Hyaluronic Acid Gel Injection for the Treatment of Tear Trough Deformity: A Multicenter, Observational, Single-Blind Study.

BACKGROUND: Hyaluronic acid (HA) gel injections were first used to treat the tear trough in 2005 and since then it has been a mainstay of the approach to lower eyelid deformities. OBJECTIVE: The authors present this retrospective multicentric observational study based on single-blind objective and subjective evaluation and patient satisfaction in relation to the aesthetic improvement of a large group of patients treated. METHODS AND MATERIALS: Between January 2016 and December 2019, 600 patients (468 women and 132 men), were enrolled in this study, and 1200 tear trough deformities were treated with both needle and cannula techniques. RESULTS: Average follow-up time was 12 ± 1 months, and the outcomes were assessed both objectively and subjectively with respect to Hirmand's classification. Statistical analysis shows an inverse correlation between age and class amelioration. CONCLUSION: HA injection of the tear trough is most effective in patients between 30 and 40 years of age, while its benefits extend to up to 50 years old; afterward, it should no longer be the treatment of choice. This confirms that correction of tear trough with hyaluronic acid injections may provide an option to achieve immediate and durable results for up to one year after the injection. 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 .

Hyaluronic acid delayed inflammatory reaction after third dose of SARS-CoV-2 vaccine.

BACKGROUND: Treatments based on hyaluronic acid represent one of the most largely used practice of esthetic medicine. In the literature, it has already been described delayed reaction after vaccine like flu vaccine mediated by T-lymphocytes. AIM: We report three cases of dermal filler reactions following mRNA vaccination against SARS-CoV-2; all the patients had received the filler months or even years before the vaccine. PATIENTS: Patient one: A 60-year-old female patient that was treated one year ago in the lip developed swelling days after getting mRNA Pfizer Biotech vaccine. She received her booster of Pfizer vaccination one week before. Patient two: A 45-year-old female patient treated in the lip two years before developed angioedema days after getting her booster of Pfizer Biotech vaccine. In this case, it was necessary to prescribe cortisone per os. Patient three: A 40-year-old female patient treated for the nasolabial fold five months before developed erythema and edema after receiving the booster of Moderna Vaccine. RESULTS: As demonstrated in our three case reports, even the booster of vaccine can cause delayed inflammatory reactions in patients that have previously received fillers. CONCLUSION: Delayed inflammatory reactions in patients that have received filler in the past are uncommon and usually self-limited. Those are the first example reported in the literature of reaction after the booster dose without any previous symptoms.

Microbotox: A prospective evaluation of dermatological improvement in patients with mild-to-moderate acne and erythematotelangiectatic rosacea.

BACKGROUND: Botulin toxin (BTX) is a potent neurotoxin produced by the bacterium Clostridium botulinum, since its approval by FDA in 2002 for cosmetic purpose has been widely used. Recent studies indicate that it exerts its activity on various type of skin cells and can be used in some dermatological disease. OBJECTIVE: The aim of the study was to demonstrate how to use a peculiar dilution of botulinum toxin type A in the treatment of some dermatological disease like mild-to-moderate acne vulgaris and erythematotelangiectatic rosacea. MATERIAL AND METHODS: 50 patients were enrolled, 35 with mild-to-moderate acne and 15 with erythematotelangiectatic rosacea. Both group of patients were treated with a specific dilution of Onabotulinum toxin A called Microbotox. Patient images were taken before and 4 weeks after the treatment. RESULTS: The authors and patients were extremely satisfied with their treatments. There were no immediate or delayed complication in none of both group of patients. CONCLUSION: Botulinum toxin shows a great promise either in dermatological disease like mild-to-moderate acne vulgaris and erythematotelangiectatic rosacea. Microbotox appears to be a valid, long-lasting, and a standardized approach to treat these kind of two disease.

Nonsurgical reshaping of the nose, chin, and jawline: A retrospective analysis using experience-based eligibility criteria.

BACKGROUND: Nonsurgical reshaping of the nose, chin, and jawline with hyaluronic acid fillers is becoming increasingly popular. Appropriate patient selection is essential. OBJECTIVES: To assess the safety and efficacy of nonsurgical treatment of these facial areas using experience-based eligibility criteria and injection of the high G' filler, VYC-25L. METHODS: This was a retrospective analysis of patients undergoing aesthetic improvement of the nose, chin, and/or jawline with VYC-25L, selected based on detailed criteria derived from extensive experience and imaging assessments. In a subgroup of subjects, high-resolution 3D imaging was used to assess nasal angles, nasal hump height, and chin projection. RESULTS: A total of 135 patients were included (n = 106 females; mean age, 43.4 ± 14.3 years; n = 44 nose treatment only, n = 24 chin/jawline only, n = 67 both). Mean treatment volume was 3.3 ± 2.0 ml. In total, 111 individuals (82.2%) were injected in the nose (mean volume: 0.9 ± 0.2 ml) and 91 (67.4%) in the chin/jawline (mean volume: 3.8 ± 0.8 ml). Most complications were injection site-related (bruising, n = 27 [20.0%]; pain, n = 1 [0.7%]). One patient (0.7%) experienced lip herpes, successfully managed with antiviral therapy. Thirty-two individuals underwent 3D imaging, which showed substantial mean changes from baseline in nasofrontal angle (3.5 ± 1.6 degrees), nasofacial angle (2.2 ± 0.8 degrees), and nasolabial angle (3.9 ± 2.6 degrees); decreases in nasal hump height (1.7 ± 0.9 mm); and increased chin projection (2.7 ± 1.5 mm). CONCLUSIONS: Nonsurgical reshaping of the nose, chin, and jawline was safe and effective using experience-based eligibility criteria and VYC-25L.

Efficacy of a combined chemical peel and topical salicylic acid-based gel combination in the treatment of active acne.

BACKGROUND: Acne vulgaris is a common skin condition affecting the pilosebaceous unit of the skin characterized by the presence of comedones, papules, pustules, nodules, and cysts, which might result in permanent scars. It commonly affects adolescents, but it can occur in any age-group with the second group of incidence in young women in their 30s. Acne vulgaris can highly affect a person's quality of life. Therefore, it is necessary to act against it to prevent emotional impact and long-term complications. AIM: This study aimed to demonstrate the efficacy of a chemical peel in combination with a home care-exfoliating and purifying product in improving mild and moderate acne. METHODS: The study included 45 patients with mild-to-moderate acne. Patients were treated with a chemical peel containing a mix of salicylic acid, pyruvic acid, and retinoic acid once every 3 weeks for 4 times, plus a home care treatment after the healing process. Michaelson's acne severity score, Subject Global Aesthetic Improvement Scale, and Face Skin Q questionnaire were used to evaluate patients' skin improvement and patients' satisfaction. RESULTS: All patients have shown improvement in skin lesions after 4 sessions of chemical peel according to Michaelson's acne severity score and Subject Global Aesthetic Improvement Score. Face Skin Q questionnaire demonstrated an improved quality of life in all treated patients. CONCLUSION: The combination of salicylic acid-based chemical peel plus exfoliating home care treatment appears to be a very good strategy against acne. Therefore, the physician may use this combination as an effective treatment for patients dealing with acne vulgaris.

Microbotulinum: A Quantitative Evaluation of Aesthetic Skin Improvement in 62 Patients.

BACKGROUND: Microbotulinum refers to the systematic injection of tiny blebs of diluted botulinum toxin at repeated intervals into the skin. This targets the superficial fibers of the facial muscles, and weakens their insertion into the undersurface of the skin, which is responsible for the fine lines and wrinkles on the face. The authors present a pilot study based on quantitative evaluation, by means of a skin-scanning technology, of the aesthetic improvement of skin texture, microroughness, and enlarged pore size in a patient group treated with microbotulinum injections for cosmetic purposes. METHODS: The treatment was performed using a 32-gauge needle to deliver injections on a regular 1-cm grid from the forehead to the cheek and down to the jawline. RESULTS: Sixty of the 62 patients completed the study. All analyzed parameters improved significantly (p < 0.0001) at 90 days with respect to the pretreatment time point (skin texture, -1.93 ± 0.51; microroughness, -2.48 ± 0.79; and pore diameter, 2.1 ± 0.43). Best results have been obtained in patients aged between 42.7 and 46.8 years, and standard deviation calculation allows us to recommend it in patients aged between 36.5 and 53 years. CONCLUSIONS: The results of this pilot study suggest that intradermal botulinum toxin injection, or so-called microbotulinum, is a safe and effective method to treat skin flaws. Because of the high satisfaction rate among both physicians and patients, further studies are indeed mandatory to determine the optimal number of units needed for a longer and lasting effect with this particular novel dilution. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Rejuvenation of the perioral and lip regions with two new dermal fillers: The Italian experience with Vycross™ Technology.

BACKGROUND: Hyaluronic acid fillers are frequently used for maintenance of youthful appearance of perioral and lip region. The introduction of Juvederm® Volbella™ with lidocaine and Juvederm® Volift™ with lidocaine to the European aesthetic market in 2012 increased the options of fillers to be used and it appears to be a new solution to improve this area. OBJECTIVE: the aim of this study is to demonstrate how to correct this area using two new dermal fillers: Juvederm® Volift™ with lidocaine, and Juvederm® Volbella™ with lidocaine, based on the experience of two Italian phycians. MATERIAL AND METHODS: 510 patients were enrolled, 195 were treated with Juvederm® Volbella™ with Lidocaine, 160 with Juvederm® Volift™ with lidocaine and 150 with both dermal fillers. Patients were photographed before and immediately after the treatment. RESULTS: All patients were extremely satisfied with their treatments. There were no immediate or delayed complications with either of the dermal fillers when used alone, or in combination. CONCLUSION: The dermal filler portfolio in Europe is among the largest and most varied available. ( 5 ) We propose here two new 15mg/ml and 17.5mg/ml hyaluronic acid fillers that utilize Vycross™ technology, that are suitable for lip and perioral region. According to the severity of the wrinkles and to the lip augmentation that we want to obtain we can select either one filler or another.

Midface and perioral volume restoration: a conversation between the US and Italy.

BACKGROUND: There are numerous dermal fillers available to injectors in the US and Europe for the correction of age-related volume loss in the midface and perioral regions. Product availability differs between these two aesthetic markets due to US Food and Drug Administration (FDA) regulatory requirements. The purpose of this study is to discuss differences in filler selection by two practitioners in the US and Europe based upon both stylistic approach and filler availability in each market. OBJECTIVE: To analyse and discuss the approach to midface as well as lip and perioral volume restoration by two independent dermatologists working in the US and Italy. METHODS: Seven patients were selected for discussion and divided into two groups: 1) those requiring midface volumization and 2) those undergoing perioral or lip volume replacement. Patients in the midface group were injected with Juvéderm Voluma® XC, Juvéderm® Volift® with lidocaine, Restylane- L®, Perlane-L® or Radiesse®. Patients in the perioral and/or lip group were injected with Juvéderm® Volbella™, with lidocaine, or Belotero Balance™. Patients were photographed before and immediately after injection to evaluate aesthetic outcomes. In each case, filler selection was based upon patient characteristics, anatomical considerations and inherent filler properties. RESULTS: All patients were extremely satisfied with their treatments. There were no significant immediate or delayed complications following treatment with any of the dermal fillers used. CONCLUSIONS: Volume restoration in the midface and perioral or lip region can be effectively achieved using a variety of dermal fillers. The dermal filler portfolio available in Europe is exponentially larger than that in the US. Product selection in either market is ultimately the result of the physician's experience injecting each dermal filler, as well as his or her personal preferences.