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Klinger M, Fondrini R, Bandi V, Veronesi A, Catania B, Di Giuli R, Vaccari S, Bucci F, Klinger F, Vinci V. Rejuvenation in Men Facial Aging: A Combined Approach. Aesthetic Plast Surg 2024; 48:1522-1528. [PMID: 38286900 DOI: 10.1007/s00266-023-03839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/22/2023] [Indexed: 01/31/2024]
Abstract
Facelift surgery, also known as rhytidectomy, is a popular cosmetic procedure aimed at reversing the signs of facial aging. While facelift surgery is more commonly performed in women, an increasing number of men are seeking this procedure to maintain a youthful appearance. The long recovery period conflicts the overall primary outcome anticipated by men undergoing rhytidectomy, i.e., appear younger, youthful, and ready to reaffirm their value in the working environment. Anterior direct neck lift, blepharoplasty (upper and lower eyelid blepharoplasty), and lipofilling are three techniques that have been shown to be effective in improving facial rejuvenation outcomes in elderly male patients. However, there is little to no evidence of the safety and efficacy of these techniques when used in combination. By combining these techniques, we hypothesized that we could achieve outcomes comparable to traditional facelift surgery, but with a lower risk of complications and a shorter recovery time. We conducted a retrospective case series study of 18 male patients who underwent facial rejuvenation surgery using the combination of anterior direct neck lift, blepharoplasty (upper and lower eyelid blepharoplasty), and lipofilling at our institution between 2018 and 2021. All 18 patients completed the study, with an average follow-up of 12 months. No major complications were observed, and all patients reported a high level of satisfaction with their outcomes.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Marco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, 20090, Rozzano, Milan, Italy
| | - Riccardo Fondrini
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy.
| | - Valeria Bandi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, 20090, Rozzano, Milan, Italy
| | - Alessandra Veronesi
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, 20090, Rozzano, Milan, Italy
| | - Barbara Catania
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, 20090, Rozzano, Milan, Italy
| | - Riccardo Di Giuli
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy
| | - Stefano Vaccari
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy
| | - Flavio Bucci
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Reconstructive and Aesthetic Plastic Surgery School, Humanitas Clinical and Research Hospital, University of Milan, Via Manzoni 56, 20090, Rozzano, Milan, Italy
| | - Francesco Klinger
- Department of Health Sciences, Ospedale San Paolo, University of Milan, Via Antonio di Rudinì, 8, 20142, Milan, Italy
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
- Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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Alimova SM, Sharobaro VI, Avdeev AE, Sidorenkov DA, Guseva TS. Cone-Beam Computed Tomography for Objective Diagnosis of Age-Related Soft Tissue Changes in Lower Face and Neck. Aesthetic Plast Surg 2023; 47:2370-2377. [PMID: 37204468 DOI: 10.1007/s00266-023-03401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/22/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND An objective assessment of the causes of age-related contour deformities of the soft tissues of the face and neck is very important in esthetic surgery, especially as minimally invasive techniques gain increasing popularity. METHODS To visualize the tissues that cause age-related soft tissue changes, we performed cone-beam computed tomography (CBCT) in 37 patients who underwent facial and neck rejuvenation procedures in 2021-2022. RESULTS Vertical CBCT enabled visualization of the causes and degree of tissue involvement in age-related changes in the lower third of the face and neck. CBCT showed the location and condition of the platysma (hypo- [ptosis], normo-, or hyper-tonus), position, thickness, and location (above and/or below the platysma) of fat tissue, presence of ptosis of the submandibular salivary glands, condition of the anterior bellies of the digastric muscles, and the degree of their participation in contours of the cervicomandibular angle, and location of the hyoid bone. Moreover, CBCT enabled demonstrating for the patient the facial and neck contour deformations and discussing the suggested corrective methods using a clear objective visual image. CONCLUSIONS CBCT in the upright position enables objective assessment of each soft tissue in the age-related deformity of the cervicofacial region and provides an opportunity to plan the appropriate impact on the particular anatomical structures during rejuvenation procedures and estimate their results. This is the only study to date to objectively and clearly visualize the entire topographic anatomy of the soft tissues of the face and neck vertically for plastic surgeons and patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Sekina M Alimova
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Valentin I Sharobaro
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alexey E Avdeev
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Dmitry A Sidorenkov
- Department of Plastic Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana S Guseva
- Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Duplechain JK. Ablative Laser Therapy of Skin. Facial Plast Surg Clin North Am 2023; 31:463-473. [PMID: 37806680 DOI: 10.1016/j.fsc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Laser skin rejuvenation was introduced in the mid-1990s. Early ablative laser devices relied on scanner technology that provided significant ablation and longer time on tissue treatments. These early treatments provided significant improvement in the appearance of the skin, but because of the longer treatment times and in some cases excessive treatment, complications such as scarring and hypopigmentation were significant. More recent advances in skin resurfacing technology have now minimized these risks providing certain key principles are observed. These parameters are reviewed in detail to improve the reader's ability to propose and execute proper skin resurfacing treatments.
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Affiliation(s)
- J Kevin Duplechain
- Division of Facial Plastic Surgery, Department of Otolaryngology, Tulane Medical School, 1103 Kaliste Saloom Road, Suite 300, Lafayette, 70508, LA, USA.
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Inocêncio GSG, Meneses-Santos D, Costa MDMDA, Vieira WA, de Almeida VL, Rodrigues RPCB, Rode SDM, Paranhos LR. Efficacy, safety, and potential industry bias in using deoxycholic acid for submental fat reduction ‒ A systematic review and meta-analysis of randomized clinical trials. Clinics (Sao Paulo) 2023; 78:100220. [PMID: 37806137 PMCID: PMC10570630 DOI: 10.1016/j.clinsp.2023.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/30/2023] [Accepted: 05/12/2023] [Indexed: 10/10/2023] Open
Abstract
Lipolytic substance injections to reduce localized fat have been extensively used because it is a low-invasive method. This review aimed to evaluate the efficacy and safety of deoxycholic acid in submental fat reduction compared to a placebo and investigate the potential industry sponsorship bias in the results of randomized clinical trials on this topic. Ten electronic databases were extensively searched for randomized clinical trials without restriction on language and year of publication. Two reviewers extracted the data and assessed the individual risk of bias in the studies with the RoB 2.0 tool. The industry sponsorship bias was evaluated according to citations in the articles regarding industry funding/sponsorship throughout the texts. Fixed and random effects meta-analyses were performed, and the results were reported in Risk Ratio (RR) at a 95% Confidence Interval (95% CI). The initial search provided 5756 results, of which only five were included. Only two studies had a low risk of bias. All studies showed a potential industry bias. The meta-analysis showed that patients treated with deoxycholic acid had significant positive results for all efficacy outcomes and a higher risk of fibrosis, pain, erythema, numbness, swelling, edema, pruritus, nodules, headache, and paresthesia. The low to moderate certainty of evidence found allows concluding that deoxycholic acid is effective in submental fat reduction, causing well-tolerated adverse effects. However, all eligible studies showed a potential industry bias.
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Affiliation(s)
| | - Daniela Meneses-Santos
- Division of Morphology, Centro de Ciências da Saúde e Biológicas, Universidade Federal de Sergipe, SE, Brazil
| | | | - Walbert A Vieira
- Department of Restorative Dentistry, Endodontics Division, Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Vinicius Lima de Almeida
- Postgraduate Program in Dentistry, Faculdade de Odontologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | - Sigmar de Mello Rode
- Department of Dental Materials and Prothesis, Instituto de Ciência e Tecnologia, Universidade Estadual Paulista Júlio de Mesquita Filho, São José dos Campos, SP, Brazil
| | - Luiz Renato Paranhos
- Division of Preventive and Community Dentistry, Faculdade de Odontologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
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Sullivan K, Law RM, Lain E, Jiang LI, Acevedo SF, Choudhary H, Lee B, Patel K, Lynch S. Evaluation of a retinol containing topical treatment to improve signs of neck aging. J Cosmet Dermatol 2023; 22:2755-2764. [PMID: 37461826 DOI: 10.1111/jocd.15904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND The neck region is an area that can be indicative of signs of skin aging. A novel topical product that combines multiple active ingredients including retinol, tripeptide and glaucine was formulated to specifically target neck aging correction and complement post-procedure as part of an integrated skincare regimen. OBJECTIVES To evaluate the efficacy of a topical neck treatment through clinical subject evaluation, in addition to ultrasound and biopsy assessment. METHODS Evaluation for the efficacy of this novel topical product on improving the aging signs of neck skin was performed in multiple clinical trials. The first trial focused on clinical efficacy and included clinical assessment, subject questionnaires, ultrasound imaging and digital photographs. The second trial focused on biomarker analysis through skin biopsy. RESULTS Data from the clinical trials showed that aging signs on the neck were significantly improved after 12 or 16 weeks of product usage. Changes were readily observed by clinical evaluators and participants. They were documented with digital photos, ultrasound images, and biomarker expression in the skin which clearly display the improvements. CONCLUSIONS This novel topical product is effective in treating the aging signs on the neck skin and has been shown to provide statistically significant improvement on a myriad of neck aging attributes including fine lines/wrinkles, crepiness, laxity, and texture.
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Affiliation(s)
| | | | | | | | | | | | - Brittany Lee
- L'Oréal Research and Innovation, Clark, New Jersey, USA
| | - Komal Patel
- L'Oréal Research and Innovation, Clark, New Jersey, USA
| | - Stephen Lynch
- L'Oréal Research and Innovation, Clark, New Jersey, USA
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Atiyeh B, Emsieh S, Oneisi A, Hakim C, Ghieh F. Surgical Management of Platysma Bands: A Narrative Review of Evolving Concepts and Changing Techniques for Neck Rejuvenation. Aesthetic Plast Surg 2023; 47:1824-1834. [PMID: 37653178 DOI: 10.1007/s00266-023-03604-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Platysmal bands are an unappealing feature of the aging face. Incomplete understanding of anatomy and physiology of platysmal bands has led to a long period of flawed or incomplete treatment. This review aims to elucidate the correct study of platysmal bands along with the most recent surgical treatments. MATERIALS AND METHODS To identify all articles related to the topic of surgical management of platysmal bands, an extensive search was performed on PubMed and Medline databases for all articles related to platysmal bands from 1990 to 2023. The articles were then reviewed by 2 independent reviewers, and all relevant articles were selected. The search was narrowed down to clinical trials and cohort studies. RESULTS 6130 articles were identified, of which 21 articles matched the inclusion criteria and were selected for the study totaling 2331 patients. Different surgical procedures were mentioned. Assessment of results was mostly subjective and done by the surgeon. CONCLUSION Composite platysma-skin flap repositioning as opposed to wide skin undermining with or without submental incisions is being gradually accepted as a valid approach, with closed platysma myotomy and platysma denervation emerging as effective less invasive surgical modalities. Nevertheless, merits of more extensive procedures involving wide skin undermining and anterior platysma plication must not be lightly forgotten. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saif Emsieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ahmad Oneisi
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christopher Hakim
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Ghieh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Khan H, Ul Ain N, Bhatti DS, Khan J. An Assessment of the Reduction of Submental Fullness With ATX-101 (Deoxycholic Acid Injection) in the Expanded Safe Zone. Cureus 2023; 15:e35286. [PMID: 36968884 PMCID: PMC10037223 DOI: 10.7759/cureus.35286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
Background and objective Facial aesthetics have a huge impact on how individuals view themselves and are viewed by society. The aesthetics of the face are tremendously influenced by the shape of the chin and neck. In this study, we aimed to observe the outcomes in individuals after the use of ATX-101 (deoxycholic acid injection) in an expanded safe zone for submental fullness. To ensure optimal outcomes and reduce the risk of adverse events, appropriate patient selection is the key. ATX-101 treatment may be administered in combination with hyaluronic acid fillers, botulinum toxins, cryolipolysis, and radiofrequency treatment. This is the first study of its kind to be carried out at the national level in Pakistan. Materials and methods This was a quasi-experimental study conducted at the Rawalian Burn and Reconstructive Surgery Unit, Holy Family Hospital, Rawalpindi, Pakistan for a period of nine months, from 10-1-2021 to 11-10-2021. A total of 62 patients who fulfilled the inclusion criteria were enrolled. We recorded if any complications had occurred or not. Moreover, the total number of treatment sessions, the volume of injectables used, and the interval between sessions were also documented. ATX-101 package was injected into the treatment area. Due care was taken to avoid the region of the marginal mandibular nerve. After the procedure, outcomes and complications were observed. Results In this study, patient satisfaction was reported in 59 (95.2%) patients. After the fourth session, final improvement was observed in 59 (95.16%) patients. Tenderness was found in seven (11.3%) patients, bruising was noted in four (6.5%), edema was found in seven (11.3%), numbness was noted in one (1.6%), whereas paresis and alopecia were not found in any of the patients. Conclusion Our study concluded that ATX-101 is a very useful modality with fewer complication rates and is associated with significant improvement in the expanded safe zone for submental fullness.
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McCleary SP, Moghadam S, Le C, Perez K, Sim MS, Roostaeian J. Age-Related Changes in the Submandibular Gland: An Imaging Study of Gland Ptosis Versus Volume. Aesthet Surg J 2022; 42:1222-1235. [PMID: 35639754 DOI: 10.1093/asj/sjac129] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Debate surrounding the morphological evolution of the submandibular gland (SMG) with aging, and the uncertain influence of patient demographics, has led to hesitancy about incorporating targeted interventions of the SMG into clinical practice. OBJECTIVES The aim of this study was to determine whether SMG ptosis, hypertrophy, or both is the primary etiology behind the increase in submandibular volume with age. METHODS MRI segmentation was used to calculate the total and inframandibular (IM) volume and height of the SMG. Adult subjects with previous MRIs of the head and neck were used for analysis. Those with pathology or artifact compromising the SMG were excluded. Subjects were divided into 4 age-defined cohorts, for clinical applicability. RESULTS The study included 129 patients (65 females; 64 males) with a mean age of 52.3 years (range, 20-85 years). No significant change in total SMG volume was observed between the reference group and all cohorts. The IM-SMG volume of the reference cohort was 5.77 cm3. All 3 cohorts had a greater IM-SMG volume than the reference group. The 45- to 54-year cohort had a mean volume of 6.7 cm3 (P = 0.4), the 55- to 64-year cohort, 7.5 cm3 (P = 0.01), and the ≥65-year cohort, 7.2 cm3 (P = 0.01). Male sex and overweight or obese BMI were associated with significantly larger total and IM-SMG volumes. CONCLUSIONS The novel finding of a significantly larger IM-SMG volume with no change in total volume provides evidence for SMG ptosis rather than hypertrophy as a significant contributor to age-related submandibular fullness. The lack of any significant difference in total volume or height with aging emphasizes the role of glandular descent.
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Affiliation(s)
- Sean P McCleary
- Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shahrzad Moghadam
- Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Christina Le
- Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kevin Perez
- Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Myung-Shin Sim
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Jason Roostaeian
- Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Rohrich RJ, Chamata ES, Bellamy JL, Alleyne B. Jawline Refinement in Face Lifting: The Five Zones and the Five-Step Technique. J Plast Reconstr Aesthet Surg 2022; 75:3506-3512. [DOI: 10.1016/j.bjps.2022.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 05/02/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
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Jacono AA, Alemi AS, Harmon JJ, Ahmedli N. The Effect of a Novel Platysma Hammock Flap During Extended Deep Plane Facelift on the Signs of Aging in the Neck. Aesthet Surg J 2022; 42:845-857. [PMID: 35446382 DOI: 10.1093/asj/sjac086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Aging changes in the neck including platysmal banding, skin laxity and submandibular gland visibility have a high degree of recurrence after rhytidectomy. OBJECTIVES To assess the long term (>12 month) improvement in platysma banding (PB), skin laxity (SL) and submandibular gland visibility (SGV) with addition of aplatysmal hammock flap to the extended deep plane facelift. To assess long term (>12 month) post-operative patient satisfaction. METHODS Prospective study of 123 consecutive patients undergoing extended deep plane facelift incorporating platysma hammock flap with or without midline platysmaplasty performed by a single surgeon (AAJ) between February 1st, 2017 and June 15th, 2017. Standard two-dimensional patient photographs were used to assess PB, SL, and SGV pre- and >12 months post-surgery. Severity of each was graded on a 4-point scale by an independent reviewer. One year postoperative patient satisfaction survey was conducted. RESULTS The platysmal hammock flap without midline platysmaplasty (PH) cohort had a statistically significant (p < .01) reduction in the mean preoperative PB, SL, and SGV scores from 1.03, 1.88 and 1.21, to 0.06, 0.03, and 0.15 at 21 months. The platysmal hammock flap with midline platysmaplasty (PHMP) cohort had a statistically significant (P < .01) reduction in the pre-operative PB, SL and SGV scores from 1.81, 2.43, and 1.81, to 0.10, 0.15, and 0.48 at 18 months. The PHMP cohort had a 96.2% satisfaction, and the PH cohort had an 88.9% satisfaction. CONCLUSIONS Extended deep place facelift with a platysmal hammock flap achieves long term, sustained improvements in PB, SL, and SGV. This procedure is well-tolerated and results in substantial patient satisfaction.
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Affiliation(s)
| | | | | | - Nigar Ahmedli
- Department of Otorhinolaryngology/Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Montefiore Medical Center , Bronx, NY , USA
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Crook JL, Hamidian Jahromi A, Konofaos P. Long-term Effects of Repeated Botulinum Toxin Injection in Cosmetic Therapeutics. Ann Plast Surg 2022; 88:345-352. [PMID: 34611099 DOI: 10.1097/sap.0000000000002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Botulinum toxin (BT), a potent neurotoxin, has been used in clinical medicine since the 1970s for cosmetic and therapeutic purposes. Studies have consistently shown positive outcomes with a very limited adverse effect profile and a conventional understanding that results dissipate after 3 to 5 months. However, more recent evidence suggests that changes in muscle composition, function, and appearance persist for much longer, even years. To examine the potential implications of these findings on cosmetic use of BT injections in reduction of skin lines and wrinkles, we first needed to further our understanding of the current literature on long-term outcomes after repeated BT injections. METHODS A comprehensive review of the literature on long-term outcomes after repeated BT injections for cosmetic indications was performed. We evaluated the study designs, and results were compared. RESULTS A total of 22 publications met our inclusion criteria, of which 14 were clinical trials. Few studies extended outcome measurement past 6 months postinjection, and many were funded or supported by industry. However, the studies that extended follow-up saw persistent changes after BT injection, in some cases as far as 4 years postinjection. CONCLUSION The current body of knowledge on the long-term results after repeated cosmetic BT injections is very limited, and the available literature provides insufficient evidence on how prolonged effects could alter clinical use of BT. Further clinical studies with extended follow-up periods with inclusion of both subjective and objective measured outcomes of appearance and muscle function are required to better understand the long-term impacts of repeated BT injections.
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Affiliation(s)
- Jennifer L Crook
- From the College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | | | - Petros Konofaos
- Department of Plastic Surgery, University of Tennessee Health Science Center, Memphis, TN
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12
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A Novel Algorithm for Defining the Mandibular Border. Plast Reconstr Surg 2022; 149:429e-432e. [PMID: 35196678 DOI: 10.1097/prs.0000000000008881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY Techniques for defining the mandibular angle are a particular focus for patients around the world. Developing the desirable sharp contours is a combination of reducing bulkiness around the mandible while augmenting the border. Invasive techniques (e.g., face lifts and chin augmentation) can help define the mandible; however, younger patients are demanding more affordable and less invasive procedures. The "Nefertiti lift," masseter neurotoxin, buccal fat excision, mandibular border augmentation with filler, and liposuction of the neck can all be done in the office and will produce excellent results. If the loss of definition is due to superior soft tissue, the next step is to determine if this is based on anterior or posterior soft-tissue excess. Posteriorly, it is caused by masseter hypertrophy, and anteriorly, it may be because of an enlarged or full buccal fat pad in the lower cheek area. If the loss of definition is inferior, the next step is to again define if it is anterior or posterior. Anterior excess tissue can be corrected with liposuction of the neck along with energy-based skin tightening technology. Posteriorly, the inferior pull of the platysma can be blunted with neurotoxin. Finally, once the soft tissues are adequate, the mandibular border can be augmented with filler. In this article, the authors propose an algorithm for when to utilize each of these procedures while reviewing proper technique.
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Oh SM, Kim BC, Hong GW, Jung W. Changes in the neck tissue layers during pinch manipulation: Implications for lipolytic deoxycholate injections for double chin. J Cosmet Dermatol 2022; 21:3754-3758. [PMID: 35041769 DOI: 10.1111/jocd.14696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The skin of the neck is often pinched during minimally invasive esthetic procedures for the double chin using a lipolytic agent in order to facilitate injecting into the subcutaneous fat layer rather than under the platysma muscle. However, how the neck tissue layers move during the pinch manipulation is not well understood. AIMS To determine which layer of the neck is lifted during pinching and to evaluate the usefulness of the pinch manipulation during injection therapy. METHODS The pinched submentum of a living person was scanned using MRI, and ultrasonography was also performed in the same area in both resting and pressed states. At four sites on a fresh cadaver, the skin of the neck was pinched and the elevated neck skin was excised. The exposed areas were grossly examined. RESULTS MRI scanning revealed that the pinch manipulation extended the subcutaneous fat layer and moved the platysma muscle to a deeper location. Ultrasonography revealed that the thickness of each layer of the neck was reduced when pressing the neck. In the cadaver examination, pinching resulted in part of the subcutaneous fat lifting, and this was removed when the lifted skin was cut, leaving the platysma muscle intact. CONCLUSIONS When performing an esthetic procedure that involves injecting a lipolytic agent into the submental area, the pinch manipulation is a very useful technique for ensuring a safe procedure that avoids injecting into the deep layer under the platysma muscle.
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Affiliation(s)
| | | | | | - Wonsug Jung
- Yonsei University College of Medicine, Seoul, Korea
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Kwon HH, Yang SH, Choi M, Jung JY, Park GH. Tightening and Reduction of Unwanted Submental Fat Using Triple-Layer High-Intensity Focused Ultrasound: Clinical and 3-Dimensional Imaging Analysis. Dermatol Surg 2021; 47:1595-1600. [PMID: 34608087 DOI: 10.1097/dss.0000000000003241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unwanted submental fat (SMF) is aesthetically unappealing, but methods of reduction are either invasive or lack evidence of their use. OBJECTIVE The authors sought to evaluate the safety and efficacy of a novel triple-layer high-intensity focused ultrasound (HIFU) regimen for SMF reduction. METHODS Forty Korean subjects with moderate/severe SMF were evaluated after receiving a session of triple-layer HIFU treatments (using 3.0-, 4.5-, and 6.0-mm focusing transducers). The objective evaluation based on the 5-point Clinician-Reported Submental Fat Rating Scale (CR-SMFRS) and patients' satisfaction based on the 7-point Subject Self-Rating Scale (SSRS) were determined 8 weeks after treatment. Three-dimensional image analysis was also performed. RESULTS At the follow-up visit, the proportion of treatment responders defined as subjects with ≥1-point improvement in CR-SMFRS was 62.5%, and the proportion of patients satisfied with appearance of their face and chin (score ≥4 on the SSRS) was 67.5% of the total patients. The results of 3-dimensional analysis were consistent with clinical observations. Only mild and transient side effects were observed for some patients with no serious adverse effects. CONCLUSION The triple-layer HIFU regimen including the novel 6.0-mm transducer has benefits for tightening and rejuvenation of the area with unwanted SMF, showing reasonable safety profiles.
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Affiliation(s)
| | | | - Mira Choi
- Department of Dermatology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | | | - Gyeong-Hun Park
- Department of Dermatology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
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Humphrey S, Cohen JL, Bhatia AC, Green LJ, Green JB, Bowen B. Improvements in Submental Contour up to 3 Years After ATX-101: Efficacy and Safety Follow-Up of the Phase 3 REFINE Trials. Aesthet Surg J 2021; 41:NP1532-NP1539. [PMID: 33617632 PMCID: PMC8520020 DOI: 10.1093/asj/sjab100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND ATX-101 (deoxycholic acid) significantly reduced submental fat (SMF) severity in two 24-week Phase 3 studies (REFINE-1 and REFINE-2). OBJECTIVES The aim of this study was to evaluate the durability of effect and long-term safety of ATX-101. METHODS REFINE study patients who maintained ≥1-grade improvement on the Clinician-Reported SMF Rating Scale (CR-1 responders) 12 weeks after their last REFINE treatment were eligible for enrollment in this multicenter, double-blind, nontreatment, long-term, follow-up study (NCT02163902). The primary endpoint was CR-1 response at Years 1, 2, and 3. Patient-reported satisfaction, psychological impact, and adverse events were monitored. RESULTS In total, 224 patients (ATX-101, n = 113; placebo, n = 111) were enrolled. Maintenance of CR-1 response was significantly better in the ATX-101 group than in the placebo group at Year 1 (86.4% vs 56.8%; P < 0.001), Year 2 (90.6% vs 73.8%; P = 0.014), and Year 3 (82.4% vs 65.0%; P = 0.03). Most (74%) ATX-101‒treated patients satisfied at 12 weeks remained satisfied at Year 3. Significant reductions from baseline in psychological impact scores were sustained through Year 3 (P < 0.001). No new treatment-related adverse events were reported. CONCLUSIONS Improvements in submental contour achieved with ATX-101 are maintained for 3 years in most patients. No new safety signals emerged. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Shannon Humphrey
- clinical assistant professor, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Joel L Cohen
- plastic surgeon in private practice in Greenwood Village, CO, USA
| | - Ashish C Bhatia
- associate professor, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lawrence J Green
- clinical professor, Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| | - Jeremy B Green
- clinical assistant professor, Department of Dermatology, University of Miami, Miami, FL, USA
| | - Beta Bowen
- the executive director of global development, Allergan Aesthetics, an AbbVie Company, Irvine, CA, USA
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand age-related changes to the face and neck and pertinent anatomy and discuss important aspects of fat graft harvesting, processing, and infiltration. 2. Recognize key differences between common techniques for fat processing and infiltration and develop a plan for patients based on site-specific facial anatomical zones. 3. Appreciate the utility of fat grafting as an adjunct to other facial rejuvenating procedures such as face lift and blepharoplasty procedures and list the potential complications from fat grafting to the face and neck. SUMMARY Fat grafting to the face and neck aids in volume restoration, thereby addressing soft-tissue atrophy associated with the aging face, acquired conditions, or congenital malformations. Often, fat grafting may sufficiently restore facial volume alone or in conjunction with other facial rejuvenation procedures. Facial/neck fat grafting requires a systematic and thoughtful approach, with special care to atraumatic technique. This CME article covers the principles and techniques for modern facial fat grafting to the face and neck. Increasing data support the ability of autologous fat to produce significant and sustainable appearance-related changes. The authors follow the general principles of the Coleman technique for facial fat grafting and have observed tremendous success over the years. Other techniques for facial fat grafting are also discussed including microfat and nanofat processing. As the understanding of facial fat compartments continues to evolve, the authors may better predict fat grafting outcomes following augmentation. Finally, the technique described as "lipotumescence" has been successfully used in the breast and other regions of the body that have radiation damage and is discussed in this article specifically for the face and neck.
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Swift A, Liew S, Weinkle S, Garcia JK, Silberberg MB. The Facial Aging Process From the "Inside Out". Aesthet Surg J 2021; 41:1107-1119. [PMID: 33325497 PMCID: PMC8438644 DOI: 10.1093/asj/sjaa339] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The normal course of aging alters the harmonious, symmetrical, and balanced facial features found in youth, not only impacting physical attractiveness but also influencing self-esteem and causing miscommunication of affect based on facial miscues. With this evidence-based paper, the authors aim to provide a comprehensive overview of the latest research on the etiology and progression of facial aging by explaining the aging process from the “inside out,” that is, from the bony platform to the skin envelope. A general overview of the changes occurring within each of the main layers of the facial anatomy is presented, including facial skeleton remodeling, fat pad atrophy or repositioning, changes in muscle tone and thickness, and weakening and thinning of the skin. This is followed by an in-depth analysis of specific aging regions by facial thirds (upper, middle, and lower thirds). This review may help aesthetic physicians in the interpretation of the aging process and in prioritizing and rationalizing treatment decisions to establish harmonious facial balance in younger patients or to restore balance lost with age in older patients.
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Affiliation(s)
- Arthur Swift
- Westmount Institute of Plastic Surgery in Montréal, QC, Canada
| | - Steven Liew
- Shape Clinic in Darlinghurst, NSW, Australia
| | - Susan Weinkle
- Dermatology at the University of South Florida, Tampa, FL, USA
| | - Julie K Garcia
- Health Economics Outcomes Research at Allergan plc, an AbbVie Company, Irvine, CA, USA
| | - Michael B Silberberg
- Allergan Ltd, an AbbVie Company, Parkway, Marlow, Buckinghamshire, United Kingdom
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Best Clinical Practices with ATX-101 for Submental Fat Reduction: Patient-related Factors and Physician Considerations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3668. [PMID: 34262836 PMCID: PMC8274802 DOI: 10.1097/gox.0000000000003668] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023]
Abstract
Background: Submental fat can be reduced with ATX-101 (deoxycholic acid injection), a customizable and minimally invasive alternative to liposuction. In the years since its approval, the treatment patterns of ATX-101 have evolved. Methods: A panel of experienced physicians from the United States gathered to generate best practices for the use of ATX-101 in submental contouring. Results: The expert panel provided their insights on appropriate patient selection, managing patient expectations of ATX-101 treatment outcomes, and adverse events, and guidance on ATX-101 administration for optimal outcomes are presented here. Conclusion: These best clinical practices on the use of ATX-101 for the reduction of submental fat should enable physicians to enhance the patient treatment experience and outcomes.
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Friedman O, Singolda R, Mehrabi JN, Artzi O, Boggio RF, Bento AM. Current use of botulinum neurotoxin in esthetic practice-Clinical guide and review. J Cosmet Dermatol 2021; 20:1648-1654. [PMID: 33872439 DOI: 10.1111/jocd.14152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Botulinum neurotoxin is one of the most versatile and widely used medical products in the world. AIMS The review's focus is the plastic and dermatologic uses of botulinum neurotoxin currently supported by published data. METHODS Relevant clinical articles regarding botulinum neurotoxin use in plastic surgery, dermatology, and general esthetic literature were searched and reviewed. RESULTS The search yielded 258 studies. Two hundred articles were excluded following title and abstract review. Twenty-one studies were excluded following full-text screening. A total of 37 studies remained and were discussed in this review. CONCLUSIONS Botulinum neurotoxin is widely used for numerous off-label indications from head to toe. Some uses are well documented, and their safety has been demonstrated in controlled trials, yet most remain poorly researched.
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Affiliation(s)
- Or Friedman
- Maccabi Healthcare Services, Tel Aviv, Israel.,Mayanei HaYeshua Medical Center, affiliated with the Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roei Singolda
- Plastic Reconstructive Surgery Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Joseph N Mehrabi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Robenpour M, Fuchs Orenbach S, Hadash-Bengad R, Robenpour O, Heller L. The Wide Suture Suspension Platysmaplasty, a revised technique for neck rejuvenation: A retrospective cohort study. J Cosmet Dermatol 2021; 20:3603-3609. [PMID: 33583136 DOI: 10.1111/jocd.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Restoration of an esthetic neck contour is an integral component of facial rejuvenation. The corset platysmaplasty and the suture suspension neck lift were introduced by Feldman in 1990 and by Giampapa in 1995, respectively. Both techniques are routinely used in current practice with satisfactory and long-lasting results. However, some patients who have undergone the suture suspension platysmaplasty report long-term discomfort, excessive neck tightening, and recurrence of deformity. OBJECTIVE To achieve an improvement in the Cervicomental (CM) angle and other parameters in patients with a difficult neck and to reduce the probability of long-term discomfort, excessive neck tightening, and a recurrence of deformity. The author developed a new technique that includes a very wide suture suspension with no interlocking. We hereby present a revised suture suspension technique-The Wide Suture Suspension Platysmaplasty. METHODS Between the years 2015 and 2017, the senior author performed 286 face and neck rejuvenation surgeries with or without blepharoplasty. Of these cases, 35 patients with a heavy neck were chosen for the new Wide Suture Suspension Technique. This was a single surgeon retrospective cohort study. Patients were photographed in a lateral view preoperatively and 6 months postoperatively. Pre- and postoperative photographs were compared in four measured parameters: the cervicomental angle, the jowl angle, the horizontal distance between the mentum and the cervicomental angle and the vertical distance between the mentum and the cervicomental angle. RESULTS The Wide Suture Suspension Platysmaplasty resulted in pleasing esthetics, with minimal complications in patients with difficult necks. The cervicomental angle decreased by 42° (P < .0001), the jowl angle increased by 12° (P < .0001), the horizontal distance between the mentum and the cervicomental angle rose by 12.4% and the vertical distance between the mentum and the cervicomental angle was reduced by 34.5%. CONCLUSION The Wide Suture Suspension Platysmaplasty resulted in improved esthetics, as demonstrated by objective measurements. None of the patients in this series had any secondary intervention during the follow-up period. Particularly in the case of a difficult neck, surgeons should consider this technique.
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Affiliation(s)
- Manoocher Robenpour
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Shir Fuchs Orenbach
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Reut Hadash-Bengad
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ophir Robenpour
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Lior Heller
- Department of Plastic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
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21
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Abstract
AbstractOver the history of facial rejuvenation surgery there has been a progressive assimilation of knowledge about the anatomy of neck structures that are central to the manifestations of the aging neck. These advances in knowledge have been accompanied by the innovation and introduction of several surgical techniques to restore the neck to a more youthful appearance. The rejuvenation of the aging neck frequently incorporates a consideration and execution of accepted methods to restore the platysma muscles to a more aesthetic form. Lasting and dependable surgical techniques remain somewhat elusive and late failures in the neck continue to be a frustration for both patients and surgeons.In this manuscript, the author reviews some of the more enduring and innovative methods to manage the platysma in facelifting and cites the rationale and limitations of the various techniques. The concept of the restoration of an effective platysma “sling” in the upper neck to eliminate platysma bands and recreate a defined jawline is highlighted. A framework of patient evaluation and decision making is presented, and a suggested individualized application of accepted surgical maneuvers is suggested.
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Affiliation(s)
- Fred G. Fedok
- Fedok Plastic Surgery, Foley, Alabama
- Department of Surgery, University of South Alabama, Mobile, Alabama
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22
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Skin Excursion with Cannula Lipodissection and the Anatomical Implications of Superficial Musculoaponeurotic System Movement in the Tumescent Face Lift. Plast Reconstr Surg 2020; 146:269-276. [PMID: 32740573 DOI: 10.1097/prs.0000000000006977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The tumescent face lift uses the concept of subcutaneous cannula lipodissection of the neck, as opposed to wide skin undermining. Lipodissection mobilizes soft tissue while preserving perforating neurovascular branches. The purpose of this study is two-fold: (1) to compare the skin recruitment with subcutaneous lipodissection of the neck alone versus wide undermining and (2) to examine the effect of superiorly oriented superficial musculoaponeurotic system (SMAS) movement on jowl excursion in the tumescent face lift. METHODS A cadaveric study was performed on five fresh tissue cadavers. Postauricular skin excursion was measured following subcutaneous lipodissection and then measured again after traditional, wide undermining of the neck skin. Jowl excursion (in reference to the mandibular border) was measured following superiorly oriented SMAS excursion. An electronic force gauge was used to measure force application during measurements. RESULTS Cannula lipodissection resulted in a mean skin excursion of 41.9 mm. There was no significant difference in skin excursion compared to wide undermining (41.9 mm versus 42.1 mm; p = 0.785). Jowl position, in reference to the mandibular border, moved superiorly by a mean distance of 18.3 mm with vertical SMAS excursion. CONCLUSIONS Subcutaneous cannula lipodissection results in equivalent skin recruitment in comparison to wide undermining of the neck. A superior vector of pull on the SMAS results in vertical excursion of the jowl in reference to the mandibular border.
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23
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Charles-de-Sá L, Gontijo-de-Amorim NF, Loureiro Claro V, Vieira DML, de Andrade GM, Dantas-Rocha L, da Silva CGR, Abboudib JH, de Castro CC. Does the Approach of the Lateral Platysmal Bands Widen the Gap between the Medial Bands? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2853. [PMID: 32766034 PMCID: PMC7339373 DOI: 10.1097/gox.0000000000002853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The first visible change in an aging face and neck is the loss of neck contour, which can be corrected by treating the platysmal bands; however, it remains unclear as to which is the best strategy to approach these bands. The aim of the present study is to verify whether the lateral platysmal bands approaches, before the medial ones, cause widening of the gap between them. METHODS This is a prospective, randomized, comparative study involving 30 individuals presenting various stages of neck and facial flaccidity and sagging. The patients were split into 2 groups according to the lateral platysmal approach (group A: lateral platysmal traction/plication; group B: lateral platysmal undermined/traction). A protocol was established to measure the gap between the medial bands, 3 and 5 cm away from the chin, before and after superficial musculoaponeurotic system/platysma lateral suspension. Measurements were taken using a compass and a ruler. The endpoint was to determine whether the gap between the medial platysmal bands widens after the lateral procedure. RESULTS Group A, first measure (1-M): the gap ranged between 1.0 and 1.6 cm in point M3 (3 cm away from chin) and between 1.8 and 3.0 cm in point M5 (5 cm away from chin) (mean in M3 = 1.2; SD, 0.22 and mean in M5 =2.3; SD, 0.52). Group A, second measure (2-M): the measure ranged between 1.0 and 1.7 cm in point M3 and between 1.8 and 3.2 cm in point M5 (mean = 1.28; SD, 0.25 and mean = 2.42; SD, 0.63, respectively). Group B, first measure (1-M): the gap ranged between 1.1 and 1.7 cm in M3 (mean = 1.32; SD, 0.21) and between 1.8 and 3.2 cm in M5 (mean = 2.38; SD, 0.57). Group B, second measure (2-M): the measure ranged between 1.2 and 1.7 cm in M3 (mean = 1.4; SD, 0.18) and between 2.0 and 3.2 cm in M5 (mean = 2.5; SD, 0.55). Group A: P = 0.07 (M3) and 0.10 (M5); Group B: P = 0.09 (M3) and 0.07 (M5). CONCLUSION The lateral platysmal approach, plication or undermined, does not lead to a widening of the gap between the medial platysmal bands.
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Affiliation(s)
- Luiz Charles-de-Sá
- From the Department of Plastic Reconstructive and Aesthetic Surgery, University of the Estate of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | - Valéria Loureiro Claro
- From the Department of Plastic Reconstructive and Aesthetic Surgery, University of the Estate of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Diogo Maciel Lobão Vieira
- From the Department of Plastic Reconstructive and Aesthetic Surgery, University of the Estate of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Gustavo Maltez de Andrade
- From the Department of Plastic Reconstructive and Aesthetic Surgery, University of the Estate of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Lucas Dantas-Rocha
- From the Department of Plastic Reconstructive and Aesthetic Surgery, University of the Estate of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Cláudio Gonçalves Ramos da Silva
- From the Department of Plastic Reconstructive and Aesthetic Surgery, University of the Estate of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - José Horácio Abboudib
- From the Department of Plastic Reconstructive and Aesthetic Surgery, University of the Estate of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Cláudio Cardoso de Castro
- From the Department of Plastic Reconstructive and Aesthetic Surgery, University of the Estate of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Use of 3-Dimensional Imaging in Submental Fat Reduction Following Hyperthermic Laser Lipolysis. Dermatol Surg 2019; 45:988-991. [PMID: 30939517 DOI: 10.1097/dss.0000000000001953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sugrue CM, Kelly JL, McInerney N. Botulinum Toxin Treatment for Mild to Moderate Platysma Bands: A Systematic Review of Efficacy, Safety, and Injection Technique. Aesthet Surg J 2019; 39:201-206. [PMID: 30052764 DOI: 10.1093/asj/sjy179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Platysma bands are characteristic of an aging neck. Resection and plication of the platysma muscle is the basis of treatment. However, unfavorable surgical outcomes and improved understanding of platysma band etiology have shifted treatment towards nonsurgical rejuvenation. Objectives The aim of this paper was to assess the efficacy, injection techniques, and complications associated with botulinum toxin injection for the treatment of platysma bands. Methods A systematic literature search was performed to identify articles reporting botulinum toxin injections for platysma bands in neck rejuvenation. The search included published articles in three electronic databases-Ovid MEDLINE, EMBASE, and the Cochrane Library-between January 1985 and December 2017. Results Three studies met the inclusion criteria, with a total of 78 patients undergoing botulinum toxin injection for platysma bands. Incobotulinumtoxin A was used in 62.3% (n = 45/78) of patients, with 38.4% (n = 30/78) receiving abobotulinumtoxin A. Efficacy was assessed using the Merz platysma score scale. A mean score improvement of 2.0 points, with a response rate of 93.7%, was observed after 14 ± 2 days. At 3 months, the mean score improvement was 1.2 points with a response rate of 86%. Patient-reported metrics demonstrated an improvement in 91% (n = 71/78) of subjects. The three studies used a standard injection technique, with a maximum 20 IU of incobotulinumtoxin A and 5 U abobotulinumtoxin A administered per band. Complications were reported in 15.4% (n = 12/78) of patients, with none requiring further intervention. Conclusions Botulinum toxin is a highly effective treatment for isolated platysma bands. A safe injection technique is described and recommended for clinical practice. Level of Evidence 4
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Affiliation(s)
- Conor M Sugrue
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Jack L Kelly
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Niall McInerney
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
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Affiliation(s)
- Gulhima Arora
- Department of Dermatology, Mehektagul Dermaclinic, New Delhi, India
| | - Sandeep Arora
- Department of Dermatology, Command Hospital Air Force, Bengaluru, Karnataka, India
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27
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Abstract
Various methods and ancillary procedures have been defined in the era of face-lifting surgery.The purpose of this study was to evaluate the esthetic outcomes of our face-neck cases and the importance of adding ancillary procedures based on individual assessment.We conducted a retrospective review of 203 face-neck cases, basically following the endoscopic and open principles of Vasconez. The ancillary procedures added in selected cases included genioplasty, augmentation with autologous facial superficial fascial tissue or fat injections, upper lip shortening, perioral dermabrasion, ear lobe reduction, buccal fat reduction, mentum lifting, and upper orbital rim shaving. Complications, postoperative follow-up, esthetic outcomes, and contribution of the ancillary procedures were recorded.Our esthetic face complication rates were comparable to those of previous studies and included chemosis, hematoma, cyst on the eyelid suture line, skin sloughing, scar abnormalities (hypertrophic scar and widespread scar), pseudoparalysis of the marginal mandibular branch, temporary hypoesthesia of the forehead, irregularity of the glabella after endoscopy, and asymmetry. We did not observe any comorbidity owing to genioplasty and augmentation with autologous tissue except for a case with infection after fat injection.More improvement can be obtained with careful planning of ancillary procedures in face-neck lifting surgery.
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Affiliation(s)
- Recep Anlatici
- Assistant Professor, Sanko University Dep. of Plastic and Reconstructive Surgery, G.Antep
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28
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The Avoidance and Management of Complications, and Revision Surgery of the Lower Face and Neck. Clin Plast Surg 2018; 45:623-634. [PMID: 30268247 DOI: 10.1016/j.cps.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Complications are an inherent occurrence in surgery. In rhytidectomy, many complications are avoidable with thorough preoperative assessment and optimal intraoperative and postoperative care. Nevertheless, complications do occur. In certain situations, avoidance of risks is the best way to decrease the occurrence. Once complications do occur, there is a large body of literature to aid in the correction.
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Innovative Surgical Approach Using a Mesh Sling for the Aging Neck. Plast Reconstr Surg 2018; 141:1386-1391. [PMID: 29794700 DOI: 10.1097/prs.0000000000004422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rejuvenation of the neck is essential to achieve a young facade. Different approaches for aging neck rejuvenation have been developed throughout the years. Most of them focus on specific elements that contribute to the aging neck. The main drawbacks of these techniques are recurrence of the platysma bands, malposition, deformations, salivary problems, and defatting. These disadvantages and limitations have led the author to create a novel surgical approach to improve the aging neck that would be suitable for most patients. Instead of dealing with each of the elements of the aging neck, the author's approach involves use of a sling to elevate all the descending elements as a whole to create a natural and longstanding result. METHODS Since March of 2014, 10 patients have been operated on for neck lifting with this new approach. Four different types of material have been used: absorbable synthetic braided (Vicryl) in five patients, semiabsorbable synthetic braided and monofilament (Vypro) in one patient, absorbable synthetic matrix (TIGR) in three patients, and biological mesh-allograft material (AlloDerm) in one patient. Follow-up visits were made after 10 days, 3 months, 6 months, and annually. RESULTS In all cases, the operations were uneventful. There were no major complications. Minor complication occurred in one patient with the Vypro mesh. The mesh caused stiffness and was replaced. Final aesthetic results were satisfactory in all cases. CONCLUSIONS Current approaches for improvement of the aging neck do not fit all aging neck cases and are suitable for only a specific dominant element. The aging neck tends to reappear faster than expected because of recurrence or dominance of another element. The author's novel approach is more predictable and is suitable for most cases regardless of the dominant part causing the aging. More experience and longer follow-up are needed to choose the most appropriate material for the mesh. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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30
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DiBernardo GA, DiBernardo BE. Prediction of Treatment Outcomes for Neck Rejuvenation Utilizing a Unique Classification System of Treatment Approach Using a 1440-nm Side-Firing Laser. Aesthet Surg J 2018; 38:S43-S51. [PMID: 29767718 DOI: 10.1093/asj/sjy066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The appearance of a youthful neck is lost with age causing excessive skin laxity, a loss of subcutaneous fat, prominence of platysmal banding, and jowling. In view of the success obtained with laser treatment for neck rejuvenation, the authors have recently taken an algorithmic approach to developing a 7-category classification system of the aging conditions throughout the anatomic spectrum of three areas: skin, fat, and muscle. This system will correlate with specific treatment options. OBJECTIVE The objective of the study was to confirm the 7-category classification system and treatment approaches based on clinical outcome data for treatment of the mandibular and submandibular areas, specifically for skin tightening and laser lipolysis after a single 1440-nm laser treatment. METHODS Patients were treated with a single treatment of PrecisionTX™ 1440-nm wavelength laser on their necks. Baseline and posttreatment photographs were taken and evaluated by 3 blinded reviewers using the Cervicomental Angle Scale (CAS). RESULTS Subjects were rated grades II-III (2.9 ± 0.8) on average at baseline and grades I-II (1.3 ± 0.5) at follow-up. The average improvement was a mean score of 1.5 ± 0.07. Patients, 23/25 (92%), showed at least a 1 score improvement. CONCLUSIONS This study confirms a new minimally invasive treatment approach based on a unique classification system with no adverse events reported and high patient satisfaction. LEVEL OF EVIDENCE 4
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Multimodal Approach for Treating Horizontal Neck Wrinkles Using Intensity Focused Ultrasound, Cohesive Polydensified Matrix Hyaluronic Acid, and IncobotulinumtoxinA. Dermatol Surg 2018; 44:421-431. [DOI: 10.1097/dss.0000000000001312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guida S, Persechino F, Rubino G, Pellacani G, Farnetani F, Urtis GG. Improving mandibular contour: A pilot study for indication of PPLA traction thread use. J COSMET LASER THER 2018; 20:465-469. [PMID: 29461124 DOI: 10.1080/14764172.2018.1427875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: The request for less-aggressive procedures to improve mandibular contour is increasing. Several kinds of threads have been used for this purpose. Nevertheless, PLLA (poly-L-Lactic acid) traction thread procedure has not been previously described. Aim: To investigate the role of PLLA traction threads in improving mandibular contour. Methods: Twenty women were enrolled in the study. They were differentially classified for skin laxity. Patients were treated in a single session with two PLLA traction threads per side. Specific post-procedure instructions were given to patients, and complications occurred after the procedures were estimated. A Fisher's t-test was performed to identify criteria related to longevity of results. Results: We found longevity of results to be associated with younger age (p = 0.001), absence of severe skin laxity of jawline and neck (p = 0.001), and aesthetic satisfaction (p = 0.024). Edema, swelling, and temporary skin contour irregularities were found in most cases (N = 16; 80%), whereas paresthesia resolving without sequelae in 2-4 weeks was found in two cases (10%). Conclusions: Our results show that selected patients, younger than 51 and showing a mild-moderate degree of skin laxity of jawline and neck angle represent ideal candidates for PLLA traction thread treatment. Further studies will be performed to confirm our results.
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Affiliation(s)
- Stefania Guida
- a Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, Dermatology Unit , University of Modena and Reggio Emilia , Modena , Italy
| | - Flavia Persechino
- a Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, Dermatology Unit , University of Modena and Reggio Emilia , Modena , Italy
| | - Giuseppe Rubino
- b Department of Maxillofacial Surgery , Galeazzi Hospital , Milan , Italy
| | - Giovanni Pellacani
- a Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, Dermatology Unit , University of Modena and Reggio Emilia , Modena , Italy
| | - Francesca Farnetani
- a Department of Surgical, Medical, Dental and Morphological Sciences with Interest transplant, Oncological and Regenerative Medicine, Dermatology Unit , University of Modena and Reggio Emilia , Modena , Italy
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Konstantinow A, Fischer T, Zink A. Neck rejuvenation by direct anterior medial cervicoplasty: the modified zigzag-plasty according to Tschopp. J Eur Acad Dermatol Venereol 2017; 32:805-811. [PMID: 29283463 DOI: 10.1111/jdv.14776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conventional cervicofacial rhytidectomy has become the standard treatment of skin excess of the ageing neck. However, some patients want to avoid an extensive surgical procedure, especially if the anterior neck is the predominant problem zone. OBJECTIVE To report on the efficacy and safety of a zigzag-shaped skin excision combined with platysma plication. METHODS AND MATERIALS We present a retrospective case review series of six female patients. Skin excess was marked preoperatively using the skin pinching technique, then transferred to a zigzag-shaped area and finally excised using the method according to Tschopp, which is described. Patients were followed up for at least 1 year. RESULTS All patients (age: 55-82 years, median: 65 years) were very satisfied with the results. On an overall patient satisfaction scale of 1-10 (1 being the best), the scars were graded on average 1.85 (median: 2) 1 year after surgery. No scar hypertrophy, functional impairment, nerve damage or other serious complications were observed. CONCLUSION In selected patients, the direct anterior zigzag-shaped excision poses an effective, safe and easy surgical option for both skin excess and fat excess and platysma banding. The technique is easily reproducible, with low morbidity and high patient satisfaction.
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Affiliation(s)
- A Konstantinow
- Department of Dermatology and Allergology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - T Fischer
- Department of Dermatology and Allergology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - A Zink
- Department of Dermatology and Allergology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Southwick G. Invited Commentary on "A Simplified Method for Management of Platysmal Bands: Platysmotomy as an Office Procedure". Aesthetic Plast Surg 2017; 41:1360-1361. [PMID: 28779412 DOI: 10.1007/s00266-017-0950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Graeme Southwick
- Melbourne Institute of Plastic Surgery, Melbourne, Australia.
- Departments of Anatomy and Cell Biology, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.
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Abstract
BACKGROUND A multimodal approach is essential for neck rejuvenation because many factors contribute to the aging of the neck. OBJECTIVES We evaluated the effect of combined therapy using microfocused ultrasound with visualization (MFU-V), neuromodulator injection, and filler injection for neck rejuvenation. METHODS Subjects were sequentially treated with three kinds of interventions in a single session, as follows: (A) MFU-V or calcium hydroxyapatite injection for restoring skin laxity; (B) hyaluronic acid filler injection for horizontal neck lines; and (C) neuromodulator injection for platysmal bands. RESULTS All ten patients showed clinical improvement of neck aging after combined treatment. Patients with more aged neck at baseline were more likely to show greater improvement after treatment. CONCLUSION Neck rejuvenation using multimodal approach is effective in Asians.
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Affiliation(s)
- Eun Jin Doh
- a Department of Dermatology , Seoul National University Hospital , Seoul , Korea
| | - Jiwon Kim
- a Department of Dermatology , Seoul National University Hospital , Seoul , Korea
| | - Dong Hun Lee
- a Department of Dermatology , Seoul National University Hospital , Seoul , Korea.,b Institute of Human-Environment Interface Biology , Seoul National University , Seoul , Korea
| | - Je-Young Park
- c Apkoo-Jung Department , Oracle Dermatology Center , Seoul , Korea
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Use of 3-Dimensional Imaging in Submental Fat Reduction After Deoxycholic Acid Injection. Dermatol Surg 2017; 44:599-602. [PMID: 29059140 DOI: 10.1097/dss.0000000000001342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Anatomical and Clinical Implications of the Deep and Superficial Fat Compartments of the Neck. Plast Reconstr Surg 2017; 140:405e-414e. [DOI: 10.1097/prs.0000000000003618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim H, Yoo KH, Zheng Z, Cho SB. Pressure- and dose-controlled transcutaneous pneumatic injection of hypertonic glucose solution for the treatment of atrophic skin disorders. J COSMET LASER THER 2017; 19:479-484. [PMID: 28665146 DOI: 10.1080/14764172.2017.1343950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Needleless transcutaneous pneumatic injections (TPIs) are a minimally invasive way to deliver the solution into the skin for therapeutic purposes. The suggested action mechanisms of TPI therapy include mechanical stimulation, immediate tissue shrinkage and late wound healing. METHODS Thirteen Korean patients were treated with TPI for atrophic skin disorders, including acne scars, striae albae, post-furuncle, or carbuncle scars, and horizontal wrinkles with lipoatrophy. At each TPI treatment session, a single pass was made along with the atrophic skin lesions without overlapping. Thereafter, two dermatologists objectively evaluated the clinical improvement in the lesions in the photographs via the global aesthetic improvement scale (GAIS). RESULTS One month after the final treatment, the overall mean GAIS score was 2.3 ± 0.8. Six of the 13 (46.2%) patients exhibited clinical improvement of grade 3, five (38.5%) patients grade 2 and two (15.4%) patients grade 1. The overall mean subjective satisfaction score with the TPI treatment was 2.3 ± 0.9. Six of the 13 (46.2%) patients achieved subjective satisfaction of grade 3, six (46.2%) patients grade 2 and one (7.7%) patient grade 0. CONCLUSIONS The present study demonstrated that the TPI treatment is effective and safe for treating atrophic skin disorders of varying causes in Korean patients.
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Affiliation(s)
- Heesu Kim
- a Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea
| | - Kwang Ho Yoo
- a Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea
| | - Zhenlong Zheng
- a Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea.,b Department of Dermatology , Yanbian University Hospital , Yanji , China
| | - Sung Bin Cho
- a Department of Dermatology and Cutaneous Biology Research Center, International St. Mary's Hospital , Catholic Kwandong University, College of Medicine , Incheon , Republic of Korea.,c Kangskin Sillim Dermatology Clinic , Seoul , Republic of Korea
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Abstract
BACKGROUND Cosmetic surgery among male patients has become increasingly popular. The face-lift technique is different in male patients, specifically regarding preservation of hair follicles, restoration of a youthful and well appearance, and reduction of the risk of hematoma. METHODS A retrospective review of a single surgeon's past 20 years of consecutive male rhytidectomies revealed a cohort of 83 patients. A control group was created by random selection of 83 age-matched female rhytidectomy patients during the same period. Data were collected and analyzed critically for factors contributing to complications, including hematoma, seroma, skin sloughing, alopecia, infection, and nerve injury. The evolution in the senior author's technique in male rhytidectomy is described. RESULTS Differences in facial analysis and rhytidectomy technique in male patients and female patients are highlighted. Five male patients (6.0 percent) and no female patients in the control group developed postoperative hematoma (p = 0.0587). No other complications occurred. CONCLUSION Respecting the patterns of hair growth in incision design, avoiding damage to follicles during dissection, and exercising standard of care (especially avoidance of hypotensive anesthesia) in prevention of postoperative hematoma have delivered safe and consistently reproducible aesthetic outcomes and acceptable complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Abstract
BACKGROUND The most common features of aging in the anterior neck are skin laxity and anterior platysma bands. Most neck correction techniques fail to obtain lasting correction of these despite promising early improvement. The authors use a major procedure to obtain the best results, combining full neck undermining with complete platysma transection and midline platysma approximation. Even using this technique, the authors have had concerns about the long-term results, and are aware of the lack of published studies of results using this technique. METHODS A prospective study was conducted on 150 consecutive neck-lift patients operated on by the same senior surgeon (M.P.C.) between 2010 and 2014 to evaluate patient satisfaction and recurrence rates of anterior skin laxity and platysma bands. Patients were reviewed at 3 months (138 cases) and 1 year (96 cases). At both time points, patients completed questionnaires on level of satisfaction and eventual complaints regarding their surgical treatment, and were objectively evaluated for skin excess and recurrent bands. RESULTS At 1 year, 76 percent of the patients were satisfied with the outcome using this technique, although satisfaction had been 100 percent at 3 months. However, only 52 percent showed no anterior neck skin excess and 55 percent had no recurrence of bands 1 year after surgery. CONCLUSIONS Despite obtaining satisfactory results in most patients, this technique has several downsides: it is time consuming, there is the risk of iatrogenic deformities unless it is carried out precisely, the postoperative recovery is often very long, and there is a significant failure to maintain long-term correction. After 25 years' experience with these deficiencies, a reconsideration of the most appropriate procedure for correction of the anterior neck is warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Auersvald A, Auersvald LA, Oscar Uebel C. Subplatysmal Necklift: A Retrospective Analysis of 504 Patients. Aesthet Surg J 2017; 37:1-11. [PMID: 27356946 DOI: 10.1093/asj/sjw107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Improvement of neck contour is a primary goal of patients who seek rejuvenation of the face and neck. Subplatysmal structures, including fat, the digastric muscle, and the submandibular salivary glands (SMSGs), may contribute to the appearance of a disproportionately large neck. OBJECTIVES The authors sought to evaluate the safety, effectiveness, and predictability of necklift combined with reshaping and repositioning of the subplatysmal structures. METHODS The records of 504 patients were reviewed retrospectively. Surgical maneuvers for subplatysmal necklift were described comprehensively and supplemented with videos. The subplatysmal anatomy was detailed by means of 2 cadaver dissections. RESULTS A total of 430 patients (85.3%) underwent subplatysmal necklift. The most commonly treated structures were fat (423 patients [83.9%]), the SMSGs (307 patients [60.9%]), and the digastric muscle (91 patients [18.1%]). The most common complications were weakness of the lower lip depressor (29 patients [5.7%]), followed by sialoma of the parotid gland (10 patients [2%]). No patients experienced subplatysmal hematoma. CONCLUSIONS Subplatysmal necklift is a safe, effective, and reliable option for patients who desire improved cervical contour. LEVEL OF EVIDENCE 4 Therapeutic.
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Affiliation(s)
- André Auersvald
- Drs A. Auersvald and L. Auersvald are plastic surgeons in private practice in Curitiba, Paraná, Brazil. Dr Uebel is a Professor and Chair of the Section of Plastic Surgery, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luiz A Auersvald
- Drs A. Auersvald and L. Auersvald are plastic surgeons in private practice in Curitiba, Paraná, Brazil. Dr Uebel is a Professor and Chair of the Section of Plastic Surgery, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Oscar Uebel
- Drs A. Auersvald and L. Auersvald are plastic surgeons in private practice in Curitiba, Paraná, Brazil. Dr Uebel is a Professor and Chair of the Section of Plastic Surgery, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Noninvasive Submental Fat Compartment Treatment. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1155. [PMID: 28018773 PMCID: PMC5172481 DOI: 10.1097/gox.0000000000001155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/11/2016] [Indexed: 11/26/2022]
Abstract
Background: KYBELLA, ATX-101, is an injectable form of sodium deoxycholic acid. It is currently the only Food and Drug Administration–approved injectable drug for the reduction of submental fat. Objectives: A literature review and discussion of the treatment of submental fat. Results: KYBELLA is a well-tolerated alternative for the treatment of submental fat. Conclusions: KYBELLA is a safe and efficacious, first in class, injectable drug for the reduction of submental fat.
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Naini FB, Cobourne MT, McDonald F, Wertheim D. Submental-Cervical Angle: Perceived Attractiveness and Threshold Values of Desire for Surgery. J Maxillofac Oral Surg 2016; 15:469-477. [PMID: 27833339 DOI: 10.1007/s12663-015-0872-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 11/23/2015] [Indexed: 11/25/2022] Open
Abstract
AIM The submental-cervical angle may alter as a result of mandibular orthognathic surgery and/or the ageing process and is therefore an important facial aesthetic parameter for comparative diagnosis and treatment planning. The purpose of this study was to undertake a quantitative evaluation of the influence of the submental-cervical angle on perceived attractiveness and threshold values of desire for surgery. STUDY DESIGN The submental-cervical angle of an idealized profile silhouette image was altered incrementally between 90° and 130°. The images were rated on a seven-point Likert scale by pre-treatment orthognathic patients (n = 75), laypeople (n = 75), and clinicians (n = 35). RESULTS A submental-cervical angle of 90°-105° was deemed acceptable. Angles up to 120° were deemed slightly unattractive by the lay and clinician groups, but very unattractive by the patient group. By 125°-130° all groups perceived the angle as very unattractive. The threshold value of desire for surgery was 110° for patients, 115° for lay people and 125° for clinicians. Patients appear to be more critical than lay and clinician groups. CONCLUSIONS These ranges of normal variability of the submental-cervical angle and threshold values of desire for surgery, in terms of observer acceptance, should be considered by clinicians in planning mandibular orthognathic surgery and aesthetic surgical procedures of the submental-cervical region.
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Affiliation(s)
- Farhad B Naini
- Kingston and St George's Hospitals and Medical School, Blackshaw Road, London, SW17 0QT UK
| | | | | | - David Wertheim
- Faculty of Science, Engineering and Computing, Kingston University, London, UK
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Ascher B, Fellmann J, Monheit G. ATX-101 (deoxycholic acid injection) for reduction of submental fat. Expert Rev Clin Pharmacol 2016; 9:1131-43. [PMID: 27457304 DOI: 10.1080/17512433.2016.1215911] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The shape and contour of the chin and neck play an important role in facial esthetics. As such, excess fat within the submental area (double chin) can negatively affect facial esthetics and body image. Common treatments for submental contouring include invasive procedures such as surgical rejuvenation and targeted liposuction. Energy devices (lasers, radiofrequency, and ultrasound) may be used to improve submental skin laxity while cryolipolysis was recently cleared in the United States for use in the submental area. However, ATX-101 (deoxycholic acid injection) is the only injectable drug approved in the United States and Canada for reduction of submental fat. AREAS COVERED The efficacy and safety of ATX-101 have been extensively evaluated in a global clinical development program including multiple Phase I/II studies and four large Phase III trials. Available data from ATX-101 trials are reviewed. Expert commentary: Injectables have been well established for facial rejuvenation. Extending injectable treatment into the chin and neck is a major advance for nonsurgical cosmetic correction. Overall, the evidence supports ATX-101 as a safe and effective, minimally invasive treatment alternative for reduction of submental fat that will provide a major tool for the esthetic physician.
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Affiliation(s)
| | - Jere Fellmann
- b Kythera Biopharmaceuticals, Inc ., Westlake Village , CA , USA (an affiliate of Allergan plc, Dublin, Ireland)
| | - Gary Monheit
- c Private Practice (Total Skin & Beauty Dermatology Center, P.C.) and Department of Dermatology, Department of Ophthalmology , University of Alabama at Birmingham , Birmingham , AL , USA
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Humphrey S, Sykes J, Kantor J, Bertucci V, Walker P, Lee DR, Lizzul PF, Gross TM, Beddingfield FC. ATX-101 for reduction of submental fat: A phase III randomized controlled trial. J Am Acad Dermatol 2016; 75:788-797.e7. [PMID: 27430612 DOI: 10.1016/j.jaad.2016.04.028] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND ATX-101, an injectable form of deoxycholic acid, causes adipocytolysis when injected subcutaneously into fat. OBJECTIVE We sought to evaluate the efficacy and safety of ATX-101. METHODS In this phase III trial (REFINE-2), adults dissatisfied with their moderate or severe submental fat (SMF) were randomized to ATX-101 or placebo. Coprimary end points, evaluated at 12 weeks after last treatment, were composite improvements of 1 or more grades and 2 or more grades in SMF observed on both the validated Clinician- and Patient-Reported SMF Rating Scales. Other end points included magnetic resonance imaging-based assessment of submental volume, assessment of psychological impact of SMF, and additional patient-reported outcomes. RESULTS Among those treated with ATX-101 or placebo (n = 258/treatment group), 66.5% versus 22.2%, respectively, achieved a composite improvement of 1 or more grades (Mantel-Haenszel risk ratio 2.98; 95% confidence interval 2.31-3.85) and 18.6% versus 3.0% achieved a composite improvement of 2 or more grades in SMF (Mantel-Haenszel risk ratio 6.27; 95% confidence interval 2.91-13.52; P < .001 for both). Those treated with ATX-101 were more likely to achieve submental volume reduction confirmed by magnetic resonance imaging, greater reduction in psychological impact of SMF, and satisfaction with treatment (P < .001 for all). Overall, 85.7% of adverse events in the ATX-101 group and 76.9% in the placebo group were localized to the injection site. LIMITATIONS Follow-up was limited to 44 weeks. CONCLUSION ATX-101 is an alternative treatment for SMF reduction.
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Affiliation(s)
- Shannon Humphrey
- University of British Columbia, Vancouver, British Columbia, Canada; Carruthers & Humphrey, Vancouver, British Columbia, Canada.
| | | | - Jonathan Kantor
- Florida Center for Dermatology PA, St. Augustine, Florida; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Vince Bertucci
- University of Toronto and Women's College Hospital, Toronto, Ontario, Canada; Bertucci MedSpa, Woodbridge, Ontario, Canada
| | - Patricia Walker
- Kythera Biopharmaceuticals, Inc, Westlake Village, California
| | - Daniel R Lee
- Kythera Biopharmaceuticals, Inc, Westlake Village, California
| | - Paul F Lizzul
- Kythera Biopharmaceuticals, Inc, Westlake Village, California
| | - Todd M Gross
- Kythera Biopharmaceuticals, Inc, Westlake Village, California
| | - Frederick C Beddingfield
- Kythera Biopharmaceuticals, Inc, Westlake Village, California; David Geffen School of Medicine, University of California, Los Angeles, California
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Abstract
Botulinum toxin type A (BTA) can be used for facial aesthetics. The 3 currently available BTA types include onabotulinumtoxinA (Botox; Botox Cosmetic, Allergan, Irvine, CA), abobotulinumtoxinA (Dysport; Ipsen, Ltd, Berkshire, UK), and incobotulinumtoxinA (Xeomin; Merz Pharmaceuticals, Frankfurt, Germany). The mechanism of action and clinical uses for treatment of dynamic lines of the forehead, brow, glabella, lateral orbit, nose, and lips are presented, as well as treatment of masseter hypertrophy, platysmal bands, and improvements of the perioral region. Specific BTA injection sites and suggested doses are presented.
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