-1 increase by 2.77 ± 1.06 mm, an aperture improvement of 3.35 ± 1.76 mm, and a mid-pupil to crease distance increase of 2.69 ± 1.81 mm. No cases of under-correction or overcorrection were observed.

Immediate post-operative complications included ecchymosis (n=5), edema (n=18), erythema (n=3), dry eyes (n=4), numb eyelids (n=2), and one case each of pain over incision, blurred vision, glare sensitivity, lacrimal gland infection, and loss of forehead sensation. Late complications were reported in 5 patients, including dry eyes (n=2), mild ptosis (n=1), upper forehead hypopigmentation (n=1), and blurred vision (n=1). All patients expressed satisfaction with the outcomes, citing improved peripheral vision and improved quality of life.

Conclusion: This study highlights the efficacy of levator shortening in improving eyelid function for patients with ptosis. By utilizing these eyelid parameters, we demonstrated postoperative improvements following bilateral levator advancement. These findings support the clinical utility of using these parameters as reliable assessment tools and reinforce levator advancement as an effective surgical technique for eyelid ptosis correction.

References: 1. Richards HS, Jenkinson E, White P, et al. Patient reported psychosocial functioning following successful ptosis surgery. Eye (Lond). 2022;36(8):1651-1655. 2. Cahill KV, Bradley EA, Meyer DR, et al. Functional indications for upper eyelid ptosis and blepharoplasty surgery. Ophthalmology. 2011;118(12):2510-2517. 3. Bilici S, Harbigil-Sever T, Ugurbas SH. Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection. Arq Bras Oftalmol. 2024;87(3):e20230028.

Introduction With the rising incidence of obesity, alternative weight loss methods beyond lifestyle such as weight loss surgeries and pharmacological interventions like GLP-1 agonists are increasing in popularity. Despite the mental and physical benefits of significant weight loss, patients are often left with excess skin and subcutaneous tissue, which can cause functional impairments. Abdominal body contouring, a surgical procedure to remove this excess tissue, carries inherent risks. While complications from body contouring procedures are well-documented, the complication rates following abdominoplasty and panniculectomy across different weight loss methods have not been extensively studied. This meta-analysis aims to evaluate the complication rates of panniculectomy/abdominoplasty following weight loss surgery (WLS), lifestyle-induced weight loss (Non-WLS), and GLP-1 agonist-induced weight loss.

Methods A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and the Cochrane Library, using keywords related to weight loss, WLS, GLP-1 agonists, lifestyle, abdominoplasty, panniculectomy, and surgical complications. A total of 71 articles were screened using Covidence systematic review software, with studies included if they reported surgical complications in patients who had undergone panniculectomy and specified the type of preoperative weight loss (WLS, Non-WLS, GLP-1 agonists).

Results Ten articles met the inclusion criteria for the meta-analysis. Among these, the WLS group had 279 reported complications compared to 188 in the Non-WLS group, yielding an odds ratio (OR) of 2.02 (95% confidence interval [CI] 1.62-2.51; p < 0.001). This indicates that WLS patients are over twice as likely to experience complications compared to Non-WLS patients. Hematoma, seroma, and wound infections were the most frequently reported complications. WLS patients were 57% more likely to develop hematomas (OR 1.57, CI 1.01-2.42; p = 0.04), which was the only statistically significant individual complication. No articles found mentioned weight loss through pharmacological interventions such as GLP-1 agonists.

Conclusions WLS patients face a higher risk of overall complications, particularly hematomas, compared to Non-WLS patients undergoing panniculectomy or abdominoplasty. The absence of data regarding pharmacological weight loss, particularly GLP-1 agonists, highlights a critical gap in the current literature and emphasizes the need for further studies to evaluate outcomes in this growing population. More research is needed to address the heterogeneity in complication rates and study methodologies, small sample sizes, and to better understand the risks associated with different weight loss methods.

Introduction Obesity is a significant public health crisis in the United States that continues to rise, with a recent reported prevalence of 40.3% from the National Health and Nutrition Examination Survey (NHANES). Obesity is associated with numerous chronic diseases and imposes substantial social, psychological, and economic burdens. To improve health and quality of life, many individuals pursue weight loss through surgery, such as bariatric procedures, and medical treatments like GLP-1 agonists, alongside traditional lifestyle changes. However, massive weight loss often consequently results in excess skin, which can cause functional limitations and psychological distress. As part of the patient's weight loss journey, body contouring procedures can alleviate these issues and offer both physical and mental benefits, but are frequently classified as cosmetic and excluded from insurance coverage. Evaluating quality of life (QoL) in patients following massive weight loss is crucial, but the diversity of QoL measures used in the literature complicates comparisons. This study provides a scoping review to assess the use of Patient-Reported Outcome (PRO) measures related to QoL following weight loss and body contouring procedures.

Methods A literature search was performed using the PubMed database, focusing on keywords related to weight loss, weight loss surgery, and quality of life. An initial screening of 3,275 broadly relevant articles was conducted, and 799 were imported into Covidence systematic review software. After an additional round of screening, 670 articles discussing post-weight loss QoL measures, QoL following both surgical and non-surgical weight loss, and QoL after body contouring procedures were included for analysis.

Results The number of studies addressing patient-reported QoL following weight loss more than doubled from 149 articles between 2004-2013 to 360 articles between 2014-2024. The most commonly used scales for measuring QoL after weight loss were the Short Form-36 Health Survey (SF-36), Bariatric Analysis and Reporting Outcome System (BAROS), and BODY-Q, followed by the Moorehead-Ardelt Quality of Life Questionnaire II, Impact of Weight on Quality of Life (IWQOL), EuroQol 5-Dimension 5-Level (EQ-5D-5L), and Gastrointestinal Quality of Life Index (GIQLI). SF-36 was the most widely used across diverse medical fields, BAROS was more common in bariatric surgery literature, and BODY-Q was predominant in studies focused on body contouring. While all these scales address psychological and health-related quality of life, only BODY-Q specifically evaluates the impact of excess skin.

Conclusions Understanding QoL from the patient's perspective is vital for recommending appropriate medical, lifestyle, and surgical interventions for weight loss. While many studies explore patient-reported QoL following weight loss and body contouring, there is significant variability in the scales used, leading to challenges in comparing outcomes. The weight loss journey has two parts, starting from the initial weight loss and associated health benefits, but then there can be profound mental and physical impact associated with excess skin after massive weight loss. The benefits of body contouring procedures are often neglected across weight loss literature, and more attention should be given to including these outcomes in standardized scales to better inform insurance coverage decisions.

Purpose: Rib cage remodeling surgical techniques, such as rib osteotomy with osteosynthesis, have shown promising results in aesthetic surgery for waist narrowing (1). However, the ideal osteotomy location and fixation angle have not been thoroughly explored. This study aims to: 1) quantify the impact of osteotomy location relative to the midline and rib angle on waist circumference using an open-source database of CT images of adult rib cages in MATLAB, and 2) determine the combination of rib number, rib angle, and osteotomy location that may result in the greatest waist reduction, informing surgical planning for rib cage remodeling.

Methods & Materials: We utilized the open‐source RibFrac dataset, containing high‐resolution CT scans of rib cages (2). RibSeg, an open-source deep learning tool, was used to segment the individual ribs from these CT volumes. From the segmented data, we extracted 600 ribs (300 each from ribs X and XI) for the simulation.

A custom MATLAB script was created to apply five bending angles (10°, 20°, 30°, 45°, 55°) and three osteotomy distances along the midline (7 cm, 8 cm, 9 cm) to each rib. Using a chord-perpendicular method, the apex of each rib was localized, and displacement was calculated after simulating the bending. The script allowed manual selection of bending points and distance calculations through a graphical user interface (GUI). A linear mixed-effects model was used to quantify the effects of bending angle, osteotomy distance, and their interaction on rib displacement, controlling for inter-rib variation.

Results: The linear mixed-effects model showed that both bending angle (p< 0.001) and osteotomy distance (p< 0.001) significantly affected rib displacement. A significant negative interaction (p< 0.001) indicated that bending angle had less impact on displacement with more distal osteotomy. The average displacements for rib X at angles of 10, 20, 30, 45, and 55 were: 11.1, 22.2, 33.0, 48.9, 58.9 (7 cm osteotomy); 9.3, 18.5, 27.6, 40.8, 49.3 (8 cm); and 7.4, 14.8, 22.0, 32.5, 39.3 (9 cm). For rib XI, displacements were: 4.2, 8.3, 12.4, 18.4, 22.2 (7 cm); 3.0, 6.0, 9.0, 13.2, 16.0 (8 cm); and 2.3, 4.6, 6.8, 10.1, 12.1 (9 cm). The GUI-based framework allows users to visually compare pre- and post-osteotomy rib interactions in 3D space.

Conclusions: This study has important implications for aesthetic rib remodeling surgery aimed at waist reduction. Surgeons could upload patient CT scans into this software to determine the optimal approach for desired outcomes, enhancing personalized care. Future research may apply this method to CT images of patients from specific age, sex, and BMI categories, further advancing these findings.

References - Aguilar Villa H, Villabona-Florez SJ, Hoyos AE, Perez Pachon ME, Serrano-Reyes HM, Diaz Sandoval CJ. Aesthetic Rib Cage Remodeling with Osteosynthesis: Body Structural High-Definition Reshaping (Rib Osteotomy with Osteosynthesis Stabilization). Plast Reconstr Surg. 2025;155(2):279-288. doi:10.1097/PRS.0000000000011512 - Deep-learning-assisted detection and segmentation of rib fractures from CT scans: Development and validation of FracNet. eBioMedicine. 2020;103106(62):2352-3964. doi:10.1016/j.ebiom.2020.103106

Background: The standard approach to release of the orbital ligament via endoscopic technique is in the areolar plane between the temporoparietal fascia and the deep temporal fascia lateral to the temporal line of fusion. This plane of dissection is anatomically complex and contains the sentinel veins, branches of the frontal nerve and the inferior temporal septum, all of which obstruct access to the orbital ligament.

Methods: A retrospective review was performed of the senior author's approach to endoscopic forehead lifting, consisting of 18 patients between 2016-2024. Comparisons of pre- and postoperative photographs were made at 6-8 weeks and >6 months postoperatively to quantitate the effectiveness of this alternative technique. Measurements of the infrabrow height at five standardized points relative to the mid inter-pupillary line were taken. Patient demographics and outcomes were tabulated. Manual scaling was performed on images due to software limitations preventing automated adjustment to the targeted 80mm, thus minor variations (range:79-82 mm) occurred.

Results: Eighteen patients were identified for inclusion in this study with 100% follow-up. The average age was 59 years (43-70). At the immediate post-operative period, the mid pupillary distance remained the same at 80.2 mm, supporting measurement reliability. Additionally, spacing between the eye and eyebrow demonstrated proportional expansion, with universal measurable increases accounting for approximate positioning of these structures, and these increases were consistent regardless of sidedness. Left-sided and right-sided measurements showed comparable distances from the mid inter-pupillary line (IPL), demonstrating bilateral symmetry both pre-operatively and post-operatively. There were no instances of frontal nerve weakness or palsy, and no instances of hematoma. One patient had a small scalp wound over a single spike of an Endotine which healed promptly with conservative management. For 10 patients, follow-up extended beyond 6 months post-operatively, with an average follow-up of 10.9 months (range: 6-32 months). Extended follow-up measurements underwent pairwise comparisons with pre-operative measurements, resulting in more remarkable differences in post-operative appearance. While symmetry was still found to be conserved in both the pre- and post-operative period, mid inter-pupillary line (IPL) to medial canthus (p=0.14), medial limbus (p=0.12), mid-pupillary line (p=0.11), lateral limbus (p=0.25), and lateral canthus (p=0.26), depicted subtle efficacy in achieving ideal brow positioning. Averaged measurements at each anatomical landmark demonstrated between 1.7-3.1 mm increase in brow height. With all measurements averaged together, the overall increase in brow height was 2.22 mm at 6-8 weeks post-operatively and 2.64 mm at >6 months post-operatively. All patients were satisfied with their result.

Conclusion: The plane deep to the deep temporal fascia (dDTF) provides eyebrow elevation comparable to the classic sub-temporoparietal fascial plane, avoids critical anatomic structures, allows unfettered access to the orbital ligament, and provides satisfactory objective and subjective clinical results.

Purpose: Dermal fillers have become an increasingly popular non-surgical option for aesthetic enhancement, with nearly three million procedures performed annually. The growing demand has contributed to a lucrative market; however, variations in provider training and expertise have led to inconsistencies in patient safety and an increased risk of medical malpractice. This study aims to analyze malpractice cases related to dermal filler to gain a deeper understanding of the associated risks and challenges.

Methods: The Westlaw legal database was searched for medical malpractice final jury verdicts or settlements related to dermal fillers. The names of all currently available fillers were also individually queried. Litigant demographics and credentials, type of filler, allegations for malpractice, complications, case outcomes, and award payments were analyzed. Board certification in an aesthetic specialty was defined as plastic surgery, otolaryngologist (ENT), dermatology, or oculoplastics, while all other specialties were categorized as non-aesthetic.

Results: Analysis of 22 cases revealed that four defendants (18.2%) were non-medical professionals, while the remaining 18 were physicians, two of whom (11.1%) were not board certified in an aesthetic specialty . Plastic surgeons (n=8) were the most commonly named defendants, followed by dermatologists (n=4) and ENT specialists (n=4). Silicone was the most frequently cited filler (n=4), followed by Juvederm, Radiesse, Restylane, and Sculptra (all n=3). Negligence and lack of informed consent were the most common allegations, with scarring, disfigurement, and granuloma formation as prevalent complications. A majority of case outcomes favored the defendant (72.7%), while 22.7% resulted in plaintiff verdicts and one (4.5%) in a settlement. The average payout for plaintiff verdicts was $501,267.81 (range: $20,707.00–$1,160,000.00), while the settlement resulted in a payment of $425,000.00. Cases involving non-physician injectors or non-aesthetic board certified physicians (OR=14.00, p=0.022), as well as claims involving battery (OR=8.67, p=0.045) and fraud (OR=15.00, p=0.040), were significantly more likely to result in legal payments to the plaintiff. Additionally, plastic surgeons were more frequently named in claims related to inadequate post-injection care (p = 0.008) and loss of consortium (p = 0.036), where a plaintiff's partner claims the injury adversely affected their relationship.

Conclusion: Medical malpractice cases involving dermal fillers mainly favored defendants. Most defendants were aesthetic specialized physicians, though some lacked medical licenses or board certification in aesthetic specialties. Cases involving unqualified injectors or allegations of battery or fraud had higher odds of plaintiff verdicts or settlements. Providers should remain vigilant in postoperative care and maintain strong patient relationships to mitigate potential litigation risks in cosmetic injectable procedures.

Purpose: With the growing social acceptance of cosmetic enhancements, injectable treatments have surged in popularity. Manhattan has become a major hub, hosting numerous medspas and injectors. However, aesthetic injections are medical procedures that carry risks and require qualified providers. This study examines top web search results in Manhattan to assess injector credentials and practices.

Methods: Aesthetic injectors and clinics were identified using two online methods. First, providers were located through the "Find a Provider" feature on the official websites of dermal filler brands, including Bellafill, Juvederm, Radiesse, Restylane, RHA, Belotero, and Sculptra, with search parameters set to Manhattan, New York, and within a 5-mile radius. The second method involved a Google search using the query "filler in Manhattan," in which the first five pages of search results were reviewed. Duplicates across both methods were counted only once. Each clinic's website was analyzed for practice ownership, injector credentials, board certification, and presence of an on-site physician.

Results: Out of 219 clinics analyzed, 167 (75.3%) were owned or founded by medical doctors, 38 (17.4%) by non-physician healthcare providers (e.g., dentists, DNPs, NPs, PAs, and RNs), and 13 (5.48%) by non-medical professionals such as estheticians and business owners. Twenty one clinics indicated having a Medical Director, two of whom were DNPs. Among the 19 physician Medical Directors, 10 (52.63%) were not board-certified in an aesthetic specialty, defined as plastic surgery, ENT/facial plastics, oculoplastic, or dermatology. Out of 166 clinics that had physician injectors available, 142 (64.8%) were board certified in an aesthetic field. Clinics founded by non-physicians were significantly less likely to have an on-site physician (p < 0.001), and when present, these physicians were more likely to not be board-certified in aesthetic specialties (p < 0.001). Furthermore, physicians certified in non-aesthetic fields were significantly less likely to display their credentials online (p < 0.001).

Conclusions: Our review of the top online results for aesthetic injectors in Manhattan reveals a wide variation in provider qualifications. Although most clinics are physician-owned, a notable number were founded by non-physicians that often lacked on-site doctor or employed non-aesthetic board certified specialists with limited credential transparency. These findings potentiate the need for greater regulatory oversight and consumer education in cosmetic injections.