It is becoming widely accepted that volume changes in the skin and soft tissue contribute greatly to age-related facial reshaping. A significant contribution to these volume changes is the loss of craniofacial skeletal support to the overlying soft tissue. Gravity, once considered the major culprit in facial aging, is now recognized to determine the direction, rather than the extent, of tissue deflation. Although the sequence of events observed in aging is somewhat predictable, its pace among individuals is variable and may be influenced by both intrinsic (e.g., gender, genetics) and extrinsic (e.g., photoaging, smoking, stress) factors. Changes in different tissue layers within a single individual do not occur independently, but interdependently; changes in one tissue within an individual may influence subsequent changes in other tissues. Midfacial soft tissue descent has been observed in response to decreased craniofacial support in both congenital craniofacial hypoplasia and following trauma, leading to a hypothesis that the loss of underlying bony support for any reason, including aging, leads to soft tissue descent in the face. As craniofacial support (the "table") decreases, it leaves less surface area for the outer soft tissue envelope (the "tablecloth") causing it to fold or sag. Replacing this deep support with craniofacial implants has been shown to reposition the overlying soft tissue. Following a brief review of the current literature on aging changes in the skin, soft tissue, and bone; the authors describe their experience with the use of poly-L-lactic acid (PLLA), both as a soft tissue volumizer and as an injectable craniofacial implant in a supraperiosteal location to address both soft tissue volume loss and loss of craniofacial support. In the cases presented, the most striking result noted was the ability to restore a youthful proportion to the perioral area, which had not been achieved previously with soft tissue treatment alone.
[Show abstract][Hide abstract] ABSTRACT: The demand for evidence-based cosmetic treatments against visible signs of skin aging is growing. Nonsurgical procedures in particular are becoming more and more popular. Although until recently the primary aim in cosmetic dermatology was softening of facial lines and wrinkles, replacement of volume loss and facial contouring is now rapidly catching up. However, modern cosmetic dermatology takes into consideration all three key areas of skin aging ("3-D" approach): (1) wrinkles and lines, (2), loss of volume and contour, and (3), skin surface and texture impairment. A "holistic" approach accessing the entire face, and combining different treatment modalities, achieves best aesthetic results. This article presents minimal-invasive treatment modalities to address all three key areas of facial skin aging. In addition novel treatment modalities and combinations are discussed. Overall aesthetic results are now aimed to be more "natural" appearing, achieving a harmonious look, and should include evaluation and treatment of extra-facial, exposed skin such as the neck, décolletage, and hands.
[Show abstract][Hide abstract] ABSTRACT: Objective: To assess the clinical outcomes of triamcinolone acetonide spray for steroid-responsive dermatoses using investigator and patient global assessment scores and evaluate patient satisfaction. Design: This open-label, single-center, noncomparator study enrolled 42 patients (aged 18 years or older) with dermatoses. Patients were instructed to use triamcinolone acetonide spray 1 to 4 times daily, depending on investigator instructions, for up to 28 days. Measurements: Investigators and patients scored the overall severity of dermatoses based on a global assessment scale. Investigators also rated signs and symptoms of dermatoses and evaluated clinical outcomes based on an improvement assessment scale. Patient satisfaction with treatment was assessed at the end of treatment or at Day 28 using a questionnaire. Patients were evaluated on Days 7, 14, 21, and 28. Complete clearing of dermatoses warranted early discontinuation from the study. Results: Triamcinolone acetonide spray effectively improved dermatoses scores, clinical outcomes, and signs and symptoms of dermatoses. More than 80 percent of patients entered the study with moderate or severe dermatoses. Within 14 days, none had severe dermatoses, and by 28 days, 64 percent of patients were completely clear or almost clear. From the patient perspective, 51.3 percent experienced improvement in only three days, and 84.6 percent experienced improvement in seven days. An overwhelming number of patients (95%) preferred triamcinolone acetonide spray over creams and ointments, and more than half experienced a cooling effect upon contact with the spray. Conclusion: Triamcinolone acetonide spray is an effective topical corticosteroid that should be considered for patients with steroid-responsive dermatoses of all ranges of severity.
Journal of Clinical and Aesthetic Dermatology 05/2010; 3(5):27-31.
[Show abstract][Hide abstract] ABSTRACT: Nonsurgical methods represent the majority of cosmetic procedures performed in the United States and include the use of toxins and injectable medical devices for soft-tissue augmentation. In some cases, both nonsurgical and surgical modalities can be used synergistically for optimal facial rejuvenation. Aesthetic surgical procedures remove and reposition lax or sagging skin and tighten and/or resuspend facial musculature. Injectable medical devices can enhance the aesthetic effect of cosmetic surgery by replacing lost volume and restoring the three-dimensional appearance of the face while maintaining natural facial contours. Soft-tissue augmentation can also provide additional support for the skin, correcting natural variations in facial symmetry. This article provides a descriptive review of the age-related facial changes and suggests a method for the use of three-dimensional volumetric augmentation for soft-tissue facial rejuvenation. Age-related changes in skin elasticity, fat distribution, and facial contours require a three-dimensional treatment approach that addresses the pathophysiology of chronological aging. Volume replacement restores the youthful appearance of the face in patients opting for nonsurgical rejuvenation and complements surgical approaches as well. Optimal three-dimensional soft-tissue augmentation can be achieved using a combination of aesthetic surgery and injectable medical devices, such as collagen, hyaluronic acid, calcium hydroxylapatite, and injectable poly-L-lactic acid to improve facial volume changes and contour irregularities. Injectable medical devices replace lost volume and restore facial convexity, reestablishing the bloom of youth.
Journal of Clinical and Aesthetic Dermatology 08/2010; 3(8):27-33.
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