The AestheCode System: A Safe and Efficient Guide for AestheFill Injection.

AestheFill is a biostimulator based on poly-D,L-lactic acid. It is supplied as lyophilized powders and is referred to as a versatile biostimulator. According to the amount of water added, the suspensions can be vary in thickness which can be divided into four groups for different indications: the thickest suspension (D1.5-3) for nose or chin augmentation, thick suspension (D3-6) for deep wrinkle correction, thin suspension (D6-12) for shallow wrinkle correction, and super-thin suspension (D12-24) for skin rejuvenation. However, practitioners may be confused about which filler thickness, injection layer, method, and amount should be chosen for their patients. Biostimulators tend to form non-inflammatory nodules if technical mishaps occur during injection. Based on 10 years of AestheFill injection experience, the authors proposed the AestheCode system for the safe and effective injection of AestheFill.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 .

Retrograde flow phenomenon of poly-D,L-lactic acid filler injection over lower eyelids.

The occurrence of 'retrograde flow along the cannula/needle tract' during filler injections has not been extensively addressed in the existing literature, possibly because it is often imperceptible unless the injection is conducted at a superficial layer. In our experience with poly-D,L-lactic acid filler for lower eyelid injections, we have observed and documented this phenomenon through the skin. This article aims to elucidate and illustrate the retrograde flow phenomenon and discuss the factors influencing it.

Nonsurgical lower eyelid rejuvenation using injectable poly-d,l-lactic acid in Asian patients.

BACKGROUND: Filler injection for lower eyelid rejuvenation remains a difficult subject due to many complicated anatomic changes as the face ages. OBJECTIVES: To propose an alternative, simple, and effective filler injection method in lower eyelids for Asian patients. METHODS: Any patient who has tear trough deformities, infra-orbital hollows, nasojugal grooves, dark eye circles, as well as mild eyebags is a potential candidate for this method. Our filler choice is injectable poly-d,l-lactic acid (PDLLA; AestheFill; REGEN). PDLLA must be reconstituted with sterile water for injection (SWFI) before administration. When the patient's troughs, grooves, or volume deficit are classes II and III, 3-4 ml of SWFI and 1 ml of lidocaine are used. When the deficits are class I, 5-7 ml of SWFI and 1 ml of lidocaine are used. With the fanning injection technique, a wide region that covers all the deficits is evenly injected. The depth is under the dermis layer. The total amount of filler injection is not more than 2 ml on each side. RESULTS: Since 2019, we have injected more than 100 patients by following these steps in Taiwan. The level of patient satisfaction is high. Only some mild and transient post-injection complications such as edema, erythema, and ecchymosis were found. CONCLUSIONS: We propose an alternative, simple and effective method for non-surgical lower eyelid rejuvenation for Asian patients. However, anyone who wants to perform this procedure should be well-trained and knowledgeable about the anatomy, product, and procedure to prevent adverse events.

Reconstitution of Injectable Poly-d,l-lactic Acid: Efficacy of Different Diluents and a New Accelerating Method.

Injectable poly-d,l-lactic acid (PDLLA) is a new collagen-stimulating filler containing PDLLA microspheres and carboxymethyl cellulose. It is available as a lyophilized powder that must be reconstituted with a diluent before administration. The aims of this study were to investigate the efficacy of different diluents and a new accelerating "back-and-forth" method. METHODS: Six different diluents, sodium bicarbonate, sterile water for injection (SWFI), normal saline, lidocaine, lidocaine with epinephrine (lidocaine + E), and mannitol, were tested. The recommended "vortex" method for preparation of thin suspensions and a new back-and-forth method suitable for both thin and thick suspensions were compared. Gross and microscopic views of the prepared suspensions were examined. RESULTS: Using the vortex method, only mannitol and SWFI are found to be effective reconstitution diluents for injectable PDLLA. Using the back-and-forth method, all six diluents can be used for reconstitution of injectable PDLLA. Moreover, the time needed for reconstitution of injectable PDLLA by this back-and-forth method is very short, regardless of the thickness of the suspension. CONCLUSIONS: Clinically, only SWFI can be used for reconstitution of injectable PDLLA by "hand-shaking" or vortex method. To accelerate the reconstitution time especially when using small amount of SWFI, back-and-forth is the method of choice. Besides, when SWFI is not available, other diluents such as normal saline, lidocaine, or lidocaine + E can be used by this novel back-and-forth reconstitution method.

The extended lateral arm flap in head and neck reconstruction.

BACKGROUND: The lateral arm flap has been proven to be a reliable and versatile flap for the coverage of small to moderated-sized defects, especially in the head and neck and in the extremities. This flap has been modified by either extending the vascular pedicle or the flap territory. METHODS: From September 1997 to October 2000, we performed 17 free lateral arm flaps with extension of the flap size, including 1 osteofasciocutaneous flap for the coverage of head and neck defects. The reconstructions included a partial circumference defect of the esophagus, extensive intraoral defects, through-and-through bucco-cheek defect, etc. Follow-up was from three months to 12 months, with an average of 8 months. RESULTS: All but one flaps survived completely. Necrosis of the distal part occurred in one flap. Follow-up of donor sites revealed minimal morbidity when the flaps were extended to the below-elbow level. CONCLUSIONS: The cutaneous territory of the lateral arm flap, based on the posterior radial collateral artery, can be extended distally onto the forearm up to 10 cm. The center point of the flap design could be located more distally toward the lateral epicondyle in order to increase the size of the flap and the length of the vascular pedicle. The lateral arm flap provides a considerable amount of thin, pliable fasciocutaneous tissue. The advantages of the flap are constant anatomy, very easy and fast dissection, and the donor site being easier to camouflage than that of the radial forearm flap. The lateral arm flap is an excellent choice of fasciocutaneous flap for the reconstruction of head and neck defects.