Consensus Statement on the Use of Botulinum Neurotoxin in the Middle East.

Background: Aesthetic minimally invasive procedures have become very popular and culturally acceptable among Middle Eastern populations. Botulinum neurotoxin type A (BoNTA) is a valuable treatment modality for many cosmetic as well as therapeutic indications. The presence of BoNTA in our toolkit has revolutionized the field of aesthetic medicine to the point where it is now one of the most commonly performed cosmetic procedures worldwide. This consensus considers popular on- and off-label BoNTA indications in the Middle East. Methods: A multinational group of ten key opinion leaders, experts in facial plastic surgery and dermatology, convened the Middle East Aesthetics Consensus Group and reviewed the aesthetic applications of BoNTA. Recommendations and position statements were drafted based on the integration of the panel's clinical experience with published data, targeted to the practices implemented in the Middle Eastern and the global population. Results: Guidance statements are presented covering Middle Eastern facial characteristics and beauty ideals, BoNTA characteristics, pre-operative counselling, treatment indications and anatomical considerations, off-label and special uses including high-dose recommendations, and post-treatment advice. Throughout, an evidence-based approach to selection of products and injection techniques is provided, supplemented by the experts' advice on injections dosages and placement. Conclusion: This consensus reflects the knowledge and expertise of physicians practicing in the Middle East. The panel acknowledged the use of on-label indications and variability in the toxin formulations and immunogenicity and agreed upon a wide use of "off-label" indications.

Endoscopic Facial Rejuvenation: Endoforehead, the Functional Lift. Case Reports.

Endoscopic techniques have only very recently been applied to aesthetic plastic surgery procedures, especially in carpal tunnel release, in forehead plasties , and in breast augmentation operations. The author briefly outlines his experiences with endoscopic forehead lifts, first reported at surgical conferences in Los Angeles and Buenos Aires in 1992, and now totaling 61 cases performed in the 11 months just prior to the submission of this article. This endoscopic approach to forehead lifting has provided similar and comparable results to conventional coronal forehead lift operations , by means of small incisions made in the scalp area with minimal and fewer complications.

A novel variation of the suture suspension facelift.

BACKGROUND: We propose a technical variation of the minimally invasive suture suspension facelift. METHODS: A novel variation of the minimally invasive facelift is proposed. The technique consists of two components. The anterior component addresses aging of the midface by anchoring the SMAS on to the sturdy retroauricular supra-helical deep temporal fascia using approximately 6-8 passes of a 4/0 Mersilene suture. The posterior component addresses cervical aging by securing the posterior edge of the platysma onto the sturdy mastoid fascia, using multiple loops of a 4/0 Mersilene suture. This technique was performed on 100 consecutive patients between 2005 and 2010. RESULTS: The technique was found to be safe due to the plane of dissection remaining superficial to the parotid gland in the anterior component. There were no instances of facial nerve injury or sensory disturbance. None of the patients required a secondary procedure within the first 18 months following the procedure. CONCLUSIONS: This technique offers a safe and effective option for patients who seek a facelift, especially in combination with other procedures. It is envisaged that the use of multiple loops of suture to anchor mobile tissue onto fixed sturdy fascia will contribute to the longevity of the results. The limited skin undermining also makes this procedure a better choice for smokers.

Silhouette sutures for treatment of facial aging: facial rejuvenation, remodeling, and facial tissue support.

During facial aging, a series of physical and biochemical changes leading to tissue hypotrophy, sagging, and wrinkles takes place not only at the level of the skin but also in the fatty tissue, muscle, and other structures. One of these changes is the decrease in volume and elasticity of the tissue because of alteration of collagen fiber formation. The intermittent use of silhouette sutures (partially reabsorbable) is aimed at preventing and treating the tissue sagginess and reinforcing the soft tissue of the face.

Elevating the midface with barbed polypropylene sutures.

Barbed sutures, either used alone in a closed approach or as part of an open face lift procedure, may be combined with malar implants, soft tissue fillers, chemical peeling, and laser resurfacing. Because cephalad cheek repositioning affects adjacent facial areas, results may include shortening of the lower eyelid distance, flattening of the nasolabial fold, elevation of the submalar tissue, improvement of jowling, and decrease in submalar area fullness.