Method For Facial Rejuvenation Research Articles

Filler Migration to the Orbit

Dermal filler injections continue to grow in popularity as a method of facial rejuvenation. This increase in the number of injections performed has resulted in an increasing number of types of filler-related complications. We report a series of cases where dermal filler injected in the face migrated to the orbit. Treatment methods and possible mechanisms of this newly reported complication are discussed. A retrospective, multicenter analysis was performed on patients with dermal filler migration to the orbit after facial filler injections. Seven patients (6 females, 1 male; age range, 42-67 years) presented with orbital symptoms after filler injection and were subsequently found to have dermal filler in the orbit. Four out of 7 patients underwent orbitotomy surgery, 1 patient underwent lacrimal surgery, 1 patient had strabismus surgery, and 1 patient was treated with hyalurodinase injections. All patients have remained stable postoperatively. Orbital complications secondary to migrated filler may occur long after the initial procedure. Because the site of the complication is distant from the injection site, patients and physicians may not immediately make the connection. Furthermore, this may lead to unnecessary examinations and a delay in diagnosis while looking for standard orbital masses. Dermal fillers should therefore be considered in the differential diagnosis of patients presenting with new-onset orbital masses.

Adjuncts to Facial Rejuvenation

The preferred methods for facial rejuvenation have been changing over the past decade, with operative procedures on the decline and minimally invasive, office-based procedures on the rise. As a result, it is critical for plastic surgery practitioners to understand the intricacies of the use of neuromodulators and soft tissue fillers in this milieu. While these procedures are usually performed in an office, without general anesthesia, the risk of significant complications still exists. The knowledge of facial anatomy, techniques, and pitfalls is essential for achieving high quality, predictable, and reproducible results. Likewise, when a complication arises, prompt recognition and appropriate treatment is paramount. In this chapter, the history, purpose, technical guidelines, and complications of adjunctive techniques for facial rejuvenation are reviewed in detail. This review contains 2 tables, and 52 references. Keywords: facial rejuvenation, neuromodulator, soft tissue filler, botulinum toxin, dermal filler, aging face, facial rhytids, filler complications, glabellar lines, nasolabial fold

Morphometric study of facial wrinkles and aesthetic skin as dermaroller treatment combined with platelet rich plasma (PRP)

Abstract Background: Facial wrinkles are a multifactorial, complex process that negatively affects individuals’ appearance, consequently their quality of life. The treatment for these wrinkles varies with the degree of severity. This prospective study aimed to evaluate the clinical effect of pure dermaroller and dermaroller combined with platelet rich plasma therapy (PRP dermaroller), to treat facial wrinkles, and to quantitatively evaluate histological changes of the skin that occur in the two different cohorts. Methods and materials: Twenty healthy women aged 43-48 years with scores ranging between 2 and 4 on the baseline facial fine wrinkle grading scale were enrolled in the this clinical study. Nineteen of the patients were treated with a pure dermaroller on the one half of face, and with a dermaroller that included a platelet rich plasma on the other half of the face. Three treatments, each in a 4 weeks interval were performed. Standard photographs and skin biopsies were obtained from the treatment area at baseline and 8 weeks after the final session. Comparisons of the treatments were analyzed using clinical and histological findings. Results: The degree of baseline facial fine wrinkle grading scale after treatment revealed statistically significant effects of the PRP dermaroller treatment side compared to the side of pure dermaroller treatment. At 8 weeks after the final session, the wrinkling grade on the PRP dermaroller side and the pure dermaroller side showed significant differences (p<0.05). Microscopic evaluation of haematoxylin eosin and Masson’s trichrome stained sections revealed significant differences in dermal fibers, epidermal thickness, papillas and skin glands. Conclu s ion: Significant changes were noted between treatments of facial wrinkles with pure dermaroller and PRP dermaroller. Dermaroller combined with platelet rich plasma is a promising novel method of facial rejuvenation.

Our Technique of Thread Lifting for Facial Rejuvenation

Thread lifting of the facial soft tissues without undermining has earned a controversial reputation.1 This may be due to the overly enthusiastic promotion of this “lunch-time” procedure without proper patient selection for commercial reasons. However, growing patient interest in mini-invasive techniques has made us consider thread lifting among other methods of facial rejuvenation. We distinguish 2 facial zones with different aging mechanisms: the central oval, which ages by deflation, and the lateral face, where gravitational changes predominate.2 Hence, the very idea of lifting may be productive in lower lateral facial zones but not in the central oval.

Clinical values of using platelet rich plasma with autologous fat injection in facial rejuvenation

Objective To explore the clinical value of autologous fat injection with platelet rich plasma in facial rejuvenation. Methods 35 female beauty seekers were collected in this study. They were divided into two groups: sample autologous fat group (FAT group, n=20) and combined autologous fat and platelet-rich plasma group (PRP group, n=15). The average level of injection was 34 ml. The fat was collected at the abdominal or thigh sites using 18 G needle connecting with negative pressure suction-pump. The fat was centrifugated 2 min to get rid of the lower layer of water and the upper layer of oil. Weigao PRP extract kit was used to obtain the PRP. The ratio of PRP to fat was 1∶5. The injection technique was according to Colemen method. The survival rate, satisfaction and complication were compared between the 2 groups. Results There were no infection, hematoma, fat liquefaction necrosis occurred in the 2 groups. Compared with the FAT group, the skin texture and facial contour of the PRP group was improved. Conclusions The platelet rich plasma can improve the survival rate of fat and has a stable effect, which is one of the safe and ideal methods of facial rejuvenation. Key words: Platelet-rich plasma; Fat granule; Fat transplantation; Facial rejuvenation

Clinical effect of autologous fat grafting in the frontotemporal augmentation

Objective To explore the clinical effect of autologous fat grafting in frontotemporal augmentation. Methods The fat granule was harvested from patient's abdomen or both medial knees by a multi-holed liposuction cannula attached to a syringe with negative pressure. Then the syringe was held vertically with the open end pointing downward until the fat and fluid were separated. The aqueous layer at the bottom and the oil layer on the top were discarded. The fat without being washed was directly transferred into 2 ml syringes and injected into bilateral temple and frontal depression area with a multi-plane, multi-tunnel, multi-point approach. The volume of injection was over 20%-30%. From March 2010 to March 2013, 117 patients underwent this procedure. Results In all the 117 cases, there were no complications such as hematoma, induration, and infection. There were 11 cases (11.4%) in temple and 13 cases (20.0%) in frontal region achieved aesthetically-acceptable results after the second treatment. There was no statistically significant difference in secondary operation rates between the temple group and the frontal grouup (χ2=2.229, P>0.05). Based on the follow-up for 3-36 months on all 117 cases, satisfactory results were obtained with improved frontotemporal contour and skin texture. The volume retention of transplanted fat was estimated between 60% and 80%, which was based on subjective analysis of photographs. Conclusions Autologous fat grafting in frontotemporal depression is a convnient technique with reliable clinical results. It is also an optimal and safe method for facial rejuvenation and contouring remodeling. Key words: Autologous fat transplantation; Fat granule; Facial rejuvennation

Fractional Carbon Dioxide Laser and Acoustic-Pressure Ultrasound for Transepidermal Delivery of Cosmeceuticals: A Novel Method of Facial Rejuvenation

This study aimed to determine the efficacy and safety of a new facial rejuvenation procedure that combines a fractional carbon dioxide (CO2) laser, an ultrasound emitter, and a cosmeceutical preparation to be applied intraoperatively. A split-face, double-blind randomized prospective study of 14 patients was designed, in which one half of the face was treated with a fractional CO2 laser, with the other half receiving the same laser and acoustic pressure ultrasound for transepidermal delivery of cosmeceuticals. Two semiquantitative scales and two visual analog scales were completed to evaluate the efficacy of each treatment. The results were assessed on the basis of photographs taken before treatment and then after 1, 2, and 6 months afterward. Potential adverse effects and complications were recorded. Both treatments achieved significant improvements in all parameters evaluated (p < 0.001). The combined ultrasound and cosmeceutical treatment had better scores for reduced fine lines and wrinkles as well as for overall facial aging at 6 months (p < 0.01), with nearly 80 % overall improvement in facial aging. The treatment was well tolerated, and no unexpected adverse effects were observed. The majority of the patients (86 %) stated that they were satisfied or very satisfied with their results. One session of fractional ablative CO2 laser and acoustic pressure ultrasound technology for transepidermal delivery of cosmeceuticals is an effective method for treating facial rejuvenation.

Fat Transfer for the Management of Soft Tissue Trauma: The Do's and the Don'ts

Fat transfer for the aging face is an increasingly popular method for facial rejuvenation. However, there are inherent risks with fat transfer due to the nature of a fat graft that limits its potential use in the context of soft tissue trauma. This article reviews these limitations and also describes techniques for performing fat transfer to attain safe and long-term aesthetic results in varied clinical settings.

The Ultralift: A Simple, Safe, Effective Facelift Technique

Background: Experience with smaller ultrasonic liposuction cannulas for neck and lower facial contouring has led to the incorporation of this technique into face-lifting procedures. Combining ultrasonic liposuction of the neck and a subcutaneous face-lift with the superficial musculoaponeurotic system plication (hereby called the Ultralift) provides a benefit greater than either technique alone. Objective: To determine if incorporating ultrasonic liposuction of the submental, jowl, and lateral neck regions is a safe and effective adjunct to a face-lift. Methods: The Vaser lipoplasty system was used to emulsify fat in the submental, jowl, and lateral neck regions. The fat was then evacuated with a VentX cannula, and the face-lift was then performed. Results: A retrospective chart review was performed on all patients who underwent the Ultralift procedure. This technique has been used on 47 patients. Patient ages ranged from 39 to 78 years, with an average age of 57 years. Follow-up ranged from 4 months to 4 years. There were no hematomas, seromas, skin burns, sloughs, or persistent nerve injuries. Conclusions: Ultrasonic liposuction combined with face-lifting is an effective and safe method of facial rejuvenation.

Skin barrier function recovery after diamond microdermabrasion

Microdermabrasion is a popular method for facial rejuvenation and is performed worldwide. Despite its extensive usage, there are few publications on skin barrier change after microdermabrasion and none concerning diamond microdermabrasion. Our object was to see changes in transepidermal water loss (TEWL), hydration and erythema of the face following diamond microdermabrasion. Twenty-eight patients were included in this spilt face study. TEWL, stratum corneum hydration and the degree of erythema were measured from the right and left sides of the face (forehead and cheek) at baseline. One side of the face was treated with diamond microdermabrasion and the other side was left untreated. Measurements were taken right after the procedure and repeated at set time intervals. Diamond microdermabrasion was associated with a statistically significant increase in TEWL immediately after the procedure and at 24 h. However, on day 2, levels of TEWL were back to baseline. An increase in hydration and erythema was observed right after microdermabrasion, but both returned to baseline on day 1. The results show that skin barrier function of the forehead and cheek recovers within 2 days of diamond microdermabrasion. Diamond microdermabrasion performed on a weekly basis, as presently done, is expected to allow sufficient time for the damaged skin to recover its barrier function in most parts of the face.

The lamellar peel: A sequential nonablative and ablative laser treatment for facial skin rejuvenation

Objectives. Ablative and nonablative laser treatments have established themselves independently in the rejuvenation of aging skin. This study was designed to determine the effects of sequential nonablative and ablative laser treatments on facial skin.Materials and methods. Twelve patients, ages 32–56 years, with skin phototypes I‐IV, received three treatments spaced six weeks apart. Each treatment consisted of one pass with 1319‐nm Nd:YAG laser at 16 J/cm2, 50 ms pulse duration. This was immediately followed by one pass of 2940‐nm Er:YAG laser at 5 J/cm2. Photographs and biopsies were taken prior to the first treatment and following the third treatment.Results. Clinical improvements in facial skin tone and texture, acne scarring and dyschromia were noted in all patients. Histologic changes included a more compact epidermal granular layer and lamellar collagen formation with decreased solar elastosis in the dermis. Compared to controls, treated skin had a thicker, more homogeneous papillary dermis.Conclusion. The sequential use of nonablative and superficial ablative laser treatments clinically and histologically improved photodamaged and chronologically aged skin. This occurred with minimal recovery and little morbidity, demonstrating this laser application to be a safe and effective method for facial rejuvenation.

Refinements of minimal-incision rhytidectomy

Minimal-incision rhytidectomy has achieved increased popularity in recent years and is used successfully to rejuvenate the mid-face and submental regions. A technique of minimal-incision rhytidectomy is presented that eliminates post-auricular scarring and hairline distortion without need for a visible dog ear adjacent to the lobule. All dissection is performed through an incision in the temporal hairline and pre-auricular areas. A multi-vector SMAS plication is performed with the addition of submental liposuction and limited laser resurfacing if necessary. Skin excess is distributed into the temporal hair and a downward rotation flap is utilized to eliminate the resultant dog ear. Representative results are presented utilizing this technique which has become the author's preferred method of facial rejuvenation where limited correction of cervical aging is required. With the exception of more limited correction in the mid and lower cervical areas, results are comparable to traditional methods with a more extensive scar burden. The technique presented is applicable to a wide range of patients and may have special utility in male patients and in tobacco users.

Carbon Dioxide Laser Resurfacing: Long-Term Follow-Up in 2123 Patients

Carbon dioxide (CO2) laser resurfacing has become increasingly popular as a method of facial rejuvenation, enabling the surgeon to repair sun-damaged skin, wrinkles, and acne scars precisely. This article presents the results of the authors' histologic studies with all of the current CO2 laser systems as well as the conclusions of her experience with 2123 patients over a 5-year period. Improvements obtained from CO2 laser resurfacing appear to be long lasting, especially when combined with other procedures, and it is likely that laser resurfacing will remain in the armamentarium of facial rejuvenation for some time.

Computerized scanning erbium:YAG laser for skin resurfacing.

Laser skin resurfacing has become increasingly popular as a method of facial rejuvenation. Although carbon dioxide (CO2) laser resurfacing is extremely effective, there is considerable morbidity associated with this procedure. Erbium (Er):YAG lasers, like CO2 lasers, are highly absorbed by water, and are absorbed superficially in skin. In our study of 141 patients using the computerized scanning Er:YAG laser, we found that it was possible to precisely ablate skin with less thermal injury than the currently available scanning CO2 lasers. The scanning system allowed very precise and homogeneous skin ablation. It was possible to ablate epidermis and superficial dermis, although deeper resurfacing led to pinpoint bleeding. Furthermore, healing was more rapid than generally experienced using CO2 lasers. Erythema was less marked, and disappeared usually within 3-4 weeks. Histological studies confirmed the minimal degree of thermal injury, as was evident clinically. Fluences of at least 20 J/cm2 were necessary to produce new collagen formation.