Primary and adjunctive use of botulinum toxin type A (Botox) in facial aesthetic surgery: beyond the glabella.

The use of Botox for the treatment of hyperkinetic facial lines and furrows is another effective primary, adjunctive, or prophylactic therapy to offer cosmetic patients in the spectrum of treatment options for full facial rejuvenation. Unwanted side effects can be minimized, and beneficial effects can be maximized with a thorough understanding of the facial soft-tissue anatomy, proper patient selection, and administration of the lowest effective doses with minimal volume of delivery. Most often, Botox injection does not replace surgery, skin resurfacing, soft-tissue augmentation, or skin care; however, it is useful when used alone or with the various treatment options to give selected patients the most effective and comprehensive solutions for a more youthful appearance.

Botulinum A exotoxin for the management of platysma bands.

Injections of botulinum A exotoxin are successfully used to treat neuromuscular disorders and to improve hyperkinetic muscles and dynamic rhytids of the upper face. Using these principles, we extended its use to the treatment of the aging neck (hypertrophic platysma muscle bands). A classification system (I to IV) based on horizontal neck rhytids, platysma bands, and skin laxity was devised to categorize the degree of deformity and serve as a guideline for suggested dosages of botulinum. The results correlated with the degree of age-related neck degeneration. Type II (mild horizontal neck rhytids; thin, mild platysma muscle flaccidity; and mild skin laxity) and III (moderate horizontal neck rhytids; thick, moderate platysma muscle flaccidity; and moderate skin laxity) patients were the most satisfied, followed closely by types I and IV. A total of 1500 patients were treated by three independent practices. The majority of them achieved good-to-excellent results, as evaluated by both the physician and patient. The degree of muscle flaccidity and hypertrophy were the factors that most influenced success rates, not the anatomic variations in muscle configuration.

Cosmetic use of botulinum A exotoxin for the aging neck.

BACKGROUND: The use of botulinum toxin for facial rhytides has become more popular. In the past, plastic surgery was the only choice for rejuvenation of the aging neck. We discuss the cosmetic use of botulinum toxin for the rejuvenation of the neck and review the anatomy. OBJECTIVES: We will review the four age-related neck degeneration categories and discuss how to inject botulinum A exotoxin into the platysmal neck bands. RESULTS: We will discuss how botulinum can tighten neck jowls, eliminate horizontal neck rhytides, and improve skin laxity. CONCLUSION: Botulinum A exotoxin is a safe, effective, alternative treatment for rejuvenation of the aging neck and lower face. Patients are uniformly satisfied and complications are minimal.

Subcutaneous pheohyphomycotic cyst from a traumatic injury: reactivation after thirty-five years.

Pheohyphomycoses are an uncommon diverse group of dematiaceous fungi present in soil and plant material and are potential pathogens. We report the case of a 45-year-old white Hispanic woman who presented with a hard round cyst on the dorsum of her right foot caused by a traumatic implantation of a piece of wood thirty-five years earlier. The cyst was surgically excised and the patient empirically treated with a two-month course of oral itraconazole. To our knowledge, this represents a case of the longest-lived asymptomatic pheohyphomycotic cyst in an immunocompetent person ever reported. The clinical manifestations, treatment options, and disease course are reviewed.

Infection with methicillin-resistant Staphylococcus aureus after carbon dioxide resurfacing of the face. Successful treatment with minocycline, rifampin, and mupiricin ointment.

BACKGROUND: The incidence of cutaneous bacterial infection after carbon dioxide (CO2 laser resurfacing is increasing. Patients with staphylococcal colonization of their anterior nares may be at greater risk for postoperative cutaneous colonization and/or infection, which can potentially cause scarring. OBJECTIVE: We present a case report of methicillin-resistant Staphylococcus aureus secondary infection of the skin after CO2 laser resurfacing. We discuss the possible etiologies of this patient's infection, her postoperative management, and preoperative suggestions for possibly preventing infection. METHODS: A 49-year-old woman was treated with CO2 laser resurfacing for moderate actinic damage and facial rhytides. She developed a cutaneous infection with methicillin-resistant S. aureus, which caused diffuse linear scarring on her cheeks and upper lip. RESULTS: The patient was successfully treated with oral minocycline, rifampin, and topical mupiricin ointment to her cutaneous erosions. CONCLUSIONS: We propose that it would be helpful for patients undergoing CO2 laser resurfacing to have their nares cultured to see if they are staphylococcal carriers. If a patient is found to be a carrier, mupiricin ointment can be used preoperatively treat to the nares, to help decrease the risk of infection of the skin from this potential source.