Influences of Age, Gender, and Body Mass Index on the Depth of the Superficial Fascia of the Arm and Thigh.

BACKGROUND: Nonsurgical skin-tightening procedures are increasing in popularity because of their noninvasiveness as the energy is transdermally applied to the subcutaneous tissues. OBJECTIVE: To provide precise data on the depth of the superficial fascia for potentially safer and better targeted treatments of arms and thighs. METHODS: One hundred fifty Caucasian individuals were investigated with an equal distribution of men and women (each n = 75) and a balanced distribution of age (n = 30 per decade). Ultrasound-based measurements were conducted, measuring the distance between skin and the superficial fascia in the posterior arm and the anterior, medial, and posterior thigh. RESULTS: Deep to the skin, 5 layers were consistently and bilaterally identified in both sexes: skin, superficial fat, superficial fascia, deep fat, and deep fascia. The overall mean distance between the skin surface and the superficial fascia was for the posterior arm 4.38 ± 0.9 mm; range (2.60-6.70), for the anterior thigh 7.90 ± 2.3 mm range (3.50-13.20), for the medial thigh 5.74 ± 1.2 mm range (3.10-8.20), and for the posterior thigh 7.77 ± 3.2 mm range (3.60-14.50). CONCLUSION: Knowing the precise depth of the superficial fascia for nonsurgical skin-tightening procedures could potentially guide practitioners toward safer and more effective outcomes.

Recommendations for volume augmentation and rejuvenation of the face and hands with the new generation polycaprolactone-based collagen stimulator (Ellansé®).

BACKGROUND: The range of fillers currently available for soft-tissue augmentation is constantly expanding. The latest advances in filler technology include collagen biostimulators that exert their esthetic effect by promoting neocollagenesis. One such product is the next-generation collagen biostimulator (Ellansé®) that demonstrates properties as yet unseen in soft-tissue fillers. It is composed of polycaprolactone (PCL) microspheres in an aqueous carboxymethylcellulose gel carrier. Given its specific characteristics and the number of areas that can be treated with this innovative product, experts' recommendations were deemed necessary and are therefore presented in this paper with a specific focus on the indications, treatment areas and procedures as well as injection techniques. METHODS: A multinational, multidisciplinary group of plastic surgeons and dermatologists convened to develop recommendations with a worldwide perspective. This publication provides information on the specific characteristics of the product and focuses on the recommendations on the injection techniques. RESULTS: Recommendations on injection techniques are provided for the upper face, mid-face and lower face and zone by zone for each of these areas, as well as hands. Based on the particular anatomy of each area, the focus is on the techniques and devices of injection and the volume and depth of injection. The information is tabulated, and photos are presented for illustration. CONCLUSION: These recommendations provide a guideline for physicians who wish to perform safe and efficacious treatment with the PCL collagen stimulator for face and rejuvenation with volume augmentation.

Long-lasting and permanent fillers: biomaterial influence over host tissue response.

BACKGROUND: The purpose of this study was to attempt to understand why some injectable fillers produce frequent ill effects and some do not, by reviewing the available agents and analyzing them through the knowledge of biomaterial studies, which show clearly what type of reactions can be expected according to the chemical used. METHODS: A study of long-lasting and permanent fillers was performed in an attempt to understand the specific reactions induced by each agent. Agents were then compared with manufacturers' allegations and published data on complications. RESULTS: All the available products have a potential for complications. However, the difference between the normal healing process and true inflammatory granuloma must be established. For a volume effect, the implant, although deep, should induce the smallest inflammatory reaction, to avoid any long-term side effects. Particulate implants with porous or irregular surfaces are potentially more reactive than spherical, smooth-surface particles. Gels and oils have a potential for fragmentation, and each droplet will start a new inflammatory phase. For a superficial treatment, is seems better to use a "passive" filler, which should have no inflammatory reaction. The problem remains for combined indications: volume and smoothing, deep and superficial. After hyaluronic acid injections in areas previously treated with a nonresorbable agent, severe inflammatory granulomas have appeared, and it is not possible to state whether they are attributable to the new product, even a resorbable one, or to reactivation of the sleeping reaction from the previous implant. CONCLUSION: There is an obvious need for serious, precise, and objective studies on most of the available fillers, which have not been properly scientifically studied on human skin.

ArteFill: a third-generation permanent dermal filler and tissue stimulator.

The technical and physiologic shortcomings associated with prior generations of polymethylmethacrylate (PMMA) dermal fillers have been reduced significantly since their original market introduction in 1989. For example, the PMMA microspheres in the third-generation product ArteFill meet the new limit set by the FDA of less than 1 particle below 20 micrometers per 100 microspheres (< 1% by the number). Therefore, it is expected that the already low granuloma rate following injections with second-generation product Artecoll (1:5000) will be reduced further with injections of ArteFill. In the authors' experience, both Artecoll and ArteFill have proven to be safe, predictable, and effective dermal fillers. It is anticipated that Artefill will receive FDA approval in late 2006 and will be marketed internationally.