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In Focus: State of the Art
Safety Measures: ASERF Offers Recommendations for Safer Gluteal Fat Grafting
An average of 91 percent of all buttock augmentation procedures consist of fat grafting, and research has shown that there are significantly higher mortality rates with such gluteal fat grafting than with any other aesthetic surgical procedure.
Recently, the Aesthetic Surgery Education and Research Foundation (ASERF) formed the Gluteal Fat Grafting Task Force to investigate the risks associated with this increasingly popular procedure.
The Task Force, comprised of board-certified plastic surgeons, identified factors that either added risk or proved to be protective and/or preventative techniques associated with the procedure.
These findings were published in the Aesthetic Surgery Journal and have led to the adoption of the following recommendations:
• Avoid injecting fat into the deep muscle
• Use a >4.1mm single hole injection cannula
• Avoid downward angulation of the cannula
• Position patient and place incisions to create a path that will avoid deep muscle injections
• Maintain constant three-dimensional awareness of the cannula tip
• Only inject when cannula is in motion
• Consider pulmonary fat embolism in unstable intra- and postoperative patients
• Review gluteal vascular anatomy and draw landmarks to identify and avoid injection into the pedicle
• Include risk of fat embolism and surgical alternatives in the informed consent process
The creation of the Fat Grafting Task Force and its findings are important first steps in research and education surrounding this sought-after procedure.
Focus on a Growing Patient Demographic: Aesthetic Procedures for Male Patients
Dermatologic Surgery, the journal of the American Society for Dermatologic Surgery (ASDS), recently published a special issue titled, “Aesthetic Procedures for the Male Patient,” which featured topics geared specifically towards men, including hair transplantation, cosmetic concerns in men of color, chemical peels, body contouring, neck rejuvenation and facial aging.
“Men are considering cosmetic procedures more than ever because it’s being discussed in the media, making our society more accepting of men embracing the fountain of youth,” said Seth Matarasso, MD, Clinical Professor of Dermatology at the University of California School of Medicine in San Francisco and co-guest editor of the issue. “The ability to access more information, educate oneself and see successful examples of the subtlety these procedures can provide are all contributing factors driving men to make appointments with their ASDS member dermatologists. I find that men want to have years of wisdom but not look it and are starting to embrace the ‘I look as young as I feel’ component.”
The desire to “look as young as I feel” was among the top three reasons consumers are turning to cosmetic procedures more than ever according to the 2017 ASDS Consumer Survey on Cosmetic Dermatologic Procedures, where nearly seven in 10 respondents were contemplating a cosmetic procedure.
“Over half of my patients are men, and I find that they are more curious about these treatments after hearing about them multiple times, whether that be through aesthetic industries or from a spouse or male peers willing to talk about it openly,” said Terrence Keaney, MD. “It’s not unreasonable that in 15 years men will account for 25 percent of these procedures. Millennials are already spending money on fashion and health trends, so as they age, we can expect to see growth in the wellness area too.”
Neurotoxins are the most popular treatments among male patients at Dr. Matarasso’s office. He says this is because the results are gradual and subtle, not painful. It’s a quick ambulatory procedure that leaves patients looking more rested without the need to cover up the fact that they’ve received treatment.
Dr. Keaney’s male patients typically see him to resolve hair loss issues. They are open to additional cosmetic procedures, such as body contouring and neuromodulators, once they experience positive results and become more educated on the safety and natural look that can be achieved.
“The topics covered in Dermatologic Surgery’s Special Issue are incredibly relevant and evidenced by the five-year trends revealed in the 2016 ASDS Survey on Dermatologic Procedures earlier this year where we see that aesthetic appearance is a universal concern,” said Co-guest Editor and ASDS President Lisa M. Donofrio, MD. “We found a nine percent increase in male use of neurotoxins since 2012, and their use of fillers increased from two to nine percent.”
“This is a confirmation that the stigma around cosmetic procedures has significantly decreased as ‘daddy do-overs’ join the ‘mommy makeover’ generation,” said Dr. Matarasso.
“Our role as dermatologists is to provide each patient with the best care possible, which means always seeking to further our understanding of how various treatments work for specific demographics,” said Derek Jones, MD, a former member of the ASDS Board of Directors. “Only with more research will we be able to increase our knowledge of the relationship between nonsurgical cosmetic treatments and the male face—an increasingly vital subject as men continue to demonstrate a growing interest in their options.”