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de Sanctis Pecora C. The Anatomical Layering Assessment: The Construction of Beauty. Clin Cosmet Investig Dermatol 2024; 17:605-620. [PMID: 38505808 PMCID: PMC10949303 DOI: 10.2147/ccid.s447865] [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: 11/02/2023] [Accepted: 02/20/2024] [Indexed: 03/21/2024]
Abstract
Restructuring an aging face from bone structure to the surface of the skin can be metaphorically compared to building and renovating a house. While each anatomical layer of the face undergoes an aging process of its own, there is also an interdependency of superficial structures on deeper layers, so that a change in one layer may lead to changes to the adjacent layers. This interaction among the structures deep into the skin, along with the skin's ability to envelope them is what determine the aspect of the aging face. Thus, a careful assessment of all the layers is imperative and we describe herein a step-by-step facial layering assessment and facial restructuring approach from bone structure to the surface of the skin to implement a treatment plan able to deliver a harmonious rejuvenating outcome.
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2
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Soares DJ. Commentary on "How to improve infraorbital hollows with neuromodulators-A clinical prospective interventional study about the application of facial biomechanics". J Cosmet Dermatol 2023. [PMID: 37983907 DOI: 10.1111/jocd.16096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Danny J Soares
- American Foundation for Aesthetic Medicine (AFFAM), Fruitland Park, Florida, USA
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Germani M, Almeida CCMS, Munoz-Lora VRM, Rogério V, Moelhoff N, Freytag DL, Green JB, Alfertshofer M, Davidovic K, Cotofana S. How to improve infraorbital hollows with neuromodulators-A clinical prospective interventional study about the application of facial biomechanics. J Cosmet Dermatol 2023; 22:2950-2956. [PMID: 37632259 DOI: 10.1111/jocd.15970] [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: 05/23/2023] [Revised: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND A previous injection algorithm termed the "Toxin Lift" was recently introduced and described volume increases in the midface following neuromodulator treatments of the jawline. Increase in midfacial volume due to soft tissue repositioning could also affect the severity of infraorbital hollows. OBJECTIVE The objective is therefore to evaluate whether the severity of infraorbital hollows can be improved by injecting neuromodulators in the supra-mandibular segment of the platysma. MATERIALS AND METHODS A total of 35 volunteers (11 males/24 females) with a mean age of 39.8 (9.6) years and a mean BMI of 25.2 (5.2) kg/m2 were investigated. Bilateral infraorbital regions were evaluated via clinical assessment and semi-quantitative 3D imaging. The applied injection technique targeted the platysma via four injection points administering 5 I.U. per injection point resulting in a total of 20 I.U. per facial side. RESULTS Volume increase of the infraorbital region was 0.13 cc at 15 days (p = 0.001) and was 0.02 cc at 30 days (p = 0.452) whereas the skin displacement in cranial direction was 0.54 mm at 15 days (p < 0.001) and was 0.31 mm at 30 days (p < 0.001). Clinical evaluation revealed a highly statistically significant improvement of the tear trough, palpaebromalar groove, and of the lid-cheek junction when compared to baseline with all p < 0.001. CONCLUSION The results of this clinical prospective interventional analysis revealed that the "Toxin Lift" injection technique is capable to improve the clinical appearance of infraorbital hollows. The effects can be explained by the concepts of facial biomechanics.
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Affiliation(s)
| | | | | | | | - Nicholas Moelhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - David L Freytag
- Department of Plastic Surgery, Gemeinschaftsklinikum Havelhöhe, Berlin, Germany
| | - Jeremy B Green
- Skin Associates of South Florida and Skin Research Institute, Coral Gables, Florida, USA
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian University Munich, Munich, Germany
| | - Kristina Davidovic
- Department of Radiology & Medical School, University of Belgrade, Belgrade, Serbia
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
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4
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Martín JM, Revelles JM, Aznar NM, Jiménez LM, Orellana JB, Gomariz MÁ, Alfertshofer M, Cotofana S. Superficial versus deep injections of the upper midface-A prospective interventional split-face study. J Cosmet Dermatol 2023; 22:2940-2949. [PMID: 37594172 DOI: 10.1111/jocd.15795] [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: 03/10/2023] [Accepted: 04/16/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Various injection algorithms have been proposed in the past which are in line with the three aesthetic principles: upper face first, lateral face first, and deep regions first. However, increasing evidence is provided that the upper midface can be targeted with superficial soft tissue filler injections alone too. OBJECTIVE To investigate in a prospective split-face study design whether superficial or deep upper midfacial injections provide superior aesthetic outcomes. METHODS A total of n = 20 study participants (100% females; age 43.95 (11.7) years; BMI 22.92 (2.6) kg/m2 ) were treated with superficial soft tissue filler injections on side of their face and deep injections on the contralateral side with a mean volume of 0.78 cc. Outcome was evaluated at 7 weeks follow-up for midfacial, and lower facial volume, for medial and lateral facial skin vector displacement, and for improvement of nasolabial, crow's feet, and upper cheek fullness severity scores. RESULTS No adverse events related to safety or product tolerability were observed during the entire study period. All semiquantitative scores improved statistically significantly after the observational period (p < 0.001) but displayed no difference between the two applied injection techniques (p > 0.05). CONCLUSION The results of this split-face study revealed that both the superficial and the deep cannula injection technique for midface volumization statistically significantly improve the midfacial volume, reduce nasolabial fold and crow's feet severity. No statistically significant difference was observed between the two injection techniques when compared via semiquantitative and objective outcome evaluation after 7 weeks follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Michael Alfertshofer
- Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munchen, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Lorenc ZP, Smith S, Bass LS, Bank D, Weiss R, Canfield D, D’Alessandro BM, Cramer LM. Validating the Reliability and Clinical Relevance of an Infraorbital Hollow Photonumeric Scale. Aesthet Surg J Open Forum 2023; 5:ojad052. [PMID: 37564461 PMCID: PMC10411921 DOI: 10.1093/asjof/ojad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Background Infraorbital hollowing is a facial aesthetic issue for which a broad age range of patients seek treatment. Expanding treatment options for this region warrants the development of validated tools to objectively assess infraorbital hollow (IOH) severity before and after treatment. Objectives To validate a 4-point rating scale to assess depression of IOH, depression relative to the mid-pupillary line, and visibility of the lateral orbital rim. Methods The IOH scale described herein was developed and subjected to live validation with a total of 73 patients representing the full range of IOH severities. Scale validation was performed by board-certified plastic surgeons and dermatologists (3 raters) over 2 rounds, 2 weeks apart. Intrarater and interrater reliabilities were used to demonstrate test-retest reliability as quantitated with percentage of agreement, weighted kappa statistic with 95% confidence interval (CI), and intraclass correlation coefficient with 95% CI. The clinical relevance of a 1-grade difference was evaluated by comparing rater assessments of 77 photo pairs with their previously determined designation as "clinically different" or "not clinically different." Results The IOH scale demonstrated substantial to near-perfect intrarater and interrater reliabilities when utilized by trained raters to assess a diverse group of live patients. Furthermore, clinically relevant differences between grades were established, and detection of a 1-point difference could be achieved by trained evaluators using the IOH scale. Conclusions This highly reliable, clinically relevant, and validated IOH scale provides a user-friendly, standardized grading system to objectively evaluate and track changes in infraorbital hollowing in clinical practice and research. Level of Evidence 3
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Affiliation(s)
- Z Paul Lorenc
- Corresponding Author: Dr Z. Paul Lorenc, 983 Park Ave, New York, NY 10028, USA. E-mail:
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Hayajneh A, Shaqfeh M, Serpedin E, Stotland MA. Unsupervised anomaly appraisal of cleft faces using a StyleGAN2-based model adaptation technique. PLoS One 2023; 18:e0288228. [PMID: 37535557 PMCID: PMC10399833 DOI: 10.1371/journal.pone.0288228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/22/2023] [Indexed: 08/05/2023] Open
Abstract
A novel machine learning framework that is able to consistently detect, localize, and measure the severity of human congenital cleft lip anomalies is introduced. The ultimate goal is to fill an important clinical void: to provide an objective and clinically feasible method of gauging baseline facial deformity and the change obtained through reconstructive surgical intervention. The proposed method first employs the StyleGAN2 generative adversarial network with model adaptation to produce a normalized transformation of 125 faces, and then uses a pixel-wise subtraction approach to assess the difference between all baseline images and their normalized counterparts (a proxy for severity of deformity). The pipeline of the proposed framework consists of the following steps: image preprocessing, face normalization, color transformation, heat-map generation, morphological erosion, and abnormality scoring. Heatmaps that finely discern anatomic anomalies visually corroborate the generated scores. The proposed framework is validated through computer simulations as well as by comparison of machine-generated versus human ratings of facial images. The anomaly scores yielded by the proposed computer model correlate closely with human ratings, with a calculated Pearson's r score of 0.89. The proposed pixel-wise measurement technique is shown to more closely mirror human ratings of cleft faces than two other existing, state-of-the-art image quality metrics (Learned Perceptual Image Patch Similarity and Structural Similarity Index). The proposed model may represent a new standard for objective, automated, and real-time clinical measurement of faces affected by congenital cleft deformity.
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Affiliation(s)
- Abdullah Hayajneh
- Electrical and Computer Engineering Department, Texas A&M University, College Station, TX, United States of America
| | - Mohammad Shaqfeh
- Electrical and Computer Engineering Program, Texas A&M University, Doha, Qatar
| | - Erchin Serpedin
- Electrical and Computer Engineering Department, Texas A&M University, College Station, TX, United States of America
| | - Mitchell A Stotland
- Division of Plastic, Craniofacial and Hand Surgery, Sidra Medicine, and Weill Cornell Medical College, Doha, Qatar
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Hernandez CA, Zapata DEU, Bermudez MP, Frank K, Moellhoff N, Alfertshofer M, Gotkin RH, Davidovic K, Cotofana S. Clinical validation of the upper face first principle-A clinical, prospective, interventional split-face study. J Cosmet Dermatol 2023; 22:418-425. [PMID: 36573471 DOI: 10.1111/jocd.15563] [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: 08/18/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous clinical and anatomic investigations have identified the clinical relevance of facial biomechanics. Based on this new understanding, principles for facial aesthetic procedures were established: Lateral Face First, Deep Layers First, and Upper Face First. OBJECTIVE To test the upper face first principle by showing that an injection sequence, starting in the upper face is superior to an injection sequence starting in the lower face. METHODS This study was designed as an interventional split-face study administering the same amount and type of soft tissue filler for the upper, middle, and lower face but in a different sequence: upper, middle, lower face versus lower, middle, and upper face. A total of 15 patients (5 males and 10 females) with a mean age of 39.4 years (9.6) and a mean BMI of 23.4 kg/m2 (1.7) were studied. Follow-up at D0, D30, and D90 was conducted utilizing semiquantitative scores and objective 3D imaging. RESULTS Despite not reaching statistical significance, midfacial volume and jawline contouring were rated better at every follow-up visit (D0, D30, D90) when treated with the upper versus the lower face first injection algorithm. The global aesthetic improvement scale showed statistically significantly better values for the upper face first algorithm when compared to the lower face first algorithm at all evaluated time points with all p < 0.001. CONCLUSION Applying the upper face first injection algorithm seems to result in better aesthetic outcomes when directly compared to the lower face first algorithm. Semiquantitative and objective outcome measurements confirm its clinical effectiveness.
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Affiliation(s)
| | | | | | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, LMU University Hospital, Munich, Germany
| | | | - Kristina Davidovic
- Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Belgrade, Serbia
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Wang X, Wu Y, Li B, Mu X, Li L. Lifting the midface using a hyaluronic acid filler with lidocaine: A randomized multi-center study in a Chinese population. J Cosmet Dermatol 2022; 21:6710-6716. [PMID: 35925834 DOI: 10.1111/jocd.15286] [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: 04/06/2021] [Revised: 05/20/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Soft-tissue augmentation of the midface is increasingly requested by patients, and hyaluronic acid (HA) fillers are frequently used in treatment. AIMS To evaluate the efficacy and safety of treatment of midface volume/contour deficit with a firm HA filler including lidocaine (HARL ). PATIENTS/METHODS This was a 12-month, randomized, evaluator-blinded, controlled study. Chinese adults with mild to substantial volume loss were randomly assigned in a 3:1 ratio to treatment or untreated control groups. RESULTS A total of 148 subjects were enrolled. The primary objective was met; results of the midface volume scale (MMVS) rated by a blinded evaluator were in favor of HARL at Month 6 (p < 0.0001 vs. the untreated control group). Similar to the MMVS improvement, improved midface fullness and aesthetic appearance was observed based on the Global Aesthetic Improvement Scale (GAIS) up to 12 months by both treating investigators and subjects (at least 96% at Week 4 and 65% at Month 12). Subject satisfaction was high, and the majority of subjects considered the results to look natural (>97%). The study product was well tolerated. CONCLUSIONS Midfacial treatment using HARL was effective, well tolerated, and led to high levels of satisfaction in a Chinese population for up to 12 months. CLINICALTRIALS GOV IDENTIFIER NCT03097783.
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Affiliation(s)
- Xiaojun Wang
- Peking Union Medical College Hospital, Beijing, China
| | - Yan Wu
- Peking University First Hospital, Beijing, China
| | - Bi Li
- Peking University Third Hospital, Beijing, China
| | | | - Li Li
- West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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9
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Abstract
BACKGROUND The assessment of the human body, whether for aesthetic or reconstructive purposes, is an inherently visual endeavor. Ideally, reproducible, prompt, and cost-effective systems of visual evaluation would exist that can provide validated assessments of the aesthetic endpoints of treatment. One method to accomplish a standardization of the appreciation of visual endpoints is the use of visual scales. The goal of this systematic review is to summarize and evaluate the use of validated visual scales within aesthetic medicine, dermatology, and plastic and reconstructive surgery. METHODS A literature search was performed with a defined search strategy and extensive manual screening process. The Medical Outcomes Trust guidelines for visual scales in medicine were used, with special attention paid to each study's validation metrics. The review process identified 44 publications with validation data of sufficient quality from an initial survey of 27,745 articles. All rating scales based on imaging other than standardized clinical photographs were excluded. RESULTS The review demonstrates that validated visual assessment in plastic surgery is incomplete. Within specific subfields of aesthetic medicine and dermatology, many of the ( n = 20) facial aging scales were well-validated and demonstrated high reliability. Publications ( n = 8) focused on the evaluation of facial clefts demonstrated heterogeneity in the methods of validation and in overall reliability. Within the areas of breast surgery ( n = 9), body contouring ( n = 2), and scarring ( n = 5), the scales were variable in the methods used and the validation procedures were diverse. Scales using a visual guide tended to have better interrater (kappa = 0.75) and intrarater reliability (kappa = 0.78), regardless of the specific area of interest. CONCLUSIONS The fields of aesthetic medicine, and aesthetic and reconstructive plastic surgery require assessment of visual states over time and between many observers. For these reasons, the development of validated and reliable methods of visual assessment are critical. Until recently, the use of these tools has been limited by their time-consuming nature and cost.
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10
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Hernandez CA, Davidovic K, Avelar LET, Alfertshofer M, Freytag DL, Frank K, Moellhoff N, Bihun R, Green JB, Cotofana S. Facial Soft Tissue Repositioning With Neuromodulators: Lessons Learned From Facial Biomechanics. Aesthet Surg J 2022; 42:1163-1171. [PMID: 35416929 DOI: 10.1093/asj/sjac090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Neuromodulators have proven efficacy in reducing facial rhytides and have also been reported to improve jawline contour and the appearance of platysmal bands. Lifting effects of the tail of the eyebrow are expected outcomes when targeting the lateral peri-orbital region underscoring the versatility of neuromodulator treatments. OBJECTIVE To analyze the clinical effectiveness of a novel neuromodulator-based injection algorithm with regards to its ability to reposition the middle and lower facial soft tissues. METHODS Seventy-five study participants (8 males, 67 females) with a mean age of 37.5 (8.5) years were injected with neuromodulators in the subdermal plane of the mandibular soft tissues following a standardized algorithm. Live rating of clinical appearance was performed, as well as volume change and skin vector displacement using 3-dimensional imaging at baseline, day 14 and day 30. RESULTS 3-dimensional volume analysis revealed an increase in midfacial volume by 0.46 cc, and a decrease of the lower facial volume by 0.30 cc compared to baseline. Additionally, an improvement of midfacial fullness (change of 0.13) and jawline contour (change of 0.44) was reported on clinical rating scales at day 30 compared to baseline. CONCLUSIONS Facial soft tissues can be repositioned during the 30 days follow-up period following a neuromodulator treatment; this was reflected through an increase in middle facial volume as well as through a decrease in lower facial volume. The novel injection algorithm presented can provide a safe and effective option for patients desiring improvement of midfacial fullness and jawline contour with neuromodulator treatment alone.
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Affiliation(s)
| | - Kristina Davidovic
- Department of Radiology & Medical School, University of Belgrade , Belgrade, Serbia
| | | | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich , Munich , Germany
| | - David L Freytag
- Department of General Surgery, Community Hospital Havelhöhe , Berlin , Germany
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich , Munich , Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich , Munich , Germany
| | - Rebekah Bihun
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science , Rochester , MN , USA
| | - Jeremy B Green
- Skin Associates of South Florida and Skin Research Institute , Coral Gables, FL , USA
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science , Rochester , MN , USA
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11
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Bertossi D, Chirumbolo S, Nocini R, Kapoor KM. Puzzle Facelift: A non-surgical, whole treatment for facial modelling and rejuvenation. Facial Plast Surg 2022; 38:166-172. [PMID: 34996117 DOI: 10.1055/a-1733-2858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The assessment of correct anatomy of face and the evaluation of the dynamic interplay between anatomy and function, in order to get an overall improvement, is a leading topic in aesthetic surgery and has increased its impact in the recent years. A non-surgical impact technique reduces both post-treatment discomfort and the overall cost. Obtaining the simultaneous correction in forehead, nose, lips and chin means obtaining an overall improvement in face view. Likewise, the high predictability of the procedure and the absence of alloplastic implant, bone re-absorption and scars have to be considered in non-surgical aesthetic medicine. In conclusion, a single-session of profile correction using HA filler should be proposed to patient, every time the aesthetic practitioner sees a coexistence of forehead, nose lips and chin defects.
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Affiliation(s)
- Dario Bertossi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology-Unit of Maxillo-Facial Surgery, University of Verona, Verona, Italy
| | - Salvatore Chirumbolo
- Department of Neurosciences, Biomedicine and Movement Sciences-Unit of Human Anatomy, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Department of surgery, Dentistry, Paediatrics and Gynaecology-Unit of Otorhinolaryngology, University of Verona, Verona, Italy
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Takiddin A, Shaqfeh M, Boyaci O, Serpedin E, Stotland MA. Toward a Universal Measure of Facial Difference Using Two Novel Machine Learning Models. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4034. [PMID: 35070595 PMCID: PMC8769118 DOI: 10.1097/gox.0000000000004034] [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: 10/07/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
A sensitive, objective, and universally accepted method of measuring facial deformity does not currently exist. Two distinct machine learning methods are described here that produce numerical scores reflecting the level of deformity of a wide variety of facial conditions. METHODS The first proposed technique utilizes an object detector based on a cascade function of Haar features. The model was trained using a dataset of 200,000 normal faces, as well as a collection of images devoid of faces. With the model trained to detect normal faces, the face detector confidence score was shown to function as a reliable gauge of facial abnormality. The second technique developed is based on a deep learning architecture of a convolutional autoencoder trained with the same rich dataset of normal faces. Because the convolutional autoencoder regenerates images disposed toward their training dataset (ie, normal faces), we utilized its reconstruction error as an indicator of facial abnormality. Scores generated by both methods were compared with human ratings obtained using a survey of 80 subjects evaluating 60 images depicting a range of facial deformities [rating from 1 (abnormal) to 7 (normal)]. RESULTS The machine scores were highly correlated to the average human score, with overall Pearson's correlation coefficient exceeding 0.96 (P < 0.00001). Both methods were computationally efficient, reporting results within 3 seconds. CONCLUSIONS These models show promise for adaptation into a clinically accessible handheld tool. It is anticipated that ongoing development of this technology will facilitate multicenter collaboration and comparison of outcomes between conditions, techniques, operators, and institutions.
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Affiliation(s)
- Abdulrahman Takiddin
- From the Electrical and Computer Engineering Department, Texas A&M University, College Station, Tex
| | - Mohammad Shaqfeh
- Electrical and Computer Engineering Department, Texas A&M University, Doha, Qatar
| | - Osman Boyaci
- From the Electrical and Computer Engineering Department, Texas A&M University, College Station, Tex
| | - Erchin Serpedin
- From the Electrical and Computer Engineering Department, Texas A&M University, College Station, Tex
| | - Mitchell A. Stotland
- Division of Plastic, Craniofacial and Hand Surgery, Sidra Medicine, Doha, Qatar
- Weill Cornell Medical College, Doha, Qatar
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Roshdy OH, Abd Elall HM, Eid AA. A randomized comparative study of the effect of two different flow rates of carboxytherapy in the treatment of infraorbital dark circles. J Cosmet Dermatol 2021; 21:4020-4027. [PMID: 34971475 DOI: 10.1111/jocd.14714] [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: 09/25/2021] [Revised: 11/06/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carboxytherapy is a minimally invasive, relatively safe modality that has been used for the treatment of dark circles; however, different flow rates and different injection techniques have been described in the literature. AIM To study the effect of the flow rate on the therapeutic outcome of carboxytherapy in infraorbital dark circles. METHODS Eighty patients with infraorbital dark circles were divided into two equal groups: Group A received carboxytherapy at a flow rate of 30 ml/min, and group B received carboxytherapy at a flow rate of 60 ml/min. Patients received weekly sessions for 6 weeks, and the treatment response was evaluated 6 weeks after the last treatment session. RESULTS Significant improvement of the dark circles was detected in both treatment groups. However, no significant difference in the treatment response was found when both flow rates were compared. The frequency of development of side effects was significantly higher in the group receiving CO2 at a flow rate of 60 ml/min. No significant difference in the overall post-treatment patient satisfaction between the two groups was detected. CONCLUSION Carboxytherapy is an effective therapeutic modality for infraorbital dark circles. Lower flow rates achieve therapeutic responses similar to higher flow rates but with fewer side effects.
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Affiliation(s)
- Ossama Hussein Roshdy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Heba Mahmoud Abd Elall
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amira Abulfotooh Eid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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14
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Pavicic T, Pooth R, Prinz V, Cajkovsky M, Green JB, Hernandez CA, Mueller DS, Sattler S, Klepetko H, Day D, Kerscher M, Suwanchinda A, Cotofana S, Frank K, Fabi SG. Validated 5-point photonumeric scales for the assessment of the periorbital region. J Cosmet Dermatol 2021; 21:158-166. [PMID: 34865301 DOI: 10.1111/jocd.14643] [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: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this investigation was to create and validate 5-point photonumeric scales for the assessment of dynamic crow's feet, static crow's feet, and infraorbital hollows. MATERIAL AND METHODS Three novel 5-point photonumeric scales were created by a medical team. A total of 12 raters from all over the world performed a digital validation, and a total of 5 raters a live validation of the created scale. RESULTS The statistical analysis revealed almost perfect intra-rater and inter-rater reliability in the digital validation of the scales for the assessment of static and dynamic crow's feet as well as infraorbital hollows. In the live validation, both crow's feet scales showed almost perfect intra-rater reliability, while the Croma Infraorbital Hollow Assessment Scale showed substantial intra-rater reliability. Inter-rater reliability was substantial for all three scales in the live validation. All three scales, the Croma Dynamic Crow's Feet Assessment Scale, Croma Static Crow's Feet Assessment Scale, and Croma Infraorbital Hollow Assessment Scale, were validated digitally and in a live setting. CONCLUSION The created scales to assess infraorbital hollowing, dynamic and static crow's feet have been shown to provide substantial to almost perfect agreement in the digital and live validation and can thus be considered as helpful tools in the clinical and research setting. While technical methods and appliances to assess the degrees of severity of age-dependent features are advancing, validated scales are of great importance due to their ease of use and, as shown by the validations, reliability, and reproducibility.
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Affiliation(s)
- Tatjana Pavicic
- Private Practice for Dermatology & Aesthetics Dr. Tatjana Pavicic, Munich, Germany
| | - Rainer Pooth
- ICA Aesthetic Navigation GmbH, Frankfurt, Germany
| | | | | | - Jeremy B Green
- Skin Associates of South Florida, Skin Research Institute, Coral Gables, Florida, USA
| | | | | | | | | | - Doris Day
- Private Practice, New York City, New York, USA
| | - Martina Kerscher
- Division of Cosmetic Sciences, University of Hamburg, Hamburg, Germany
| | - Atchima Suwanchinda
- Faculty of Medicine, Division of Dermatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
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15
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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.
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Affiliation(s)
- Z Paul Lorenc
- Corresponding Author: Dr Z. Paul Lorenc, 983 Park Avenue, New York, NY 10028, USA. E-mail:
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16
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Camargo CP, Xia J, Costa CS, Gemperli R, Tatini MD, Bulsara MK, Riera R. Botulinum toxin type A for facial wrinkles. Cochrane Database Syst Rev 2021; 7:CD011301. [PMID: 34224576 PMCID: PMC8407355 DOI: 10.1002/14651858.cd011301.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Botulinum toxin type A (BontA) is the most frequent treatment for facial wrinkles, but its effectiveness and safety have not previously been assessed in a Cochrane Review. OBJECTIVES To assess the effects of all commercially available botulinum toxin type A products for the treatment of any type of facial wrinkles. SEARCH METHODS We searched the following databases up to May 2020: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs with over 50 participants, comparing BontA versus placebo, other types of BontA, or fillers (hyaluronic acid), for treating facial wrinkles in adults. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Primary outcomes were participant assessment of success and major adverse events (AEs) (eyelid ptosis, eyelid sensory disorder, strabismus). Secondary outcomes included physician assessment of success; proportion of participants with at least one AE and duration of treatment effect. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 65 RCTs, involving 14,919 randomised participants. Most participants were female, aged 18 to 65 years. All participants were outpatients (private office or day clinic). Study duration was between one week and one year. No studies were assessed as low risk of bias in all domains; the overall risk of bias was unclear for most studies. The most common comparator was placebo (36 studies). An active control was used in 19 studies. There were eight dose-ranging studies of onabotulinumtoxinA, and a small number of studies compared against fillers. Treatment was given in one cycle (54 studies), two cycles (three studies), or three or more cycles (eight studies). The treated regions were glabella (43 studies), crow's feet (seven studies), forehead (two studies), perioral (two studies), full face (one study), or more than two regions (nine studies). Most studies analysed moderate to severe wrinkles; mean duration of treatment was 20 weeks. The following results summarise the main comparisons, based on studies of one treatment cycle for the glabella. AEs were collected over the duration of these studies (over four to 24 weeks). Compared to placebo, onabotulinumtoxinA-20 U probably has a higher success rate when assessed by participants (risk ratio (RR) 19.45, 95% confidence interval (CI) 8.60 to 43.99; 575 participants; 4 studies; moderate-certainty evidence) or physicians (RR 17.10, 95% CI 10.07 to 29.05; 1339 participants; 7 studies; moderate-certainty evidence) at week four. Major AEs are probably higher with onabotulinumtoxinA-20 U (Peto OR 3.62, 95% CI 1.50 to 8.74; 1390 participants; 8 studies; moderate-certainty evidence), but there may be no difference in any AEs (RR 1.14, 95% CI 0.89 to 1.45; 1388 participants; 8 studies; low-certainty evidence). Compared to placebo, abobotulinumtoxinA-50 U has a higher participant-assessed success rate at week four (RR 21.22, 95% CI 7.40 to 60.56; 915 participants; 6 studies; high-certainty evidence); and probably has a higher physician-assessed success rate (RR 14.93, 95% CI 8.09 to 27.55; 1059 participants; 7 studies; moderate-certainty evidence). There are probably more major AEs with abobotulinumtoxinA-50 U (Peto OR 3.36, 95% CI 0.88 to 12.87; 1294 participants; 7 studies; moderate-certainty evidence). Any AE may be more common with abobotulinumtoxinA-50 U (RR 1.25, 95% CI 1.05 to 1.49; 1471 participants; 8 studies; low-certainty evidence). Compared to placebo, incobotulinumtoxinA-20 U probably has a higher participant-assessed success rate at week four (RR 66.57, 95% CI 13.50 to 328.28; 547 participants; 2 studies; moderate-certainty evidence), and physician-assessed success rate (RR 134.62, 95% CI 19.05 to 951.45; 547 participants; 2 studies; moderate-certainty evidence). Major AEs were not observed (547 participants; 2 studies; moderate-certainty evidence). There may be no difference between groups in any AEs (RR 1.17, 95% CI 0.90 to 1.53; 547 participants; 2 studies; low-certainty evidence). AbobotulinumtoxinA-50 U is no different to onabotulinumtoxinA-20 U in participant-assessed success rate (RR 1.00, 95% CI 0.92 to 1.08, 388 participants, 1 study, high-certainty evidence) and physician-assessed success rate (RR 1.01, 95% CI 0.95 to 1.06; 388 participants; 1 study; high-certainty evidence) at week four. Major AEs are probably more likely in the abobotulinumtoxinA-50 U group than the onabotulinumtoxinA-20 U group (Peto OR 2.65, 95% CI 0.77 to 9.09; 433 participants; 1 study; moderate-certainty evidence). There is probably no difference in any AE (RR 1.02, 95% CI 0.67 to 1.54; 492 participants; 2 studies; moderate-certainty evidence). IncobotulinumtoxinA-24 U may be no different to onabotulinumtoxinA-24 U in physician-assessed success rate at week four (RR 1.01, 95% CI 0.96 to 1.05; 381 participants; 1 study; low-certainty evidence) (participant assessment was not measured). One participant reported ptosis with onabotulinumtoxinA, but we are uncertain of the risk of AEs (Peto OR 0.02, 95% CI 0.00 to 1.77; 381 participants; 1 study; very low-certainty evidence). Compared to placebo, daxibotulinumtoxinA-40 U probably has a higher participant-assessed success rate (RR 21.10, 95% CI 11.31 to 39.34; 683 participants; 2 studies; moderate-certainty evidence) and physician-assessed success rate (RR 23.40, 95% CI 12.56 to 43.61; 683 participants; 2 studies; moderate-certainty evidence) at week four. Major AEs were not observed (716 participants; 2 studies; moderate-certainty evidence). There may be an increase in any AE with daxibotulinumtoxinA compared to placebo (RR 2.23, 95% CI 1.46 to 3.40; 716 participants; 2 studies; moderate-certainty evidence). Major AEs reported were mainly ptosis; BontA is also known to carry a risk of strabismus or eyelid sensory disorders. AUTHORS' CONCLUSIONS BontA treatment reduces wrinkles within four weeks of treatment, but probably increases risk of ptosis. We found several heterogeneous studies (different types or doses of BontA, number of cycles, and different facial regions) hindering meta-analyses. The certainty of the evidence for effectiveness outcomes was high, low or moderate; for AEs, very low to moderate. Future RCTs should compare the most common BontA (onabotulinumtoxinA, abobotulinumtoxinA, incobotulinumtoxinA, daxibotulinumtoxinA, prabotulinumtoxinA) and evaluate long-term outcomes. There is a lack of evidence about the effects of multiple cycles of BontA, frequency of major AEs, duration of effect, efficacy of recently-approved BontA and comparisons with other treatments.
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Affiliation(s)
- Cristina Pires Camargo
- Laboratory of Microsurgery and Plastic Surgery (LIM-04), School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Jun Xia
- Nottingham China Health Institute, The University of Nottingham Ningbo, Ningbo, China
| | - Caroline S Costa
- Department of Specialised Medicine, Discipline of Dermatology, Universidade Federal do Piaui, Teresina, Brazil
| | - Rolf Gemperli
- Department of Surgery, Discipline of Plastic Surgery, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Dc Tatini
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rachel Riera
- Cochrane Brazil Rio de Janeiro, Cochrane, Petrópolis, Brazil
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de Maio M, Chatrath V, Hart S, Hoo AJS, Marchac A, Sykianakis D, Lee ILI. Multi-Dimensional Aesthetic Scan Assessment (MD ASA™): Initial experience with a novel consultation, facial assessment, and treatment planning tool. J Cosmet Dermatol 2021; 20:2069-2082. [PMID: 33977669 DOI: 10.1111/jocd.14216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comprehensive patient assessment and planning are central to esthetic treatment with injectables. MD ASA™ (Multi-Dimensional Aesthetic Scan Assessment) is a novel tool developed for this purpose. AIMS To describe the MD ASA technique and present its preliminary application. METHODS MD ASA breaks down the face into five hierarchies (H1-H5). H1 shifts patients' focus from "distractions" (individual lines and folds) toward the overall messages their face portrays, based on eight Emotional Attributes: four negative (tired, sad, angry, and saggy); four positive (youthful, attractive, contoured, and feminine/masculine). Three priority Emotional Attributes are selected for each patient. This is followed by a process of narrowing down through facial thirds (H2), periorbital and perioral dynamics (H3), facial units (H4), and subunits (H5), to arrive at a final assessment. Based on the key facial signs identified, this can be translated into MD Codes equations and thus a treatment formula. A retrospective analysis was performed based on 12 female patients injected by expert clinicians at an educational event. All patients were selected for, and treated using, a single MD Codes formula derived from a common MD ASA work-up. RESULTS There were substantial differences between patients and clinicians in their views of which anatomical areas needed treatment-but good alignment on priority Emotional Attributes. Patients were treated only for three negative Emotional Attributes, but improvements were observed across all eight attributes. CONCLUSIONS MD ASA provides a practical method for translating facial messages into actionable injectable treatment plans and facilitates greater patient-clinician alignment. Prospective studies are warranted.
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Affiliation(s)
| | | | | | | | | | | | - Izzy Lung I Lee
- Shang-Ho Aesthetic Medical Clinic, Kaohsiung City, Taiwan ROC
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18
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Hernandez CA, Schneider C, Gold D MH, Muniz M, Green JB, Alfertshofer M, Frank K, Cotofana S. After the Temporal Lifting Technique-What comes next? J Cosmet Dermatol 2021; 20:3857-3862. [PMID: 34021958 DOI: 10.1111/jocd.14247] [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: 04/16/2021] [Accepted: 05/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The temporal lifting technique can provide lateral facial lifting when administering hyaluronic acid (HA)-based soft tissue fillers into the subdermal plane of the temple. However, the central facial oval is not influenced by this technique. OBJECTIVES To identify the safety and esthetic effectiveness of additional midfacial injection points (in addition to the temporal lifting technique) that can volumize the medial midface, lift the lateral face, and increase jawline contouring when included into a full-face injection algorithm. METHODS The patient records of nine consecutive patients (all females) with a mean age of 35.0 (8.4) years and a mean body mass index of 21.7 (2.4) kg/m2 were retrospectively analyzed after a full-face injection algorithm was performed using HA-based fillers. The additional injection points target the supraperiosteal plane of the medial zygomatic arch, the lateral infraorbital region, and the pyriform fossa using both needles and cannula. RESULTS No adverse events were observed during the 6-month retrospective observational period. The volume of the medial midface increased, the volume of the lateral midface decreased, and the contour of the jawline improved; all effects reached a highly statistically significant level with p < 0.001. CONCLUSION Despite each individual injection is currently performed on a daily clinical basis the evaluated injection algorithm following the temporal lifting technique shows some evidence that it is safe and esthetically effective. Future studies will need to confirm the results presented herein in a larger sample and with objective outcome measures to guide safe and effective esthetic outcomes.
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Affiliation(s)
| | | | - Michael H Gold D
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
| | | | - Jeremy B Green
- Skin Associates of South Florida and Skin Research Institute, Coral Gables, FL, USA
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University, Munich, Germany
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University, Munich, Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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19
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Boyaci O, Serpedin E, Stotland MA. Personalized quantification of facial normality: a machine learning approach. Sci Rep 2020; 10:21375. [PMID: 33288815 PMCID: PMC7721909 DOI: 10.1038/s41598-020-78180-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022] Open
Abstract
What is a normal face? A fundamental task for the facial reconstructive surgeon is to answer that question as it pertains to any given individual. Accordingly, it would be important to be able to place the facial appearance of a patient with congenital or acquired deformity numerically along their own continuum of normality, and to measure any surgical changes against such a personalized benchmark. This has not previously been possible. We have solved this problem by designing a computerized model that produces realistic, normalized versions of any given facial image, and objectively measures the perceptual distance between the raw and normalized facial image pair. The model is able to faithfully predict human scoring of facial normality. We believe this work represents a paradigm shift in the assessment of the human face, holding great promise for development as an objective tool for surgical planning, patient education, and as a means for clinical outcome measurement.
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Affiliation(s)
- Osman Boyaci
- Electrical and Computer Engineering Department, Texas A&M University, College Station, 77843, USA
| | - Erchin Serpedin
- Electrical and Computer Engineering Department, Texas A&M University, College Station, 77843, USA
| | - Mitchell A Stotland
- Division of Plastic and Craniofacial Surgery, Department of Surgery, Sidra Medicine, C1-121 OPC, Doha, 26999, Qatar.
- Department of Surgery, Weill Cornell Medical College-Qatar, Doha, 26999, Qatar.
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20
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Nestor MS, Arnold D, Fischer D. The mechanisms of action and use of botulinum neurotoxin type A in aesthetics: Key Clinical Postulates II. J Cosmet Dermatol 2020; 19:2785-2804. [PMID: 32866999 PMCID: PMC7693297 DOI: 10.1111/jocd.13702] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The literature on botulinum neurotoxin type A (BoNT-A) is extensive, often contradictory, and confounded by a competitive market of products and research attempting to distinguish brand individuality. METHODS A comprehensive review of literature on the principles of BoNT-A in aesthetics as well as clinical examples. RESULTS In 2017, the Eight Key Clinical Postulates were formulated as a guide for the aesthetic practitioner in understanding BoNT-A pharmacodynamics and to compare different toxins. These are now updated to include (a) All type A toxins act identically; (b) The mathematical relationship between toxin and receptor is the basis of efficacy, and clinical efficacy is influenced by molecular potency and patient attributes including muscle mass, gender, age, and ethnicity; (c) Efficacy, onset, and duration are functions of "molecular potency" defined as the number of active 150 kDa molecules available for binding; (d) "Molecular potency" is difficult to objectively quantify for commercially available toxins; (e) Up to a point, increased molecular potency decreases time to onset and increases duration of effect, and the "Molecular Potency Quotient" is a construct for comparing molecular potency commercial cost; (f) The area of effect of a toxin injection is dependent upon molecular potency, diffusion (passive), and spread (active); (g) Differing reconstitution volumes; and (h) Increased number of injection sites can affect spread, onset, and duration of effect. CONCLUSIONS The principles of BoNT-A use in aesthetics are complex yet understandable as outlined in the framework of the updated Eight Key Clinical Postulates and serves as a useful tool for providing the most effective treatment and interpreting research on present and future toxin formulations.
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Affiliation(s)
- Mark S. Nestor
- Center for Clinical and Cosmetic ResearchAventuraFloridaUSA
- Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Department of SurgeryDivision of Plastic SurgeryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - David Arnold
- Center for Clinical and Cosmetic ResearchAventuraFloridaUSA
| | - Daniel Fischer
- Center for Clinical and Cosmetic ResearchAventuraFloridaUSA
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21
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Casabona G, Frank K, Moellhoff N, Gavril DL, Swift A, Freytag DL, Kaiser A, Green JB, Nikolis A, Cotofana S. Full‐face effects of temporal volumizing and temporal lifting techniques. J Cosmet Dermatol 2020; 19:2830-2837. [DOI: 10.1111/jocd.13728] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/18/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Konstantin Frank
- Department for Hand Plastic and Aesthetic Surgery Ludwig – Maximilian University Munich Munich Germany
| | - Nicholas Moellhoff
- Department for Hand Plastic and Aesthetic Surgery Ludwig – Maximilian University Munich Munich Germany
| | | | - Arthur Swift
- Westmount Institute of Plastic Surgery Montreal QC Canada
| | - David L. Freytag
- Department for Hand Plastic and Aesthetic Surgery Ludwig – Maximilian University Munich Munich Germany
| | - Antonia Kaiser
- Department for Hand Plastic and Aesthetic Surgery Ludwig – Maximilian University Munich Munich Germany
| | - Jeremy B. Green
- Skin Associates of South Florida and Skin Research Institute Coral Gables FL USA
| | - Andreas Nikolis
- Clinical Research Unit Erevna Innovations Inc Montreal QC Canada
- Division of Plastic Surgery McGill University Montreal QC Canada
| | - Sebastian Cotofana
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester MN USA
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22
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Hernandez CA, Freytag DL, Gold MH, Pavicic T, Ascher B, Almeida AT, Green JB, Fabi SG, Frank K, Cotofana S. Clinical validation of the temporal lifting technique using soft tissue fillers. J Cosmet Dermatol 2020; 19:2529-2535. [DOI: 10.1111/jocd.13621] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/08/2020] [Indexed: 12/01/2022]
Affiliation(s)
| | - David L. Freytag
- Department for Hand, Plastic and Aesthetic Surgery Ludwig–Maximilian University Munich Munich Germany
| | - Michael H. Gold
- Gold Skin Care Center Tennessee Clinical Research Center Nashville TN USA
| | | | | | - Ada Trindade Almeida
- Clinica de Dermatologia do Hospital do Servidor Público Municipal de São Paulo São Paulo Brazil
- Private Practice Sao Paulo Brazil
| | - Jeremy B. Green
- Skin Associates of South Florida and Skin Research Institute Coral Gables FL USA
| | | | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery Ludwig–Maximilian University Munich Munich Germany
| | - Sebastian Cotofana
- Department of Clinical Anatomy Mayo Clinic College of Medicine and Science Rochester MN USA
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23
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Ye R, Chang W, Hu J, Qiao L, Wang Q. A new method for skin aging evaluation of Chinese women. J Cosmet Dermatol 2020; 20:256-262. [PMID: 32597551 DOI: 10.1111/jocd.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND With the development of cosmetic industry in China, an aging evaluation method of Chinese women is in great need. AIMS The aim of this study is to establish a skin aging assessment method using convenient portable machine Antera 3D. METHODS The quantitative approach was developed by capturing 11 areas of the face, and overall, 48 parameters were extracted for aging evaluation. Later, 297 subjects were recruited to take facial image and life style questionnaire. Evaluation of age was accomplished by establishing prediction method with detected skin traits. RESULTS The age prediction model was built by using the evaluated facial traits, and a R square of 0.6 is achieved by comparing to the chronological age. The crow's feet, cheek skin pigmentation, forehead skin tone, and wrinkles around the month are critical factors in evaluating Chinese women skin aging. In addition, we also explored life styles associated with important skin aging traits. CONCLUSION The method developed in this research provides reliable alternative in aging study of Chinese women.
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Affiliation(s)
- Rui Ye
- Inertiabiotech Co., LTD, Shanghai, China
| | | | | | | | - Qianqian Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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24
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Chen YC, Chih PL, Lin SY, Cheng YC, Lan CCE. Simple procedure to evaluate mid-face sagging: A pilot study from Taiwan. Australas J Dermatol 2020; 61:346-348. [PMID: 32403195 DOI: 10.1111/ajd.13326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/12/2020] [Indexed: 11/28/2022]
Abstract
An easy and objective way to evaluate mid-face sagging is marking straight lines between the nasal alar and the mandibular angle, one in the supine and the other in an upright position. The maximal distance between the two lines drawn is measured. Statistic analyses shows that this maximum distance demonstrates positive correlation with age and body mass index that reflects the level of mid-face sagging. This simple method may be utilised to evaluate the effect of anti-ageing treatment on the face in the context of mid-face sagging.
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Affiliation(s)
- Yin-Chun Chen
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Ling Chih
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Yiao Lin
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yang-Chun Cheng
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Che E Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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25
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Duscher D, Maan ZN, Hu MS, Thor D. A single-center blinded randomized clinical trial to evaluate the anti-aging effects of a novel HSF™-based skin care formulation. J Cosmet Dermatol 2020; 19:2936-2945. [PMID: 32306525 DOI: 10.1111/jocd.13356] [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: 09/23/2019] [Revised: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Similar to chronic wounds, skin aging is characterized by dysfunction of key cellular regulatory pathways. The hypoxia-inducible factor-1 alpha (HIF-1α) pathway was linked to both conditions. Recent evidence suggests that modulating this pathway can rejuvenate aged fibroblasts and improve skin regeneration. Here, we describe the application of a novel HIF stimulating factor (HSF™)-based formulation for skin rejuvenation. METHODS Over a period of 6 weeks using a split-face study design, the effects on skin surface profile, skin moisture, and transepidermal water loss were determined in 32 female subjects (mean age 54, range 32-67 years) by Fast Optical in vivo Topometry of Human Skin (FOITSHD ), Corneometer, and Tewameter measurements. In addition, a photo documentation was performed for assessment by an expert panel and a survey regarding subject satisfaction was conducted. RESULTS No negative skin reactions of dermatological relevance were documented for the test product. A significant reduction in skin roughness could be demonstrated. The clinical evaluation of the images using a validated method confirmed significant improvement of wrinkles, in particular of fine wrinkles, lip wrinkles, and crow's feet. A significant skin moisturizing effect was detected while skin barrier function was preserved. The HSF™-based skin care formulation resulted in a self-reported 94% satisfaction rate. CONCLUSION With no negative skin reactions and highly significant effects on skin roughness, wrinkles, and moisturization, the HSF™-based skin care formulation achieved very satisfying outcomes in this clinical trial. Given the favorable results, this approach represents a promising innovation in aesthetic and regenerative medicine.
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Affiliation(s)
- Dominik Duscher
- Department of Plastic and Hand Surgery, Technical University Munich, Munich, Germany.,Section of Plastic Surgery, Johannes Kepler University Linz, Linz, Austria.,Tomorrowlabs GmbH, Wien, Austria
| | - Zeshaan N Maan
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael S Hu
- Department for Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dominik Thor
- College of Pharmacy, University of Florida, Gainesville, FL, USA.,Tomorrowlabs GmbH, Wien, Austria
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Rezaee Khiabanloo S, Nabie R, Aalipour E. Outcomes in thread lift for face, neck, and nose; A prospective chart review study with APTOS. J Cosmet Dermatol 2020; 19:2867-2876. [PMID: 32267994 DOI: 10.1111/jocd.13397] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/13/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION To evaluate the surgical efficacy and outcomes related to midface, mandible, neck (and double chin), and nose lifting with APTOS thread lift. METHODS In this prospective review chart study, a total of 58 patients were included (from July 2018 to July 2019). All participants underwent facial thread lifting using APTOS. The patients were followed up first week, third, and sixth month after lifting surgery. Outcomes were assessed by two surgeons and patients based on the GAIS score. All data were analyzed by SPSS-17 software with chi-square test. RESULTS A total of 58 patients (Mean ± SD: 52.52 ± 10.58) (F: 45, Mean ± SD:53.13 ± 11.27 years, M:13, Mean ± SD: 50.38 ± 9.43 years) were included in the study. The most common sites for the face-lifting surgery were midface and mandibular (N = 45, 77.5%), neck (N = 10, 17.3%), and nose (N = 3, 5.2%), respectively. The level of satisfaction remained unchanged (after 6 months), about 80%, for the patients, increased from 90.7% (first week) to 94.8% (sixth month) after surgery, and increased from 93.1% (first week) to 94.8% (sixth month after surgery). The highest rate of potential complications after the surgery was related to ecchymosis (17 cases, 30%), followed by complications of pain (N = 10, 17.2%), tumefaction (N = 4, 6.9%), and dimple (N = 1, 1.7%) were reported. CONCLUSION The results showed that satisfaction in patients and surgeons increased over time (after 6 months). Postoperative (minor) complications were also assessed and ecchymosis was found to be the most common complication. However, the proportion of postoperative complications was relatively low.
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Affiliation(s)
- Samad Rezaee Khiabanloo
- Novin Didehgan Skin and Laser Clinic, Tehran, Iran.,Medico Derma Eexir Skin and beauty Clinic, Tehran, Iran
| | | | - Ezatollah Aalipour
- Research and Development Center, Medico Derma Eexir Skin and beauty Clinic, Tehran, Iran
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Rovatti PP, Pellacani G, Guida S. Hyperdiluted Calcium Hydroxylapatite 1:2 for Mid and Lower Facial Skin Rejuvenation: Efficacy and Safety. Dermatol Surg 2020; 46:e112-e117. [DOI: 10.1097/dss.0000000000002375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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A Randomized, Active-Controlled, 52-Week Study of Hyaluronic Acid Fillers for Anteromedial Malar Region Augmentation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2648. [PMID: 32309093 PMCID: PMC7159933 DOI: 10.1097/gox.0000000000002648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Hyaluronic acid (HA) fillers for volume augmentation in the anteromedial malar region of Asians have been popular for many years. However, studies on their long-term effectiveness are lacking. This study aimed to evaluate the effectiveness and safety of HA fillers injected into the anteromedial malar region for volume augmentation for up to 52 weeks. Methods: Each anteromedial malar region of the subjects was treated with YVOIRE Contour (YVOC) in one side and Restylane Sub-Q (RESS) in the other and followed up at weeks 2, 14, 26, and 52. The volume using the mid-face aesthetic scale (MFAS) ranging from 0 (full) to 4 (very severely sunken) and the subject’s satisfaction and adverse events were evaluated. Results: Total 83 subjects were randomized and treated with YVOC and RESS. The LS means (standard error) of MFAS score in the YVOC and RESS groups were both 2.56 (0.05) at baseline, 1.32 (0.07) and 1.39 (0.07) at week 26, and 1.84 (0.10) and 1.89 (0.10) at week 52, respectively. The difference in the LS mean of MFAS score between the groups at week 26 was 0.07 (95% confidence interval, 0.01–0.12), showing the non-inferiority of YVOC to RESS. About 70% of subjects were still satisfied with the results at week 52. No specific safety concern was detected. Conclusions: The HA fillers injected for the anteromedial malar augmentation maintained the volume well for up to 52 weeks. Additionally, both YVOC and RESS show similar effectiveness and safety profiles.
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Moradi A, Lin X, Allen S, Fagien S, Norberg M, Smith S. Validation of Photonumeric Assessment Scales for Temple Volume Deficit, Infraorbital Hollows, and Chin Retrusion. Dermatol Surg 2019; 46:1148-1154. [DOI: 10.1097/dss.0000000000002269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Casabona G, Frank K, Koban KC, Freytag DL, Schenck TL, Lachman N, Green JB, Toni S, Rudolph C, Cotofana S. Lifting vs volumizing-The difference in facial minimally invasive procedures when respecting the line of ligaments. J Cosmet Dermatol 2019; 18:1237-1243. [PMID: 31402563 DOI: 10.1111/jocd.13089] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The arrangement of the facial soft tissue layers is different with respect to the line of ligaments: medially oblique and laterally in parallel. AIMS This split-face study was designed to investigate the effects on midfacial volumization if the same medial vs lateral injection points are targeted in various sequences. METHODS Twelve patients (3 males, 9 females; 46.67 years ± 4.5) were included in this interventional study. On the right side of the face, lateral injection points were performed first, whereas on the left side, medial injection points were executed first. The infraorbital hollowness score, the upper cheek fullness score, the global aesthetic improvement scale, and the injected volume were assessed. RESULTS No side differences were observed after the intervention with P = 1.00 for all scores. When the lateral injection points were performed first, the volume injected into the medially located injection points (0.46 ± 0.26 cc vs 0.73 ± 0.31 cc [P = .037]), into the lateral injection points (0.79 ± 0.40 cc vs 1.15 ± 0.28 cc [P = .017]), and overall (1.26 ± 0.64 cc vs 1.88 ± 0.57 cc [P = .02]) was significantly reduced. CONCLUSION The results of the present study emphasize the importance of respecting the layered arrangement of the facial soft tissues when performing minimally invasive soft tissue filler injections. Targeting injection points lateral to the line of ligaments first reduces the volume needed to symmetrically and aesthetically appealing manner and volumizes the infraorbital and upper cheek regions.
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Affiliation(s)
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Konstantin C Koban
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - David L Freytag
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Thilo L Schenck
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig - Maximilian University Munich, Munich, Germany
| | - Nirusha Lachman
- Division of Plastic Surgery, Department of Anatomy and Department of Surgery, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | | | - Sabiha Toni
- Department of Medical Education, Albany Medical College, Albany, NY, USA
| | - Christina Rudolph
- Department of Medical Education, Albany Medical College, Albany, NY, USA
| | - Sebastian Cotofana
- Department of Medical Education, Albany Medical College, Albany, NY, USA.,Division of Plastic Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA
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Validation of a Photonumeric Assessment Scale for Grading the Slope of the Asian Forehead. Dermatol Surg 2019; 45 Suppl 1:S38-S45. [PMID: 31246870 DOI: 10.1097/dss.0000000000001997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the number of aesthetic treatments has grown, so have the number of photonumeric assessment scales used to compare the effectiveness of these aesthetic treatments in specific anatomical areas; however, these are primarily based on Caucasian features. OBJECTIVE To assess the validity of the first aesthetic scale for assessing the slope of the Asian forehead. A secondary objective was to correlate this scale with subject demographics and baseline characteristics. METHODS During 2 validation sessions, 13 raters assessed full frontal and lateral facial images of female (n = 28; 56.0%) and male (n = 22; 44%) subjects. For each subject, the severity of forehead sloping was graded from 0 (convex forehead, optimal forehead volume) to 4 (concave forehead, very severe sloping). Raters also assessed the age of each subject and the estimated aesthetic treatment effort required to treat each subject. RESULTS Inter-rater reliability was "substantial" with scores of 0.67 and 0.68 for the first and second validation sessions, indicating high reliability. BMI showed the highest correlation with the scale and was a significant predictor in the final regression model. CONCLUSION This photonumeric assessment scale will be useful for assessing the slope of the Asian forehead in both clinical and research settings.
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Abstract
BACKGROUND Clinical photonumeric scales have been developed and validated to objectively measure the effectiveness of aesthetic treatments in specific anatomical areas; however, these are based on the typical features of Caucasian patients. No clinical scale for Asian calf appearance currently exists. OBJECTIVE To develop and validate a calf assessment scale for use in the female Asian patient population. METHODS AND MATERIALS During 2 validation sessions, 13 raters assessed calf images of female Asian subjects (N = 35) viewed from behind with feet flat on the floor (at rest) and on tiptoes (dynamic). Images were rated from 0 (very slim, linear profile) to 4 (very severe convex profile). RESULTS Inter-rater and intra-rater reliability were "substantial" (≥0.6, intraclass correlation coefficient [ICC] and weighted kappa) for the calf-at rest, calf-dynamic, and calf summary score. Reliability was "substantial" for calf-at rest and calf-dynamic (≥0.6, ICC and weighted kappa) and "almost perfect" (0.85) for the calf summary score. BMI and calf circumference were highly correlated with scale ratings, and calf circumference was a significant predictor. CONCLUSION This new photonumeric assessment scale has value for assessing the female Asian calf, providing a standardized measure of calf appearance in clinical practice and clinical research settings.
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Rezaee Khiabanloo S, Jebreili R, Aalipour E, Eftekhari H, Saljoughi N, Shahidi A. Innovative techniques for thread lifting of face and neck. J Cosmet Dermatol 2019; 18:1846-1855. [DOI: 10.1111/jocd.12969] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/02/2019] [Accepted: 02/11/2019] [Indexed: 12/28/2022]
Affiliation(s)
| | - Rogieh Jebreili
- Dermatologist Medico Derma Eexir Skin and beauty Clinic Tehran Iran
| | - Ezatollah Aalipour
- MPH, Student Research Committee Shahid Sadoughi University of Medical Sciences Tehran Iran
| | - Hojat Eftekhari
- Assistant Professor of Dermatology Guilan University of Medical Sciences Rasht Iran
| | - Nazi Saljoughi
- General Physician Medico Derma Eexir Skin and beauty Clinic Tehran Iran
| | - Arian Shahidi
- General Physician Medico Derma Eexir Skin and beauty Clinic Tehran Iran
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Wollina U, Brzezinski P. Aesthetic dermatology: What's new, what's true? Dermatol Ther 2018; 32:e12623. [PMID: 30182495 DOI: 10.1111/dth.12623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/08/2018] [Indexed: 01/21/2023]
Abstract
Aesthetic dermatology (AD) is a rapidly growing subspecialty of dermatology. The acceptance of AD in scientific community and the society is associated with its competence, efficiency, and seriousness. This review highlights some recent developments toward new tools, techniques, and understanding in the field of AD. Analyzing the specific needs of patients and assessing the effect by objective measurements is important for further progress. For long time ignored, white adipose tissue has gained increasing interest in biology and rejuvenation. Characterization of dermal and subcutaneous white adipose tissue has made progress. The interaction of hyaluronic acid and calcium hydroxyl apatite (CaHA) fillers with adipocytes could be responsible for clinical efficacy. New developments of oral collagen treatment and highly diluted CaHA to contour the body outside the face will be discussed. Submental contouring using purified desoxycholic acid is another new development.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden, Dresden, Germany
| | - Piotr Brzezinski
- Faculty of Mathematics and Natural Sciences, Institute of Biology and Environmental Protection, Pomeranian Academy, Slupsk, Poland.,Department of Dermatology, 6th Military Support Unit, Ustka, Poland
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Peng PHL, Peng JH. Treating the tear trough: A new classification system, a 6-step evaluation procedure, hyaluronic acid injection algorithm, and treatment sequences. J Cosmet Dermatol 2018; 17:333-339. [PMID: 29504668 DOI: 10.1111/jocd.12514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The tear trough deformity is commonly requested for correction, most often by filler injections. However, the tear trough remains difficult to treat due to its complex anatomy, a variety of other concurrent deformities, and the high risk of complications. OBJECTIVES To create a standardized categorization, evaluation, and treatment protocol for the management of tear troughs with fillers. METHODS (1) Patient deformity profiles are determined using three categories of traits: A (Atrophy), B (Bulging), L (Laxity). (2) A 6-step evaluation process (Tilt, Snap, Smile, Squint, Pull, Push) aids in ABL determination. (3) Treatment is simplified into a comprehensive protocol for each category (with 6 major injection points and a variety of injection depths and volumes). RESULTS The author has achieved satisfactory results using the presented protocols, with photographic examples. CONCLUSION The author proposes a comprehensive categorization system that takes into account both the tear trough and other concurrent deformities. The author also presents 6 tests to aid in categorization, and simple protocols with injection sequences, amounts, and depth.
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Affiliation(s)
| | - Jui-Hui Peng
- National Yang-Ming University School of Medicine, Taipei, Taiwan
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Alam M, Walter AJ, Geisler A, Roongpisuthipong W, Sikorski G, Tung R, Poon E. Association of Facial Exercise With the Appearance of Aging. JAMA Dermatol 2018; 154:365-367. [PMID: 29299598 DOI: 10.1001/jamadermatol.2017.5142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anne J Walter
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Dermatology and Skin Surgery Specialists, Scottsdale, Arizona
| | - Amelia Geisler
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Wanjarus Roongpisuthipong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Division of Dermatology, Department of Medicine, Vajira Hospital, Navamindrahiraj University, Bangkok, Thailand
| | | | - Rebecca Tung
- Division of Dermatology, Loyola University, Maywood, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Lee H, Yoon K, Lee M. Outcome of facial rejuvenation with polydioxanone thread for Asians. J COSMET LASER THER 2017; 20:189-192. [DOI: 10.1080/14764172.2017.1400167] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hyejeong Lee
- Thehills Aesthetic Surgical Clinic, Seoul, Korea
| | - Kichan Yoon
- School of Health Policy & Management, Health Science College, Korea University, Seoul, Korea, Korea University
| | - Munjae Lee
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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Gauglitz G, Steckmeier S, Pötschke J, Schwaiger H. Cohesive Polydensified Matrix ® hyaluronic acid volumizer injected for cheek augmentation has additional positive effect on nasolabial folds. Clin Cosmet Investig Dermatol 2017; 10:507-513. [PMID: 29276401 PMCID: PMC5733916 DOI: 10.2147/ccid.s141906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) volumizer has been used successfully for several years to reverse biometric volume loss during facial aging. This observational study explored the additive effect on nasolabial folds when CPM-HA volumizer is injected into the neighboring cheek area. Patients and methods In this open-label, prospective, postmarketing noninterventional study, 18 adult patients seeking esthetic enhancement of the lateral cheek hollows and cheekbone area were injected with CPM-HA volumizer integrated with lidocaine (CPM-HA-VL) in the upper or lower cheek area. Safety and performance of CPM-HA-VL up to 12 months after injection with follow-up visits at week 4 and month 3, 6, and 12 were assessed. The primary endpoint was improvement of cheek fullness on the validated Merz Aesthetics Scales. Additionally, changes in nasolabial folds were quantified using a phaseshift rapid in vivo measurement of skin optical three-dimensional (3D) in vivo measurement device. Results Patients (94.4% female, median age 52 years, age range 39–69 years) were injected with a mean volume of 2.5±1.1 mL CPM-HA-VL per side. Immediately after injection, mean severity for upper and lower cheek fullness assessed on the validated MAS improved from 2.5±0.6 and 2.8±0.5, respectively, to 1.0±0.0, and remained unchanged through month 12. Improvement in relation to baseline was attested on the Global Aesthetics Improvement Scale for all assessments. Compared with baseline, the following assessments offered a statistical significance in the reduction of wrinkle depth of nasolabial folds (maximum depth reduction by 30.4% at 3 months) according to optical 3D in vivo measurements. Pain during injection was minimal and abated within 30 minutes. Treatment was well tolerated and led to great patient satisfaction. Conclusion CPM-HA-VL injected into the upper and lower cheeks led to long-lasting satisfactory cosmetic results in cheek augmentation as well as in reducing depth of nasolabial folds adjacent to the injection site.
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Affiliation(s)
- Gerd Gauglitz
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Stephanie Steckmeier
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Julian Pötschke
- Department of Plastic and Hand Surgery, Klinikum St Georg gGmbH, Leipzig, Germany
| | - Hannah Schwaiger
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
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The Use of Botulinum Neurotoxin Type A in Aesthetics: Key Clinical Postulates. Dermatol Surg 2017; 43 Suppl 3:S344-S362. [PMID: 33065958 DOI: 10.1097/dss.0000000000001412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The most common aesthetic procedure performed worldwide is the injection of botulinum neurotoxin Type A (BoNT-A). Aesthetic providers must fully comprehend the objective scientific data, theoretical mechanisms of action, and differences between brands of BoNT-A. OBJECTIVE To determine and review the relevant clinical postulates for the use of botulinum toxin in aesthetics. MATERIALS AND METHODS The BoNT-A clinical postulates presented here discuss how each brand of BoNT-A acts identically, how the molecular potency may vary between the different products, how patient age, gender, genetics, and muscle mass cause variation in toxin receptor number and density, and how both practitioner and patient can affect toxin distribution. RESULTS A total of 8 clinical postulates have been identified that are key to understanding the use of botulinum toxin in aesthetics and to obtaining the best clinical results. CONCLUSION All of these factors affect the potential efficacy of the injected toxin and hence the aesthetic results obtained.
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Commentary on Male Surgical Neck Rejuvenation. Dermatol Surg 2017; 43 Suppl 2:S208-S209. [PMID: 29064987 DOI: 10.1097/dss.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A Prospective, Open-Label Study of Hyaluronic Acid-Based Filler With Lidocaine (VYC-15L) Treatment for the Correction of Infraorbital Skin Depressions. Dermatol Surg 2017; 43:1271-1280. [DOI: 10.1097/dss.0000000000001127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Niforos F, Liew S, Acquilla R, Ogilvie P, Safa M, Signorini M, Jones D, Hawthorn J, Collins C, Kerson G, Sithamparanathan M. Creation and Validation of a Photonumeric Scale to Assess Volume Deficiency in the Infraorbital Region. Dermatol Surg 2017; 43:684-691. [PMID: 28375974 DOI: 10.1097/dss.0000000000001088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The eyes are particularly important aesthetic features of the face and revitalization of the infraorbital region has become a focus of aesthetic treatments. Published infraorbital scales to date have limitations in that they have been descriptive, subjective, or have used computer-generated images. Thus, there is an unmet need for a validated scale based on actual images. OBJECTIVE To develop a practical photonumeric scale that respects the complex anatomy and age-related changes occurring in the orbital area. METHODS AND MATERIALS The Allergan Infra-oRbital Scale (AIRS) was developed through a multistep process in collaboration with 16 physicians (plastic surgeons, dermatologists, and aesthetic physicians). Scale development involved both online photographs and live assessments of subjects. Interrater and intrarater reliability was assessed using intraclass correlation coefficients (ICCs). RESULTS The final AIRS showed intrarater and interrater ICCs of 0.78 to 0.86 and 0.91 to 0.98 for live validation and 0.76 to 0.82 and 0.86 to 0.91 for online validation, respectively, demonstrating robust validity. CONCLUSION The AIRS can be considered a photonumeric scale that accurately describes volume loss in the infraorbital region. It has been validated and is appropriate for use in research or for everyday clinical use for both live and photographic assessment.
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Affiliation(s)
- François Niforos
- *Centre Chirurgical Niforos, Lyon, France; †Shape Clinic, Sydney, Australia; ‡The Gatehouse, Cheshire, United Kingdom; §Skin Concept, Munich, Germany; ‖La Jouvence, Neuchâtel, Switzerland; ¶Private Practice, Milano, Italy; #Division of Dermatology, University of California at Los Angeles, Los Angeles, California; **Collins Therapeutic Consulting Ltd, Gloucestershire, United Kingdom; ††Surrey, United Kingdom; ‡‡Allergan plc, Marlow, United Kingdom
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Kerscher M, Agsten K, Kravtsov M, Prager W. Effectiveness evaluation of two volumizing hyaluronic acid dermal fillers in a controlled, randomized, double-blind, split-face clinical study. Clin Cosmet Investig Dermatol 2017; 10:239-247. [PMID: 28721082 PMCID: PMC5498678 DOI: 10.2147/ccid.s135441] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Enhancement of the midface can be achieved with volumizing hyaluronic acid (HA) fillers. Objective The objective of this study was to compare the safety and effectiveness of Cohesive Polydensified Matrix® 26 mg/mL HA gel (CPM-26) and Vycross® 20 mg/ml HA gel (VYC-20) in a controlled, randomized, evaluator-blind, split-face clinical study. Patients and methods Subjects with moderate-to-severe malar volume loss on the Merz Aesthetics Scale (MAS) received CPM-26 on one side and VYC-20 on the contralateral side of the face. Effectiveness assessments were performed by blinded evaluators including photographic and live MAS ratings and live Global Aesthetic Improvement Scale (GAIS) ratings. Calculations of anatomical volume variations at month 3 (M3), month 6 (M6), month 12 (M12) and month 18 (M18) were also performed. Results Non-inferiority of CPM-26 versus VYC-20 was demonstrated at M3 (primary end point) based on MAS. GAIS rating showed that significantly more subjects had better improvement with CPM-26 than with VYC-20 at month 1, M3, M12 and M18 (p=0.0032, p=0.0074, p=0.0384 and p=0.0110, respectively). Standardized evaluation of volume variations from baseline to M3, M12 and M18 showed that CPM-26 created more volume augmentation at all time points, and the difference was significant at M3. Conclusion CPM-26 was non-inferior to VYC-20 based on MAS ratings at M3 and demonstrated a favorable safety and effectiveness profile for midfacial volume enhancement with results lasting up to M18.
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Affiliation(s)
| | | | | | - Welf Prager
- Prager & Partner Dermatologische Praxis, Hamburg, Germany
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Consensus Recommendations for Combined Aesthetic Interventions in the Face Using Botulinum Toxin, Fillers, and Energy-Based Devices. Dermatol Surg 2017; 42:586-97. [PMID: 27100962 DOI: 10.1097/dss.0000000000000754] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aging process is a complex interplay of intrinsic and extrinsic factors across multiple layers of the face. Accordingly, combining aesthetic interventions targeting different manifestations of aging often leads to better results than single modalities alone. However, no guidelines for a pan-facial approach using multiple interventions have been published to date. OBJECTIVE To develop consensus recommendations for the optimal combination and ideal sequence of botulinum toxin (BoNT), hyaluronic acid, calcium hydroxylapatite, and microfocused ultrasound with visualization (MFU-V) in persons of all Fitzpatrick skin types. METHODS AND MATERIALS Fifteen specialists convened under the guidance of a certified moderator. Consensus was defined as approval from 75% to 94% of all participants, whereas agreement of ≥95% denoted a strong consensus. RESULTS Optimal aesthetic treatment of the face begins with a thorough patient assessment and an individualized treatment plan. Spacing consecutive treatments 1 to 2 weeks apart allows for resolution of side effects and/or to assess results. For same-day treatments, BoNT and fillers may be performed together in either sequence, whereas MFU-V is recommended before injectable agents. CONCLUSION Expert consensus supports a combination approach using multiple modalities in specific sequence for the safe and effective treatment of the aging face.
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Investigation on the Cutaneous Change Induced by Face-Lifting Monodirectional Barbed Polydioxanone Thread. Dermatol Surg 2017; 43:74-80. [DOI: 10.1097/dss.0000000000000925] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Kühne U, Esmann J, von Heimburg D, Imhof M, Weissenberger P, Sattler G. Safety and performance of cohesive polydensified matrix hyaluronic acid fillers with lidocaine in the clinical setting - an open-label, multicenter study. Clin Cosmet Investig Dermatol 2016; 9:373-381. [PMID: 27799807 PMCID: PMC5076541 DOI: 10.2147/ccid.s115256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cohesive polydensified matrix (CPM®) hyaluronic acid fillers are now available with or without lidocaine. The aim of this study was to investigate the safety and performance of CPM® fillers with lidocaine in the clinical setting. In an open-label, prospective, postmarketing study, 108 patients from seven sites in Germany and Denmark were treated with one or more lidocaine-containing CPM® fillers. Performance was assessed using the Merz Aesthetics Scales® (MAS). Pain was rated on an 11-point visual analog scale. Patients’ and physicians’ satisfaction as well as adverse events were recorded. Improvements of ≥1-point on MAS immediately after and 17 days posttreatment were observed in ~90% of patients compared with baseline. All investigators assessed ejection force, product positioning, and performance as similar or superior to the respective nonlidocaine products. Overall, 94% of investigators were satisfied with the esthetic outcomes and were willing to continue using the products. All patients except one were satisfied with the results, and all were willing to repeat the treatment. Mean pain scores were low during (<3.0) and after injection (<0.6). Except for one case of bruising, all adverse events were mild to moderate. CPM® fillers with lidocaine are safe and effective for a wide range of esthetic facial indications.
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Affiliation(s)
- Ulrich Kühne
- Aesthetische Dermatologie im Medico Palais, Bad Soden, Germany
| | | | | | - Matthias Imhof
- Aesthetische Dermatologie im Medico Palais, Bad Soden, Germany
| | - Petra Weissenberger
- Corporate Clinical Research, Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany
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Abstract
BACKGROUND A validated scale is needed for objective and reproducible comparisons of infraorbital hollows (i.e., tear troughs) before and after treatment in practice and clinical studies. OBJECTIVE To describe the development and validation of the 5-point photonumeric Allergan Infraorbital Hollows Scale. METHODS The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 297) completed during 2 sessions occurring 3 weeks apart. RESULTS A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 0.90 [0.79-1.02] for clinically different image pairs and 0.33 [0.19-0.46] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was substantial (mean weighted kappa = 0.79). Interrater agreement was substantial during the second rating session (0.70, primary end point). CONCLUSION The Allergan Infraorbital Hollows Scale is a validated and reliable scale for physician rating severity of hollowing in the infraorbital area.
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Prasetyo AD, Prager W, Rubin MG, Moretti EA, Nikolis A. Hyaluronic acid fillers with cohesive polydensified matrix for soft-tissue augmentation and rejuvenation: a literature review. Clin Cosmet Investig Dermatol 2016; 9:257-80. [PMID: 27660479 PMCID: PMC5021061 DOI: 10.2147/ccid.s106551] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Cohesive monophasic polydensified fillers show unique viscoelastic properties and variable density of hyaluronic acid, allowing for a homogeneous tissue integration and distribution of the material. Objective The aim of this paper was to review the clinical data regarding the performance, tolerability, and safety of the Belotero® fillers for soft-tissue augmentation and rejuvenation. Methods A literature search was performed up until May 31, 2015 to identify all relevant articles on Belotero® fillers (Basic/Balance, Hydro, Soft, Intense, Volume) and equivalent products (Esthélis®, Mesolis®, Fortélis®, Modélis®). Results This comprehensive review included 26 papers. Findings from three randomized controlled trials showed a greater reduction in nasolabial fold severity with Belotero® Basic/Balance than with collagen (at 8, 12, 16, and 24 weeks, n=118) and Restylane® (at 4 weeks, n=40), and higher patient satisfaction with Belotero® Intense than with Perlane® (at 2 weeks, n=20). With Belotero® Basic/Balance, an improvement of at least 1 point on the severity scale can be expected in ~80% of patients 1–6 months after injection, with an effect still visible at 8–12 months. Positive findings were also reported with Belotero® Volume (no reduction in hyaluronic acid volume at 12 months, as demonstrated by magnetic resonance imaging), Soft (improvement in the esthetic outcomes when used in a sequential approach), and Hydro (improvement in skin appearance in all patients). The most common adverse effects were mild-to-moderate erythema, edema, and hematoma, most of which were temporary. There were no reports of Tyndall effect, nodules, granulomas, or tissue necrosis. Conclusion Clinical evidence indicates sustainable esthetic effects, good safety profile, and long-term tolerability of the Belotero® fillers, particularly Belotero® Basic/Balance and Intense.
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Affiliation(s)
| | | | | | - Ernesto A Moretti
- Gamma Health Group, Sanatorio Los Arroyos, Santa Fe, Republic of Argentina
| | - Andreas Nikolis
- Victoria Park Clinical Research Centre, Westmount, QC, Canada
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