A light and electron microscopic evaluation of Zyderm collagen and Zyplast implants in aging human facial skin. A pilot study.

Four patients received Zyderm collagen implant (ZCI) or Zyplast implant (ZI) in preauricular and infraauricular regions of facial skin periodically between one and nine months. Both materials were identified microscopically in the mid- to deep dermis at all points of the study and, in 60% to 70% of the injected sites, some material was also present subdermally. A slow, gradual colonization of ZCI by fibroblasts was noted compared with a delayed intense interaction of these cells with ZI. Also, there was some new collagen deposition associated with remodeling of the ZI, while no demonstrable synthetic activity occurred in relationship to ZCI. The results suggest that ZCI and ZI "migrate" deeper and eventually move into the subcutaneous plane. This movement could explain the loss of correction at six to nine months that is noted when this implant is used for age-related changes.

The effect of cadmium on the development of the facial prominences: surface area measurements of day 10-8 a.m. hamster embryos.

The environmental contaminant cadmium (Cd) is a proven teratogenic agent in rodents. In hamsters, it causes craniofacial dysmorphogenesis. The underlying mechanism for this damage is unknown. Early facial development in hamsters occurs during gestation days 9-11 and involves the formation and appropriate fusion of several prominences surrounding the stomodeum. The hypothesis for this study is that the occurrence of Cd-induced facial defects involves a disruption of the normal formation and/or fusion of one or more of the facial prominences. Pregnant hamsters were treated with Cd (2 mg/kg) or water intravenously on gestation day 8 (8 A.M.). On gestation day 10 (8 A.M.) surviving embryos were processed to obtain scanning electron micrographs of the frontal view of the face. Measurements of the surface areas of 15 different portions of the face were obtained using a microcomputer equipped with a digitizer. Both qualitative and quantitative differences in the faces were detected upon comparing the Cd-exposed and control embryos. The surface areas of the prominences measured were significantly smaller in the Cd-exposed embryos. However the sizes of the other regions of the Cd-exposed faces were either little affected (nasal pit areas) or markedly increased (the interval of the face between the medial nasal prominences). Two possible explanations for these data are discussed.

Epithelial-mesenchymal interactions in the development of chick facial primordia and the target of retinoid action.

The development of the chick face involves outgrowth of buds of tissue, accompanied by the differentiation of cartilage and bone in spatially defined patterns. To investigate the role of epithelial-mesenchymal interactions in facial morphogenesis, small fragments of facial tissue have been grafted to host chick wing buds to continue their development in isolation. Fragments of the frontonasal mass give rise to typical upper-beak-like structures: a long central rod of cartilage, the prenasal cartilage and an egg tooth. Meckel's cartilage, characteristic of the lower beak, develops from fragments of the mandible. Removal of the ectoderm prior to grafting leads to truncated development. In fragments of frontonasal mass mesenchyme only a small spur of cartilage differentiates and there is no outgrowth. The mandible is less affected; a rod of cartilage still forms but the amount of outgrowth is reduced. Retinoid treatment of chick embryos specifically affects the development of the upper beak and outgrowth and cartilage differentiation in the frontonasal mass are inhibited. The mandibles, however, are unaffected and develop normally. In order to investigate whether the epithelium or the mesenchyme of the frontonasal mass is the target of retinoid action, recombinations of retinoid-treated and untreated facial tissue have been grafted to host wing buds. Recombinations of retinoid-treated frontonasal mass ectoderm with untreated mesenchyme develop normally whereas recombinations of untreated ectoderm with retinoid-treated mesenchyme lead to truncations. The amount of outgrowth in fragments of mandibular tissue is slightly reduced when either the ectoderm or the mesenchyme has been treated with retinoids. These recombination experiments demonstrate that the mesenchyme of the frontonasal mass is the target of retinoid action. This suggests that retinoids interfere with the reciprocal epithelial-mesenchymal interactions necessary for outgrowth and normal upper beak development.

Acquired craniofacial features associated with chronic phenytoin therapy.

Although the teratogenic effect of phenytoin on the fetus has been well-documented, the effect on postnatal facial structure has not been emphasized. The evolution of such changes is illustrated with serial photographs and case histories of five mentally retarded individuals not known to have diagnoses that could account for these dysmorphic features. The intent of this report is to increase awareness of this serious consequence of phenytoin therapy and to stimulate interest in further studies of the phenomenon. The incidence and prevalence, mechanism of production, genetic predisposition, and critical age for development of this effect in patients treated with phenytoin needs to be determined.

Side effects occurring during administration of epoprostenol (prostacyclin, PGI2), in man.

1 Fifty infusions of epoprostenol (PGI2) were made, usually increasing the infusion rate until adverse effects were encountered. The volunteers were appraised that they might experience headache and facial flushing. 2 Facial flushing, headache, tachycardia and decrease in diastolic blood pressure were seen in almost all subjects. Erythema over the venous infusing site was also encountered in 13 infusions. Less common effects were sudden bradycardia, pallor and sweating--the vagal reflex--(seven times) and chest pain (twice). Other complaints included restlessness, abdominal discomfort, nausea and drowsiness. 3 The literature on side effects reported during PGI2 infusion is reviewed and recommendations are made concerning administration of PGI2.

Temporal fat pad sign during corticosteroid treatment.

Hypercortisolism alters the distribution of body fat, causing truncal obesity, moon facies, buffalo hump, and other localized fatty deposits. In a patient with a mixed collagen vascular disease (overlap syndrome), who received high systemic doses of prednisone, prominent painless bitemporal masses developed in association with moon facies. Punch biopsy specimens of the lesion disclosed normal adipose tisue. This unappreciated feature of hypercortisolism is described, and other clinical manifestations of glucocorticoid excess involving fat tissue are reviewed briefly.

The role of acetaldehyde in mediating reactivity to an acute dose of ethanol among different racial groups.

Physiologic changes after ingestion of alcohol were monitored in Chinese and white volunteers, and absorption rate, acetaldehyde concentration, facial flushing, and heart rate increases were correlated.

Suppression of plasma catecholamines and flushing by clonidine in man.

Administration of the anti-hypertensive agent clonidine as a single (0.5 mg) oral dose or as multiple doses (0.2-0.4 mg/day for 4 days) markedly reduced plasma catecholamines (decrement = 81 +/- 3% and 68 +/- 5%, respectively; X +/- SE, % of basal; both P less than 0.001) in normal male volunteers. Five patients with various metabolic disorders showed similar responses. The absolute decrements in plasma catecholamines correlated significantly with basal catecholamine levels (P less than 0.001). Clonidine-induced decrements in mean arterial blood pressure correlated significantly with decrements in plasma catecholamines (P less than 0.001). The clonidine effect upon catecholamine levels was reversed by phentolamine (clonidine = -68 +/- 5%; clonidine with phentolamine = -1 +/- 16%). The decrements in catecholamines induced by clonidine in normal subjects were associated with increased sensitivity to the pressor effect of infusion of exogenous norepinephrine. In an analogous fashion flushing associated with endogenous adrenergic discharge was blocked by clonidine, whereas that due to exogenous catecholamines was intensified. These data are compatible with data in experimental animals suggesting that clonidine acts at least in part by interaction with a central alpha adrenergic receptor.

Chemexfoliation as an adjunct to facial rejuvenation.

Rhytidectomy and chemexfoliation are complementary procedures. The combination of rhytidectomy and chemexfoliation as a one-stage procedure is advocated for the rejuvenation of the aging face. The advantages of the combined technique are stressed. Recognition of the facial T-zone for application of a stronger solution and occlusive mask is noted. Careful selection of patients and technical details of the procedure are outlined.

Facial receptive fields of trigeminal neurons: increased size following estrogen treatment in female rats.

In order to assess the generality of previous reports of enlarged genital sensory fields following estrogen treatment, facial receptive fields of individual trigeminal ganglion neurons from ovariectomized female rats injected with estrogen were compared with fields from noninjected controls. Mechanoreceptive field boundaries were determined with a series of stimulating probes varying in diameter, and calibrated according to the force delivered at the bending point (Von Frey technique). For each single unit, the threshold receptive field was determined with the smallest stimulus probe capable of reliably activating single unit discharges. Facial receptive fields from estrogen-treated females were significantly larger in area (by a factor of 10) than fields from noninjected controls. Furthermore, the increase in field area was independent of spatial location within the facial region (normally, field size decreases in a proximal-distal direction from the body trunk), and was not affected by cutting the trigeminal nerve root. Receptive field thresholds were also significantly lowered by estrogen treatment. The fact that long-term systemic estrogen treatment influences tactile sensory fields in the facial region of females suggests that this pehnomenon is not peculiar to the genital region normally contacted by the male during mating.

Short-term assessment of 0.1% hydrocortisone 17-butyrate ('Locoid') in the treatment of skin disease.

An assessment was made of the local use of 0.1% hydrocortisone 17-butyrate in the treatment of 15 patients with a variety of skin conditions involving face and neck. Treatment was used on a short-term basis ranging from 3 to 22 days. There was marked clinical improvement of the lesions in 12 patients. The results of this short study are in accord with earlier published work and suggest that this new nonfluorinated steroid has promising potential.