Hyaluronic acid (HA) injection is a popular nonsurgical, facial rejuvenating procedure. Due to the rapidly expanding use of HA injections, significant potential complications have also increased in frequency. Among these complications, the rare but most devastating one is arterial occlusion, which can result in skin necrosis or blindness. To describe the mechanisms behind vision loss secondary to hyaluronic acid injection and the efficacy of treatments to restore vision and associated ocular functionality. We reviewed six cases of patients from October 2011 to December 2017 who experienced vision loss after receiving facial HA injections and the subsequent treatments undertaken to attempt to reverse the vision loss and additional eye complications. Of the six patients, four received nose, one received forehead, and another one received temple injections. All six patients developed vision loss secondary to hyaluronic acid embolization in retinal or ophthalmic arteries. Additional complications included severe periorbital pain, ptosis, impairment of extraocular muscle functionality. Recovery of vision was dependent on the type, frequency, and duration of subsequent treatment. Vision loss is a rare but catastrophic complication caused by hyaluronic injection that occurs secondary to hyaluronic acid embolization in retinal or ophthalmic arteries due to retrograde flow from facial vascular anastomoses. We suggest the early supratrochlear/supraorbital hyaluronidase injection, ocular massage, and re-breathing into a plastic bag as safe, uncomplicated and effective methods to restore the retinal circulation and reverse vision loss.

Eyebrows serve as a key feature of the face and have many roles, including cosmetic appearance and social communication. Eyebrow hypotrichosis, which refers to reduction or absence of the eyebrow hair, could be a major problem that leads to negative functional, psychological, and social consequences. Bimatoprost is an ophthalmic prostamide analog that is approved by the United States Food and Drug Administration for the treatment of eyelash hypotrichosis. Its proposed mechanism is stimulation of the prostaglandin receptor in dermal papilla and melanocyte, thus leading to a prolonged anagen phase and increased melanogenesis. The hair follicle then increases in thickness, length, and darkness. The efficacy of bimatoprost for the treatment of eyebrow hypotrichosis has been supported by well-controlled studies. Bimatoprost, which is noninvasive, effective, and well tolerated, is worth considering as a treatment option for eyebrow hypotrichosis.

Background: A recent report suggested potential of high-intensity focused ultrasound in improving UVB-induced hyperpigmentation in patients with Fitzpatrick skin type IV, but reports regarding its efficacy in other hyperpigmented conditions including melasma are lacking.Objectives: To investigate efficacy and safety of high-intensity focused ultrasound for the treatment of melasma in Asians.Methods: Each side of the face of 25 melasma patients was randomized to receive 3monthly sessions of high-intensity focused ultrasound treatment or serve as control.Lightness index, Melasma Area and Severity Index of malar area (MASI m ) by blinded dermatologists, self-evaluated improvement and satisfaction scales by patients, and side effects were assessed every 4 weeks for 20 weeks.Results: Twenty-one patients with Fitzpatrick skin type III and IV completed the study. There was a greater reduction of relative lightness index and MASI m after treatment in high-intensity focused ultrasound-treated side. However, there were no statistically significant differences between both sides. More than 50% improvement on treatment side was rated in 11 patients (52.4%). Side effects were minimal. None had worsening of melasma. Conclusions:High-intensity focused ultrasound may be an adjuvant for treatment of melasma. Further studies with larger sample size and proper parameter settings are recommended to determine its efficacy.

BACKGROUND Eyebrow hypotrichosis is an important dermatological problem. However, there is no standard treatment. OBJECTIVE To study the efficacy and safety of bimatoprost 0.01% for the treatment of eyebrow hypotrichosis. MATERIALS AND METHODS Although bimatoprost 0.03% has been studied previously, this is the first study to evaluate the efficacy and safety of bimatoprost 0.01% for the treatment of eyebrow hypotrichosis. A randomized, double-blinded, vehicle-controlled trial was conducted in 40 patients. All patients were randomized to receive bimatoprost 0.01% or placebo vehicle, once daily, for 6 months. The primary outcome was improvement in eyebrow density and diameter. Additional outcomes were the improvement in clinical assessments and safety evaluation. RESULTS Compared to the vehicle group, bimatoprost 0.01% significantly increased mean eyebrow hair density, eyebrow hair diameter, and clinical assessments (p < .001) in the drug group. Patients' satisfaction score was higher for the drug group than the vehicle group (p < .05). Adverse effects of the treatment were minimal and similar between the 2 groups. CONCLUSION Bimatoprost 0.01% was found to be superior to a placebo for eyebrow enhancement. Bimatoprost 0.01% can be considered effective, safe, and well-tolerated for the treatment of eyebrow hypotrichosis.

Background Previous studies have proven the efficacy and safety of 0.01% and 0.03% bimatoprost for the treatment of eyebrow hypotrichosis; however, there is no comparison study between both concentrations. Aims To compare the efficacy and safety between 0.01% and 0.03% bimatoprost for the treatment of eyebrow hypotrichosis. Patients/Methods This prospective, randomized, double‐blind, split‐face clinical study was conducted in 30 patients with eyebrow hypotrichosis. Each side of eyebrow of individual patients was randomly assigned for 0.01% and 0.03% bimatoprost, applied on each eyebrow once daily. Eyebrow density, diameter, the Global Eyebrow Assessment scale, 7‐point rating scale, and patient satisfaction were evaluated. Side effects were also recorded. Results Both 0.01% and 0.03% bimatoprost significantly improved eyebrow density and diameter (P < .05), although there were no statistically significant differences in changes in eyebrow density and diameter from baseline between both concentrations (P = .96 and .84, respectively). Additionally, patients significantly preferred 0.03% bimatoprost in terms of clinical improvement and satisfaction (P = .04 and .003, respectively). Conclusions Both 0.01% and 0.03% bimatoprost are effective and safe for the treatment of eyebrow hypotrichosis. Bimatoprost 0.03% is superior to its 0.01% counterpart, albeit without statistical significance.