Qualit?tskriterien beim Einsatz von Fillern zur Gesichtsaugmentation

The popularity of minimally invasive cosmetic procedures continues to rise. Hyaluronic acid-based dermal fillers are of paramount importance in this context. This paper investigates standard quality criteria for current dermal fillers. In terms of clinical experience and safety, hyaluronic acid-based fillers have proved to be significantly better than other filling materials. The possibility to reverse their effects is yet another benefit of hyaluronic acid fillers. Due to the varying properties of the products now available on the market, the whole spectrum of minimally invasive procedures, ranging from correcting shallow wrinkles to volume augmentation, can be carried out safely and effectively.     

Is Breast Augmentation Using Hyaluronic Acid Safe?

Macrolane™, a compound composed of hyaluronic acid, is the newest product to be marketed for breast augmentation. Like many previous breast augmentation products, Macrolane has been authorised for use with very little published scientific data on its safety and efficacy in breast augmentation. This article reviews the evidence available on the safety of using hyaluronic acid and raises concerns with regard to its use as a product for breast augmentation, the technique recommended for its use, and the authorisation process for new implantable medical devices. It is strongly recommended that clinicians review the lack of data on Macrolane before offering it as a treatment option to patients.     

Therapie mit injizierbaren Fillern beim Lipodystrophiesyndrom

The rapid development of highly active antiretroviral therapy (HAART) has considerably ameliorated the life expectancy of HIV-infected patients. Unfortunately the number of patients under long-term medication with stigmatizing facial lipoatrophy has increased and most affected patients want treatment to remove the facial deformation. During the last years numerous minimally invasive procedures and products have been developed for treatment of facial volume loss due to age or disease. Autologous fat, HA-based volume fillers, synthetic products as poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHa) and even non-degradable substances such as polyacrylamide hydrogel (PAAG) are frequently used for soft tissue augmentation in patients with facial lipoatrophy. The choice of the best product should be made in concordance with the physician’s clinical evaluation and the patient’s preferences. All procedures and products have a significant positive impact on physical and psychological well-being. All procedures require a comprehensive knowledge with respect to materials, injection technique and anatomical structures of the face.     

Successful Treatment with Injected Hyaluronic Acid in a Patient with Lip Asymmetry after Surgical Correction of Cleft Lip

BACKGROUND Surgical repair of cleft lip, while correcting deformity and dysfunction, may leave residual cosmetic imperfections. The resultant asymmetry and low volume of the upper lip can be addressed surgically and via less invasive methods.
OBJECTIVE We present the first reported use of injectable hyaluronic acid to correct the characteristic lip asymmetry and poor volume after surgical repair of a cleft lip.
METHODS AND MATERIALS Using injectable hyaluronic acid, we treated the patient's upper lip to restore symmetry and achieve an augmented volume.
RESULTS We obtained a symmetric correction and aesthetically pleasing volume augmentation in the affected lip. These results lasted approximately 4 months.
CONCLUSION Using a temporary, alloplastic, injectable soft tissue filler such as hyaluronic acid satisfactorily achieves correction of asymmetry and low volume in a surgically repaired cleft lip. For patients who have endured multiple corrective surgeries, this is a novel and less invasive way to improve their cosmetic concerns.     

Tissue Augmentation with Fibrin Sealant and Cultured Fibroblasts: A Preliminary Study

Background  

Nonoperative subdermal tissue augmentation is one of the most frequently performed procedures in plastic surgery and dermatological practice. Many products, from biological to synthetic filler substances, are currently available. However, none has achieved ideal clinical efficacy, especially regarding volume maintenance and longevity. We examined the use of fibrin sealant as a biological and fully degradable matrix for dermal augmentation in combination with precultured human fibroblasts and hyaluronic acid gel (HYAFF).     

Use of Macrolane to treat pectus excavatum

The use of subcutaneous hyaluronic acid injection in cosmetic surgery is a popular and well-accepted technique. A new highly reticulated, nonanimal, stabilized hyaluronic acid has been recently developed for high-volume enhancement, especially breast augmentation. We describe this technique for funnel chest treatment.     

?sthetische Mammaaugmentation

Breast augmentation has become one of the most popular procedures in aesthetic plastic surgery. In addition to the well-established procedure for breast enlargement with silicone implants, two further procedures have become established in recent years. The use of autologous fat for augmentation is not new but has become more important due to further developments in the sampling method and preparation of fatty tissue. Since 2006 a product based on hyaluronic acid has complemented the available options and offers an additional clinically tested method for breast enlargement. The correct method for each patient must be decided on an individual basis. This article gives a review of the individual procedures for breast enlargement and sketches the known advantages and disadvantages.     

An overview of current biomaterials in aesthetic soft tissue augmentation

Today an increasing number of patients seek aesthetic improvement through minimally invasive procedures, and interest in soft tissue augmentation and filling agents is rising steadily. However, a thorough understanding of these substances, their indications and contraindications, as well as a profound knowledge of different implantation techniques is essential to provide an aesthetically pleasing result for the patient. This presentation gives an overview of the current injectable biomaterials, their major indications, advantages and disadvantages, with focus on collagen, hyaluronic acid, poly-l-lactide, and autologous fat grafting.     

伊妍仕与玻尿酸注射美容的区别

注射和光电等微创疗法在抗衰方面的效果良好，且恢复时间较短，目前已成为热门医疗美容 项目。软组织填充剂进行组织增容已有20余年，有多种软组织填充剂可选择，如非动物源性透明质酸 （NASHA）、羟基磷灰石钙（微晶瓷）和聚左旋乳酸（PLLA）填充剂等，不同填充剂的疗效存在一定差 异。本文在阅读相关文献的基础上，对伊妍仕? 和玻尿酸注射美容的区别作一综述，以期为临床医美填充 材料的选择提供一定参考价值。     

Injectable treatments for the aging face

The use of injectable agents, specifically soft tissue fillers and botulinum toxin type A, has risen dramatically over recent years, due to the increased demand for minimally invasive techniques. In fact, today they represent the most commonly performed cosmetic procedures in the United States, with botulinum type A injections topping the list. In the treatment of the aging face, these agents, when used individually or in combination, can effectively decrease rhytids and restore lost volume. The result is a fuller, smoother, more youthful appearance. This article provides an overview of botulinum type A (Botox Cosmetic; Allergan, Inc., Irvine, CA) and the two injectable fillers most commonly used in our practice, namely hyaluronic acid (Restalyne; Medicis Aesthetics, Inc., Scottsdale, AZ) and human-derived collagen (Cosmoderm and Cosmoplast; Inamed Aesthetics, Inc., Santa Barbara, CA). Although we commonly use autologous fat as an injectable filler for facial-volume augmentation, its discussion is beyond the scope of this article. Conceptually, the aging face can be divided into upper, middle, and lower thirds. Using this framework, we will discuss our treatment strategies for addressing each facial region. General principles, preinjection evaluation, and specific approaches and techniques for each anatomic region will be discussed, with particular emphasis on the benefit of using dermal fillers in conjunction with botulinum toxin type A to achieve optimal aesthetic results for facial rejuvenation.     

The treatment of catheterizable stomal incontinence with endoscopic implantation of dextranomer/hyaluronic acid

PURPOSE: The creation of a catheterizable stoma has revolutionized the management of complex bladder reconstruction. Unfortunately, urinary incontinence per catheterizable stoma is seen in some patients. We present our experience with the use of submucosal implantation of dextranomer/hyaluronic acid in patients with catheterizable stomas with urinary incontinence. MATERIALS AND METHODS: A total of 14 patients 9 to 49 years old (mean age 17.8) underwent submucosal implantation of dextranomer/hyaluronic acid for incontinence of catheterizable stoma at our institutions between October 2001 and March 2004. RESULTS: There were 9 males and 5 females. Type of bowel for stoma creation included 12 appendixes and 2 small bowels. All patients had significant leak per stoma and were candidates for revision. The dextranomer/hyaluronic acid volume injected ranged from 2 to 6 cc (mean 3.7). A total of 10 patients were dry after 1 injection, 1 was dry after 2 injections and 3 remained incontinent after the procedure. Our success rate was 79%. CONCLUSIONS: Our initial experience with the endoscopic treatment of incontinence of catheterizable stoma is encouraging, with a 79% success rate. We believe that this minimally invasive approach is warranted as an initial step in the management of urinary incontinence of catheterizable stoma before undertaking more challenging procedures.     

Injectable fillers for volume replacement in the aging face

In recent years, there has been a better understanding of the aging process. In addition to changes occurring in the skin envelope, significant changes occur in the subcutaneous fat and craniofacial skeleton. This has led to a paradigm shift in the therapeutic approach to facial rejuvenation. Along with soft tissue repositioning, volumizing the aging face has been found to optimize the result and achieve a more natural appearance. Early in the aging process, when there has not been a significant change to the face requiring surgical intervention, fillers alone can provide minimally invasive facial rejuvenation through volumizing. Multiple injectable soft tissue fillers and biostimulators are currently available to provide facial volume such as hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, polymethyl methacrylate, and silicone. A discussion of the morphological changes seen in the aging face, the properties of these products, and key technical concepts will be highlighted to permit optimum results when performing facial volumizing of the upper, middle, and lower thirds of the face. These fillers can act as a dress rehearsal for these patients considering structural fat grafting.     

Hyaluronic acid fillers: Restylane and Perlane

The list of injectable skin fillers available for soft-tissue augmentation is constantly growing, giving aesthetic surgeons more options in the treatment of scars, lines, and wrinkles. Various products for soft-tissue augmentation are currently available in the United States based on hyaluronic acid. One should keep in mind that for these hyaluronic acid gel to have the desired longevity they must have repeating chemical bridges to withstand the constant mechanical and chemical enzymatic degradation to which they are subjected once implanted. Restylane and Perlane have proved to be safe, effective, and liked by patients. The Restylane family of products is currently expanding and soon practitioners will be able to have a diversified arsenal of cross-linked hyaluronic acid products to rejuvenate the aging face.     

Trends in the Use of Neurotoxins and Dermal Fillers by US Physicians

Background: Demand for minimally invasive cosmetic procedures have led to an increased market of available products for facial rejuvenation. Objective: To characterize trends in the usage of aesthetic products, specifically the use of botulinum toxins and dermal fillers, by United States physicians. Methods: Data from the National Ambulatory Medical Care Survey was analyzed from 1993 to 2010 to evaluate the use of dermal fillers and neurotoxins in the United States outpatient setting. The types of physician specialties administering these products and their preferences in products were characterized. Results: There were an estimated 100,000 annual cosmetic visits at which a dermal filler was administered from 1993 to 2010. From 2002 to 2010, there were 140,000 annual cosmetic visits for a dermal filler and 440,000 visits for a neurotoxin. While collagen was the most common filler used over the entire study period, its use declined eight percent annually. Hyaluronic acid fillers were preferred from 2002 to 2010, followed by calcium hydroxylapatite filler, representing 50 percent and 16.1 percent of visits, respectively. The leading neurotoxin was onabotulinumtoxin A, used at 87.1 percent of visits. Dermatologists were the leading specialty for the cosmetic use of both dermal fillers and neurotoxins. Conclusion: Providers’ preference for cosmetic products appears to be influenced by their familiarity with them, with products that first came to market, such as the neurotoxin onabotulinumtoxin A and the hyaluronic acid fillers being used most frequently from 2002 to 2010.The demand for minimally invasive cosmetic play a role in a provider’s preference of which specific procedures, such as the use of botulinum toxin and product(s) to use is not well studied, but is likely dermal fillers, has become increasingly popular. multifactorial and may include cost, personal experience, According to the American Society of Plastic Surgeons potential adverse effects, and patient preference. Surveyed 2012 statistics report, there has been a 680-percent experts in Asia recently reported choosing soft tissue fillers increase in the cosmetic use of botulinum toxin type A and and injection techniques based on experience, with the a 205-percent increase in soft tissue fillers from 2000 to visco-elasticity of the product being the determinant when 2012 among plastic surgeons, with 6.1 million and 2.0 choosing a filler depending on which specific facial unit is to million procedures, respectively, being performed in 2012.1 With this increased demand comes the introduction of newer injectable neurotoxins and fillers.As newer facial rejuvenation products come to market, and as the number of minimally invasive procedures increase, it becomes increasingly important to characterize the current trends in aesthetic product usage. What factors play a role in a provider''s preference of which specific product(s) to use is not well studied, but is likely multifactorial and may include cost, personal experience, potential adverse effects, and patient preference. Surveyed experts in Asia recently reported choosing soft tissue fillers and injection techniques based on experience, with the visco-elasticity of the product being the determinant when choosing a filler depending on which specific facial unit is to be augmented.2 Choice of products is also dependent on the market; the United States market is more restricted in which products are available due to United States Food and Drug Administration (FDA) regulations compared to the European market where access to greater aesthetic product selection exists.3While the usage of aesthetic products for minimally invasive procedures has been monitored and reported by the American Society of Plastic Surgeons, characterization of usage trends by other specialists commonly performing these procedures has not been studied and may differ from plastic surgeons. The goal of this study is to characterize trends in the usage of aesthetic products, specifically the use of botulinum toxins and dermal fillers, by US physicians.     

注射隆乳填充物的微创取出方法

目的探讨聚丙烯酰胺水凝胶（PAHG）注射隆乳填充物微创取出的有效方法。方法通过文献复习,总结PAHG注射隆乳并发症的诊断和治疗方法。回顾性分析自2011年1月至2013年12月收治的24例患者的临床资料和治疗方法。结果本组共24例患者,注射物均基本取净,双侧取出浑浊液300～1500ml,平均700ml。术后随访6～12个月,所有患者均对手术效果满意。有假体隆乳术需求者,均于术后半年施行手术。结论PAHG注射隆乳填充物的微创取出方法安全、有效,值得临床推广。     

Injectable volumetric fillers and botulinum toxin in facial rejuvenation

There has been an upsurge in the technology of injectable volumetric filler materials for soft tissue augmentation of the face in the past decade. This is a dynamic field that has provided plastic surgeons and dermatologists who treat the aging face with newer tools and techniques. Injectable volumetric fillers can be applied in a variety of combinations and can be added to the various surgical options in conjunction with surgery or as maintenance following surgery. In practice, there are essentially four classes of materials that may be considered gold standard for minimally invasive rejuvenation and beautification of the face: botulinum toxin A, autologous fat, derivatives of hyaluronic acid, and, to a limited extent, hydroxyapatite. These coincide with the philosophy of applying materials and devices associated with the least amount of risk. Long lasting, or permanent–nondegradable, nonextractable, and nonabsorbable fillers remain an unresolved controversial issue, as the longer lasting the device, the greater also is the likelihood for long-term or even irreversible complications. The current trend for nonsurgical minimally invasive procedures for beautifying the face will most probably continue to surge, in light of their affordability in the growing economies around the globe, the increasing demand for a youthful look, and the need for less downtime for these procedures. There will be a rising demand for more hi-tech (bio- or genetically engineered) safe fillers with higher purity and less immunogenicity that allow a short recuperation time in order to attain a product that will serve as an ideal injectable volumetric filler for soft tissue augmentation.     

Evaluation of the Efficacy and Safety of a Lidocaine and Tetracaine (7%/7%) Cream for Induction of Local Dermal Anesthesia for Facial Soft Tissue Augmentation with Hyaluronic Acid

Injection of dermal fillers for soft tissue augmentation is a minimally invasive cosmetic procedure with growing popularity. However, patients often express concern about pain with such procedures. A topical anesthetic cream formulated with lidocaine/tetracaine 7%7% was approved by the United States Food and Drug Administration in 2006 and recently reintroduced to the market for use during superficial dermatological procedures. A Phase 3 study was conducted to assess the efficacy and safety of lidocaine/tetracaine 7%7% cream versus placebo cream when used to induce local dermal anesthesia during injections with hyaluronic acid. Mean visual analog scale scores significantly favored lidocaine/tetracaine 7%7% cream. A significant percent of subjects also indicated that lidocaine/tetracaine 7%7% cream provided adequate pain relief and that they would use lidocaine/tetracaine 7%7% cream again. Investigators also rated lidocaine/tetracaine 7%7% cream significantly better than placebo cream for providing adequate pain relief and on the assessment of pain scale. Lidocaine/tetracaine 7%7% cream was safe and well tolerated with most subjects reporting no erythema, edema, or blanching. No related adverse events were reported with lidocaine/tetracaine 7%7% cream; one related adverse event of erythema was reported with placebo cream. The results of this study indicate that lidocaine/tetracaine 7%7% cream is efficacious and safe at providing pain relief for soft tissue augmentation with hyaluronic acid.Soft tissue augmentation with dermal fillers is a popular, minimally invasive cosmetic procedure with an increasing number of procedures performed each year.1 Despite the popularity of dermal filler procedures and other cosmetic procedures, most patients are concerned about the pain associated with these procedures.2 Seventy-four percent of surveyed subjects expressed concern about associated pain with cosmetic procedures, and 42 percent of subjects who had a cosmetic procedure would consider not having other procedures due to concerns about pain.2 These results suggest that a sizeable number of subjects are given inadequate measures to control pain during cosmetic procedures.Various types of topical anesthetics are available to manage pain and provide relief during cosmetic procedures and contain ingredients such as lidocaine, tetracaine, and prilocaine.3 Many physicians use compounded formulations of anesthetics to provide dermal anesthesia before a procedure. However, these products have been found to not be standardized and frequently have higher concentrations of anesthetics than United States Food and Drug Administration (FDA)-approved products.3 This resulted in the FDA issuing a warning in 2006 to multiple pharmacies to stop compounding topical anesthetic creams.4 And in 2007, a public health advisory was issued by the FDA when two women died after using compounded high-concentration topical anesthetics under occlusion before a procedure.5 Therefore, it is recommended that only FDA-approved topical anesthetics be used as they have demonstrated efficacy as well as safety.5An anesthetic cream formulated with lidocaine and tetracaine 7%/7% (LT cream; Pliaglis® Cream; Galderma Laboratories, LP) was approved by the FDA in 2006 and recently reintroduced to the market. LT cream is indicated for use on intact skin in adults to provide topical analgesia for superficial dermatological procedures.6 In addition to being formulated with the maximum allowable FDA-approved concentrations of lidocaine and tetracaine, LT cream also dries to a flexible membrane that functions as a self-occlusive barrier. Multiple studies have demonstrated the efficacy and safety of LT cream in various dermatological cosmetic procedures including ablative and nonablative laser resurfacing, laser tattoo removal, laser hair removal, and CO₂ laser resurfacing.7-10A Phase 3 study was conducted to investigate the efficacy and safety of LT cream when used as a topical anesthetic for facial soft tissue augmentation with hyaluronic acid. The results of this study indicate that LT cream provided significantly better pain relief than vehicle cream, was well tolerated, and is an ideal choice to provide topical anesthesia before dermal filler injections.     

The extended use of deflux (dextranomer/hyaluronic acid) in pediatric urology

The use of injectable bulking agents into the submucosal layer of the pediatric urinary tract continues to grow. Treatment strategies for vesicoureteral re.ux and urinary incontinence have changed with the introduction of dextranomer/ hyaluronic acid as a minimally invasive option. Socially and medically debilitating conditions requiring major surgical reconstruction and hospitalization in the past have now been replaced by outpatient endoscopic procedures. As experience has been gained, broader uses of this agent have been applied to more complex etiologies of re.ux and incontinence.     

Facial Volumetric Correction with Injectable Poly-l-Lactic Acid

Background. Polymers of lactic acid have been widely used for many years in different types of medical devices, such as resorbable sutures, intrabone implants, and soft tissue implants. Injectable poly-l-lactic acid (PLLA; Sculptra), a synthetic, biodegradable polymer, has gained widespread popularity in Europe for the treatment of facial changes associated with aging.
Objective. To provide background information on injectable PLLA and to describe clinical experience with its use in Europe for facial volume enhancement.
Methods. Technique varies with site of injection. Generally, the product is implanted subcutaneously or intradermally in a series of treatments. No allergy testing is required.
Results. Based on experience in more than 2,500 patients, injectable PLLA has been used successfully for the correction of nasolabial folds, mid- and lower facial volume loss, jawline laxity, and other signs of facial aging. Correction lasts for 18 to 24 months in most patients.
Conclusions. Injectable PLLA treatment provides an excellent and prolonged correction of a variety of facial wrinkles, depressions, and laxity with a minimally invasive procedure that does not require allergy testing or a recovery period.     

附加锁定钢板微创治疗股骨骨折髓内钉固定术后骨不连

目的观察保留髓内钉、附加锁定钢板微创治疗股骨骨折髓内钉固定术后骨不连的效果。方法对17例股骨骨折髓内钉固定术后骨不连患者采用保留髓内钉、附加锁定钢板微创治疗。术后定期随访,观察患肢活动、负重及骨痂生长情况。结果 17例均获随访,时间6~18(9±2)个月,患者均获骨性愈合。无感染、钢板螺钉松动、断裂等现象等。结论保留髓内钉、附加锁定钢板微创治疗股骨骨折髓内钉固定术后骨不连,手术创伤小,骨膜可不用剥离,血运破坏小,固定牢靠。结合早期功能锻练,可促进骨折愈合,是一种简单有效的治疗方法。