Hyaluronidase and Restylane

Abstract

trum of the impact of the incision from disfiguring (1) to imperceptible (10). The reviewers felt that the incision obtained 94% imperceptibility.Comment. Conchal cartilage is widely accepted for use during revision and reconstructive rhinoplasty, orbital wall reconstruction, and eyelid repair. The anterior approach to conchal cartilage harvest has become the most popular technique. After observing successful changes in the ear for anterior conchal cartilage harvest, some authors 10,11 have even developed new techniques for anterior approach otoplasty. Modest complication rates have been reported for both the anterior and posterior approaches, and complications including hypertrophic scarring, delayed wound healing, and asymmetry. Our patients underwent anterior approach only by a standardized method. Feared complications of any cosmetic surgery include hypertrophic scarring, postoperative hematomas or seromas, and infections. Fortunately, in our series of patients, there were no complications in the ears in which conchal cartilage was harvested, regardless of comorbidities, including tobacco and alcohol use, cardiovascular conditions, or diabetes mellitus. Use of perioperative antibiotics for cosmetic procedures is widely accepted and should be used in patients that are undergoing conchal cartilage harvest.Most of the patients underwent conchal cartilage harvest for Mohs micrographic surgical repair of facial malignancies. The morbidities of rhinoplasty, locoregional flaps, and tissue advancements, as well as staged procedures for repair of the nasal defects, would tend to distract the patient's attention from the less morbid conchal harvest. This, combined with the average duration of follow-up from surgery to telephone questionnaire, may have allowed some recall bias. Regardless, the rate of patient satisfaction with conchal cartilage harvest was very high. The only concerns reported were those of mild pain in the immediate postoperative period. There were no complaints of irritating dental roll bolsters, hearing changes, or problems that affected sleep positions.Most of the responses by the blinded reviewers who felt that they could make a distinction between the operated and nonoperated ear were incorrect. This may reflect the relative lack of knowledge by nonmedical personnel regarding the complex 3-dimensional auricular anatomies. After the reviewers were educated about basic auricular anatomy and conchal cartilage harvest, they felt that the incision was 94% imperceptible.Septal cartilage has proved to be the type most commonly used for autologous cartilage harvest and will likely remain that way owing to the robust nature of that type of cartilage and the indication for septoplasty associated with rhinoplasty. When septal cartilage is not available, however, conchal cartilage is a safe and cosmetically acceptable alternative for autologous cartilage harvest. Patients are very satisfied with conchal cartilage harvest.

Hyaluronidase

“…Popkin also described similar success using the identical method in scleroderma patients with chronic, nonhealing ankle ulcers 31 . In 2007, Soparkar and Patrinely reported using hyaluronidase at 75 to 300 U in patients' legs to treat acute pretibial myxedema associated with autoimmune thyroid disease 24 …”

“…There is the worry that high hyaluronidase concentrations can dissolve the native HA, with resulting cosmetic deformity 23 . In 2005, Soparkar and colleagues described using 375 U of hyaluronidase to dissolve HA filler in one patient's face over 10 days without any discernable change in native facial volume 24 . They reported that they routinely use 150 to 200 U of hyaluronidase for every milliliter of HA they wish to remove 23 .…”

“…23 In 2005, Soparkar and colleagues described using 375 U of hyaluronidase to dissolve HA filler in one patient's face over 10 days without any discernable change in native facial volume. 24 They reported that they routinely use 150 to 200 U of hyaluronidase for every milliliter of HA they wish to remove. 23 They believed that the use of hundreds of units of hyaluronidase seemed to be effective and safe, without causing further collateral loss of native HA.…”

“…31 In 2007, Soparkar and Patrinely reported using hyaluronidase at 75 to 300 U in patients' legs to treat acute pretibial myxedema associated with autoimmune thyroid disease. 24 Hyaluronidase has also been used to manage lymphedema and keloids. [32][33][34][35] Lymphedema of the upper and lower extremities in five patients was successfully treated with hyaluronidase when administered using iontophoresis.…”

Minimally Invasive Treatment for Papillae Deficiencies in the Esthetic Zone: A Pilot Study

“…In order to expect a good postoperative outcome an interdisciplinary approach to esthetic treatment planning and treatment execution is a primary concern. * [20][21][22][23] The product is approved by the Federal Food and Drug Administration (FDA). 19 Recently a gel of hyaluronic acid generated by Streptococcus species of bacteria, chemically cross-linked with butanediol diglycidyl ether (BDDE), and stabilized and suspended in phosphate buffered saline at pH 7 and concentration of 20 mg/mL and fee of animal protein has been successfully used to reduce or eliminate facial creases and various other abnormalities.…”