Update on botulinum toxin and dermal fillers

Anatomical considerations of medial eye wrinkles: Guidelines for botulinum neurotoxin injections

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.

Potential benefits of adipose–derived SVF and MSCs to regenerate damaged tissues from alloplastic synthetic materials

Recent advancements in Plastic Surgery and Regenerative MedicineQuery have revolutionized tissue repair, remodeling, and regeneration. A promising approach involves Mesenchymal Stem cells and from the adipose–derived Stromal Vascular Fraction, aimed at improving tissue healing post the use of synthetic materials. This integration shows potential in mitigating adverse effects of synthetic materials like dermal fillers, offering new clinical interventions for tissue repair and regeneration. This article explores the benefits, complications, and applications of these technologies in Plastic Surgery and Cosmetic Medicine, focusing on their mechanisms of action and future perspectives.

 Level of evidence: Not ratable

Application of Nonsurgical Modalities in Improving Facial Aging

Objective. This review aims to summarize different kinds of applications of minimally invasive surgery in improving facial aging to provide a comprehensive and accurate introduction on the issue of esthetic treatment of facial skin. Overview. In the twentieth century, facial rejuvenation has become a new beauty trend. Facial cosmetology has entered a period of antiaging and rejuvenation therapies and microplastic surgery. The pursuit of beauty has promoted the development of minimally invasive plastic surgery. This review introduces the possible causes of facial aging and its related topics with a focus on facial injectable drugs, such as botulinum toxin, main filler materials (hyaluronic acid, calcium hydroxyapatite, poly L-lactic acid, collagen, autologous fat, and polymethyl methacrylate), and some current antiwrinkle technologies, such as thread lift and radiofrequency rhytidectomy. Conclusions. Despite the difference in mechanisms of action, each technique can address facial aging involving the loss of collagen, displacement and enlargement of fat, and muscle relaxation. Combinations of these treatments can provide patients with reasonable, comprehensive, and personalized treatment plans.

The role of neurotoxins in the periorbital and midfacial areas

Initially popularized for the treatment of strabismus and blepharospasm, injection of botulinum neurotoxin has become the most commonly performed cosmetic treatment in the United States. Injection techniques have been particularly well-studied in the midface and periocular region, and patient satisfaction tends to be very high. We review the salient differences among available neurotoxins, how to optimally reconstitute them, how to inject the forehead, glabella, lateral canthal lines ("crow's feet"), infralid region, and transverse nasal lines ("bunny lines"), how to sculpt the brow, and how to manage potential complications.

Survey of Common Aesthetic Practices Among Oculofacial Surgeons in Parts of the Asia-Pacific

PURPOSE

An anonymous Web-based survey was performed to assess the current practices, preferences, and complications of aesthetic procedures encountered by oculofacial surgeons in the Asia-Pacific. Results were compared with a similar study carried out in 2007 among members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).

DESIGN

This was a cross-sectional survey study.

METHODS

The study survey was sent out via e-mail to 131 oculofacial surgeons in 14 countries in the Asia-Pacific. Survey questions included the demographics of survey respondents, practices, preferences, and complications of aesthetic procedures encountered by the surgeons.

RESULTS

Seventy-four respondents (56.5%) attempted the survey between May and December 2012. Only completed surveys (43 surveys) were included in our analysis. Eighty-six percent of respondents performed aesthetic procedures in their practice. The top 3 most common nonsurgical procedures reported were injection of botulinum toxin (94.1% of respondents), tissue fillers (61.8%), and skin resurfacing (11.8%), whereas the top 3 most common surgical procedures reported were blepharoplasty (100% of respondents), brow lift (94.6%), and midface lift (29.7%).

CONCLUSIONS

The majority of our study respondents performed aesthetic procedures in their practice. The percentage of practices that comprised aesthetics services was lower than that seen in the ASOPRS study. The percentage of respondents who performed injection of botulinum toxin, tissue fillers, brow lifts, and thread lifts were similar to those in the ASOPRS study; however, the percentage of respondents who performed ablative skin resurfacing was much lower.