Quantitative assessment of the longevity of poly-L-lactic acid as a volumizing filler using 3-dimensional photography.

OBJECTIVE: To demonstrate the efficacy and longevity of injectable poly-L-lactic acid as a volumizing injectable in the midface region quantitatively using 3-dimensional (3-D) imaging. DESIGN, SETTING, AND PARTICIPANTS: Prospective study assessing changes in midfacial volume in 15 women aged between 40 and 60 years using a 3-D imaging system at 12, 24, 36, and 48 weeks after 3 treatments with poly-L-lactic acid. Three-dimensional imaging was acquired using the 3-D camera and software. INTERVENTION: Patients were treated with poly-L-lactic acid. The first 2 treatments were 6 weeks apart. The third treatment was performed 12 weeks after the second treatment. MAIN OUTCOMES AND MEASURES: Changes in midfacial volume following 3 treatments of poly-L-lactic acid were measured quantitatively using the 3-D imaging system. A paired t test was used to analyze the difference between pretreatment and posttreatment values at each study time point. RESULTS: Of the 15 patients, 1 only received 2 treatments and was therefore excluded from the statistical analysis. There was a statistically significant increase in mean midfacial volume at all study time points, 12 weeks (mean [range], 7.2 [1.6-20.7] mL; P < .001), 24 weeks (mean [range], 7.2 [1.9-19.4] mL; P < .001), 36 weeks (mean [range], 4.6 [1.1-9.2] mL; P = .002), and 48 weeks (mean [range], 4.1 [0.8-6.4] mL; P < .001), compared with pretreatment volume. There was no significant change in volume between each of the follow-up time points. CONCLUSIONS AND RELEVANCE: Our prospective investigation quantitatively demonstrates the efficacy of poly-L-lactic acid as a long-acting volumizing agent, with an increase in midfacial volume from baseline sustained at least 1 year after treatment. LEVEL OF EVIDENCE: 2. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01307865.

Complications associated with injectable soft-tissue fillers: a 5-year retrospective review.

IMPORTANCE: Even when administered by experienced hands, injectable soft-tissue fillers can cause various unintended reactions, ranging from minor and self-limited responses to severe complications requiring prompt treatment and close follow-up. OBJECTIVES: To review the complications associated with injectable soft-tissue filler treatments administered in the Williams Rejuva Center during a 5-year period and to discuss their management. DESIGN AND SETTING: Retrospective medical record review in a private practice setting. PARTICIPANTS: Patients receiving injectable soft-tissue fillers and having a treatment-related complication. INTERVENTIONS: Injectable soft-tissue filler treatments. MAIN OUTCOME MEASURES: A retrospective medical record review was conducted of patients undergoing treatment with injectable soft-tissue fillers between January 1, 2007, and December 31, 2011, and identified as having a treatment-related complication. RESULTS: A total of 2089 injectable soft-tissue filler treatments were performed during the study period, including 1047 with hyaluronic acid, 811 with poly-L-lactic acid, and 231 with calcium hydroxylapatite. Fourteen complications were identified. The most common complication was nodule or granuloma formation. Treatment with calcium hydroxylapatite had the highest complication rate. CONCLUSIONS AND RELEVANCE: Complications are rare following treatment with injectable soft-tissue fillers. Nevertheless, it is important to be aware of the spectrum of potential adverse sequelae and to be comfortable with their proper management. LEVEL OF EVIDENCE: 4.

Inflammatory cytokines in allergy and rhinosinusitis.

PURPOSE OF REVIEW: Cytokines are involved in initiating and perpetuating the host immune response to allergens and also modulating the mucosal cellular milieu characteristic of chronic rhinosinusitis. This paper reviews the current state of knowledge regarding the most relevant cytokines in allergy and rhinosinusitis and highlights recent findings in the literature. RECENT FINDINGS: Chronic rhinosinusitis with nasal polyps is characterized by a type 2 T helper cell cytokine polarization, whereas chronic rhinosinusitis without nasal polyps has a type 1 T helper cell cytokine expression pattern. Targeted therapies against specific cytokines such as interleukin-5 have shown promise in treating allergic diseases. Genetic polymorphisms in cytokines and their receptors have been shown to confer susceptibility to asthma and allergy. Transforming growth factor-beta has been found to have proinflammatory and anti-inflammatory effects in the nose and paranasal sinuses and appears to have a role in airway remodeling. SUMMARY: Cytokines drive the immune system's response to allergen exposure and participate in sinonasal mucosal inflammatory conditions. Although the roles of individual cytokines in atopic disease and rhinosinusitis are becoming clearer, future studies will need to build on our knowledge of cytokine functions by focusing on therapeutic approaches to quieting the immune system and dampening the inflammatory cascade.

Otolaryngologists and orbital pseudotumor: a case report.

Orbital pseudotumor (idiopathic orbital inflammation) is the third most common orbital disease, accounting for 5 to 6% of orbital disorders. It often presents in a manner very similar to inflammatory or neoplastic sinus disease. In addition, sinus disease is often a cause of orbital pseudotumor, although the etiology of this entity has yet to be defined. Treatment with steroids is usually successful early on, but long-term treatment-failure and recurrence rates are high. Despite otolaryngologists' intimate knowledge of sinus pathology, we have generally not been heavily involved in researching the causes and treatment of orbital pseudotumors. In this article, we report the case of an affected patient who presented with an orbital mass on radiography. The mass was likely the result of sinus disease in the setting of an untreated orbital floor fracture. We describe the clinical, radiographic, and operative features of this case, and we discuss the otolaryngologist's role in the management of orbital pseudotumors.

Considerations in male aging face consultation: psychologic aspects.

Historically, the male cosmetic surgery patient has been viewed as being highly psychopathologic. Recent studies have refuted this longheld belief. However, when conducting a male aging face consultation, it is important for cosmetic surgeons to perform a focused psychiatric assessment to screen for mentally-ill patients, who may not be good surgical candidates. Included in the spectrum of psychiatric diseases that should be recognized is body dysmorphic disorder, an illness characterized by distortions in body perception, which has a higher prevalence in the cosmetic surgery population. By taking a focused psychiatric history, the cosmetic surgeon can identify patients who have untreated psychiatric pathology and are not psychologically appropriate for surgery. These patients would instead benefit from consultation with a mental health professional.