Soft-tissue augmentation with hyaluronic acid and calcium hydroxyl apatite fillers.

Soft-tissue augmentation with hyaluronic acid and calcium hydroxyl apatite are among the most widely used minimally invasive cosmetic treatments for the correction of contour deficiencies and wrinkles of the face without the risk, recovery time, and expense of a major surgery. Training and experience in the art and science of fillers is essential for the successful creation of a more youthful and natural appearance. An understanding of the different products, the injection techniques, the indications, and the potential complications of each filler are paramount to success.

Treatment of HIV lipoatrophy and lipoatrophy of aging with poly-L-lactic acid: a prospective 3-year follow-up study.

BACKGROUND: Poly-L-lactic acid (PLLA), marketed as Sculptra (Dermik Laboratories, Bridgewater, NJ), is used for subcutaneous volume restoration. Durability studies are ongoing and longevity data are not yet available. OBJECTIVE: We sought to evaluate the long-term efficacy and safety of PLLA during 3 years of follow-up. METHODS: We conducted a prospective cohort study. Primary outcome measures were facial lipoatrophy score, complications, and patient satisfaction. RESULTS: In all, 65 patients were initially treated with PLLA; 27 patients were HIV positive and 38 were HIV negative. Of those patients, 12 were lost to follow-up. Both HIV-positive and HIV-negative patients demonstrated statistically significant improvement in facial lipoatrophy score at the end of 3 years; HIV-positive patients had a net improvement of 2.50 points (P < .01) and HIV-negative patients had a net improvement of 1.11 points (P < .01) on the Facial Lipoatrophy Grading Scale. Subgroup analyses revealed no statistically significant difference in facial lipoatrophy score between years 2 and 3 among patients who did not receive treatment during the third year. Complications were rare and included subcutaneous papule formation, which improved spontaneously and partially responded to subcision in one patient. LIMITATIONS: Sample size was limited in this study. In addition, 12 of 65 patients (18%) were lost to follow-up between years 2 and 3. CONCLUSIONS: PLLA provides volumetric correction of HIV lipoatrophy and lipoatrophy of aging. Results appear to be long lasting and correction can be maintained for up to 3 years with additional treatment sessions. In a subset of patients, correction is maintained for at least 1 year after their last treatment session. Patient satisfaction with PLLA is high.

Expanded polytetrafluoroethylene implants for soft-tissue augmentation: 5-year follow-up and literature review.

BACKGROUND: Expanded polytetrafluoroethylene implants have been used successfully for augmentation of thinning lips, deep nasolabial folds, and marionette lines without the risk, recovery time, and expense of major surgery. OBJECTIVE: The objective was to assess long-term results and patient satisfaction with expanded polytetrafluoroethylene implants. MATERIALS AND METHODS: A retrospective chart review was performed on all patients treated with expanded polytetrafluoroethylene implants from January 1, 2001, to July 1, 2002. RESULTS: Eighty-five implants were placed in 33 patients. Forty-six percent of implants were placed in the nasolabial folds, 34% in the lips, 16.5% in the marionette lines, 2% in the oral commisures, and 1% in the glabella. Eighty-seven percent of implants remain in place with excellent correction. Eleven implants in 6 patients were removed. Four of the 11 implants removed were considered too small by the patient and were replaced with larger implants without difficulty. The other reasons for implant removal included malposition, localized swelling, and an unnatural feel. Patient and physician satisfaction with the treatment was high. CONCLUSION: Expanded polytetrafluoroethylene implants are a safe, effective, and permanent option for facial volume augmentation. Patients who have had their implants in place for 5 years or more continue to report high satisfaction with the treatment. The authors have indicated no significant interest with commercial supporters.

Case reports: clearance of lentigines in Japanese men with the long-pulsed alexandrite laser.

Benign pigmented lesions can be effectively treated with multiple modalities including lasers. The treatment of pigmented lesions in phototype IV skin is more complicated and challenging given the risk of pigmentation changes and scarring. We present the novel use of the long-pulsed Alexandrite 755 nm laser for the treatment of solar lentigines in sun-reactive phototype IV skin of patients of Japanese decent. Our Japanese patients cleared with one treatment with no pigmentary changes or scarring. No recurrences were noted to date. The long-pulsed Alexandrite 755-nm laser is a novel, safe, and effective treatment of solar lentigines in Japanese patients.

A new combination technique of local anesthesia for full-face dermabrasion.

We present a safer, more efficient, and more effective technique for full-face dermabrasion utilizing a combination of regional nerve block anesthesia, refrigerant spray cryoanesthesia, and local infiltration anesthesia. This combination provides a pain-free procedure with little to no discomfort for the patient while avoiding the risks of intravenous sedation or general anesthesia.

Safety and efficacy of poly-L-lactic acid in HIV lipoatrophy and lipoatrophy of aging.

BACKGROUND: Poly-L-lactic acid (PLLA) is an injectable filler used for the treatment of facial fat loss secondary to HIV and aging. The U.S. FDA approved PLLA for the treatment of HIV lipoatrophy in August 2004. OBSERVATIONS: Sixty-five patients were treated with PLLA; 27 were HIV positive and 38 were HIV negative. The HIV patients had more severe facial lipoatrophy at presentation and improved more given their level of severity. The HIV positive patients required more treatment sessions and more PLLA to reach full correction than the non-HIV patients. Ninety-four percent of all patients had no complications and the effects of PLLA were similar in both groups. All complications were temporary and resolved over time. Patient satisfaction metrics indicated that all patients were "very satisfied" with their treatment. The HIV lipoatrophy patients indicated marked quality of life improvement. CONCLUSIONS: PLLA is a safe, efficacious, and satisfying treatment for facial fat loss associated with HIV and aging.

Topical photodynamic therapy for dermatologic disorders: results and complications.

BACKGROUND: Topical photodynamic therapy (PDT) involves the use of a photosensitizing topical medication that is activated by a light source in the presence of oxygen leading to cellular destruction and subsequent photorejuvenation. In 1999, the US FDA approved PDT for the treatment of nonhyperkeratotic actinic keratoses (AKs) on the face and scalp. OBSERVATIONS: The study population comprised 85 patients treated with short-contact, topical aminolevulinic acid (ALA)-PDT for a total of 247 treatments. Ninety percent of patients with a variety of dermatologic disorders had significant improvement or total clearance. Ninety-eight percent of patients had no complications. Only 2 patients in our series had a significant complication. CONCLUSIONS: Short-contact, topical ALA-PDT is a safe and effective treatment for a variety of dermatologic disorders including photoaging and AKs.

Need For Improved Skin Cancer Surveillance in Pediatric Cancer Survivors.

Survivors of pediatric cancer are at increased risk of developing secondary malignancies, with non-melanoma skin cancer being the most common. These patients are also at increased risk of melanoma. Currently, guidelines provided by the National Cancer Institute and Children's Oncology Group emphasize the importance of annual clinical examination for skin cancer screening; however, the literature reports that less than one-third of survivors of pediatric cancer have ever had a clinical skin exam by a physician. In this article, we review the risk factors for skin cancer in survivors of pediatric cancer as well as the current evidence and recommendations for their care. We suggest that dermatologists collectively establish guidelines for skin cancer surveillance in survivors of pediatric cancer.

Atypical Mycobacterium furunculosis occurring after pedicures.

Mycobacterium fortuitum complex are rapidly-growing nontuberculous mycobacteria found ubiquitously in the environment including, water, soil, dust, and biofilms. M fortuitum has been reported to cause skin and soft-tissue infections in association with nail salon footbath use during pedicures. Four cases of M fortuitum complex furunculosis are reported that occurred after pedicures in the Cincinnati, Ohio/Northern Kentucky area. Dermatologists and clinicians should consider mycobacterial infections from the M fortuitum complex when patients present with nonhealing furuncles on the lower legs and should inquire about recent pedicures. Early recognition and institution of appropriate therapy are critical. Public health measures should be explored to protect against such infections, given the recent popularity of the nail care industry.

Ominous Skin Lesion or Benign Sports-Related Imposter? The Most Common 'Don't Miss' Diagnoses.

Sports participants of all skill levels may develop sport-specific skin problems. Many skin disorders in athletes can mimic other potentially serious dermatologic entities that can be manifestations of musculoskeletal conditions, infections, inflammatory conditions, or carcinomas. Also, some skin conditions can alert the sports physician to look for possible anabolic steroid abuse. Physicians who are familiar with the relationship between the specific activities of various sports and skin disorders common to athletes will be able to properly diagnose, manage, and treat these conditions and educate players to prevent further injury.

Multiple juvenile xanthogranulomas in a 13-year-old.

A 13-year-old Caucasian girl presented with a 1(1/2) month history of multiple, asymptomatic, discrete, orange-yellow to skin-colored, dome-shaped, smooth, 3 to 6 mm papules on the arms, legs, trunk, and buttock. Pathology showed a dermal infiltrate of Touton-type giant cells, scattered lymphocytes, and macrophages. The patient was diagnosed with juvenile xanthogranuloma. We present this patient because of the uncommon presentation of multiple juvenile xanthogranulomas in a 13-year-old. Although juvenile xanthogranuloma generally occurs in infancy, it must be included in the differential diagnosis for an older child. This entity can less frequently occur in adults and typically a solitary lesion is found. Multiple juvenile xanthogranuloma is rare in older children and adults. Work-up should include a thorough review of systems, physical examination, and ophthalmology examination. Pediatricians and dermatologists should be aware that juvenile xanthogranulomas might occur in older children.