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Emerging Trends With Dermal Fillers
Abstract
With nearly 11.7 million surgical and nonsurgical aesthetic procedures performed in the United States in 2007 and 82% of this total encompassing nonsurgical procedures (), we can clearly see that there is a trend toward less invasive procedures and an expansion of new technologies, medications, and products. Since 1997, ASAPS reports a 754% increase in nonsurgical procedures. Hyaluronic acid (HA) dermal fillers were rated as number 2 of the top five nonsurgical procedures in 2007 (1,448,716 procedures). We can only speculate that there will be another dramatic increase in these numbers in the 2008 statistics and beyond as more dermal fillers become Food and Drug Administration (FDA) approved and widely used in the United States.In this issue of Journal Club, we are focusing our attention on dermal fillers that either contain lidocaine or have had lidocaine mixed into the product by the practitioner prior to injection (off-label use). This may be a direction we see more dermal filler products moving toward as further clinical trials take place and more products get released in the U.S. aesthetic marketplace. For some aesthetic nurse injectors, it may seem like "back to the future," as many of us who began using dermal fillers in the 1980s and early "1990s" only had experience with a product that contained lidocaine-bovine collagen.
... 8 After injection, an immediate inflammatory process takes place, which fades in 4 to 5 days. 12,16 Despite the low rate of complications, sometimes a hyaluronidase injection, antibiotics, or steroids may be necessary to treat these side effects. 16,17 The fillers based on HA can be classified as non-crosslinked or cross-linked. ...
... 12,16 Despite the low rate of complications, sometimes a hyaluronidase injection, antibiotics, or steroids may be necessary to treat these side effects. 16,17 The fillers based on HA can be classified as non-crosslinked or cross-linked. 8,18 Cross-links are intermolecular bonds that enhance the stability and durability of clinical implants. ...
Background:
Hyaluronic acid fillers are used for facial rejuvenation and are classified as non-cross-linked or cross-linked (monophasic mono- or polydensified).
Objectives:
To histologically assess the intradermal durability of three types of fillers (biphasic, monophasic monodensified, and monophasic polydensified), to compare the durability of the products over 6 months, and to evaluate the structural changes after application.
Methods:
In all, 25 volunteers received injections of three different fillers in the dermis of the right lumbar region (in one line), and equal amounts of the fillers were injected into three different sites (in the same column), yielding nine points of application in each patient. Each line was biopsied on days 2, 92, and 184; these skin samples were analyzed histologically, and the presence or absence of these fillers was verified by a dermatopathologist.
Results:
The histological analysis showed that over 182 days, the amount of the injected monophasic polydensified, monophasic monodensified, and biphasic filler products decreased by 62.5%, 25%, and 12.5%, respectively.
Conclusions:
The biphasic and monophasic monodensified fillers presented greater intradermal durability than did the monophasic polydensified filler at 6 months after intradermal injection.
Level of evidence:
2 Therapeutic.
... Mixing lidocaine with filler before injection by practitioners is not suggested since it increases the possibility of contamination, also by altering the concentration of filler, it could cause failure to attain desirable quality, consistency, and flow characteristics (Busso & Voigts, 2008;Sagrillo, 2008). Therefore, these approaches are inconvenient and time consuming, and may result in changes in the viscosity of the filler preparation (Brandt et al., 2010). ...
Botox, filler, and mesotherapy injections are very useful for both cosmetic and noncosmetic purposes, especially in the head and neck area. However, needle fear is a challenging issue for patients undergoing needle-involved procedures. This book chapter explores different studied interventions to reduce pain and discomfort during these injections.
Background:
As the desire for beauty and youthful appearance has increased in recent years, cosmetic injections are getting more attention. However, patients discomfort during these injections is a challenging issue.
Aim:
This review explores common approaches to reduce pain and discomfort during cosmetic injections through the available literature.
Methods:
The eligible studies through searching in PubMed have been entered to evaluate the common methods of pain reduction for cosmetic injections.
Results:
According to reviewed studies, vibration, local anesthesia, and vapocoolant anesthesia are common methods applied in order to reduce pain and discomfort in patients. All of these methods are able to reduce pain through their affects on neuron fibers.
Conclusion:
It seems that all common approaches can result in some amount of pain reduction. Using a combination of these methods during injections, practitioners can successfully reduce the pain of injection.
Introduction: The use of dermal filling techniques for soft tissue augmentation has greatly increased in recent years. Hyaluronic acid is one of the most used temporary dermal fillers in the treatment of facial wrinkles, furrows, and folds due to its effectiveness and safety. Objective: To evaluate the efficacy and safety of Perfectha®, a new hyaluronic acid filler, for nasolabial folds and lip correction. Methods: Open, multicenter study comprising 87 women. Efficacy was evaluated by the Global Aesthetic Improvement Scale and the Wrinkle Severity Rating Scale. Safety was evaluated through observation and the reporting of side effects. Results: One week after the injection of the filler, improvement in nasolabial folds and lips was observed in 86% and 89% of the women, respectively. Mild or moderate transient inflammatory reaction and ecchymoses occurred in 15% and 9% of patients, respectively, mainly in nasolabial folds. Two patients presented labial herpes simplex after treatment of the lips. The good results were maintained in 76% and 57% of women for nasolabial folds and in 72% and 45% of women for lips after 3 and 6 months, respectively. Conclusion: Perfectha® was effective and safe for these indications.
Introduction Pain is a common patient complaint during dermal filler injections. The primary objective of this study was to compare a new formulation of Juvéderm® injectable gel with lidocaine (denoted as JUV + L) to commercially-available Juvéderm® injectable gel without lidocaine (denoted as JUV) with respect to procedural pain scores in subjects desiring nasolabial fold (NLF) correction.
Methods Subjects received randomized treatment with the lidocaine filler in one NLF and the filler without lidocaine in the other NLF. Investigators determined the appropriate formulation (Ultra or Ultra Plus) and volume of material to inject but were blinded as to which syringe contained lidocaine. Subjects rated procedural pain (pain during injection) using an 11-point scale within 30 min after receiving treatment in both NLFs and compared procedural pain between right and left NLFs using a 5-point scale. NLF severity was rated by both subjects and investigators before and 2 weeks after treatment.
Results The mean difference on the procedural pain scale was 3.4 (P < 0.0001), and 93% of subjects found JUV + L to be less or slightly less painful than JUV. Improvement in NLF severity was comparable for both products. Common treatment site reactions (CTRs) of pain and tenderness were considerably less frequent for JUV + L than JUV while all other CTRs showed no statistically significant differences.
Conclusion The dermal filler formulated with lidocaine is effective in reducing procedural pain during correction of facial wrinkles and folds while maintaining a similar safety and effectiveness profile to the filler without lidocaine.
The hand has remained a considerable treatment challenge, as new soft tissue fillers have arrived in the esthetic marketplace. The challenge has been the result of both the multiple visits required for treatment in, for example, autologous fat grafting and the simple management of pain in the innervated areas of the hand between the bones.
This paper introduces a novel, noticeably less painful approach to treatment of the hand with calcium hydroxylapatite (CaHA; Radiesse®, BioForm Medical, San Mateo, CA). Anesthetic is added to the compound prior to injection, resulting in a homogenous admixture of CaHA and anesthetic. A bolus of the mixture is injected into the skin, using tenting, and then spread throughout the hand.
The result of this approach – mixing anesthetic with CaHA – is treatment that is easier to massage and disseminate, less painful to the patient than conventional hand injection, and characterized by less swelling and bruising, with minimal post-treatment downtime.