Hyaluronic acid fillers for the male patient

ABSTRACT:  The male cosmetic population has been more timid over the years for procedures for facial rejuvenation. Only with the advent of minimally invasive procedures such as Botox and fillers have men begun to participate in cosmetic treatments. Men come with esthetic needs and areas of treatment different from women and require a different array of injectable fillers for each of these problems. Wrinkle ablation, volumization, and sculpting facial contours are procedures with the various agents available.     

Hyaluronic acid fillers in facial rejuvenation

Nonsurgical procedures have become very popular for the rejuvenation of the aging face. Trends now are for less invasive procedures as well as for more preventative intervention to slow the damage from ultraviolet light and environmental factors, as well as from intrinsic aging. The goal of these procedures is to eliminate or delay the need for corrective surgery. The regular use of sunscreens; retinoids and improved cosmeceuticals; injectable neurotoxins; soft-tissue augmentation products; and minimally invasive laser, light, and radiofrequency treatments are decreasing and delaying need for invasive procedures. Injectable fillers entered mainstream cosmetic medicine with the development of bovine collagen injections in the 1980s. The availability of improved fillers that are less allergenic and longer lasting has resulted in a renaissance in filler techniques. No single filler has proven to be more popular than the category of hyaluronic acids (HA). This article will review the use of the hyaluronic acid fillers that are currently approved for use by the Federal Drug Administration in the United States and describe the significant differences between them to assist the practicing cosmetic physician in choosing and using this category of dermal filler.     

Rejuvenation of the lip with injectables

As the range of soft tissue augmentation products proliferates, most will be used (with varying degrees of success) to shape and augment the lip. The range of outcomes for this indication depends on the skill of the injector, the anatomy of the patient and the intrinsic properties of the product. Permutations of these interacting factors are infinite and it is the range of combinations that is responsible for the complexity (and fascination) of lip rejuvenation with injectable products. Based on personal experience, the perfect lip is the one that "wows" the patient and makes them happy with the procedure. Individualizing the injection is of paramount importance and should take priority over a formulaic approach that defines each lip injection as identical. This review will discuss some of the factors that should be considered prior to injecting a lip with soft tissue augmentation products.     

The third dimension in facial rejuvenation: a review

Background Facial rejuvenation has long been dominated by surgical techniques that act on only two dimensions of the face, ignoring the third dimension (facial volume); therefore, a truly youthful look remains elusive. Objectives This paper aims to define the various surgical procedures employed by cosmetic surgeons that can be combined with alloplastic implants or injectable devices in order to restore lost facial volume. Methods and materials A search of the literature was performed. Results Alloplastic augmentation and implants provide permanent restoration of facial volume, but require invasive surgery. Soft‐tissue fillers include autologous fat, calcium hydroxylapatite, and a variety of polymers. Devices based on collagen and hyaluronic acids provide correction of superficial lines and folds, but cannot offer long‐lasting restoration of facial volume. The only fillers that have been proven to augment facial volume are autologous fat, calcium hydroxylapatite, poly‐l ‐lactic acid, polyacrylamide, poly‐alkyl‐imide, and methylpolysiloxane. Conclusions For optimal facial rejuvenation, the accepted surgical techniques of skin lifting and tightening could be combined with volumizing devices, thereby addressing ptosis, lines, folds, and volume loss.     

Surgery for foreign body reactions due to injectable fillers

BACKGROUND: An increasing number of soft tissue fillers have been introduced to the beauty market and these filler substances are widely used as non-toxic, non-immunogenic and relatively harmless injectable alternatives to surgical rejuvenation. Generally, facial fillers are injectable - or surgically insertable - products that are used to fill up the volume loss in the aging face. Depending on bioavailability, chemical composition and degradation, fillers can be classified as temporary or permanent, organic or inorganic and autologous or heterologous. OBJECTIVE: A plethora of new products has swamped the beauty market since face rejuvenation has become socially acceptable as well as affordable to a wider population, but adverse reactions cannot be excluded. We present 4 patients with complications after injection of facial fillers [including Artecoll(polymethylmethacrylate microspheres), Restylane (hyaluronic acid), DermaLive (hyaluronic acid plus acrylic hydrogel particles) and Newfill (polylactic acid)] and surgical correction. RESULTS: Surgical intervention led to good aesthetic and functional results after multiple unsuccessful conservative therapies. CONCLUSION: We recommend that only physicians familiar with the injection techniques and the biological and chemical characteristics of the various injectable products should perform such interventions. Especially permanent fillers should be used with utmost reticence in cosmetic surgery and we would recommend their application only in reconstructive procedures. Additionally, documentation and reporting of all adverse effects must be mandatory.     

Skin filling. Collagen and other injectables of the skin

Minimally invasive soft tissue augmentation of the face with injectable substances has been performed for more than a century. During this period, many substances have been used to cosmetically improve soft-tissue defects and deficiencies. Some have lasted; most have not. These procedures have become increasingly important as more patients seek aesthetic improvement without major surgical procedures. This article reviews the current status of these materials and techniques.     

Injectable neurotoxins and fillers: there is no free lunch

Injection of neurotoxins and filling agents for the treatment of facial aesthetics has increased dramatically during the past few decades due to an increased interest in noninvasive aesthetic improvements. An aging but still youth-oriented population expects effective treatments with minimal recovery time and limited risk of complications. Injectable neurotoxins and soft tissue stimulators and fillers have filled this niche of "lunch-time" procedures. As demand for these procedures has increased, supply has followed with more noncore cosmetic specialty physicians, as well as unsupervised ancillary staff, becoming providers and advertising them as easy fixes. Despite an excellent record of safety and efficacy demonstrated in scores of published studies, injectable agents do carry risks of complications. These procedures require a physician with in-depth knowledge of facial anatomy and injection techniques to ensure patient safety and satisfaction. In general, adverse events are preventable and technique-dependent. Although most adverse events are minor and temporary, more serious complications can occur. The recognition, management, and treatment of poor outcomes are as important as obtaining the best aesthetic results. This review addresses important considerations regarding the complications of injectable neurotoxins and fillers used for "lunch-time" injectable procedures.     

Rejuvenation of the aging hand

This article reviews aging of the hand and the treatment options for cosmetic rejuvenation. Options available for cutaneous rejuvenation include microdermabrasion, chemical peeling, intense light sources, and laser therapy, including pigment lasers, ablative resurfacing, and noninvasive rejuvenation. Protuberant veins of the aging hand can be treated effectively with sclerotherapy. The soft tissue atrophy of the aging hand is best treated with fat augmentation. The article concludes with a mention of new fillers that are just beginning to be used for soft tissue atrophy of the hand.     

High frequency ultrasound imaging as a “potential” way of evaluation modality in side effects of lip augmentation – case report

Lip augmentation is a popular procedure performed by esthetic medicine doctors, however, it is associated with a significant number of side effects. High frequency ultrasound imaging helps with diagnosis of side effects.The patient was 43-year-old healthy female, 8 months after lip augmentation.The examination showed a variety of delayed side effects of lip augemntation. Ultrasound imaging revealed an increased echogenicity of lip soft tissue, too deep filler injection, occlusion of the inferior labial artery.     

The aging face in patients of color: minimally invasive surgical facial rejuvenation-a targeted approach

We are in the midst of exciting times from a demographic standpoint as the population of darker-skinned people grows exponentially in the United States. Although there is a growing demand for facial cosmetic procedures amongst people of color, the total number of individuals undergoing surgical facial rejuvenation is dwarfed by the current Caucasian market. In order to provide optimal options for facial rejuvenation, cosmetic surgeons must have an underlying appreciation for the dynamic interplay among ethnicity, facial morphology, and the progression of aging. The purpose of the present article is to outline the minimally invasive surgical options for facial rejuvenation best suited for the patient of color. Although the population of individuals with darker-pigmented skin is quite vast, the present paper will focus on individuals of African descent, with whom the author has the most experience. Preferred surgical techniques include blepharoplasty, autologous facial fat transplantation, percutaneous cheek lift, and submental liposuction. Cutaneous surgeons familiar with soft-tissue surgery and facial anatomy should feel comfortable performing these techniques.     

Soft-tissue augmentation with hyaluronic acid and calcium hydroxyl apatite fillers

Soft-tissue augmentation with hyaluronic acid and calcium hydroxyl apatite are among the most widely used minimally invasive cosmetic treatments for the correction of contour deficiencies and wrinkles of the face without the risk, recovery time, and expense of a major surgery. Training and experience in the art and science of fillers is essential for the successful creation of a more youthful and natural appearance. An understanding of the different products, the injection techniques, the indications, and the potential complications of each filler are paramount to success.     

Dermal fillers: Facts and controversies

Dermal fillers have been used for decades in soft tissue augmentation. Currently, filler implementation is among the most common minimally invasive procedures for rejuvenation and body sculpturing. There is a broad variety of filler materials and products. Despite immense experience, a number of controversies in this topic exist. Some of these controversies are addressed in this review, for example, who should perform filler injections, the difference between permanent and nonpermanent fillers, the off-label use of liquid silicone, and the role of pain reduction. Implementation of guidelines and restriction of filler use by trained physicians can improve safety for patients.     

Novel method of minimally invasive removal of large lipoma after laser lipolysis with 980 nm diode laser

Lipomas are the most common benign tumor of the soft tissue, often presenting as soft, mobile subcutaneous masses. These lesions are often removed for cosmetic reasons, although they may be removed secondary to considerable discomfort or paresthesias. The large majority of lipomas appear as small, solitary lesions that are best removed by surgical excision. However, surgical removal of large (>10 cm) or multiple lesions may result in significant scarring. Tumescent local anesthesia and liposuction of larger lesions has been successful in a number of cases although this technique can be hindered by overly fibrous lesions. Laser lipolysis, performed alone or before liposuction, can further facilitate removal of these lesions. This technique is a minimally invasive and effective method of lipoma removal, resulting in an excellent cosmetic outcome. This report describes step-by-step removal of a large lipoma located on the back, as well as a review of currently employed techniques for minimally invasive treatment of lipomas.     

Soft tissue augmentation--use of hyaluronic acid as dermal filler

Soft tissue augmentation has revolutionized the treatment of the aging face. It is a technique in which a substance is injected under the skin. The concept of utilizing materials for soft tissue augmentation actually began around 1950 with the use of fluid silicone. Today we have a large armamentarium of implant materials to delay the tell tale signs of aging. Filling has replaced conventional surgery in facial rejuvenation. In this article, the emphasis will be on hyaluronic acid as this substance is easily available in India and ranks among the most widely used dermal fillers.     

Long-term aesthetic outcomes with injectable poly-l-lactic acid: observations and practical recommendations based on clinical experience over 5 years

Background Facial rejuvenation techniques have evolved in recent decades driven by a paradigm shift to restoration of lost volume, and an increase in the number of available products. As clinical experience has increased, practitioners have further refined the use of these products. Objectives To share observations and practical recommendations based on clinical experience with the aesthetic use of injectable poly‐l ‐lactic acid (PLLA) in patients followed for up to 5 years. Methods Literature review and retrospective case history review of the first 100 patients treated with injectable PLLA, many of whom have been followed for over 5 years. Results Use of injectable PLLA, alone or in combination with other products, has provided excellent and long‐lasting (up to 5 years) aesthetic results for most of the reviewed patients. Typically, patients have received one or two touch‐up sessions between years 2 and 4 after initial full correction. There were minimal adverse events of papule formation; these eventually resolved. Conclusions Injectable PLLA is a safe and effective option for achieving long‐term patient satisfaction with soft‐tissue augmentation.     

Botulinum toxin A in the mid and lower face and neck

Botulinum toxins have been smoothing hyperkinetic lines in the upper face for over 15 years. More recently, their use has widened to include applications in the mid and lower face and neck to smooth, shape, and sculpt, blurring the line between science and art. Their use in the lower face, however, requires a thorough and detailed knowledge of not only facial and cervical anatomy, but also the complex interactions of muscles and the aesthetic and implications of a misplaced injection. Although proper patient selection and injection techniques do not guarantee optimal results, poor selection and techniques almost certainly guarantee disappointing results. In addition to its use as primary procedure, botulinum toxin is also an effective adjunct to other cosmetic procedures, enhancing and prolonging the benefits of surgery, soft tissue augmentation, and laser resurfacing.     

Fat transplantation for treatment of the senescent face

For more than a century, clinicians have attempted to utilize fat for the treatment of tissue deficiencies and contour abnormalities. Autologous fat transplantation for soft tissue augmentation has become increasingly popular in recent years. This has occurred as a result of the present authors' comprehension that the aging face is not simply as a result of gravity-induced ptosis, but also as a result of volume loss secondary to the atrophy of tissues. The popularity of tumescent liposuction has brought renewed interest and accessibility of fat for transplantation. Newer techniques and approaches to augmentation have provided more predictable and reproducible results. Fat augmentation has become an effective, safe, and reliable method for restoring volume and correcting the atrophy that accompanies senescence. In this review, the present authors describe their approach and technique of fat transplantation for the aging face.     

Decades of beauty: Achieving aesthetic goals throughout the lifespan

Background

Several elements, including age, influence judgments of beauty and attractiveness. Aging is affected by intrinsic factors (e.g., genetics, race/ethnicity, anatomical variations) and extrinsic factors (e.g., lifestyle, environment).

Aims

To provide a general overview of minimally invasive injectable procedures for facial beautification and rejuvenation to meet the aesthetic goals of patients across their lifespan, organized by decade.

Methods

This case study review describes aesthetic considerations of females in their third to sixth decade of life (i.e., 20–60 years of age or beyond). Each case study reports the treatments, specifically botulinum toxin type A and soft tissue fillers, used to address aesthetic concerns.

Results

Signs of aging, as well as aesthetic goals and motivations, vary by age groups, cultures, and races/ethnicities. However, there are overarching themes that are associated with each decade of life, such as changes in overall facial shape and specific facial regions, which can be used as a starting point for aesthetic treatment planning. Appropriate patient selection, thorough aesthetic evaluation, product knowledge, and injection technique, as well as good physician-patient communication, are essential for optimal treatment outcomes.

Conclusions

Nonsurgical facial injectable treatments can successfully enhance and rejuvenate facial features across different age ranges. A comprehensive understanding of facial aging and the aesthetic considerations of patients by the decade contributes to optimal treatment planning and maintenance.     

Aging well – the role of minimally invasive aesthetic dermatological procedures in women over 65

Background  The western world is getting older. Aging well has become the new target of preventative medicine. Aesthetic dermatology can contribute to this quest. Females over 65 represent an important and growing group of consumers of cosmetic procedures. In this group, there is a paucity of scientific evaluation of aesthetic procedures.
Objective  To review the use of minimally invasive procedures for facial rejuvenation in women over 65.
Methods  Drawing from both the literature and personal experience, the opportunities, modifications, and limitations of minimally invasive techniques for facial rejuvenation in older women are considered.
Results  In this older age group, dermal fillers, chemical and laser peels, and nonablative photorejuvenation remain useful and can each be used as stand-alone treatments. In this age group, botulinum toxin (BTX) injections are more often used in combination with other procedures.
Conclusions  With respect to aesthetic procedures, women over 65 are different from younger women. More scientific investigation is necessary to better meet needs of this growing part of the population. Available data suggest that aesthetic dermatology can make a major contribution to the complex matter of aging well.