Improvement of Burn Scars Treated With Fractional Ablative CO2 Lasers-A Systematic Review and Meta-analysis Using the Vancouver Scar Scale.

Fractional ablative CO2 laser is being used increasingly to treat burn scars; however, objective measures of outcome success vary widely. This systematic review and meta-analysis extracts and pools available data to assess the outcomes of patients with burn scars treated with fractional ablative CO2 laser. A search of MEDLINE, EMBASE, and the gray literature was performed. The review included studies that reported patients with a confirmed diagnosis of scarring as a result of a burn injury, who were treated with fractional ablative CO2 laser and whose progress was recorded using the Vancouver Scar Scale (VSS). Eight studies were included in the systematic review and meta-analysis. Treatment regimens varied amongst studies, as did patient outcomes. Pooled data revealed an average VSS improvement of 29% across 282 patients following fractional CO2 ablative laser treatment. Although the heterogeneity of treatment regimens across studies limits this systematic review's ability to provide specific treatment recommendations, the overall trend towards improvement of burns scars treated with fractional CO2 laser based on the VSS encourages further exploration of this modality as a therapeutic tool.

A Systems Approach Helps Explain Significant Improvements in Local Wellness Policies Among SNAP-Ed-Supported School Districts.

OBJECTIVE: To assess changes in written local wellness policies (LWPs) across time within Supplemental Nutrition Assistance Program Education (SNAP-Ed)-participating districts. DESIGN: Sequential, explanatory mixed methods. SETTING: From October 1, 2015 to September 30, 2016, SNAP-Ed agencies submitted LWPs from partner school districts in Arizona. They received back scores and customized recommendations. To assess changes, LWPs were rescored between October 1, 2017 and September 30, 2018. PARTICIPANTS: Sixteen local SNAP-Ed agencies worked with 57 districts. INTERVENTIONS: Districts' LWP revisions supported by SNAP-Ed agencies during the 2-year pre-post period. MAIN OUTCOME MEASURES: Policy comprehensiveness and strength from 0 (worst) to 100 (best), measured by the Wellness School Assessment Tool. ANALYSIS: Paired t test to compare pre-post scores. Content analysis of State Educational Agency administrative reviews and thematic analysis of SNAP-Ed narrative reports to explore causation. RESULTS: Total scores increased (comprehensiveness: +12.4, P < .001, 95% confidence interval, 8.1-16.7; strength: +13.5, P < .001, 95% CI, 9.3-17.7). Improvements were also found for comprehensiveness by section, except Nutrition Education, and for strength across all sections. Qualitative findings suggest that SNAP-Ed interventions combined with state and federal influence contributed to the improvements. CONCLUSIONS AND IMPLICATIONS: Local wellness policies in SNAP-Ed-supported districts improved over time. State and federal LWP guidelines can work synergistically with SNAP-Ed interventions to influence improvements.

Use of a Hyaluronic Acid Soft-tissue Filler to Correct Congenital and Post-traumatic Lip Asymmetry.

BACKGROUND: The use of hyaluronic acid soft-tissue fillers for enhancement of lip features is a popular and minimally invasive office-based procedure used worldwide due to its relative simplicity and favorable safety profile. MATERIALS AND METHODS: Hyaluronic acid was used in illustrative cases to attempt correction of congenital and acquired lip asymmetries. RESULTS: In the cases presented, accurate and cosmetically acceptable results were attained and maintained for the duration of the product life. CONCLUSIONS: Hyaluronic acid may be used successfully when lip asymmetry is evident and is a relatively simple nonsurgical alternative.

Current Concepts in the Use of Voluma, Volift, and Volbella.

BACKGROUND: Hyaluronic acids (HAs) are very popular temporary fillers with a very good safety record. Improvements and adaptations in clinical use are continuing. METHODS: We have assessed the available literature to investigate the relatively new Vycross technology that uses a mixture of high- and low-molecular-weight HAs with a relatively low but varying HA concentration with enhanced cross-linking to produce a number of products that have differing clinical indications. RESULTS: Voluma has the highest HA concentration at 20 mg/mL, a high G prime translating into lift capacity and cohesivity keeping the product capable to lift vertically adding structure, form, and volume, whereas Volbella has much lower concentration at 15 mg/mL, a lower G prime and cohesivity allowing it to be used in more a horizontal spreading fashion enabling a superficial approach to lips, lines, and more subtle depressions. Volift at 17.5 mg/mL HA is half way between the 2 other products, allowing more subtle lift capacity but retaining an element of spread making it a useful agent for the perioral region in general and in the treatment of fine lines. CONCLUSION: A range of products has been released that allows different components of facial structure, volume, and lines to be adequately addressed.