Techniques for the Optimization of Facial and Nonfacial Volumization with Injectable Poly-L-lactic Acid
ABSTRACT With the recognition of the key role of volume loss in the facial aging process, injectable dermal fillers and volumizers have become increasingly important treatment options for recontouring and rejuvenating the aging face. While replacement fillers effectively correct individual lines and wrinkles, volumizing agents that replace collagen provide a longer-lasting, volume-based alternative. Poly-L: -lactic acid (PLLA) has been shown to increase dermal thickness and volume for up to 2 years and beyond. Although early clinical use of this agent in patients with HIV-associated facial lipoatrophy was associated with a significant rate of nodule or papule formation, subsequent experience has helped define the proper reconstitution volumes and injection techniques for optimizing results and minimizing nodule/papule formation. While injectable PLLA has been used successfully for rejuvenation of most facial areas, increasing experience suggests that it is a versatile agent capable of providing aesthetic enhancement in multiple areas of the body, including the dorsum of the hands, the décolleté, the neck, the buttocks, the medial ankles, and acne scars. Although the current published experience in these areas is limited, further studies and clinical use of injectable PLLA will clarify the potential of this agent as a minimally invasive alternative and/or adjunct to surgery for restoring volume loss in multiple anatomic areas. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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ABSTRACT: Abstract Background: Poly-L-lactic acid (PLLA) is a biocompatible and biodegradable polymer device indicated for correction of facial contour deficiencies, with a gradual onset of effect that is maintained for up to 25 months. PLLA is currently widely used to correct age- related facial volume deficits in Asians. Objectives: We sought to evaluate the safety and long term efficacy of PLLA on treating age-related sunken cheeks in Asians. Patients and Methods: This was a retrospective, single-center study of 11 subjects with age-related sunken cheeks who were treated with 3 sessions of PLLA, and then followed-up for 24 months. A questionnaire was used to evaluate patient satisfaction and the incidence of adverse reactions. Results: Seven female and four male subjects with mild to moderate age-related sunken cheeks were included in the study. The mean age of the subjects was 41.5 (range 25-50). Overall, 90.9% of patients replied that they were either satisfied or very satisfied with the results at 24 months follow-up; 91% of patients rated the volume correction to be good or excellent. Despite the high incidence of bruising (63.7%) and post-treatment nodules (27.3%), all subjects (100%) were willing to undergo the procedure again. Conclusion: PLLA has shown long-lasting effects in reversing age-related sunken cheeks in Asians, with high patient satisfaction. Special consideration should be made to minimize the side effects.Journal of Cosmetic and Laser Therapy 04/2014; 16(4). DOI:10.3109/14764172.2014.910084 · 1.11 Impact Factor
Article: Are Nurse Injectors the New Norm?[Show abstract] [Hide abstract]
ABSTRACT: Purpose As Botox®/filler use has increased in recent years, a growing number of nonaesthetic health professionals have emerged to perform these procedures. Since studies have shown that patients identify training as the most important factor in considering these procedures, this study seeks to summarize the perspective of plastic surgeons regarding these paradigm shifts. Methods In the summer of 2013, an eight-question survey was sent to members of ISAPS, ASAPS, and ASPS (approximately 26,113 plastic surgeons globally). Two questions assessed practice location and membership affiliation and six questions assessed various healthcare practitioners’ capability to administer Botox, fillers, and vaccines (control). Healthcare practitioners included plastic surgeons and dermatologists, gynecologists, dentists, nurses in plastic surgery and dermatology, or nurses in other fields. Results On three e-mail notifications, 14,184 plastic surgeons opened the survey and 882 responded: 36.6 % from North America, 29.1 % from Europe, 12.9 % from South America, 10.1 % from Asia, 4.5 % from the Middle East, 3.4 % from Australia, 1.9 % from Africa, and 1.6 % from Central America. Seventy-seven percent believed nurses were not as capable as plastic surgeons in administering Botox; 81 % felt the same for fillers. Conversely, 84 % agreed that nurses were as capable as plastic surgeons in administering vaccines. Plastic surgeons ranked nurses in other fields (48 %) as most capable in administering vaccines, then plastic surgeons (42 %), nurses of plastic surgeons (9 %), gynecologists (1 %), and dentists (Aesthetic Plastic Surgery 06/2014; 38(5). DOI:10.1007/s00266-014-0367-6 · 1.19 Impact Factor
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ABSTRACT: In nonsurgical facial rejuvenation, autologous fat and dermal fillers have become an effective method to achieve symmetry and balance of the midface. Nonsurgical techniques that target the dynamic anatomical relationships existing in the midface can improve rejuvenation outcomes in this commonly augmented region. The authors described techniques for fat compartment and potential space volumization of the midface via a standardized and reproducible technique. They placed emphasis on access to anatomical spaces and compartments within the midface. In 11 hemifacial cadavers, hyaluronic acid filler homogenized with red dye was injected via 3 midfacial ports that were anatomically designed to access the superficial fat compartments, deep fat compartments, or traverse the prezygomatic space. Specimens were dissected in a layered fashion to analyze relationships between the injected filler and midfacial anatomy. We have described 4 site-specific procedural techniques and created a video containing anatomical renderings of each targeted viaduct accompanied by technique demonstrations. We found that Beut techniques 1 through 4 can be performed through 3 midfacial viaducts. Port placement 1.5 cm inferolateral to the alar base in the nasolabial crease created a medial midface viaduct, suitable for access to the deep medial cheek fat, medial superficial fat compartment, premaxillary space, and adjacent superior nasolabial cheek compartment. Port placement within the nasojugal groove provided a middle midface viaduct to access the middle superficial fat compartment and medial suborbicularis oculi fat (SOOF). Port placement 1.5 cm inferolateral to the lateral canthus created a lateral midface viaduct to approach the pre-periosteal fat, prezygomatic space, lateral SOOF, and infraorbital fat compartment. Our findings indicate that anterior and lateral cheek projection, V-deformity correction, rhytid softening, and tear trough effacement can be achieved through the midfacial viaducts. Systematic assessment and site-specific nonsurgical rejuvenation of the midface may lead to increased safety, accuracy, and technique reproducibility in this commonly injected region. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: firstname.lastname@example.org.Aesthetic surgery journal / the American Society for Aesthetic Plastic surgery 02/2015; 35(2):121-34. DOI:10.1093/asj/sju073 · 2.03 Impact Factor