Improvement of Facial Skin Laxity by a Combined Technique With Hyaluronic Acid and Calcium Hydroxylapatite Fillers: A Clinical and Ultrasonography Analysis.

BACKGROUND: Facial aging involves skeletal changes, loss of volume in the fat compartment, and skin component changes. The current objective of cosmetic facial filling is to reestablish the overall aspect that was lost during the aging process. Hyaluronic acid (HA) and calcium hydroxyapatite (CaHA) fillers are indicated for facial rejuvenation, and these agents promote dissimilar effects regarding volume restoration and dermal biostimulation. OBJECTIVE: This study aimed to assess clinical and ultrasonographic improvements in facial skin laxity using a technique that combines the injection of HA and CaHA. METHODS: A 120-day follow-up, quasi-experimental study was conducted based on the enrollment of fifteen women (36–47 years old) with mild face flaccidity scores who underwent subcutaneous injection of up to 3 mL of HA (zygomatic-malar region, pyriform aperture, temporal region, and jaw) followed by 3 mL of 1:1 diluted CaHA using a fan technique (temporal, zygomatic-malar, and jaw regions). OBJECTIVE: Adverse effects were registered, and the monthly assessed outcomes included clinical improvement, satisfaction, and high-frequency ultrasonography (dermal thickness) parameters. RESULTS: At 120 days of follow-up, clinical assessment by blinded physicians yielded six (40%) very improved patients and nine (60%) exceptionally improved patients. All the participants were highly satisfied with the results and reported exceptional improvement. Dermal thickness increased 11.1% (8.8–13.4%), and augmented dermal homogeneity was evidenced by ultrasonography. Local adverse effects were mild and transient. CONCLUSION: In conclusion, the combined technique with HA and CaHA fillers was well-tolerated and yielded high satisfaction and safe improve in facial skin laxity and dermal thickness in women with mild midface aging. J Drugs Dermatol. 2022;21(1): 102-106. doi:10.36849/JDD.633.

Septal Ulcer After Nasal Filling with Hyaluronic Acid.

Nonsurgical rhinoplasty is a good treatment choice when surgery is not a viable option. However, serious complications, including blindness or cerebral ischemia, can occur given this area is one of external and internal carotid anastomosis. Here, we describe a case of a patient with a septum ulcer secondary to local ischemia postnasal fillling with hyaluronic acid without skin lesion. Due to the rarity of the condition, her diagnosis was made late, but she was treated with hyaluronidase and showed total resolution.

Analysis of the Columellar-Labial Angle in Perioral Aging.

BACKGROUND: The young face presents a convex and rounded aspect; with aging, this changes to a more concave and flattened aspect, with the angles of the face undergoing changes through soft tissue repositioning and bone remodeling. The columellar-labial angle is one of the features that change. OBJECTIVES: The objective of the present study was to analyze the columellar-labial angle at different stages of adult life and assess its contribution to facial changes during aging. METHODS: We analyzed a database (December 2017-March 2018) of 722 female patients, aged 21 to 88 years, and obtained anthropometric measurements of the columellar-labial angle with a Canfield Vectra 3D image analysis system. Our database originates from a private clinic where all patients were registered and photographed. RESULTS: Our analysis showed a decrease in the columellar-labial angle, mainly observed from patients aged 60 years and older. This decrease can be explained by the absorption of body structures that occurs during aging. CONCLUSIONS: The columellar-labial angle decreases with age, and this finding may provide a better understanding of the transformation that occurs with aging. Obtaining a clearer view of the changes that occur in the face will improve treatments for facial rejuvenation, either conservative or surgical, and provide a basis for future studies and knowledge expansion.

Definition of the Mandibular Angle Using Botulinum Toxin Type A: A New Technique for the Improvement of Mandibular Contour and Definition.

While the injection of botulinum toxin type A (BoNTA) in the neck area, for face contouring through the blockade of the platysmal bundles, and in the mandibular body line has previously been explored, reports of its application for the demarcation of the mandibular angle are more limited. This article described a new technique of BoNTA injection in the mandibular angle for the improvement of contour and definition. At roughly 15 days after application in 30 patients, better visualization of the mandibular angle and its contours was evident and, consequently, smoothing of the appearance of sagging around the mandible with no adverse effects was noted. Further investigation of this technique is warranted.

Delayed-type Necrosis after Soft-tissue Augmentation with Hyaluronic Acid.

The growing use of dermal fillers, specifically the use of hyaluronic acid, can be explained by their effectiveness and versatility as well as their favorable safety profiles. Nevertheless, early and late complications with varying levels of severity may occur. The incidence of complications is low and the majority of adverse events are mild (edema, erythema, and local ecchymosis) and of limited duration. However, more severe events, such as ischemia and necrosis, may occur. The symptoms of ischemia can occur immediately after the injection or several hours after the procedure. Here, the authors report three cases of necrosis after hyaluronic acid injection with the first symptoms presenting only several hours after the procedure. The patients were treated immediately after the diagnosis. The aim of this review is to communicate the possibility of the delayed-type presentation of necrosis, present the signs and symptoms that lead to early diagnosis, and review the treatment possibilities of this severe complication.