Injectables and Fillers
Lifting the corner of the mouth.
Feb 3rd
Scottsdale – When the corner of mouth sags, the individual can look sad, angry and aged.
There are several ways of lifting the corner of the mouth.
The non-surgical method includes the application of Botox to the Depressor Anguli Oris (DAO) muscle. This is the simplest approach to the problem with the down-turned corner of the mouth. It is a nice, quick and relatively pain-free approach. The down side is that results only last about 3 to 4 months. The treatment has to be repeated to maintain the results. Adding dermal filler, like Juvederm or Restylane, can make the results more impressive and longer lasting.
The DAO can also be surgically manipulated. Direct surgical manipulation can lift the corners and create a more permanent result. This can be performed during facelift surgery. This procedure, however, is relatively new and results will vary depending on surgeon experience.
Another approach includes the direct lift of the corner of the mouth. This is performed with the excision of a small sliver of skin right above the corner of the mouth. With the closure of the incision that is created, the corner of the mouth comes up to a normal level and the patient loses that scowling downward turn of the mouth. This is a procedure that has a long history and is more predictable.
Liquid Face Lift.
Feb 2nd
Non-surgical liquid facelift.
Scottsdale – A liquid face lift involves the use of advanced dermal fillers with the capacity to last longer used in combination with BOTOX® to rejuvenate the appearance of the face. The dermal fillers used are considered 2nd generation dermal fillers and provide more enduring results than earlier products.
The new group of 2nd generation, advanced dermal fillers includes:
Juvederm Ultra, Juvederm Ultra Plus, and Juvederm XC
Radiesse® and Radiesse® with lido
Restylane® and Perlane®
Sculptra®
Using these products a liquid face lift can give your face a gentle lift, reduce your wrinkles, laugh lines and other folds, and restore a more natural, rested and energetic appearance to your face.
FDA approves Juvederm XC.
Feb 1st
Scottsdale – Allergan, Inc., today announced the U.S. FDA’s approval of JUVÉDERM® XC, a new formulation of the currently FDA-approved JUVÉDERM® dermal filler and the latest advancement in hyaluronic acid (HA) dermal fillers. Allergan’s new JUVÉDERM® formulation contains the local anesthetic lidocaine to provide patients with enhanced comfort during treatment of moderate to severe facial wrinkles and folds, such as the nasolabial folds that appear around the nose and mouth. JUVÉDERM® is the first and only hyaluronic acid dermal filler approved by the FDA to last up to one year from initial treatment and number-one selling hyaluronic acid dermal filler (Source: Businesswire).
Dermal fillers in rhinoplasty?
Jan 21st
Dermal fillers for Rhinoplasty?
Scottsdale – Dermal fillers are not FDA approved for rhinoplasty or post-rhinoplasty correction. However, because of their potential reversibility, low risks and ease of use, these are used in the nose with high frequency, especially for correction of minor defects after rhinoplasty.
The latest issue of the Aesthetic Surgery Journal discusses the use of dermal fillers to correct post-rhinoplasty deformities in the nose. The article was published through the University of Illinois Medical Center in Chicago.
The authors point out that dermal fillers are minimally invasive and can reduce the financial expense, anesthetic risks, or downtime associated with revision nose surgery. The researchers discussed these options and give some sound advice.
The authors like hyaluronic acid (HA) derivatives, such as Restylane and Juvederm, and calcium hydroxylapatite gel, such as Radiesse. Tips on patient selection and injection technique in the article are important, including:
1. Nasal injection includes sub-SMAS placement to reduce visible or palpable nodules.
2. Restricting the use of fillers to the nasal dorsum and sidewalls.
3. Avoiding injections to the tip and alae, which carry more adverse risks with injections.
4. Radiesse is an acceptable treatment for post-rhinoplasty deformities, but patients must be carefully selected to minimize risks.
5. Avoid silicone altogether because of severe granulomatous reactions, infection, thinning of the skin, and necrosis.
I found the article to be quite useful. I do agree with the authors, patients who are treated with dermal fillers must be followed closely for complications. The use of any soft tissue filler must be carefully considered by the patient. An explanation of the risks and the off-label use must be clearly explained to patients before any non-surgical plastic surgery procedure is administered (model used in illustration).
New study: Botox used to treat unsightly (hypertrophic) scars.
Nov 26th
Scottsdale – Hypertrophic scarring is best described as a refractory skin disease. Patients with this disease experience major physical deformities, restricted range of motion, pain, and itching where this scarring occurs. Because the basis for hypertrophic scar has not been fully elucidated, the clinical management of these thickened scars remains a problem. A recent article in the journal, Aesthetic Plastic Surgery, demonstrates the efficacy of using botulinum type A, also known as Botox, for the treatment of these thick and unpleasant scars that offers hope for patients.
Nineteen patients were enrolled in the study. All patients had only one lesion, each one had persisted for at least 2 years and had maintained active hypertrophic characteristics. All patients were treated once a month with intralesional botulinum type A for a total of 3 months. Each lesion was injected until slight blanching was visible. The dosage was adjusted to 2.5 U per cubic centimeter of lesion.
The lesions were found, 3 on the face and neck, 5 on the chest, 6 on the back, 3 on the earlobe, and 2 on the buttocks. Patients and surgeons were allowed to assess the results with an average follow up period at 6 months.
All the lesions had some positive response. In the assessment from the plastic surgeons, improvement was seen in 15 lesions that reached a ‘‘good,’’ rating, including 1 on the face, 2 on the neck, 3 on the chest, 5 on the back, 2 on the earlobe, and 2 on the buttocks. Four lesions reached an ‘‘excellent’’ rating, including 1 on the back, 2 on the chest, and 1 on the earlobe.
The authors speculate that botulinum type A affects the cell cycle distribution of fibroblasts derived from the hypertrophic scars as the most likely explanation for their findings.
I like this study because injection of Botox is simple and safe and the before and after photos of the lesions are quite impressive. However, the study has limitations. First, it did not include a control group and was not double blinded, which may affect the degree of confidence. Additionally, the follow-up period was only six months.
It may be possible to offer Botox to some patients based on this research, but it should be made clear to patients that more research will be needed to see how well this technique works and what the long-term results actually last. Moreover, use if Botox in such cases would be off -label.
New Study: Fat grafting shown to improve skin quality.
Sep 23rd
Scottsdale – Fat grafting in plastic surgery is not new, but a new study published in the September issue of Plastic and Reconstructive Surgery outlines results which demonstrate a positive effect of fat grafting on human skin. The study was conducted in France. According to the researchers, the aim of this study was to investigate the histologic modifications of the skin after fat tissue grafting on an animal model.
In the study 30 nude mice, divided into three groups, were used. All 30 mice received human fat tissue on one side. On the opposite side, 10 mice received nothing (negative control group), 10 mice received cell proliferation medium, and the remaining 10 mice received only subcutaneous tunneling. After 8 weeks the investigators analyzed the tissues via biopsy of the skin and subcutaneous tissue. Dermis thickness was measured. To differentiate human from mice collagen fibers, human and murine (mice) collagen type I antibodies were used.
The results found human fat tissue was in all animals and appeared normal, with abundant peripheral neo-vascularization (establishing a new blood supply). Examination under the microscope, showed abundant extracellular matrix around the injected human fat tissue. This was primarily type I collagen fibers of mice origin as a result of the murine fibroblast stimulation by the grafted human fat tissue. Dermal thickness after fat grafting was significantly greater. The researchers excluded inflammation as a cause of the increased thickness because no modification was detected in our control groups.
For years, plastic surgeons have been reporting improved skin quality after fat grafting. However, a biologic mechanism has not been fully elucidated to account for these observations. This study demonstrates the biologic steps which lead to improved skin quality. Based on the findings, it is safe to say that the generation of collagen in the overlying skin produces several positive effects. Overall, this study shows that fat tissue grafting stimulates a neo-synthesis of collagen fibers at the recipient site and makes the dermis thicker. However, I agree with the investigators that long-term effects remain undetermined and need further investigation.
