Facial aesthetic minimally invasive procedure: More than just vanity, a social-psychological approach.

BACKGROUND: Due to the great importance of the face in social interaction, minimally invasive treatments can-besides their ability to rejuvenate and enhance beauty-also change the way facial impressions of a person are perceived. In recent literature, three main character traits (attractiveness, trustworthiness, and competence) and subdomains essential for facial perception were described. OBJECTIVE: To investigate whether minimally invasive procedures truly influence different character traits when evaluated by independent, objective observers. METHODS: Photographs of n = 34 female faces before and after treatment with injectable fillers and botulinum toxin were rated by 393 individuals without aesthetic background with regards to different character traits on a 7-point Likert scale. Tests for dimensionality were performed, and composite scores of the impressions underlying each of the three dimensions were created and compared using within-subjects t tests. RESULTS: Treatments statistically significantly improved the overarching character trait domains attractiveness, trustworthiness, and competence in posttreatment photographs compared with pretreatment. Posttreatment ratings of the respective subdomains also showed a statistically significant difference compared with pretreatment photographs, with the exception of the subdomain dominance which failed to reach statistical significance. CONCLUSION: Impressions of facial attractiveness, trustworthiness, and competence can be improved by injectables while the naturalness of the face is left intact. An implication is that the improvement of traits highly relevant to social interaction will accommodate the patient's desires for beautification and rejuvenation.

Temporary hair loss after injection of hyaluronic acid filler.

BACKGROUND: Compromised blood flow after filler injection is generally thought to result from intra-arterial obstruction. AIMS: To test this hypothesis. PATIENT: A case presented with the clinical picture of reduced arterial blood flow after hyaluronic acid filler injection in the temporal region and subsequent hair loss. METHOD: Clinical and ultrasound (US) assessments as well as ultrasound guided hyaluronidase injection were performed. RESULT: Blood flow was restored and hair loss proved to be temporary. CONCLUSION: There are many arguments to conclude that the problem did not result from intra-arterial occlusion, but rather from outside compression of the artery.

A Prospective, Open-Label, Observational, Postmarket Study Evaluating VYC-17.5L for the Correction of Moderate to Severe Nasolabial Folds Over 12 Months.

BACKGROUND: VYC-17.5L (17.5 mg/mL hyaluronic acid, 0.3% lidocaine) is a dermal filler intended for deep dermis injection for the treatment of skin depressions. OBJECTIVE: To evaluate 12-month effectiveness and safety of VYC-17.5L for the treatment of moderate/severe nasolabial folds (NLFs). METHODS: Subjects ≥18 years old with moderate/severe NLFs were recruited (N = 70). Injected volume was aimed at achieving optimum correction; top-up treatment was given at 2 weeks if needed. The primary endpoint was investigator-assessed change in NLF severity over 12 months using the validated photonumeric NLF Severity Scale. Secondary endpoints included investigator- and subject-assessed satisfaction and safety. Adverse events judged to be more severe or prolonged than routinely observed were recorded. RESULTS: Sixty-five subjects completed study requirements. Mean volume injected was 3.0 ± 1.0 mL for both NLFs combined. Significant improvement was maintained in investigator-assessed NLF severity at 12 months, and investigators and subjects reported high satisfaction with VYC-17.5L throughout the study. Two unexpected adverse events were reported: (1) redness, swelling, and decreased sensitivity (resolved after 4 days) and (2) swelling (resolved after 48 hours); neither event was serious or life threatening. CONCLUSION: VYC-17.5L is effective and well tolerated for the treatment of moderate to severe NLFs for 1 year.

A prospective, observational study of the volumizing effect of open-label aesthetic use of Juvéderm® VOLUMA® with Lidocaine in mid-face area.

INTRODUCTION: Juvéderm® VOLUMA® with Lidocaine is a hyaluronic acid (HA)-based injectable gel that is used to restore the volume of the face. This study was designed to assess the real-world effectiveness of this HA gel over 21 days when used for mid-face augmentation in normal, healthy subjects desiring aesthetic improvement. MATERIALS AND METHODS: This prospective, observational, single-arm, open-label post-marketing study enrolled 115 healthy subjects, from five European centers. The primary objective was to evaluate subject-reported satisfaction and experience of the treatment across a range of doses of Juvéderm® VOLUMA® with Lidocaine (1 ml/2 ml/combination), immediately after injection and 21 days post-treatment. RESULTS: Subject satisfaction questionnaire (SSQ) scores of Delighted or Happy were given by 95.6% of subjects immediately after injection, and by 93.7% of subjects at Day 21. Overall, subject and investigator satisfaction with cosmetic effect and smoothness was very positive. Pain was minimal; most subjects experienced only minor degrees of discomfort, and this was mainly related to the procedure itself. CONCLUSIONS: Juvéderm® VOLUMA® with Lidocaine was well accepted by both subjects and investigators, associated with high levels of satisfaction, was considered smooth and easy to use, and was well tolerated when used for the treatment of mid-face area volume enhancement.

Use of ultrasound to provide overall information on facial fillers and surrounding tissue.

BACKGROUND: Information on fillers and their behavior over time in the different layers of tissue is limited. Ultrasound may be used to visualize these fillers and their surrounding tissue to broaden knowledge. OBJECTIVE: To evaluate the use of ultrasound as a diagnostic and research tool to obtain information on facial fillers and their behavior in human tissue. METHODS AND MATERIALS: Patients with a history of facial filler treatment were examined using ultrasound in an outpatient setting. RESULTS: Seventy-two patients were examined. Hydrophilic fillers were echo visible, whereas tissue-generating fillers, permanent and resorbable, could be detected according to their tissue-generating reaction within the tissue. Filler characteristics such as longevity and reaction within the tissue and complications such as migration and granulomas could be visualized. CONCLUSION: The use of ultrasound may provide information to broaden our knowledge of facial fillers and may improve the performance and safety of filler treatments. The authors have indicated no significant interest with commercial supporters.

Complications after treatment with polyalkylimide.

BACKGROUND: Polyalkylimide is a nonresorbable, biocompatible polymeric filler that has been used for several years to treat soft tissue deficits. The literature has shown a minor complication rate. We noticed that complications typically appear several years after injection. OBJECTIVE: To evaluate the complications reported after treatment with polyalkylimide. METHODS AND MATERIALS: We describe a retrospective evaluation, reported by members and candidate members of the Dutch Society of Cosmetic Medicine, of complications after use of polyalkylimide. RESULTS: In total, 3,196 patients were treated, and 4,738 treatments were performed, from which 154 complications (patient complication rate 4.8%, treatment complication rate 3.3%) were reported. The most common complication was inflammation; other complications were hardening, migration, and accumulation of the product. In some patients, skin biopsy followed by histologic examination was performed. CONCLUSION: Treatments with polyalkylimide have been reported to give rise to complications years after treatment. Even though the study described is a retrospective evaluation, we consider an overall complication rate of 4.8%, the severity of the complications, and the difficulty in treating them too high a risk for a cosmetic treatment. The Dutch Society of Cosmetic Medicine advises against the use of polyalkylimide.