Retrospective review of delayed adverse events secondary to treatment with a smooth, cohesive 20-mg/mL hyaluronic acid filler in 4500 patients.

BACKGROUND: Recent publications have suggested an increased risk of delayed adverse events (DAEs) with a smooth, cohesive 20-mg/mL hyaluronic acid filler, Juvéderm Voluma (HA-V). OBJECTIVE: To examine the occurrence of HA-V DAEs and identify patterns and characteristics. METHODS: Charts from patients who received HA-V between February 1, 2009, and February 28, 2018 from 2 clinics were analyzed. RESULTS: In 4500 patients who received 9324 treatments with HA-V, 44 DAEs were identified, for a combined incidence of 0.98% per patient, 0.47% per treatment, and 0.23% per syringe. Patients with DAEs received a slightly larger cumulative amount of HA-V than those who did not. Delayed swelling and nodule formation were the most common reactions and occurred a median of 4 months after treatment, with an increase in frequency between October and January. About a third were preceded by an identifiable immunologic stimulus. DAEs were transient and resolved without incident. LIMITATIONS: The retrospective nature made it difficult to capture time to resolution or remember potential triggers. CONCLUSION: In this large, long-term, retrospective review, HA-V DAEs occurred at a rate of 0.98% per patient. Although the exact cause has yet to be elucidated, we hypothesize that an increase in fragmentation during the HA-V degradation process may trigger an inflammatory response after an immunologic trigger.

Rasgos tomográficos de los septos del seno maxilar en pacientes de la clínica dental docente de la Universidad Peruana Cayetano Heredia / Tomographic features of the maxillary sinus septa in patients of the dental clinic of the Universidad Peruana Cayetano Heredia

Los septos del seno maxilar son variantes anatómicas que se forman como resultado de los residuos de la hipoplasia en diferentes áreas del proceso alveolar siendo de forma, tamaño y número variable. Su hallazgo se puede realizar mediante radiografías panorámicas de rutina. La importancia de un septo en el seno maxilar es que puede generar modificaciones para las cirugías, pudiendo ser necesario abrir dos o más ventanas quirúrgicas para su remoción. Objetivo: La finalidad de este estudio fue analizar los rasgos tomográficos de los septos del seno maxilar en pacientes que asistieron entre los años 2014 - 2016 a la clínica dental docente de la Universidad Peruana Cayetano Heredia. Materiales y métodos: Esta investigación fue de tipo transversal y descriptivo, para ello se examinaron 813 tomografías computarizadas volumétricas. La prueba de chi cuadrado y la estadística descriptiva se usaron para el análisis, con un intervalo de confianza al 95%, con un valor p < 0,05. Resultados: 298 pacientes presentaron septos, presentando mayor porcentaje los septos congénitos (69.2%) y fueron más comunes en pacientes de sexo femenino con un 36%.Conclusiones: prevalecieron los septos de tipo congénito, lo que indica que se formaron a partir del desarrollo radicular.

The septa of the maxillary sinus are anatomical variants that are formed as a result of the residues of hypoplasia in different areas of the alveolar process, being of variable shape, size and number.Your finding can be made using routine panoramic radiographs. The importance of a septum in the maxillary sinus is that it can generate modifications for maxillary sinus surgeries, and it may be necessary to open two or more surgical windows for its removal. Objective: The purpose of this study was to analyze the tomographic features of the maxillary sinus septa in patients who attended the teaching dental clinic of the Universidad Peruana Cayetano Heredia between 2014- 2016. Materials and methods: This research was cross-sectional and descriptive, for which 813 cone beam CT scans were examined. Chi square test and descriptive statistics were used for the analysis, with a 95% confidence interval, with a value p < 0.05. Results: 298 patients presented septa, with a higher percentage of congenital septa (69.2%) and were more common in female patients with 36%. Conclusions: the congenital type septa prevailed, which indicates that they were formed from root development.

Effectiveness evaluation of two volumizing hyaluronic acid dermal fillers in a controlled, randomized, double-blind, split-face clinical study.

BACKGROUND: Enhancement of the midface can be achieved with volumizing hyaluronic acid (HA) fillers. OBJECTIVE: The objective of this study was to compare the safety and effectiveness of Cohesive Polydensified Matrix® 26 mg/mL HA gel (CPM-26) and Vycross® 20 mg/ml HA gel (VYC-20) in a controlled, randomized, evaluator-blind, split-face clinical study. PATIENTS AND METHODS: Subjects with moderate-to-severe malar volume loss on the Merz Aesthetics Scale (MAS) received CPM-26 on one side and VYC-20 on the contralateral side of the face. Effectiveness assessments were performed by blinded evaluators including photographic and live MAS ratings and live Global Aesthetic Improvement Scale (GAIS) ratings. Calculations of anatomical volume variations at month 3 (M3), month 6 (M6), month 12 (M12) and month 18 (M18) were also performed. RESULTS: Non-inferiority of CPM-26 versus VYC-20 was demonstrated at M3 (primary end point) based on MAS. GAIS rating showed that significantly more subjects had better improvement with CPM-26 than with VYC-20 at month 1, M3, M12 and M18 (p=0.0032, p=0.0074, p=0.0384 and p=0.0110, respectively). Standardized evaluation of volume variations from baseline to M3, M12 and M18 showed that CPM-26 created more volume augmentation at all time points, and the difference was significant at M3. CONCLUSION: CPM-26 was non-inferior to VYC-20 based on MAS ratings at M3 and demonstrated a favorable safety and effectiveness profile for midfacial volume enhancement with results lasting up to M18.

Hyaluronic Acid Fillers: Science and Clinical Uses.

Hyaluronic acid soft tissue fillers include a range of products (Juvederm Ultra, Juvederm Ultra Plus, Voluma, Restylane Silk, Restylane, Restylane Lyft, and Belotero Balance) that are used commonly for facial rejuvenation and enhancement of facial features. Although these products are similar in many ways, they are not interchangeable and have unique characteristics that need to be considered. Injection sites and techniques for facial rejuvenation are discussed.

The modified tower vertical filler technique for the treatment of post-acne scarring.

BACKGROUND: Acne scarring remains a difficult problem for patients and physicians. Often it is treated as a two-dimensional disease with lasers and similar devices, whereas it is really a three-dimensional problem. Fillers have been used for many years but recently fillers with more lifting potential have been made available and serve the purpose of the selective elevation of atrophic scars, adding the third dimension to treatment. METHODS: Five patients with atrophic acne scarring were selected in this pilot study. Each patient was treated twice with a 3-month follow up from the second treatment. A vertical modified tower technique was used with a hyaluronic acid filler to lift each scar and support the skin to adopt a more flattened appearance. RESULTS: The mean scar count declined from 48.8 scars to 15.4 visible after the second session. The mean volume to total correction with filler of all scars declined from 1.144 mL to 0.525 mL from the first to second session. Global subjective improvement was assessed at 5.4 and 5.5 (-3 to +10 scale). The static objective grading scale showed an improvement from 3.2 at time of first treatment to 3.0 at the second, to 2.6 at final review. CONCLUSIONS: The relative speed, accuracy and efficacy of high lift hyaluronic acid is shown in this small case series with subjective and objective measurement.

Current Concepts in Filler Injection.

When evaluating the face in thirds, the upper face, midface, and lower face, one may assume the lateral the temple, midface, and lateral mandible as the pillars of these subdivisions. Many of our facial aesthetic procedures address these regions, including the lateral brow lift, midface lift, and lateral face lift. As the use of facial fillers has advanced, more emphasis is placed on the correction of the temples, midlateral face, and lateral jaw line. This article is dedicated to these facial aesthetic pillars.

A prospective, observational study of the volumizing effect of open-label aesthetic use of Juvéderm® VOLUMA® with Lidocaine in mid-face area.

INTRODUCTION: Juvéderm® VOLUMA® with Lidocaine is a hyaluronic acid (HA)-based injectable gel that is used to restore the volume of the face. This study was designed to assess the real-world effectiveness of this HA gel over 21 days when used for mid-face augmentation in normal, healthy subjects desiring aesthetic improvement. MATERIALS AND METHODS: This prospective, observational, single-arm, open-label post-marketing study enrolled 115 healthy subjects, from five European centers. The primary objective was to evaluate subject-reported satisfaction and experience of the treatment across a range of doses of Juvéderm® VOLUMA® with Lidocaine (1 ml/2 ml/combination), immediately after injection and 21 days post-treatment. RESULTS: Subject satisfaction questionnaire (SSQ) scores of Delighted or Happy were given by 95.6% of subjects immediately after injection, and by 93.7% of subjects at Day 21. Overall, subject and investigator satisfaction with cosmetic effect and smoothness was very positive. Pain was minimal; most subjects experienced only minor degrees of discomfort, and this was mainly related to the procedure itself. CONCLUSIONS: Juvéderm® VOLUMA® with Lidocaine was well accepted by both subjects and investigators, associated with high levels of satisfaction, was considered smooth and easy to use, and was well tolerated when used for the treatment of mid-face area volume enhancement.