ABSTRACT
The use of Botox for the treatment of hyperkinetic facial lines and furrows is another effective primary, adjunctive, or prophylactic therapy to offer cosmetic patients in the spectrum of treatment options for full facial rejuvenation. Unwanted side effects can be minimized, and beneficial effects can be maximized with a thorough understanding of the facial soft-tissue anatomy, proper patient selection, and administration of the lowest effective doses with minimal volume of delivery. Most often, Botox injection does not replace surgery, skin resurfacing, soft-tissue augmentation, or skin care; however, it is useful when used alone or with the various treatment options to give selected patients the most effective and comprehensive solutions for a more youthful appearance.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Face/surgery , Plastic Surgery Procedures/methods , Blepharoplasty/methods , Humans , Rhytidoplasty/methodsABSTRACT
Soft-tissue augmentation lends another dimension to facial rejuvenation. Human collagen tissue matrix offers the most physiologic solution to dermal volume depletion, structural soft-tissue malposition, and the correction of facial rhytides and various soft-tissue contour defects. Results with the use of Dermalogen have been comparable with other injectable dermal agents with the most natural effects. The absolute longevity or persistence of human tissue collagen matrix has not been established fully and depends on facial region, technique, and total volume administered. The natural fate of most related bio-materials suggest that internal dosing is required to maintain maximum effects. Dermaplant is now commercially available and is an effective agent for facial soft-tissue augmentation-nasolabial folds and lip augmentation-and secondary eyelid and nasal reconstruction. Final clinical studies will provide data on long-term persistence and relative results when compared with other acellular dermal and alloplastic grafts.
Subject(s)
Collagen/administration & dosage , Face/surgery , Plastic Surgery Procedures/methods , Female , Humans , InjectionsABSTRACT
Facial soft-tissue augmentation has become increasingly popular as an option for those patients in whom age-related changes manifest as contour defects or who desire volume enhancement for various areas of the face. A variety of agents and techniques are currently available that, when used appropriately, can improve or correct facial rhytids and regional volume depletion. Failures of some agents are due to reduced biocompatibility, inadequate administration technique, or failure to match the actual underlying defeat with the most appropriate solution. Dermal soft-tissue augmentation with human tissue collagen matrix (Autologen and Dermalogen) is physiologic, appears to be ultimately safe and effective, and has many qualities consistent with an ideal dermal filler. Several autologous, allogeneic (cadaver-derived), heterologous, and alloplastic agents will be discussed in this article with regard to rationale, patient selection, optimum administration technique, and persistence.
Subject(s)
Biocompatible Materials , Collagen/administration & dosage , Prosthesis Implantation/methods , Rhytidoplasty/methods , Adult , Aged , Collagen/adverse effects , Female , Foreign-Body Reaction/etiology , Foreign-Body Reaction/pathology , Humans , Injections, Subcutaneous , Male , Materials Testing , Middle Aged , Skin/drug effects , Skin/pathology , Treatment OutcomeABSTRACT
Results of aesthetic lower eyelid surgery have improved through a better understanding of the anatomy, indications for surgery, and more effective, individualized solutions for the varied problems. Most treatment options have the potential risk of inducing lower eyelid malposition if support is not applied through either canthoplasty or canthopexy. An algorithm for selecting the most appropriate method of canthal support in lower eyelid and midfacial rejuvenation is presented. A new, simplified, effective, and aesthetic suture canthopexy, the transpalpebral lateral retinacular suspension, is introduced; it can be universally applied.
Subject(s)
Blepharoplasty/methods , Suture Techniques , Blepharoplasty/adverse effects , Female , Humans , MaleABSTRACT
Our improved understanding of the pathophysiology of facial lines, wrinkles, and furrows has broadened the treatment options for a variety of facial cosmetic blemishes. The persistence or recurrence of certain facial rhytids after surgery has confirmed the lack of full comprehension of their origin. Glabellar forehead furrows (frown lines) and lateral canthal rhytids (crow's feet) have been the most popular facial lines that have been shown to be mostly the result of regional hyperkinetic muscles, and their eradication may be more suitable, at times, to chemodenervation than to soft-tissue fillers, skin resurfacing, or surgical resection. Aesthetic surgical procedures that have yielded suboptimal results may also occur from failure to recognize other causative factors including hyperkinetic or dynamic musculature, which may contribute to etiology of the visible soft-tissue changes and lack of persistent effect after surgery. Chemodenervation with botulinum toxin A (Botox) has proven to be useful both as a primary treatment for certain facial rhytids and as an adjunctive agent for a variety of facial aesthetic procedures to obtain optimal results.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Face , Neuromuscular Agents/therapeutic use , Skin Aging , Denervation/methods , HumansABSTRACT
Cosmetic eyelid surgery has benefited from the use of the carbon dioxide laser. The short pulsed laser cuts through tissue with limited surrounding thermal damage, resulting in incisions that heal with minimal scarring comparable to traditional cold steel methods. The laser provides excellent hemostasis, which shortens surgical time, and lessens postoperative bruising and swelling.
Subject(s)
Blepharoplasty/methods , Laser Therapy , Eyelid Diseases/surgery , Eyelids/surgery , Humans , Treatment OutcomeABSTRACT
Fifteen patients and 28 eyes with measurable eyebrow ptosis underwent standard upper eyelid blepharoplasty with or without sub-brow fat excision. The patients were educated about the status of their eyebrow position and the effects of either direct or indirect methods of brow elevation. The patients either refused or chose not to undergo browpexy by any method. Eleven patients and 22 eyes showed an insignificant change in their eyebrow position after surgery. Two patients and three eyes had a mild to moderate descent of the eyebrow and two patients had what was felt to be significant worsening of their eyebrow ptosis in one or both eyes. However, all were pleased with their result. Information as such, after a careful review of the literature, has not previously been published.
Subject(s)
Blepharoptosis/surgery , Eyebrows/surgery , Eyelids/surgery , Adult , Aged , Eyebrows/physiology , Humans , Middle Aged , Surgery, Plastic/methodsABSTRACT
Five patients with severe dysthyroid optic neuropathy were treated with intravenous methylprednisolone (1 g daily for 3 consecutive days). Before administration, visual acuity of the more severely affected eyes of each patient was counting fingers at 5 feet, 8/200, 20/400, 20/200, and 20/80. Immediately after completion of pulse therapy, visual acuity improved to 20/25 in four patients and 20/30 in one. Remissions were maintained with oral prednisone and external beam irradiation of the orbit. Pulse methylprednisolone therapy appears to be beneficial in the initial management of severe dysthyroid optic neuropathy.
