Journal of Aesthetic Medicine

Facial aging is not a singular phenomenon but a cascade of anatomical and biological transformations unfolding across the skeleton, fat, ligaments, muscles, dermis, and epidermis. Its clinical expression-volume loss, sagging, wrinkling, and surface irregularities-cannot be adequately explained by simplistic metaphors of “filling” or “lifting.” This article is a narrative review synthesizing current anatomical, physiological, and clinical evidence relevant to multimodal facial rejuvenation. Traditional monotherapies, while sometimes effective in isolation, are increasingly inadequate for contemporary patients who demand outcomes that are natural, harmonious, and durable. Modern esthetic practice has therefore shifted toward multimodal approaches that address aging across multiple planes. Hyaluronic acid (HA) fillers provide volumetric scaffolding and hydration; collagen stimulators such as poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) induce neocollagenesis and long-term dermal remodeling; botulinum toxin restores balance to muscular vectors and improves expression dynamics; while energy-based devices (EBDs), including fractional lasers, radiofrequency microneedling, and high-intensity focused ultrasound (HIFU), enhance skin texture, tone, and elasticity. When applied in a sequenced and evidence-based manner, these modalities act synergistically to deliver results unattainable by any single intervention. In addition to established modalities, the field has recently witnessed aggressive promotion of “regenerative” therapies-growth factors, exosomes, platelet-rich plasma (PRP), and platelet-rich fibrin (PRF). While biologically plausible, their efficacy and safety remain uncertain due to the absence of robust, randomized clinical trials and the heterogeneity of current data. This raises a critical question: is aesthetic medicine advancing through science, or being driven by novelty and marketing? This review synthesizes current anatomical and physiological knowledge of aging, evaluates the mechanisms, clinical applications, and safety considerations of major treatment modalities, and proposes practical sequencing strategies. It also emphasizes the ethical imperative that aesthetic medicine, while innovative and fast-evolving, must remain anchored in scientific evidence and patient safety—because aesthetic medicine is, fundamentally, still medicine.

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings.

Objective: Tranexamic acid (TXA) is widely used in rhinoplasty to minimize intraoperative bleeding and improve visualization; however, its effect on postoperative bleeding remains unclear. This study aimed to evaluate whether intravenous TXA reduces postoperative bleeding in patients undergoing primary or secondary rhinoplasty. Methods: A retrospective cohort study was performed using the TriNetX national research database to identify patients who underwent primary (CPT 30400, 30410, 30420) or secondary (CPT 30430, 30435, 30450) rhinoplasty from 2010 to 2023. Patients were grouped based on perioperative usage of intravenous TXA. Propensity score matching adjusted for demographics and coagulation disorders (ICD-10 D65–D69). The primary outcome was postoperative bleeding, including epistaxis, within one month of surgery. Results: Among 2586 patients who met inclusion criteria, 1293 (50%) received TXA. TXA recipients had a higher prevalence of bleeding risk factors, including prior use of antihemorrhagic medications (5.9% vs. 1.8%, p < 0.0001) and prolonged prothrombin time (20% vs. 16.1%, p = 0.032). TXA patients more frequently underwent concurrent septoplasty (29.7% vs. 21%, p < 0.0001). There were no significant differences observed in postoperative epistaxis or bleeding between cohorts. Similar postoperative bleeding rates despite these higher-risk characteristics suggest that TXA may have benefit in the mitigation of elevated bleeding risk in the treated cohort. Conclusions: TXA is preferentially administered to patients at higher risk of bleeding and during more complex, vascular procedures prone to increased blood loss. Prospective studies are needed to directly test whether TXA normalizes bleeding risk in higher-risk rhinoplasty patients.