1
|
Paramo R, Barmettler A. Dermal Fillers in the Oculoplastics Office: Applications and Strategies for Complication Prevention and Treatment. Int Ophthalmol Clin 2024; 64:23-28. [PMID: 38910502 DOI: 10.1097/iio.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Affiliation(s)
- Ricky Paramo
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY
| | - Anne Barmettler
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Mannino F, Irrera N, Pallio G, Bitto A. Steady state plasma and tissue distribution of low molecular weight hyaluronic acid after oral administration in mice. Nat Prod Res 2024; 38:773-780. [PMID: 37081790 DOI: 10.1080/14786419.2023.2197598] [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: 12/20/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023]
Abstract
The oral administration is probably the most used and largely applicable method, even if absorption across the intestinal epithelium is a limiting factor that can invalidate the achievement of a therapy. The aim of this study was to assess the steady state bioavailability of very low molecular weight hyaluronic acid (vLMW-HA) and its distribution in different districts of mice. Adult female C57BL6/J mice (n = 26) were divided in three groups and orally treated for 7 days with: saline solution (SHAM-HA), high dose of vLMW-HA (5 kDa; 500 mg/kg/day; HD-vLMW-HA), and low dose of vLMW-HA (5 kDa; 100 mg/kg/day; LD-vLMW-HA). HA content was quantified in plasma, skin, bladder, gut, rectum, vagina, and eyes with ELISA assay at the end of treatment. HA level significantly increased after treatment with HD-vLMW-HA in all analyzed tissues and plasma. Therefore, vLMW-HA easy absorption and distribution after the oral intake opens new possibilities for future biomedical applications.
Collapse
Affiliation(s)
- Federica Mannino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Natasha Irrera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- SunNutraPharm s.r.l., Spin-Off Company of University of Messina, Messina, Italy
| | - Giovanni Pallio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessandra Bitto
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- SunNutraPharm s.r.l., Spin-Off Company of University of Messina, Messina, Italy
| |
Collapse
|
4
|
Schelke L, Harris S, Cartier H, Alfertshofer M, Doestzada M, Cotofana S, Velthuis PJ. Treating facial overfilled syndrome with impaired facial expression-Presenting clinical experience with ultrasound imaging. J Cosmet Dermatol 2023; 22:3252-3260. [PMID: 37772766 DOI: 10.1111/jocd.16013] [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: 07/19/2023] [Revised: 08/26/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Facial overfilled syndrome is an adverse event following minimally invasive soft tissue filler injections. It presents in most cases as excess midfacial volume and/or as unnatural smile which is difficult to detect due to the absence of standardized evaluation methods. OBJECTIVE To showcase how to identify, evaluate, and treat facial overfilled syndrome by utilizing facial ultrasound and simultaneous hyaluronidase injections. METHODS Twenty-eight consecutive patients (26 females, 2 males) were enrolled in this study in which facial ultrasound was performed to evaluate the location previously implanted filler material. The position of the oral commissure was objectively measured in relation to bony landmarks, and the severity of lateral canthal lines was assessed by independent and blinded raters. RESULTS The material was identified in 35.7% inside the subdermal fatty layer, in 28.6% inside the deep supra-periosteal fatty layer, in 10.7% inside the fibrous layer deep to the subdermal fatty layer, whereas in 25.0%, the product was not possible to locate clearly inside one specific layer. On average, 81.6 I.U. [range: 75-150] of hyaluronidase were injected. Lateral canthal line severity was before the treatment 2.28 (1.4) and was after the hyaluronidase treatment 2.02 (1.3) with p = 0.578. The position of the oral commissure increased by 0.60 cm in vertical and by 0.30 cm in horizontal directions (both p < 0.001). CONCLUSION Facial overfilled syndrome following aesthetic soft tissue filler injections can present as excess midfacial volume but also as unnatural smile. Targeted hyaluronidase injections into the culprit pockets inside the midfacial soft tissues have shown to re-establish a natural smile, to reduce excess midfacial volume, and to decrease lateral canthal line severity.
Collapse
Affiliation(s)
- Leonie Schelke
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Sebastian Cotofana
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Peter J Velthuis
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
5
|
Lu JT, Lee KC. Global facial rejuvenation with one treatment of incobotulinumtoxinA, hyaluronic acid, and calcium hydroxyapatite results in long-term patient-reported satisfaction. Int J Womens Dermatol 2023; 9:e124. [PMID: 38028021 PMCID: PMC10664851 DOI: 10.1097/jw9.0000000000000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background Global facial rejuvenation using injectables (neuromodulators and fillers) has reported patient satisfaction after 2 treatments: an initial and touch-up treatment at 2-4 weeks afterward. In practice, patients typically receive only 1 treatment and do not return for a touch-up treatment within a month. Objective The purpose of this study was to assess patient-reported satisfaction after only 1 treatment, thus mimicking real-world scenarios. Methods Patients with facial photoaging (Glogau facial aging scale ≥2) were treated with calcium hydroxyapatite, hyaluronic acid 22.5 mg/mL, and incobotulinumtoxinA injections for full facial rejuvenation, with no touch-up treatments. Patients completed the FACE-Q Satisfaction with Facial Appearance survey at baseline and 1- and 3-month post-treatment. The treating physician completed the Global Aesthetic Improvement Scale at 1- and 3-month post-treatment. Results Twenty-two patients were enrolled in the study, with 1 patient lost to follow-up. There was a significant improvement in mean FACE-Q scores at 1-month (80.1, P = .01) and 3-month (77.9, P = .02) compared to baseline (71.4). Mean Global Aesthetic Improvement Scale scores at 1-month (2.1) and 3-month (2.2) were not statistically significant, indicating sustained improvement at 3 months. The product amount used per patient varied and was not correlated with either score. Limitations included a lack of a control group and follow-up ending at 3 months. Strengths included assessment of patient satisfaction after only 1 treatment, compared to other studies allowing 2 treatments. Limitations Limitations include a small sample size and lack of a control group. Conclusion Global full facial rejuvenation using 1 treatment of calcium hydroxyapatite, hyaluronic acid 22.5 mg/mL, and incobotulinumtoxinA provides sustained patient-reported satisfaction at 3 months.
Collapse
Affiliation(s)
- Jasmine Thai Lu
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Kachiu C. Lee
- Main Line Center for Laser Surgery, Ardmore, Pennsylvania
- Department of Dermatology, Temple University, Philadelphia, Pennsylvania
| |
Collapse
|
6
|
de Maio M, Brenninkmeijer EEA, Nurlin I, Colucci L, Sanchez T. Applying the MD Codes™ to Treat Emotional and Social Attributes with HA Fillers: A Retrospective Serial Case Study. Clin Cosmet Investig Dermatol 2023; 16:3441-3453. [PMID: 38050477 PMCID: PMC10693774 DOI: 10.2147/ccid.s430747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023]
Abstract
Background Aesthetic treatment directed at improving facial emotional messages and social attributes may maximize patient satisfaction with treatment results. The MD Codes™ is an approach to facial aesthetic treatment that accounts for emotional messages and social attributes while minimizing variability in patient assessment, injection technique, injection sites, and treatment outcomes. Objective To assess the impact of the MD Codes systematic treatment approach on emotional and social attributes and natural appearance after facial aesthetic treatment with hyaluronic acid (HA) fillers. Methods A retrospective analysis was performed in patients treated with 12 mL of HA fillers (Juvéderm® Vycross™ products) per patient using the MD Codes. Study injectors, experienced clinician observers, clinical staff, laypeople, and patients evaluated impact of treatment on emotional and social attributes and natural appearance based on pre- and post-treatment photographs of patients. Results Twelve patients and 49 external observers, from 12 countries, evaluated the images. More than 90% of patients named "eye bags" as the facial area most in need of aesthetic treatment; >55% of external observers identified "cheeks." The top 3 facial emotional attributes noted by all evaluators after treatment were, in order, "less tired", "less saggy", and "younger." All patients reported a visible and positive change in emotional attributes except for "less sad." After 9 months, most patients reported looking "less tired" (n=11/12), "less saggy" (n=8/12), and "less sad" (n=6/12). At months 6 and 9, all patients rated their appearance as natural looking. At least 90% of external observers considered the frontal view results natural for all but 1 patient. Patients reported improved positive social attributes (eg, "looking friendlier") and improvements in well-being after treatment. No serious side effects were reported. Conclusion Implementing the MD Codes for facial aesthetic treatment may improve facial emotional attributes as well as enhance social attributes and well-being, with natural-looking results.
Collapse
Affiliation(s)
| | | | | | | | - Tania Sanchez
- Instituto Dermatológico de Jalisco, Zapopan, Jalisco, Mexico
| |
Collapse
|
7
|
Wang X, Xi H, Wei C. Connections between cohesion and properties that related to safety and effectiveness of the hyaluronic acid dermal fillers: A comparative study of the cohesive and non-cohesive gels. Skin Res Technol 2023; 29:e13395. [PMID: 37753686 PMCID: PMC10450830 DOI: 10.1111/srt.13395] [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: 01/18/2023] [Accepted: 06/06/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Although the importance of the cohesion of a hyaluronic acid (HA) filler has been recognized, the relationship between the cohesion and the other performance that related to safety and effectiveness, as well as the underlying mechanism is barely studied. Much efforts need to be made on this subject to provide guidance for clinical practice. MATERIALS AND METHODS Two types of the HA fillers (cohesive and particulate gels) were selected for the comparison of the cohesion and the other key physicochemical properties. RESULTS Hyalumatrix, with significantly higher cohesion, was homogeneously smooth and showed a linearly oriented morphology, whereas Matrifill and Restylane were particulate and showed obvious boundaries between particles. The high cohesion of Hyalumatrix is beneficial to the properties that related to safety and effectiveness, including recovery under shear stress, injectability, tissue integration and in vitro resistance to enzymolysis. The underlying reason was that the strong internal interactions of the cohesive gel protect the network structure from collapse and keep the gel as an intact whole when the gel was subjected to the stress. The homogeneously smooth morphology further improved the tissue compliance and injectability. The G' of Hyalumatrix is in the middle level of the commercially available HA fillers. CONCLUSION Hyalumatrix is a rare HA filler product to possess good cohesion and intermediate G' simultaneously. More clinical practice is needed to verify the connection between the cohesion of Hyalumatrix and the clinical performance.
Collapse
Affiliation(s)
- Xiaotong Wang
- Shanghai Qisheng Biological Preparation Co., LtdShanghaiP. R. China
| | - Hongwei Xi
- Shanghai Qisheng Biological Preparation Co., LtdShanghaiP. R. China
| | - Changzheng Wei
- Shanghai Qisheng Biological Preparation Co., LtdShanghaiP. R. China
| |
Collapse
|
8
|
Chiu A, Bertucci V, Coimbra DD, Li D. Assessment and Treatment Strategies for the Aesthetic Improvement of the Lower Face and Neck. Clin Cosmet Investig Dermatol 2023; 16:1521-1532. [PMID: 37337568 PMCID: PMC10276991 DOI: 10.2147/ccid.s405639] [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: 03/10/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
Background Interest in aesthetic rejuvenation of the lower face and neck is growing, but published expert guidance is limited. Objective Review aesthetic concerns of the lower face and neck and provide expert guidance on evaluation and treatment. Methods Twelve international experts participated in an advisory board on lower face and neck aesthetic treatment. They completed a premeeting survey and met twice, reviewing responses and discussing patient evaluation and treatment strategies. They developed decision tree algorithms on patient assessment and treatment planning and sequencing, using clinical cases as a reference. Results Treatment concerns include neck and lower face skin laxity, structural bone deficiency, insufficient or excess volume, submental fat, jowls, platysma bands, and masseter muscle prominence. Advisors agreed that the lower face and neck may be the most challenging areas to assess and treat; treatment goals include lower facial contour and overall facial harmony/balance. Advisors recommended first ruling out a surgical approach, then determining whether midface treatment is needed to support the lower face, and lastly evaluating the lower face for significant submental fat, excess or insufficient volume, and structural bone deficiency. To treat the lower face and neck, an anatomical layer approach, moving from deep to superficial layers, beginning with structural support, was recommended. Assessment and treatment decision trees were based on this approach. Conclusion The lower face and neck are important but underrecognized areas of aesthetic concern. This article provides expert guidance and a suggested algorithm for assessment and treatment aimed at achieving satisfying and harmonious facial aesthetic results.
Collapse
Affiliation(s)
- Annie Chiu
- The Derm Institute, Redondo Beach, CA, USA
| | | | - Daniel Dal'Asta Coimbra
- Department of Cosmetic Dermatology at Santa Casa de Misericórdia, Rio de Janeiro, RJ, Brazil
| | - Dan Li
- Department of Plastic and Reconstructive Surgery, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China
| |
Collapse
|
9
|
Alonci G, Boussard A, Savona M, Cordella F, Angelici G, Mocchi R, Sommatis S, Monticelli D. A LC-QTOF Method for the Determination of PEGDE Residues in Dermal Fillers. Gels 2023; 9:gels9050409. [PMID: 37233001 DOI: 10.3390/gels9050409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
Hyaluronic acid is one of the most important ingredients in dermal fillers, where it is often cross-linked to gain more favorable rheological properties and to improve the implant duration. Poly(ethylene glycol) diglycidyl ether (PEGDE) has been recently introduced as a crosslinker because of its very similar chemical reactivity with the most-used crosslinker BDDE, while giving special rheological properties. Monitoring the amount of the crosslinker residues in the final device is always necessary, but in the case of PEGDE, no methods are available in literature. Here, we present an HPLC-QTOF method, validated according to the guidelines of the International Council on Harmonization, which enables the efficient routine examination of the PEGDE content in HA hydrogels.
Collapse
Affiliation(s)
| | - Anna Boussard
- Matex Lab Switzerland SA, 1228 Plan-les-Ouates, Switzerland
| | - Martina Savona
- Matex Lab Switzerland SA, 1228 Plan-les-Ouates, Switzerland
| | - Fabiana Cordella
- Dipartimento di Chimica e Chimica Industriale, Università di Pisa, Via Moruzzi 13, 56124 Pisa, Italy
| | - Gaetano Angelici
- Dipartimento di Chimica e Chimica Industriale, Università di Pisa, Via Moruzzi 13, 56124 Pisa, Italy
| | - Roberto Mocchi
- UB-CARE S.r.l., Spin-Off University of Pavia, Via della Scienza 12, 27100 Pavia, Italy
| | - Sabrina Sommatis
- UB-CARE S.r.l., Spin-Off University of Pavia, Via della Scienza 12, 27100 Pavia, Italy
| | - Damiano Monticelli
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| |
Collapse
|
10
|
Dubrovin EV, Barinov NA, Ivanov DA, Klinov DV. Single-molecule AFM study of hyaluronic acid softening in electrolyte solutions. Carbohydr Polym 2023; 303:120472. [PMID: 36657830 DOI: 10.1016/j.carbpol.2022.120472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Investigation of hyaluronic acid (HA) morphology and mechanical properties at a single-molecule level is important for the development of HA based biomaterials. We have developed the atomic force microscopy (AFM) based approach for quantitative characterization of conformation of HA molecules. HA molecules adsorbed on a modified graphitic surface form oriented linear segments. Conformation of HA molecules can be considered as two-dimensional quasi-projection of a three-dimensional conformation locally straightened by a substrate. The persistence length and Young's modulus of biomolecules estimated using wormlike chain model decrease from 15.7 to 9.9 nm, and from ∼21 to ∼13 GPa, respectively, when KCl concentration increases from 0 to 100 mM. The dependence of the persistence length on ionic strength supports the Odijk-Skolnick-Fixman model of polyelectrolyte stiffening in electrolyte solution. The obtained results represent a new insight into the conformation and mechanical characteristics of HA molecules and complement the characterization of this biopolymer by bulk methods.
Collapse
Affiliation(s)
- Evgeniy V Dubrovin
- Sirius University of Science and Technology, 1 Olympic Ave, 354340 Sochi, Russian Federation; Moscow Institute of Physics and Technology, Institutskiy Per. 9, Dolgoprudny 141700, Russian Federation; Lomonosov Moscow State University, Leninskie Gory 1 bld. 2, 119991 Moscow, Russian Federation.
| | - Nikolay A Barinov
- Sirius University of Science and Technology, 1 Olympic Ave, 354340 Sochi, Russian Federation; Moscow Institute of Physics and Technology, Institutskiy Per. 9, Dolgoprudny 141700, Russian Federation.
| | - Dmitry A Ivanov
- Sirius University of Science and Technology, 1 Olympic Ave, 354340 Sochi, Russian Federation; Institut de Sciences des Matériaux de Mulhouse - IS2M, CNRS UMR7361, 15 Jean Starcky, Mulhouse 68057, France.
| | - Dmitry V Klinov
- Sirius University of Science and Technology, 1 Olympic Ave, 354340 Sochi, Russian Federation; Moscow Institute of Physics and Technology, Institutskiy Per. 9, Dolgoprudny 141700, Russian Federation.
| |
Collapse
|
11
|
Michon A, Hassan H. Is More Better? Benefits of Hyaluronic Acid Soft Tissue Filler on the Psychological- and Social-Related Quality of Life Dimensions. Aesthet Surg J Open Forum 2022; 4:ojac086. [PMID: 36540630 PMCID: PMC9757680 DOI: 10.1093/asjof/ojac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Hyaluronic acid (HA) soft tissue fillers are popular for volumizing, sculpting, or rejuvenating the face. Their effect beyond these cosmetic benefits remains poorly defined, especially the changes in the psychological and social dimensions of health following cosmetic HA filler injections. Objectives To determine whether injecting more facial aesthetic units with HA soft tissue filler will improve the health-related quality of life dimension of patients. Methods A prospective study was conducted to assess the psychological and social benefits of treating multiple facial aesthetic units with HA soft tissue filler using 3 validated FACE-Q scales at baseline and 4 weeks posttreatment between January and August 2022. Results Data for 28 participants (n = 26 females [93%]; mean age: 49.7 ± 10.1 years) are available and reveal significant improvements on the psychological (+24.5; P < .001) and social functioning (+18.5; P < .001) FACE-Q scales and a reduction in the appearance-related distress score (-17.8; P < .001) posttreatment compared to baseline. A mean volume of 4.7 mL (range 1.0-15.2 mL) was injected. However, patients who had >2 facial aesthetic units injected did not statistically score better on the FACE-Q scales. Conclusions Facial treatment with HA fillers was associated with a marked improvement in the health-related quality of life dimension. While understanding patients' aims and motivation, an individualized treatment approach is strongly encouraged instead of a "whole-face" approach. Level of Evidence 3
Collapse
Affiliation(s)
- Alain Michon
- Corresponding Author: Dr Alain Michon, 349 St. Laurent Blvd, Ottawa, Canada K1K 2Z7. E-mail:
| | - Haidar Hassan
- Clinical senior lecturer, Blizard Institute, Queen Mary University of London, London, UK
| |
Collapse
|
12
|
Calomeni M, Alfertshofer MG, Frank K, Moellhoff N, Dennison R, Bravo B, Schelke L, Velthuis P, Green JB, Cotofana S. Real-Time Ultrasound Imaging of the Tear Trough: Lessons Learned From Functional Anatomy. Aesthet Surg J 2022; 42:518-526. [PMID: 34610093 DOI: 10.1093/asj/sjab351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The tear trough is one of the most challenging facial regions for soft-tissue filler injections. A thorough understanding of the underlying facial, muscular, and vascular anatomy is crucial to perform safe and effective tear trough injectable treatments. OBJECTIVES The authors sought to evaluate the location and function of the angular vein in the tear trough in 3 different facial expressions: repose, smiling, and max. orbicularis oculi contraction. METHODS Twenty study participants with a mean age of 48.3 years and mean BMI of 24.5 kg/m2 were investigated via functional ultrasound imaging. The diameter of the angular vein and the velocity and direction of venous blood flow were analyzed in repose, smiling, and during max. orbicularis oculi contraction. RESULTS The angular vein was identified in 100% of the cases to travel inside the orbicularis oculi muscle (intra-muscular course) within the tear trough, whereas the angular artery was not identified in this location. The distance between the angular vein and the inferior orbital rim was (lateral to medial): 4.6 mm, 4.5 mm, 3.9 mm, and 3.8 mm. The caudally directed blood flow was in repose 10.2 cm/s and was 7.3 cm/s at max. orbicularis oculi muscle contraction; however, no blood flow was detectable during smiling. CONCLUSIONS The diameter and the venous blood flow of the angular vein varied between the 3 tested facial expressions. Based on these anatomical findings, the deep injection approach to the tear trough is recommended due to the intramuscular course of the angular vein.
Collapse
Affiliation(s)
| | - Michael G Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | - Konstantin Frank
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | - Nicholas Moellhoff
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Germany
| | | | | | - Leonie Schelke
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | | |
Collapse
|
13
|
Lorenc ZP, Jones D, Kim J, Gwak HM, Batham S, Vachon G. Validating a Series of Photonumeric Rating Scales for Use in Facial Aesthetics Using Statistical Analysis of Intra- and Inter-rater Reliability. Aesthet Surg J Open Forum 2021; 3:ojab039. [PMID: 35350387 PMCID: PMC8958901 DOI: 10.1093/asjof/ojab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Growing demand for minimally invasive aesthetic procedures to correct age-related facial changes and optimize facial proportions has been met with innovation but has created an unmet need for objective assessment tools to evaluate results empirically. Objectives The purpose of this study is to establish the intra- and inter-rater reliability of ordinal, photonumeric, 4-, or 5-point rating scales for clinical use to assess facial aesthetics. Methods Board-certified plastic surgeons and dermatologists (3 raters) performed live validation of jawline contour, temple volume, chin retrusion, nasolabial folds, vertical perioral lip lines, midface volume loss, lip fullness, and crow's feet dynamic- and at rest-rating scales over 2 rounds, 2 weeks apart. Subjects selected for live validation represented the range of scores and included 54 to 83 subjects for each scale. Test-retest reliability was quantitated through intra- and inter-rater reliability, determined from the mean weighted kappa and round 2 intraclass correlation coefficients, respectively. The clinical significance of a 1-grade difference was assessed through rater comparison of 31 pairs of side-by-side photographs of subjects with the same grade or a different grade on the developed scales. Results The study demonstrated substantial to near-perfect intra- and inter-rater reliability of all scales when utilized by trained raters to assess a diverse group of live subjects. Furthermore, the clinical significance of a 1-point difference on all the developed scales was established. Conclusions The high test-retest reliability and intuitive layout of these scales provide an objective approach with standardized ratings for clinical assessment of various facial features.
Collapse
Affiliation(s)
- Z Paul Lorenc
- Corresponding Author: Dr Z. Paul Lorenc, 983 Park Avenue, New York, NY 10028, USA. E-mail:
| | | | | | | | | | | |
Collapse
|
14
|
Valachová K, Šoltés L. Hyaluronan as a Prominent Biomolecule with Numerous Applications in Medicine. Int J Mol Sci 2021; 22:7077. [PMID: 34209222 PMCID: PMC8269271 DOI: 10.3390/ijms22137077] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
Hyaluronan (HA) is a natural glycosaminoglycan present in many tissues of all vertebrates. HA has various biological functions, which are dependent on its molar mass. High-molar-mass HA has anti-angiogenic, immunosuppressive and anti-inflammatory properties, while low-molar-mass HA has opposite effects. HA has also antioxidative properties, however on the other hand it can be readily degraded by reactive oxygen species. For many years it has been used in treatment of osteoarthritis, cosmetics and in ophthalmology. In the last years there has been a growing interest of HA to also be applied in other fields of medicine such as skin wound healing, tissue engineering, dentistry and gene delivery. In this review we summarize information on modes of HA administration, properties and effects of HA in various fields of medicine including recent progress in the investigation of HA.
Collapse
Affiliation(s)
- Katarína Valachová
- Centre of Experimental Medicine, Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, Dúbravská cesta 9, 84104 Bratislava, Slovakia;
| | | |
Collapse
|