Fat grafting.

This article from 2001 reviews the state of the art of fat grafting from a historical approach by two dermatologists. At that time, autologous tissue augmentation was controversial and the authors describe initial efforts at improving retention of fat grafting.

Lip augmentation with liquid silicone.

BACKGROUND: Many fillers have been used to augment the lips. One of these that has provided long-term satisfactory results is liquid silicone. OBJECTIVE: To demonstrate the efficacy and safety of lip augmentation with liquid silicone. METHOD: Following a discussion of the benefits and risks of the procedure and the benefits and risks of alternatives and after answering all of the patients' questions, an informed consent form was signed. After obtaining anesthesia with a regional nerve block of the infraorbital and mental nerves, 0.25 to 0.5 cc of liquid silicone (1,000 centistokes) was injected using the microdroplet technique into the vermilion border of both the upper and lower lips. Depending on the desire of the patient, the procedure was repeated monthly. The augmentation of the lips was documented with histology, micrometry, and digital photography. RESULTS: Lip augmentation was achieved gradually during the months following liquid silicone injections into the vermilion border of the lips in the 608 patients studied. Most of the patients requested a second and third injection session. The results were most dramatic in the patients with type I and type II lips and less satisfactory in patients with type III lips. Bruising occurred in the majority of the patients. Eleven patients (2%) developed small palpable granulomas. These granulomas either required no treatment, responded to steroid injections, or were excised. CONCLUSION: The use of liquid silicone remains an effective method of lip augmentation. It returns the adolescent vermilion curl to the lips.

Chemical peels: their place within the range of resurfacing techniques.

The photoaging index has been developed to determine the level of skin rejuvenation required to reduce the visible signs of aging. Minor photoaging is reversed with free-radical avoidance and peeling with a topical skin care regimen consisting of buffing grains, alpha-hydroxy acid normalizing tonics and vitamin A conditioning lotions. The reversal of moderate photoaging requires the addition of light-to-moderate peels using alpha-hydroxy acids combined with microdermabrasion. For the more advanced case the Jessner/trichloroacetic acid (TCA) combination peel (Monheit peel) is used which can be repeated once to twice a year. Laser resurfacing is especially useful to shrink the collagen and produce a 'face-lift bypass'. The phenol peel remains the standard to reverse heavy lines. A new modified formula (Hetter) is used which contains less phenol and less croton oil. Dermabrasion is helpful for removing multiple actinic keratosis. With this combination of skin care, chemical peels, and dermabrasion it is possible to reverse the photoaging index.

The treatment of hypopigmentation after skin resurfacing.

BACKGROUND: Hypopigmentation has plagued all methods of skin resurfacing. Whether the physician uses chemical peels, dermabrasion or laser resurfacing hypopigmentation can develop. OBJECTIVE: To examine the pathogenesis and treatment of hypopigmentation after resurfacing. METHODS: Areas of hypopigmentation after skin resurfacing were blended in with laser-assisted chemabrasion (LACA). The process begins with preconditioning of the skin with vitamin A/glycolic skin conditioning lotions. Then the area is resurfaced with the LACA. This resurfacing usually requires three to four freeze-sand cycles to remove the areas of hypopigmentation associated with dermal fibrosis. The resurfaced skin is then occluded with a combination of polyethylene/silicone sheeting during the acute phase of wound healing. Ultraviolet photography and histologic examination were used to demonstrate the improvement in dermal fibrosis and hypopigmentation. RESULTS: The LACA improved areas of hypopigmentation in the 22 cases studied. Under occlusive wound dressings, the melanocytes migrated into the areas of hypopigmentation, and the wounds healed without extensive fibrosis. This produced a blending of skin color. CONCLUSION: It is possible with skin preconditioning, LACA, and occlusive wound healing to provide for a wound healing environment that blends in areas of hypopigmentation that have developed after previous skin resurfacing.