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1.
J Cosmet Dermatol ; 2020 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-32418303

RESUMO

OBJECTIVE: The most promising facial region for inducing pan-facial effects is the temporal region. The temple displays signs of facial aging itself which include temporal volume loss and increased visibility of the temporal crest, the temporal vasculature, the lateral orbital rim and the upper zygomatic arch. The objective of this article is to provide a detailed review of temple anatomy pertaining to routinely performed temporal injection techniques, their expected aesthetic outcomes as well as the intendant advantages, disadvantages, and procedure pearls. MATERIALS AND METHODS: This narrative review is based on the clinical experience of the authors treating the temporal region for aesthetic purposes. The postulated outcome of each technique was observed during the routine clinical practice of the authors. RESULTS: The temporal region is based on a bony platform consisting of the parietal, frontal, sphenoid and temporal bones. The overlying soft tissues are arranged in layers which contain the temporal neurovascular structures. The temporal soft tissues consist of 10 parallel layers which vary in their thickness depending on age-related influences. Six different techniques will be addressed, which include subdermal and interfascial techniques for volumizing, low and high supraperiosteal techniques for volumizing, and supraauricular and temporal lifting techniques. CONCLUSION: This narrative provides a detailed anatomic overview of the temporal region and describes each commonly performed injection technique with respect to anatomy, aesthetic outcome, as well as potential pearls and pitfalls. It is hoped that the description contained herein may guide aesthetic practitioners toward safer and more natural outcomes when treating the face.

2.
Nat Commun ; 11(1): 2366, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398639

RESUMO

Epithelial bending is a fundamental process that shapes organs during development. Previously known mechanisms involve cells locally changing shape from columnar to wedge-shaped. Here we report a different mechanism that occurs without cell wedging. In mammalian salivary glands and teeth, we show that initial invagination occurs through coordinated vertical cell movement: cells towards the periphery of the placode move vertically upwards while their more central neighbours move downwards. Movement is achieved by active cell-on-cell migration: outer cells migrate with apical, centripetally polarised leading edge protrusions but remain attached to the basal lamina, depressing more central neighbours to "telescope" the epithelium downwards into underlying mesenchyme. Inhibiting protrusion formation by Arp2/3 protein blocks invagination. FGF and Hedgehog morphogen signals are required, with FGF providing a directional cue. These findings show that epithelial bending can be achieved by a morphogenetic mechanism of coordinated cell rearrangement quite distinct from previously recognised invagination processes.

3.
Plast Reconstr Surg ; 145(5): 1155-1162, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32332530

RESUMO

BACKGROUND: Cosmetic treatment of the forehead using neuromodulators is challenging. To avoid adverse events, the underlying anatomy has to be understood and thoughtfully targeted. Clinical observations indicate that eyebrow ptosis can be avoided if neuromodulators are injected in the upper forehead, despite the frontalis muscle being the primary elevator. METHODS: Twenty-seven healthy volunteers (11 men and 16 women) with a mean age of 37.5 ± 13.7 years (range, 22 to 73 years) and of diverse ethnicity (14 Caucasians, four African Americans, three Asians, and six of Middle Eastern descent) were enrolled. Skin displacement vector analyses were conducted on maximal frontalis muscle contraction to calculate magnitude and direction of forehead skin movement. RESULTS: In 100 percent of investigated volunteers, a bidirectional movement of the forehead skin was observed: the skin of the lower forehead moved cranially, whereas the skin of the upper forehead moved caudally. Both movements converged at a horizontal forehead line termed the line of convergence, or C-line. The position of the C-line relative to the total height of the forehead was 60.9 ± 10.2 percent in men and 60.6 ± 9.6 percent in women (p = 0.941). Independent of sex, the C-line was located at the second horizontal forehead line when counting from superior to inferior (men, n = 2; women, n = 2). No difference across ethnicities was detected. CONCLUSIONS: The identification of the C-line may potentially guide practitioners toward more predictable outcomes for forehead neuromodulator injections. Injections above the C-line could mitigate the risk of neuromodulator-induced brow ptosis.

4.
Plast Reconstr Surg ; 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32032342

RESUMO

OBJECTIVE: Cosmetic treatment of the forehead utilizing neuromodulators is challenging. To avoid adverse events the underlying anatomy has to be understood and thoughtfully targeted. Clinical observations indicate that eyebrow ptosis can be avoided if neuromodulators are injected in the upper forehead, despite the frontalis muscle being the primary elevator. MATERIAL AND METHODS: 27 healthy volunteers (11 males, 16 females) with a mean age of 37.5 ± 13.7 years [range: 22 - 73] and of diverse ethnicity (14 Caucasians, 4 African - American, 3 Asian, 6 Middle Eastern) were enrolled. Skin displacement vector analyses were conducted upon maximal frontalis muscle contraction to calculate magnitude and direction of forehead skin movement. RESULTS: In 100% of investigated volunteers a bi-directional movement of the forehead skin was observed: the skin of the lower forehead moved cranially whereas the skin of the upper forehead moved caudally. Both movements converged at a horizontal forehead line, termed the line of convergence or C-line. The position of the C-line relative to the total height of the forehead was 60.9% ± 10.2 in males and 60.6% ± 9.6 in females (p = 0.941). Independent of gender, the C-line was located at the second horizontal forehead line when counting from superior to inferior: males n = 2, females n = 2. No difference across ethnicities was detected. CONCLUSION: The identification of the C-line may potentially guide practitioners towards more predictable outcomes for forehead neuromodulator injections. Injections above the C-line could mitigate the risk of neuromodulator-induced brow ptosis.

5.
J Cosmet Dermatol ; 19(2): 312-320, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31922337

RESUMO

BACKGROUND: Soft tissue filler product distribution and tissue integration have been shown to depend on myriad factors including the injector type, injector size, and injection angle. AIM: This study aims to investigate the magnitude of product spread across fascial soft tissue layers in relation to product viscoelastic properties. PATIENTS/METHODS: A total of 168 injection procedures were conducted in two female Caucasian body donors with a mean age of 80 years (range: 79-81) and a mean body mass index of 23.6 kg/m2 (range: 21.0-26.6). The injection procedures were performed in the forehead, scalp, zygomatic arch, mandible, clavicle, and sternum. The injected materials included Belotero® Soft, Belotero® Balance, Belotero® Intense, Belotero® Volume, Radiesse® , and Radiesse® Plus. Layer-by-layer dissections were performed to investigate the vertical distribution of the injected product. RESULTS: The mean product spread was for Belotero® Soft 4.54 ± 0.91; Belotero® Balance 3.85 ± 1.19; Belotero® Intense 3.04 ± 1.34; Belotero® Volume 2.58 ± 1.27; Radiesse® 1.31 ± 0.47; and Radiesse® Plus 1.27 ± 0.45 with P < .001. Bivariate correlations between product spread and storage modulus (G') revealed an inverse relationship of moderate strength with rp  = -0.651 and P < .001. CONCLUSION: The results of the present study revealed that products that were more fluid and less viscous distributed into more superficial fascial layers than products that were less fluid and more viscous (P < .001). This relationship held true irrespective of injected location.

6.
J Drugs Dermatol ; 19(1): 36-44, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31985910

RESUMO

BACKGROUND: Injections of biostimulator agents are increasing in popularity as an alternative to surgical or energy-based skin tightening procedures. The present study was designed to develop a formula that helps to guide health care providers injecting biostimulators into the correct plane to enhance effectiveness and longevity by targeting precisely the superficial fascial system. METHODS: 150 Caucasian individuals (75 males and 75 females) were investigated with a balanced distribution of age (n=30 per decade: 20­29, 30­39, 40­49, 50­59, and 60­69 years) and body mass index (n=50 per group: BMI≤24.9kg/m2, BMI between 25.0 and 29.9kg/m2 BMI≥30kg/m2). The distance between skin surface and the superficial fascia was measured via ultrasound in the buccal region, premasseteric region, the lateral neck, posterior arm, abdomen, buttocks, anterior thigh, medial thigh, and posterior thigh. RESULTS: Mean thickness of the superficial fatty layer is variable between the different locations investigated with smallest values for the lateral neck of 3.71mm ± 0.55 [range, 2.00­5.00mm] and greatest values for the gluteal region with 20.52mm±10.07 [range, 6.10­38.40mm]. A formula was developed to estimate the thickness of the superficial fatty layer based on the targeted region, age, gender, and body mass index of the patient: Thickness of superficial fatty layer (mm): Region constant + (XX* BMI) - (YY*Age). CONCLUSIONS: Injections of biostimulators deeper than the calculated values might result in reduced efficacy as the superficial fascial system is not targeted and the effected collagen neogenesis does not affect the skin surface. J Drugs Dermatol. 2020;19(1):36-44. doi:10.36849/JDD.2020.4619

7.
J Cosmet Dermatol ; 19(3): 590-595, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31310047

RESUMO

BACKGROUND: It can be hypothesized that safety during soft tissue filler injection could be enhanced if the product could be positioned between the periosteum and the bone surface i.e. subperiosteal. AIM: This study investigated the feasibilityof subperiosteal injections. PATIENTS/METHODS: We analysed 126 injection procedures performed in seven Caucasian body donors (4 males, 3 females) with a mean age of 75.29 ± 4.95 years [range: 70 - 87] and a mean body mass index of 23.53 ± 3.96 kg/m2 [range: 16.46 - 32.23]. The injection procedures were performed in the forehead, scalp, zygomatic arch and the mandible bilaterally. Injection procedures were conducted using 25G, 27G and 30G sharp-tip needles (TSK Laboratory, Tochigi, Japan) and at various angles from the bone surface measured with a goniometer: 90 degrees (perpendicular), 45 degrees and 10 degrees (as tangential as possible to bone surface). RESULTS: Cadaveric dissections of the injection sites showed that no product was located deep to the periosteum in any of the investigated regions. This indicates that all performed injection procedures positioned the product superficial to the periosteum (100%) with a zero-success rate of subperiosteal injections. CONCLUSION: In the setting of this cadaveric investigation, despite varying needle size and injection angle, subperiosteal injection could not be achieved. This indicates that the product can spread uncontrolled into more superficial layers yielding an increased risk for adverse aesthetic and vascular events.

8.
J Cosmet Dermatol ; 19(2): 321-327, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31820574

RESUMO

BACKGROUND: The understanding of functional facial anatomy and the interplay between facial structures is crucial for safe and effective minimally invasive and cosmetic surgical procedures. AIM: In this experimental study, we investigate the hypothesis that smiling can alter the blood flow in the angular/facial vein. MATERIALS AND METHODS: Twenty-six observations from 15 healthy volunteers (6 men, 9 women) with a mean age of 50.53 ± 13.27 (range: 24-66) were obtained. Doppler ultrasound imaging of the infraorbital segment of the angular vein (cranial to the zygomaticus major muscle) was performed and the venous flow was measured in a smiling and a resting, nonsmiling facial position. RESULTS: A statistically significant change in venous blood flow was detected upon smiling: a reduction in flow from 6.12 ± 3.0 cm/s to 0.52 ± 1.3 cm/s (P = .001). After three seconds, 80.8% of the observations had a blood flow of 0.0 cm/s. Increasing age was significantly correlated with a persistent blood flow during smiling (rp  = .469; P = .016). No differences between gender and sides of the face were observed. CONCLUSION: The results of this experimental study reveal that smiling can significantly reduce the venous flow in the angular/facial vein. Contraction of the zygomaticus major muscle compresses the vein against the underlying maxilla. Both minimally invasive and surgical procedures that alter the SMAS, the periocular musculature or the deep midfacial fat compartments might affect angular/facial venous flow.

9.
Best Pract Res Clin Anaesthesiol ; 33(4): 447-463, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31791563

RESUMO

PURPOSE OF THE REVIEW: The purpose of this manuscript is to provide a brief discussion of the current direction in pediatric regional anesthesia, highlighting both newer nerve blocks and techniques and traditional nerve blocks. RECENT FINDINGS: The number of nerve blocks performed in pediatric patients continues to increase. This growth is likely related in part to the recent focus on perioperative multimodal analgesia, in addition to growing data demonstrating safety and efficacy in this patient population. Multiple studies by the Pediatric Regional Anesthesia Network (PRAN) and the French-Language Society of Pediatric Anesthesiologists (ADARPEF) have demonstrated lack of major complications and general overall safety with pediatric nerve blocks. The growing prevalence of ultrasound-guided regional anesthesia has not only improved the safety profile, but also increased the efficacy of both peripheral nerve blocks and perineural catheters. SUMMARY: As the push for multimodal analgesia increases and the breadth of pediatric regional anesthesia continues to expand, further large prospective studies will be needed to demonstrate continued efficacy and overall safety.

10.
J Drugs Dermatol ; 18(11): 1140-1145, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31741359

RESUMO

Introduction: Acne vulgaris is a highly prevalent skin condition that can adversely affect the quality of life. Acne-predisposed skin is in a state of subclinical inflammation leading to skin barrier dysfunction. A multi-center cohort study was designed to evaluate clinical efficacy and safety of twice daily facial cleansing using an oscillatory sonic brush, acne brush head, and cleansing gel for 4 weeks. Methods: Subjects with mild-to-moderate acne and acne-prone skin used the cleansing regime after which they applied the skin care products they routinely used. Physician-assessed skin condition comparing baseline versus week 4 using the FDA/IGA scale and subject satisfaction with cleansing efficacy and handling properties of the regime were scored during the last visit. Results: Forty-six subjects completed the study. Physician-scored skin condition showed a statistically significant improvement in FDA/IGA scores and a significant reduction of inflammatory and non-inflammatory lesions comparing baseline versus 4 weeks. Thirty-five (76.0%) subjects had cleared or almost cleared. Subjects similarly assessed their skin to be improved. Conclusion: Both the physician and subject scores revealed the gentle cleansing routine using the sonic brush to be effective reducing the number of acne lesions, improving skin condition. No adverse events were reported during the study period. The cleansing regime may offer an attractive, safe option for maintenance and treatment of subjects with mild-to-moderate acne and acne-prone skin. J Drugs Dermatol. 2019;18(11):1140-1145.


Assuntos
Acne Vulgar/terapia , Detergentes/administração & dosagem , Dermatoses Faciais/terapia , Higiene da Pele/instrumentação , Adulto , Estudos de Coortes , Feminino , Géis , Humanos , Masculino , Resultado do Tratamento , Estados Unidos
11.
J Drugs Dermatol ; 18(9): 896-902, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524345

RESUMO

OBJECTIVE: Vascular events are among the most dreaded complications of safe soft tissue filler injections. The aim of the present study is to present a practical guide for regional facial soft tissue filler injections, which is founded in anatomy and considers safety as its first priority. MATERIAL AND METHODS: The study sample consisted of 20 fresh (non-embalmed) hemi-faces from 10 Caucasian body donors (7 females, 3 males) with a mean age of 83.5±6.8 years and a mean BMI of 25.3±4.3 kg/m2. Injections of the upper, middle and lower faces of the body donors were performed using a commercially available hyaluronic acid based soft tissue filler. RESULTS: The results of the layer by layer dissections revealed that the injected material was separated from crucial neuro-vascular structures by fascial and/or muscular planes, which were not permeated by the product. Utilizing a single cutaneous access point per facial region, safe planes can be reached. CONCLUSION: This study provides a practical guide for safe soft tissue filler injections for the upper, middle, and lower face. Using cadaveric dissections and dyed product revealed that the targeted facial planes are separated either by fascial planes or by muscular tissue from arterial vasculature. J Drugs Dermatol. 2019;18(9):896-902.


Assuntos
Técnicas Cosméticas/normas , Preenchedores Dérmicos/efeitos adversos , Face/irrigação sanguínea , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Preenchedores Dérmicos/administração & dosagem , Dissecação , Embalsamamento , Feminino , Humanos , Injeções Subcutâneas/efeitos adversos , Masculino , Pele/irrigação sanguínea
12.
J Cosmet Dermatol ; 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31402563

RESUMO

BACKGROUND: The arrangement of the facial soft tissue layers is different with respect to the line of ligaments: medially oblique and laterally in parallel. AIMS: This split-face study was designed to investigate the effects on midfacial volumization if the same medial vs lateral injection points are targeted in various sequences. METHODS: Twelve patients (3 males, 9 females; 46.67 years ± 4.5) were included in this interventional study. On the right side of the face, lateral injection points were performed first, whereas on the left side, medial injection points were executed first. The infraorbital hollowness score, the upper cheek fullness score, the global aesthetic improvement scale, and the injected volume were assessed. RESULTS: No side differences were observed after the intervention with P = 1.00 for all scores. When the lateral injection points were performed first, the volume injected into the medially located injection points (0.46 ± 0.26 cc vs 0.73 ± 0.31 cc [P = .037]), into the lateral injection points (0.79 ± 0.40 cc vs 1.15 ± 0.28 cc [P = .017]), and overall (1.26 ± 0.64 cc vs 1.88 ± 0.57 cc [P = .02]) was significantly reduced. CONCLUSION: The results of the present study emphasize the importance of respecting the layered arrangement of the facial soft tissues when performing minimally invasive soft tissue filler injections. Targeting injection points lateral to the line of ligaments first reduces the volume needed to symmetrically and aesthetically appealing manner and volumizes the infraorbital and upper cheek regions.

13.
J Cosmet Dermatol ; 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31282119

RESUMO

OBJECTIVE: Neuromodulator injections of the forehead are often performed using standardized protocols. This study was designed to identify the individual skin motion pattern of the forehead and to relate this pattern to the underlying frontalis muscle morphology to offer guidance for neuromodulator placement. MATERIAL AND METHODS: Thirty-seven healthy volunteers (29 Caucasians, six African Americans, two Asians) with a mean age of 39.84 ± 14.4 years [range: 22-73] were enrolled. 3D images of the forehead were analyzed using a Vectra H1 camera system computing skin displacement vectors between the noncontracted and the maximally contracted forehead of the volunteers. Relationships between the shape of the horizontal forehead lines (straight vs wavy) and the forehead motion pattern were calculated. RESULTS: Independent of age or gender, a greater forehead motion angle was associated with the presence of wavy forehead lines 21.34°± 5.9 with P < 0.001, whereas straight forehead lines were associated with a smaller forehead motion angle 6.68°± 2.9 P < 0.001. Females had more frequently straight horizontal forehead lines versus males: 68.4% vs 44.4% (P = 0.037). Young volunteers (<39.8 years) did not differ in their mean forehead motion angle when compared to older volunteers (>39.8 years): 13.70°± 9.0 vs 12.39°± 8.0 with P = 0.530. CONCLUSION: Injections of neuromodulators in the forehead can be individualized by respecting the shape of the horizontal forehead lines. Wavy lines require injection points that are located more laterally, whereas straight lines require more centrally located injection points.

14.
J Cosmet Dermatol ; 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31282607

RESUMO

BACKGROUND: Soft tissue filler injections are performed using either sharp-tip needles or blunt-tip cannulas. Product can change planes in an uncontrolled manner during needle injections, potentially leading to unintentional intra-arterial placement. There is a paucity of data on the influence of injection angle on the dispersion patterns of soft tissue fillers. MATERIALS AND METHODS: A total of 126 injection procedures were conducted in seven Caucasian body donors (four males, three females) with a mean age of 75.29 ± 4.95 years and a mean body mass index of 23.53 ± 3.96 kg/m2 . Injection procedures were performed in various facial regions (forehead, scalp, zygomatic arch, mandibular angle), utilizing different needle sizes (25G, 27G, 30G) and different angles (90°, 45°, 10°). Layer-by-layer dissections were performed to verify the location of the injected product. Dissections were facilitated by the colored material. RESULTS: Utilizing a 30G needle (compared to a 25G needle) reduces the superficial spread with OR 0.70 (95% CI, 0.48-0.99) and P = 0.049, whereas injecting at 90° (vs 10° with the bevel down) increases the odds for superficial spread with OR 10.0 (95% CI, 7.11-14.09) and P < 0.001. CONCLUSION: Precision during soft tissue filler injections, defined as the product remaining in the plane of intended implantation, can be enhanced by changing the needle size and the injection angle. Utilizing a 30G needle and injecting at a 10° angle with bevel facing down reduces the uncontrolled product distribution into superficial fascial layers.

15.
Dermatol Surg ; 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31318826

RESUMO

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.

16.
Curr Pain Headache Rep ; 23(7): 49, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31209656

RESUMO

PURPOSE OF REVIEW: Well-informed staff can help decrease risks and common misconceptions regarding opioid-tolerant patients, especially those taking methadone. RECENT FINDINGS: In 2015, opioid pain relievers were the second most used drug at 3.8 million. Overdose death was three times greater in 2015 than in 2000. Medication-assisted treatment was sought by more than 2 million individuals with substance use disorder, one of which is methadone. Chronic pain affects millions of adults in the USA. Opioid therapy is widely used among these adults. Related to the risk of abuse and dependence, guidelines suggest that opioid therapy may not be considered first-line treatment. A multidisciplinary approach, including thorough preoperative evaluation, the utilization of multimodal pain management strategies, and opioid-sparing techniques in both the intraoperative and postoperative periods will allow for the best possible outcome.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Buprenorfina/uso terapêutico , Humanos , Metadona/efeitos adversos , Manejo da Dor/métodos
17.
J Drugs Dermatol ; 18(6): 533, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31251545

RESUMO

Objective: The aim of the present study is to compare the temporal surface volume coefficient obtained in the cadaveric model from subdermal and supraperiosteal injections to the clinical setting when treating temporal hollowing. Material and Methods: A total of 36 subjects were included in this investigation, 17 patients (16 females, 1 male; 46.3 ± 8.9 years; 25.5 ± 2.8 kg/m2) and 19 cadaveric specimens (11 females, 8 males; 76.4 ± 11.5 years; 24.0 ± 5.1 kg/m2). Subdermal and supraperiosteal injections were performed and live subjects were evaluated and followed for 12 months. The surface volume coefficients were calculated using 3D surface volume scanning and compared for validity. Results: No statistically significant difference was detected between the clinical outcome scores of the subdermal vs supraperiosteal injection technique. The supraperiosteal injection technique utilized significantly more product 1.20 ± 0.5 cc [range: 0.50 ­ 2.6 cc] compared to the subdermal 0.71 ± 0.2 cc [range: 0.30 ­ 1.20 cc] vs with P< 0.001. This difference was consistent with the different values of the cadaveric surface volume coefficient (subdermal vs supraperiosteal): 1.00 ± 0.2 vs 0.70 ± 0.2. At 12-month follow-up, the product loss was 19% for the subdermal injection and 21% for patients treated with supraperiosteal injections. Conclusion: The results of the study support the clinical validity of the surface volume coefficient. They demonstrate that the different injection volumes necessary to deliver aesthetically appealing results when utilizing the subdermal vs the supraperiosteal technique can be explained by the region-specific surface volume coefficient. J Drugs Dermatol. 2019;18(6):533-540.


Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos/administração & dosagem , Face/anatomia & histologia , Injeções Subcutâneas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Estética , Face/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Rejuvenescimento , Pele , Envelhecimento da Pele , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Plast Reconstr Surg ; 144(1): 83-92, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246807

RESUMO

BACKGROUND: The deep intramuscular approach during buttock augmentation with fat grafting has been associated with a significantly increased risk for pulmonary fat embolism. This study was designed to provide guidance for injection into the subcutaneous fat. METHODS: The authors investigated 150 Caucasian individuals with an equal distribution of men and women (n = 75 each) and a balanced distribution of age (n = 30 per decade: 20 to 29, 30 to 39, 40 to 49, 50 to 59, and 60 to 69 years) and body mass index (n = 50 per group: ≤24.9 kg/m, between 25.0 and 29.9kg/m, and ≥30 kg/m). Ultrasound-based measurements were conducted of the thickness of the total, superficial, and deep gluteal fatty layers. RESULTS: An increase in body mass index of 1.0 kg/m corresponded to an increase of 3 mm of the total gluteal subcutaneous fat of men and a 4-mm increase of the total gluteal subcutaneous fat in women. With increasing age, the thickness of the deep fatty layer increased, whereas with increasing body mass index the thickness of the superficial layer primarily increased. Formulas were generated to estimate the total thickness of the gluteal subcutaneous fatty layer for men [total thickness (in millimeters) = -33.56 + (age × 0.078) + (body mass index × 3.042)] and women [total thickness (in millimeters) = -56.997 + (age × 0.1) + (body mass index × 3.86)]. CONCLUSIONS: Knowing the total thickness of the gluteal subcutaneous fat (i.e., the safe space) allows surgeons to estimate their operating range for cannula motion even if no ultrasound machine is available during buttock augmentation with fat grafting. This can increase safety, potentially reducing the number of adverse events.


Assuntos
Envelhecimento/fisiologia , Contorno Corporal , Nádegas/anatomia & histologia , Caracteres Sexuais , Gordura Subcutânea/anatomia & histologia , Adulto , Idoso , Índice de Massa Corporal , Nádegas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
J Anaesthesiol Clin Pharmacol ; 35(Suppl 1): S14-S23, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31142954

RESUMO

Enhanced recovery pathways are a novel approach focused on enhancing the care of surgical patients. "Prehabilitation" is the term applied to any intervention administered before surgery to reduce surgery-related morbidity, decrease the length of hospital stay, expedite the return of organ function, and facilitate the patient's return to normal life. A PubMed search was performed with the following key words: enhanced recovery, preoperative preparation, cessation of smoking and euvolemia. The results from this Pubmed search revealed that female patients may have higher levels of anxiety than male patients. Intensive smoking and alcohol cessation 6-8 weeks before elective surgery may reduce the incidence of postoperative morbidity. Preoperative exercise can be effective for reducing the postoperative complications like pulmonary complications and shortening the length of hospital stay. It is safe to allow patients to drink clear fluids up until 2 h before elective surgery (Level II evidence). Perioperative normoglycemia is the single most important factor to prevent surgical site infection. Intermittent pneumatic compression devices and low molecular weight heparin are effective in preventing postoperative thromboembolism. No advantage is gained by preoperative mechanical bowel preparation in elective colorectal surgery. The goal of preoperative fluid management is for the patient to arrive in the operating room in a hydrated and euvolemic state. Mild perioperative hypothermia may promote surgical wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension.

20.
Pain Ther ; 8(1): 5-18, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31037504

RESUMO

Thoracic outlet syndrome, a group of diverse disorders, is a collection of symptoms in the shoulder and upper extremity area that results in pain, numbness, and tingling. Identification of thoracic outlet syndrome is complex and a thorough clinical examination in addition to appropriate clinical testing can aide in diagnosis. Practitioners must consider the pathology of thoracic outlet syndrome in their differential diagnosis for shoulder and upper extremity pain symptoms so that patients are directed appropriately to timely therapeutic interventions. Patients with a definitive etiology who have failed conservative management are ideal candidates for surgical correction. This manuscript will discuss thoracic outlet syndrome, occurrence, physical presentation, clinical implications, diagnosis, and management.

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