Nonanimal stabilized hyaluronic acid is commercially available and has been used increasingly as a facial soft tissue filling agent. Stephen Bosniak, MD, and associates present their experience in injecting the glabella, melolabial fold, commissure lines, and lips for augmentation. A total of 2242 treatments were performed in 1446 patients. Results were assessed by both patients and investigators. Patient and investigator evaluation levels paralleled each other, and scores were highest for relatively immobile areas such as the melolabial fold and the botulinum toxin A–treated glabella. All groups were evaluated at 3, 6, and 9 months. There was a decrease in satisfaction level and perceived degree of correction at 9 months.
Although significant exposure to solar radiation, and UV exposure in particular, has led to a high incidence of epidermal and dermal cutaneous damage, photorejuvenation therapies can be used, alone or in concert. Jeffery A. Hall, MD, and colleagues present their work combining radiofrequency energy, intense pulsed light, and photodynamic therapy in patients with Fitzpatrick skin types I through III. The application duration of topical photosensitizer 5-aminolevulinic acid and the fluence of intense pulsed light varied, but radiofrequency energy was constant. The study reports dose-response results from the minimal erythema dose to the maximal tolerated dose for each group. Effects of combined treatment were synergistic and enhanced photodamaged cell destruction. Based on their findings, the authors have developed protocols for combined radiofrequency energy, intense pulsed light, and photodynamic therapy based on skin type and severity of damage.
Facial wasting syndrome is a complication of highly active antiretroviral therapy used to treat human immunodeficiency virus and is part of a lipodystrophy that results in loss of fat in the cheeks and temples, leading to an emaciated appearance. William J. Binder, MD, and David C. Bloom, MD, present their experience in treating this condition with facial implants. Fourteen patients with severe facial wasting were treated with custom-designed implants, and 8 patients with facial wasting of moderate severity were treated with “off-the-shelf” implants. Custom implants were constructed using high-resolution computed tomographic scans, computer-aided design, and surgeon input. The authors present their technique for construction and placement of submalar implants. They report a high patient satisfaction level, with no serious complications. Minor complications consisted of 1 postoperative and 1 delayed infection. This approach represents a useful addition to the techniques used to treat these patients.
The search for nonablative skin tightening techniques has recently come into the spotlight, and Michael Fritz, MD, and colleagues have examined the application of radiofrequency energy using the ThermaCool TC system (Thermage Inc, Hayward, Calif) for treatment of middle and lower face laxity. Patients were randomly assigned to receive 1 or 2 treatments and blinded observers rated pretreatment and posttreatment photographs. Statistically significant improvements were found in the melolabial fold with 2 treatments. Continued improvement was also noted between 1 and 4 months for all subsites. Unfortunately, only modest improvements were noted in most patients. Advantages of this approach include few adverse effects, minimal downtime, and high patient tolerance of the procedure.
Highlights of Archives of Facial Plastic Surgery. Arch Facial Plast Surg. 2004;6(6):365. doi:10.1001/archfaci.6.6.365