Volumizing Fillers for Skin: Selection Strategies.

The normal processes of aging in the face are accompanied by facial volume loss. Aesthetic treatments have been developed to restore lost volume to and below the skin. Understanding the properties and appropriate usages of those volumizing fillers is vital to achieving the best outcomes for patients. Gel firmness, cohesivity, hydrophilicity, tissue integration, and collagen stimulatory properties are attributes to take into consideration when deciding on a volumizing filler. Beyond filler properties, a clinician's understanding of facial harmony and natural aging changes help in understanding how to visualize a holistic response to the use of fillers for youthful restoration.

The evolving etiology of bilateral vocal fold immobility.

In the past, bilateral vocal fold immobility (BVFI) occurred most commonly after thyroidectomy. However, no large series documenting the etiology of adult BVFI has been published within the past fifteen years. This study reviews the etiologic patterns of BVFI at our institutions. We compare BVFI from before and after 1980. We also review combined studies of unilateral vocal fold immobility (UVFI) to compare and unilateral versus bilateral etiologic trends. In comparison with previously published series, fewer cases of BVFI present today as a complication of thyroid surgery and more as the result of malignancies and nonsurgical trauma. Unfortunately, BVFI caused by malignancy is not usually an initial sign of local disease, but an ominous sign of recurrence or metastases. In comparing UVFI and BVFI we found that thyroidectomy causes a higher percentage of BVFI than of UVFI. Over one-third of UVFI cases were caused by neoplasm which further underscores the potential seriousness of immobile vocal folds and the need for careful investigation.

Laser hair removal.

Laser hair removal is a minimally invasive cosmetic procedure that is well suited to the office-based practice. A great deal of improvement has occurred in the past 5 years with the technology and the understanding of how and for whom the procedure works. A review of the physics of laser-skin interactions is included as well as guidelines for safe and effective clinical treatments. Four wavelengths of lasers and intense light sources have proven successful for a variety of skin types. Average rates of long-term hair reduction, for properly treated subjects, are consistently reported between 70 and 90% at a minimum of 6 months. When performed by physician extenders under the supervision of a physician, maximal use of time and resources can be achieved.