The use of hyaluronic acid (HA) injectable fillers has become increasingly widespread in facial recontouring and rejuvenation. We report our experiences to emphasize the role of HA fillers as tools beyond aesthetic treatments in cases of post-surgical facial sequelae. HA fillers are generally used for aesthetic rejuvenation, but one potential new horizon could be their application in trauma, reconstructive, and craniofacial surgery. This study was conducted retrospectively, evaluating medical reports of patients treated at the Maxillofacial Surgery Unit, University of Campania “Luigi Vanvitelli”, Naples, for lip incompetence, trauma, oncological, reconstructive, and craniosynostosis surgery sequelae. Visual analog scale (VAS) evaluation was performed to assess patient satisfaction. No major complications (i.e., impending necrosis or visual loss) were reported. Bruising and swelling was reported for 48 h after lip injection. At the immediate VAS evaluation, 67% of the patients were “extremely satisfied” and 33% “satisfied”. In those 33%, VAS scores changed to “extremely satisfied” at 6–9 weeks and 3–6 months of VAS evaluation (contextually to improvement in tissue flexibility, elasticity, and aesthetic appearance). Results indicate that this minimally invasive approach achieves a high level of aesthetic enhancement, improving patient satisfaction. The concept of HA filler applications could be a frontier that may be applicable to other areas of reconstructive facial plastic surgery.
The SPA results align with other patient-reported outcomes from the same study. For example, most patients rated their hands and decolletage as "improved" or "much improved" on the Global Aesthetic Improvement Scale out to 12 months of follow-up. 1 The mechanisms responsible for skin aging and how it is perceived include environmental factors (e.g., sun exposure) and biological aspects (e.g., nutrition). In addition, there is likely to be a substantial genetic element. A recent genomewide association study identified 74 genetic loci that were independently associated with perceived aging-primarily in regulatory networks relevant to the skin. 3 The largest effect size of a minor allele was from an intronic variant of the MFAP4 gene, encoding a glycoprotein involved in elastin fiber organization within the extracellular matrix. 3 Patients with this variant are more likely to feel older than they are and hence HA filler injection could be especially valuable.Irrespective of underlying genetics, the improvements in SPA in this analysis are particularly important given that mitigation of aging is a key reason for wanting these treatments in the first place. In a recent prospective, multicenter analysis of more than 500 patients, the most commonly cited motivation for seeking aesthetic procedures was to look younger and fresher. 2 Thus, improving how patients perceive the age of their own appearance is central to a successful outcome. This may be particularly important with the hands, which many women conceal because they are self-conscious about signs of aging.Furthermore, it is possible that the impact of treatment could go beyond the psychological and into physical wellbeing. It has been reported that self-perception of being old, or negative changes in SPA, is predictive of increased longterm mortality risk. 4 These effects are not well understood in the context of aesthetic treatment with injectables but merit further study.
ConclusionsHelping patients to look and feel younger is central to the purpose of aesthetic treatment with fillers, but this effect has not been extensively assessed outside the face. In this study, injection of the hands and décolletage with VYC-17.5L led to substantial, rapid, and durable improvements in patients' SPA. Greater focus on treating these areas may be warranted.
Since the advent of HIV antiretroviral therapies at the end of the 20th century, the morbidity and mortality rates associated with HIV infection have decreased dramatically. Unfortunately, these benefits are associated with substantial morphologic changes in the body, such as abnormal fat distribution with peripheral lipohypertrophy and facial lipoatrophy. Facial wasting is considered the major stigma for HIV–infected people and may result in reduced antiretroviral adherence. Patients suffering from the stigmata of HIV infection can benefit from non-surgical aesthetic treatments performed with fillers or lipolytic agents that provide a quick and reliable service for facial rejuvenation, with high patient satisfaction and a low risk of complications. In the present paper, a retrospective analysis of complications following non-surgical aesthetic treatments (calcium hydroxyapatite-based filler, hyaluronic acid filler, polyacrylamide hydrogel filler and dehoxycholic acid injections), in a cohort of 116 consecutive HIV+ patients, treated over a period of 12 years, was performed. With the exception of the tardive swelling reported after calcium hydroxyapatite injections, complications were recorded just after polyacrylamide hydrogel treatment as small, palpable, nonvisible nodules or aseptic abscess. Our experience is consistent with those already published in the literature and the complication rate seems to be comparable to non-infected patients.
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