Chronic regional impairments of the lymphatic circulation often lead to striking architectural abnormalities in the lymphedematous tissues. Lymphedema is a common, disabling disease that currently lacks a cure. Vascular endothelial growth factors C and D mediate lymphangiogenesis through the VEGFR-3 receptor on lymphatic endothelia. The purpose of this study was to investigate the therapeutic potential for lymphangiogenesis with VEGF-C. We developed a rabbit ear model to simulate human chronic postsurgical lymphatic insufficiency. Successful, sustained surgical ablation of the ear lymphatics was confirmed by water displacement volumetry. After complete healing, the experimental animals (n=8) received a single, s.c. 100 microg dose of VEGF-C in the operated ear; controls (n=8) received normal saline. Radionuclide lymphoscintigraphy was performed to quantitate lymphatic function. Immunohistochemistry (IHC) was performed 7-8 days following treatment. After VEGF-C, there was a quantifiable amelioration of lymphatic function. IHC confirmed a significant increase in lymphatic vascularity, along with reversal of the intense tissue hypercellularity of untreated lymphedema. This study confirms the capacity of a single dose of VEGF-C to induce therapeutic lymphangiogenesis in acquired lymphedema. In addition to improving lymphatic function and vascularity, VEGF-C can apparently reverse the abnormalities in tissue architecture that accompany chronic lymphatic insufficiency.

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This novel bipolar RF device represents a safe, effective treatment option for non-invasive skin tightening.

Dermal fillers have become an integral part of both medical and cosmetic dermatology. Our expanding knowledge of the aging face has allowed us to shift the focus from skin-reduction lifting procedures to soft tissue augmentation. Within the past 5 years alone, nine new dermal fillers have been approved by the U.S. Food and Drug Administration for soft tissue augmentation. The rise in both the use and number of dermal fillers in recent years is a testament to their safety and efficacy. Dermal fillers can be broken down to three major types: temporary, semipermanent, and permanent. The former, which include hyaluronic acid based fillers, provide safe and effective correction but only for a limited time, typically approximately 1 to 2 years at best. This review will cover the semipermanent (poly-L-lactic acid and calcium hydroxylapatite) and permanent (polymethylmethacrylate and liquid silicone) injectable fillers. These so-called deep dermal fillers are valuable, durable tools in correcting the aging face. Given their extended duration of effect, these fillers inherently carry their own risk for potential adverse events. Thus, it is essential that clinicians have a thorough understanding of these products to best counsel, recommend, and perform soft tissue augmentation using these fillers.

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