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Wang RJ, Wang Y, Wu JF, Si TT. Clinical effect of botulinum toxin type A combined with autologous fat grafting in patients with nasolabial fold depression. World J Clin Cases 2024; 12:4973-4982. [DOI: 10.12998/wjcc.v12.i22.4973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Nasolabial fold (NLF) depression can affect the facial appearance of patients to some extent and increase their psychological burdens. In recent years, autologous fat grafting (AFG) combined with botulinum toxin A (BTX-A) injection (AFG + BTX-A injection) has been gradually applied in the treatment of patients with NLF depression. Although studies have been conducted on the efficacy and safety of AFG + BTX-A injection in treating NLF depression, the experimental design, observational indicators, and sample enrollment criteria vary remarkably, making it difficult to draw convincing and consistent conclusions. Thus, further relevant research is warranted.
AIM To assess the esthetic improvement, efficacy, and safety of AFG + BTX-A injections in patients with NLF depression.
METHODS This study included 60 patients with NLF depression who were treated in our hospital from February 2019 to April 2021. These patients were categorized into control (n = 30) and observation (n = 30) groups. The observation group received AFG + BTX-A injection, whereas the control group underwent AFG only. All patients were evaluated using the wrinkle severity rating scale (WSRS) and global aesthetic improvement scale. The compactness of facial contours, skin evaluation indexes, adverse reactions, and satisfaction of the two groups were evaluated 3 months postoperatively.
RESULTS The WSRS scores of the observation group at 1, 3, and 6 months postoperatively were lower than those of the control group (P < 0.05). Three months postoperatively, facial fine lines and pores showed obvious improvement and the skin index score was higher in the observation group than in the control group (P < 0.05). The compactness of facial contours was better in the observation group than in the control group (P < 0.05). In addition, no remarkable differences were noted in the incidence of postoperative adverse reactions such as facial stiffness, facial asymmetry, facial bruising, and facial concavity inequality (P > 0.05).
CONCLUSION AFG + BTX-A injection is a highly safe, cost-effective, effective, and long-lasting treatment for NLF depression with high esthetic value, which should be promoted in the future.
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Affiliation(s)
- Ru-Jie Wang
- Department of Burns and Plastic Surgery, 903rd Hospital of PLA, Hangzhou 310013, Zhejiang Province, China
| | - Ying Wang
- Department of Dermatology, Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai 200434, China
| | - Jin-Fang Wu
- Department of Burns and Plastic Surgery, 903rd Hospital of PLA, Hangzhou 310013, Zhejiang Province, China
| | - Ting-Ting Si
- Department of Burns and Plastic Surgery, 903rd Hospital of PLA, Hangzhou 310013, Zhejiang Province, China
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2
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Wang Q, Yan H, Zhang J, Tian B, Li W, Xiao J. Agarose-collagen composite microsphere implants: A biocompatible and robust approach for skin tissue regeneration. Int J Biol Macromol 2024; 277:134510. [PMID: 39111473 DOI: 10.1016/j.ijbiomac.2024.134510] [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: 05/04/2024] [Revised: 07/28/2024] [Accepted: 08/03/2024] [Indexed: 08/10/2024]
Abstract
Photoaged skin, a consequence of UV radiation-induced collagen degradation, presents a significant challenge for skin rejuvenation. Synthetic polymer microspheres, while offering collagen regeneration potential, carry risks like granulomas. To overcome this, we developed a novel agarose-collagen composite microsphere implant for skin tissue regeneration. Fabricated using an emulsification-crosslinking method, these microspheres exhibited excellent uniformity and sphericity (with a diameter of ~38.5 μm), as well as attractive injectability. In vitro studies demonstrated their superior biocompatibility, promoting cell proliferation, adhesion, and migration. Further assessments revealed favorable biosafety and blood compatibility. In vivo experiments in photoaged mice showed that implantation of these microspheres effectively reduced wrinkles, increased skin density, and improved elasticity by stimulating fibroblast encapsulation and collagen regeneration. These findings highlight the potential of agarose-collagen microspheres in dermatological and tissue engineering applications, offering a safer alternative for skin rejuvenation.
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Affiliation(s)
- Qi Wang
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, PR China; Gansu Engineering Research Center of Medical Collagen, Lanzhou, Gansu 730000, PR China
| | - Huiyu Yan
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, PR China; Gansu Engineering Research Center of Medical Collagen, Lanzhou, Gansu 730000, PR China
| | - Jingting Zhang
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, PR China; Gansu Engineering Research Center of Medical Collagen, Lanzhou, Gansu 730000, PR China
| | - Bei Tian
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, PR China; Gansu Engineering Research Center of Medical Collagen, Lanzhou, Gansu 730000, PR China
| | - Wenhua Li
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, PR China; Gansu Engineering Research Center of Medical Collagen, Lanzhou, Gansu 730000, PR China
| | - Jianxi Xiao
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, PR China; Gansu Engineering Research Center of Medical Collagen, Lanzhou, Gansu 730000, PR China.
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3
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Yi KH, Wan J. Anatomical considerations of medial eye wrinkles: Guidelines for botulinum neurotoxin injections. J Cosmet Dermatol 2024. [PMID: 39017034 DOI: 10.1111/jocd.16474] [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: 04/12/2024] [Revised: 06/25/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024]
Abstract
Crow's feet lines in the lateral canthal region are a common concern among aging patients, initially appearing as dynamic wrinkles during facial expressions and becoming more pronounced with age. Botulinum neurotoxin temporarily paralyzes muscles by inhibiting acetylcholine release, smoothing wrinkles and enhancing skin's youthful appearance. Effective treatment requires tailored approaches considering individual anatomy and muscle activity. Recent cadaveric studies identified the tear trough muscle, emphasizing its role in infraorbital support and aging. Clinically, patients often present medial eye wrinkles after BoNT treatment for crow's feet, prompting exploration of underlying mechanisms and management strategies. Three cases demonstrated that medial BoNT injections in the orbicularis oculi muscle significantly improve medial eye wrinkles and tear trough appearance. The study underscores the importance of understanding muscle hyperactivity and anatomical variations for precise treatment. Enhanced injection techniques targeting specific areas can achieve better outcomes and minimize complications, particularly in culturally sensitive regions where facial expressions are valued. This research highlights the necessity for comprehensive anatomical knowledge and patient-specific treatment strategies to address medial eye wrinkles effectively.
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Affiliation(s)
- Kyu-Ho Yi
- Maylin Clinic (Apgujeong), Seoul, Korea
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, Korea
| | - Jovian Wan
- Asia-Pacific Aesthetic Academy, Hong Kong, Hong Kong
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4
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Landau M, Goldust M. Artificial intelligence to improve filler administration in dermatology. J Cosmet Dermatol 2024. [PMID: 39015042 DOI: 10.1111/jocd.16472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Marina Landau
- Arena Dermatology and Department of Plastic Surgery, Shamir Medical Center, Be'er Ya'akov, Israel
| | - Mohamad Goldust
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
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5
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Zhou Z, Huang F, Chen J. Study on botulinum toxin in dermatology from 2000 to 2023: A CiteSpace-based bibliometric analyses. J Cosmet Dermatol 2024. [PMID: 38978347 DOI: 10.1111/jocd.16423] [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: 02/23/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVE Using bibliometric methods, this study analyzed and summarized the current situation and development of the global application of botulinum toxin in dermatology. METHODS Literature published in the Web of Science Core Collection database from January 1, 2000 to October 28, 2023 was searched for topics such as "Botulinum toxin," "Dermatology," and so forth. The number of publications, countries, institutions, journals, authors, cited literature, keywords, and so forth, were analyzed and a visual knowledge map was created using scientometric tools such as CiteSpace, VOSviewer, and Scimago Graphica. RESULTS A total of 2039 documents were retrieved and 1877 documents were included after de-duplication and transformation. The country with the highest number of published periodical articles was the United States; the main research institution was Yonsei University; the author with the highest number of published periodical articles was Kim, Hee Jin; and the high-frequency keywords mainly related to indications, combination therapy, and safety optimization. CONCLUSION The results of this study provide information on the current status and trends in clinical studies of botulinum toxin in dermatology, which will help researchers identify hotspots and explore new research directions in this field.
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Affiliation(s)
- Ziwenyan Zhou
- Department of Dermatology, the First Affilated Hospital of Chongqing Medical University, Chongqing, China
| | - Fujun Huang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Jin Chen
- Department of Dermatology, the First Affilated Hospital of Chongqing Medical University, Chongqing, China
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6
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Landau M, Klein J, Leizgold FR, Kroumpouzos G. Rare and novel complications of botulinum neurotoxin type A and dermal filler injections. Clin Dermatol 2024:S0738-081X(24)00107-X. [PMID: 38914174 DOI: 10.1016/j.clindermatol.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Botulinum neurotoxin type A (BoNTA) and filler injection procedures usually provide predicted outcomes with a low incidence of complications. Most of the complications after these procedures have been extensively discussed. In this study, we report on these injectables' less well-known, recently reported, and novel complications and attempt to clarify the underlying mechanisms. Counterfeit or mishandled BoNTA has been associated with botulism. BoNTA has been linked to uncommon complications, including morphea-like lesions, nontuberculous mycobacterial infections, vascular occlusion, and pseudoaneurysm of the superficial temporal artery. Unusual complications from filler injection include nonscarring alopecia, intraoral necrosis, nontuberculous mycobacterial infections, xanthelasma-like reactions, intracranial perforation, and pneumosinus dilatans. Post-BoNTA injection nodules and filler infection from bone destruction due to cocaine use are new complications. These complications pose a challenge for diagnosis and treatment. This publication aims to assist in promptly identifying and managing these rare and novel complications when necessary.
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Affiliation(s)
| | - Jerome Klein
- Jules Stein Eye Institute, UCLA Medical Center, Los Angeles, California, USA
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7
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Li Y, Zheng Q, Lin J, Su X, Zhuang J, Wei Q, Hu J. Mild Allergic Reactions after Botulinum Toxin Injection: A Case Series and Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5845. [PMID: 38798928 PMCID: PMC11124596 DOI: 10.1097/gox.0000000000005845] [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: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 05/29/2024]
Abstract
Background Botulinum toxin type A (BTA) is becoming more and more prevalent as an injection agent in cosmetic surgery. However, there is an increasing amount of cases reporting unexpected adverse reactions related to BTA injection. BTA can invoke many kinds of hypersensitive reactions, some of which can be delayed-type or even fatal; hence, it is of crucial importance to pay close attention to atypical and early symptoms that may indicate the presence of BTA allergy in patients. Methods In this study, we reported three cases of mild and unexpected BTA-related hypersensitive reaction with a symptom of nonpruritic erythema on the chest that happened after BTA treatment of upper facial wrinkles and proposed several suggestions based on our practical experience and literature review. Results Two patients' symptoms were alleviated spontaneously, and one patient's were alleviated after taking oral corticosteroid. According to our literature review, we believe that these incidences indicate a kind of unreported allergic reaction relevant to botulinum toxin. Conclusions We suggest clinicians consider warily patients' subsequent BTA injection schedule if any suspicious reaction occurs after treatment. We suggest that patients who experience nonpruritic erythema after botulinum toxin injection should suspend subsequent injection plans for at least 3 months to prevent more severe consequences.
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Affiliation(s)
- Yingzi Li
- From the Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Qiaoyuan Zheng
- College of Clinical Medicine, Fudan University, Shanghai, People’s Republic of China
| | - Jinhao Lin
- Xinjiang Second Medical Collage, Karamay, People’s Republic of China
| | - Xueshang Su
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jun Zhuang
- Department of Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qingqian Wei
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jintian Hu
- Department of Cicatrix Minimally Invasive Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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8
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Ismailoglu AV, Ismailoglu P, Aktekin M. Mapping the Vascular and Muscular Topography of the Glabellar Region: Implication for Improving Safety and Efficacy of the Glabellar Injections. Aesthetic Plast Surg 2024; 48:1628-1634. [PMID: 37855934 DOI: 10.1007/s00266-023-03708-1] [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: 08/04/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Botulinum neurotoxin (BoNT) and filler injections into the highly vascularized glabellar region for aesthetical purposes are extremely common. Injections into the glabellar region without precise anatomical knowledge of its vascular and muscular topography may pose the risk of severe complications. OBJECTIVES We aimed to improve the safety and efficacy of the glabellar injections by mapping the regional muscles and vasculature in relation to the medial canthus and the defined reference lines. METHODS Meticulous dissection was performed to reveal glabellar region muscles and arteries under surgical microscope, in 16 hemifaces of whom arteries are injected with red-dyed latex. Location of the angular artery (AA) along with its branches was noted in relation to glabellar muscles. RESULTS The AA was always located superficial to the levator labii superioris alaeque nasi muscle (LLSAN) and then coursed toward the medial canthus to anastomose with the supratrochlear artery deep to the origin of the depressor supercilii (DS). The AA gave subcutaneously located central and paracentral branches coursing close to the mid-face line in 14 out of 16 hemifaces. Variable muscular connections were also present between the LLSAN, the DS and the procerus (P) muscles. No arteries were detected at the base of the medial eyebrow to which the DS, the P, and the frontalis (F) inserted. CONCLUSIONS This study provides a detailed map of muscular and vascular anatomy of the glabellar region to facilitate safe and efficient filler and BoNT injections without complications. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Abdul Veli Ismailoglu
- Department of Anatomy, School of Medicine, Marmara University, Maltepe Basibuyuk Yolu, No:9, 34854, Maltepe, Istanbul, Turkey.
| | - Pelin Ismailoglu
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Program, Fenerbahce University, Ataturk Mah. Atasehir Bulvarı, Metropol Istanbul, 34758, Atasehir, Istanbul, Turkey
| | - Mustafa Aktekin
- Department of Anatomy, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Kayisdagi cad, Kerem Aydinlar Kampusu, No: 32, 34752, Atasehir, Istanbul, Turkey
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9
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Wang X, Li X, Yu M. Pulmonary Embolism after Botulinum Toxin Treatment for Leg Muscle Hypertrophy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5594. [PMID: 38322811 PMCID: PMC10846760 DOI: 10.1097/gox.0000000000005594] [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: 10/11/2023] [Accepted: 12/19/2023] [Indexed: 02/08/2024]
Abstract
Leg muscle hypertrophy is a unique physical symptom in East Asian women. Compared with traditional surgical treatment for calf muscle hypertrophy, botulinum toxin is widely favored by East Asian women because of its minimal trauma and significant effects. We describe the case of a 22-year-old woman with pulmonary embolism because of deep vein thrombosis, who presented with hypertrophy of bilateral calf muscles, and was administered 300 U of botulinum toxin A injection in July 2022. On the third day after the injection, she experienced swelling and pain in her left leg, which gradually worsened and made walking difficult. She underwent an ultrasound examination of lower limbs, which revealed several deep and shallow vein thrombi in the left lower limb. Computed tomography arterial imaging indicated multiple embolisms in pulmonary arteries. This study aimed to explore and analyze the causes of pulmonary embolism after botulinum toxin treatment for calf muscle hypertrophy by reviewing and analyzing the patient's symptoms, diagnosis, and treatment process to provide management strategies for treatment and prevention of this disease.
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Affiliation(s)
- Xiaoli Wang
- From the Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaofei Li
- Medical Department of Suizhou Central Hospital, Hubei University of Medicine, Suizhou, Hubei Province, China
| | - Mosheng Yu
- From the Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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10
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Guida S. Neurotoxin in the Lower Third of the Face. Dermatol Clin 2024; 42:63-67. [PMID: 37977685 DOI: 10.1016/j.det.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Botulinum toxin A (BT) is the most required treatment in face rejuvenation. However, applications of BT on the lower third are off-label and specific tips for the treatment of this area should be taken into account to achieve best results. In the current study, literature concerning BT treatment of lower face has been revised and summarized according to anatomy and indications, tips, and complications. BT treatment of the lower face has been reported to be effective and safe when performed with adequate knowledge of anatomy and techniques.
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Affiliation(s)
- Stefania Guida
- Dermatology, Vita-Salute San Raffaele University, Via Olgettina n. 60, Milano 20132, Italy.
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11
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Bertucci V, Huang C. Neuromodulator Assessment and Treatment for the Upper Face: An Update. Dermatol Clin 2024; 42:51-62. [PMID: 37977684 DOI: 10.1016/j.det.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Neuromodulator treatment of the upper face has been extensively studied and serves as an excellent tool to enhance facial appearance, non-verbal communication, and social functioning. Optimal outcomes are best achieved when health care providers take an individualized approach, based on knowledge of structural and functional anatomy, thorough facial assessment, and customized injection techniques and patterns.
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Affiliation(s)
- Vince Bertucci
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Private Practice, 100-8333 Weston Road, Woodbridge, Ontario L4L 8E2, Canada.
| | - Christina Huang
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Nicoletti MM, Anatriello A, Liguori V, Cantone A, di Mauro G, Izzo I, Lettera N, Della Ragione JM, Campitiello MR, Cosenza V, Scavone C. Skin Toxicities Associated with Botulin Toxin Injection for Aesthetic Procedures: Data from the European Spontaneous Reporting System. Pharmaceuticals (Basel) 2023; 16:1611. [PMID: 38004476 PMCID: PMC10675122 DOI: 10.3390/ph16111611] [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: 10/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Botulinum toxin is a protein deriving from the bacteria Clostridium botulinum and it is widely used for the treatment of a variety of muscle hyperactivity syndromes and for cosmetic indications. Having a long-lasting effect, Botulinum toxin type A (BTA) is one of the most botulin toxin products used. Even if BTA has shown benefits in reducing the vertical lines between the eyebrows, Adverse Drug Reactions (ADRs) have been experienced as well, of which the most common ones are headache and drooping eyelids. In addition, since other local and systemic risks have been identified, a non-interventional post-authorization safety study (PASS) has been started. The aim of the present study was to report cases of skin toxicity associated with this drug, considering Individual Case Safety Reports (ICSRs) existing on the Eudravigilance website. Among 1464 ICSRs sent to the EV database, 718 ICSRs, including 5154 PTs, reported BTA as a suspected drug associated with cutaneous toxicity. The majority of patients experiencing BTA-induced skin toxicity were female (92.1%) belonging mostly to the age group of 18-64 years. The most serious criteria, when reported, were "Other Medically Important Condition" and "Caused/prolonged hospitalization", although the outcome was mainly reported as "Unknown". The most reported PTs, related to skin disorders, were: "Erythema", "Rash", "Pruritus", "Urticaria", "Swelling face", "Brow ptosis", "Eyelid ptosis", "Injection site pain", and "Angioedema". Considering that in most ICSRs, ADRs related to skin disorders were symptoms of hypersensitivity reactions which in some conditions could be life-threatening, further studies are required to better define the safety profile of BTA used for aesthetic procedures.
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Affiliation(s)
| | - Antonietta Anatriello
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.A.); (V.L.); (A.C.)
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Valerio Liguori
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.A.); (V.L.); (A.C.)
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Andrea Cantone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.A.); (V.L.); (A.C.)
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Gabriella di Mauro
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
- UOC Pharmacy, AORN Santobono Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - Imma Izzo
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Nicoletta Lettera
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Joao Marcos Della Ragione
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
| | - Maria Rosaria Campitiello
- Department of Obstetrics and Gynaecology and Physiopathology of Human Reproduction, ASL Salerno, 84124 Salerno, Italy;
| | - Vincenzo Cosenza
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DiSTABiF), University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Cristina Scavone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.A.); (V.L.); (A.C.)
- Regional Center of Pharmacovigilance and Pharmacoepidemiology of Campania Region, 80138 Naples, Italy; (G.d.M.); (I.I.); (N.L.); (J.M.D.R.)
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13
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Bertucci V, Green JB, Fezza JP, Brown J, Gallagher CJ, Solish N. Impact of Glabellar Injection Technique With DaxibotulinumtoxinA for Injection on Brow Position. Aesthet Surg J 2023; 43:S10-S18. [PMID: 36322141 PMCID: PMC10638665 DOI: 10.1093/asj/sjac002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Precise injection technique is vital for avoiding suboptimal eyebrow position when treating glabellar lines with botulinum toxin type A. OBJECTIVES The aim of this study was to evaluate the impact of glabellar injection technique on eyebrow position in patients treated with DaxibotulinumtoxinA for Injection (DAXI). METHODS This retrospective post hoc analysis involved 60 adults who received a single treatment with DAXI 40 U to the glabella and had standardized facial photography. Median vertical and horizontal displacement of the brows (at rest) at baseline and 2 weeks after glabellar injection were measured. Brow position outcomes were evaluated by an oculoplastic surgeon and expert anatomist. Investigators were interviewed to ascertain individual injection techniques. RESULTS Precise injection location and depth, and median resting brow position following treatment varied between investigators. Positive brow outcomes were achieved with deep DAXI injections into the medial corrugator, superficial lateral corrugator injections placed between the midpupil and lateral limbus, and deep midline procerus injections. Glabellar injection technique that more precisely targeted the corrugator muscles resulted in longer glabellar line treatment duration compared to a less targeted technique. Medial corrugator injections above the medial brow; lateral corrugator injections administered deeply or more medially, toward the medial third of the brow; and procerus injections superior to the inferomedial brow tended to be associated with suboptimal outcomes that were more apparent during dynamic expression. CONCLUSIONS Aesthetically pleasing brow outcomes and greater duration of efficacy can be achieved with an injection pattern that precisely treats the anatomic location of the corrugator supercilii and procerus muscles, avoiding the frontalis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | | | | | - Jessica Brown
- Corresponding Author: Dr Jessica Brown, Medical Affairs, Revance Therapeutics, Inc., 1222 Demonbreun St, Nashville, TN, 37203, USA. E-mail:
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Solish N, Kane MAC, Biesman BS, Brown J, Gallagher CJ. Impact of DaxibotulinumtoxinA for Injection on Brow Position and Frontalis Muscle Activity Following Treatment of Glabellar Lines. Aesthet Surg J 2023; 43:S1-S9. [PMID: 36095026 PMCID: PMC10638667 DOI: 10.1093/asj/sjab362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Botulinum toxin type A (BoNTA) injections for the treatment of facial lines may lead to pleasant or undesirable changes in eyebrow height and position. OBJECTIVES The aim of this study was to evaluate the impact of glabellar injection of DaxibotulinumtoxinA for Injection (DAXI), a novel BoNTA formulation, on eyebrow position and frontalis activity. METHODS This study involved the post hoc analysis of adult patients from the Phase 2a forehead lines (FHL, N = 60) and open-label safety (OLS, N = 175) studies who received a single dose of DAXI 40 U to the glabella and for whom facial photographs were taken at rest and at maximum eyebrow elevation. Median vertical and horizontal displacement of the brows and median forehead strain (an objective quantitative assessment of frontalis activity) from baseline to 2 weeks after glabellar DAXI injection were measured. RESULTS Two weeks after glabellar DAXI injection, vertical eyebrow movement (at rest) of the lateral brow was observed. In both studies, vertical movement was greatest in the lateral (0.6-0.9 mm) and mid (0.5-0.7 mm) brow regions; movement in the medial brow was negligible (0-0.23 mm). In both studies, a graded reduction in forehead strain was observed 2 weeks post glabellar DAXI injection, with the greatest reduction being in the lower segment (FHL, -73%; OLS, -82%). Treatment with DAXI showed improvements in FHL wrinkle severity. CONCLUSIONS Glabellar injection of DAXI showed a positive reduction in dynamic frontalis activity that maintained or had a positive effect on eyebrow position. Vertical movement of the brow was suggestive of an improved eyebrow shape with a mild lateral arch. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Nowell Solish
- Corresponding Author: Dr Nowell Solish, Division of Dermatology, University of Toronto, 66 Avenue Road, Toronto, ON M5R3N8, Canada. E-mail:
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Bertucci V, Carruthers JD, Sherman DD, Gallagher CJ, Brown J. Integrative Assessment for Optimizing Aesthetic Outcomes When Treating Glabellar Lines With Botulinum Toxin Type A: An Appreciation of the Role of the Frontalis. Aesthet Surg J 2023; 43:S19-S31. [PMID: 36322138 PMCID: PMC10638666 DOI: 10.1093/asj/sjac267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Despite the perception that treatment of glabellar lines with botulinum toxin A is straightforward, the reality is that the glabellar region contains a number of interrelated muscles. To avoid adverse outcomes, practitioners need to appreciate how treatment of 1 facial muscle group influences the relative dominance of others. In particular, practitioners need to understand the independent role of the frontalis in eyebrow outcomes and the potential for negative outcomes if the lower frontalis is unintentionally weakened by botulinum toxin A treatment. In addition, practitioners must recognize how inter-individual variation in the depth, shape, and muscle fiber orientation among the upper facial muscles can affect outcomes. For optimal results, treatment of the glabellar complex requires a systematic and individualized approach based on anatomical principles of opposing muscle actions rather than a one-size-fits-all approach. This review provides the anatomical justification for the importance of an integrated assessment of the upper facial muscles and eyebrow position prior to glabellar treatment. In addition, a systematic and broad evaluation system is provided that can be employed by practitioners to more comprehensively assess the glabellar region in order to optimize outcomes and avoid negatively impacting resting brow position and dynamic brow movement. LEVEL OF EVIDENCE: 5
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Affiliation(s)
| | | | | | | | - Jessica Brown
- Corresponding Author: Dr Jessica Brown, Medical Affairs, Revance Therapeutics, Inc., 1222 Demonbreun St, Nashville, TN, 37203, USA. E-mail:
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Kim YG, Jeon A, Hwang K, Chung YH, Han SH. The Distribution of the Nerves and Arteries of the Platysma for Clinical Applications. J Craniofac Surg 2023; 34:2206-2211. [PMID: 37610024 DOI: 10.1097/scs.0000000000009592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/25/2023] [Indexed: 08/24/2023] Open
Abstract
This study aimed to provide anatomical data on the platysma for clinical procedures. The authors obtained 25 specimens from 15 adult Korean cadavers (9 men, 6 women; mean age, 72 years; range, 61-85 years). Lines connecting the gonion with the gnathion (G-GN) and the acromial end (acromial end of the clavicle) with the sternal end (sternal end of the clavicle) were used as references. Modified Sihler staining was used to trace the nerves distributed in the platysma. The superior border values of the platysma were 12.1 ± 2.7 mm, 31.5 ± 5.3 mm, 42.4 ± 5.6 mm, and 61.7 ± 6.4 mm, respectively, for sections 2 through 5 on the G-GN line. The inferior border values of the platysma were 83.6 ± 19.1 mm, 80.1 ± 14.0 mm, 74.8 ± 14.5 mm, 67.2 ± 13.7 mm, and 54.6 ± 7.1 mm, respectively, for the 5 sections on the acromial end of the clavicle-sternal end of the clavicle line. In the hyoid bone, cricoid cartilage, and jugular notch, the mean distance between the bilateral platysma was 14.4 ± 2.2 mm, 22.6 ± 10.6 mm, and 51.1 ± 15.7 mm, respectively. The mean angle at the cervical branch of the facial nerve and the anterior border of the sternocleidomastoid muscle sternal head was 28.7 ± 2.6 degrees and 53.4 ± 7.7 degrees from the G-GN line, respectively. The upper third of the platysma was supplied by branches of the facial artery and submental artery. The middle third was supplied by branches of the occipital artery and received its direct blood supply from branches of the external carotid artery. The lower third was supplied by branches of the transverse cervical artery. The authors hope that the results of this study will be helpful for rejuvenation procedures of the neck.
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Affiliation(s)
- Ye-Gyung Kim
- Department of Anatomy, College of Medicine, Chung-Ang University
| | - Anna Jeon
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea
| | - Kun Hwang
- Department of Plastic Surgery, Armed Forces Capital Hospital, Bundang-gu, Seongnam City, Gyeonggi-do, and Ewha Medical Academy, Ewha Womans University Medical Center
| | - Yoon-Hee Chung
- Department of Anatomy, College of Medicine, Chung-Ang University
| | - Seung-Ho Han
- Department of Anatomy, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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18
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Kroumpouzos G, Harris S, Bhargava S, Wortsman X. Complications of fillers in the lips and perioral area: Prevention, assessment, and management focusing on ultrasound guidance. J Plast Reconstr Aesthet Surg 2023; 84:656-669. [PMID: 37002059 DOI: 10.1016/j.bjps.2023.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/30/2022] [Accepted: 01/29/2023] [Indexed: 03/09/2023]
Abstract
An ever-increasing interest in perioral rejuvenation with dermal fillers reflects the esthetic importance of this region. However, filler injections in the lips and perioral area have been associated with various complications. Such complications are classified according to severity (mild, moderate, severe) or by the time of onset: immediate (within 24 h after injection), early (24 h to 4 weeks post-procedure), and late or delayed (>4 weeks after injection). While most complications are mild and manageable, vascular compromise, infections, and the development of delayed-onset nodules may significantly undermine the ultimate esthetic outcome and cause substantial morbidity. These more serious complications often require more invasive treatment modalities. This article details the prevention and management of such adverse events and discusses safe filler injection principles, including safety recommendations for the lips. Lastly, we highlight the use of ultrasound guidance in complication prevention (vascular mapping, filler identification, location, and extent), assessment (identification of intravascular embolus or external vascular compression by the filler implant), and management (real-time imaging of hyaluronidase or other drug injection in the affected area). Esthetic practitioners should be versed in injection anatomy, and the prevention, recognition, and management of filler complications in the perioral area.
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Affiliation(s)
- George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School at Brown University, Providence, RI, USA.
| | | | - Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College and C.R. Gardi Hospital, Ujjain, India.
| | - Ximena Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile; Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile; Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Al Mashhrawi YM, AlNojaidi TF, Alkhaldi RA, Alshami NS, Alhadlaq AS. Awareness and Knowledge of the Adverse Effects of Dermal Fillers Among the Saudi Population: A Cross-Sectional Study. Cureus 2023; 15:e40322. [PMID: 37448388 PMCID: PMC10337987 DOI: 10.7759/cureus.40322] [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: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Dermal filling for aesthetics and facial rejuvenation is one of the most common aesthetic procedures, with hyaluronic acid (HA) being the most commonly used filler due to its high safety profile. Nevertheless, adverse effects have been reported that people should be aware of before the procedure. This study aims to assess Saudi Arabians' awareness of dermal fillers, their side effects, and information sources. Methods This cross-sectional study used an online questionnaire to determine participants' level of knowledge, from January 2, 2022, to February 19, 2023. Statistical analysis and ordinal logistic regression were used to assess the respondents' knowledge of dermal fillers and other parameters. Results Of the 1,208 respondents, 290 reported using fillers, and 44% reported that complications were mentioned to them before the procedure. The results also showed that the primary source of information was social media (44.8%), followed by the Internet, physicians, and books. Respondents to whom physicians explained complications reported bruising, bluish discoloration at the injection site, redness, swelling, and accumulation of body cells under the skin, as discussed with them. Bruising and bluish discoloration were the significantly reported complications in people who received fillers, whereas lumps, epistaxis, ulceration/loss of skin, and swelling/accumulation were reported in those who did not receive fillers. Conclusion Although some adverse effects may occur with HA, its enormous advantages led to its use in facial rejuvenation. With social media as a major source of information, many respondents reported unlikely adverse effects as common ones, suggesting that information sources need to be corrected by physicians to raise awareness of the adverse effects of cosmetic procedures and enhance informed decision-making by patients.
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Affiliation(s)
| | - Taif F AlNojaidi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | - Raghad A Alkhaldi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Rutnin S, Suchonwanit P, Kositkuljorn C, Pomsoong C, Korpaisarn S, Arunakul J, Rattananukrom T. Characterizing Dermatological Conditions in the Transgender Population: A Cross-Sectional Study. Transgend Health 2023; 8:89-99. [PMID: 36824384 PMCID: PMC9942180 DOI: 10.1089/trgh.2021.0105] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose This study aimed to demonstrate the effects of gender-affirming hormone therapy (GAHT) and gender-affirming procedures on the skin in transgender individuals. Methods We conducted a cross-sectional study among transgender people. Skin conditions related to GAHT were assessed, including acne (using the Investigator's Global Assessment, IGA), postacne sequelae, melasma, hypertrichosis in androgen-sensitive areas (HAAs) in transgender men (TM) and hirsutism in transgender women (TW) (using the modified Ferriman-Gallwey score, mFG score), and hair loss (using the Hamilton-Norwood and Ludwig scale) at baseline, 6 months after GAHT, and the day on which the questionnaire was completed. Dermatological problems after gender-affirming procedures were evaluated. Results A total of 159 patients, including 134 TM and 25 TW, were eligible to participate. The median duration of GAHT was 23 and 36 months in TM and TW, respectively. In TM, the median IGA score of facial acne increased from 1 at baseline to 3 after 6 months and decreased to 2 after 2 years of GAHT. The mFG score indicated HAA in all TMs after testosterone treatment. A total of 88.1% of TM had no hair loss before hormone therapy. However, after 2 years of GAHT, 76.1% of TM developed male pattern hair loss (MPHL), and 26.1% of them had moderate-to-severe MPHL. In TW, the median IGA and mFG scores decreased after 3 years of hormone therapy, and the proportion of female pattern hair loss (FPHL) in TW increased to 16% after GAHT. In both groups, the most common skin complication after gender-affirming surgery was hypertrophic scarring. Conclusions GAHT in TM resulted in acne and MPHL, whereas GAHT in TW caused melasma and FPHL.
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Affiliation(s)
- Suthinee Rutnin
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninan Kositkuljorn
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Cherrin Pomsoong
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sira Korpaisarn
- Divisions of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jiraporn Arunakul
- Division of Child and Adolescent Health, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teerapong Rattananukrom
- Divisions of Dermatology and Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Address correspondence to: Teerapong Rattananukrom, MD, MSc, Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, Thailand,
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Effect and Optimal Timing of Extracorporeal Shock-Wave Intervention to Patients With Spasticity After Stroke: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2023; 102:43-51. [PMID: 35394471 DOI: 10.1097/phm.0000000000002019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study investigated the efficacy of extracorporeal shock wave therapy as well as the optimal intervention timing for extracorporeal shock wave therapy for patients with spasticity after stroke. DESIGN A search of randomized controlled trials was conducted in different electronic databases. We performed a meta-analysis to measure the effect of extracorporeal shock wave therapy versus sham interventions on spasticity and limb functionality. The meta-regression analysis was performed to determine the adequate intervention timing of extracorporeal shock wave therapy. The follow-up period of the outcomes was divided into the short (<2 wks), mid (>2 wks and ≤4 wks), and long (>4 wks and ≤3 mos) terms. RESULTS Thirteen studies with 677 participants were evaluated. Spasticity significantly improved throughout the follow-up duration. Limb functionality significantly improved in the short-term follow-up period. The meta-regression analysis showed that patients with stroke duration less than 45 mos may be benefited from extracorporeal shock wave therapy in improving limb function in all follow-up periods. CONCLUSIONS Extracorporeal shock wave therapy is an effective method for reducing spasticity in patients with stroke, and the effect could be maintained for up to 3 mos. Its effects on limb functionality could persist for at least 2 wks. Patients who had stroke for less than 45 mos may have significant benefit from extracorporeal shock wave therapy in all follow-up periods.
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Yi KH, Lee JH, Lee K, Hu HW, Lee HJ, Kim HJ. Anatomical Proposal for Botulinum Neurotoxin Injection Targeting the Platysma Muscle for Treating Platysmal Band and Jawline Lifting: A Review. Toxins (Basel) 2022; 14:toxins14120868. [PMID: 36548765 PMCID: PMC9783622 DOI: 10.3390/toxins14120868] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/03/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
The platysma muscle is a thin superficial muscle that covers the entire neck and lower part of the face. The platysma muscle is the primary target muscle for botulinum neurotoxin injection therapy aimed at treating platysmal band and lower facial lifting. In the procedure of botulinum neurotoxin injection therapy, a lack of knowledge of the anatomy of the platysma muscle and the properties of botulinum neurotoxin can lead to side effects such as dysphagia, dysphonia, and weakness of the neck muscles. Anatomically safe injection sites have been proposed for the platysma muscle, and the appropriate injection technique has been reviewed. We proposed optimal injection sites based on the external anatomical features of the mandible. The aim of these proposal was to standardize the procedure for the effective use of botulinum neurotoxin injections by minimizing the dose unit and injection points and thereby preventing adverse events.
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Affiliation(s)
- Kyu-Ho Yi
- Wonju Public Health Center, Wonjusi 26417, Republic of Korea
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Ji-Hyun Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Kangwoo Lee
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Hye-Won Hu
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
| | - Hyung-Jin Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 PLUS Project, Yonsei University College of Dentistry, 50-1 Yonsei-ro, Seoul 03722, Republic of Korea
- Correspondence: ; Tel.: +82-2-2228-3047
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Liu X, Wang J, Xu X, Zhu H, Man K, Zhang J. SDF-1 Functionalized Hydrogel Microcarriers for Skin Flap Repair. ACS Biomater Sci Eng 2022; 8:3576-3588. [PMID: 35899941 DOI: 10.1021/acsbiomaterials.2c00755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Critically sized skin flaps used to treat skin defects often suffer from necrosis due to insufficient blood supply. Hence there is an urgent need to improve the survival rate of skin flaps by promoting local angiogenesis. The delivery of growth factor loaded microcarriers have shown promise in enhancing defect repair, however, their rapid clearance from the defect site limits their regenerative potential. Thus, it is critical to develop microcarriers which can promote the sustained release of bioactive factors to effectively stimulate tissue repair. This study aimed to develop a stromal cell-derived factor 1 (SDF-1) loaded microcarrier coated with Matrigel (MC@SDF-1@Mat) to promote skin flap repair. SEM imaging showed that the surface of the microcarrier was coated by a porous Matrigel film. The drug release experiment showed that the Matrigel-coated microcarriers enhanced the sustained release of the model drug methylene blue when compared to uncoated group. MC@SDF-1@Mat significantly promoted the proliferation, migration, and angiogenesis of HUVECs via CCK-8, wound healing assay, and tube formation assay, respectively. Moreover, the murine random skin flap model was further established and treated. It was found that the flap necrosis area in the MC@SDF-1@Mat treated group was significantly reduced. H&E and Masson staining showed the histological structure and collagen organization exhibited a normal phenotype in the MC@SDF-1@Mat treated group. Additionally, CD31 immunohistochemical analysis showed that the MC@SDF-1@Mat treated group exhibited the greatest degree of neovascularization. In conclusion, our SDF-1 functionalized gelatin-based hydrogel microcarrier has potential clinical applications in promoting skin flap repair and drug delivery.
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Affiliation(s)
- Xiaochuan Liu
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523710, P.R. China
| | - Jinsi Wang
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523710, P.R. China
| | - Xiaoqin Xu
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523710, P.R. China
| | - Hong Zhu
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523710, P.R. China
| | - Kenny Man
- School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Jingying Zhang
- Key Laboratory of 3D Printing Technology in Stomatology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan 523710, P.R. China
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Lai D, Liu H, Kong L, Cheng S. Delayed complication of botulinum toxin and hyaluronic acid filler injections: A case report. J Cosmet Dermatol 2022; 21:2374-2378. [PMID: 35460324 DOI: 10.1111/jocd.15016] [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: 11/20/2021] [Revised: 03/11/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Botulinum toxin and hyaluronic acid (HA) filler injections are popular minimally invasive cosmetic procedures owing to their convenience, efficiency, and durability; however, adverse reactions often occur. MATERIALS AND METHODS We describe the delayed hypersensitivity reaction that occurred after sequential injections of botulinum toxin and HA filler. RESULTS The histopathologic and dermatoscopic findings suggested a delayed hypersensitivity reaction with the formation of a dermal foreign body granuloma. The rash resolved 2 months following treatment with antihistamines and topical steroids cream. CONCLUSION We assume that local trauma during the blepharoplasty stimulated an immune response, which was the basis for this complication.
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Affiliation(s)
- Dihui Lai
- Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing, China
| | - Hongmei Liu
- Department of Dermatology, MEIYAN Aesthetic Plastic Medical Clinic, Beijing, China
| | - Linghong Kong
- Department of Pathology, Beijing ChuiYangLiu Hospital, Beijing, China
| | - Shaowei Cheng
- Department of Dermatology, Beijing ChuiYangLiu Hospital, Beijing, China
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25
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Leng M, Zhao H. Cervical lymphadenopathy following botulinum toxin type A injection for masseter hypertrophy: is just a coincidence? J Cosmet Dermatol 2022; 21:5264-5265. [PMID: 35263487 DOI: 10.1111/jocd.14904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Mengying Leng
- Department of Plastic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, China
| | - Haiguang Zhao
- Department of Plastic Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, China
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26
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Borba A, Matayoshi S, Rodrigues M. Avoiding Complications on the Upper Face Treatment With Botulinum Toxin: A Practical Guide. Aesthetic Plast Surg 2022; 46:385-394. [PMID: 34341857 PMCID: PMC8328485 DOI: 10.1007/s00266-021-02483-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Currently, botulinum toxin (BoNT) injections are the most commonly performed non-invasive procedure for rejuvenation on the upper face. The therapeutic use of botulinum toxin has generally been safe and well tolerated. Adverse effects are considered mild, transient, and self-limited. However, as with all other injectable procedures, this one is also susceptible to adverse events and complications. When the safety zones are respected, the chance of any of these complications is practically null. Thus, this review aims to describe the main complications of treatment with BoNT on the upper face and to present a practical guide based on current evidence on how to avoid them. METHODS The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. RESULTS The main complications secondary to BoNT injections on the upper face are: ptosis of eyelid or eyebrow, eyebrow asymmetry, diplopia, Lakeophthalmos, Palpebral ectropion, and prominence of the palpebral bags. To avoid such complications, it is necessary to have knowledge of the anatomy of this region and adequate and individualized planning based on the existing patterns of the frontalis muscle, glabella, and crow's feet. This review presents the specificities of each of these regions and practical suggestions to obtain satisfactory results, avoiding complications. CONCLUSION Particularly on the upper face treatment with BoNT offers predictable results, has few adverse effects, and is associated with high patient satisfaction. However, it is suggested that the commented parameters and safety areas be incorporated into daily practice so that the possibilities of complications are minimized as much as possible. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- André Borba
- Department of Ophthalmology, Division of Oculoplastic, University of São Paulo Medical School, 255 Eneas Aguiar Street Office 4079, São Paulo, Zipcode 05403000 Brazil
| | - Suzana Matayoshi
- Department of Ophthalmology, Division of Oculoplastic, University of São Paulo Medical School, 255 Eneas Aguiar Street Office 4079, São Paulo, Zipcode 05403000 Brazil
| | - Matheus Rodrigues
- Department of Medicine, Division of Dermatology, Mato Grosso State University, Tancredo Neves Avenue 1095, Cáceres, Mato Grosso 78200000 Brazil
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Proietti I, Skroza N, Mambrin A, Marraffa F, Tolino E, Bernardini N, Marchesiello A, Rossi G, Volpe S, Potenza C. Aesthetic Treatments in Cancer Patients. Clin Cosmet Investig Dermatol 2021; 14:1831-1837. [PMID: 34898993 PMCID: PMC8654687 DOI: 10.2147/ccid.s342734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022]
Abstract
Cancer patients are experiencing an increase in overall survival as a consequence of earlier diagnosis and newer effective anticancer therapies. However, cancer survivors often face long-term consequences from their original cancer diagnosis and long-term sequelae of anticancer treatment. Maintaining patients' quality of life is of paramount importance and this can be accomplished by a multidisciplinary treatment approach, including aesthetic treatments to improve patients' body image and positively impact their quality of life. In this perspective, we will discuss the importance of aesthetic treatments in cancer patients. In addition, we will summarise the data available regarding the use of several aesthetic treatments such as fillers, botulinum toxin and laser use in cancer patients, their safety, their efficacy, and the specific precautions that need to be implemented in this particular subset of cancer patients.
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Affiliation(s)
- Ilaria Proietti
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
| | - Nevena Skroza
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
| | - Alessandra Mambrin
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
| | - Federica Marraffa
- Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Ersilia Tolino
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
| | - Nicoletta Bernardini
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
| | - Anna Marchesiello
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
| | - Giovanni Rossi
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
| | - Salvatore Volpe
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
| | - Concetta Potenza
- Dermatology Unit “Daniele Innocenzi”, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, 04019, Italy
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Munsterman C, Broussard T, Strauss P. Botulinum Toxin A Injection and Perianesthesia Neuromuscular Monitoring: Case Report and Review. J Perianesth Nurs 2021; 37:11-18. [PMID: 34802920 DOI: 10.1016/j.jopan.2021.05.009] [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: 03/30/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 11/16/2022]
Abstract
The popularity of looking younger has been facilitated by the availability of botulinum toxin (BoNT) injection. In 2019, over 7.7 million injections of BoNT occurred, making it the number one minimally invasive cosmetic procedure in the United States. With the ease of patients obtaining BoNT in an outpatient setting, coupled with the fact that it is considered a minimally invasive procedure, most patients do not disclose the use of BoNT during the preoperative anesthesia evaluation. This case report involves a female whose recent BoNT injections interfered with neuromuscular (NM) monitoring during anesthesia. Neuromuscular monitoring was performed using the orbicularis oculi muscle with repeated train-of-four (TOF) 0/4. It was not until completion of procedure when the arms were accessible that the adductor pollicis muscle was assessed with a TOF of 2/4. During postoperative follow up, the patient revealed she had received BoNT injections prior to surgery. A review of BoNT pharmacology, barriers to NM monitoring and use of sugammadex are discussed. This case demonstrates the importance of ascertaining BoNT injection history in any case in which access to the ulnar nerve or tibial nerve is not available.
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Affiliation(s)
| | | | - Penelope Strauss
- The University of Texas Health Science Center at Houston, Houston, TX
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Temporomandibular Disorder Patients Benefit From Intramuscular Botulinum Toxin Type a Injections. J Craniofac Surg 2021; 33:1159-1161. [PMID: 34743162 DOI: 10.1097/scs.0000000000008331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to analyze the clinical outcome of the use of botulinum toxin type A (BTX) intramuscular injections to the head and neck, particularly the masticatory muscles of patients with temporomandibular disorder (TMD). METHODS The medical records of all patients who had received intramuscular BTX injections between 2005 and 2018 at Päijät-Häme Central Hospital, Lahti, Finland were analyzed retrospectively. Gender, age, previous medical history, number of injections, injection areas, and therapeutic results were collected and analyzed. The outcome was divided into three categories based on the patients' subjective reports: not beneficial, beneficial, and highly beneficial. RESULTS A total of 68 patients had received intramuscular BTX injections in our unit for TMD symptoms. Clinical effectiveness could be analyzed from 63 patients. Overall, 87% of them reported favorable outcomes. 8 (13%) reported BTX injections as not beneficial, 15 (24%) as beneficial, and 40 patients (63%) as highly beneficial.Most patients had already received conventional treatment with an occlusal splint (93%) combined with pain medication (60%) in the primary care units before they were referred to our hospital.There were 59 (83%) female patients, and they responded better to BTX therapy than the male patients: 91% versus 57% (P value = 0.04). Average age at the first BTX injection visit was 44.6 years (range 17.8-77.2). Most commonly (65%), BTX was divided bilaterally to the masseter and temporalis muscles. CONCLUSIONS BTX injections had good therapeutic outcomes for our TMD patients. However, most patients require multiple injection visits.
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Mangan MS, Imamoglu S. Preseptal cellulitis associated with cosmetic eyelash lifting procedure. J Cosmet Dermatol 2021; 20:1846-1848. [PMID: 33829632 DOI: 10.1111/jocd.14142] [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: 02/23/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The increased popularity of periocular cosmetic applications in recent years has resulted in the appearance of various complications. The cosmetic eyelash lifting is one of these new techniques and is gradually becoming more popular. There are no previous reports of any complications of this procedure in the literature. AIMS In this study, we present a clinical case of preseptal cellulitis following cosmetic eyelash lifting procedure. PATIENT/METHODS A 55-year-old woman presented with bilateral eyelid swelling and redness. The history revealed that she had undergone cosmetic eyelash lifting procedure 2 days ago. There was no ocular movement limitation or pain. The biomicroscopic examination revealed bilateral eyelid edema and hyperemia, conjunctival hyperemia, chemosis, and mucopurulent secretion. The diagnosis was preseptal cellulitis when the clinical examination was evaluated together with the results of the laboratory tests and radiological imaging. RESULTS Systemic and topical antibiotics were started, and the signs recovered in the first week. CONCLUSIONS Cosmetic eyelash lifting can rarely be one of the causes of preseptal cellulitis. It is important to detect and treat any blepharitis or meibomitis before the procedure. Eyelid hygiene and the proper sterilization conditions during the procedure must also be ensured.
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Affiliation(s)
- Mehmet Serhat Mangan
- Division of Ophthalmic Plastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Institute, Istanbul, Turkey
| | - Serhat Imamoglu
- Division of Ophthalmic Plastic and Reconstructive Surgery, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Sadik Eratik Eye Institute, Istanbul, Turkey
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Safety Profile of Combined Same-Day Treatment for Botulinum Toxin With Full Face Nonablative Fractionated Laser Resurfacing. Dermatol Surg 2020; 47:500-503. [DOI: 10.1097/dss.0000000000002851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Fairmont I, Winkler A. Novel Cosmetic Uses of Botulinum Toxin in the Head and Neck. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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