Nonsurgical rhinoplasty using dermal fillers.

With the advent of newer injectables with less immunogenicity and greater longevity, nonsurgical rhinoplasty has become a viable alternative to surgery. An understanding of the surgical anatomy of the nose, particularly in a postrhinoplasty patient, affords the physician injector the opportunity to better plan the injectable treatment. This article outlines the evolution of nonsurgical rhinoplasty and identifies properties to consider when selecting which dermal filler to use. It includes a description of the types of nasal deformities that can be treated with injectables, as well as the role of nonsurgical rhinoplasty in a comprehensive regimen for correction of nasal deformities.

Calcium hydroxylapatite (Radiesse) for correction of the mid- and lower face: consensus recommendations.

Restoring volume in the middle and lower portions of the face is becoming an indispensable component of modern facial rejuvenation. Radiesse (BioForm Medical, San Mateo, Calif.) is an injectable filler material composed of synthetic calcium hydroxylapatite microspheres (30 percent) suspended in an aqueous carrier gel (70 percent). At present, Radiesse is indicated in the United States for correction of moderate to deep nasolabial folds and for correction of the signs of facial fat loss (lipoatrophy) in people with human immunodeficiency virus. Its off-label use in other facial aesthetic indications is widely reported in the literature. The ability of Radiesse to provide immediate and durable effects has fueled interest in its use for expanded aesthetic applications, particularly in the middle and lower face. The authors' consensus panel, consisting of a cross-section of experts in plastic surgery, facial plastic surgery, and dermatology, was convened to review the scientific literature and compare clinical experiences regarding the use of calcium hydroxylapatite. This report describes the characteristic effects of aging in the middle and lower face and reviews the composition of calcium hydroxylapatite, its safety and durability, and its appropriate use in a variety of facial applications, including nasolabial folds, correction of human immunodeficiency virus-associated lipoatrophy, augmentation of the malar, submalar, and zygomatic regions, and correction of oral commissure defects, marionette lines, and prejowl sulcus. Recommendations for Radiesse use in each area, including anesthesia, and injection techniques are provided. Measures for enhancing patient comfort, anticipating and minimizing potential complications, and optimizing aesthetic results are also discussed.

Submentoplasty as an isolated rejuvenative procedure for the neck.

As facial cosmetic surgery has become more popular, patients' desires for minimally invasive surgery and brief healing times have increased. Submentoplasty has been described as an isolated procedure, but it is more commonly incorporated into a face-lift for rejuvenation of the cheeks, jowls, and neck. However, many patients considering submentoplasty do not need or desire face-lift surgery. Submentoplasty, in combination with liposuction, wide undermining, and platysma plications, has proven to be an effective way to rejuvenate the neck by restoring the cervicomental angle without large-incision surgery such as a face-lift. Presented here is a technique for performing submentoplasty developed over experience with more than 100 patients of widely varying ages. Recovery time is shorter than with standard face-lift techniques, and complications have been few. Submentoplasty is a viable option for patients who desire rejuvenation of the neck as a solo procedure or in combination with other facial cosmetic surgery.

Achieving superior resurfacing results with the erbium:YAG laser.

Laser skin resurfacing has become increasingly popular. The carbon dioxide (CO2) laser seemingly remains the most commonly used laser modality for skin resurfacing. Many surgeons still promote the CO2 laser as being superior to the erbium:YAG laser, particularly for individuals with deeper lines. However, further experience with the erbium:YAG laser has shown the converse to be true. The erbium:YAG laser can be used to treat deep rhytids successfully, many times achieving results superior to those seen with the CO2 laser, particularly in the perioral region. The theory behind this relates to the 10-fold greater absorption of the erbium:YAG wavelength by water. The greater absorption produces more efficient vaporization, even at low fluences, with greatly reduced adjacent thermal injury. Ablation can be carried to deeper levels of the dermis than is consistently safe with the CO2 laser. Deliverance of total fluences in the range of 100 to 150 J/cm2, or more, produces a marked reduction or elimination of deeper rhytids. Clinically, experience with more than 300 cases indicates collagen remodeling occurs to a similar degree with the erbium:YAG laser as with the CO2 laser, as improvement in rhytids can be seen for 2 to 3 months after surgery. It would appear that superior results can be obtained without the "heat effect" of the CO2 laser. The erbium:YAG laser is capable of achieving superior resurfacing results, while offering many advantages to the patient, eg, reduced anesthetic requirements, shorter healing time, reduced erythema, less risk of pigmentary change, and more flexibility for resurfacing the skin off of the face.