The aging process occurs in all anatomical layers of the face; therefore, rejuvenation should not be limited to the dermic signs of aging. 1,2 Regardless of the beauty concept, a search for rejuvenation through aesthetic procedures is universal, which makes the number of these procedures increase each year. 2 The treatment with fillers in strategic points can reconstruct young anatomy, providing natural results.. 1 There are two instruments used for facial application of hyaluronic acid: cannula and needle. Both of them have advantages and disadvantages. Needles often come together with the products.However, there are some problems associated with its use, including pain, tissue damage from the use of a sharp instrument, a greater chance of ecchymosis, laceration of vessels, and the need for multiple punctures. 3,4 Positioning the needle tip in the periosteum is assumed to be relatively easy and results in accurate placement of the filler. This assumption still represents the view of the majority, as shown in our survey of expert injectors. 1 In some applications, the use of cannulas offers advantages and the main one is related to safety. 5 Cannulas are instruments with
Aesthetic treatment with hyaluronic acid (HA)-based fillers has shown a growing demand and becoming a choice as an option in minimally invasive rejuvenation, either as a volumizer in cases of tissue loss, facial contouring with definition or correction of rhytids. 1,2 As the HA injections had increased, the reports of adverse events related to it also raised. The first-line treatment of these undesirable effects is hyaluronidase (HYAL). 3,4 HYAL is a natural enzyme that degrades hyaluronic acid and can be used in the management of the majority of adverse events related to the use of this filler, such as overcorrections like nodules and bumps, Tyndall effect or late nodules, and even more severe complications as tissue ischemia. 1,5 This study aims to describe the safety and effectiveness of the use of HYAL in the correction of undesirable results of hyaluronic acid fillers in 114 patients in private dermatologic practice. | MATERIAL S AND ME THODSA retrospective study of 114 patients submitted to the application of HYAL (hyaluronidase 2.000 UI, BIOMETIL tm ) was performed to correct unaesthetic effects after filler injections on the face. Cases were selected from a private clinic from June 2015 to November 2018 by reviewing charts and analyzing photographic documentation, and the following data were evaluated: age, gender, the indication of use, the anatomical unit involved, number of sessions, amount of HYAL used, and adverse effects after the application of
Pain evaluation during local injections is a complex process. Injections cause patient's distress, especially when the target is a sensitive area such as scalp. Nonpharmacological methods as vibration before and during the procedure have been used to reduce pain. Mesotherapy has become a popular nonsurgical procedure for nonscarring alopecia, such as androgenetic alopecia (AGA) and alopecia areata (AA). Vibration has been successfully used in dermatological procedures, pediatrics, and dentistry. No study was found on vibration anesthesia during scalp mesotherapy. To analyze the effect of a vibration anesthetic device (VAD) during scalp mesotherapy on the patients’ comfort.This is a randomized split‐scalp study; thirty patients received mesotherapy with or without VAD on half of their scalp. Numerical rating scale (NRS) was used to measure self‐reported pain. To test difference in means and medians in comparing device use and by treatment (AGA or AA), Student's t tests and Wilcoxon signed rank tests were used. Overall mean pain score on the no vibration‐assisted side was 8.0 ± 1.0 while pain score for the vibration side was 2.3 ± 1.5, for AGA (P < .001) and 7.4 ± 1.2 and 2.1 ± 1.3, respectively, for AA (P < .001). Findings were similar for medians. No complications were found following procedure. To the best of our knowledge, this is the first study analyzing the effect of VAD in patients undergoing scalp mesotherapy. The VAD technique was found to be safe, effective, simple, and suitable for scalp procedures.
Backgroud Aging is the result of the interplay of changes occurring in the facial skeleton, ligaments, muscles, adipose tissue, and skin (1), and these changes befall each mentioned structure at a different pace, start in each individual at a different age, and differ between ethnic background. (4) It changes directly the measurements of the face angles, making the face more concave and flattened aspect, while the young face presents a more convex and rounded aspect. Female skulls had an increase in all transverse facial widths and depth of the middle face with increasing age. Therefore, aging is consequence of progressive changes through intrinsic and extrinsic factors (5) and different methods can be used to assess and diagnose these changes. Aims The aim of the study is to evaluate facial angles and their aging changes. Methods A retrospective study was performed with a total of 1213 Caucasian female patients in the author's private clinic. The angles evaluate age‐related changes were analyzed: facial, naso‐mental, and columella‐labial angle. Photograph analysis program Vectra 3D (Canfield) was used to perform the anthropometric assessment of the angles, and after data collection, the analysis was performed statistics. Results and Conclusion We could conclude angles analyzed change with age, while two angles increase (naso‐mental and facial angle), the other decreases (columella‐labial angle). The study reinforces the principle of an objective clinical anthropometric assessment of facial angles as a relevant guide for a more appropriate treatment plan for the doctor to perform aesthetic procedures in order to restore a youthful face.
Female pattern hair loss (FPHL) is the most common form of alopecia in women. FPHL may compromise body image and strongly affect self‐esteem, negatively impacting quality of life. Currently, the only Food and Drug Administration (FDA) approved drug for its treatment is topical minoxidil, with a variable response rate. Recently, a few studies in FPHL have pointed out bicalutamide as an emergent selective androgen receptor antagonist with a favorable safety and tolerability profile. This review aimed to summarize and discuss the key information on this new therapy for FPHL. Bicalutamide has no diuretic effect. It does not cross the blood–brain barrier, and it has little effect on serum luteinizing hormone. Additionally, bicalutamide was found to be effective on women presenting with other features of hyperandrogenism such as seborrhea, acne, and hirsutism with mild and well‐tolerated adverse effects. Despite the high prevalence and psychosocial impairment, FPHL treatment remains challenging. Therefore, although future prospective, comparative, randomized clinical trials are essential to establish the ideal dose and efficacy of the drug, oral bicalutamide appears to be a promising option to expand the arsenal of FPHL treatment.
The use of injectable soft-tissue fillers and neurotoxins for correcting the facial changes associated with aging is the gold standard in esthetic medicine. 1 Poly-l-lactic acid (PLLA) is a biocompatible, biodegradable, synthetic polymer able to be tailored into various desired morphologic features. 2,3 An injectable form of PLLA (New-Fill®, Valeant US, Sinclair Pharma Paris, France) has been available in Europe since 1999 for soft-tissue augmentation and the treatment of facial rhytides. In 2004, injectable PLLA received food and drug administration (FDA) approval under the trade name Sculptra ® (Galderma) for the treatment of HIV-associated lipoatrophy. 4 The mechanism through which it stimulates neocollagenesis is by triggering a foreign body reaction to the injected material, succeeded by a cellular inflammatory response which leads to the formation of vascularized, connective tissue. 1,[5][6][7] Poly-l-lactic acid is presented as freeze-dried preparation of 150mg per vial and, according to consensus, the recommendation
Androgenetic alopecia (AGA) is the most common form of non-cicatricial alopecia in both genders. Currently approved drugs for the treatment of AGA include topical minoxidil in women and topical minoxidil and oral finasteride in men. Other routes of administration of approved drugs have been proposed to enhance therapeutic results for AGA, including intradermal injections, known as mesotherapy. Mesotherapy-or intradermotherapy-is a non-surgical procedure, consisting of multiple intradermal injections of pharmacological substances diluted in small doses. Although minimally invasive, mesotherapy may be related to mild side effects like burning, erythema and headaches, as a few reports indicate. Among the most serious adverse events, subcutaneous necrosis, scalp abscesses, and angioedema have been described. This multicenter retrospective, descriptive study aims to report 14 cases of frontal edema resulting from mesotherapy for AGA treatment. In our patients, the edema mostly arose in the first two sessions and lasted between 1 and 4 days, with a favorable outcome after a local cold compress. In all our cases of edema, lidocaine was the anesthetic used. Minoxidil and dutasteride might also play a role as causative agents. To the best of our knowledge, this is the largest case series focused on frontal edema after mesotherapy for AGA and gives clinicians helpful information for when performing this technique. Dermatologists should already consider and be conscious of this possible mesotherapy side effect, as it can be remarkably disruptive to affected patients.
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