Treating Glabellar Lines With Botulinum Toxin: Does Your Patient Need to Frown Steadily?

BACKGROUND: The variable relationship between the orbicularis supercilii and frontalis muscles may cause side effects with botulin toxin; steadily frowning is the usual recommendation. Eliminating the need to frown until all injections are over might enhance efficacy and lessen the neurotoxicity risks related to muscle exhaustion. OBJECTIVES: The goal of this study was to investigate whether the digital caliper-assessed distances between the medial and lateral corrugator injection sites and the midline differed significantly in patients persistently frowning from patients resting. METHODS: Seventy-six individuals with glabellar wrinkles treated with botulinum toxin in the authors' private practices for glabellar lines voluntarily contributed their retrospective data about the positions of injection sites. The investigators had freely chosen to inject the medial and lateral sections of the corrugator supercilii during persistent maximum frown or at rest. RESULTS: The mean differences in distances between the medial and lateral injection points and the estimated midline were clinically trivial (1.0 ± 1.28 and 1.5 ± 2.53 mm, respectively), although the distances between the relaxed and contracted medial and lateral injection sites exceeded 1.8 and 2.5 mm in 33.9% and 46.4% of patients, respectively. Distance differences, not significant before 40 years old, were statistically significant only for the lateral injections in older patients (on average, 1.9 ± 3.01 mm). CONCLUSIONS: The average distances from the medial and lateral injection points and the midline appear minimally different in patients who frown until all injections are over and, conversely, patients who rest. Persistently frowning might be advisable only in patients older than 40. Facial asymmetries may be a confounding factor.

Satisfaction outcomes for patients and physicians following use of a new hyaluronic acid fillers.

BACKGROUND: The aesthetic appearance of the skin, with the emergence of wrinkles, blemishes, and infraorbital hollowing, can be a cause of social distress and is a process exacerbated by aging. The presence of skin imperfections and aging is partly due to a loss of hyaluronic acid (HA), which normally contributes to a maintain a healthy and voluminous skin. Attempts to restore volume and revert the signs of aging have therefore focused on the use of dermatologic fillers based on HA. AIM: Here, we tested the safety and efficacy of MelHA®-Monophasic Elastic Hyaluronic Acid (Concilium FEEL® filler products) containing HA at different concentrations and injected at different sites according to recommendations. METHODS: Five different physicians assessed 42 patients across five different medical facilities in Italy, where they performed the treatment and assessed the patients after a follow-up visit. Safety and efficacy of the treatment and change in quality of life after treatment were evaluated with two surveys, one directed to medical personnel, and one directed to patients. RESULTS: Our results show that, across all products and personalized treatments, patients', physicians' and "independent photography reviewer" satisfaction was very high and that the treatment show a favorable safety profile. CONCLUSION: These results are promising and suggest the use of Concilium Feel® filler products can contribute to an increased self-esteem and quality of life in aging patients.

Customized lip enhancement for clinical different lip features: An observational study.

BACKGROUND: The request for lip improvement treatments with injectable hyaluronic acid (HA) is increasing. However, as the patient's needs can be extremely different, it is unconceivable to use the same technique/product for clinical different lips to grant customized results. AIMS: To provide a specific treatment approach for clinically different lips based on the Author's clinical experience. PATIENTS/METHODS: Patients belonged to four clinical groups: young lips requiring volume enhancement or a reshaping intervention, and senescent lips requiring rejuvenation or a rebuild intervention. At first visit T0, subjects underwent a pretreatment evaluation and the investigator performed an individual treatment based upon patient's esthetic goals and lip's baseline features. Lip fullness was assessed by the investigator using a Medicis Lip Fullness Scale (MLFS) at first visit (T0) and at 2 weeks (T1). Subjects and investigator answered to the Global Aesthetic Improvement Scale (GAIS) at 2 weeks T1 and at 12 weeks (T2). A photographic evaluation was undertaken at T0 and T2. RESULTS: Only, in the two groups requiring volumization there was 1 grade of improvement in the MLFS (young lips-volume and senescent lips-rebuild). Nonetheless, the performed combination of techniques/products was overall very satisfactory: 80% of the subjects reported a much improved/very much improved outcome in the GAIS, and the same was reported by the investigator in 90% of the subjects. A weak positive correlation was found between MLFS responses and subject's GAIS at T1 in all groups. CONCLUSIONS: This customized treatment approach, consisting in choosing the right gel technology injected in minimum quantities with the right technique, ensures a harmonic result avoiding aberrations and standardizations.