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Demchenko I, Swiderski A, Liu H, Jung H, Lou W, Bhat V. Botulinum Toxin Injections for Psychiatric Disorders: A Systematic Review of the Clinical Trial Landscape. Toxins (Basel) 2024; 16:191. [PMID: 38668616 PMCID: PMC11054929 DOI: 10.3390/toxins16040191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024] Open
Abstract
Botulinum toxin type A (BONT-A) has shown promise in improving the mood-related symptoms of psychiatric disorders by targeting muscles linked to the expression of negative emotions. We conducted a systematic review of past and ongoing efficacy trials of BONT-A therapy for psychiatric disorders to identify relevant trends in the field and discuss the refinement of therapeutic techniques. A comprehensive search for published clinical trials using BONT-A injections for psychiatric disorders was performed on 4 May 2023 through OVID databases (MEDLINE, Embase, APA PsycINFO). Unpublished clinical trials were searched through the ClinicalTrials.gov and International Clinical Trial Registry Platform public registries. The risk of bias was assessed using the JBI Critical Appraisal tools for use in systematic reviews. We identified 21 studies (17 published, 4 unpublished clinical trials) involving 471 patients. The studies focused on evaluating the efficacy of BONT-A for major depressive, borderline personality, social anxiety, and bipolar disorders. BONT-A was most commonly injected into the glabellar area, with an average dose ranging between 37.75 U and 44.5 U in published studies and between 32.7 U and 41.3 U in unpublished trials. The results indicated significant symptom reductions across all the studied psychiatric conditions, with mild adverse effects. Thus, BONT-A appears to be safe and well-tolerated for psychiatric disorders of negative affectivity. However, despite the clinical focus, there was a noted shortage of biomarker-related assessments. Future studies should focus on pursuing mechanistic explorations of BONT-A effects at the neurobiological level.
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Affiliation(s)
- Ilya Demchenko
- Interventional Psychiatry Program, St. Michael’s Hospital—Unity Health Toronto, 193 Yonge Street, Toronto, ON M5B 1M4, Canada; (I.D.); (A.S.); (H.L.)
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Institute for Biomedical Engineering, Science, and Technology (iBEST), Keenan Research Centre for Biomedical Science, St. Michael’s Hospital—Unity Health Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada
| | - Alyssa Swiderski
- Interventional Psychiatry Program, St. Michael’s Hospital—Unity Health Toronto, 193 Yonge Street, Toronto, ON M5B 1M4, Canada; (I.D.); (A.S.); (H.L.)
| | - Helen Liu
- Interventional Psychiatry Program, St. Michael’s Hospital—Unity Health Toronto, 193 Yonge Street, Toronto, ON M5B 1M4, Canada; (I.D.); (A.S.); (H.L.)
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael’s Hospital—Unity Health Toronto, 193 Yonge Street, Toronto, ON M5B 1M4, Canada; (I.D.); (A.S.); (H.L.)
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Institute for Biomedical Engineering, Science, and Technology (iBEST), Keenan Research Centre for Biomedical Science, St. Michael’s Hospital—Unity Health Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada
- Neuroscience Research Program, St. Michael’s Hospital—Unity Health Toronto, 209 Victoria Street, Toronto, ON M5T 3M7, Canada
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2
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Yuan P, Shan L, Yang X, Yu F, Ge Z, Wang M, Tan H. The merging of dual umbilical port-incisions for contained morcellation in laparoscopic myomectomy. Am J Obstet Gynecol 2023; 229:72-74. [PMID: 36933684 DOI: 10.1016/j.ajog.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
Uncontained power morcellation during laparoscopic myomectomy may spread tissue fragments or malignant cells into the abdominal cavity. Recently, various approaches to contained morcellation, have been adopted to retrieve the specimen. However, each of these methods has its own drawbacks. Intraabdominal bag-contained power morcellation adopts a complex isolation system, which prolongs the operation and increases medical costs. Contained manual morcellation via colpotomy or mini-laparotomy increases the trauma and the risk of infection. Contained manual morcellation via umbilical incision during single-port laparoscopic myomectomy may be the most minimally invasive and cosmetic approach. But the popularization of single-port laparoscopy is challenging because of technical difficulties and high costs. We have therefore, developed a surgical technique using 2 umbilical port-incisions (5 mm and 10 mm), which are merged into 1 large umbilical incision (25-30mm) for contained manual morcellation during specimen retrieval, and one 5mm incision in the lower left abdomen for an ancillary instrument. As demonstrated in the video, this technique significantly facilitates surgical manipulation using conventional laparoscopic instruments while still keeping the incisions minimal. It is also economical because the use of an expensive single-port platform and special surgical instruments is avoided. In conclusion, the merging of dual umbilical port-incisions for contained morcellation adds a minimally invasive, cosmetic, and economical option to laparoscopic specimen retrieval that would enrich a gynecologist's skill set, which is particularly relevant in a low-resource settings.
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Affiliation(s)
- Peng Yuan
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China.
| | - Li Shan
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China
| | - Xiaohua Yang
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China
| | - Fan Yu
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China
| | - Zhonghu Ge
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China
| | - Mengyao Wang
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China
| | - Hongwei Tan
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, China.
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3
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Steenen SA, Bauland CG, van der Lei B, Su N, van Engelen MDG, Anandbahadoer-Sitaldin RDRRAL, Koeiman W, Jawidan T, Hamraz Y, Lange JD. Head-to-head comparison of 4 hyaluronic acid dermal fillers for lip augmentation: A multicenter randomized, quadruple-blind, controlled clinical trial. J Am Acad Dermatol 2023; 88:932-935. [PMID: 36370906 DOI: 10.1016/j.jaad.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/18/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Serge A Steenen
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands; Faceland Clinics, the Netherlands; Foundation for the Integration of Cosmetic Medicine, Capelle aan den IJssel, the Netherlands; Dutch Association of Cosmetic Medicine, Bussum, the Netherlands.
| | - Constantijn G Bauland
- Faceland Clinics, the Netherlands; Foundation for the Integration of Cosmetic Medicine, Capelle aan den IJssel, the Netherlands
| | - Berend van der Lei
- Department of Plastic Surgery, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Naichuan Su
- Academic Centre for Dentistry, Amsterdam, The Netherlands
| | - Muriëlle D G van Engelen
- Faceland Clinics, the Netherlands; Dutch Association of Cosmetic Medicine, Bussum, the Netherlands
| | | | - Whitney Koeiman
- Faceland Clinics, the Netherlands; Dutch Association of Cosmetic Medicine, Bussum, the Netherlands
| | - Tina Jawidan
- Faceland Clinics, the Netherlands; Dutch Association of Cosmetic Medicine, Bussum, the Netherlands
| | - Yama Hamraz
- Faceland Clinics, the Netherlands; Dutch Association of Cosmetic Medicine, Bussum, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers/Academic Center for Dentistry, University of Amsterdam, Amsterdam, the Netherlands
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4
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Beer K, Biesman B, Cox SE, Smith S, Picault L, Trevidic P. Efficacy and Safety of Resilient Hyaluronic Acid Fillers Injected with a Cannula: A Randomized, Evaluator-Blinded, Split-Face Controlled Study. Clin Cosmet Investig Dermatol 2023; 16:959-972. [PMID: 37038451 PMCID: PMC10082220 DOI: 10.2147/ccid.s402315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/04/2023] [Indexed: 04/12/2023]
Abstract
Purpose Cannulas are increasingly used for injecting hyaluronic acid fillers, as they are thought to improve patient comfort safety and treatment tolerability. This study aimed to demonstrate the non-inferiority of a Resilient Hyaluronic Acid 4 (RHA 4) filler injected with a cannula versus a needle for the treatment of moderate to severe nasolabial folds (NLF). Patients and Methods A total of 50 subjects were included in a randomized, evaluator-blinded, split-face trial. The NLF were injected with RHA 4 using a cannula on one side of the face and using a needle on the other side on Day 0. A touch-up could be performed 4 weeks later. The subjects were followed up for 12 weeks after the last injection, ie, injection on Day 0 or touch-up. Efficacy was evaluated using a Wrinkle Severity Rating Scale (WSRS), the Global Aesthetic Improvement Scale (GAIS), and patient-reported outcomes. Safety assessments included the injection-site pain, common treatment reactions (CTRs), and adverse events (AEs). Results Twelve weeks after the last injection, the efficacy of the cannula treatment was found to be non-inferior to that of the needle treatment, based on the WSRS score improvements. The other study endpoints showed the equivalent efficacy and safety of the two methods. No serious or unexpected AEs were reported. Conclusion RHA 4 may be effectively and safely injected into the NLF using a cannula or a needle, provided it is administrated by a trained practitioner.
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Affiliation(s)
| | | | | | - Stacy Smith
- California Dermatology & Clinical Research Institute, Encinitas, CA, USA
| | - Laura Picault
- Teoxane Clinical Development Department, Genève, Switzerland
| | - Patrick Trevidic
- Expert 2 Expert, Paris, France
- Correspondence: Patrick Trevidic, Expert 2 Expert, 7 Rue de Sontay, Paris, 75116, France, Tel +33 145 016 415, Fax +33 145 008 981, Email
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Zheng S, Feng Z, Chen C, He A, Liu J. Social-economic impact of infection after cosmetic facial injection: A retrospective study. J Cosmet Dermatol 2022; 21:6706-6709. [PMID: 35451164 DOI: 10.1111/jocd.15012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The overwhelming interest in economically cost-effective treatments had led to an increase in the development of cosmetic facial injections. Concomitantly, complications have been also on the increasing trend. This article aimed to investigate the social-economic impact caused by infection after cosmetic facial injection. METHODS A retrospective study was conducted between January 2014 and December 2019. Information including demographics, location of the original injection site, treatments, economic loss, and time away from work associated with complications was documented. Patients were asked to complete 2 FACE-Q domains 4 weeks after the first presentation, including quality of life and patient experience. RESULTS Complete data were available for 12 patients. All patients were female; the mean age was 32.66 years (range, 26-49 years). The mean therapeutic cost of atypical mycobacterium was 18170.58 USD. The mean time away from work was 51.25 days (range, 21-103 days). The mean cost of time away from work was 400.80 USD (range, 164.23-805.50 USD). From FACE-Q, patients reported a decreased quality of social life, including social function (38.83 ± 12.10), psychological distress (48.67 ± 11.01), and early-life impact (39.92 ± 10.15). Patients also reported low satisfaction with their decision to undergo the cosmetic facial injection. CONCLUSIONS Infection after cosmetic facial injection comes at a considerable social-economic impact on patients. Patients who responded in this study were extremely unsatisfied with the quality of life following the infection.
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Affiliation(s)
- Shaoluan Zheng
- Department of Plastic and Reconstructive Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Zihao Feng
- Department of Plastic and Reconstructive Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.,Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenxi Chen
- Department of Plastic and Reconstructive Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Anqi He
- Department of Plastic and Reconstructive Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Jiaqi Liu
- Department of Plastic and Reconstructive Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Gupta R, John J, Ranganathan N, Stepanian R, Gupta M, Hart J, Nossoni F, Shaheen K, Folbe A, Chaiyasate K. Outcomes of Closed versus Open Rhinoplasty: A Systematic Review. Arch Plast Surg 2022; 49:569-579. [PMID: 36159386 PMCID: PMC9507448 DOI: 10.1055/s-0042-1756315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Open and closed rhinoplasty are two main approaches to perform nasal modifications. According to current literature, there is no current consensus among plastic surgeons and otolaryngologists on which technique is preferred in terms of aesthetic result, complications, and patient satisfaction. This study uses published research to determine whether open or closed rhinoplasty leads to superior patient outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed and a literature search was conducted in four databases based on our search strategy. Articles were then imported into COVIDENCE where they underwent primary screening and full-text review. Twenty articles were selected in this study after 243 articles were screened. There were 4 case series, 12 retrospective cohort studies, 1 prospective cohort study, 1 case–control, and 2 outcomes research. There were three cosmetic studies, eight functional studies, and nine studies that included both cosmetic and functional components. Sixteen studies utilized both open and closed rhinoplasty and four utilized open rhinoplasty. Both techniques demonstrated high patient and provider satisfaction and no advantage was found between techniques. Based on available studies, we cannot conclude if there is a preference between open or closed rhinoplasty in terms of which technique leads to better patient outcomes. Several studies determined that open rhinoplasty and closed rhinoplasty leads to comparative patient satisfaction. To make outcome reporting more reliable and uniform among studies, authors should look to utilize the Nasal Obstruction and Septoplasty Effectiveness scale and the Rhinoplasty Outcome Evaluation.
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Affiliation(s)
- Rohun Gupta
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Jithin John
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Noopur Ranganathan
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Rima Stepanian
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Monik Gupta
- The University of Toledo Health Science Campus, Toledo, Ohio
| | - Justin Hart
- Department of Plastic Surgery, Beaumont Health Systems, Royal Oak, Michigan
| | - Farideddin Nossoni
- Department of Plastic Surgery, Beaumont Health Systems, Royal Oak, Michigan
| | - Kenneth Shaheen
- Department of Plastic Surgery, Beaumont Health Systems, Royal Oak, Michigan
| | - Adam Folbe
- Department of Otolaryngology, Beaumont Health Systems, Royal Oak, Michigan
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7
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Munia C, Parada M, de Alvarenga Morais MH. Changes in Facial Morphology Using Poly-L-lactic Acid Application According to Vector Technique: A Case Series. J Clin Aesthet Dermatol 2022; 15:38-42. [PMID: 35942018 PMCID: PMC9345188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The search for nonsurgical cosmetic procedures has increased considerably in recent years. A new injection technique, using vector direction, has shown good results in improving facial aesthetics but to date has only been performed with hyaluronic acid which can be associated with a risk of vascular complications. Therefore, in clinical practice, it would be interesting to assess this technique with a liquid product already widely used in the facial region, and at the same time bring the same aesthetic benefits, but with greater durability than hyaluronic acid. OBJECTIVE To investigate the improvement of facial morphology in patients with facial flaccidity submitted to the vector technique using poly-L-lactic acid (PLLA) (Sculptra®; Galderma, Lausanne, Switzerland). CASE SERIES Here we report the outcomes of three cases of female patients, aged between 41 and 55 years, seeking improvement of facial flaccidity. In each patient, PLLA was applied in the posterior temporal region as a bolus, in three points, with a 2-mL injection in the upper region, 1.5mL in the midpoint, and 1.5mL at the bottom point. Each of the three patients showed an improvement in face morphology, with concomitant improvement in the support and stretching of the face and improvement in skin sagging in the upper, middle, and bottom regions. CONCLUSION The vector technique with PLLA is a viable alternative for the treatment of patients with facial skin flaccidity, providing harmonious and progressive improvement in the face morphology.
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Affiliation(s)
- Christine Munia
- Drs. Munia and Parada are in private practice in Sao Paolo, Brazil
| | - Meire Parada
- Drs. Munia and Parada are in private practice in Sao Paolo, Brazil
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Pando BL, Goldsmith B, Webb AL, Kinger K, Helmly B. Free Silicone-Induced Granulomatosis and Hypercalcemia in a Transgender Female. HCA Healthc J Med 2022; 3:161-166. [PMID: 37424606 PMCID: PMC10324841 DOI: 10.36518/2689-0216.1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction Vitamin D derangements are a rare but important cause of hypercalcemia. Granulomatous disease is a primary cause of vitamin D derangements and is frequently associated with sarcoidosis, tuberculosis, and in the present case, foreign body granulomatosis. Liquid or injectable silicone is used as a filler for cosmetic body contouring. Transgender patients may seek silicone injections as part of gender affirmation surgeries. Granuloma formation is a rare but well-described complication of injectable silicone. Case Description A 40-year-old, assigned male at birth (AMAB) transgender female patient, with a history of HIV and chronic kidney disease (CKD) stage 3b, was admitted to the emergency department for evaluation of hypercalcemia. One year prior, the hypercalcemia was attributed to CKD secondary to HIV or HIV medications. The patient presented after two weeks of polyuria and polydipsia. Her vital signs were stable, and the physical exam, EKG, and chest x-ray were unremarkable. Labs were notable for calcium (14.1 mg/dL, assay normal range 8.5-10.5 mg/dL) and acute-on-chronic kidney disease. Follow-up labs were consistent with a vitamin D aberration causing hypercalcemia, raising suspicion for granulomatous disease. CT chest/abdomen/pelvis without contrast demonstrated diffuse skin thickening of the bilateral breasts and buttocks with associated ill-defined soft tissue density and scattered punctate calcifications. No hilar adenopathy or lung abnormalities were observed, decreasing the suspicion of sarcoidosis or an infectious etiology. The patient disclosed having received free silicone injections to which the hypercalcemia was attributed. After single doses of calcitonin (100U SC/IM) and zoledronic acid (4 mg IV), her hypercalcemia resolved. Kidney function gradually returned to baseline with IV fluids. Conclusion This case illustrates the importance of readily recognizing the imaging characteristics of free silicone granulomatosis, which showed subcutaneous fat infiltrated with soft tissue nodules and calcifications. The distribution of findings in the bilateral breast and buttocks and history of free silicone injections were most useful in arriving at a diagnosis and treatment plan.
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Affiliation(s)
| | | | | | - Komal Kinger
- Memorial Health University Medical Center, Savannah, GA
| | - Brian Helmly
- Memorial Health University Medical Center, Savannah, GA
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Galadari H, Weinkle SH. Injection techniques for midface volumization using soft tissue hyaluronic acid fillers designed for dynamic facial movement. J Cosmet Dermatol 2021; 21:924-932. [PMID: 34964234 PMCID: PMC9303613 DOI: 10.1111/jocd.14700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022]
Abstract
Volume loss of the face occurs over time; thus, volume enhancement of the midface can counteract the effects of aging. Hyaluronic acid (HA) fillers are often used for facial revolumization for a more youthful appearance due to their favorable outcomes and safety profiles. A patient‐centric approach, in which dynamic facial expressions are considered, is needed for optimal aesthetic results. In addition, injectors must be familiar with midface anatomy, how it is affected by the aging process, and must also consider the rheological and physical properties of fillers, including their stretch and dynamic strength. In this article, optimal injection techniques are described for a new range of HA‐based fillers for midface revolumization using a needle, cannula, or both. The layering technique involves product placement in both the deep and superficial fat compartments to achieve natural‐looking outcomes at rest and during motion. The Resilient Hyaluronic Acid (RHA®) line of fillers was designed to maintain their durability and integrity while adapting to the dynamic movements of the face. RHA 2 is applicable for superficial placement, whereas the balanced stretch and dynamic strength of RHA 3 render it more versatile. The novel rheological properties of RHA 4, with the highest dynamic strength and sufficient stretch, allow it to be injected superficially and into deep facial compartments. Depending on patient characteristics, the appropriate RHA filler can be chosen to reach the goal of a natural, younger appearance and avoid overfilling.
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Affiliation(s)
- Hassan Galadari
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Susan H Weinkle
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, Florida, USA
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10
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Oliveira Paggiaro A, Pinheiro R, Soares K, Fernandes Carvalho V, Gemperli R. Evaluation of the evidence level for the use of radiofrequency in aesthetic treatments: A systematic review and meta-analysis. J Cosmet Dermatol 2021; 20:2691-2702. [PMID: 34333828 DOI: 10.1111/jocd.14353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Radiofrequency (RF) is a non-invasive or minimally invasive procedure with a low risk of complications. It has been employed for several aesthetic purposes. AIM This study aimed to conduct a systematic literature review on the use of RF for aesthetic applications and assess the level of accumulated evidence for each condition. METHODS Using the MEDLINE/PubMed and EMBASE databases, we searched for articles published from 2009 to 2019 describing the use of RF treatment for aesthetic purposes. RESULTS Our search approach identified 25 randomized clinical trials investigating the efficacy of RF in the following clinical situations: body contour improvement, facial rejuvenation, acne scar treatment, alopecia, and rosacea. There were problems with the quality of the studies, especially regarding selection, performance, and detection bias. CONCLUSION Our study revealed that RF treatment is potentially promising in all of the evaluated clinical situations; however, we were not able to identify a level of evidence that justifies its use over other therapeutic options currently available on the market.
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Affiliation(s)
- André Oliveira Paggiaro
- Plastic Surgery Department, São Paulo University, São Paulo, Brazil.,Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Rafael Pinheiro
- Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | - Kaolanna Soares
- Nursing Post Graduation, Guarulhos University, Guarulhos, São Paulo, Brazil
| | | | - Rolf Gemperli
- Plastic Surgery Department, São Paulo University, São Paulo, Brazil
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11
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Artzi O, Cohen JL, Dover JS, Suwanchinda A, Pavicic T, Landau M, Goodman GJ, Ghannam S, Al Niaimi F, van Loghem JAJ, Goldie K, Sattler S, Cassuto D, Lim TS, Wanitphakdeedecha R, Verner I, Fischer TC, Bucay V, Sprecher E, Shalmon D. Delayed Inflammatory Reactions to Hyaluronic Acid Fillers: A Literature Review and Proposed Treatment Algorithm. Clin Cosmet Investig Dermatol 2020; 13:371-378. [PMID: 32547150 PMCID: PMC7244356 DOI: 10.2147/ccid.s247171] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/18/2020] [Indexed: 12/28/2022]
Abstract
Background and Objectives There is a wide diversity of opinions regarding the management of delayed inflammatory reactions (DIRs) secondary to hyaluronic acid (HA)-based fillers. The plethora of approaches has led the authors to conduct a review regarding management and treatment of DIRs as well as establish therapeutic guidelines for this purpose. Materials and Methods A review of the literature was performed through databases such as PubMed using keywords including HA-fillers and complications, delayed HA filler sequelae and therapy, soft tissue and dermal filler reactions and management. Additionally, a survey comprised of questions regarding the management and treatment of DIRs was sent to 18 physicians highly experienced with soft-tissue filler injections in 10 countries. Their answers and recommendations were analyzed and debated amongst these panelists. Results Sixteen panelists favored antibiotic therapy as first-line treatment for DIRs, specifically dual antibiotic therapy consisting of a fluoroquinolone along with a tetracycline or macrolide for a period of 3-6 weeks. The majority refrained from the use of intralesional (IL) or systemic steroids except in the case of disfiguring or recalcitrant reactions. IL hyaluronidase was recommended by 13 panelists; however, some preferred a watchful waiting approach for a period of 48 hours to 2 weeks prior to IL hyaluronidase, and in cases where antibiotics did not lead to improvement. Conclusion A consensus was reached and summarized to propose a clear, easy-to-follow, stepwise algorithm for the treatment of DIRs.
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Affiliation(s)
- Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joel L Cohen
- AboutSkin Dermatology and AboutSkin Research, , Greenwood Village and Lone Tree, CO, USA
| | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, MA, USA.,Dermatology, Yale University School of Medicine, New Haven, CT, USA.,Dermatology, Brown Medical School, Rhode Island, USA
| | - Atchima Suwanchinda
- Department of Dermatology, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand.,Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tatjana Pavicic
- Private Practice for Dermatology and Aesthetics Dr. Tatjana Pavicic, Munich 80539, Germany
| | | | | | - Sahar Ghannam
- Associate Prof. of Dermatology, Alexandria University, Alexandria, Egypt
| | | | | | - Kate Goldie
- Medical Director European Medical Aesthetics Ltd, London W1G 8QN, UK
| | | | | | | | | | - Ines Verner
- Verner Clinic, Tel Aviv, Israel.,Department of Dermatology, University of Rome, Guglielmo Marconi, Italy
| | - Tanja C Fischer
- Skin and Laser Center, Potsdam, Germany.,School of Medicine, University of Frankfurt, Germany
| | - Vivian Bucay
- Bucay Center for Dermatology and Aesthetics, UTHSC, San Antonio, TX, USA
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Shalmon
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shalmon D, Cohen JL, Landau M, Verner I, Sprecher E, Artzi O. Management Patterns of Delayed Inflammatory Reactions to Hyaluronic Acid Dermal Fillers: An Online Survey in Israel. Clin Cosmet Investig Dermatol 2020; 13:345-349. [PMID: 32440187 PMCID: PMC7216297 DOI: 10.2147/ccid.s247315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Over the past few decades, soft tissue augmentation is ever-increasing, specifically hyaluronic acid (HA)-based filler injections. As the number of these procedures have risen, so have the adverse reactions. Delayed-type inflammatory reactions (DIRs) secondary to tissue fillers are typically classified according to the time of appearance post-procedure and have various presentations including nodules, abscesses, edema, and discoloration. Currently, the treatment of these complications varies among physicians. OBJECTIVE The aim of this study was to assess the knowledge and experience of practitioners in Israel who inject HA-based tissue fillers with respect to the management of late-onset procedural complications. MATERIALS AND METHODS A survey regarding management and treatment of late-onset inflammatory reactions was sent to 1120 physicians and dentists in Israel who practice tissue filler injections. RESULTS Three hundred thirty-four out of the 1120 practitioners replied to the questionnaire. The majority of respondents were dentists (group A) comprising 31% of all respondents. Group B accounted for 31% of injectors and consisted of dermatologists (19%) and plastic surgeons (12%), and group C (38%) accounted for all other practitioners; 48.2% of all injectors indicated that they have not previously encountered a DIR, whereas 11.4% responded that they have encountered more than 5 DIRs. In order to assess treatment management, we presented the injectors with a simulatory case of a woman with a late-onset complication. Most injectors referred the patient to the emergency department. When asked to establish a treatment plan, the majority of practitioners prescribed short-term oral steroids, ie, prednisone (35.3%). A limited number of patients were treated with intra-lesional hyaluronidase (31.4%) injection as only 34% of injectors kept hyaluronidase at their clinic. CONCLUSION The varied approach regarding the management of delayed type reactions to HA-based filler injections, reflected in our study, illustrates the existing ambivalence in the current literature regarding the management and therapy of late-onset complications.
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Affiliation(s)
- Dana Shalmon
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Joel L Cohen
- AboutSkin Dermatology and AboutSkin Research, Greenwood and Lone Tree, CO, USA
| | | | - Ines Verner
- Verner Clinic Tel Aviv, University of Rome “Guglielmo Marconi”, Israel, Italy
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Ribeiro F, Steiner D. Quality of life before and after cosmetic procedures on the face: A cross-sectional study in a public service. J Cosmet Dermatol 2018; 17:688-692. [PMID: 30105787 DOI: 10.1111/jocd.12723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/16/2018] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Quality of life can be impaired by health conditions that modify body appearance. AIMS The objective of this cross-sectional study was to evaluate the quality of life of patients before and after free-of-charge esthetic dermatological treatments offered in a philanthropic Dermatological Clinic for nonpathological conditions, such as anti-aging procedures. METHODS All consecutive patients admitted between March and November 2016 were recruited. All esthetic treatments in this study were simple procedures applied in one session only, on the face, neck, arms, and upper chest, with a consult visit scheduled four weeks later for clinical evaluation. The WHOQOL-BREF instrument was used before and one month after the procedure. RESULTS WHOQOL-BREF scores increased significantly after treatment (P < 0.001) in all the domains. CONCLUSION Patients undergoing simple dermatological treatments applied by specialists report overall and specific domain improvements in quality of life, according to the World Health Organization instrument, regardless of the type of procedure.
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Affiliation(s)
- Felipe Ribeiro
- Dermatology, Universidade de Mogi das Cruzes, Mogi das Cruzes, Brazil
| | - Denise Steiner
- Dermatology, Universidade de Mogi das Cruzes, Mogi das Cruzes, Brazil
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Abstract
Facial expressions convey emotions that form the foundation of interpersonal relationships, and many of these emotions promote and regulate our social linkages. Hence, the facial aging symptomatological analysis and the treatment plan must of necessity include knowledge of the facial dynamics and the emotional expressions of the face. This approach aims to more closely meet patients' expectations of natural-looking results, by correcting age-related negative expressions while observing the emotional language of the face. This article will successively describe patients' expectations, the role of facial expressions in relational dynamics, the relationship between facial structures and facial expressions, and the way facial aging mimics negative expressions. Eventually, therapeutic implications for facial aging treatment will be addressed.
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Örtqvist L, Fossum M, Andersson M, Nordenström A, Frisén L, Holmdahl G, Nordenskjöld A. Long-term followup of men born with hypospadias: urological and cosmetic results. J Urol 2015; 193:975-81. [PMID: 25268894 DOI: 10.1016/j.juro.2014.09.103] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 11/21/2022]
Abstract
PURPOSE We present data on long-term functional and cosmetic results after hypospadias surgery. MATERIALS AND METHODS Males older than 18 years with hypospadias treated in Sweden were asked to participate in the study, as well as age matched controls and circumcised men. All participants answered questionnaires, and a subgroup was examined during an outpatient visit. Relationships with outcome were analyzed using analysis of variance and regression analysis. RESULTS A total of 167 patients with a mean age of 34 years and 169 controls with a mean age of 33 years answered the questionnaire. Of the patients 63% had distal, 24% mid and 13% proximal hypospadias. A total of 46 patients and 49 controls presented for physical examination. Patients were significantly less satisfied with the penile cosmetic outcome regarding all parameters of the Penile Perception Score. There was a difference in penile length between patients and controls (mean 9.7 vs 11.6 cm, p <0.001). More patients than controls reported voiding dysfunction symptoms (p = 0.003). Patients had a lower maximum urinary flow rate than controls (p = 0.001). These differences were most prominent between patients with proximal hypospadias and controls. CONCLUSIONS Men operated on for hypospadias were less satisfied with the cosmetic result than controls, and had a shorter penile length. Patients presented with more symptoms of voiding dysfunction and displayed a lower maximum urinary flow rate. Patients with proximal hypospadias were more affected than those with milder hypospadias. Our results indicate that patients with hypospadias can be subgrouped and that those with severe phenotypes should be followed more closely during childhood as well as later in adulthood.
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Culton DA, Lachiewicz AM, Miller BA, Miller MB, Mackuen C, Groben P, White B, Cox GM, Stout JE. Nontuberculous mycobacterial infection after fractionated CO(2) laser resurfacing. Emerg Infect Dis 2013; 19:365-70. [PMID: 23628077 PMCID: PMC3647652 DOI: 10.3201/eid1903.120880] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nontuberculous mycobacteria are increasingly associated with cutaneous infections after cosmetic procedures. Fractionated CO2 resurfacing, a widely used technique for photorejuvenation, has been associated with a more favorable side effect profile than alternative procedures. We describe 2 cases of nontuberculous mycobacterial infection after treatment with a fractionated CO2 laser at a private clinic. Densely distributed erythematous papules and pustules developed within the treated area within 2 weeks of the laser procedure. Diagnosis was confirmed by histologic analysis and culture. Both infections responded to a 4-month course of a multidrug regimen. An environmental investigation of the clinic was performed, but no source of infection was found. The case isolates differed from each other and from isolates obtained from the clinic, suggesting that the infection was acquired by postprocedure exposure. Papules and pustules after fractionated CO2 resurfacing should raise the suspicion of nontuberculous mycobacterial infection.
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Affiliation(s)
- Donna A Culton
- University of North Carolina, Chapel Hill, NC 27514, USA
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Abstract
PURPOSE Many options are available for repairing mid shaft to distal hypospadias. Reported complications include poor cosmesis, persistent chordee, meatal stenosis and fistula. We hypothesized that advancing the intact native urethra would facilitate chordee correction and minimize complications. MATERIALS AND METHODS We retrospectively reviewed our records of all 248 hypospadias repairs done from July 2003 to May 2009 and identified patients younger than 18 years with distal or mid shaft hypospadias who underwent repair by urethral mobilization. The outcomes recorded were patient satisfaction, bladder scan volume, and the rate of fistula, meatal stenosis or other complications. RESULTS Of the patients 83 met study inclusion criteria, including 5 (6%) treated with previous failed hypospadias operations. The hypospadias site was the distal, mid shaft and megameatal intact prepuce variant in 69 (83.1%), 11 (13.3%) and 3 patients (3.6%), respectively. Chordee was present in 80 patients (96.4%). The mean degree of chordee was 61.5 degrees, mean age at operation was 35.7 months and mean followup was 18 months (range 0.25 to 79). Of parental responses 94% were pleased or very pleased. Mean bladder volume on bladder scan was 9.7 ml (range 0 to 81). Fistula developed in 1 patient (1.2%). There were no meatal stenosis cases. CONCLUSIONS Urethral mobilization results in excellent cosmesis and a low complication rate. This technique is especially well suited to patients with prior operations or deficient preputial skin. Using the native urethra with its blood supply is our preferred method of repairing distal and mid shaft hypospadias with chordee.
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Affiliation(s)
- Joel F Koenig
- School of Medicine, Southern Illinois University, Springfield, Illinois; School of Medicine and Public Health, University of Wisconsin (PHM), Madison, Wisconsin
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