[Lessons on reactions to aesthetic fillers]. / Leçons sur les réactions aux produits de comblement à visée esthétique.

Any product injected to fill wrinkles can behave like a foreign body and cause unsightly granulomatous reactions. The subject is constantly evolving, subject to the vagaries of the market. Hyaluronic acid is the most injected product because it is resorbable and probably the least "toxic". In the event of sarcoidosis or an immune disorder, and in the event of vaccination against Covid, granulomas can develop even after very old injections.

[Effectiveness and interest of retrobulbar hyaluronidase injections in the treatment of blindness complicating facial hyaluronic acid injections: A literature review]. / Efficacité et intérêt des injections rétrobulbaires de hyaluronidase dans le traitement des cécités compliquant une injection faciale d'acide hyaluronique : revue de la littérature.

INTRODUCTION: Hyaluronic acid injections are becoming increasingly common among both the general public and the medical community, but they are not without risks. The occurrence of blindness, although rare, is a tragic event for both the patient and the practitioner. One of the treatments proposed in the literature is to inject hyaluronidase as close as possible to the site of ischemia, retrobulbarly. The aim of our study is to evaluate the effectiveness and potential benefits of retrobulbar hyaluronidase injections. MATERIALS AND METHODS: A literature review was conducted using the PubMed database. Only articles addressing retrobulbar hyaluronidase injections for the treatment of blindness following hyaluronic acid injections were included. RESULTS: We identified 12 case reports or series, comprising a total of 16 patients. Among these 16 patients, 3 regained their vision. Hyaluronidase was injected between 20minutes and 7days after the onset of the complication, with injected doses ranging from 3×150IU to 3×1500IU. DISCUSSION: Literature reveals only 3 cases of successful treatment out of the 16 reported injections. The time interval before retrobulbar injection, as well as the dose and the experience of the injecting practitioner, may influence the success rate of this treatment. Other treatments, such as intravascular hyaluronidase injections, remain to be explored.

Surgical rhinoplasty after prior hyaluronic acid based nose remodeling.

BACKGROUND: Medical rhinoplasty by hyaluronic acid injection (HA) has become nowadays a common practice. The number of patients requesting surgical rhinoplasty and having already undergone one or more injections of HA is increasing. However, the literature lacks publications regarding the management of these patients. OBJECTIVES: The aim of this study is to discuss the management of patients who have been treated with previous nasal HA injections and who seek surgical rhinoplasty, and elaborate a treatment protocol and algorithm to standardize surgical plans. METHODS: We are reporting case studies based on our clinical experience. We also reviewed the literature to suggest perioperative management for rhinoplasty with previous HA injections. RESULTS: Hyaluronidase injection preoperatively allows to carry out an accurate preoperative analysis of the nasal deformities to treat, in order to make an adapted treatment plan. Postoperative course is similar to other rhinoplasty cases without the use of this enzyme. CONCLUSION: Hyaluronidase should be used in all patients with nasal injections of HA (unless contraindications), who are willing to undergo a surgical rhinoplasty. The operation can be undertaken at one-week interval as soon as the edema subsides and no further treatments are necessary.

[Restoration of the labial barcode by simultaneous "one shot" injection of botulinum toxin-hyaluronic acid in the same syringe]. / Restauration du code barre labial par injection simultanée « one shot ¼ toxine botulique-acide hyaluronique dans une même seringue.

The purpose of this technique is to offer patients wishing a labial restoration without morphological changes a simple, fast, discreet, comfortable, adaptable and reversible method by combining the two compounds most used in aesthetic medicine, botulinum toxin and hyaluronic acid. The originality of this combination is based on their mixing in the same syringe and their injection with cannula through a paracommissural approach which makes it possible to treat the entire upper lip in a very homogeneous manner. Botulinum toxin diffuses directly into the underlying muscle layer; hyaluronic acid allows to unfold the damaged cutaneous fan. The useful reciprocal dose of the two products remains intuitive; for starting barcodes the dose of botulinum toxin will be 8-10 Speywood units (4 Allergan units), for those already marked at rest 10-20 Speywood units (4-8 Allergan units); the hyaluronic acid will be chosen according to the depth of the wrinkles. We present a series of 63 patients with an average age of 67 years with a result deemed positive in 79% of cases. The incidents reported are generally due to excessive doses of botulinum toxin which can lead to the classic incidents of fluid leaks in this location (6%). The expected efficacy of the treatment depends on that of the components used (four to six months) but prolonged results have been regularly observed (up to 18 months). All complementary resurfacing treatments have been discarded here since the aim pursued is that of a natural labial restoration allowing an immediate return to socio-professional activities.

Self-injection: Inescapable DIY and real danger? A case study and literature review.

Aesthetic medicine is booming, and expanding Internet delivery is not controlled by health authorities. More than ever, conditions are thus favorable for patient self-injection. We present the case of a 45-year-old woman self-injected in breast with hyaluronic acid purchased on the Internet. She developed a bilateral breast infection treated with antibiotic treatment. Despite the ban on the use of filler in the breast by our health authorities since 2011, we will talk about the management of this type of patient. In light of this complication, we will discuss the public health issue raised by the development of the injectable products market. We wish to emphasize in France the emergency of establishing a strict legal framework for the use of fillers.

Acide hyaluronique intra articulaire dans la gonarthrose: une étude long-terme, ouverte, de Phase IV, avec analyse détaillée par stade de Kellgren-Lawrence.

INTRODUCTION: Les injections intra articulaires (IA) d'acide hyaluronique (HA) désignées sous le nom de viscosupplémentation (VS), sont fréquemment utilisées dans le traitement symptomatique de la gonarthrose (OA), une affection ostéo-articulaire chronique douloureuse et handicapante, qui touche une fraction importante de la population âgée. La sévérité de la gonarthrose est en général décrite par la classification en stades radiologiques de Kellgren-Lawrence (KL). La VS a été largement étudiée à travers de nombreux essais cliniques; cependant, les résultats sont rarement analysés en détail, en fonction du stade KL. MÉTHODE: Une étude ouverte importante, portant sur 1 177 patients souffrant de gonarthrose, fut réalisée de 2004 à 2007. Chaque patient a reçu un traitement de VS consistant en 3 injections d'ARTHRUM H 2% (LCA Pharmaceutical, Chartres, France). A l'inclusion, les patients ont été décrits par leur profil démographique, leur indice de masse corporelle (IMC), leur stade KL et leur état clinique selon les sous-scores douleur et fonction de l'indice Western Ontario and McMaster Universities (WOMAC). Les visites de suivi étaient à M3, M6 et M9 (mois) après la VS. Cette large base de données a été entièrement retraitée en 2019, de manière à fournir une analyse séparée par stade KL, et fut complétée par l'évaluation des taux de patients répondeurs (%) au traitement, selon l'Outcome Measures in Rheumatoid Arthritis Clinical Trials & Osteoarthritis Research Society International (OMERACT-OARSI). L'analyse fut menée à la fois sur les populations en intention de traiter (ITT) et per protocole (PP) ayant terminé l'étude. RÉSULTATS: En analyse ITT du critère principal, les variations du sous-score WOMAC A (douleur) depuis l'inclusion jusqu'à la fin de l'étude, ont été respectivement de 19,8 ; 19,8 ; 17,8 et 14,2, sur une échelle de 0-100, pour les patients des stades KL I à KL IV. En analyse PP dans les mêmes conditions, ces variations ont été de 20,6 ; 19,9 ; 17,1 et 11,7. Tous ces résultats étaient significatifs par rapport aux valeurs à l'inclusion (p<0.001) et cliniquement pertinents à chaque stade KL. Des améliorations significatives ont été également observées pour le sous-score WOMAC C (fonction), et pour les autres critères secondaires. Le taux de répondeurs OMERACT-OARSI variait de 72 à 82% pour les patients KL I à III à M6 et M9. Pour les patients KL IV, le maximum atteint a été 47.7% à M6. Les autres paramètres tels que le sexe, l'IMC ou l'âge, ne furent pas identifiés comme des facteurs de pronostic pour la réponse à la VS. CONCLUSIONS: L'analyse détaillée par stade KL d'une large cohorte de patients suivis en ouvert, suggère le traitement de VS avec ARTHRUM H 2% est applicable à une grande variété de patients gonarthrosiques.

Heparan sulphate and hyaluronic acid components of the glycocalyx do not play a role in flow-mediated dilation of the iliac in the anaesthetized pig.

The shear-stress sensor function of vascular glycocalyx heparan sulphate and hyaluronic acid was investigated in vivo by assessing flow-mediated dilation before and after their removal. Heparinase III exposure (100 mU·mL-1 for 20 min;n = 6) did not significantly affect flow-mediated dilation of the iliac, from 0.42 ± 0.08 mm (mean ± SEM) to 0.34 ± 0.07 mm after (P = 0.12; paired Student's t test) for a statistically similar increase in shear stress; 18.24 ± 4.2 N·m-2 for the control and 15.8 ± 3.6 N·m-2 for the heparinase III experiment (P = 0.18). Hyaluronidase exposure (0.14-1.4 mg·mL-1 for 20 min; n = 8) also did not significantly reduce flow-mediated dilation of the iliac, which averaged 0.39 ± 0.08 mm before and 0.38 ± 0.09 mm after (P = 0.11) for a statistically similar increase in shear stress; 11.90 ± 3.20 N·m-2 for the control and 9.8 ± 3.33 N·m-2 for the hyaluronidase experiment (P = 0.88). Removal of both heparan sulphate and hyaluronic acid was confirmed using immunohistochemistry. Neither the heparan sulphate nor the hyaluronic acid components of the glycocalyx mediate shear-stress-induced vasodilation in conduit arteries in vivo.

Injections intra articulaires (IA) d'acide hyaluronique (AH) dans le traitement symptomatique de la gonarthrose : une méta-analyse des injections uniques (mono-injections).

INTRODUCTION: La viscosupplémentation du liquide synovial par injections intra articulaires (IA) d'acide hyaluronique (AH), est un traitement symptomatique bien connu dans la gonarthrose. La question se pose de savoir si les traitements par injection unique (mono-injection) peuvent présenter autant d'efficacité que les multi-injections (3 à 5). MÉTHODES: Une méta-analyse des résultats publiés pour les essais de mono-injections IA de AH a été réalisée. Le critère d'efficacité retenu a été le sous-score douleur de l'indice Western Ontario and MacMaster universities (WOMAC A). Toutes les conceptions d'études ont été admises, depuis les essais randomisés contrôlés jusqu'aux études observationnelles ouvertes à simple bras. Une recherche extensive a été effectuée à partir de PubMed, Google, Google Scholar, et des listes de références trouvées dans les méta-analyses récentes, pour obtenir tous les articles publiés avant fin avril 2018. Les profils des populations furent analysés en termes d'âge, de sexe, d'indice de masse corporelle (IMC) et de stade radiologique selon Kellgren-Lawrence (KL). Les résultats d'injection IA unique de placebo, ont été pris en compte pour créer une base permettant des comparaisons post-hoc. Chaque bras AH IA étudié a été comparé à un bras placebo IA (seul ou mixé), de manière à présenter un profil KL similaire, contrôlé à l'aide du test Chi2. Les tailles de l'effet (ES) avec intervalles de confiance (IC 95%) et p-valeurs furent calculées et synthétisées pour chacune des visites de contrôle à 1, 2, 3 et 6 mois. En parallèle, une approche globale a été utilisée afin de représenter les variations par rapport à la baseline, pour chacun des sous-groupes étudiés. RÉSULTATS: En partant de 1 547 citations, 28 études ont été incluses dans la méta-analyse, décrivant 4 129 patients traités par mono-injection: 3 360 ont reçu de l'AH IA et 769 patients ont reçu du placebo IA. Le patient moyen (SD) traité par AH IA était âgé de 61,2 (9,6) ans dont 63% de femmes, avec un IMC de 28,0 (4,1) kg/m2, et un stade radiologique à 47% KL III pour 3% KL IV. Un bon appariement du profil KL a été obtenu pour 26 des 31 bras AH IA. Sur l'ensemble de la population AH IA, ES = 0,30 (0,25; 0,35) à 3 mois et ES = 0,39 (0,33; 0,44) à 6 mois. Dans une analyse restreinte, après élimination des cas aberrants, des KL mal appariés et des bras actifs < 30 patients, les résultats sont restés inchangés, ES = 0,29 (0,23; 0,34) et ES = 0,40 (0,34; 0,45) à 3 et 6 mois respectivement, tandis que l'hétérogénéité était améliorée. DISCUSSION: Il existe certainement des limites à la méthode de comparaison post-hoc versus placebo, appliquée à des essais individuels. Mais pour chaque synthèse par sous-groupe ou groupe, les résultats ont été confirmés en utilisant plusieurs approches statistiques et différentes méthodes de pondération. Cette méta-analyse suggère que les résultats des mono-injections sont similaires à ceux des multi-injections d'acide hyaluronique intra articulaire en termes de soulagement de la douleur, dans le traitement de la gonarthrose.

Mono-injection intra-articulaire d'acide hyaluronique dans la gonarthrose : Étude multicentrique prospective ouverte (ART-ONE 75) avec comparaison post hoc versus placebo.

INTRODUCTION: La viscosupplémentation du liquide synovial par injection intra-articulaire d'acide hyaluronique est un traitement symptomatique de l'arthrose, largement utilisé dans la gonarthrose (arthrose du genou). À côté des produits conçus pour être administrés par injections multiples (typiquement 3 à 5 injections à intervalles de 1 semaine), un intérêt particulier se porte sur produits en injection unique (mono-injection) qui offrent des avantages spécifiques tels que la réduction du nombre de visites au médecin et du nombre d'interventions invasives avec leurs risques associés. Il subsiste toutefois une question concernant l'efficacité de ces mono-injections, par rapport aux protocoles à injections multiples. MÉTHODES: Une étude post-commercialisation, prospective, multicentrique, ouverte (ART-ONE 75), a été réalisée avec le produit pour injection unique Arthrum 2,5 % (3 mL, 75 mg d'acide hyaluronique) (LCA Pharmaceutical, Chartres, France), sur 214 patients atteints de gonarthrose. Les patients ont été suivis à 30, 60, 120 et 180 jours. Le profil moyen des patients à l'inclusion était un âge de 62,9 ans, 56 % de femmes, un stade radiologique Kellgren-Lawrence de I à III (46 % KL III), un indice de masse corporelle de 27,2 kg/m2 et une antériorité de 4 ans pour la gonarthrose. Une comparaison post hoc a été réalisée par rapport à une injection intra-articulaire unique de placebo (326 patients regroupés à partir de 3 essais randomisés contrôlés), et présentant un profil similaire de patients. RÉSULTATS: Le critère principal était la variation par rapport à la baseline, de l'indice Western Ontario and McMaster Universities, sous-échelle de la douleur (WOMAC A) dont le score (base 0-100), était réduit à 60 jours, de 28,9 (17,4) pour la population en intention de traiter (199 patients), de 28,0 (17,8) pour la population per protocole à l'inclusion (175 patients), et de 27,7 (16.8) pour la population per protocole ayant terminé l'étude (143 patients). Les critères secondaires et accessoires comprenaient le score WOMAC A aux autres dates, le score WOMAC B (raideur), le score WOMAC C (fonction), la qualité de vie et le handicap à chaque date de suivi. Tous les indices étaient significativement améliorés et continuaient à s'améliorer à la fin de l'étude. L'évaluation thérapeutique à 180 jours a montré que plus de 75 % des patients étaient satisfaits de la réduction de la douleur, de l'amélioration de la mobilité et de la réduction de la consommation d'analgésiques et d'anti-inflammatoires non stéroïdiens. Le pourcentage de patients définis comme répondeurs selon les critères de l'OMERACT-OARSI Initiative était > 86 %, à partir de 60 jours. La tolérance globale était bonne, sans aucun évènement indésirable grave. Les résultats de la comparaison post hoc pour le score WOMAC A ont montré une taille d'effet variant de 0,33 (IC 95 % 0,15-0,51), à 60 jours à 0,65 (IC 95 % 0,45-0,85) à 180 jours (p < 0.001), versus placebo injecté (solution saline), qui est cliniquement significative en faveur d'Arthrum 2,5 %. CONCLUSION: La présente étude suggère l'efficacité clinique d'une mono-injection IA de 3 mL de solution viscoélastique contenant 75 mg d'AH natif de haut poids moléculaire (> 2 MDa).

[What's new in interventional dermatology?] / Quoi de neuf en dermatologie interventionnelle?

This year, many publications have focused on understanding, avoiding and treating vascular complications when injecting fillers. New protocols for the use of hyaluronidase have shown their effectiveness in preventing skin necrosis or blindness after vascular embolism when injecting hyaluronic acid. Other areas of interventional dermatology have been well documented: myomodulation is an interesting concept that describes the impact of the injection depth of a filler on muscle forces in order to correct the balances between the lowering and elevators during congenital or acquired defcits with aging. Treatment of melasma remains diffcult but the prescription of oral tranexamic acid could be useful. Botulinum toxin is expanding its feld of activity for both aesthetic and medical treatments. Pulsed dye laser remains the reference treatment for port wine stains, but the rate of recurrence by post laser neo-angiogenesis justifes the need of reliable and effective adjuvant treatments.

[Facial injections of hyaluronic acid-based fillers for malformations. Preliminary study regarding scar tissue improvement and cosmetic betterment]. / Injections d'acides hyaluroniques au niveau de visages atteints de malformations faciales. Étude préliminaire de l'assouplissement des zones cicatricielles et de l'amélioration esthétique.

BACKGROUND: Cross-linked hyaluronic acid-based fillers have gained rapid acceptance for treating facial wrinkles, deep tissue folds and sunken areas due to aging. This study evaluates, in addition to space-filling properties, their effects on softness and elasticity as a secondary effect, following injection of 3 commercially available cross-linked hyaluronic acid-based fillers (15mg/mL, 17,5mg/mL and 20mg/mL) in patients presenting with congenital or acquired facial malformations. PATIENTS ET METHODS: We started injecting gels of cross-linked hyaluronic acid-based fillers in those cases in 2013; we performed 46 sessions of injections in 32 patients, aged from 13-32. Clinical assessment was performed by the patient himself and by a plastic surgeon, 15 days after injections and 6-18 months later. RESULTS: Cross-linked hyaluronic acid-based fillers offered very subtle cosmetic results and supplemented surgery with a very high level of satisfaction of the patients. When injected in fibrosis, the first session enhanced softness and elasticity; the second session enhanced the volume. Cross-linked hyaluronic acid-based fillers fill sunken areas and better softness and elasticity of scar tissues. CONCLUSION: In addition to their well-understood space-filling function, as a secondary effect, the authors demonstrate that cross-linked hyaluronic acid-based fillers improve softness and elasticity of scarring tissues. Many experimental studies support our observations, showing that cross-linked hyaluronic acid stimulates the production of several extra-cellular matrix components, including dermal collagen and elastin.

[Hyaluronic acid rheology: Basics and clinical applications in facial rejuvenation]. / Rhéologie des acides hyaluroniques : principes fondamentaux et applications cliniques en rajeunissement facial.

Hyaluronic acid (HA) is the most widely used dermal filler to treat facial volume deficits and winkles specially for facial rejuvenation. Depending on various areas of the face, filler is exposed to two different forces (shear deformation and compression/stretching forces) resulting from intrinsec and external mechanical stress. The purpose of this technical note is to explain how rheology, which is the study of the flow and deformation of matter under strains, can be used in our clinical practice of facial volumization with fillers. Indeed, comprehension of the rheological properties of HA has become essential in selection of dermal filler targeted to the area of the face. Viscosity, elasticity and cohesivity are the main three properties to be taken into consideration in this selection. Aesthetic physicians and surgeons have to familiarize with those basics in order to select the HA with the right rheological properties to achieve a natural-looking and long-lasting outcome.

[Benefits of volumetric to facial rejuvenation. Part 2: Dermal fillers]. / Apport de la volumétrie au rajeunissement facial. Partie 2 : produits de comblement.

Injectable substances known as fillers are used to palliate age-related atrophy and ptosis, and for their so-called "pseudo-lifting" action. They do not replace face and neck lift, but allow it to be postponed or, when injected after surgical lifting, make the result durable. Hyaluronic acid has a predominant and unchallenged place among fillers, well ahead of poly-L-lactic acid or calcium hydroxyapatite. Approaches and injection methods are the same for all fillers, corresponding to those for autologous fat injection, the reference substance, with a few particularities. The substance used, the level of hyaluronic acid reticulation, and the depth of the injection depend on the injection site and intended effect. Effects range from smoothing superficial wrinkles to remodeling whole parts of the face. Complications related to such fillers are well known, especially in the case of hyaluronic acid, where overcorrection is the most frequent. To limit the risk of complications and also to offer each patient the most individually adapted corrections, before any procedure, the plastic surgeon needs to question the patient and perform precise medical examination.

Preventative effects of prostaglandin E1 in combination with iodized olive oil on liver fibrosis after transcatheter arterial chemoembolization in a rabbit model of CCl4-induced liver fibrosis.

To explore the preventative effects of prostaglandin E1 (PGE1) on a rabbit model of CCl4-induced liver fibrosis after transcatheter arterial chemoembolization (TACE), we generated a rabbit model of CCl4-induced liver fibrosis by treatment with 40% CCl4 in iodized olive oil for 16 weeks. Body mass and serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein (TP), albumin (ALB), albumin:globulin ratio (A:G), total bilirubin (TBIL), and direct bilirubin (DBIL) were measured. After TACE, the levels of hyaluronic acid (HA), procollagen III (PC III), laminin (LN), and collagen IV (IV-C) were measured, and the severity of liver fibrosis as well as the morphology of liver tissues were determined. Body mass in the model group was significantly decreased from 10 to 16 weeks, and the serum levels of ALT, AST, TP, TBIL, and DBIL levels were significantly increased while the model was being generated; the levels of ALB and A:G were significantly decreased. After TACE, serum levels of HA, PC III, and LN in the group injected with 1.0 mL iodized olive oil (Group B) were higher than in the group that were injected with 1.0 mL iodized olive oil + 0.2 mL PGE1 (Group C), whereas the serum levels of IV-C were lower. The severity of liver fibrosis was ameliorated in Group C. The combination of PGE1 and iodized olive oil prevented the development of liver fibrosis following TACE.

Hyaluronan, a truly "youthful" polysaccharide. Its medical applications.

Hyaluronan (hyaluronic acid, HA) is a ubiquitous linear polysaccharide endowed with some exceptional physicochemical properties such as strong hydration and viscoelasticity that depend on the size of the molecule. It plays a variety of important physiological roles in tissue hydration and mechanical protection, for example in the umbilical cord, skin and most other tissues. Since its large scale preparation and the invention by E.A. Balazs of the preparation of its non-inflammatory fraction (NIF-NaHA), there have been several important medical and cosmetic applications, most notably of viscosurgery for eye operation, intra-articular injections for osteoarthritis and also for wrinkle filling on the face, as well as for drug administration. Its concentration in tissues is decreasing with age, source of loss of function and structure of tissues. The purpose of this review is to present a succinct overview of the essential properties of hyaluronan and its medical and esthetic applications.

[What's new in instrumental dermatology?]. / Quoi de neuf en dermatologie instrumentale?

The publications in the field of aesthetic dermatology including those related to laser treatment and related procedures are numerous. Nevertheless, a large number of them lack a serious and well-structured methodological approach or are biased and may lead to false conclusion due to conflict of interest. The selection of the publications used for this review, while subjective, has been based on the strength of the methodology applied as well as their benefit to the dermatological community as a whole. The themes evaluated in this review are the following: injections of botulinum toxin, male ageing skin, complications after aesthetic procedures, innovative therapeutic advanced treatment in aesthetic, laser therapies cryolipolysis and photodynamic therapy.

Supermicrosurgery and hyaluronic acid: experimental feasability study of a new method.

INTRODUCTION: As a technique of anastomosis for vessels of less than 0.8mm in diameter, supermicrosurgery has aroused renewed interest on account of its potential clinical applications. The technical difficulty of surgery at such a small scale necessitates exploration of new methods likely to render the anastomoses accessible and reliable. The aim of this article is to present the results of an experimental study on the feasibility of anastomoses (arterial diameter ≤0.5mm), assisted by the injection of hyaluronic acid (HA). MATERIALS AND METHODS: Ten end-to-end arterial anastomoses of the inferior epigastric artery (diameter ≤0.5mm) were performed in 5 rats. An injection of HA had previously been carried out in the vessel lumen and the sutures were made with 12-0 nylon. Immediate and 3-day permeability were controlled and anastomosis times were measured. RESULTS: Average diameter of the arteries was 0.42 mm (range 0.29-0.48 mm). Mean anastomosis duration was 19.5 min (range 15-23 min). The average number of stitches was 6. Immediate patency was 100% with a success rate of 80% at 3 days. CONCLUSIONS: The properties of HA seem to effectively facilitate anastomoses of arteries with a diameter ≤0.5mm. HA provides comfort and promotes safety in performance of exceedingly small-scale surgery. While the results appear promising, but further studies are needed in order to determine the potential toxicity of this method on tissues.

[Rhinoplasty and dermal fillers]. / Rhinoplastie et produits de comblement.

The use of fillers for camouflage after surgical rhinoplasty or during medical rhinoplasty process represent an attractive technique which allows to avoid or to delay surgical time often dreaded by the patients. This technique apparently quite simple, must be applied carefully in order to avoid possible complications that can sometimes be very serious. Through their seven years of experience, the authors have selected absorbable type of products: hyaluronic acid or calcium hydroxylapatite, both approved by ANSM. Preference is given to microcannulas (27G) over needles and injection techniques through multiple tunnels fitted with small fragmented boluses. Due to possible Tyndall effect and skin necrosis risk, a one-shot injection with a lot of product should be avoided. Calcium hydroxyapaptite is preferred for the dorsum area while hyaluronic acid is recommended for the tip. The authors also relate the major encountered complications and describe the appropriated treatments. Nevertheless the strict application of the described technique represents the best way to prevent adverse complications.

[Endoscopic management of urinary incontinence in neurogenic bladder due to spinal cord lesions in children]. / Prise en charge endoscopique de l'incontinence urinaire des vessies neurologiques d'origine médullaire de l'enfant.

INTRODUCTION: The urological management of urinary incontinence in neurogenic bladder due to spinal cord lesions in children is intended to achieve social continence while preserving the upper urinary tract, combining clean intermittent catheterization with anticholinergic agents. The objective of this study was to report the results on continence of endoscopic management of bladder and/or sphincter of children with failure or intolerance to first intention therapy. PATIENTS AND METHODS: Of the 364 children followed for neurologic bladder in our institution, 22 required endoscopic management between 2000 and 2012. Urinary incontinence was related to detrusor overactivity in 16 children and sphincter deficiency in 13 children, requiring one or several intradetrusor injections of botulinium toxin-A (BTA) and/or dextranomer/hyaluronic acid (Dx/Ha) injection in the bladder neck. Continence was reassessed between six and eight weeks after the last injection using the Schulte-Baukloh score. RESULTS: At the end of the mean follow-up of four years, 16 children received 54 injections of BTA and 13 children had 24 injections of Dx/Ha. Social continence, defined as a score between 0 and 1, was acquired quickly after injection of BTA and required to repeat the injections every 8.7 months (6-12) with a very low morbidity. After the first injection of Dx/Ha, 69% of the children improved significantly their incontinence score (from 1 to 0 or from 2 or 3 to 1) with better results for girls. CONCLUSION: An appropriate endoscopic management has enabled an improvement of the continence of two-thirds of children who fail first intention treatment for their neurogenic bladder. This is an alternative to delay or avoid major surgery.

[Infectious cellulitis of the face complicating injection for esthetic nasolabial sulcus by hyaluronic acid: report of seven cases]. / Dermohypodermite infectieuse de la face compliquant l'injection à visée esthétique des sillons nasogéniens par de l'acide hyaluronique : à propos de sept cas.

We report a case series of seven patients with bacterial cellulitis of the face complicating a filler injection for cosmetic reason, treated in a university hospital from 2005 to 2012. There were seven women aged 34 to 57 years. Two patients had a deep collection requiring surgical excision combined with antibiotics. Five patients were treated with antibiotics only. In two cases the bacteria was found streptococcus A and in one case Staphylococcus aureus. One patient required hospitalization in an intensive care unit. Only patients who needed surgical treatment showed moderate aesthetic sequelae.