Influence of the Topographic Vascular Distribution of the Face on Dermal Filler Accidents.

OBJECTIVE: Dermal fillers are an important tool in the field of aesthetic dermatology. Fillers are relatively noninvasive and easy to use but are not free of secondary complications. The main complications are vascular and are due to either the compression of an artery or the direct introduction of the product into the arterial lumen. The aim of this study is to provide an overview of the vascular territories of the face to avoid many possible complications when using facial fillings. Anatomical localization of the main arterial supply to the face has been described to assess the risk of vascular injury. METHODS: The authors dissected 17 hemifaces of embalmed adult cadavers that had previously been injected, through the common carotid artery, with latex containing a red dye. RESULTS: A topographic distribution was generated by facial regions following a clinical approach from where the facial fillings were placed and related to the pathways of the arteries. Following these criteria, we established 8 topographic regions (I-VIII) that indicate the main vascular problems of each of these regions. Detailed anatomical localizations of the main arteries in these topographic regions of the face and their relationships are described. CONCLUSIONS: The highest index of vascular lesions and especially visual alterations occurred for fillings of the upper third of the face. To prevent and avoid this type of lesion, it is advisable to avoid, as much as possible, treatments with filling materials in the upper third of the face, mainly including the glabellar and nasal region (III) and supraorbital region (VIII).

Are combined same-day treatments the future for photorejuvenation? Review of the literature on combined treatments with lasers, intense pulsed light, radiofrequency, botulinum toxin, and fillers for rejuvenation.

BACKGROUND: Skin rejuvenation requires a treatment combination including lasers, intense pulsed light (IPL), radiofrequency, botulinum toxin (BT) and fillers. A combined approach is considered optimum but usually same-day combined treatments are avoid and lasers are performed prior to filler or toxin injections owing to the concern that the light may inactivate or degrade them. OBJECTIVE: To review the literature on the use of combination treatments with radiofrequency, IPL, non ablative and ablative lasers plus fillers or BT. RESULTS: review of the literature identified 15 studies of combination treatments: three of them on animal models and 12 were clinical studies. Seven studies contained combined light system treatments with fillers and eight studies combined physical therapies with botulinum toxin injection. In all of them treatments were used as standard protocols. Six studies documented no histological changes in fillers injected after applying radiofrequency, IPL or laser treatments and one studied documented improvement in collagen after IPL treatment and toxin injection. These studies reported clinical improvement in various features of photodamaged skin, no increase of adverse effects and neither decrease on efficacy of substances injected. CONCLUSIONS: review of the literature demonstrates safety of same day combined treatments for rejuvenation, which improve clinical results, are more comfortable for patients have no loss of efficacy or other apparent adverse effect.

Plasma rico en plaquetas: fundamentos biológicos y aplicaciones en cirugía maxilofacial y estética facial / Platelet-rich plasma: biology and applications in maxillofacial surgery and facial aesthetics

Esta revisión presenta el uso del preparado de plasma rico en plaquetas (PRP) como una herramienta potenciadora de ciertas características histológicas de los tejidos conformados por células con receptores para los factores de crecimiento plaquetarios. Se ha realizado una revisión sobre el plasma rico en plaquetas de la literatura publicada en PubMed. Se describen los fundamentos biológicos del PRP a nivel celular, la técnica de obtención, y sus usos clínicos en la actualidad(AU)

This review shows platelet-rich-plasma (PRP) as an enhancer of the histological characteristics of the tissues with platelet-derived growth factor receptors. A review has been made of the literature on the platelet-rich plasma published in PubMed. The article describes the cellular biology of PRP, the technique for obtaining it, and its clinical applications(AU)

Lipoescultura facial: técnica quirúrgica y revisión bibliográfica / Facial liposculpture: surgical technique and literature review

Esta revisión presenta la infiltración de grasa autóloga como un procedimiento de gran utilidad para el relleno de las partes blandas faciales con objetivos estéticos o reconstructivos. Se ha realizado una revisión sobre los procedimientos de lipoescultura de la literatura publicada en PubMed. Se describen la técnica de Coleman, la técnica subdérmica, y la infiltración intramuscular, así como sus principales modificaciones, y los agentes estudiados y usados para incrementar la tasa de mantenimiento del injerto graso(AU)

This review shows that autologous fat grafting is useful for filling the soft tissues of the face for cosmetic and reconstructive purposes. The literature on liposculpture techniques published on PubMed was reviewed. The Coleman technique, subdermal technique, and intramuscular infiltration are described, in addition to their primary modifications, and the agents used to improve fat graft maintenance were studied(AU)

Influence of platelet-rich plasma on the histologic characteristics of the autologous fat graft to the upper lip of rabbits.

BACKGROUND: This study evaluated the influence of platelet-rich plasma (PRP) on the histologic characteristics of autologous fat grafts to the upper lip of rabbits. METHODS: Nine New Zealand white rabbits were used. Eight of the rabbits underwent fat harvest from the groin fat pads using a modified Coleman technique. One side of the upper lip was infiltrated with autologous fat and the other side with fat and PRP. Four of the infiltrated rabbits were killed 8 weeks after the lip augmentation, and the remaining four infiltrated rabbits plus one control case were killed 12 weeks after the procedure. Coronal sections of both upper lips were analyzed microscopically to evaluate the quality of the fat graft, the inflammatory reaction, the presence of oil cysts, the degree of fibrosis, and the neovascularization. RESULTS: The infiltration of adipose tissue plus PRP presented less inflammatory reaction (p < 0.05) and fewer oil cysts (p < 0.05) than the infiltration of adipose tissue without PRP. CONCLUSIONS: The infiltration of fat tissue plus PRP generates a lower inflammatory reaction and less formation of oil cysts than the infiltration of isolated fat. Platelet-rich plasma increases the maintenance of the transplanted fat cells.