Background Infraorbital hollows can give a fatigued or aged appearance which can be treated by volumizing the segmented transition from the tear trough to the cheek with hyaluronic acid filler. Due to thin skin and the complex anatomy of the infraorbital area, both short- and long-term side effects from this treatment are very common. While some patients are clear surgical candidates vs. filler candidates, in real-world practice, many, if not most patients are on a continuum where either procedure is appropriate, and the treatment decision is individualized based on each person’s risk vs. benefit profile. Objectives Common aesthetic side effects from hyaluronic acid filler treatment in the infraorbital area will be reviewed, including their etiology, prevention, detection, and treatment. Method The authors’ experience from injecting the infraorbital areas of more than 800 patients in private clinical practice and observations from both short and long-term follow ups over eight years is leveraged to provide detailed guidance. Results Recommendations on injection techniques, patient selection, and patient education are presented along with algorithms for the prevention and management of bruising, short- and long-term swelling, bumps, and blue discoloration (which is usually secondary to swelling from the filler rather than just the filler alone placed or migrating too superficially). Conclusion For nearly all patients, complete dissolution of filler with hyaluronidase is not required to address the issue, and the guidelines provided here will assist clinicians in management of side effects to increase patient satisfaction with their treatment and aesthetic outcome.
BACKGROUND Hyaluronic acid (HA) fillers have been studied extensively on the face; however, their safety and efficacy on the neck has not yet been evaluated in a prospective trial in the United States. OBJECTIVE Analyze the efficacy and safety of a HA filler for static horizontal neck rhytides using either a cannula or needle. MATERIALS AND METHODS Twenty-six subjects were randomized to receive up to 1 mL of the HA filler Restylane Refyne (HARR, n = 20) or saline (n = 6) using a cannula on one side and a needle on the other with optional repeat treatment. Subjects were graded using the Transverse Neck Line Scale, Canfield photography, and the Global Aesthetic Improvement Scale. RESULTS A significant improvement 30 days after the last treatment was achieved on the Transverse Neck Line Scale when comparing HARR with saline according to the blind evaluator, subjects, and investigator without any significant side effects. In addition, the blind evaluator, subjects, and investigator rated the side of the neck injected with a needle as having significantly greater improvement than the cannula. CONCLUSION The hyaluronic acid filler, Restylane Refyne, achieved significant improvement in static horizontal neck rhytides using either a cannula or needle without any serious side effects, although the needle was more effective.
Background and Objectives Senile purpura is a common condition characterized by recurrent ecchymoses in the elderly on the extensor surfaces of the forearms, hands, and legs. Our objective is to assess the efficacy and safety of a protocol using intense pulsed light (BBL; Sciton Inc., Palo Alto, CA) to improve the appearance of senile purpura on subjects' extensor forearms. Study Design/Materials and Methods Five subjects over 65 years of age, with ecchymotic lesions measuring over 1 cm on each forearm and five younger subjects under 35 years of age, without any ecchymotic lesions, were included in the study. The subjects were treated on one randomized forearm with a new intense pulsed light protocol for four weekly sessions. Photographs and subject questionnaires were taken weekly before each treatment as well as 1 month after all treatments. Skin biopsies were taken 1 day after the last of four weekly treatments. Histological analysis, including hematoxylin and eosin, elastic van Gieson, and Masson's Trichrome staining, were carried out to assess both the epidermal thickness and dermal connective tissue structure. The protocol consists of multiple passes using an intense pulsed light (BBL; Sciton Inc.) device in which the wavelength, filter, and fluence are adjusted for each step. Step 1 uses infrared light (800–1,400 nm), high intensity, a smooth adapter, and a constant motion technique. Step 2 employs a 590‐nm filter with two different fluences and step 3 utilizes a 560‐nm filter. The fluence of steps 2–3 is increased by 1 J each treatment if no side effects are noted. Results Using a new intense pulsed light protocol in subjects with senile purpura, both the number and square area of ecchymoses on the treated arm were significantly reduced (P = 0.02 and P = 0.04, respectively, paired t test) as compared with the untreated arm at 1 month after four weekly treatments. Despite this pilot study including challenging cases of subjects on both inhaled and injected corticosteroids and blood thinners, all subjects with senile purpura had at least a 50% reduction in the total square area of their ecchymoses on their treated arm. There were no significant or long‐lasting side effects, and all subjects reported satisfaction with the treatment with a desire to continue treatments on their control arm. Blinded evaluators were able to select 100% of the time in the subjects with senile purpura, which was the treated arm as compared with the control arm when reviewing photographs from 1 month after the last treatment. In addition, several subjects were noted to have a significant improvement in the appearance of hemosiderin deposition and photodamage. Histologically, intense pulsed light treatments significantly increased epidermal thickness in elderly subjects by 21.14% (P = 0.0153, two‐tailed, paired t test), to levels comparable with young subjects. Such restoration is consistent with the other histological observations by blinded evaluators of more abundant and organized collagen fibers in the dermis and reduced aggreg...
No abstract
Background Vascular penetration during aesthetic filler injections can cause serious side effects such as skin necrosis and blindness. Objectives To analyze the effect of cannula brand and gauge on the risk of vascular penetration. Methods The minimal force to penetrate the superficial temporal artery with 3 cannula brands and 1 needle brand in 4 sizes (22, 25, 27, and 30-gauge) was measured in 4 fresh frozen cadavers utilizing a force gauge that measures as low as 0.1 newtons. Tissue penetration force in the subdermal plane of the nasolabial fold was measured and compared to retrospective training data in live humans. A second site repeated the arterial penetration test on one fresh cadaver with 2 different force gauges. Results Significantly lower forces were needed with all size needles vs the same gauge cannulas in all brands to penetrate the cadaveric artery and advance in the subdermal plane of the nasolabial fold in both cadavers and live humans. To successfully enter the artery in a cadaver with any cannula, numerous attempts were necessary. The tissue penetration force in the subdermal plane of the nasolabial fold in a cadaver was not significantly different than a living person; however, it was significantly higher than the arterial penetration force in a dissected cadaver. Conclusions All gauge cannulas (including 27 and 30-gauge), require more force than the same size needle to penetrate an artery. However, it appears the friction coefficient and flexibility, not the arterial penetration force, is the most important factor in keeping the instrument outside the vessel.
Myofibroblastic dermatofibroma (MFD) is an unusual neoplasm characterized by a predominance of myofibroblastic differentiation. It is extremely rare and it is not well described. Expressions of smooth muscle actin, CD34, S-100, desmin, CD31, and Factor XIIIa were evaluated along with hematoxylin-eosin and trichrome staining of fixed tissue specimens from a fibrohistiocytic neoplasm. The neoplasm demonstrated a storiform pattern characteristic of fibrohistiocytic origin. It was strongly and diffusely positive for smooth muscle actin and vimentin, and negative for all other stains performed. A trichrome stain showed the entire tumor to be blue, demonstrating the collagenous and fibrous tissue to a marked degree. MFD is a distinct variant of dermatofibroma characterized by a predominance of myofibroblastic differentiation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.