Analysis of Use of Cosmetic Facial Injections after Facial Cosmetic Surgery

Goals/Purpose: Facial cosmetic surgery and cosmetic facial injections have grown immensely in popularity over the last decade. Between 2000 and 2020, there was a 174% increase in minimally-invasive cosmetic procedures such as neurotoxins and dermal facial fillers and a 22% increase in cosmetic surgical procedures. Literature is lacking, however, on how cosmetic surgery affects a patient’s future facial injection use. We sought to elucidate different factors that may affect how patients maintain their facial aesthetic over time.

Methods/Technique: All adult patients operated on by the senior author between 2013 and 2021 at our institution were retrospectively reviewed. Patients were included if 1) they had any cosmetic facial surgery, and 2) if their surgery was only for cosmetic indications and not medically necessary. Cosmetic facial surgeries included rhytidectomy, blepharoplasty, rhinoplasty, and genioplasty. Intraoperative facial fat grafting, facial liposuction, and facial CO2 lasering was also recorded. These patient records were reviewed for any use of the following cosmetic facial injections: neurotoxin (Botox, Dysport, Xeomin, Juveau), dermal facial fillers, Kybella, and Sculptra. Statistical analysis was done using RStudio and an α< 0.05 was considered significant. Categorical variables were analyzed using chi-square tests. Continuous variables predicting categorical variables were analyzed using logistic regression.

Results/Complications: 183 patients who had facial cosmetic surgery were reviewed, of which 140 patients had purely cosmetic surgery without medical indications. The cohort included 124 females and 16 males with median age of 60 years old (IQR = 54.3 – 67.1). Most were White (n = 128, 91%). The most common procedures were blepharoplasty (n = 117, 84%) and rhytidectomy (n = 95, 68%). 93 patients (66%) underwent facial fat grafting during their procedure, 8 patients (6%) had liposuction , and 89 patients (64%) had CO2 lasering . Median follow up was 9.8 months following index surgery (IQR = 3.2 – 20.4 months). Of these, 51% patients received injections at some point after their surgery (n = 71), while 49% of patients did not (n = 69). The most common post-operative injections were: neurotoxins (n = 46, 44%) and facial fillers (n = 42, 40%), followed by Kybella (n = 10, 10%) and Sculptra (n = 6, 6%). Demographically, there were no differences between sex nor race between those who received injections after surgery and those who did not (p> 0.05). Logistic regression revealed the following factors were positively correlated with future facial injection use: if the patient had facial liposuction, had facial fat grafting, were younger at age of surgery, and were from a zipcode with greater median income (p<0.05). Factors negatively correlated with future injection use were: if their index surgery involved a genioplasty, and if the patient had injections prior to surgery (p<0.05).

Conclusion: Cosmetic facial injections are an important consideration in maintaining facial aesthetic following surgery, as most patients who undergo facial cosmetic surgery eventually receive injections. The most popular injections are neurotoxins and dermal facial filler. It is important for clinicians to know the demographic and operative variables that predict future cosmetic injection use. In particular, patients who are younger and who come from higher socioeconomic statuses, and who have either facial fat grafting or liposuction, are more likely to return for facial injections post-operatively. Those who had genioplasty or prior injections are less likely to have injections post-operatively.