A 5-year safety and efficacy evaluation with fibrel in the correction of cutaneous scars following one or two treatments

Subcision for Atrophic Acne Scarring: A Comprehensive Review of Surgical Instruments and Combinatorial Treatments

Subcutaneous incisionless surgery, also known as subcision, is a minimally invasive procedure that is commonly indicated for the treatment of atrophic acne scars. In recent years, many new techniques have been developed to maximize results from this procedure. This review article aims to identify an updated list of instruments and combinatorial treatments available for atrophic acne scar patients undergoing subcision. We constructed a comprehensive PubMed search term and performed triple-blinded screening on all resulting studies for mentions of subcision as indicated by acne scarring. Our results show that there are four main categories of subcision tools that are commonly employed to treat atrophic acne scars: needles, cannulas, wires, and blunt-blade instruments. Usage of these devices varies by scar depth, personal preference, and combinatorial treatment options. Overall, subcision is a particularly effective treatment for atrophic acne scars, and there is vast potential for further innovation with this technique.

Assessment of the efficacy and safety of platelet poor plasma gel as autologous dermal filler for facial rejuvenation

BACKGROUND

The popularity of dermal fillers has grown rapidly in the last few years for facial rejuvenation. Plasma gel is an autologous gelatinous material that is prepared from the patient's own platelet poor plasma.

OBJECTIVE

To evaluate the clinical efficacy and safety of plasma gel injection as a dermal filler for facial rejuvenation.

PATIENTS AND METHODS

The current study was carried out on 52 females presented with facial aging divided into two groups: Group A included 34 females with facial wrinkles, and Group B included 18 females with tear trough deformity. After taking written informed consent, they received two sessions of plasma gel injections at 2-week interval and followed up monthly for 3 months. They were assessed clinically before treatment sessions and at the end of follow-up period.

RESULTS

Both studied groups showed immediate significant clinical improvement after plasma gel injection that maintained till the end of follow-up period. This finding was confirmed by significant reduction in the mean values of Wrinkle Severity Rating Scale (WSRS) in Group A and Tear Trough Rating Scale (TTRS) in group B, and significant improvement of skin homogeneity and texture in both groups. In general, the reported side effects were minimal and transient.

CONCLUSION

Autologous platelet poor plasma gel injection seems to be a cost-effective, safe, well-tolerated, and minimally invasive technique producing significant aesthetic correction of facial wrinkles and tear trough deformity.

History of Dermatologic Cosmetic Surgery

Dermatology has been one of the major disciplines that has contributed to the rapid advancement of cosmetic surgery. Various cosmetic procedures including chemical peel, dermabrasion, hair transplantation, laser surgery, soft-tissue augmentation, and liposuction have been refined or developed by dermatologists. This article describes the involvement by dermatologists in these cosmetic procedures.

Update on Soft Tissue Augmentation

This article reviews all of the materials currently available for soft tissue augmentation as well as those that have recently been available and those undergoing current evaluation for possible use in the future. Techniques, side effects, and tips on the use of each of the substances are described, and the future of soft tissue augmentation is discussed.

Skin rejuvenation without a scalpel. I. Fillers

Fillers are an important tool in the armamentarium of the physician combating aging phenomena. A wide variety of filler substances are now available that meet many, but by far not all, needs in aesthetic medicine. The most commonly used substances now are hyaluronic acid and collagen preparations that have slightly different indications, but collagen requires pre-use testing to rule out inflammatory complications. Poly-L-lactic acid has gained its place in the filling of adipose tissue wasting in HIV-infected patients. Autologous fat is easy to harvest and inject and has virtually no risk of adverse side effects. Permanent fillers may be of advantage but carry the risk of permanent adverse reactions. Skillful combination of different fillers as well as with botulinum toxin injections and other cosmetic procedures may give optimal results.

Dermal fillers for facial soft tissue augmentation

Nowadays, patients are demanding not only enhancement to their dental (micro) esthetics, but also their overall facial (macro) esthetics. Soft tissue augmentation via dermal filling agents may be used to correct facial defects such as wrinkles caused by age, gravity, and trauma; thin lips; asymmetrical facial appearances; buccal fold depressions; and others. This article will review the pathogenesis of facial wrinkles, history, techniques, materials, complications, and clinical controversies regarding dermal fillers for soft tissue augmentation.

Efficacy and safety of polyacrylamide hydrogel for facial soft-tissue augmentation

BACKGROUND

Polyacrylamide is a nonabsorbable soft-tissue filler that has been used for body contouring for more than 10 years. Aquamid is a soft-tissue filler containing polyacrylamide hydrogel. Safety and aesthetic results after injection of polyacrylamide hydrogel for facial soft-tissue enhancement were assessed at a 1-year follow-up.

METHODS

In a prospective, multicenter study, 251 patients were enrolled and assigned for injection of polyacrylamide hydrogel (Aquamid) as a means of facial augmentation and enhancement of facial contours. Subjects with facial contour deformities or soft-tissue deficiencies caused by aging, acne, trauma, surgery, or other causes were included. Persons presenting with connective tissue disorders, skin disorders affecting the face, uncontrolled diabetes mellitus, compromised immune functions or acute inflammatory diseases, known substance abuse, or mental disorders were excluded from participation in the study, as were those who had experienced treatment with any nonabsorbable filler within 6 months before the start of the study. To assess the safety and efficacy of the treatment, follow-up visits were scheduled for day 7, day 28, and 3 months, 6 months, and 12 months after the first injection. Standardized photographs were taken before treatment and during month-3 and month-12 visits. Blood and urine samples were collected and analyzed before injection and at 6 and 12 months after injection. The most common sites of injection were the nasolabial folds (48 percent) and lips (25 percent) followed by glabella folds (8 percent) and other sites. The amount of injected gel ranged from 0.2 to 12 ml.

RESULTS

Two hundred twenty-eight patients were followed for 12 months after treatment. In 93 percent, results were judged to be good or very good by the investigators and satisfactory or very satisfactory by the patients. Adverse events that could be ascribed to the treatment were observed in 37 cases, most commonly presenting as transient swelling, hematoma, redness, and pain or itching. In one case, a slight change of skin color at the site of injection was reported. No severe adverse events related to the gel were observed. In one case, neutropenia was detected in month-12 blood samples. The other values were within the normal ranges.

CONCLUSIONS

Aquamid is an easy-to-use soft-tissue filler. The effect of tissue enhancement lasted over the entire study period. Transient local tissue reactions observed were attributable to the injection procedure rather than the chemical properties of the gel. During the first year after treatment, no permanent soft-tissue reaction was observed. Long-term results need to be evaluated in the future.

Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles

BACKGROUND

A new method of subcuticular underming for the treatment of depressed cutaneous scars and wrinkles is introduced.

OBJECTIVE

To define the newly coined term "Subcision" and to describe this minor surgical procedure for treating depressed scars and wrinkles.

METHODS

A tri-beveled hypodermic needle is inserted through a puncture in the skin surface (hence, "incisionless" surgery), and its sharp edges are maneuvered under the defect to make subcuticular cuts or "-cisions."

RESULTS

The depression is lifted by the releasing action of the procedure, as well as from connective tissue that forms in the course of normal wound healing.

CONCLUSION

This technique is useful in treating a variety of cutaneous depressions, including scars and wrinkles.

The Fibrel mechanism of action study. A preliminary report

BACKGROUND

Fibrel is a medical implant device that has demonstrated use in the correction of cutaneous depressions from acne scars and wrinkles.

OBJECTIVE

Mechanisms of actions have been proposed that have theorized the production of new collagen over time as a result of the Fibrel implant. The present study utilized human volunteers to study the histologic response of Fibrel over time.

METHODS

Fibrel was injected into tattoo sites behind the ears of human volunteers; skin biopsies were taken at various time intervals and studied histologically by a clinical pathologist.

RESULTS

An overall increase over time was noted with regard to production of collagen and inflammatory response. No change in elastic tissue was found.

CONCLUSIONS

Fibrel does promote new collagen synthesis and inflammatory response and thus is useful to correct cutaneous depressions via soft tissue augmentation.