Hand Rejuvenation With A Hyaluronic Acid-Based Dermal Filler: A 12-Month Clinical Follow-Up Case Series.

BACKGROUND: Requests for hand rejuvenation, in particular with nonsurgical aesthetic procedures, are increasing. Several injectable dermal fillers are currently used to restore soft tissue volume; however, the anatomic complexity of the hand and extreme mobility of its underlying tissues involve the use of specific implants and adapted injection technique. We report a case series demonstrating the efficacy, durability, and safety of a hyaluronic acid-based dermal filler (HA-filler) for hand rejuvenation. METHODS: Five female subjects aged 56 to 67 with moderate to severe hand aging were treated by one physician (PM) at his private office. The HA-filler was injected in the hypodermis using a retrograde injection technique. A massage performed at the site of injection ensured optimal cosmetic results. Four subjects had a touch-up 3 months later. The aesthetic effect was evaluated on each hand, by 5 evaluators and the subjects, up to 12 months following the last injection. Adverse events, including pain, were collected. RESULTS: Merz Aesthetic Hand Aging Scale (MAS) and the Global Aesthetic Improvement Scale (GAIS) scores indicated stable and significant improvement in hand aging up to 12 months following the last injection. Despite a slight decrease over time, there was a durable enhancement of skin glow, quality, and hydration on the GAIS. The retrograde injection of the HA-filler, which was usually described as painless, was well tolerated by all subjects. CONCLUSIONS: Hand rejuvenation using a HA-filler and a retrograde injection technique was associated with subjects’ satisfaction and was proved safe for the 5 subjects of this case-series. J Drugs Dermatol. 20(4):451-459. doi:10.36849/JDD.5154.

Ultrasound and Histologic Examination after Subcutaneous Injection of Two Volumizing Hyaluronic Acid Fillers: A Preliminary Study.

BACKGROUND: This study examined the influence of hyaluronic acid (HA) crosslinking technology on the ultrasound and histologic behavior of HA fillers designed for subcutaneous injection. METHODS: One subject received subcutaneous injections of 0.25 ml Cohesive Polydensified Matrix (CPM) and Vycross volumizing HA in tissue scheduled for abdominoplasty by bolus and retrograde fanning techniques. Ultrasound analyses were performed on days 0 and 8 and histologic analyses on days 0 and 21 after injection. A series of simple rheologic tests was also performed. RESULTS: Day 0 ultrasound images after bolus injection showed CPM and Vycross as hypoechogenic papules in the hypodermis. CPM appeared little changed after gentle massage, whereas Vycross appeared more hyperechogenic and diminished in size. Ultrasound images at day 8 were similar. On day 0, both gels appeared less hypoechogenic after retrograde fanning than after bolus injection. Vycross was interspersed with hyperechogenic areas (fibrous septa from the fat network structure) and unlike CPM became almost completely invisible after gentle massage. On day 8, CPM appeared as a hypoechogenic pool and Vycross as a long, thin rod. Day 0 histologic findings confirmed ultrasound results. Day 21 CPM histologic findings showed a discrete inflammatory reaction along the injection row after retrograde fanning. Vycross had a more pronounced inflammatory reaction, particularly after retrograde fanning, with macrophages and giant cells surrounding the implant. Rheologic tests showed CPM to have greater cohesivity and resistance to traction forces than Vycross. CONCLUSIONS: CPM HA volumizer appears to maintain greater tissue integrity than Vycross after subcutaneous injection with less inflammatory activity.

Risks and benefits of using an absorbable mesh in one-stage immediate breast reconstruction: a comparative study.

BACKGROUND: Complete implant coverage by pectoralis major muscle in immediate breast reconstruction prevents implant exposure but restricts implant volume, increases the risk of a high-riding implant, and prevents natural ptosis. The authors hypothesized that extension of the subpectoral pocket with Vicryl mesh may produce more satisfactory results. The safety and efficiency of this technique were assessed by comparing complication rates and clinical results of the two reconstruction techniques: with and without mesh. METHODS: The authors reviewed 161 immediate breast reconstructions in 139 patients from 2002 to 2010. A complete submuscular pocket was performed in 46 breasts and a partial submuscular pocket with Vicryl mesh extension was performed in 115 breasts. Complications, surgical revisions rates, implant size, and contralateral breast procedures were compared between the two groups. RESULTS: Early and late surgical revisions were similar between the mesh and nonmesh groups (11.6 percent versus 4.3 percent at 90 days, p = 0.09; and 34.3 percent versus 41.4 percent at 5 years, p = 0.41). There were fewer revisions for implant malposition in the mesh group (8.9 percent versus 21.7 percent, p = 0.05). Patients with mesh could have a larger implant in comparison with those without mesh (329 g versus 284 g, p = 0.01) and had fewer contralateral mastopexies (12 percent versus 30 percent, p = 0.01). CONCLUSIONS: Larger implants and perhaps better control of implant position were possible using the Vicryl mesh extension without increasing complications. Because the mesh technique also recreates a slightly ptotic breast, fewer contralateral mastopexies were needed. The Vicryl mesh extension is a low-cost alternative to biological matrices or tissue expanders. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Massive subcutaneous emphysema after carbon dioxide mesotherapy.

UNLABELLED: The authors report the observation of a 43-year-old woman with severe pain on her right upper abdominal quadrant. Differential diagnoses included acute cholecystitis, spontaneous pneumothorax, perforated appendicitis and a recidive of renal calculus. CT-scan showed a huge subdermal gas bubble along her right flank and anterior abdominal wall up to the submammary fold. Only at this point, the patient admitted to have undergone a carboxytherapy procedure on both thighs one day before onset of pain in a paramedical facility. As some of the injection trajects were still patent on CT-scan, she received prophylactic antibiotic coverage. Though there was a complete resorption of gas after 10 days, dysesthesias and muscle contracture persisted for 3 weeks. To the authors' knowledge this migration and coalescence of injected gas in a single bubble has not been previously reported. 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 http://www.springer.com/00266 .

[Injectable soft tissue fillers: are they medical devices or drugs? Implications for HIV lipodystrophy]. / Produits de comblement du visage: dispositifs médicaux ou médicaments? Implication pour les patients VIH+ atteints de lipoatrophie.

Physical modifications associated to lipodystrophy syndrome in HIV+ patients remain a challenge for management, even in a well controlled chronic infection. Indications, evaluation and filling treatments of facial lipoatrophy are described. Many exogenous filling products are on the market and their use and tolerance profile better known. These medical devices should be closely followed in patients with chronic HIV infection.

Hyaluronan and the "mushroom" technique: an assessment of hyaluronan injections into the glans.

BACKGROUND: An Asian technique of injecting collagen below the corona of the glans-the "mushroom" technique-increases the diameter of the penis glans and heightens sexual sensations for the participant and his sexual partner. OBJECTIVES: To improve the physical and aesthetic results of the "mushroom" technique-compared with previous procedures using collagen-by using a new material and alternative injection locations and patterns. MATERIALS AND METHODS: The team used a monophasic polydensified hyaluronan (HA) gel for superficial injection into the glans of 12 men aged 28 to 61. Local anesthetic was applied, and one of three injection patterns was tried. Participants self-assessed efficacy and pre- versus postinjection sensitivity using a visual analogue scale and a multiple-choice questionnaire. RESULTS: All participants experienced heightened levels of sensation and increased glans diameter. The hyaluronan gel was well tolerated. Of the three injection patterns tested, one (retrograde contiguous injection) was found to be an improvement over the "mushroom" injection protocol. CONCLUSIONS: Injection directly into the glans increases its diameter when the penis is erect, and heightens sexual sensations. The monophasic and polydensified hyaluronan gels are suitable alternatives to collagen.

Locating perforator vessels by dynamic infrared imaging and flow Doppler with no thermal cold challenge.

BACKGROUND: Dynamic Infrared Imaging (DIRI) is a noninvasive technique that precisely analyzes the infrared radiation of any object. We used this technique to locate the dominant perforator vessels in flap surgery in conjunction with conventional Doppler. METHODS: Ten patients scheduled for deep inferior epigastric artery perforator flap and 6 for free-fibular flaps were selected. Perforator vessels were localized in the donor area, using Doppler and DIRI. The ability to locate the dominant perforators was compared between both techniques. RESULTS: DIRI produced a precise map showing the location of the perforators and their area of perfusion at the skin level. Their dominance can be determined by their size. Flow Doppler located the perforators at the aponeurotic level without size and perfusion information. CONCLUSIONS: DIRI produces a skin thermographic map of perforator vessels and their perfusion area. Handheld Doppler locates perforators at the aponeurotic level. Their combination increases safety in the planning of perforator flap surgery.

[Skin-sparing mastectomy and immediate breast reconstruction]. / Mastectomie avec préservation cutanée et reconstruction immédiate.

Skin-sparing mastectomy is a new surgical approach that allows a mastectomy while preserving the natural envelope of the breast. Skin-sparing mastectomy followed by immediate reconstruction can be used for prophylaxis for high- risk patients or BRCA carriers. It represents an effective treatment option for patients with extensive DCIS or early invasive breast cancer, but is contraindicated for inflammatory breast cancer and extensive skin involvement by the tumor. Skin-sparing mastectomy had similar surgical outcomes compared to non- skin- sparing mastectomy, but skin flap ischemia and necrosis is more common and is associated with a range of risk factors, including smoking. Skin-sparing mastectomy seems to be an oncologically safe technique and does not increase in particular the risk of local, regional or systemic recurrences. It facilitates immediate breast reconstruction using implants or myocutaneous flaps, resulting in excellent cosmesis and high level of patient satisfaction. This article reviews the published data on skin-sparing mastectomy and immediate reconstruction and aim to establish its current role in clinical practice, as there is a lack of prospective data.