John P Arkins’s research while affiliated with DeNova Research and other places

Patient expectations of botulinum toxin type A (BoNTA) treatments can vary considerably and need to be managed depending on the needs and desires of the patient. In 2009, the second BoNTA, abobotulinumtoxinA was approved by Food and Drug Administration (FDA) for the cosmetic treatment of glabellar rhytids. It is also extremely important to identify patients with preexisting eyelid ptosis and/or brow ptosis, which can be accentuated following BoNTA treatment. It is essential to evaluate brow position in any patient considering treatment of their glabellar creases with BoNTA. It is important for patients to understand that achievement of a complete reduction in the glabellar creases often requires an amount and placement of BoNTA that will often result in a lowered brow position. Signs of aging that occur lateral to the eye are often referred to as "crow's feet". These are the result of the lateral orbicularis muscle, which is very responsive to BoNTA treatments.

Soft tissue filler augmentation of the periorbital regions is a valuable tool in the plastic surgeon’s armamentarium. When performed correctly, periorbital rejuvenation pedestals the eyes and draws attention to this very expressive area and away from the lower third of the face that is most commonly associated with signs of aging. This chapter discusses the variety of fillers available, their advantages and disadvantages, proper technique, and how to recognize and avoid complications.

The aging neck is accompanied by an increase in submental fat, platysmal banding, and redundant dyspigmented skin. Creating a more acute cervicomental angle, distinct mandibular border, homogeneous skin tone, and smoother texture helps to achieve a more youthful appearance. The aesthetic provider's armamentarium has long had surgical techniques in the highest regard, but a new wave of minimally invasive procedures looks to offer a nonsurgical approach to cervicomental rejuvenation. Selecting the appropriate procedure for appropriate patients that will effectively meet their aesthetic goals and expectations is the core of successful neck rejuvenation.

Rosacea is a cutaneous condition with several clinical subtypes that are commonly seen in daily medical practice. There are many different treatment modalities for each of the physical !ndings associated with this disease, and all have varying results. As the use of onabotulinumtoxinA rises, its bene!t in the treatment of a growing number of medical diseases increases. The authors report anecdotal evidence of patients with rosacea experiencing improved symptoms of erythema and "ushing after treatment with intradermal, microdroplets of onabotulinumtoxinA. There were no adverse events reported for any of the treatments. The mechanism of action through a likely neurogenic component to vascular dysfunction, in"ammation, and hypersebaceous activity is reviewed. J Drugs Dermatol. 2012;11(12):e76-e79.

The authors report the case of a 58-year-old woman presenting with "puffiness" in her lower eyelids persisting for approximately 5 years. While dark, puffy eyelid circles following hyaluronic acid placement periorbitally are not uncommon, what is so unusual in our case is that it was noted 5 years after treatment with Restylane. It has been our experience that hyaluronic acid within periorbital tissues can result in a negative cosmetic outcome that can persist for years after the treatment.

Part I of this two-part supplement brings together experts from the U.S., Europe, Canada, and Israel to discuss the state-of-the-art in soft tissue fillers in a fair-balanced, CME-accredited format. It includes a roundtable discussion on hyaluronic acid (HA) fillers that charts the clinical and scientific path that has led dermatologists from wrinkle-chasing to true volumetry. International case vignettes with commentary highlight a variety of applications for fillers'some currently available in the U.S., and some available elsewhere and on the American horizon. Topics covered include single-product and multi-product volumetry, anatomic and safety considerations, and the use of blunt injection microcannulas. Quick poll surveys provide an engaging snapshot of the faculty's personal approaches, with the first three surveys focusing on the palette of HA fillers. This is a CME supplement; visit the JDD Medical Education Library to participate in this activity and earn 2 AMA PRA Category 1 Credits.

The female face of youth is exemplified by a petite lower one-third of the face as opposed to the aging face that is evident by jowling and a squaring of the jaw more representative of a masculine appearance. By placing fillers in the cheeks and infraorbital areas, it deemphasizes the lower one-third and allows unimpeded attention to the eyes, which are the first facial feature to be evaluated during impression construction. We present the case of a 37-year-old female desiring a more youthful appearance through non-surgical intervention. J Drugs Dermatol. 2012;11(suppl 3): s10-s11.

Despite an abundance of nutritional supplements, very few well-controlled trials have assessed their beneficial effect on the skin, such as hydration, antioxidant levels, texture or appearance. The objective of the following placebo-controlled, double-blind study was to determine the effects of the Skin Health Experimental Product (SHEP) on skin health. The study enrolled healthy men and women aged 30 years or older. Subjects were randomized to receive a twice-daily regimen of SHEP or placebo. The effects SHEP had on overall skin appearance and health were assessed by measuring improvements in: (1) skin hydration using a closed-aperture transepidermal water-loss moisture meter and a vapometer; (2) skin texture using silicon profilometry; (3) skin carotenoid concentration using Raman spectrometry; and (4) reported self-image assessments using the Global Aesthetic Improvement Scale (GAIS). SHEP-treated subjects demonstrated a significant reduction in fine lines compared to the placebo-treated group. Raman spectroscopy showed that SHEP increased carotenoids at some measurement sites. Based on the GAIS, SHEP-treated subjects were three times more likely to perceive an improvement in their appearance compared to placebo-treated subjects (P>0.049). The orally-administered SHEP nutritional supplement improves skin texture, carotenoid levels in specific areas of the hand, and improves patients' perception of skin health.