Proposal of a Noninvasive Method to Reduce Injection-Related Bruising in Aesthetic Medicine: Transillumination.

BACKGROUND: Hyaluronic acid (HA) injections involve a risk of vascular complications. Transillumination (TL) is a noninvasive technique that appears to allow preliminary detection of superficial vascular structures of the face to avoid intravascular HA injection. The purpose of our study was to test the efficacy of TL in terms of its sensitivity to locate vessels in the areas undergoing treatment and to reduce post-injection vascular complications. MATERIAL AND METHODS: We conducted a prospective study enrolling 72 patients who consulted for HA injections to treat facial wrinkles. We used TL on one side of the face to obtain a vascular mapping of the face. The area undergoing testing was randomized for the TL technique. The primary study endpoint was sensitivity for identifying subcutaneous veins and the differences in complication rates between the side of the face where TL was used to guide the injection and the side of the face where no vascular exploration method was used. RESULTS: TL sensitivity for locating the superficial temporal vein was 100%, 91% for the supratrochlear, supraorbital and infraorbital veins, and 95% for the dorsal nasal veins (p < 0.01). The complication rate was higher on the side of the face where no vascular exploration method was used (22.2% vs 2.7%; p = 0.010046). CONCLUSIONS: Our preliminary findings validate our hypothesis concerning the advantage of using TL to identify superficial veins before performing injections. This method is simple and affordable, and the learning curve is small. LEVEL OF EVIDENCE IV: 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.

Conservative approach to facial upper third feminisation: a retrospective study.

The aim of this study was to assess patient satisfaction and postoperative quality of life following the combined procedure of frontal eminence milling and hairline advancement in the upper third feminisation. This study is based on the assessment of satisfaction data of Transgender adult patients. Postoperative patient quality of life was assessed by the Facial feminisation surgery outcomes evaluation and patient satisfaction was assessed by the Face-Q™. Forty eight patients were included. The age of the patients ranged from 20 to 63 years. According to the Facial feminisation surgery outcomes evaluation, 67.2% of patients were satisfied with the outcomes. 56.3% of the patients found the appearance of their faces "very much" and "completely" feminine. According to the Face-Q™, 79% of patients were satisfied or very satisfied with the position of their eyebrows post-operatively. 83.4% found their foreheads natural, 81.3% found their foreheads younger and 77.1% were satisfied or very satisfied with the smoothness of their forehead. Within the limitations of the study it seems that a combined procedure of frontal eminence milling and hairline advancement is an adequate treatment option forpatients with typically masculine features of the forehead and moderate to slight frontal eminences.

Objective estimation of patient age through a new composite scale for facial aging assessment: The face - Objective assessment scale.

Most patients requesting aesthetic rejuvenation treatment expect to look healthier and younger. Some scales for ageing assessment have been proposed, but none is focused on patient age prediction. The aim of this study was to develop and validate a new facial rating scale assessing facial ageing sign severity. One thousand Caucasian patients were included and assessed. The Rasch model was used as part of the validation process. A score was attributed to each patient, based on the scales we developed. The correlation between the real age and scores obtained, the inter-rater reliability and test-retest reliability were analysed. The objective was to develop a tool enabling the assigning of a patient to a specific age range based on the calculated score. All scales exceeded criteria for acceptability, reliability and validity. The real age strongly correlated with the total facial score in both sex groups. The test-retest reliability confirmed this strong correlation. We developed a facial ageing scale which could be a useful tool to assess patients before and after rejuvenation treatment and an important new metrics to be used in facial rejuvenation and regenerative clinical research.