Injectable Success: From Fillers to Botox®

Pneumosinus dilatans following dermal filler injections

When an adverse event occurs after a dermal filler treatment, simple ultrasound can be of help for diagnosis. But sometimes a more sophisticated imaging technique as MRI is needed to find the true reason for a complication. As in the case of pneumosinus dilatans after injection of a dermal filler, we present. The relation of this rare disorder and filler injection is discussed.

Clinical results of skin remodeling using a novel pneumatic technology

BACKGROUND

A myriad of technologies are available for the treatment of aging skin. These, however, still lack the ability to combine immediate, short-term and long-term aesthetic results with no downtime. Furthermore, the treatment of fine wrinkles on large surfaces remains challenging, as does the treatment of delicate regions, such as the dorsal hand, neck, and chest.

OBJECTIVES

The aims of this study were to evaluate the short-term as well as the long-term efficacy and safety of a new skin remodeling device that pneumatically accelerates a jet of hyaluronic acid (HA) solution under high pressure into the dermis.

METHODS

Thirty-four participants at three clinical sites underwent treatments with the Airgent device on the face, neck, chest, and dorsal hands for a total of 69 sites. Safety and efficacy were evaluated in short-term (1-3 months) and long-term follow-up (up to 18 months) by photography, by an independent reviewer and by participant self-evaluation. Histology was assessed before and 4 months after the third treatment.

RESULTS

A total of 69 treatment areas were evaluable at 1-3 months follow-up. Photographic analysis demonstrated improvement in skin variables at all body sites treated. Treatment of the face and neck reduced the mean Fitzpatrick-Goldman Wrinkle Classification score by 39.4 and 30.4%, respectively, representing a full wrinkle class improvement. Treatments of the chest demonstrated significant visual improvement. Treatment of the dorsal hands produced good overall improvement (OI), with good improvement of protruding veins. Overall improvement increased with increasing number of treatments. A total of 56 treatment areas were evaluable for long-term follow-up. Treatment of the face and neck reduced the mean Fitzpatrick-Goldman Wrinkle Classification score by 27.6 and 21.2%, respectively. Improvement after treatment of the face represented a full wrinkle class reduction. Treatment of the chest and dorsal hands yielded significant visual improvement. Overall, 80% of subjects were satisfied with the treatment outcome and would recommend the treatment to friends and family. Histological analysis demonstrated increased dermal collagen ΙΙΙ.

CONCLUSIONS

Pneumatic injection of HA under high pressure provides a safe, well-tolerated and effective method for improving the appearance of wrinkles on the face, neck, chest, and dorsal hands. Improvement can be seen as early as 1 month and as long as 18 months after treatment.

Tissue integration of polyacrylamide hydrogel: an experimental study of periurethral, perivesical, and mammary gland tissue in the pig

BACKGROUND Polyacrylamide hydrogel (PAAG) is a nondegradable water-based polymer with high viscoelasticity. The gel is used as a tissue filler, the only risk being prolonged infection with anaerobic, contaminating microorganisms if not treated early with broad-spectrum antibiotics. OBJECTIVE With silicone gel as reference, PAAG tissue integration and migration was studied in a longitudinal study of the pig. MATERIALS AND METHODS Forty-one pigs were used. PAAG and silicone gel were injected into mammary tissue, and PAAG was injected into urethral or bladder wall or the anal canal. Tissues and regional lymph nodes were examined at 1, 1(1/2), 3, 3(1/2), 6, 12, and 14 months, and other lymph nodes and organs were examined at 1, 6, 12, and 14 months. RESULTS PAAG was invaded by macrophages and giant cells that were gradually replaced by a network of fibrous tissue. Silicone gel was seen inside these cells or as large vacuoles, surrounded by a fibrous capsule. Regional lymph nodes contained PAAG only at 1 1/2 months and silicone gel at 12 months. CONCLUSION PAAG is a stable, viscoelastic bulking agent, which unlike silicone gel is slowly integrated within its host tissue via a thin fibrous network. Long-term risk of fibrosis and migration is minimal.

Hyaluronic acid gel fillers in the management of facial aging

Time affects facial aging by producing cellular and anatomical changes resulting in the consequential loss of soft tissue volume. With the advent of new technologies, the physician has the opportunity of addressing these changes with the utilization of dermal fillers. Hyaluronic acid (HA) dermal fillers are the most popular, non-permanent injectable materials available to physicians today for the correction of soft tissue defects of the face. This material provides an effective, non invasive, non surgical alternative for correction of the contour defects of the face due to its enormous ability to bind water and easiness of implantation. HA dermal fillers are safe and effective. The baby-boomer generation, and their desire of turning back the clock while enjoying an active lifestyle, has expanded the popularity of these fillers. In the US, there are currently eight HA dermal fillers approved for commercialization by the Food and Drug Administration (FDA). This article reviews the innate properties of FDA-approved HA fillers and provides an insight on future HA products and their utilization for the management of the aging face.