October 20, 2022

As cellphones distort facial features, surgeons must now address the phenomenon with their patients.

Patients often use selfies to show cosmetic surgeons how they want to enhance their appearance. However, selfies taken at 12- and 18-inch distances distort facial features, a factor leading to an uptick in plastic surgery requests.

According to a study published in Plastic and Reconstructive Surgery, patients increasingly use photographs they've taken with a smartphone camera to discuss their goals with a plastic surgeon. "If young people are using selfies as their only guide, they may be coming to plastic surgeons to fix problems that don't exist except in the world of social media," says study leader Bardia Amirlak, MD, an associate professor of plastic surgery at UT Southwestern in Dallas.

Dr. Amirlak and his colleagues recruited 23 women and seven men to have their pictures taken from 12 inches and 18 inches away with a cellphone to simulate selfies taken with a bent or straight arm, and a third from five feet away with a digital single-lens reflex camera, the type typically used in plastic surgery clinics. All three photographs were taken in the same sitting under standard lighting conditions.

The selfies showed considerable distortions in the volunteers' noses and chins. The nose appeared 6.4% longer in 12-inch selfies and 4.3% longer in 18-inch selfies compared to the standard clinical photograph. The length of the chin decreased 12% in 12-inch selfies, leading to a 17% increase in the ratio of nose-to-chin length. Selfies also made the base of the nose appear wider relative to the width of the face.

"As the popularity of selfie photography increases, it is crucial to understand how they distort facial features and how patients use them to communicate," states the study authors.

Research says the treatment should begin in a matter of weeks rather than months postoperatively.

A new study explores whether a postoperative nonsurgical procedure called microneedling can improve the final appearance of surgical scars.

The study, published in the September issue of Plastic and Reconstructive Surgery, finds best results occur when the procedure is performed within six to seven weeks of surgery. This bucks conventional wisdom that treatments to improve the appearance of surgical scars should be delayed for up to a year. "Our findings suggest that microneedling six weeks after surgery to restart the healing process is an option to improve the final outcomes of postoperative scarring," the researchers write.

Microneedling, also known as minimally invasive percutaneous collagen induction, has been used to improve the appearance of skin with conditions such as chronic acne scars. The skin is numbed, and then the provider uses a powered handpiece with needles of different sizes to create tiny channels in the skin. The treatment induces the body's healing factors, such as collagen and elastin.

Microneedling and other cosmetic treatments for surgical scars are usually delayed until the scar has fully matured, which can take between six and 12 months. The researchers evaluated an alternative approach using microneedling earlier in the healing process, with the goal of reactivating the healing pathway.

During the study, 25 women with surgical scars resulting from procedures such as benign lesion removal, facelifts and tummy tucks underwent microneedling at six to 16 weeks after surgery. Second and third treatments were performed four and eight weeks after the first.

The researchers found significant improvement in scar appearance using three standardized assessments. For example, the patients' average scores on the Patient and Observer Scar Assessment Scale (POSAS), which ranges from 6 to 60 with lower scores indicating better appearance, decreased from 23.7 before microneedling to 11.7 at follow-up two months after the last treatment.

When comparing results for patients who started microneedling six to seven weeks after surgery versus 13 to 16 weeks, the patients who received the earlier first treatments showed "markedly better" improvement in POSAS scores of 16.8 to 8.1, compared with 26.1 to 14.2 in the group that received treatments later postoperatively. Patients in different age groups and with different scar locations achieved the same types of improvements and outcomes.

"While more research is needed to fully evaluate this finding, it certainly represents a significant paradigm shift in scar management," the researchers say. "Patients and surgeons interested in maximizing scar management may elect for early intervention with microneedling prior to development of undesirable scars as a matter of preventative care."

Reconstructive surgeon leverages best practices and tools to deliver the best care on the patient journey.

John G. Apostolides, MD
John G. Apostolides, MD

Plastic surgeons are in more demand than ever before as remote work has spurred the increase in cases along with the sensibilities of the aging boomer population who wants to look and feel their best. What does this mean for the plastic surgery industry overall? What are the best practices in patient care and infection control for this specialty? Outpatient Surgery Magazine spoke to John G. Apostolides, MD, Medical Director and Plastic Surgeon at DEFY Plastic & Reconstructive Surgery, and Chief of Plastic Surgery at Scripps Memorial Hospital La Jolla in California, who specializes in cosmetic and reconstructive surgery, to discuss the trends in plastic surgery and what patients can expect.

Q: Plastic surgery is making a comeback after the pandemic, especially in the ambulatory setting. Are you seeing a change in case volume so far this year and how are you handling it?

The pandemic was an unprecedented challenge and shock to the entire world. The field of medicine and surgery was equally affected. We were forced to adapt and evolve in order to continue patient care safely, effectively and with continued unsurpassed quality. In the early stages, we were only permitted to perform urgent procedures, and we were required to find ways to keep all of our plastic surgery procedures as outpatient cases, in order to avoid strain and overload on the inpatient care.

As we began to perform elective cases, it was still important that all cases continue to be outpatient. We were forced to find ways to safely and effectively treat patients but send them home after surgery. Case numbers in Plastic Surgery were unexpectedly high during the pandemic. I suspect that remote work for most of the population created an opportune time to have elective procedures.

Q: What types of reconstructive surgery is most common in outpatient facilities?

Plastic Surgery is a specialty with a significant focus on outpatient surgical care. The majority of our procedures are less than 6 hours of surgical time and commonly qualify as outpatient. In the aesthetic space, we aim to send most of our patients home after procedures such as breast augmentation and mastopexy (lifts), abdominoplasty (tummy tuck), face lifts and liposuction procedures. It has typically been the reconstructive procedures that required inpatient stays. Pre-pandemic, only my breast reduction surgeries and implant exchange surgeries were outpatient. Currently, our mastectomy and reconstruction procedures have also become outpatient surgeries.

Q: Do you see any changes in how these cases are handled in the outpatient setting from five or ten years ago? What is new?

Absolutely! In addition to the pandemic forcing the surgical specialties to convert procedures into outpatient cases, surgical techniques and medical technology have continued to evolve over the last 5-10 years. Our surgical techniques have become less and less invasive, our pain management protocols have improved to control and minimize post operative pain and opioid requirements, and our post operative dressings and care have improved to maintain safe and healthy surgical sites.

In breast reconstruction, we have adopted pre-pectoral techniques for implant reconstruction. This is less invasive, less painful and, in my opinion, safer and much more aesthetic. We have really worked to reduce opioid usage in the medical care regimen by adopting ERAS protocols to use adjunct techniques for pain control. Closed incision negative pressure therapy, such as 3M^™ Prevena^™ Therapy, has allowed surgeons to modulate and maintain the optimal healing environment for surgical sites, enhancing our ability to send patients home the same day of surgery.

Q: What do you and your team do to make the patient journey stress-free and safe?

Patient education is essential in a successful and stress-free surgical journey. Our team ensures that we listen to our patients' goals, concerns and questions. We inform them of what to expect before, during and after surgery. We show them the types of surgical dressings they will have, the science behind our techniques and post operative care, and the reasons why all of these factors will give them the safest and most optimal opportunity for a successful surgery and recovery.

In addition, we prepare post operative appointments, medications and supplies in advance, so that the patients can focus on their health and healing process. Finally, we make sure that the patients have a reliable and easy way to reach our team with questions and concerns, so that they are confident that we are there with them each step of the way.

Q: For wound care, what do you see as the best practices?

I believe strongly that closed incision negative pressure therapy, such as 3M^™Prevena^™ Therapy, is the most advanced and optimal therapy for surgical incision management. The -125mmHG negative pressure delivered to a bolstered, protected surgical site creates a combination of postoperative factors that helps optimize the healing environment for surgical incisions.

The future of plastic surgery, I believe, is held in understanding regenerative principles in surgical techniques and tissue healing. We must find less and less invasive ways to achieve better results. This may come in the form of better understanding of regenerative cell therapy, 3D printing of human tissue, and optimal ways of improving the body's ability to heal.

NOTE: For more information please go to www.3m.com/PrevenaCentral.

Note: Dr. Apostolides is a paid consultant for 3M.