An Objective, Quantitative, Dynamic Assessment of Hyaluronic Acid Fillers That Adapt to Facial Movement.

BACKGROUND: Objective dynamic assessments are central to the evaluation of facial rejuvenation treatments. This study used three-dimensional digital stereophotogrammetry to generate a quantitative dynamic assessment of facial strain and hyaluronic acid filler efficacy. METHODS: Thirty women (aged 41 to 65 years) with moderate to severe bilateral nasolabial folds and marionette lines received Restylane Refyne, Restylane Defyne, or both, and were compared to a "younger" untreated group (n = 20; aged 25 to 35 years). Three-dimensional videos were collected at baseline and at day 42. Dynamic strain was analyzed at the marionette lines and nasolabial folds as subjects went from a neutral position through a series of facial expressions. RESULTS: Baseline nasolabial folds and marionette lines showed statistically significant (p ≤ 0.05) differences in the level of stretch between younger and older untreated subjects, with higher stretch profiles observed in the older cohort. In the older cohort, filler treatment reduced peak strain (stretch) in the nasolabial folds and marionette lines compared with baseline across all tested expressions, resembling the youthful strain profile of the younger untreated control group. Treatment was well tolerated. CONCLUSIONS: Quantitative dynamic strain analysis is an innovative method for evaluating the dynamic face following dermal fillers and provides objective evidence that such treatment results in stretch levels resembling a younger phenotype in areas prone to the effects of facial aging. The strain reduction following filler treatment objectively conveys a dermal tightening effect, likely secondary to the volumization of treated areas. Additional studies will refine the technology and associated procedures to optimize quantitative dynamic strain analysis for treatment planning and patient outcome optimization. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Dynamics of hyaluronic acid fillers formulated to maintain natural facial expression.

BACKGROUND: Subjects seeking facial rejuvenation want the results to appear natural. Currently, however, there is no consensus definition of, or assessment scale for, "naturalness." AIMS: This open-label pilot study explored evaluation techniques and criteria to assess naturalness of facial movement and expression following optimal bilateral correction of moderate-to-severe nasolabial folds and marionette lines with soft-tissue hyaluronic acid fillers formulated with XpresHAn Technology™. METHODS: Primary efficacy was investigator assessed naturalness of dynamic expressions using baseline and Day 42 posttreatment 2D video. Other evaluations included investigator assessed naturalness using static images, wrinkle severity, investigator and subject Global Aesthetic Improvement Scale assessments, and subject satisfaction. RESULTS: Thirty Caucasian females (41-65 years) received either Restylane® Refyne, Restylane® Defyne or both. Naturalness of dynamic expressions was at least maintained in all subjects. Naturalness of static expressions was not negatively affected in most subjects (96.7%). For dynamic expressions, 83.3% of subjects showed enhanced attractiveness, younger appearance and maintained naturalness. CONCLUSIONS: Overall, nasolabial folds and marionette lines improved significantly based on severity and Global Aesthetic Improvement Scale scores, with high subject satisfaction and favorable safety profile. Based on subject satisfaction and investigator assessments, using highly flexible hyaluronic acid dermal fillers did not compromise naturalness of lower facial expressions while achieving the desired improvements in attractiveness and youthfulness. The preliminary results obtained in this pilot study suggest that dynamic and static assessments of facial animation may aid the evaluation of natural outcomes in facial rejuvenation procedures.

Postoperative ischemic optic neuropathy.

STUDY DESIGN: Systematic literature review. OBJECTIVE: To determine if there are predictors or preventative measures for postoperative ischemic optic neuropathy (ION) associated with spine surgery. SUMMARY OF BACKGROUND DATA: Postoperative ION is a devastating complication that is most common after cardiac and spinal fusion surgery. Identifying patient or perioperative predictors for postoperative ION could lead to therapeutic modifications designed to minimize its occurrence. METHODS: A systematic literature review was conducted in MEDLINE, EMBASE, and the Cochrane Collaboration Library for literature published in English from 1990 through 2008 reporting on ION following spine surgery. References from review articles of ION were used, but articles without original material were excluded. Data on study design, patient demographics, and perioperative characteristics were collected and analyzed. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus. RESULTS: Nineteen of 360 articles on postoperative ION after spine surgery met inclusion/exclusion criteria. The quality of evidence was very low as the majority of articles were case reports. The majority of ION patients were men between 30 and 69 years, undergoing spinal fusion surgery with an operative duration greater than 5 hours and an estimated blood loss greater than 1 L. Confounding factors and lack of a denominator from the case reports and case series precluded identification of risk factors with even a modest level of evidence. CONCLUSION: Postoperative ION after spinal surgery is a rare event, which may be associated with prone position surgery of more than 5 hours surgical duration and blood loss of more than 1 L. Informing patients of this remote risk should be considered during preoperative counseling. The quality of evidence for preventative measures for postoperative ION after spinal fusion surgery is very low, but it has been proposed that efforts aimed at reducing the duration or severity of venous congestion in the head may be beneficial.

The basics of animal biosafety and biocontainment training.

The threat of biocontamination in an animal facility is best subdued by training. 'Training' is an ambiguous designation that may not be adequately appreciated in all animal facilities. The authors set down concrete training topics and provide practical advice on incorporating the basic principles of facility biosafety training--as well as the precautions and procedures that employees must know in case of accident or emergency--into various training models. They also discuss the current biosafety publications and guidelines and their relationship to biosafety training.