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The Aesthetic Surgery Education and Research Foundation

Award Winners and Funded Projects
Development of Genital Surgery Patient-Reported Outcome Measure Print

The ASERF Scientific Research Committee and Board of Directors are pleased to announce the following grant award:

Researcher: Gemma Sharp, PhD

Grant Award: ASERF Interim Grant

Amount Awarded: $8,500

Project Name: Personalized Facelift: Development of Genital Surgery Patient-Reported Outcome Measure

Project Summary:  Adult women aged 18 and over in the USA and Australia who have ever undergone an aesthetic genital procedure of any type will be invited to participate in the proposed study through the private clinics of my collaborators (Dr Christine Hamori and Dr Jayson Oates). I will endeavour to include a broad spectrum of procedure types as well as patient demographic features in the sample. I would aim to involve approximately 50 women in the study.
In the first phase of the study, I will interview women via video conference or over the phone obtaining verbal consent at the start of the each interview. The interviews will take a semi-structured approach and involve an in-depth exploration of the personal experiences of patients with aesthetic genital surgery thus providing the areas/topics which are most important for them. The results from the interviews will allow the development of a conceptual framework of patient satisfaction and quality of life in aesthetic genital surgery. Briefly, I will undertake a qualitative analysis of all interview transcripts to identify common themes across the interviews. I will consult with my collaborators regularly to discuss and reach consensus on the themes identified and the content of the conceptual framework. I will also examine the literature and discuss with my collaborators/other medical professionals to determine whether any other important domains need to be added to the conceptual framework.  An exhaustive list of potential items will be generated for each domain within the conceptual framework. It is likely that there will be some domains which will be specific to the surgery type (e.g., hymenoplasty patients are likely to nominate different topics than vaginoplasty patients). This list will form a draft version of the PROM.

I will then invite the same women who participated in the first semi-structured interviews to review the draft PROM in a cognitive or "think aloud" interview. This will involve the participant going through the draft with me asking questions aimed at soliciting her interpretation of the item and the thought process around selecting a response. The data from these interviews will allow me to determine whether participants have understood the item and whether the response options are suitable. The draft PROM will be revised as needed on the basis of the feedback from the "think aloud" interviews and in discussion with my collaborators. After revision, the PROM will be field-tested with pre- and post-genital surgery patients (aged 18 and over) from Dr Hamori and Dr Oates' clinics. I will also invite other clinics in the USA and Australia to become involved at this stage to increase participant numbers. The PROM will be developed into an online survey using the platform, Qualtrics, and a weblink to the survey disseminated to patients via email. I would aim for 1,000 patients to complete the survey. Using Qualtrics, I will be able to accurately measure completion times. I will also offer space at the end of the online survey for patients to add feedback on acceptability of the measure. Psychometric statistical analyses will be performed on the data collected and the final PROM will be developed based on these results. Depending on the time taken to reach the required number of participants for the interviews as well as the field testing of the measure, this project may take longer than 12 months. Please note that my ethics application for this project, ensuring the safety of the research method and participants, is currently being assessed by the Monash University Human Research Ethics Committee (see attached receipt of submission). We expect to receive full approval from this committee in July 2018 and will submit this official notification to ASERF as soon as it is received

 
Eye Tracking Technology in Aesthetic Surgery Print

The ASERF Scientific Research Committee and Board of Directors are pleased to announce the following grant award:

Researcher: James Zins, MD

Grant Award: ASERF Interim Grant

Amount Awarded: $4,575

Project Name: Personalized Facelift: Eye Tracking Technology in Aesthetic Surgery

Project Summary:  Eye tracking technology has been utilized extensively in marketing and consumer research, and is now being used clinically. For example, autism severity is being evaluated by measuring eye gaze and fixation times in order to create an objective risk assessment algorithm. We use this same technology to analyze the eye gaze patterns and fixation times on the face of patients that have undergone facial aesthetic surgery. Therefore, the purpose of this study is to investigate eye-tracking technology as a novel outcome assessment tool, enhancing our understanding of the ability of facial rejuvenation procedures to shift visual attention away from the prominent signs of facial aging. We hypothesize that an observer's eye fixation and dwell times (visual attention) on the prominent signs of facial aging will decrease following facial rejuvenation procedures. In addition, we predict that the normal facial scan path, consisting of a central triangle of eyes, nose, and mouth, will differ preoperatively due to the distracting facial features in an aging face. Likewise, we also predict postoperative photos will align to the central triangle earlier in the visual scan path sequence. Moreover, we believe that eye tracking technology can provide a powerful link between objective gaze and subjective aesthetic preferences, adding further objective evidence to the strongly visually based field of aesthetic surgery. Furthermore, this technology has immense potential for many applications throughout Plastic and Reconstructive Surgery.

 
Personalized Facelift: Does Skin Composition Influence Outcome? Print

The ASERF Scientific Research Committee and Board of Directors are pleased to announce the following grant award:

Researcher: Lorne Rosenfield, MD

Grant Award: ASERF Interim Grant

Amount Awarded: $70,000

Project Name: Personalized Facelift: Does Skin Composition Influence Outcome?

Project Summary:  Determining if intrinsic differences in skin collagen and elastin influence aesthetic outcomes and tissue relaxation post facelift (rhytidectomy). This is relevant since facelift surgery has reliable and predictable long-term clinical and patient-reported outcomes. However, a proportion of patients exhibit early post-operative recurrence of facial rhytids, despite undergoing a technically comparable procedure to those with successful long-term outcomes. We hypothesize an ‘early recurrence’ cohort of patients exist who are predisposed to a sub-optimal surgical outcome due to inherent structural differences in the collagen and elastin of the facial skin. These patients are intrinsically predisposed to a poor aesthetic outcome, possibly due to the undiagnosed presence of a lower-spectrum (“microform”) of cutis laxa. This study aims to quantify collagen and elastin structure at a histological, immunological and cellular level in skin excised during facelift. Patients will be prospectively followed-up, with post-operative aesthetic outcome compared with pre-operative collagen/elastin data.

 
In-Vivo Study of Gluteal Vein Caliber & Anatomy to Improve Safety in Gluteal Augmentation Print

The ASERF Scientific Research Committee and Board of Directors are pleased to announce the following grant award:

Researcher: John Y.S. Kim, MD

Grant Award: ASERF Interim Grant

Amount Awarded: $20,600

Project Name: In-Vivo Study of Gluteal Vein Caliber & Anatomy to Improve Safety in Gluteal Augmentation

Project Summary: Fat grafting for gluteal augmentation has become a very popular procedure. Unfortunately, there have been a number of deaths due to fat emboli associated with this surgery. The root cause is hypothesized to be laceration of the gluteal veins in the deep submuscular plane, allowing the surrounding fat graft to enter the lumen. This event is rare, and practitioners (both board-certified plastic surgeons as well as other medical professionals) continue to perform the procedure. Our goal is to improve the safety of the procedure by examining the gluteal vein.

The specific aims of this study are to conduct an in-vivo evaluation of gluteal veins and their large tributaries in different body positions (prone, supine, lateral decubitus) using MRI to determine whether positioning has any significant effect on their caliber. We also aim to describe the locations of the large tributaries and the course of the main trunks of the gluteal veins in relation to the bony landmarks to assist in avoiding these structures during large-volume gluteal lipofilling.

We hypothesize that lateral decubitis positioning may be associated with a decrease in gluteal vein caliber for the non-dependent side.

We have already completed data acquisition to map the caliber and location of the large gluteal veins in a series of 10 patients who had previously undergone MRI in the supine position. While data on the relative sizes of the branches and their locations should be accurate, the absolute caliber measurements are likely to be confounded by the supine positioning. There, this child study will allow us to accurately measure both the caliber of the gluteal veins in the surgical position as well as the changes in their size with position changes.

 

 
Correlating Technique with Proximity to Anatomic Danger Zones in Gluteal Fat Transfer: A Patient Safety Study Print

The ASERF Scientific Research Committee and Board of Directors are pleased to announce the following grant award:

Researcher: Peter Rubin, MD

Grant Award: ASERF Interim Grant

Amount Awarded: $115,100

Project Name: Correlating Technique with Proximity to Anatomic Danger Zones in Gluteal Fat Transfer: A Patient Safety Study

Project Summary: Gluteal fat grafting is growing in popularity. Along with this rise in case numbers, serious safety issues are evolving, with morbidity and mortality publicized in the media. Although gluteal fat grafting (GFG) has been performed for decades without safety concerns raised, recent expansion in case volume broadened the cohort of surgeons performing this procedure.  Moreover, clinicians not trained in plastic surgery are performing GFG. A recent published study by the ASERF task force suggests that the rate of mortality from GFG may be many times higher than other plastic surgery procedures. Autopsy findings indicate that the key technical problem is fat graft material entering major blood vessels, including the iliac veins. This proposal by the Multi-Society Gluteal Fat Grafting Task Force, seeks to mitigate the risk of the procedure through key anatomic studies and education of plastic surgeons. Our central hypothesis is that safe approaches for buttock fat grafting can be delineated by modeling the operation in cadavers. 

Aim 1: Determine proximity to iliac veins and gluteal venous trunks with varying cannula angles from common incision/port sites.

Aim 2: Model the operation in the same 5 cadavers with 5 experienced buttock fat grafting surgeons.

Aim 3: Create an educational tool to teach the safety lessons obtained from the study and make it available through a central portal. 

Impact:  This work will directly impact patient safety by mapping safe and dangerous cannula approaches during gluteal fat grafting, and creating a strong educational program for plastic surgeons.

 
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