Perioral Lines Research Articles

Efficacy and Safety of and Patient Satisfaction with Injectable Hyaluronic Acid with 0.3% Lidocaine Hydrochloride for the Treatment of Superficial Perioral Lines or Superficial Lateral Canthal Lines

It is commonly requested that perioral and lateral canthal rhytides, which result from extrinsic and intrinsic factors, be rejuvenated. To valuate the safety and efficacy of and patient satisfaction with injectable hyaluronic acid (HA) with 0.3% lidocaine hydrochloride in reducing superficial, vertical perioral wrinkles and superficial, horizontal, lateral canthal rhytides. This was a two-center, evaluator-masked, 180-day study in which 40 patients with moderate to severe superficial, vertical perioral lines or superficial, horizontal, lateral canthal lines were treated at their baseline visit with up to three 0.9-mL syringes of HA (5.5mg/mL) with 0.3% lidocaine hydrochloride. The investigator and a blinded evaluator assessed patients 7days after treatment and then every 30days after the initial treatment session for 180days. Subjects experienced statistically significant improvement in their superficial, vertical perioral lines and superficial, horizontal, lateral canthal lines and maintained those results for 180 and 120days, respectively. Three patients experienced delayed-onset periocular nodule formation associated with swelling and erythema at sites of injection, which were histologically consistent with a granulomatous reaction to the product. Injectable HA with a particle size of 350μm was efficacious and resulted in high patient improvement scores in improving moderate to severe superficial, vertical perioral lines and superficial, horizontal, lateral canthal lines. Three of the 40 enrolled patients demonstrated granuloma formation.

OnabotulinumtoxinA Dose-Ranging Study for Hyperdynamic Perioral Lines

Few dosing data on onabotulinumtoxinA to treat hyperdynamic perioral lines (POLs) are available. Studying onabotulinumtoxinA in controlled settings is beneficial to treating a hyperfunctional orbicularis oris. To compare the dose-response relationship of two doses of onabotulinumtoxinA in hyperdynamic POLs. Female subjects (N = 60) received injections of onabotulinumtoxinA at four sites totaling 7.5 U or 12.0 U. Subjects returned at weeks 2, 4, 8, 12, 16, and 20. POL severity and total lip satisfaction (TLS) were assessed at all visits. Investigator-assessed POL severity was reduced through week 20 for 12.0 U (p < .01). POL reduction for 7.5 U persisted until week 16 (p < .05). Responder rates did not differ until week 12 (12.0 U, 77%; 7.5 U, 36%; p = .003). Subject-assessed TLS was improved (p < .05) at all time points for both groups except at week 20 (12.0 U; p = .06). Most adverse events (AEs) were mild to moderate in severity and typical for onabotulinumtoxinA treatment in the lips, and the incidence was dose-dependent. OnabotulinumtoxinA provides significant reductions in POL severity and high levels of subject satisfaction. Lack of dose response and fewer AEs suggest that treatment of hyperdynamic POLs with 7.5 U appears adequate for up to 16 weeks.

Indications and limitations of cosmetic botulinum toxin type A

Botulinum toxin type A has recently been licensed for cosmetic use for the glabellar frown in the USA (Botox Cosmetic ®, Allergan Inc), and has been used extensively since the early 1990s for the management of other wrinkles such as crow’s feet, horizontal forehead wrinkles, perioral lines and neck wrinkles. Botox ® is currently the only Botulinum toxin available in the USA but other European and South American countries may choose between Botox Cosmetic ® and Dysport ® (Ipsen pharmaceuticals). Differences relate to the time of onset of paralysis and the degree of diffusion of the toxin from the injection site. Both types have their own advantages. Limitations of use of Botulinum toxin type A relate in particular to the patient’s skin tone, eyebrow position, lid lash distance and position of their zygomatic arch. Long-term use is affected by the balance between hypertrophy of untreated muscle and atrophy of treated muscles. Careful analysis of facial features during the initial consultation will indicate the choice of toxin; the likely immediate and long-term results and the need for adjunctive treatments. The author describes her conclusions based on over 10,000 cosmetic Botulinum toxin type A treatments.

Laser Resurfacing with a Dual-Mode, Long-Pulse Erbium:YAG Laser Compared to the 950-μs Pulsed CO2 Laser

Introduction: Laser resurfacing with the 950-μs pulsed CO2 laser (UPCO2) is an effective treatment for photodamage and acne scarring. Adverse sequelae such as prolonged erythema and delayed would healing are not uncommon after resurfacing. Less adverse sequelae are seen with the use of erbium lasers alone; however, the same degree of improvement cannot be achieved as with the CO2 laser. New long-pulse erbium:YAG lasers (LP Er:Yag) have been developed to deliver increased thermal effects to tissue. It is hypothesized that, with use of these lasers, improved clinical outcomes may be achieved while still allowing for diminished erythema and improved wound healing. Materials and Methods: Nineteen patients were randomized to receive laser resurfacing with the UPCO2 followed by short-pulse erbium:YAG ablation on one half of the face and LP Er:YAG followed by traditional short-pulse erbium laser on the other half. Patients were evaluated clinically before resurfacing and at 1, 2, 4, 8, and 12 weeks postoperatively. Histologic samples taken at various time periods before and after resurfacing were also evaluated. Results: Overall clinical improvement was equal for both UPCO2 and LP Er:YAG treated sides, with an average improvement in photoaging scores of 53%. In 5 patients, greater clinical improvement in periorbital lines, perioral lines, or both was noted on the UPCO2 side, but overall average photoaging scores were equal. There was a tendency toward faster healing and less edema on the LP Er:YAG-treated side. Histologic examination of tissue taken after resurfacing revealed greater thermal damage on the UPCO2-treated side, and both sides showed evidence of new collagen formation 3 months after the procedure. Conclusion: The LP Er:YAG laser can achieve a similar degree of improvement as seen with short-pulse CO2 laser resurfacing, with decreased thermal tissue effects and decreased risk for adverse sequelae.

A New Autologous Collagen Technique

Introduction: Autologous tissue culture fibroblasts and collagen (Isolagen) have been evaluated in rhytids, scars, and defects to determine indications and effects of filling. Materials and Methods: Forty-nine patients since January 1997 have been injected with Isolagen for depressed scars, rhytids, and lip augmentation. Results: Fine lines, such as periorbital and perioral lines, respond better than deeper furrows. Saucer-shaped scars and depressions with soft, distensible shoulders improve with an average of three injections. Lips can be augmented quite well. There were essentially no side effects. Discussion: Isolagen is expensive and requires precise patient scheduling since the material degenerates quickly. Patients are impressed by the fact that we are using their own collagen and because it provides a more permanent result than bovine collagen.

Thread Augmentation for Facial Rhytides

Thread augmentation, a subsurface technique for correcting facial rhytides, is especially applicable to perioral wrinkles, melolabial furrows, and frown lines about the forehead. It is basically an augmentation technique which places a volume of well-tolerated, slowly absorbable or nonabsorbable sutures underneath the wrinkle. These threads produce augmentation by their volume and the mild local reaction of edema, lymphocytic infiltration, and fibrosis. This process gradually progresses to internal scar formation as the suture material is dissolved by slow hydrolysis in the presence of tissue fluid over a period of months; the nonabsorbable suture remains as a permanent implant. A high level of patient satisfaction with minimal complications has proved the value of this technique in over 100 cases.