Update on botulinum toxin and dermal fillers.

PURPOSE OF REVIEW: The art and science of facial rejuvenation is an ever-evolving field of medicine, as evidenced by the continual development of new surgical and nonsurgical treatment modalities. Over the past 10 years, the use of botulinum toxin and dermal fillers for aesthetic purposes has risen sharply. Herein, we discuss properties of several commonly used injectable products and provide basic instruction for their use toward the goal of achieving facial rejuvenation. RECENT FINDINGS: The demand for nonsurgical injection-based facial rejuvenation products has risen enormously in recent years. Used independently or concurrently, botulinum toxin and dermal filler agents offer an affordable, minimally invasive approach to facial rejuvenation. SUMMARY: Botulinum toxin and dermal fillers can be used to diminish facial rhytides, restore facial volume, and sculpt facial contours, thereby achieving an aesthetically pleasing, youthful facial appearance.

Silent sinus syndrome.

BACKGROUND: Silent sinus syndrome (SSS) is similar to and a subset of chronic maxillary atelectasis (CMA), which refers to a persistent decrease in sinus maxillary volume due to inward retraction of the maxillary sinus walls secondary to obstruction of the osteomeatal complex. It differs from CMA, however, in that there is no pain or maxillary sinus congestion. Patients with SSS usually manifest spontaneous unilateral enophthalmos and hypoglobus, with no history of facial trauma or surgery. They also do not have any nasal symptoms, sinusitis, or pain. CASE REPORT: A 28-year-old woman with asymptomatic enophthalmos and hypoglobus is described. The presentaton, diagnosis, and treatment of silent sinus syndrome are discussed. CONCLUSIONS: Silent sinus syndrome should be included in the differential diagnosis of enophthalmos and hypoglobus in the absence of trauma, surgery, and nasal symptoms. In addition to a thorough eye examination, axial and coronal computerized tomography of the sinus and orbits should be obtained to confirm the diagnosis.

A comparison of rates of fibrovascular ingrowth in wrapped versus unwrapped hydroxyapatite spheres in a rabbit model.

PURPOSE: To compare the rate of fibrovascularization of wrapped versus unwrapped hydroxyapatite (HA) spheres in an animal model and to investigate how drilling small-diameter access holes at the time of implantation affects the rate of fibrovascular ingrowth in wrapped implants. METHODS: The right eyes of 20 New Zealand White rabbits were removed and a 12-mm HA sphere was implanted in each socket. The spheres were left bare in 8 of the animals. In the other 12, the implant was wrapped in an autologous sclera shell. In 4 animals from each group, a 1-mm diameter access hole was drilled into the spherical center of the implant at the sites of extraocular muscle insertion and at the posterior pole before implantation. All implants were explanted after 1 week. RESULTS: The mean depth of fibrovascularization in the bare group without access holes (n = 4) was 100% (SD = 0). The mean depth of fibrovascularization in the wrapped group without access holes (n = 8) was 30.1% (SD = 11.0). The difference between these two groups was statistically significant (P<0.001). The mean depth of fibrovascularization in the wrapped group with access holes (n = 4) was 91.5% (SD = 9.8). Compared with the wrapped group without access holes, the difference was statistically significant (P<0.001). The difference in the mean depth of fibrovascularization between the bare group without access holes and the wrapped group with access holes failed to reach statistical significance (P = 0.18). CONCLUSIONS: On the basis of this preliminary study, we conclude that whereas scleral wrapping does significantly slow the rate of fibrovascular ingrowth, the concomitant placement of access holes greatly improves the rate of fibrovascularization.

A histologic analysis and three-dimensional reconstruction of the muscle of Riolan.

PURPOSE: To describe the anatomic and histologic relations of the muscle of Riolan in the eyelid margin. METHODS: Serial microscopic sections of the eyelid were prepared, digitally scanned, and then reconstructed with computer software to create a 3-dimensional profile of this muscle group in two planes. RESULTS: The muscle of Riolan is a distinct subdivision of striated muscle that is separate from the pretarsal orbicularis muscle. In parasagittal eyelid sections, the muscle appears to be composed of two separate bundles, the pars ciliaris, located anterior to the tarsal plate, and a second smaller bundle, the pars subtarsalis, located posterior to the orifices of the meibomian glands. Coronal sections, however, demonstrate numerous muscle fibers that traverse the tarsus, connecting the two muscle groups that we describe for the first time as the pars fascicularis. CONCLUSIONS: The three muscle subdivisions are therefore physically joined together and appear to act as a single functional entity that should be collectively referred to as the muscle of Riolan.