Treating Aging Changes of Facial Anatomical Layers with Hyaluronic Acid Fillers.

The aging process affects every anatomical layer of the face. Improved knowledge of how aging occurs in each anatomical layer of the face has helped evolve the facial rejuvenation strategies with HA fillers. Understanding the age-related changes in the anatomical facial layers, including their time of onset and how the changes occur in the different tissue layers, an injector can provide much more targeted and refined HA filler treatments. As fillers' use has increased, there has been a distinct shift away from procedures lifting the skin and SMAS. We can selectively target the anatomical facial layers with HA fillers for more refined and predictable outcomes. An extensive range of HA filler variants is now available. Each filler type is optimized and designed to be injected into specific tissue planes for the best results. Knowing the predictable aging changes in the different tissue layers of the face is crucial as this guides the optimum filler choice. Working knowledge of the individual characteristics of the numerous HA-based products allows for their effective placement in the correct layer. Familiarity with the correct HA product may also help to minimize the downtime and risk of adverse events.

Synchronous metastatic omental melanoma and colonic adenocarcinoma: a case report.

BACKGROUND: Malignant melanoma is a rare malignancy of the skin with very high mortality rates. Distal metastases are common especially to other areas of the skin, subcutaneous tissues lungs or liver. There are no previously reported cases of skin melanoma metastasizing to the omentum. CASE PRESENTATION: A 62 year-old white British man with a past medical history of a malignant melanoma of the skin underwent a laparotomy for a partially obstructing sigmoid tumour. Intra-operatively, a round, smooth textured black lesion was identified on the anterior surface of the omentum; the nodule was confirmed to be a metastatic malignant melanoma with abundant brown pigment and a focal necrotic area. CONCLUSION: A metastatic malignant melanoma was discovered incidentally on the omentum during a laparotomy for bowel obstruction. The significance of this is unclear but it is possible that the omentum may have played a protective role in limiting its spread systemically.

A true aneurysm of the superficial temporal artery: Is there an underlying pre-disposition to such rarities?

INTRODUCTION: A 32 year old man presented to our vascular clinic with a lump over the left eyebrow. It had become larger in size and was cosmetically unacceptable. PRESENTATION OF CASE: Clinical examination of the lump demonstrated a pulsatile swelling consistent with an aneurysm of the superficial temporal artery (STA). Doppler ultrasound demonstrated arterial flow within the lump that could be controlled with pressure over the proximal branch of the vessel. The STA aneurysm was excised under local anaesthesia by ligation of the feeding and draining branches. It measured 3.4cm×3.7cm. Histological examination confirmed a rare finding of a true aneurysm of the STA. DISCUSSION: Aneurysms are classified into false or true types, with false aneurysms of the STA accounting for 95% of cases reported. It has therefore been suggested that true aneurysms of the STA may develop from a yet unknown pre-existing vessel condition. The histological findings in our case demonstrated myxoid/mucoid deposits replacing elastin fibres of the media layer, in addition to cystic lesions seen in the adventitia. These features were thought to be nonspecific but have been reported in rare conditions known as cystic adventitial disease and cystic medial necrosis. Such is their obscurity that we speculate that both of these may represent variations of the same underlying pathology. As myxoid/mucoid changes are also noted in more well-known connective tissue disorders including Marfan's syndrome, imaging was arranged to screen our patient for thoracic and abdominal aneurysms. These proved negative and there were no Marfanoid features noted prior. CONCLUSION: Aneurysms of the STA are easily treated by surgical excision. This should be considered when they become large, painful or are cosmetically undesirable. Unusual histological findings in the specimen may indicate a connective tissue disorder that should be investigated if indicated.

Large intra-articular anterior cruciate ligament ganglion cyst, presenting with inability to flex the knee.

A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI) revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL), extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.