Incidence of complications and early recurrence in 29 patients after facial rejuvenation with barbed suture lifting.

BACKGROUND: Barbed suture lifting is a minimally invasive procedure for rejuvenation of the aging face. Few studies have examined its efficacy and associated risks. OBJECTIVES: To evaluate the morbidity associated with this procedure and its long-term effects. METHODS AND MATERIALS: A retrospective review of 29 cosmetic patients who underwent thread lifting was conducted. A chart review provided information on patient demographics, surgical technique, and postoperative course. RESULTS: Analysis demonstrated that adverse events occurred in 69% and early recurrence in 45% of the patients in the study group. The incidence remained high upon extraction of independent variables, including technique used, location of thread placement, and number of threads placed. CONCLUSIONS: Indications for performing minimally invasive cosmetic surgery include obtaining outcomes comparable with those of an established widely used criterion standard. The goal for new procedures should be to deliver predictable long-term results while providing less morbidity, less downtime, and greater patient satisfaction. The results of this study indicate that the barbed suture lift was unable to accomplish these goals. This study also reflects the importance of a critical review of the ever-expanding options available to aesthetic surgeons.

Mesothelial Stem Cells and Stromal Vascular Fraction for Skin Rejuvenation.

The use of stem cells in regenerative medicine and specifically facial rejuvenation is thought provoking and controversial. Today there is increased emphasis on tissue engineering and regenerative medicine, which translates into a need for a reliable source of stem cells in addition to biomaterial scaffolds and cytokine growth factors. Adipose tissue is currently recognized as an accessible and abundant source for adult stem cells. Cellular therapies and tissue engineering are still in their infancy, and additional basic science and preclinical studies are needed before cosmetic and reconstructive surgical applications can be routinely undertaken and satisfactory levels of patient safety achieved.

Increases in spontaneous neural activity in the hamster dorsal cochlear nucleus following cisplatin treatment: a possible basis for cisplatin-induced tinnitus.

Recent investigations in the hamster have implicated increased spontaneous activity (SA) in the dorsal cochlear nucleus (DCN) as a contributing factor in the etiology of tinnitus induced by intense sound exposure. It might therefore be expected that increased SA would also develop in the DCN of hamsters treated with cisplatin, another cause of tinnitus. We tested this hypothesis by measuring the effects of cisplatin on SA in the DCN. Adult hamsters were divided into three groups, each receiving five injections of cisplatin at one of the following doses: 3 mg/kg, 2.25 mg/kg, or 1.5 mg/kg. Each group had corresponding controls receiving injections of isotonic saline. The effects of cisplatin were studied electrophysiologically 1 month after treatment by recording multiunit SA on the surface of the DCN. Measurements of SA were obtained in three rows of 13-15 locations spaced roughly 100 microm apart and spanning the length of the DCN along the tonotopic axis. Effects of cisplatin were evaluated by comparing plots of mean SA vs. tonotopic locus for cisplatin-treated groups with those of their corresponding untreated control groups. The results demonstrated a consistently higher level of SA in cisplatin-treated groups than in untreated controls. Whereas the highest rates of mean SA in control groups were between 10 and 15 events/s, the highest mean spontaneous rates in cisplatin-treated groups were between 25 and 38 events/s. The cisplatin-induced hyperactivity was greatest in the medial half of the DCN corresponding to the high frequency portion of the tonotopic range. These results suggest that cisplatin treatment is an effective inducer of hyperactivity in the DCN. This hyperactivity may be an important neural correlate of cisplatin-induced tinnitus.

Skin rejuvenation regimens: a profilometry and histopathologic study.

OBJECTIVE: To quantitatively examine the effects of skin rejuvenation regimens in treating photodamaged skin. METHODS: Fourteen patients with photodamaged skin were considered for analysis. Skin rejuvenation regimens were as follows: (1) 10 weeks of treatment with topical 0.05% tretinoin emollient cream, (2) 10 weeks of treatment with 0.05% tretinoin emollient cream and topical ascorbic acid lotion, (3) 6 superficial trichloroacetic acid peels, and (4) a combination of the topical treatments and superficial peels. Comparisons of the treatments were analyzed using profilometry and histologic findings. RESULTS: Profilometry analysis provided quantification of the changes from each treatment group and among the treatment programs. Each group showed improvements from baseline. Trichloroacetic acid peels combined with application of the topical products improved skin topography to a greater extent than the less aggressive regimens. Histologic changes correlated well with the skin replica findings. CONCLUSIONS: A 10-week skin rejuvenation regimen objectively improved photodamaged facial skin. Significant changes are noted when combining topical treatments with superficial peels. Hence, use of a combination of trichloroacetic acid peels, 0.05% tretinoin emollient cream, and ascorbic acid lotions is well tolerated and superior to either component alone as part of a comprehensive skin care and sun protection program.

Relationship of energy settings and impedance in different anatomic areas using a radiofrequency device.

BACKGROUND: Radiofrequency (RF) used for volumetric heating into the deep dermis has been used effectively for rejuvenation of the face. The delivery of the RF energy depends on several variables, including the electrical impedance of the underlying tissue. OBJECTIVE: To describe the effects of impedance on energy delivery into the treated site. MATERIALS AND METHODS: We report four patients who underwent treatment using the ThermaCool TC system (Thermage, Inc, Hayward, CA, USA). Five sites on each patient were selected for impedance evaluation at two treatment levels. RESULTS: Impedance levels varied only slightly between treatment levels. The impedance levels varied greatly between patients and from site to site in each patient. The impedance levels for each of the patients were greatest on the arm, followed by the forehead, cheeks, and back. CONCLUSION: Energy delivery to a treated area is directly related to the impedance of the tissue. The impedance is shown to vary by site and can be changed by manipulation of the tissue, such as by injection of local anesthesia. Alteration of the impedance may have an effect on the uniform delivery of the selected energy.

Resolution of retracted scar after 585-nm pulse dye laser surgery.

BACKGROUND: Laser scar revision has been an effective method for improving several aspects of scarring through ablative and non-ablative sources. The 585-nm pulsed dye laser (PDL) is an important non-ablative instrument for reducing scar bulk and symptoms. OBJECTIVE: To describe the use of a 585-nm PDL for the treatment of a retracted and atrophic facial scar. METHODS: We report the case of a 26-year-old patient who presented with a retracted facial scar following surgical excision of an aggressive benign tumor. Treatment was carried out using the 585-nm PDL. RESULTS: Treatment of the scar using two low-level PDL therapies significantly altered the appearance of the scar and augmentation of the retracted defect was avoided. CONCLUSION: Treatment of this retracted and atrophic facial scar with the 585-nm PDL was very effective and safe.

Valacyclovir prophylaxis for herpes simplex virus infection or infection recurrence following laser skin resurfacing.

BACKGROUND: The CO2 laser for cutaneous resurfacing has been associated with the reactivation of herpes simplex virus (HSV), causing delayed reepithelialization and scarring. Antiviral agents appear to be effective in reducing reactivation, however, the optimal therapeutic regimen has yet to be clearly defined. OBJECTIVE: To assess the reactivation rates of HSV after CO2 laser resurfacing in patients who received prophylactic valacyclovir for either 10 or 14 days. METHODS: One hundred twenty patients received valacyclovir 500 mg twice a day for either 10 or 14 days starting the day prior to facial laser resurfacing. Serology levels and consecutive Tzank preparations were obtained to determine past exposure to HSV and the presence of virus. RESULTS: No patients in either group developed an HSV infection or had a recurrence. CONCLUSION: These results support the use of valacyclovir in a 10- or 14-day regimen as a preventive agent against HSV outbreaks following facial laser resurfacing.

Cisplatin-induced hyperactivity in the dorsal cochlear nucleus and its relation to outer hair cell loss: relevance to tinnitus.

Cisplatin causes both acute and chronic forms of tinnitus as well as increases in spontaneous neural activity (hyperactivity) in the dorsal cochlear nucleus (DCN) of hamsters. It has been hypothesized that the induction of hyperactivity in the DCN may be a consequence of cisplatin's effects on cochlear outer hair cells (OHCs); however, systematic studies testing this hypothesis have yet to appear in the literature. In the present investigation, the relationship between hyperactivity and OHC loss, induced by cisplatin, was examined in detail. Hamsters received five treatments of cisplatin at doses ranging from 1.5 to 3 mg. kg(-1). day(-1), every other day. Beginning 1 mo after initiation of treatment, electrophysiological recordings were carried out on the surface of the DCN to measure spontaneous multiunit activity along a set of coordinates spanning the medial-lateral (tonotopic) axis of the DCN. After recordings, cochleas were removed and studied histologically using a scanning electron microscope. The results revealed that cisplatin-treated animals with little or no loss of OHCs displayed levels of activity similar to those seen in saline-treated controls. In contrast, the majority (75%) of cisplatin-treated animals with severe OHC loss displayed well-developed hyperactivity in the DCN. The induced hyperactivity was seen mainly in the medial (high-frequency) half of the DCN of treated animals. This pattern was consistent with the observation that OHC loss was distributed mainly in the basal half of the cochlea. In several of the animals with severe OHC loss and hyperactivity, there was no significant damage to IHC stereocilia nor any observable irregularities of the reticular lamina that might have interfered with normal IHC function. Hyperactivity was also observed in the DCN of animals showing severe losses of OHCs accompanied by damage to IHCs, although the degree of hyperactivity in these animals was less than in animals with severe OHC loss but intact IHCs. These results support the view that loss of OHC function may be a trigger of tinnitus-related hyperactivity in the DCN and suggest that this hyperactivity may be somewhat offset by damage to IHCs.