scholarly journals MD Codes™: A Methodological Approach to Facial Aesthetic Treatment with Injectable Hyaluronic Acid Fillers

2020 ◽  
Author(s):  
Maurício de Maio
Keyword(s):  
Patient Satisfaction ◽  
Hyaluronic Acid ◽  
Methodological Approach ◽  
Full Description ◽  
Injection Technique ◽  
Symbolic Language ◽  
Level Of Evidence ◽  
Delivery Technique ◽  
The Face ◽  
Facial Attributes

Abstract Background Patients often seek aesthetic correction of facial deficiencies (e.g., lines and folds) that are rarely the underlying cause of dissatisfaction with their appearance. Use of a more holistic approach focused on improving the emotional messages of the face (e.g., looking less sad) may improve patient satisfaction with treatment outcomes. The MD Codes™ system was developed to increase clinician success rates by reducing variability in the technical aspects of hyaluronic acid (HA) filler treatment and focusing on addressing unfavorable emotional attributes of the face. Methods The MD Codes, or medical codes, represent specific anatomical subunits for injection of HA fillers. Each MD Code includes information regarding the target depth of injection, the proper delivery tool (needle or cannula) and delivery technique (e.g., aliquot, bolus, fanning), and the minimum product volume recommended to achieve visible, reproducible results (active number). During treatment planning, the appropriate MD Codes are selected using algorithms focused on lessening unfavorable facial attributes (a saggy, tired, sad, or angry look) and enhancing positive attributes (an attractive, younger, more contoured, or feminine [soft] or masculine look). Results Three case studies are presented to illustrate how the MD Codes and their algorithms were used to address sagginess, tiredness, and sadness in two women and one man. Conclusions MD Codes provide a universal symbolic language for reducing variability in injection technique. The platform provides user-friendly algorithms to help clinicians increase patient satisfaction by going beyond treatment of lines and folds and to focus on reducing unfavorable facial attributes. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Nonsurgical Redefinition of the Chin and Jawline of Younger Adults With a Hyaluronic Acid Filler: Results Evaluated With a Grid System Approach

2020 ◽  
Author(s):  
Dario Bertossi ◽  
Massimo Robiony ◽  
Andrea Lazzarotto ◽  
Giorgio Giampaoli ◽  
Riccardo Nocini ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Grid System ◽  
Level Of Evidence ◽  
Younger Adults ◽  
Lower Face ◽  
Age Related ◽  
Tissue Edema ◽  
The Face ◽  
The Mean ◽  
And Performance

Abstract Background Aesthetic treatment of the lower face is increasingly in demand, particularly owing to age-related changes in appearance. VYC-25L is a novel hyaluronic acid filler with high G′ and high cohesivity, specifically designed for sculpting and contouring of the chin and jaw. Objectives The aim of this study was to assess the use of a grid traced onto the chin and jaw for guiding treatment with VYC-25L. Methods This was a retrospective, single-center analysis of data from adult patients undergoing treatment of the lower third of the face with VYC-25L. A grid system of horizontal and vertical lines was used to systematize the process of treatment planning and performance. Results Thirty subjects were enrolled (53.3% female; mean [standard deviation] age, 34.4 [2.8] years). The mean quantity of VYC-25L used was 4.0 [0.8] mL. Based on the 5-point Global Aesthetic Improvement Scale, 29 patients (96.7%) rated their appearance at 20 days posttreatment as “much improved” or “very much improved.” The only complications recorded were early transient soft-tissue edema (n = 14; 46.7%) and bruising (n = 6; 20.0%). There were no cases of infection, paresthesia, asymmetry, hematoma, necrosis, or skin discoloration. Conclusions Treatment of the chin and jawline with VYC-25L, with injection locations determined by a standardized grid-based approach, appears to be effective and safe with high rates of patient satisfaction. Injection of this filler offers a potentially high-impact approach for patients across a variety of biological and economic circumstances. Level of Evidence: 4

scholarly journals Is the Treatment of the Tear Trough Deformity with Hyaluronic Acid Injections a Safe Procedure? A Systematic Review

2021 ◽  
Vol 11 (23) ◽  
pp. 11489
Author(s):  
Salvatore D’Amato ◽  
Romolo Fragola ◽  
Pierfrancesco Bove ◽  
Giorgio Lo Giudice ◽  
Paolo Gennaro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Hyaluronic Acid ◽  
Cochrane Library ◽  
Injection Technique ◽  
Safe Procedure ◽  
Aesthetic Result ◽  
Tear Trough ◽  
Tear Trough Deformity ◽  
Mesh Terms

Among the various therapeutic options for the treatment of tear trough deformities, the use of hyaluronic acid-based fillers has constantly been increasing. The aim of this research is to conduct a systematic review of the published literature related to the use of hyaluronic acid-based dermal fillers for the treatment of tear trough deformities and possible related complications. A search of the published literature was conducted following the PRISMA guidelines, including PubMed, Cochrane Library, and Ovid databases. Text words and Medical Search Headings (MeSH terms) were used to identify nine articles included in our analysis. The most used filler was Restylane (Galderma). The injection technique was performed through the use of a cannula or, more frequently, with a needle, through the execution of boluses or retrograde release. The injection plane was predominantly the supra-periosteal layer. The most observed side effects were mild and included redness, edema, contour irregularities, bruising, and blue-gray dyschromia. The degree of patient satisfaction was high, with an optimal aesthetic result that was maintained for 6 to 12 months. Although the duration of treatment of tear trough deformities with HA fillers is not comparable to surgical treatment, this is a minimally invasive, safe procedure, quick to perform, and with a high degree of patient satisfaction.

scholarly journals Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler

2021 ◽  
Author(s):  
Nabil Fakih-Gomez ◽  
Jonathan Kadouch
Keyword(s):  
Hyaluronic Acid ◽  
Adverse Events ◽  
Retrospective Chart Review ◽  
Full Description ◽  
Limited Data ◽  
Level Of Evidence ◽  
Hybrid Filler ◽  
Calcium Hydroxylapatite ◽  
Study Support ◽  
Based Medicine

Abstract Background Limited data are available describing effectiveness of combining the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA). Methods The authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA (CaHA:CPM-HA ) in the authors’ aesthetic practices. The midface and lower face were injected. Patients’ records were evaluated, and treatment results were scored using the Merz Aesthetics Scale for the jawline® (clinician rated, CR-MASJ). Adverse events were recorded. Results A total of 41 patients were included, all females with a mean age of 47.5 years (range 21–63 years). The mean CR-MASJ score improved from 2.12 at baseline to 0.68 at t = 3 months (SD = 0.69, 95% CI 1.28–1.60) and 1.27 at t = 12 months (SD = 0.74, 95% CI 0.43–0.74). 100% of the subjects had experienced a ≥1-point improvement in CR-MASJ score at t = 3 months, versus 85% at t = 12 months. No adverse events were reported. Conclusion The results of this study support the volumizing and lifting potential of the hybrid mix CaHA:CPM-HA for treatment of cheeks and jawline. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Prevention and Management of Filler Induced Iatrogenic Stroke of the Eye

2021 ◽  
pp. 120347542199934
Author(s):  
John P. Arlette ◽  
Michael Ashenhurst ◽  
Vivian Hill ◽  
Kailun Jiang
Keyword(s):  
Hyaluronic Acid ◽  
Patient Characteristics ◽  
Injection Technique ◽  
Sudden Loss ◽  
Filler Injection ◽  
The Past ◽  
Facial Esthetics ◽  
The Face ◽  
Ophthalmologic Examination ◽  
Retinal Artery

In the past few decades, minimally-invasive esthetic treatments and the use of injectable Hyaluronic Acid Gels and other filling agents to treat facial esthetics have increased dramatically. Although extremely rare, a filler can cause ocular and orbital ischemia by retrograde flow from the ophthalmic artery when injected in any of the anastomosis of the face. Once filler reaches the central retinal artery, blindness is inevitable, and no treatment is effective. While the risk of blindness happening with any filler injection is rare, the life-altering irreversible consequence of a procedure that was anticipated to be simple and beautifying is a reality that each injector must be prepared for with every injection. The parameters associated with an iatrogenic stroke of the eye are the site of injection, the injection technique, patient characteristics, and the material injected. Understanding the interplay of each of these variables might help us reduce the possibility of blindness during the injection of a soft-tissue cosmetic filler. Here, we explore the causes of Hyaluronic Acid Gels Filler embolic phenomena, review the natural course of the process, and discuss appropriate immediate interventions. We also (1) propose an education plan for injectors and describe how to carry out a focused ophthalmologic examination and procedural activities for a referral to an ophthalmologist, (2) outline steps to prevent emboli during filler injection, and (3) how to manage and support a patient with a sudden loss of vision during or immediately after a Hyaluronic Acid Gels filler treatment.

scholarly journals Clinical Efficacy and Safety of Non-Cross-Linked Hyaluronic Acid Combined with L-carnosine for Horizontal Neck Wrinkles Treatment

2021 ◽  
Author(s):  
Shiwei Wang ◽  
Huanyun Niu ◽  
Yao Liu ◽  
Yawen Tan ◽  
He Gao ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Adverse Events ◽  
Treatment Plan ◽  
Treatment Options ◽  
Critical Role ◽  
Full Description ◽  
Efficacy And Safety ◽  
Level Of Evidence ◽  
Filler Injection ◽  
Based Medicine

AbstractBackground Horizontal neck wrinkle formation is gaining more attention among cosmetic practitioners and clients. To date, hyaluronic acid products are one of the most common treatment options for this aesthetic concern. However, different therapeutic strategies should be given to solve the problem due to multiple etiological reasons. Given that oxidative damage plays a critical role in neck wrinkle formation, anti-oxidative compounds are now considered by physicians when making a treatment plan. Aims To evaluate the efficacy and safety of a non-cross-linked hyaluronic acid filler in combination with L-carnosine in treating horizontal neck wrinkles. Methods Thirteen patients with a Wrinkle Assessment Scale (WAS) of 2–5 for horizontal neck wrinkles were treated with L-carnosine-containing non-cross-linked hyaluronic acid. Participants were followed-up for 3 months after treatment. The post-treated WAS scores evaluated by physicians were collected when patient satisfaction was surveyed. Any post-treatment adverse events were recorded. Results With a single injection of the above filler, the physician-evaluated WAS scores improved by at least one score at one month and the improvement kept consistent as far as three months after injection. According to the last follow-up visit, 11/13 patients were satisfied with the treatment effect of their neck wrinkle. Moreover, adverse events were rare after filler injection, except for local complications that were considered common reactions to the filler injection procedure. Conclusion The non-cross-linked hyaluronic acid filler containing L-carnosine is safe and effective for treating horizontal neck wrinkles.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

scholarly journals The Influence of Different Light Angles During Standardized Patient Photographic Assessment on the Aesthetic Perception of the Face

2021 ◽  
Author(s):  
Claudia A. Hernandez ◽  
John Mario Espinal ◽  
David Uribe Zapata ◽  
Daniel Coimbra ◽  
Michael Alfertshofer ◽  
...  
Keyword(s):  
Facial Attractiveness ◽  
Threshold Value ◽  
Full Description ◽  
Aesthetic Perception ◽  
Level Of Evidence ◽  
Clinical Images ◽  
Facial Perception ◽  
The Face ◽  
The Aesthetic ◽  
Based Medicine

Abstract Background 2D baseline and follow-up clinical images are potentially subject to inconsistency due to alteration of imaging parameters. However, no study to date has attempted to quantify the magnitude by which such images can be influenced. Objective The objective of the present study is to identify the magnitude by which images can be influenced by changing the imaging light angle. Methods This study is based on the evaluation of 2D frontal images of the face and included a total of 51 subjects of which n = 14 were males and n = 37 were females. Faces were photographed at 0°, 30°, and 60° light angle under identical and standardized conditions. Images were randomized and rated by 27 blinded raters for age, facial attractiveness, body mass index (BMI), temporal hollowing, lower cheek fullness, nasolabial sulcus severity, and jawline contour. Results Facial attractiveness decreased, facial unattractiveness increased and the evaluated BMI (based on facial assessment) increased statistically significantly at 60°. The assessment of regional facial scores, i.e., temporal hollowing, lower cheek fullness, and jawline contour, showed no statistically meaningful changes both at 30° and at 60° light angle. Conclusion The results indicate that there might be an observed blind range in light angle (0°–30°) which does not influence facial assessment. Increasing the light angle past the threshold value to 60° might result in a statistically significant impact on facial perception which should be accounted for when documenting and/or presenting facial 2D images. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

scholarly journals Eradication of Benign Skin Lesions of the Face by Voltaic Arc Dermabrasion (Atmospheric Plasma): Postoperative Pain Assessment by Thermal Infrared Imaging

2020 ◽  
Vol 44 (6) ◽  
pp. 2277-2285
Author(s):  
Antonio Scarano ◽  
Francesco Carinci ◽  
Valentina Candotto ◽  
Felice Lorusso
Keyword(s):  
Infrared Imaging ◽  
Skin Pigmentation ◽  
Skin Lesions ◽  
Atmospheric Plasma ◽  
Full Description ◽  
Facial Skin ◽  
Level Of Evidence ◽  
Thermal Infrared Imaging ◽  
Plasma Irradiation ◽  
The Face

Abstract Objectives The face aging processes are associated with physiologic and biochemical alteration that produces wrinkles, skin pigmentation and benign growths. The aim of this study was to evaluate the clinical efficacy of voltaic arc dermabrasion with plasma to remove benign facial skin lesions. Study Design Voltaic arc dermabrasion plasma technique was used to remove the facial benign skin lesions. The study involved 45 patients (26 females;19 males) treated for benign facial skin lesions with voltaic arc dermabrasion also called plasma exeresis technique. The subjects age ranged between 43 and 65 years. The clinical observations and comparison of pretreatment and post-treatment photographs of the treated regions were performed by a joint examiner at each follow-up visit. Results During plasma irradiation, the average temperature of the skin was 290.3 ± 21.7 °C, while immediately after it was 90.6 ± 21.8 °C. Overall clinical improvement was 100% in six lesions with complete resolution of all lesions. Three patients observed a transient post-inflammatory pigmentation with a peak at 1 month after VAD treatment, gradually fading spontaneously over 2 to 3 months. Conclusions The voltaic arc dermabrasion technique (atmospheric plasma) should be considered for lesions, especially relatively superficial ones, and small lesions that are located on the face. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

scholarly journals Hyaluronic Acid Fillers Enriched with Glycine and Proline in Eyebrow Augmentation Procedure

2021 ◽  
Author(s):  
Antonio Scarano ◽  
Biagio Rapone ◽  
Domenico Amuso ◽  
Francesco Inchingolo ◽  
Felice Lorusso
Keyword(s):  
Hyaluronic Acid ◽  
Full Description ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Aesthetic Result ◽  
Study Results ◽  
High Level ◽  
Based Medicine ◽  
Augmentation Procedure

Abstract Background The eyebrow area is a clinically critical district due to the anatomical complexity and the propensity to aging-related atrophy. Hyaluronic acid fillers have been proposed to recover the dermal volume of the facial and lips regions. Aim The aim of the present investigation was to evaluate hyaluronic acid fillers enriched with glycine and proline for the treatment of eyebrow augmentation. Methods A total of 15 healthy patients were treated with eyebrow augmentation procedure. The distance between mid-bipupil to lateral eyebrow and mid-eyebrow to the medial eyebrow was measured before, immediately after treatment and at follow-up of 6 months. Results The healing period was uneventful, and no evidence of inflammation or swelling associated with the treatment was reported. No macroscopical alteration was reported in the surrounding tissues with no evidences of visible wheals or lumps in the treated sites at the follow-up. Before treatment, the angle was equal to 9.32 ± 0.2°, while after treatment it was 11.21 ± 0.4° (p < 0.01); after three and 6 weeks, it was, respectively, 10.66 ± 0.2° (p<0.05) and 10.02 ± 0.3°(p > 0.05). Conclusions The study results suggest that the hyaluronic acid fillers enriched with glycine and proline treatment resulted as being a useful procedure for augmentation, contour and volume definition and elevation of the eyebrow region with a high-level aesthetic result. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

scholarly journals Concomitant Use of Hyaluronic Acid and Laser in Facial Rejuvenation

2019 ◽  
Vol 43 (4) ◽  
pp. 1061-1070 ◽  
Author(s):  
Fernando Urdiales-Gálvez ◽  
Sandra Martín-Sánchez ◽  
Mónica Maíz-Jiménez ◽  
Antonio Castellano-Miralla ◽  
Leonardo Lionetti-Leone
Keyword(s):  
Hyaluronic Acid ◽  
Botulinum Toxin A ◽  
Scientific Evidence ◽  
Combined Treatment ◽  
Facial Rejuvenation ◽  
Full Description ◽  
Dermal Fillers ◽  
Level Of Evidence ◽  
Laser Technology ◽  
Patient’S Satisfaction

AbstractBackgroundFacial aging is a process that involves many different changes. Therefore, in many patients, it may be necessary to perform a combined treatment. Botulinum toxin A and dermal fillers are the two most popular nonsurgical cosmetic procedures performed globally to treat age-associated changes. However, there are not many studies reporting the concomitant use of dermal fillers and laser technology for facial rejuvenation. This review aims to assess the concomitant use of dermal hyaluronic acid (HA) fillers and laser technology for facial rejuvenation.MethodsThe present updated consensus recommendations are based on the experience and opinions of the authors and on a literature search.ResultsIf a combined procedure (HA and light treatments) is to be performed, on the same day, the panel recommends starting always with the light treatments, avoiding skin manipulations after having injected HA. To customize the therapeutic management, it is crucial to establish a precise diagnosis of the photodamage and loss of volumes suffered by the patients.ConclusionsThe currently available scientific evidence about the combined use of HA fillers and laser–radiofrequency–intense pulsed light (laser/RF/IPL) is limited and encompasses mainly small and nonrandomized studies. Nevertheless, most of these studies found that, on average, the concomitant use (same day) of laser and HA fillers for facial rejuvenation represents an effective and safe strategy which improves clinical results and patient’s satisfaction. Future well-designed clinical studies are needed regarding the effectiveness and safety of combination filler/laser treatments.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authorswww.springer.com/00266.

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