Effect of Surgical versus Nonsurgical Rhinoplasty on Perception of the Patient: An Eye-Tracking-Based Investigation.

Because of its central location in the face, the nose plays an important role in the aesthetic perception of the face. To improve the appearance of the nose, surgical and nonsurgical rhinoplasty techniques have been described, although it still remains elusive if both options show comparable results in their aesthetic perception. This study assesses the fixation pattern and duration when looking at postinterventional images compared with baseline images for surgical and nonsurgical rhinoplasty procedures. According to this study, the nasal appearance, especially in a lateral view, is more fundamentally altered when surgical rhinoplasty is performed, compared with nonsurgical rhinoplasty.

Non-Surgical Rhinoplasty: The Ascending Technique and a 14-Year Retrospective Study of 2130 Cases.

INTRODUCTION: Non-surgical rhinoplasty or liquid/filler rhinoplasty is one of the fastest-growing cosmetic procedures worldwide. While several papers have been published on this topic, there has been no standardization of the technique. Most techniques advise injection in a top-down manner, similar to a traditional rhinoplasty. We present our ascending technique performed in 2130 cases. This constitutes one of the largest series published on this subject. METHODS: Patient records were retrospectively analysed from 2006 to 2019. All patients were injected with hyaluronic acid fillers. We employed an ascending approach which consisted of four sites: nasal tip, columellar base, dorsum (including supratip) and radix. The tip was first set at the appropriate projection and rotation and then the dorsum adjusted to meet it. RESULTS: Since 2006, 2130 patients underwent non-surgical rhinoplasty; 2023 patients were female (95%), and 107 were male (5%). The proportions by site injected were tip 95%, columella 58%, dorsum 83%, radix 62%. Sixty-two percent (1321) repeated the procedure after 1 year. Two percent of patients had persistent tip redness which recovered. There was no skin necrosis or ocular complications. CONCLUSIONS: In non-surgical rhinoplasty, all modifications are being done by pure addition, unlike surgical rhinoplasty. In this scenario, the risk of over-projecting the tip is higher. Hence, we believe it is important to set the tip at the desired projection and size and then raise the dorsum accordingly to match. Our high satisfaction rate over 2130 patients validates the efficacy of this ascending technique. 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 .

Triple-Blind, Prospective, Internally Controlled Comparative Study Between AbobotulinumtoxinA and OnabotulinumtoxinA for the Treatment of Facial Rhytids.

INTRODUCTION: OnabotulinumtoxinA (ONA; Botox, Allergan, Irvine, CA) was discovered for cosmetic use in the mid-1980s for which it was FDA approved in April 2002. AbobotulinumtoxinA (ABO; Dysport, Valeant Pharmaceuticals International, Inc, Montreal, Quebec) was FDA approved in April 2009 for therapeutic and esthetic uses. The most recent studies make a comparison between the two formulations; however, information is still lacking in comparison studies. In this study, we compare efficacy and safety of a single treatment of two preparations of botulinum toxin A in patients with moderate to severe rhytids in the glabellar and crow's feet areas. METHODS: A total of 85 patients with moderate to severe wrinkles in either the glabellar or crow's feet area, or both, were given a single injection on day 0, with ABO and ONA injected on opposite sides of the face. Follow-up assessments were done at 2 weeks, 1 month, 3 months, 4 months, and 5 months. The study end points were onset of action, change in degree of wrinkles, patient satisfaction, duration of effect, and adverse effects. RESULTS: Results of onset of improvement with ABO vs. ONA in the glabellar and crow's feet regions show higher percentage of patients with earlier onset improvement with ABO. Evaluator assessment showed ABO lasted longer after 3 months in a significant number of patients in both areas, 83% with ABO vs. 48% with ONA at 4 months in the glabellar area, and 65% with ABO vs. 47% with ONA at 4 months in the crow's feet area. CONCLUSION: Time to improvement showed earlier onset and longer duration of improvement in a higher percentage of individuals with ABO when compared with ONA. ABO provides a safe and effective alternative in a dose ratio of 2.5:1 and 3:1 in the glabellar and crow's feet area, respectively.

Combination surgical excision and fractional carbon dioxide laser for treatment of rhinophyma.

Rhinophyma is a severe late complication of rosacea, which is characterized by progressive hyperplasia of sebaceous glands and connective tissue involving the lower two-thirds of the nose. It can be an emotionally devastating disorder, and serve as a medium for occult cancers and other health problems. Many surgical treatments have been advocated, as well as dermabrasion and laser therapy. In light of the problems faced with these individual therapy modalities, we advocate a combination therapy of surgical debulking and fractionated Carbon dioxide laser therapy. By excising the tissue first, we not only decreased the amount of time needed for the procedure, we were also able to preserve a histopathologic specimen that can be examined for occult cancers. After debulking, the fractionated carbon dioxide laser is then used to blend. By using fractionated carbon dioxide, we avoided the complications associated with non-fractionated carbon dioxide lasers, such as delayed healing times, hypopigmentation, hyperpigmentation, scarring, and persistent redness. We report our experience in two patients with rhinophyma who underwent a combination of surgical excision and fractional Co2 laser therapy for treatment. Pre- and postoperative protocols and treatment parameters are discussed. Both patients had excellent cosmetic and functional results and were followed for at least one year.

Extensive necrosis after injection of hyaluronic acid filler: case report and review of the literature.

BACKGROUND: Use of dermal fillers for soft tissue augmentation has become an integral part of aesthetic practices. Dermal fillers temporarily remove the appearance of rhytids and reduce the depth of skin folds. Even with the most experienced of injectors, adverse effects can and do occur ranging from mild bruising to severe injection necrosis. AIMS: Physicians should be able to treat the severe complication of vascular necrosis and detect impending necrosis after injection of a dermal filler, especially with hyaluronic acid fillers. MATERIALS AND METHODS: Case report of a patient who was followed for 6 months from time of injection of hyaluronic acid filler to complete healing of wound. RESULTS: Complete wound healing was achieved with early recognition and institution of treatment. DISCUSSION: We review a case report of injection necrosis and methods used to prevent and treat this complication. CONCLUSION: Early recognition of vascular necrosis with specific protocol for treatment after injection necrosis with hyaluronic acid fillers improves the outcome of wound healing.

Intense pulsed light for the treatment of rosacea and telangiectasias.

UNLABELLED: Abstract Background: Rosacea is a chronic disease that affects the aesthetic appearance of skin. The use of intense pulsed light (IPL) has shown significant clearing in erythema, telangiectasia, and papules in rosacea. We seek parameters for IPL that will achieve optimal reduction in the appearance of rosacea with minimal adverse effects. OBJECTIVE: To investigate the use of IPL on 102 patients at various parameters (fluence and pulse duration) in the treatment of rosacea. METHODS: 102 patients with mild to severe rosacea were treated with IPL treatment using the NaturaLight IPL system (Focus Medical, Bethel, CT). Patients received treatments at 1-3 week intervals, with an average of 7.2 treatments. The Reveal Imager (Canfield Scientific, Fairfield, NJ) was used for photodocumentation and analyses. RESULTS: Treatments were given at 2.5/5 ms double, triple, or quadruple pulsed with 20-30 ms delay time. A 530 nm filter was used with fluences varying from 10-30 J/cm(2), or 10-20 J/cm(2) with a 420 nm filter for those patients with acneiform breakouts in addition to telangiectasias. 80% of patients had reduction in redness, 78% of patients reported reduced flushing and improved skin texture, and 72% noted fewer acneiform breakouts. There were no complications or adverse effects. CONCLUSION: The use of IPL at specified parameters provides optimal therapy for the treatment of rosacea.