1
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Ren R, Xue H, Gao Z, Wang H, Xia X, Qu Y, Bromée T, Almegård B, Zhao H. Restoring long-lasting midface volume in the Asian face with a hyaluronic acid filler: A randomized controlled multicenter study. J Cosmet Dermatol 2024; 23:1985-1991. [PMID: 38487954 DOI: 10.1111/jocd.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/08/2024] [Accepted: 01/29/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Hyaluronic acid (HA) filler treatment is a minimally-invasive alternative to surgery to volumize the cheeks. HAVOL (Restylane® Volyme) is a flexible HA filler suited to contouring and volumizing the midface. METHODS This randomized, evaluator-blinded, no-treatment controlled study evaluated effectiveness and safety of HAVOL for correction of midface volume deficit and midface contour deficiency in Chinese subjects. In total 111 subjects were randomized to HAVOL and 37 to no treatment (control). The primary endpoint was response, on the blinded evaluator-assessed Medicis Midface Volume Scale (MMVS), at 6 months after last injection for the treatment group and 6 months after randomization for controls, where response was defined as ≥1-point improvement from baseline on both sides of the face. RESULTS HAVOL was superior to no treatment at 6 months, meeting the primary objective: 76% versus 8% MMVS responders, a difference of 68% (CI: 55.7%-79.4%, p < 0.0001). These effects were sustained in 51% at 12 months after last injection. A majority (≥96%) had improved aesthetic appearance of midface fullness at Month 1 (using the Global Aesthetic Improvement Scale [GAIS]), effects which remained in ≥80% up to 12 months. Volume change captured by 3D photography increased after 1 month to 3.6 mL (close to the total injected volume of 3.4 mL), and remained stable through 12 months. Over 97% reported satisfaction with results after treatment with HAVOL. Additionally, HAVOL was well tolerated, with no unanticipated related adverse events. CONCLUSIONS This study showed that HAVOL is effective and well tolerated for midface treatment in a Chinese population.
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Affiliation(s)
- Rongxin Ren
- Department of Plastic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongyu Xue
- Peking University 3rd Hospital, Beijing, China
| | - Zhanwei Gao
- China Japan Friendship Hospital, Beijing, China
| | - Hang Wang
- West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xiujuan Xia
- Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Yan Qu
- Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | | | | | - Hongyi Zhao
- Department of Plastic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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2
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de Melo MDGB, Azevedo LH, Ruiz LFN, Lobo MM, de Freitas PM. Photobiomodulation Therapy in the Management of Late Complications After Facial Filling. Cureus 2024; 16:e59513. [PMID: 38826871 PMCID: PMC11143946 DOI: 10.7759/cureus.59513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
The aim of the present study is to report a clinical case of a patient diagnosed with a late adverse reaction to the injection of filler material - persistent and intermittent delayed swelling (PIDS) - in which photobiomodulation therapy (PBMT) with low-power laser was used for edema reduction. This is an observational, descriptive, and retrospective work of a case report. The female patient, aged 73 years old, had undergone dermal filler six years before and complained of increased volume in the face region (glabellar region, labiomental sulcus, and nasolabial folds) and was submitted to ultrasound and anatomopathological analysis. PBMT using a low-power laser (660 nm and 808 nm, simultaneous irradiation, in contact, 2 J/point, 100 mW) proved to be effective for the non-invasive approach of late adverse reaction to dermal filler, such as PIDS, a common complication related to the use of dermal fillers.
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Affiliation(s)
| | | | | | | | - Patrícia M de Freitas
- Special Laboratory of Lasers in Dentistry, Department of Operative Dentistry, School of Dentistry, Universidade de São Paulo, São Paulo, BRA
- Faculty of Dentistry, Universidade de São Paulo, São Paulo, BRA
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3
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Metelitsa A, Enright KM, Rosengaus F, Avelar L, Lam S, Berros P, Di Gregorio C, Fabi S, Hamdan F, Liew S, Minocha K, Wanitphakdeedecha R, Weiner S, Nikolis A. Simplifying the injector's armamentarium: An international consensus regarding the use of gel science to differentiate hyaluronic acid fillers and guide treatment recommendations. J Cosmet Dermatol 2024; 23:1604-1612. [PMID: 38318685 DOI: 10.1111/jocd.16207] [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: 11/21/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND The Restylane portfolio of soft tissue fillers spans a wide range of indications, due in part to their complementary manufacturing technologies [non-animal stabilized hyaluronic acid (NASHA) and Optimal Balance Technology (OBT/XpresHAn)]. Using an array of products, injectors can achieve a holistic, natural looking effect for their patients. However, with a wide range of products it may be difficult to choose an optimal combination. AIM Simplify and align global use recommendations for NASHA versus OBT products. METHODS Two pre-meeting surveys were completed by 11 key opinion leaders with international representation, with the goal of collecting information regarding their current injection practices for various anatomical regions of the face (i.e., temporal region, forehead, tear trough, lateral zygoma, anteromedial cheek, nose, pyriform aperture, nasolabial fold, perioral area, lips, labiomental crease, marionette lines, chin, and jawline). The data collected from these surveys was subsequently discussed in a consensus group meeting involving 11 voting members and 3 nonvoting members. RESULTS Top product recommendations were identified for each anatomical area, along with secondary and tertiary recommendations that can also be used under defined circumstances. Recommendations were provided based on a consideration of elements such as patient features (e.g., skin thickness, bone structure), the desired aesthetic outcome, experience of the injector, and the preferred injection technique. CONCLUSION A majority consensus regarding the top NASHA versus OBT product choice for each anatomical region of the face was reached. These recommendations represent international agreement regarding the use of Restylane products.
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Affiliation(s)
- Andrei Metelitsa
- Beacon Dermatology, Calgary, Alberta, Canada
- Division of Dermatology, University of Calgary, Calgary, Alberta, Canada
| | - Kaitlyn M Enright
- Erevna Innovations Inc, Clinical Research Unit, Westmount, Quebec, Canada
| | | | - Luiz Avelar
- Clinica Domani Luiz Avelar, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Carlo Di Gregorio
- Plastic Reconstructive and Aesthetic Surgery, Private Practice, Palermo, Italy
| | - Sabrina Fabi
- University of California San Diego, California, San Diego, USA
| | - Firas Hamdan
- Highness Clinics, Dubai, UAE
- Highness Clinics, Beirut, Lebanon
| | | | | | | | | | - Andreas Nikolis
- Erevna Innovations Inc, Clinical Research Unit, Westmount, Quebec, Canada
- Department of Plastic Surgery, McGill University, Montreal, Quebec, Canada
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4
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Wang Y, Tang Z, Teng X. New advances in the treatment of thin endometrium. Front Endocrinol (Lausanne) 2024; 15:1269382. [PMID: 38745960 PMCID: PMC11092375 DOI: 10.3389/fendo.2024.1269382] [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: 07/29/2023] [Accepted: 03/22/2024] [Indexed: 05/16/2024] Open
Abstract
Thin endometrium (TE) is defined as a mid-luteal endometrial thickness ≤7mm. TE can affect endometrial tolerance, leading to lower embryo implantation rates and clinical pregnancy rates, and is also associated with impaired outcomes from assisted reproductive treatment. Herein, we systematically review TE causes, mechanisms, and treatments. TE pathogenesis has multiple causes, with the endometrium becoming thinner with age under hormonal influence. In addition, uterine cavity factors are important, as the inflammatory environment may affect expressions of certain genes thereby inhibiting endometrial stromal cell proliferation and promoting apoptosis. Long-term oral contraceptive use or the use of ovulation-promoting drugs are also definite factors contributing to endometrial thinning. Other patients have primary factors, for which the clinical etiology remains unknown. The main therapeutic strategies available for TE are pharmacological (including hormonal and vasoactive drugs), regenerative medicine, intrauterine infusion of growth factor-granulocyte colony-stimulating factor, autologous platelet-rich plasma, and complementary alternative therapies (including traditional Chinese herbal medicine and acupuncture). However, the associated mechanisms of action are currently unclear. Clinical scholars have proposed various approaches to improve treatment outcomes in patients with TE, and are exploring the principles of efficacy, offering potentials for novel treatments. It is hoped that this will improve TE tolerance, increase embryo implantation rates, and help more couples with infertility with effective treatments.
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Affiliation(s)
- Yidi Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Zunhao Tang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiuxiang Teng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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5
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Magacho-Vieira FN. Minimally invasive cosmetic procedures for mothers of brides: Strategies and considerations. J Cosmet Dermatol 2024; 23:777-779. [PMID: 37929644 DOI: 10.1111/jocd.16069] [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: 08/31/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
The pivotal role of the bride's mothers in wedding celebrations is an effective motivation to seek cosmetic therapies, making them frequent patients in a dermatologists' offices. Addressing their aesthetic concerns contributes to their holistic well-being, but faces an intricate relationship between time availability, financial factors, and the critical emotional context. This article underscores the varying behavioral patterns of mothers of brides when seeking aesthetic treatments, providing tailored strategies for effective communication and decision-making, based on individual personalities. Additionally, this paper presents a specific timeline for the implementation of these interventions, including neuromodulators, collagen stimulators, and fillers. Understanding the unique traits and expectations of this particular population can lead to improved patient satisfaction, enhanced outcomes, and an overall positive experience.
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Affiliation(s)
- Fabiano Nadson Magacho-Vieira
- Magacho Institute for Health Education, Fortaleza, Brazil
- Department of Clinical, Aesthetic and Surgical Dermatology, Batista Memorial Hospital, Fortaleza, Brazil
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6
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Enright KM, Weiner SF, Durairaj KK, Gilardino MS, Nikolis A. Evaluation of the Hydrophilic, Cohesive, and Physical Properties of Eight Hyaluronic Acid Fillers: Clinical Implications of Gel Differentiation. Clin Cosmet Investig Dermatol 2024; 17:89-101. [PMID: 38230304 PMCID: PMC10790663 DOI: 10.2147/ccid.s446429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/25/2023] [Indexed: 01/18/2024]
Abstract
Background Hyaluronic acid (HA) fillers are used to treat an array of aesthetic indications. Proper filler selection is paramount for successful patient outcomes. However, many important physiochemical and physical properties that impact HA gel behavior remain undefined. Purpose To evaluate the hydrophilicity, cohesivity and particle size of eight commercial HA fillers manufactured by either Non-Animal Stabilized Hyaluronic Acid (NASHA) or Optimal Balance Technology (OBT) techniques. Methods and Materials Three individual in vitro experiments were performed to assess HA swelling capacity, cohesion, and particle size. Image analyses, blinded evaluation using the Gavard-Sundaram Cohesivity Scale, and laser diffraction technology were utilized, respectively. Results Compared to fillers manufactured with NASHA technology, OBT products demonstrated greater swelling capacity, cohesion, and wider particle size distributions. Strong positive correlations between swelling factor, degree of cohesivity, and increasing widths of the particle size distributions were observed. Conclusions The hydrophilicity, cohesivity and particle size distributions vary among HA fillers manufactured with different techniques. The creation of new labels identifying products based on their unique combination of physiochemical and physical characteristics may help guide appropriate selection of HA fillers to optimize patient outcomes.
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Affiliation(s)
- Kaitlyn M Enright
- Clinical Research Unit, Erevna Innovations Inc, Westmount, Quebec, Canada
| | | | | | - Mirko S Gilardino
- Division of Plastic Surgery, McGill University, Montreal, Quebec, Canada
| | - Andreas Nikolis
- Clinical Research Unit, Erevna Innovations Inc, Westmount, Quebec, Canada; Department of Plastic Surgery, McGill University, Montreal, Quebec, Canada
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7
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Hall C. Optimizing Facial Aesthetics: Sequential Application of Botulinum Toxin A and Dermal Fillers for Enhanced Results. PLASTIC AND AESTHETIC NURSING 2024; 44:70-71. [PMID: 38166310 PMCID: PMC10786442 DOI: 10.1097/psn.0000000000000546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
In recent years, the field of aesthetic medicine has witnessed significant advancements, offering patients a plethora of options to rejuvenate their appearance. Among the most popular techniques are the administration of botulinum toxin A (BoNT-A) and dermal fillers. This article delves into the rationale and benefits of preparing the face with BoNT-A to weaken depressor muscles before proceeding with dermal filler injections. This sequential approach not only enhances patient outcomes but also improves procedural safety and patient satisfaction while reducing the chances of needing filler. This article reviews the anatomy, scientific evidence, and clinical implications supporting this innovative approach while shedding light on the potential for revolutionizing facial aesthetic procedures. With advanced applications of BoNT-A, it is possible to slim round faces, reduce jowling, create hollowing in some patients by obliterating masseters, slim the parotid, extend the chin, and more.
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Affiliation(s)
- Constance Hall
- Constance Hall, MSN, RN, FNP-C, is the current owner of The Secret Boutique, PLLC, Morehead City, NC. Constance is also the owner of her own CME course, The Foundations of Aesthetic Medicine offered through the University of Louisville School of Medicine, Louisville, KY, for which she receives a modest grant from AbbVie, North Chicago, IL
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8
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Fanian F, Deutsch JJ, Bousquet MT, Boisnic S, Andre P, Catoni I, Beilin G, Lemmel C, Taieb M, Gomel-Toledano M, Issa H, Garcia P. A hyaluronic acid-based micro-filler improves superficial wrinkles and skin quality: a randomized prospective controlled multicenter study. J DERMATOL TREAT 2023; 34:2216323. [PMID: 37577796 DOI: 10.1080/09546634.2023.2216323] [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: 12/07/2022] [Accepted: 05/16/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND NCTF®135HA is a bio-revitalizing solution containing hyaluronic acid designed to compensate for skin dehydration, fatigue, and fine wrinkles associated with endogenous and environmental aging. METHODS We conducted a randomized, active-controlled study to evaluate the efficacy and tolerability of NCTF®135HA injections on the face (crow's feet), neck, and décolleté regions. Subjects were randomly assigned (3:1) to receive three NCTF®135HA treatment sessions plus twice-daily anti-aging moisturizer cream or cream alone (control). The primary outcome was the reduction in superficial wrinkles between baseline and Day (D)75 in the three areas, assessed by profilometric measures, clinical scoring, subjective changes, and tolerability. RESULTS 146 subjects were randomized to NCTF®135HA (n = 107) or control (n = 38). At D75 and D120, NCTF®135HA significantly reduced wrinkles in all three areas and improved facial radiance scores compared with the control. Skin hydration significantly increased 7 d after the last NCTF®135HA injection. Self-esteem scales showed statistically significant improvements at D75 and D120 in subjects treated with NCTF®135HA versus baseline. Most adverse events were mild, resolved within 48 h, and were related to the injection procedure. CONCLUSION NCTF®135HA is an effective and well-tolerated treatment to reduce the skin signs of aging. The results are significantly superior to a routine anti-aging cream alone.(Funded by Laboratories FILLMED; ID-RCB number: 2018-A03167-48; clinicaltrials.gov number: NCT05609617).
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Affiliation(s)
| | | | | | - Sylvie Boisnic
- GREDECO (Groupe de Recherche et d'Etude en Dermatology et Cosmetologie), Paris, France
| | - Pierre Andre
- Paris Université Laser Skin Clinic, Rue de l'Université, Paris, France
| | - Isabelle Catoni
- Private Practice, 109 bis avenue Charles de Gaulle, Neuilly-Sur-Seine, France
| | | | | | - Maryna Taieb
- Private Practice, 1 avenue d'Eylau, Paris, France
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Liu S, Cong L, Pongprutthipan M, Lee W, Luo X, Han X, Li D, Moon HJ, Wang H. Use of LetibotulinumtoxinA for Aesthetic Treatment of Asians: A Consensus. Aesthet Surg J 2023; 43:NP962-NP974. [PMID: 37220644 PMCID: PMC10575620 DOI: 10.1093/asj/sjad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 05/25/2023] Open
Abstract
Treatment of wrinkles and dynamic lines with botulinum toxin has been a routine practice for years in aesthetic clinical settings. The effective treatment of wrinkles requires a comprehensive understanding of facial expression muscles and their interactions, the mechanism of action of botulinum toxin, and individual patient preferences. The dose adjustment practice and injection technique of physicians are affected by cultural differences; most Asian patients prefer natural-looking results. This article aims to present an expert consensus on the injection sites, doses, and levels of botulinum toxin for various indications in Asians, with the hope of providing guidance to some clinicians. This consensus paper reviews LetibotulinumtoxinA for patient evaluation, dosage, and delivery techniques in Asians from the time LetibotulinumtoxinA was approved up to December 2022. Panelists proposed individualized treatment plans for botulinum toxin type A (BTxA) treatments in 3 areas-wrinkle removal, contour adjustment, and face lifting-for Asians based on their extensive experience and knowledge of facial anatomy. When using a different BTxA, clinicians should start with a conservative dose and carefully individualize the treatment for each patient, and adjust it according to feedback to obtain a higher satisfaction level. LEVEL OF EVIDENCE: 5
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Affiliation(s)
| | | | | | | | | | | | | | | | - Hang Wang
- Corresponding Author: Dr Hang Wang, Sichuan University, West China Coll Stomatol, Dept Oral & Maxillofacial Surg, Chengdu 610041, Peoples R China. E-mail: ; Twitter and Instagram: @plasticsurgeonhang
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10
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Kestemont P, Fanian F, Garcia P, Grand-Vincent A, Benadiba L, Delmar H, Bodokh I, Brun P, Braccini F, Desouches C, Paris J, Nadra K, Salomon C, Trevidic P. Long-term efficacy and safety of a hyaluronic acid dermal filler based on Tri-Hyal technology on restoration of midface volume. J Cosmet Dermatol 2023; 22:2448-2456. [PMID: 37128822 DOI: 10.1111/jocd.15752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Art Filler Volume (AFV) is a hyaluronic acid (HA)-based filler formulated with "Tri-Hyal" technology, a unique combination of three sizes of HA chains. This study assessed AFV efficacy and safety over 18 months when used to restore midface volume. METHODS During this open-label study, a maximum of 1.8 mL AFV was injected into each cheek area on Day 0 (D0). Subjects were evaluated at D21, when, if necessary, a retouch could be performed (maximum 1.2 mL per cheek). Subjects were evaluated at seven follow-up visits through to D540. The primary assessment was based on the evolution of the Medicis Midface Volume Scale (MMVS) grade on D21. Secondary outcomes were local and general adverse events, investigator- and subject-assessed Global Aesthetic Improvement Scale scores and changes in self-esteem. RESULTS Of the 79 healthy Caucasians enrolled (mean age 54.8 years), 25 required a second injection. In the intention-to-treat population, mean overall MMVS scores improved significantly from D0 (3.2 ± 0.4) to D21 (1.8 ± 0.6) and D42 (1.7 ± 0.6) (all p < 0.0001). MMVS scores for each cheek also improved significantly, irrespective of retouch on D21: 22% of injections showed a persistent benefit at D540 without retouch. The most common adverse events were pain on palpation (19%), erythema (15%) and edema (13%); most were mild or moderate and resolved within 2 weeks. CONCLUSION AFV produces a sustained objective and subjective midface volume restoration in female and male subjects, often without retouching, and was well tolerated.
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Affiliation(s)
- Philippe Kestemont
- MEDITI Center, 90 Boulevard Francis Meiland, 06160, Juan-les-pins, France
| | - Ferial Fanian
- Laboratoires FILLMED, 2-4 Rue de Lisbonne, 75008, Paris, France
| | | | | | | | - Henry Delmar
- MEDITI Center, 90 Boulevard Francis Meiland, 06160, Juan-les-pins, France
| | - Isaac Bodokh
- Private Dermatology Practice, 109 Rue d'Antibes, 06400, Cannes, France
| | - Patrick Brun
- Private Dermatology Practice, 109 Rue d'Antibes, 06400, Cannes, France
| | - Frédéric Braccini
- Private Aesthetic Surgery Practice, 27 Boulevard Dubouchage, 06000, Nice, France
| | - Christophe Desouches
- Private Plastic Surgery Practice, 5 Boulevard Notre Dame, 13006, Marseille, France
| | - Jérôme Paris
- Institut Euro-méditerranéen de Médecine et Chirurgie Esthétique, 13, rue Roux de Brignoles, 13006, Marseille, France
| | - Karim Nadra
- Laboratoires FILLMED, 2-4 Rue de Lisbonne, 75008, Paris, France
| | - Catherine Salomon
- General Practitioner, ACMS, 55 Rue Rouget de Lisle, 92158, Suresnes, cedex, France
| | - Patrick Trevidic
- Private Plastic Surgery Practice, 7 Rue de Sontay, 75116, Paris, France
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Abstract
Dermal filler and botulinum toxin injections are among the most performed non-invasive procedures for rejuvenation and contouring, internationally. Although most dermal fillers and approved botulinum toxins are well tolerated with a high safety profile, adverse events and/or complications can happen. Injection-related sequelae and side effects are usually rare, mild, transient, and self-limiting in nature. However, devastating and life-changing complications, such as intravascular occlusion, skin necrosis, permanent visual impairment, and stroke, have been reported. Risk reduction measures include an in-depth knowledge of anatomy, physiology, and pharmacology, correct patient selection, correct identification of clinical indications, and, fundamentally, the importance of appropriate skill and training. In this paper, some of the complications are discussed and advice on how to minimise adverse events and complications from these injectables is provided.
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Affiliation(s)
- Souphiyeh Samizadeh
- Souphiyeh Samizadeh BDS, BSc, MJDF RCS (Eng.), PGCert (Clinical Education), MSc (Aesthetic Medicine), FHEA Visiting Clinical Teacher, King's College London, London, UK; Honorary Clinical Lecturer, University College London, London, UK; Founder and Director, Great British Academy of Aesthetic Medicine, London, UK
- Koenraad De Boulle MD Consultant Dermatologist and Director Aalst Dermatology Clinic, Aalst Belgium Associate Professor, University College London, London, UK
| | - Koenraad De Boulle
- Souphiyeh Samizadeh BDS, BSc, MJDF RCS (Eng.), PGCert (Clinical Education), MSc (Aesthetic Medicine), FHEA Visiting Clinical Teacher, King's College London, London, UK; Honorary Clinical Lecturer, University College London, London, UK; Founder and Director, Great British Academy of Aesthetic Medicine, London, UK
- Koenraad De Boulle MD Consultant Dermatologist and Director Aalst Dermatology Clinic, Aalst Belgium Associate Professor, University College London, London, UK
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12
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Etrusco A, Geru M, Laganà AS, Chiantera V, Giannini A, Buzzaccarini G. Use of botulinum toxin in aesthetic medicine and gynaecology: current approaches, controversies, and future directions. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2023; 22:155-160. [PMID: 37829261 PMCID: PMC10566329 DOI: 10.5114/pm.2023.131457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/06/2023] [Indexed: 10/14/2023]
Abstract
This review looks at the use of botulinum toxin in the gynaecological field with the aim of determining what needs to be further investigated to achieve a standardized application. Numerous studies have been conducted to explore how botulinum toxins (BoNT) can be applied, and it is becoming popular for treating various disorders such as chronic pelvic pain, vestibulodynia, and vaginism. However, the exact dosage and ideal location for injections still need to be clarified. The objective of this study is to point out which aspects need to be more carefully studied to ensure a consistent use of BoNT in gynaecology.
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Affiliation(s)
- Andrea Etrusco
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Maurina Geru
- Department of Women’s and Children’s Health, Gynaecology and Obstetrics Clinic, University of Padua, Padua, Italy
| | - Antonio Simone Laganà
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynaecological Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, Rome, Italy
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Guo J, Fang W, Wang F. Injectable fillers: current status, physicochemical properties, function mechanism, and perspectives. RSC Adv 2023; 13:23841-23858. [PMID: 37577103 PMCID: PMC10413051 DOI: 10.1039/d3ra04321e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
With the increasing understanding of the aging process and growing desire for minimally invasive treatments, injectable fillers have great potential for correcting and rejuvenating facial wrinkles/folds and contouring the face. However, considering the increasing availability of multiple soft tissue fillers, it is important to understand their inherent biophysical features and specific mechanism. Thus, in this review, we aim to provide an update on the current injectable filler products and analyze and compare their critical physicochemical properties and function mechanisms for volume-filling. Additionally, future trends and development processes for injectable fillers are also proposed.
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Affiliation(s)
- Jiahong Guo
- Yunnan Botanee Bio-technology Group Co., Ltd. Yunnan 650106 China
- Shanghai Jiyan Bio-pharmaceutical Co., Ltd. Shanghai 201702 China
| | - Wei Fang
- Yunnan Yunke Characteristic Plant Extraction Laboratory Co., Ltd. Yunnan 650106 China
- Medaesthee (Shanghai) Biotechnology Co., Ltd. Shanghai. 201700 China
| | - Feifei Wang
- Yunnan Botanee Bio-technology Group Co., Ltd. Yunnan 650106 China
- Shanghai Jiyan Bio-pharmaceutical Co., Ltd. Shanghai 201702 China
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Loyo M, Kontis T. Creating Ideal Lips with Toxins and Fillers. Clin Plast Surg 2023; 50:455-464. [PMID: 37169411 DOI: 10.1016/j.cps.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Myriam Loyo
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology & Head and Neck Surgery, Oregon Health & Sciences University, CH5E, 3303 SW Bond Avenue, Portland, OR 97239, USA.
| | - Theda Kontis
- Department of Otolaryngology-Head and Neck Surgery, Department of Plastic and Reconstructive Surgery, Johns Hopkins, 1838 Greene Tree Road, Suite 370, Baltimore, MD 21208, USA
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15
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Cristel RT, Branham GH. Evidence-Based Medicine for Lower Facial Rejuvenation. Facial Plast Surg 2023; 39:292-299. [PMID: 37011895 DOI: 10.1055/s-0043-1766102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Lower facial rejuvenation is an expanding area in facial plastic surgery with both surgical and nonsurgical treatment options. Evidence-based medicine is essential to providing high-quality care and creating long-lasting results. A systematic approach and understanding of the layers of the aging lower face is important to develop an individualized treatment plan. This review will focus on surgical and nonsurgical treatments for the aging lower face with an emphasis on evidence-based medicine.
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Affiliation(s)
- Robert T Cristel
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory H Branham
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
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de Queiroz Hernandez PM, Cotrin P, Valarelli FP, de Oliveira RCG, Bispo CGC, Freitas KMS, Oliveira RC, Cotrin DP. Evaluation of the attractiveness of lips with different volumes after filling with hyaluronic acid. Sci Rep 2023; 13:4589. [PMID: 36944639 PMCID: PMC10030776 DOI: 10.1038/s41598-023-31332-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
To compare the attractiveness of lips with different volumes after filling in the view of laypersons, dentists, and specialists. The sample comprised close-up frontal and lateral photographs of the lips of 16 women who underwent lip filling procedure with hyaluronic acid and was divided into 2 groups. Group 1: eight women with thinner lips at pretreatment. Group 2: eight female patients with thicker lips at pretreatment. Photographs from before and 10 days after lip filling were used to assess attractiveness randomly displayed in a Google Forms questionnaire and then sent via a messaging app to the evaluators. The evaluators' groups were general dentists, dentists with degrees in facial aesthetics, and laypersons. The attractiveness was evaluated with scores from 0 to 10 (0: least attractive and 10 the greatest). T-tests were used for the statistical comparisons. The group with thinner lips showed significantly improved attractiveness after filling. The group with thicker lips showed a worsening attractiveness after filling. The group with thicker lips had significantly higher attractiveness scores than those with thinner lips. There was no significant difference in the preference between men and women. The group of laypersons was more rigorous, giving significantly lower lip attractiveness scores. Thinner lips showed a significant improvement in attractiveness after filling. Thicker lips showed a worsening of the attractiveness score after filling. Before and after filling, thicker lips had significantly higher attractiveness scores than thinner lips.Clinical relevance: The amount of fillers applied to each patient must be individually evaluated.
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Affiliation(s)
| | - Paula Cotrin
- Dental School, Inga University Center, Rod. PR 317, 6114 Industrial Park 200, Maringá, State of Paraná, 87035-510, Brazil
| | - Fabricio Pinelli Valarelli
- Dental School, Inga University Center, Rod. PR 317, 6114 Industrial Park 200, Maringá, State of Paraná, 87035-510, Brazil
| | | | - Carina Gisele Costa Bispo
- Dental School, UEM, Maringá State University, Colombo Av., 5790, Zone 7, Maringá, State of Paraná, 87020-900, Brazil
| | - Karina Maria Salvatore Freitas
- Dental School, Inga University Center, Rod. PR 317, 6114 Industrial Park 200, Maringá, State of Paraná, 87035-510, Brazil
| | - Renata Cristina Oliveira
- Dental School, Inga University Center, Rod. PR 317, 6114 Industrial Park 200, Maringá, State of Paraná, 87035-510, Brazil
| | - Dra Paula Cotrin
- Dental School, Inga University Center, Rod. PR 317, 6114 Industrial Park 200, Maringá, State of Paraná, 87035-510, Brazil.
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17
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Clinical Anatomy of the Chin Evaluated by 3-Dimensional Tomography and Cadaveric Dissection: Implications for Safety and Optimal Injection Techniques in Chinese. Dermatol Surg 2023; 49:237-241. [PMID: 36728222 DOI: 10.1097/dss.0000000000003684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Soft tissue fillers have been widely used for the correction of chin volume loss because of congenital conditions and aging. OBJECTIVE This study aimed to discuss anatomical concerns for chin filler injections, which may help to reduce the incidence of severe intravascular embolization complications and improve patient satisfaction. METHODS AND MATERIALS We scanned 40 cadaveric heads with a contrast agent using a 64-row spiral computed tomography scanner. The scan was visualized by a Philips IntelliSpace workstation and analyzed by Materialise's interactive m image control system software to measure and quantify the arterial data. Twenty of 40 cadavers were dissected to define the layers of tissue. RESULTS In total, 221 arteries passed through the sagittal plane of 40 specimens. The number of superficial arteries (163 of 221) was much greater than the number of deep arteries (58 of 221). The number of arteries gradually decreased with distance from the lower lip vermilion border plane, which formed the lower third of the face. CONCLUSION This study introduces a safe and effective technique for administering chin filler injections that minimizes risks and improves patient satisfaction.
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18
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Hong SO. Cosmetic Treatment Using Botulinum Toxin in the Oral and Maxillofacial Area: A Narrative Review of Esthetic Techniques. Toxins (Basel) 2023; 15:toxins15020082. [PMID: 36828397 PMCID: PMC9964918 DOI: 10.3390/toxins15020082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
Botulinum toxin (BoNT) is an anaerobic rod-shaped-neurotoxin produced by Clostridium botulinum, that has both therapeutic and lethal applications. BoNT injection is the most popular cosmetic procedure worldwide with various applications. Patients with dynamic wrinkles in areas such as the glabella, forehead, peri-orbital lines, nasal rhytides, and perioral rhytides are indicated. Excessive contraction of muscles or hyperactivity of specific muscles such as bulky masseters, cobble stone chins, gummy smiles, asymmetric smiles, and depressed mouth corners can achieve esthetic results by targeting the precise muscles. Patients with hypertrophic submandibular glands and parotid glands can also benefit esthetically. There are several FDA-approved BoNTs (obabotuli-numtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, letibotulinumtoxinA, prabotulinumtox-inA, daxibotulinumtoxinA, rimbotulinumtoxinB) and novel BoNTs on the market. This paper is a narrative review of the consensus statements of expert practitioners and various literature on the injection points and techniques, highlighting both the Asian and Caucasian population separately. This paper can serve as a practical illustrative guide and reference for optimal, safe injection areas and effective doses for application of BoNT in the face and oral and maxillofacial area. The history of BoNT indications, contraindications, and complications, and the merits of ultrasonography (US)-assisted injections are also discussed.
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Affiliation(s)
- Sung Ok Hong
- Department of Oral and Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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Intrauterine botulinum toxin A administration promotes endometrial regeneration mediated by IGFBP3-dependent OPN proteolytic cleavage in thin endometrium. Cell Mol Life Sci 2023; 80:26. [PMID: 36602651 PMCID: PMC9816300 DOI: 10.1007/s00018-022-04684-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/13/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023]
Abstract
Adequate endometrial growth is a critical factor for successful embryo implantation and pregnancy maintenance. We previously reported the efficacy of intrauterine administration of botulinum toxin A (BoTA) in improving the endometrial angiogenesis and the rates of embryo implantation. Here, we further evaluated its potent therapeutic effects on the uterine structural and functional repair and elucidated underlying molecular regulatory mechanisms. This study demonstrated that a murine model of thin endometrium was successfully established by displaying dramatically decreased endometrial thickness and the rates of embryo implantation compared to normal endometrium. Interestingly, the expressions of insulin-like growth factor binding protein-3 (IGFBP3) and an active 35 kDa-form of osteopontin (OPN) were significantly reduced in thin endometrium, which were almost fully restored by intrauterine BoTA administration. Neutralization of BoTA-induced IGFBP3 subsequently suppressed proteolytic cleavage of OPN, exhibiting un-recovered endometrial thickness even in the presence of BoTA administration, suggesting that BoTA-induced endometrial regeneration might be mediated by IGFBP3-dependent OPN proteolytic cleavage. Our findings suggest that intrauterine BoTA administration improves the endometrial environment in our murine model with thin endometrium by increasing endometrial receptivity and angiogenesis in a manner dependent on the regulatory effect of IGFBP3 on OPN proteolytic cleavage, proposing BoTA as an efficient therapeutic strategy for the patients with thin endometrium.
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Wang X, Wu Y, Li B, Mu X, Li L. Lifting the midface using a hyaluronic acid filler with lidocaine: A randomized multi-center study in a Chinese population. J Cosmet Dermatol 2022; 21:6710-6716. [PMID: 35925834 DOI: 10.1111/jocd.15286] [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: 04/06/2021] [Revised: 05/20/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Soft-tissue augmentation of the midface is increasingly requested by patients, and hyaluronic acid (HA) fillers are frequently used in treatment. AIMS To evaluate the efficacy and safety of treatment of midface volume/contour deficit with a firm HA filler including lidocaine (HARL ). PATIENTS/METHODS This was a 12-month, randomized, evaluator-blinded, controlled study. Chinese adults with mild to substantial volume loss were randomly assigned in a 3:1 ratio to treatment or untreated control groups. RESULTS A total of 148 subjects were enrolled. The primary objective was met; results of the midface volume scale (MMVS) rated by a blinded evaluator were in favor of HARL at Month 6 (p < 0.0001 vs. the untreated control group). Similar to the MMVS improvement, improved midface fullness and aesthetic appearance was observed based on the Global Aesthetic Improvement Scale (GAIS) up to 12 months by both treating investigators and subjects (at least 96% at Week 4 and 65% at Month 12). Subject satisfaction was high, and the majority of subjects considered the results to look natural (>97%). The study product was well tolerated. CONCLUSIONS Midfacial treatment using HARL was effective, well tolerated, and led to high levels of satisfaction in a Chinese population for up to 12 months. CLINICALTRIALS GOV IDENTIFIER NCT03097783.
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Affiliation(s)
- Xiaojun Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Yan Wu
- Peking University First Hospital, Beijing, China
| | - Bi Li
- Peking University Third Hospital, Beijing, China
| | | | - Li Li
- West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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21
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Munhoz G, Cavallieri FA, de Almeida Balassiano LK, Tembra MF, Cunha JMT, Silveira ACO, Moreira MVR, Ramos-E-Silva M. Sterile abscess due to hyaluronic acid: A new diagnosis and a proposal for treatment-A series of eight cases. J Cosmet Dermatol 2022; 21:5562-5568. [PMID: 35638403 DOI: 10.1111/jocd.15135] [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: 01/28/2022] [Revised: 05/07/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND In recent years, fillers procedures with hyaluronic acid (HA) have grown significantly. Despite HA relative safety, the number of cases of complications after injections has grown, and in many of which, we are not aware of or have little control over. AIMS In this article, the authors describe a new adverse reaction after filling with HA injection, the sterile abscess. PATIENTS/METHODS We present eight patients with similar clinical, laboratory, and ultrasound characteristics for sterile abscess and report a new therapeutic modality for it. RESULTS All cases were treated with "Munhoz-Cavallieri Lavage Protocol" procedure with complete resolution. CONCLUSIONS "Munhoz-Cavallieri Lavage Protocol" serves as a guideline in diagnosis and management of sterile abscess.
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Affiliation(s)
- Gabriela Munhoz
- Clínica Gabriela Munhoz, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Aquino Cavallieri
- Cavallieri Clinic, Member of Brazilian College of Radiology and Diagnostic Imaging and of the National Commission of Ultrasound - Brazilian College of Radiology and Diagnostic Imaging Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maria Fernanda Tembra
- Clínica Maria Fernanda Tembra, University Hospital and School of Medicine, Federal University of Rio de Janeiro, São Paulo, Brazil
| | - José Marcos T Cunha
- University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcos Vinicius Rust Moreira
- German Society of Infectology, Internal Medicine, Department of Antibiotic Stewardship Vivantes Hospitals, Berlin, Germany
| | - Marcia Ramos-E-Silva
- Centro Dermatológico Marcia Ramos-e-Silva, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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22
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Solish N, Burgess CM, Weinkle SH, Ablon G, Brown J, Kooken K, Rubio RG. Efficacy and Safety of DaxibotulinumtoxinA for Injection in the Treatment of Glabellar Lines by Age and Race: Subgroup Analysis of the SAKURA Clinical Trials. Aesthet Surg J 2022; 43:205-214. [PMID: 36087303 PMCID: PMC9896135 DOI: 10.1093/asj/sjac246] [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: 04/06/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND DaxibotulinumtoxinA for Injection (DAXI) is a novel botulinum toxin type A formulation approved for the treatment of glabellar lines. The efficacy, safety, and extended duration of response of DAXI 40 U for glabellar lines were demonstrated in 2 Phase 3, randomized, double-blind studies (SAKURA 1 and 2) and a Phase 3 open-label trial (SAKURA 3). OBJECTIVES The aim of this study was to evaluate the efficacy and safety of the first DAXI 40 U treatment received in SAKURA 1, 2, or 3 across age and race subgroups. METHODS Adults with moderate-to-severe glabellar lines (Investigator Global Assessment-Frown Wrinkle Severity [IGA-FWS] and Patient FWS [PFWS] scales) were evaluated for glabellar line severity for ≤36 weeks after the first DAXI treatment. Efficacy and safety were analyzed by age (18-45, >45-55, and >55 years) and race (Asian, Black and African American, and White). RESULTS Overall, 2785 patients were included in the efficacy analysis. The proportion of patients achieving none or mild glabellar line severity at maximum frown (IGA-FWS) after DAXI treatment was high in all age and race subgroups (>96% at Week 4). Glabellar line severity of none or mild by composite IGA-FWS and PFWS rating was maintained for a median of 24.0 weeks in all age subgroups, and for 27.0, 25.3, and 24.0 weeks in the Asian, Black and African American, and White subgroups, respectively. Treatment-emergent adverse events were similar across all subgroups. CONCLUSIONS Consistent with the overall study population, DAXI 40 U demonstrated a high response rate and duration of effect of ≥24 weeks across all age and race subgroups.
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Affiliation(s)
- Nowell Solish
- Corresponding Author: Dr Nowell Solish, Division of Dermatology, University of Toronto, ON M5S 3H2, Canada E-mail:
| | - Cheryl M Burgess
- Center for Dermatology and Dermatologic Surgery, Washington, DC, USA
| | | | - Glynis Ablon
- University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Facial Rejuvenation in Patients of Color. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Creating Ideal Lips with Toxins and Fillers. Facial Plast Surg Clin North Am 2022; 30:365-374. [DOI: 10.1016/j.fsc.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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25
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Noormohammadpour P, Ehsani A, Mahmoudi H, Razavi Z, Balighi K, Azar PM, Firuz A, Jabbari A. Botulinum toxin injection as a single or combined treatment with non-cross-linked high molecular weight and low molecular weight HA gel for neck rejuvenation: A Randomized Clinical Trial. Dermatol Ther 2022; 35:e15673. [PMID: 35775872 DOI: 10.1111/dth.15673] [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: 04/24/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The unpleasant appearance of the neck through the aging process could burden the psychosocial quality of life, therefore various treatment modalities have been used to rejuvenate the neck. The present study aimed to evaluate the efficacy of botulinum toxin injection as a single or combined treatment with Profhilo gel for neck rejuvenation. METHODS Patients with a request for neck rejuvenation meeting the inclusion criteria were randomly divided into two groups. Initial clinical scoring based on Wrinkle Severity Rating Scale (WSRS) and skin biomechanical parameters using a Multi Adaptor System (MPA) were performed before starting the treatment. Dysport Botox was injected for all of the participants, moreover, in one of the groups (intervention), Profhilo gel was injected after two weeks and a follow-up visit was performed for both groups 3 months later. Patients were evaluated according to the GAIS (global aesthetic improvement scale) by two blind dermatologists and skin biophysical parameters were measured by MPA such as TEWL, hydration, thickness, density, visco-elasticity, net elasticity, pliability/firmness. RESULTS In this study, 19 participants in the control (Dysport) and intervention (Dysport + PROFhilo gel) groups were evaluated. Before starting the treatment, the two groups were similar in terms of WSRS scores and biophysical skin parameters. Three months after the treatment, it was observed that Hydration (p <0.001) and Thickness of the skin (p = 0.028) in the intervention group were significantly higher than in the control group. Similarly, the GAIS scores of the intervention group showed significantly better results comparing to the control group (p <0.001). CONCLUSION Profhilo gel following Dysport Botox can be considered as a safe and more effective treatment of neck aging comparing to Dysport Botox injection alone in patients who are not a candidate for surgery due to any reason.
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Affiliation(s)
- Pedram Noormohammadpour
- Autoimmune Bullous Diseases Research Center. Tehran University of Medical Science, Tehran, Iran
| | | | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center. Tehran University of Medical Science, Tehran, Iran
| | - Zahra Razavi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center. Tehran University of Medical Science, Tehran, Iran
| | - Pedram Molhem Azar
- Autoimmune Bullous Diseases Research Center. Tehran University of Medical Science, Tehran, Iran
| | - Ali Firuz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences
| | - Asma Jabbari
- Autoimmune Bullous Diseases Research Center. Tehran University of Medical Science, Tehran, Iran
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Pereira IN, Hassan H. Botulinum toxin A in dentistry and orofacial surgery: an evidence-based review - part 2: cosmetic applications. Evid Based Dent 2022:10.1038/s41432-022-0277-4. [PMID: 35710887 DOI: 10.1038/s41432-022-0277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022]
Abstract
Objective An evidence-based review on the role of botulinum toxin type A (BoNTA) on diverse cosmetic applications of interest to dental practitioners and allied specialities. In this context, to identify the cosmetic treatments that have an evidence-based rationale against areas requiring further research, with a view to assess the safety and efficacy of BoNTA.Data source and selection A comprehensive search was conducted using Cochrane Library of Systematic Reviews, Cochrane Central Register of Controlled Trials, and PubMed (Medline) electronic databases. Thirty-nine studies of variable quality were included. The Best Evidence Topics (BETs) Critical Appraisal Tool was used to facilitate the quality assessment of relevant studies.Data extraction Based on current level II evidence, BoNTA was safe and effective to improve facial contour, reduce volume and thickness of bilateral hypertrophic masseter. Conservative doses using a combined approach of BoNTA and hyaluronic acid was recommended as a safe and effective treatment for perioral enhancement supported by level II evidence. There was limited evidence, not higher than level III, to support BoNTA effectiveness for gummy smile associated to perioral musculature hyperactivity, while jawline sculpting targeting the platysma muscle had lower level IV evidence up to this date.Conclusion BoNTA has been widely used off-label for the investigated cosmetic orofacial conditions, with reports of 'good patient and practitioner satisfaction'. However, there is limited high-quality evidence to support the long-term safety and effectiveness of repetitive BoNTA injections. Additionally, no studies were found that provided a cost-effectiveness evaluation of BoNTA formulations against other current cosmetic interventions. Well-designed clinical trials, including long-term follow-up, would help to provide robust evidence-based recommendations for clinical practice, supporting BoNTA popularity, independently or in a combined approach.
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Affiliation(s)
- Ines Novo Pereira
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK
| | - Haidar Hassan
- Academic Plastic Surgery, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AT, UK.
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27
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Invited Discussion on "Comparison of Effectiveness and Safety of a Botulinum Toxin Mono Therapy and a Combination Therapy with Hyaluronic Acid Filler for Improving Glabellar Frown". Aesthetic Plast Surg 2022; 46:1881-1883. [PMID: 35608681 DOI: 10.1007/s00266-022-02927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/01/2022]
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28
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Kaur I, Kandhari R, Gupta J, Al-Niaimi F. Microdroplet botulinum toxin: A review. J Cutan Aesthet Surg 2022; 15:101-107. [PMID: 35965899 PMCID: PMC9364467 DOI: 10.4103/jcas.jcas_162_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Microbotox is the administration of multiple microdroplets of botulinum toxin in intradermal plane. It is increasingly becoming popular owing to its more favorable outcome and better safety profile than the conventional technique. The intention is to treat fine lines and wrinkles without imparting an undesired “frozen face like” appearance. Besides facial rejuvenation, it has found its way into the management of other indications such as rosacea, hyperhidrosis, keloid, and seborrhea. Being a relatively newer method, knowledge about the various dilution methods, desired volume, and correct depth of injection involved in this technique remain scarce. In this article, the authors have highlighted various indications, procedures, adverse effects, and contraindications of microbotox.
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Moon H, Fundaro SP, Goh CL, Hau KC, Paz-Lao P, Salti G. A Review on the Combined Use of Soft Tissue Filler, Suspension Threads, and Botulinum Toxin for Facial Rejuvenation. J Cutan Aesthet Surg 2021; 14:147-155. [PMID: 34566355 PMCID: PMC8423215 DOI: 10.4103/jcas.jcas_119_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of combining different minimally invasive techniques is to achieve the most harmonious and most natural-looking facial rejuvenation as effectively and as safely as possible. Due to their safety and versatility, botulinum toxin and soft tissue fillers have become the most sought-after modalities for correcting the signs of facial aging. Recently, bioabsorbable threads used for repositioning ptotic facial tissue have been added into the picture. More practitioners are also combining threads with fillers and botulinum toxin to achieve longer-lasting and natural-looking results. Our aim is to provide guidance on basic anatomical landmarks and areas where botulinum toxin injections, subcutaneous filler injections, and bioabsorbable suspension threads are placed on the face. We would also like to share our best practices on the best combination, spacing the appropriate time intervals in between each procedure to allow for the shortest possible recovery time, as well as periprocedural advice for an integrated treatment approach.
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Affiliation(s)
- Hyoungjin Moon
- Moon's Aesthetic Surgery Clinic, B-2010 Acrovista 188 Seocho Joongang-Ro Seochogu, Seoul 06600, Korea
| | | | | | - Kwun Cheung Hau
- Perfect Skin Surgery Centre, 17/F, 6 Queen's Road Central, Central, Hong Kong
| | - Purita Paz-Lao
- Makati Medical Center, No. 2 Amorsolo Street, Legaspi Village, Makati City, Philippines
| | - Giovanni Salti
- Medlight Institue, Via Monteverdi 2, 50144 Florence, Italy
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30
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Lee W, Moon HJ, Kim JS, Yang EJ. Safe Glabellar Wrinkle Correction With Soft Tissue Filler Using Doppler Ultrasound. Aesthet Surg J 2021; 41:1081-1089. [PMID: 32644130 DOI: 10.1093/asj/sjaa197] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glabellar wrinkle corrections are usually performed by injecting botulinum toxin and hyaluronic acid fillers. The glabella is one of the most dangerous locations for filler injection because of possible visual complications. OBJECTIVES The aim of this study was to use Doppler ultrasound to determine the anatomic relation between glabellar wrinkles and the supratrochlear artery pathway, perform safe hyaluronic acid filler injection to correct glabellar wrinkles, and determine the efficacy of the procedure. METHODS From January 2019 to July 2019, 42 patients (74 glabellar wrinkle lines; 32 bilateral and 10 unilateral wrinkles) were evaluated. Glabellar wrinkle lines were corrected with hyaluronic acid filler. Doppler ultrasound was used to avoid the supratrochlear artery. RESULTS Among the 74 wrinkle lines, the supratrochlear arteries were located either at the glabellar wrinkle lines (30/74, 41%) or lateral to the glabellar wrinkle lines (44/74, 59%). In the latter 44 wrinkles, fillers were injected into the subdermal layer of the glabellar wrinkle lines. In the 30 wrinkles where supratrochlear artery was located at the glabellar wrinkle lines, the artery was located at the deep subcutaneous layer in 24 and at the subdermal layer in 6; thus, filler injection was not performed. CONCLUSIONS The supratrochlear artery may be located either at or lateral to the glabellar wrinkle lines. When performing glabellar wrinkle correction, Doppler ultrasound can be used to confirm the location of the supratrochlear artery before filler injection, which helps in avoiding vascular complications. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Eun-Jung Yang
- Department of Plastic and Reconstructive Surgery, Yonsei University, College of Medicine, Seoul, Korea
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Abstract
BACKGROUND In the evaluation of the facial aging, the midface certainly represents the part that undergoes the most modifications and in which the aging process is most evident. The filling and redefinition of this part are fundamental to modify the perception of the age of the face and create a global rejuvenation effect. In general, high G' fillers with a deep implant are used to treat the midface, taking advantage of the high lifting capacity and persistence of the implant in place. METHODS We report our experience in the treatment of 20 patients with a hyaluronic acid (HA) filler based on an innovative crosslinking technology (XTR™-eXcellent Tridimensional Reticulation) for midface treatment. GAIS (Global Aesthetic Improvement Scale) at 1 month and 3 months after treatment was evaluated as primary endpoint. Patient satisfaction with the overall appearance, repeatability of treatment, and also an instrumental evaluation of the improvement were performed. RESULTS Global Aesthetic Improvement Scale and patient satisfaction were very good 1 month and 3 months after treatment. The majority of patients said they would undergo treatment again. Clinical results were confirmed by instrumental evaluation. CONCLUSION The treatment of midface with this innovative HA high G' filler is really effective in restoration of the volumes and in reshaping the curves of zygomatic area.
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Affiliation(s)
- Gabriele F Muti
- Segretario Nazionale AICPE (Associazione Italiana di Chirurgia Plastica Estetica), Milan, Italy
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Adverse Events Associated With Botox as Reported in a Food and Drug Administration Database. Aesthetic Plast Surg 2021; 45:1201-1209. [PMID: 33128076 DOI: 10.1007/s00266-020-02027-z] [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: 07/13/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Botulinum toxin treatment is the most frequently performed noninvasive cosmetic procedure performed in the USA. Because of its widespread use, an analysis of the adverse event (AE) profile of Botox injections is needed. METHODS The FDA Adverse Event Report System was queried using an online web-based tool to determine the top 15 adverse events reported for four Botox brand names: Botox/Botox Cosmetic, Dysport, and Xeomin. The proportional reporting ratios (PRR) and relative odds ratios (ROR) were determined. A literature review was performed for eight AEs of clinical significance: eyelid/eyebrow ptosis, asthenia, muscular weakness, facial paresis, dysphagia, botulism, and death. RESULTS Botox/Botox Cosmetic had 38367 AEs. Dysport had 3582 AEs. Xeomin had 1405 AEs. All drugs with reported cases of eyelid and eyebrow ptosis had significant PRR and ROR values. The PRR and ROR values for asthenia were not significant in any of the drugs and only reached significance for Dysport for muscular weakness and dysphagia. Both Botox/Botox Cosmetic and Dysport had elevated PRRs and RORs for facial paresis and botulism. While all drugs had at least one reported case of death related to Botox injection use, none of the PRR or ROR values were significant. CONCLUSION Known AEs for Botox injection use include eyelid/brow ptosis and muscular weakness. Feared but rare complications of Botox injection use include dysphagia, botulism, and possibly death, owing to systemic spread of the toxin. This is the first study to analyze the AE data reported to the FDA on Botox injection use. EBM LEVEL III.
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Observation and Potential Mechanisms of Mentalis Myomodulation by Hyaluronic Acid Filler in the Treatment of Microgenia. Plast Reconstr Surg 2021; 147:1085e-1087e. [PMID: 34019525 DOI: 10.1097/prs.0000000000007972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[Skin quality and ways to improve skin quality]. Hautarzt 2021; 72:375-383. [PMID: 33834271 DOI: 10.1007/s00105-021-04797-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Skin quality has a significant impact on the perception of attractiveness. Procedures to improve skin quality, whose quality is assured, should have sufficiently documented scientific evidence of in vivo and in vitro efficacy and significant effects proven in studies. OBJECTIVES This paper will present findings from recent studies and experience of experts on skin quality and treatments to improve skin quality. MATERIALS AND METHODS A PubMed database search was conducted in February 2021 on the terms skin quality and minimally invasive skin quality improvement procedures. Two reviewers independently screened the titles, resulting in the selection of 30 papers. RESULTS Hyaluronic acid (HA) is the most commonly studied agent for skin rejuvenation treatments. The efficacy and safety of the superficially injected HA products are excellently proven on the basis of current data. According to these findings, they ensure an improvement of skin quality without significant volume changes. The skin is hydrated, its elasticity increased, the skin surface smoothened, the complexion (skin redness, glow) improved and fine lines and wrinkles are reduced. They are injected intradermally and have a clinically proven effect duration of up to 12 months. CONCLUSIONS Hyaluronic acid is outstandingly suitable for deep hydration of the skin, and its effect is long-term and safe. Natural treatment results fulfil the needs of the patients and increase the patient-practitioner relation. Superficially injected HA products are currently the criterion standard to increase skin quality.
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Non-invasive Intrauterine Administration of Botulinum Toxin A Enhances Endometrial Angiogenesis and Improves the Rates of Embryo Implantation. Reprod Sci 2021; 28:1671-1687. [PMID: 33650094 PMCID: PMC8144131 DOI: 10.1007/s43032-021-00496-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/08/2021] [Indexed: 10/26/2022]
Abstract
Endometrial angiogenesis plays crucial roles in determining the endometrial receptivity. Defects in endometrial receptivity often cause repeated implantation failure, which is one of the major unmet needs for infertility and contributes a major barrier to the assisted reproductive technology. Despite the numerous extensive research work, there are currently no effective evidence-based treatments to prevent or cure this condition. As a non-invasive treatment strategy, botulinum toxin A (BoTA) was administered into one side of mouse uterine horns, and saline was infused into the other side of horns for the control. Impact of BoTA was assessed in the endometrium at 3 or 8 days after infusion. We demonstrated that BoTA administration enhances the capacity of endothelial cell tube formation and sprouting. The intrauterine BoTA administration significantly induced endometrial angiogenesis displaying increased numbers of vessel formation and expression levels of related marker genes. Moreover, BoTA intrauterine application promoted the endometrial receptivity, and the rates of embryo implantation were improved with BoTA treatment with no morphologically retarded embryos. Intrauterine BoTA treatment has a beneficial effect on vascular reconstruction of functional endometrium prior to embryo implantation by increasing endometrial blood flow near the uterine cavity suggesting BoTA treatment as a potential therapeutic strategy for patients who are suffering from repeated implantation failure with the problems with endometrial receptivity.
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Botulinum Toxin Type A to Improve Facial Symmetry in Facial Palsy: A Practical Guideline and Clinical Experience. Toxins (Basel) 2021; 13:toxins13020159. [PMID: 33670477 PMCID: PMC7923088 DOI: 10.3390/toxins13020159] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Unilateral peripheral facial nerve palsy jeopardizes quality of life, rendering psychological consequences such as low self-esteem, social isolation, anxiety, and depression. Among therapeutical approaches, use of Botulinum toxin type A (BoNT-A) on the nonparalyzed side has shown promising results and improvement of quality of life. Nevertheless, the correct technique is paramount, since over-injection of the muscles can result in lack of function, leading to a "paralyzed" appearance, and even worse, functional incompetence, which may cause greater distress to patients. Therefore, the objective of this article is to provide a practical guideline for botulinum toxin use in facial palsy. To this aim, adequate patient assessment, BoNT-A choice, injection plan and dosage, and injection techniques are covered.
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Abstract
BACKGROUND Injectable fillers have become an integral part of facial rejuvenation, but vascular occlusion is a dreaded complication of such injections. OBJECTIVE To determine the force required by the fingertip onto the plunger of the syringe to cause retrograde migration. METHODS In this cadaver study, twelve 2-cm arterial segments and 4 fillers were tested. Injection pressure required to force a column of filler for 1 cm was measured. Five oculoplastics specialists were subsequently recruited and asked to inject the filler at a typical injection pressure. RESULTS The nonhyaluronic acid filler required significantly more pressure to cause propagation of the material compared with all other fillers (p < .01). None of the other fillers differed significantly from each other. Typical injection pressures generated by experienced injectors were significantly lower than that required to cause propagation of filler at the desired velocity and significantly lower than mean arterial pressure. Measured pressure required to cause filler propagation was well within the normal range of the finger strength that can be generated by humans. CONCLUSION Typical injection pressures from fingertip to plunger are lower than required to cause propagation of filler intravascularly.
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Bravo BSF, Carvalho RDM, Gallo BF, Bravo LG. A Retrospective Study Supporting the Importance of Individualizing the Dose of Botulinum Toxin According to the Age. J Cutan Aesthet Surg 2021; 14:88-92. [PMID: 34084014 PMCID: PMC8149977 DOI: 10.4103/jcas.jcas_20_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Botulinum toxin type A injection remains the leading nonsurgical cosmetic procedure worldwide with a high rate of efficacy and patient satisfaction. OBJECTIVE This study aims to demonstrate the importance of individualization of botulinum toxin doses to treat the upper face according to the age of the patients, considering the muscles particularities and the specificities of each face area. MATERIALS AND METHODS A retrospective study with 389 female patients treated with botulinum toxin type A in the upper third of the face (forehead, glabellar, and periorbital lines). Statistical analysis of the data was performed. RESULTS The mean age was 47.49 years old and the median total dose of botulinum toxin type A was 53.76 units, whereas the median dose in the glabella was 26.28 U, the mean forehead dose was 12.23 U, and in the periorbital area was 14.79 U, adding both sides. It is possible to observe that the doses are negatively correlated with age, except in the periorbital area, where an increase in the dose was observed. CONCLUSION It is important to highlight that although there is consensus on pre-established dose suggestions, the treatment should be individualized, respecting the individual characteristics of each patient.
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Maximizing Panfacial Aesthetic Outcomes: Findings and Recommendations From the HARMONY Study. Dermatol Surg 2020; 46:810-817. [PMID: 31834076 DOI: 10.1097/dss.0000000000002271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aesthetic medicine has evolved from targeting individual treatment areas to a global approach of panfacial rejuvenation. HARMONY was the first clinical study to systematically demonstrate positive physical and psychosocial impacts of panfacial treatment. OBJECTIVE Provide evidence-based guidance on treatment strategies to help maximize outcomes in patients seeking panfacial rejuvenation. MATERIALS AND METHODS Study sites with the lowest (n = 2) and highest (n = 2) improvements based on FACE-Q Satisfaction with Face Overall scores were analyzed to understand differences in treatment strategy that may contribute to incrementally greater patient satisfaction. RESULTS The highest scoring sites exhibited greater improvement in all patient-reported outcomes and investigator-assessed measures related to dermal filler treatment compared with the lowest scoring sites. The highest sites favored lateral malar augmentation and used less volume medially versus the lowest sites. In the lower face, the highest sites used greater volumes and more HYC-24L than HYC-24L+. Initial treatment volumes were more conservative at highest than lowest sites; greater volumes were used by highest sites in touch-up treatments. CONCLUSION Product usage trends common to the highest scoring sites (including injection volume, injection sites, and product selection) may provide guidance on best practices for a panfacial approach to aesthetic treatment to maximize patient satisfaction.
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Cotofana S, Alfertshofer M, Schenck TL, Bertucci V, Beleznay K, Ascher B, Lachmann N, Green JB, Swift A, Frank K. Anatomy of the Superior and Inferior Labial Arteries Revised: An Ultrasound Investigation and Implication for Lip Volumization. Aesthet Surg J 2020; 40:1327-1335. [PMID: 32469050 DOI: 10.1093/asj/sjaa137] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lips are considered a key element of facial attractiveness due to their central position in the face and their elemental role in verbal and nonverbal communication. OBJECTIVES The authors sought to provide clinically relevant information on the 3-dimensional pathway of the superior and inferior labial arteries within the lips to increase safety during labial soft tissue filler injections. METHODS The study enrolled 41 healthy volunteers with a mean age of 26.17 ± 9.6 years and a mean body mass index of 23.09 ± 2.3 kg/m2. Ultrasound imaging was performed at 6 different locations. The position of the labial arteries within the lips, depth of the arteries, cranio-caudal location of each artery in relation to the vermilion border, and diameter of the superior/inferior labial arteries were recorded. RESULTS The most frequent location of both the superior and inferior labial arteries was the submucosal plane (58.5%) followed by intramuscular (36.2%) and subcutaneous (5.3%) planes. The depth of the superior labial artery in the upper lip was 5.6 ± 0.13 mm, whereas the depth of the inferior labial artery in the lower lip was 5.2 ± 0.14 mm. Both arteries were more frequently located within the red lip: upper lip (83% vs 18.7%) and lower lip (86.2% vs 13.8%). In the midline, the artery coursed within the red lip in all investigated volunteers. CONCLUSIONS Clinically, results of this study favor a superficial injection plane for lip volumization procedures. A perpendicular approach to the lip (coming from the cutaneous lip) might increase safety because the artery is located most frequently within the red lip.
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Affiliation(s)
- Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
| | - Thilo L Schenck
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
| | | | - Katie Beleznay
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nirusha Lachmann
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN
| | | | | | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig – Maximilian University Munich, Germany
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Expert Consensus on Hyaluronic Acid Filler Facial Injection for Chinese Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3219. [PMID: 33173709 PMCID: PMC7647603 DOI: 10.1097/gox.0000000000003219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/03/2020] [Indexed: 02/05/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Beauty standards vary by race and region, which must be accounted for in creating beauty. Chinese have unique features, including a depressed nose, flat midface, and small chin, and have different cosmetic concerns. We performed a consensus study on filler injections based on the Chinese standard of beauty due to a lack of such study. Methods: We organized the YVOIRE Consensus Group, including 5 plastic surgeons. We discussed common problematic areas seen in Chinese and described techniques based on our experience with hyaluronic acid fillers, while considering peer-reviewed articles, followed by multiple consensus-developing sessions. Results: Chinese faces are characterized by retruded forehead, chin, and low nasal bridge, with certain features believed to bring good fortune. Therefore, profiles of the forehead, nose, lip, and chin have substantial effects on attractiveness. The demand for cosmetic procedures is high among the young generation who particularly desire nose and chin augmentation. Attractive Chinese facial shapes are characterized by a long, slender facial shape and pointed chin. Lips are narrow and thick. When injecting fillers for Chinese, it is necessary to apply special methods that produce results consistent with these characteristics. Conclusions: Understanding the concept and demand of beauty depending on race and region is important. Patients should be evaluated before aesthetic procedures. Maintaining hygiene during the procedure is crucial. Moreover, methods for preventing pain are essential. Fillers should be injected into the correct anatomical site and layer to minimize side effects and maximize effectiveness.
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Barbarino SC, Woodward JA, Levine J, Fezza J. Evaluating an incobotulinumtoxinA and Cohesive Polydensified Matrix ® hyaluronic acid filler combination to treat moderate-to-severe periorbital and perioral rhytids. J Cosmet Dermatol 2020; 20:1459-1466. [PMID: 33051971 DOI: 10.1111/jocd.13745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/02/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effectiveness of treating mimetic facial lines with an incobotulinumtoxinA (INCO) and Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) combination. METHODS Subjects with moderate-to-severe lateral periorbital lines (LPL) and perioral lines at rest according to Merz Aesthetics Scales™ received 10 U of INCO/eye and up to 10 U to the perioral area. This was followed by intradermal injection of 1-3 cc CPM-HA to the same lines. Primary outcomes were physician- and subject-rated improvement at 1 month using the Global Aesthetic Improvement Scale (GAIS) and changes in line severity using the Merz Aesthetics Scales™ . RESULTS The study included 10 women aged 42-74 years with moderate-to-severe LPL and perioral lines at baseline. At 1 month, treating physician GAIS scores indicated 45.0% of subjects were very much improved and 52.5% much improved; 75% remained at least improved at 6 months. Subject GAIS results indicated 7 women rated themselves as very much improved and 3 as much improved. For LPL, improvements of ≥1-point on the Merz Aesthetics Scales™ compared with baseline were seen at 1, 3, and 6 months in 86.8%, 74.3%, and 65.8% of subjects, respectively. For perioral lines, improvements of ≥1-point were observed for 89.2%, 86.5%, and 73.0% at 1, 3, and 6 months, respectively. No treatment-related adverse events were observed. CONCLUSIONS Combined INCO/CPM-HA filler in individuals with moderate-to-severe LPL and perioral lines was effective at improving overall appearance and reducing line severity in two highly mobile facial areas that are the first to show lines of aging.
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Affiliation(s)
| | - Julie A Woodward
- Department of Ophthalmology and Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer Levine
- Lenox Hill Hospital, Manhattan Eye Ear and Throat Hospital, New York, NY, USA
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Better Results in Facial Rejuvenation with Fillers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2763. [PMID: 33173655 PMCID: PMC7647625 DOI: 10.1097/gox.0000000000002763] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022]
Abstract
Facial rejuvenation is a rapidly advancing field in aesthetic medicine. Minimally invasive techniques represent a powerful tool for rejuvenation, and fillers are a popular modality with which to restore and optimize facial proportions. Currently, our filler armamentarium is characterized by products with an increasing variety of biochemical compositions warranting tailored injection approaches. An intimate knowledge of anatomy, product characteristics, and appropriate injection techniques is essential to achieve optimal results while maintaining patient safety. Here, we review facial anatomy, structural changes secondary to aging, appropriate filler selection, safe injection techniques, and complications.
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Sattler G, Kerscher M, Noah EM, Prager W, Fischer TC, Ogilvie P, Hofmann M, Dersch H, Odena G. Safety and Performance of Etermis 3 and 4 in Wrinkles/Folds Treatment and Facial Volume Enhancement: A Prospective, Evaluator-Blinded, Open-Label Study. Clin Cosmet Investig Dermatol 2020; 13:591-599. [PMID: 32884321 PMCID: PMC7443462 DOI: 10.2147/ccid.s244598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022]
Abstract
Background Facial aging is characterized by increased prominence of nasolabial folds (NLFs), marionette lines, and thinning of the lips. Cross-linked hyaluronic acid injection is a very effective method for the temporary correction of these areas. Objective To confirm the clinical performance and the safety of Etermis 3 (ET3) and/or Etermis 4 (ET4) in the treatment of moderate and severe wrinkles/folds, as well as lip volume enhancement. Methods Subjects were treated in at least two facial areas (NLFs, marionette lines, lips). ET3 was used in facial moderate wrinkles while ET4 was used in severe facial skin volume loss. An optional touch-up 1 month after treatment was possible. A blinded investigator assessed improvement on Merz Aesthetic Scales (MAS). Subjects were followed-up for 12 months after the last treatment. Results In total, 154 healthy subjects were enrolled. The proportion of subjects achieving ≥1 score improvement in MAS after treatment was above 60% for ET4 (Month 6/7: NLFs 94.9% and marionette lines 81.4%, p≤0.0004; Month 3/4: lips 63.0%, p=0.39) and ET3 (Month 6/7: marionette lines 79.4%, p=0.0005; Month 3/4: lips 65.5%, p=0.31). Facial improvement was still visible at Month 12/13 for ET4 (NLFs ≥76.6%, marionette lines ≥61%, lips ≥36%) and ET3 (marionette lines ≥50% and lips ≥21.9%). No treatment-related serious AEs occurred. The most frequent AEs were injection-site reactions. Conclusion Etermis 3 and Etermis 4 demonstrated good clinical performance and safety for NLFs and marionette lines volume enhancement for up to 12 months. Both products can also be used safely to treat lips for volume augmentation.
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Affiliation(s)
| | - Martina Kerscher
- Division of Biochemistry and Molecular Biology, Cosmetic Science, University of Hamburg, Hamburg, Germany
| | - Ernst Magnus Noah
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Kassel, Germany
| | - Welf Prager
- Prager & Partner Dermatologische Praxis, Hamburg, Germany
| | | | | | | | - Hanna Dersch
- Merz Pharmaceuticals GmbH, Frankfurt Am Main, Germany
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Goodman GJ, Liew S, Callan P, Hart S. Facial aesthetic injections in clinical practice: Pretreatment and posttreatment consensus recommendations to minimise adverse outcomes. Australas J Dermatol 2020; 61:217-225. [PMID: 32201935 PMCID: PMC7497045 DOI: 10.1111/ajd.13273] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
Facial aesthetic treatment with injectable neuromodulators and hyaluronic acid fillers is well established, with favourable safety profiles and consistent outcomes. As with any medical treatment, adverse events and complications may occur. Adverse events associated with these products are typically transient and mild to moderate in severity. Serious adverse events, such as infection and intravascular occlusion, are rare. Proper patient selection, consent and counselling, preparation and impeccable injection technique are important risk reduction strategies. Both clinicians and patients must be alert to the signs and symptoms of complications so that appropriate treatment can be started promptly. In this article, the authors review the current literature and provide their consensus recommendations for minimising adverse outcomes when treating patients with botulinum toxin or hyaluronic acid fillers.
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Affiliation(s)
| | - Steven Liew
- Shape ClinicDarlinghurstNew South WalesAustralia
| | | | - Sarah Hart
- Skin InstituteRemuera, AucklandNew Zealand
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Hexsel D, Dal'Forno T, Camozzato F, Valente I, Soirefmann M, Silva AF, Siega C. Effects of different doses of abobotulinumtoxinA for the treatment of anterior gingival smile. Arch Dermatol Res 2020; 313:347-355. [PMID: 32725500 DOI: 10.1007/s00403-020-02096-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/13/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
Botulinum toxin type A (BoNT-A) is an easy and fast treatment for gingival smile (GS). The objective of the study was to compare the reduction of gingival exposure using three different doses of abobotulinumtoxinA (ABO) in patients with different severities of anterior GS, and to assess treatment safety and patients' satisfaction. A prospective, single-center, randomized, double-blind study was conducted. Mild GS (2 to < 3 mm) was treated with 2.5 U of abobotulinumtoxinA (ABO) per side, moderate GS (3 to < 4 mm) with 5 U of ABO per side, and severe GS (4 mm or more) with either 2.5 U, or 5 U or 7.5 U of ABO per side. All the 41 enrolled patients completed the study. The mean gingival exposure reduced significantly 4 and 12 weeks after treatment. The average reduction of gingival exposure with 5 U was significantly larger than that obtained with 2.5 U, (3.46 ± 1.39 vs. 2.05 ± 1.29 mm; p = 0.004). All groups of GS severity presented statistically significant reduction in the gingival exposure 4 and 12 weeks after ABO injections. Twelve weeks after treatment, more than 80% of the patients were satisfied or very satisfied. There were no treatment-related adverse events reported by the patients or noticed by the investigators. Gingival smile can be safely and effectively managed with BoNT-A injections and specifically with ABO injections to target the LLSAN muscle. Further and larger studies may determine the exact influence of each factor on BoNT-A treatments of GS.
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Affiliation(s)
- Doris Hexsel
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil.
| | - Taciana Dal'Forno
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil.,Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fernanda Camozzato
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
| | - Indira Valente
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
| | - Mariana Soirefmann
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
| | - Aline Flor Silva
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
| | - Carolina Siega
- Brazilian Center for Studies in Dermatology, Dom Pedro II 1592, Porto Alegre, RS, 90550-141, Brazil
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Evaluation of the Rheologic and Physicochemical Properties of a Novel Hyaluronic Acid Filler Range with eXcellent Three-Dimensional Reticulation (XTR™) Technology. Polymers (Basel) 2020; 12:polym12081644. [PMID: 32722003 PMCID: PMC7463506 DOI: 10.3390/polym12081644] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/16/2022] Open
Abstract
Soft-tissue fillers made of hyaluronic acid and combined with lidocaine have recently become a popular tool in aesthetic medicine. Several manufacturers have developed their own proprietary formulae with varying manufacturing tools, concentrations, crosslinked three-dimensional network structures, pore size distributions of the fibrous networks, as well as cohesivity levels and rheological properties, lending fillers and filler ranges their unique properties and degradability profiles. One such range of hyaluronic acid fillers manufactured using the novel eXcellent three-dimensional reticulation (XTR™) technology was evaluated in comparison with other HA fillers and filler ranges by an independent research laboratory. Fillers manufactured with the XTR™ technology were shown to have characteristic rheological, crosslinking and biophysical factors that support the suitability of this filler range for certain patient profiles.
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48
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Zhao P, Zhao W, Zhang K, Lin H, Zhang X. Polymeric injectable fillers for cosmetology: Current status, future trends, and regulatory perspectives. J Appl Polym Sci 2020. [DOI: 10.1002/app.48515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Peng Zhao
- Center for Medical Device EvaluationNational Medical Products Administration Beijing 100081 People's Republic of China
| | - Wanlu Zhao
- National Engineering Research Center for BiomaterialsSichuan University Chengdu Sichuan 610065 People's Republic of China
| | - Kai Zhang
- National Engineering Research Center for BiomaterialsSichuan University Chengdu Sichuan 610065 People's Republic of China
- Institute of Regulatory Science for Medical DeviceSichuan University Chengdu Sichuan 610065 People's Republic of China
| | - Hai Lin
- National Engineering Research Center for BiomaterialsSichuan University Chengdu Sichuan 610065 People's Republic of China
| | - Xingdong Zhang
- National Engineering Research Center for BiomaterialsSichuan University Chengdu Sichuan 610065 People's Republic of China
- Institute of Regulatory Science for Medical DeviceSichuan University Chengdu Sichuan 610065 People's Republic of China
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de Melo F, Carrijo A, Hong K, Trumbic B, Vercesi F, Waldorf HA, Zenker S. Minimally Invasive Aesthetic Treatment of the Face and Neck Using Combinations of a PCL-Based Collagen Stimulator, PLLA/PLGA Suspension Sutures, and Cross-Linked Hyaluronic Acid. Clin Cosmet Investig Dermatol 2020; 13:333-344. [PMID: 32440186 PMCID: PMC7211299 DOI: 10.2147/ccid.s248280] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022]
Abstract
Background Combinations of minimally invasive procedures (MIPs) are often used in aesthetic treatments and are increasingly considered as the new standard of care. Three agents with specific properties are available in this perspective: a polycaprolactone (PCL)-based collagen stimulator, a poly-L-lactic acid (PLLA)- and a poly-glycolic acid (PLGA)-based resorbable suspension suture with a 3D-cone technology, and a cross-linked hyaluronic acid (HA). Objective To develop the first practice guidelines on rejuvenation treatment of the face and the neck using combinations of these agents, whether associated or not with other widely used MIPs such as botulinum neurotoxins or energy-based devices. Methods A multi-disciplinary, multi-national board of plastic surgeons and dermatologists convened to develop guidelines using a predefined consensus method. The consensus was defined as ≥83% agreement rate between participants. Results Practice guidelines and algorithms, describing optimal procedure sequence and spacing, are proposed for the treatment of upper-, mid-, lower-face and neck, combining the PCL collagen stimulator, the PLLA/PLGA suspension sutures, and the cross-linked HA, whether associated or not with other MIPs. Conclusion These new guidelines provide general support to optimal management strategies. Individual treatment plans should be adapted according to the physician’s individual competence and the patient’s preferences.
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Pourang A, Rockwell H, Karimi K. New Frontiers in Skin Rejuvenation, Including Stem Cells and Autologous Therapies. Facial Plast Surg Clin North Am 2019; 28:101-117. [PMID: 31779934 DOI: 10.1016/j.fsc.2019.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
One of the greatest challenges in the progression of aesthetic medicine lies in providing treatments with long-term results that are also minimally invasive and safe. Keeping up with this demand are developments in autologous therapies such as adipose-derived stem cells, stromal vascular fraction, microfat, nanofat, and platelet therapies, which are being shown to deliver satisfactory results. Innovations in more traditional cosmetic therapies, such as botulinum toxin, fillers, and thread lifts, are even more at the forefront of the advancement in aesthetics. Combining autologous therapies with traditional noninvasive methods can ultimately provide patients with more effective rejuvenation options.
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Affiliation(s)
- Aunna Pourang
- Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA
| | - Helena Rockwell
- University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Kian Karimi
- Rejuva Medical Aesthetics, 11645 Wilshire Boulevard #605, Los Angeles, CA 90025, USA.
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