Subdermal Injection Research Articles

Efficacy of Subdermal Poly-d,l-Lactic Acid Injections for the Treatment of Melasma.

Melasma is a chronic, recurrent skin disorder with limited long-term treatment success using conventional therapies like hydroquinone and laser treatments, which primarily target epidermal components while leaving dermal aspects untreated. To evaluate the efficacy and safety of poly-d,l lactic acid (PDLLA) subdermal injections for treating moderate melasma. Three female patients (age range: 45-59 years) with Fitzpatrick skin types III and IV received three PDLLA injection sessions at 3-week intervals. Treatment outcomes were assessed using the Melasma Area and Severity Index (MASI) and patient satisfaction scores at 12-week follow-up. All patients showed significant MASI score improvements (reduction range: 3.60-6.30 points). Patient satisfaction ratings ranged from 3 to 4 out of 4. Temporary side effects included mild edema and bruising, resolving within 72 h. PDLLA subdermal injections showed promising results in melasma treatment, potentially due to its biostimulatory effects on collagen production and dermal remodeling. Further research, including histopathological analysis, is needed to confirm long-term efficacy and safety, and understand underlying mechanisms.

Pilot Study: Single-depth Superficial Ultrasound with Subdermal Injections of Diluted Calcium Hydroxylapatite for Improving Lower Face Skin Quality.

The lower face can be challenging to treat. We assessed the effectiveness of combining single-depth superficial microfocused ultrasound with visualization (MFU-V, Ultherapy; Merz North America, Inc. Raleigh, N.C.) and subdermal injections of diluted calcium hydroxylapatite (CaHA, Radiesse; Merz North America, Inc. Raleigh, N.C.) in a single session for improving skin quality in the lower face. This study enrolled women with moderate-to-severe fine lines and skin unevenness on the lower face who desired nonsurgical intervention. Single-depth MFU-V treatment (10 MHz/1.5 mm) was followed by subdermal injections of diluted (1:1) CaHA. Subjects were followed up for 24 weeks posttreatment. Objective skin quality assessments (Rv: wrinkle depth; R3z: skin unevenness) were performed using LifeViz Micro (QuantifiCare, Sophia Antipolis, France). Subjective assessments included the modified Fitzpatrick Wrinkle Scale visual analog scale, Global Aesthetic Improvement Scale, and global satisfaction scale. Twelve subjects completed the study. The mean Rv value, mean R3z value, and mean modified Fitzpatrick Wrinkle Scale visual analog scale score improved significantly from baseline to week 24 (mean differences: -0.0321 mm, -0.0684 mm, -1.1667; all P < 0.001). All subjects were rated by the investigators as having demonstrated improvement in their overall aesthetic appearance as early as week 4. All subjects were "very satisfied" or "satisfied" with their treatment from week 12 onwards. No unexpected adverse events were reported. Combination treatment with single-depth superficial MFU-V and diluted CaHA in a single session significantly improved lower facial skin quality, as assessed by both objective and subjective outcome measures.

Integrated Approach in Evaluating the Results of Cosmetic Procedures Using Ultrasonography and Magnetic Resonance Tomography (Clinical Study)

Aim. To investigate the capabilities of comprehensive assessment using ultrasound and magnetic resonance imaging (MRI) of the results of cosmetic procedures.Materials and Methods. A study of the soft tissues of the anterior abdominal wall of a 43-year-old woman complaining of skin atony and postpartum stretch marks using highresolution ultrasound and MRI.Results. At ultrasonography in the projection of injection of polylactic acid and calcium hydroxyapatite preparations and radiofrequency treatment, an increase in echogenicity of hypodermis with the presence of acoustic shadow was noted. On MRI at the level of derma and hypoderma of periumbilical region in the projection of radiofrequency treatment, injections of preparations based on polylactic acid on the left, calcium hydroxyapatite on the right in 3 months after subdermal injection, areas of hyperintense MR-signal in T2 weight image (WI) and STIR programs, hypointense in T1 WI, without diffusion limitation on DWI b=1000 were determined. In SWI mode, the focus of hypointense MR signal of rounded shape with clear and smooth contours was visualized on the right side of the image.Conclusion. The clinical study demonstrates the possibilities of an integrated approach in evaluating the results of cosmetic procedures using ultrasonography and MRI.

Botulinum Toxin Subdermal Injection for the Treatment of Neuropathic Pain in Ramsay Hunt Syndrome (P5-13.006)

Botulinum Toxin Subdermal Injection for the Treatment of Neuropathic Pain in Ramsay Hunt Syndrome (P5-13.006)

Comparing the Impact of Diluents and Injection Techniques on Patient Comfort During Indocyanine Green Lymphangiography: A Prospective Study.

Background: Indocyanine green (ICG) lymphography, a key diagnostic tool for lymphedema, is influenced by the dilution process of ICG dye, impacting patient experience. Methods and Results: In our study, we assessed three different ICG diluents-water for injection (WFI), normal saline (NS), and Dextrose® plus human albumin-in five healthy volunteer individuals undergoing superficial lymphography of the upper limb over 3 weeks. Results indicated that NS, as a diluent for ICG, caused the least discomfort during injection, in contrast to WFI, which led to the highest levels of discomfort. Transport time of ICG from the injection site to the axillary lymph nodes was notably shorter in intradermal injections than in subdermal injections. Conclusion: Our findings advocate for using NS as the optimal and cost-effective diluent for ICG, enhancing patient experience.

Comparison of the Effectiveness of Methods for Obtaining and Application the Stromal-Vascular Fraction of Adipose Tissue in an Experimental Model of a Donor Wound in Burns

Introduction. The optimal method of obtaining and application a stromal-vascular fraction (SVF) of adipose tissue in the treatment of donor wounds in burned patients has not been determined.Objective — to compare the effectiveness of the stromal-vascular fraction of adipose tissue in the treatment of donor wounds, depending on the method of obtaining (mechanical and enzymatic) and the injection (subdermal, intradermal) into the tissue.Material and methods. Wistar rats (n = 30) were divided into 2 investigated groups: in the first group (eSVF) enzymatic processing of adipose tissue (n = 10) was used, in the second group (mSVF) mechanical processing was used (n = 10). Another 10 rats were used as adipose tissue donors’ group. A deep burn was created in all animals, and after 4 days two more donor wounds were created by taking a split thickness skin autograft: the stromal-vascular fraction was injected intradermally into one of the wounds, subdermally into the other. After 14 days, the area of epithelialization, the microcirculation index and the histological microstructure of the skin were evaluated.Results. The proportion of completely epithelized donor wounds in the eSVF-group was 85 %, in the mSVF-group — 55 % (p &lt; 0.05). The index of microcirculation significantly decreased after intradermal injections in the eSVF-group (p &lt; 0.01), and after subdermal injections — in the mSVF-group (p &lt; 0.05). According to histomorphometry, with intradermal injections of eSVF, the thickness of the epidermis and the layer of granulation tissue is less than in the mSVF group (p &lt; 0.01). At the same time, the relative density of collagen fibers in the granulation tissue was significantly higher after the injections of eSVF than after mSVF (p &lt; 0.01). Comparison of injections of the stromal-vascular fraction showed: no significant differences were found when using eSVF; when using mSVF, the subdermal injections are preferable, since it was accompanied by a significantly lower thickness of granulation tissue (p &lt; 0.01).Conclusions. The enzymatically obtained stromal-vascular fraction of adipose tissue has advantages over the mechanically obtained one: the efficiency of eSVF is equally high when used with intradermally and subdermally injections, which are confirmed by the structure and blood circulation in the newly formed skin. When using mSVF, intradermal injections are the least effective, and subdermal injections are accompanied by a moderately pronounced positive dynamic in the microstructure of the skin of donor wounds.

Protective effect of bone marrow mesenchymal stem cells on the survival zone of the perforator flaps in rats.

Perforator flaps have recently been used in the field of plastic surgery. Skin defects can be reconstructed to reach functional and cosmetic goals. With the development of reconstructive approaches, utilizing stem cells is a hopeful approach to enhance wound healing and tissue recovery. In this study, we assessed the effect of bone marrow mesenchymal stem cells on the perforator flap's survival in rats. Perforator flaps (2.5 × 11 cm) were transplanted into rats and focused on the thoracodorsal, intercostal, and deep circumflex arteries, which were randomly divided into three groups: control, saline, and bone marrow mesenchymal stem cells (7 × 106 ml). Seven days after the surgery, tissue edema, inflammation, and discharge were observed and photographed. Histological analyses were performed to determine flap survival. Hematoxylin and eosin staining was performed to assess levels of microvascular density determined in skin flaps. Rats in the bone marrow mesenchymal stem cells group exhibited higher average flap survival area, and higher microvascular density levels at the dynamical regions of the flaps compared with the other two groups. Subdermal injection of bone marrow mesenchymal stem cells significantly increased ischemic perforator flap survival due to stimulated neovascularization in rats. Our findings suggest the potential usefulness of bone marrow mesenchymal stem cells in preventing skin flap perforator tissue necrosis.

Subdermal hyaluronic acid injection treatment of an upper eyelid entropion in a rabbit

Surgical correction is the typical treatment for an entropion. However, considerable anesthetic risk exists for a subset of patients, particularly rabbits and guinea pigs. In a high number of these cases, this represents the main reason for reluctance to treat an entropion. The following report describes the case of a 9-year-old rabbit with a superficial cornea defect and a mild entropion of the upper eyelid. Eversion of the eyelid from a mild entropion to a normal position was attained by the subdermal injection of a hyaluronic acid filler (Alayna SG 24 Distinct®, BSC Medical Devices GmbH, Munich, Germany) without necessitating general anesthesia or sedation. Following a period of 273 days, a relapse occurred which was subsequently successfully treated with a repeat injection. An entropion of the contralateral eye became evident during the follow-up period and was also effectively managed by a single subdermal filler injection. In the reported case, treatment with subdermal hyaluronic acid injection proved to be well tolerated and efficacious.

17. Mechanical Offloading Prevents and Rescues Microtrauma Induced Fibrosis in Large Animal Model

PURPOSE: Repetitive subdermal injections, as seen with insulin in diabetes mellitus, cause microtrauma leading to skin fibrosis and consequential pain. We hypothesized that microtrauma induced fibrosis could be attenuated by injecting through a mechanical offloading dressing (MOD). We developed a large animal porcine model to evaluate injection associated fibrosis. METHODS: Two, Red-Duroc (3-month-old) pigs were subjected to four treatment conditions over a 16-week period, in two 8-week phases. All conditions received daily bleomycin injections in Phase 1 to induce microtrauma induced fibrosis. Group 1 (NN) received no MOD. Group 2 (EE) received the MOD through Phases 1, 2. Group 3 (EN) received the MOD in Phase 1 only. Lastly group 4 (NE) received the MOD in Phase 2 only. Biopsies from each group, with their respective adjacent unwounded skin (UW), were acquired at the 16-week timepoint for both histology and transcriptional analysis using single-cell-RNA sequencing. RESULTS: Skin histology by H&E and Masson trichome demonstrated that EE-treated skin significantly reduced dermal thickness and restored hair follicle formation (*p<0.05). Picrosirius red staining confirmed that EE-treatment resembled the architecture of unwounded skin (*p<0.05). Mechanical testing of EE, EN, and NE treated skin exhibited significantly decreased stiffness compared to NN skin (*p<0.05). Finally, skin deformation, was significantly greater for EE, EN, and NE treated skin (*p<0.05). scRNA-seq analysis identified specific profibrotic notch pathways responsible for fibrosis in NN treated skin, which were downregulated following MOD application. CONCLUSION: To date there is no effective treatment to prevent injection induced fibrosis, which is a huge clinical problem in diseases such as diabetes. This pig study demonstrates for the first time that mechanical offloading may prevent and treat microtrauma induced fibrosis.

Efficacy Differences of Platelet Rich Plasma for Treatment of Androgenetic Alopecia between Men and Women

Background: Almost 50% males face a health issue called androgenic alopecia and even almost 21 million women are affected too. Aim: To determine the efficacy difference of platelet rich plasma for treatment of androgenic alopecia among patients. Study design: Quasi experimental method. Methodology: In order to collect the data, the purposive sampling technique was used. Enrolled patients (n=102) were divided into two groups. Each group received PRP infections after every 1 month for 3 months. Follow up was done at 3 and 6 months. Results were assessed by standard photographs and Hamilton Norwood scale for men and Ludwig scale for women. SPSS v 23 evaluated data. Chi-square test was used to compare the efficacy of Platelet Rich Plasma for treatment of androgenic alopecia between genders. Results: Mean age of the study participants was 27.1±4.5 years. Independent sample t test revealed that the mean age of the female participants was significantly higher than male participants (p &lt; 0.001). There was 100% response rate of PRP treatment for androgenic alopecia in both genders. Practical Implication: This study helped researchers in exploring the efficacy of PRP as a remedy for hair re-growth as it is cheap and safe. Secondly, it added to local literature regarding androgenic alopecia. Conclusion: It was concluded that sub-dermal PRP injections were effective among both genders with androgenic alopecia. Keywords: Efficacy, Androgenic alopecia, Response Rate, Treatment Options and Plasma Rich Proteins.

Impacts of Valproic Acid on Systemic Bone Loss Associated with Experimental Model of Rheumatoid Arthritis in Rats

Background: Valproic acid (VA) is a compound used for many neurological disorders, which is also known as a histone deacetylase inhibitor. The impacts of VA on adjuvant-induced arthritis (AIA) in rats were investigated. Objectives: To investigate the possible osteoprotective and anti-inflammatory effects of VA in rheumatoid arthritis (RA). Materials and Methods: AIA was achieved through subdermal injection of complete Freund’s adjuvant (CFA) into the rat hindpaw. Forty Swiss albino rats were recruited in this study. These rats were divided into four groups: the normal control group received 0.1 mL phosphate buffer saline intraperitoneally each day, the positive control group received 0.75 mg/kg intraperitoneal once weekly dose of methotrexate, the AIA group received CFA without treatment, and the VA group received 300 mg/kg/day intraperitoneal dose of VA. Statistical analysis was done, and a P value of less than 0.05 was considered as statistically significant. Results: VA (300 mg/kg body weight) administered intraperitoneally could significantly reverse the effect of adjuvant arthritis on bone mineral density and bone mineral content in addition to an improvement in bone formation markers (osteoprotegerin, osteoprotegerin/RANKL ratio). Serum levels of tumor necrosis factor and interleukin 1b were significantly reduced by VA treatment. Reduced serum malondialdehyde with the elevated superoxide dismutase level was also achieved. Conclusion: These findings support the evidence that VA has a positive effect on bone anabolism and its anti-inflammatory properties could be considered as a bonus in inflammatory disorders induced bone loss such as RA.

Enriched adipose stem cell secretome as an effective therapeutic strategy for in vivo wound repair and angiogenesis.

The therapeutic potential of adipose tissue-derived mesenchymal stem cells (ADMSCs) is well studied for use in non-healing wounds. However, concerns on the transplantable cell number requirement, cell expansion, cell viability, retained cell multipotency and the limited cell implantation time for efficient impact hinders cell therapy. Recent literature is much inclined to the superiority of the ADMSCs' secretome, pre-dominating its paracrine-mediated therapeutic impact. In this context, the possibility of attaining accelerated wound angiogenesis through non-viral mediated enrichment of the ADMSCs secretome with pro-angiogenic growth factors (AGF) seems promising. Accordingly, this study aimed to explore the effect of AGF-enriched ADMSCs secretome for accelerating wound angiogenesis and repair in acute large area full thickness excision rabbit wound model, as adopted from Salgado et al. (Chir Buchar Rom 108:706-710, 1990). Using sub-dermal single-dose injections along the margin of the dorsal wound, native ADMSCs secretome, AGF-enriched ADMSC secretome, allogenic rabbit ADMSCs and a combination of AGF-enriched ADMSC secretome with allogenic rabbit ADMSCs were transplanted independently. Twenty-eight days (28days) post-transplantation, histopathological analysis was performed to assess the effect. Hematoxylin and eosin (H&E) staining showed enhanced epithelization, notable granulation tissue and collagen fiber deposition in AGF-enriched secretome transplanted groups. This was confirmed by elevated CD31 detection, faster wound closure time and collagen organization. The use of single-dose AGF-enriched ADMSCs' secretome for therapeutic angiogenesis and wound repair seems to be a promising cell-free therapeutic option. Further investigations using multiple doses on larger animal groups remains to be explored in order to ascertain the comparative potential of AGF-enriched ADMSCs' secretome.

Guidelines for Optimal Patient Outcomes Using Calcium Hydroxylapatite for Jawline Contour.

Calcium hydroxylapatite (CaHA(+); Radiesse(+) [Merz North America, Inc., Raleigh, NC]) is the first FDA-approved injectable filler for subdermal and/or supraperiosteal injection to improve moderate-to-severe loss of jawline contour. CaHA has been recognized in the past for its ability to provide contour and support overlying tissues and utilized for jawline augmentation well before this recent indication; however, with recent FDA approval of CaHA(+) for jawline contour improvement, it is important that clinicians are aware of best practices for patient selection, treatment planning and injection, as well as safety considerations and postprocedure care. To provide guidance on best practices for patient assessment and on-label use of CaHA(+) for jawline rejuvenation and augmentation. As part of a 2-h roundtable discussion, 5 clinicians with expertise in both the use of CaHA(+) and jawline treatment discussed patient selection, CaHA(+) injection technique, and important safety measures, with the purpose of developing guidance to support optimal clinical use. The most common applications of CaHA(+) in the jawline are rejuvenation of the prejowl sulcus, recontouring the jawline, and providing definition to the gonial angle. Improving the gonial angle is of particular interest as it is a procedure sought by patients of all genders and ages. Variations in technique are discussed and case studies are presented. Jawline augmentation is a procedure with wide-ranging appeal for a diverse array of patients. CaHA(+) is an ideal filler for jawline augmentation due to its rheologic properties (high G') and ability to achieve defined contours and angles. Appropriate injection technique permits effective treatment and outcomes associated with high patient satisfaction.

Subdermal Silicone and Collagen Injection Effect on the Skin of Rats (Rattus norvegicus) on the Third Day After Injection

Collagen and silicone are substances commonly used as dermal filler in a number of beauty procedures. However, sometimes these chemicals cause unwanted side effects on the skin. The purpose of this research is to analyse the effect of collagen and silicone subdermal injection on rat skin as a model for human skin. Materials in this research are 9 Wistar rats (Rattus norvegicus) divided into three groups with a number of 3 rats in each group. The first control group (K) is not given any injections, while KI and KII are injected with 0,1 ml collagen and 0,1 ml silicone respectively. On the third day, all groups are observed for macroscopic changes. Skin samples are taken by necropsy and are made into slides using HE stain. All procedures done are approved by the ethics commission of LLPT, UGM, Yogyakarta with the certificate number 00024/04/LPPT/V/2019. The slides are observed under a microscope with 20x and 40x magnification. Any microscopic changes are noted, also epidermis and dermis lengths are measured. Mild hyperkeratosis, inflammation and proliferation of connective tissue are found. The measurements of the epidermis and dermis are analysed using T-test independent method in the program Statistical Product and Service Solution (SPSS). The mean length of the epidermis is a little thicker than normal but is not significant (P&gt;0,05). The results of this research show that the subdermal injection of 0,1 ml collagen and 0,1 ml silicone on rats do not cause significant macroscopic or microscopic changes.

Analgesic effects of sterile water injection in the management of low back pain during labor: A systematic review and meta-analysis.

Sterile water injections (SWIs) as a non-pharmacologic and cost-effective method have been adopted to relieve low back labor pain (LBLP). To compare the efficacy of intradermal and subdermal SWIs in the treatment of LBLP. Three databases (PubMed, Cochrane Library, and ScienceDirect) were searched to find relevant articles using two terms, "labor" and "sterile water". Studies reporting women with LBLP treated by intradermal or subdermal SWIs in the low back area were included. Mean differences with 95% confidence interval (CI) and relative risk with 95% CI were used to estimate VAS score and cesarean section rate, respectively. Except for 10min, the patients in the intradermal or subdermal SWI group experienced considerable pain reduction compared with the control group for 30-45, 60, and 90min. Directly comparing intradermal and subdermal SWI groups, the subdermal injection group had significantly better pain relief than the intradermal injection group only at 10min after treatment. Both intradermal and subdermal SWIs could reduce LBLP at 30-90min. The subdermal SWI had significantly better LBLP relief than the intradermal injection only at 10min after treatment.

Single shot lymphoscintigraphy in breast cancer: Effective single tracer sentinel node detection protocol with reduction in procedural pain

PurposeVariation in protocols for axillary sentinel lymph node (SLN) mapping exists. We strive to evaluate the effectiveness of reduction in number of injections on reducing procedural pain, while maintaining nodal detection. MethodsOver 7 years, the number of periareolar injections performed was reduced stepwise from 4 to 1. This was analyzed for SLN detection and patients' subjective perceived pain. Results828 patients with invasive breast cancer who underwent SLN mapping were included. Laterality of breast injection site included 326 (39.4%) in the right breast, 354 (42.8%) in the left breast and 148 (17.9%) in bilateral breasts. In patients who had 4 injection sites in a unilateral breast (n = 143), the reported pain score was 4.3 ± 2.4. Patients with 3 injections (n = 163), 2 injections (n = 163) and 1 injection (n = 211) in a breast reported pain scores of 3.4 ± 2.4, 3.2 ± 2.2, and 2.9 ± 2.6, respectively. In patients who had bilateral sentinel node procedures, those with 4 injections in each breast for a total of 8 injections (n = 37) reported a pain score of 5.7 ± 2.4. Patients with 3 (n = 51), 2 (n = 31) and 1 (n = 39) injection(s) in each breast reported perceived pain of 4.8 ± 2.8, 3.7 ± 2.7 and 3.5 ± 1.9, respectively. Incremental decreased pain scores were achieved with decreasing number of injections (p < 0.001). Nodal detection was maintained. ConclusionA single periareolar subdermal injection site reduces periprocedural pain while maintaining nodal detection.

Assessment of Intraparenchymal Injection of 1% Patent Blue Dye in the Upper Outer Quadrant of the Breast to Identify Sentinel Lymph Node in Early Retro-Areolar Breast Cancer in Women: A Tertiary Centre Experience in Egypt.

Sentinel lymph node biopsy is the gold standard for axillary assessment of patients with clinically node negative breast cancer. The current internationally accepted methods comprise of the usage of either a radioactive tracer, vital stains or the combination of both. However, in developing countries radioactive tracer is not widely used due to its high cost and limited availability. In addition, the classic retro-areolar blue dye injection has a high failure rate. Our study aimed to assess the efficacy of patent blue dye injection in the upper outer quadrant of the breast after validation by concurrent usage of radioactive nanocolloid, in comparison with the classic retro-areolar injection in identifying the sentinel node. A randomized control study involving 279 patients randomly divided into two groups. In group A lateral injection of 1% patent blue dye (validated by radioactive nanocolloid) was used, while subdermal patent blue dye injection in the retro-areolar space was performed in group B. The new technique showed the promising results with lower failure rate (3.4%) in comparison with the classic retro-areolar patent blue injection (13.7%). The lateral injection technique can be result in comparable results to the combination technique with the added benefit of being widely available and a cheaper option especially in developing countries.

Novel Quantification of Real-Time Lymphatic Clearance: Immediate Lymphatic Reconstruction in a Large-Animal Model.

The real-time quantification of lymphatic flow remains elusive. Efforts to provide a metric of direct lymphatic function are not clinically translatable and lack reproducibility. Early reports demonstrate the promise of immediate lymphatic reconstruction (immediate lymphovenous bypass after lymphadenectomy) to reduce the risk of lymphedema development. However, there remains a heightened need to appraise this technique in a clinically translatable large-animal model. The aim of the authors' experiment was to evaluate the role of molecular imaging in the quantification of real-time lymphatic flow after lymphadenectomy, and lymphadenectomy with lymphovenous bypass using novel fluorophores in a swine model. A lymphadenectomy or lymphadenectomy with subsequent lymphovenous bypass was performed in 10 female swine. After subdermal fluorophore injection, near-infrared molecular imaging of blood samples was used to evaluate change in lymphatic flow after lymphadenectomy versus after lymphadenectomy with lymphovenous bypass. Continuous imaging evaluating fluorescence of the superficial epigastric vein in the torso and adjacent skin was performed throughout all experiments. Findings between modalities were correlated. The near-infrared dye signal in central and peripheral blood samples was often difficult to separate from background and proved challenging for reliable quantification. Venous and skin near-infrared imaging demonstrated a lymphatic clearance rate decrease of 70 percent after lymphadenectomy versus a decrease by only 30 percent after lymphadenectomy with immediate lymphovenous bypass. In this article, the authors describe a noninvasive, swine, large-animal model to quantify lymphatic clearance using skin imaging. The authors' findings were consistent with results yielded from real-time imaging of the vein. The authors believe this model may have important implications for eventual direct translation to the clinical setting.

Use of subdermal hyaluronic acid injections and a free labial mucocutaneous graft for the repair of feline eyelid agenesis.

To describe a technique to repair feline eyelid agenesis using a hyaluronic acid (HA) subdermal filler injection to allow for acute soft tissue expansion, followed by a free labial mucocutaneous graft. Thirty-nine colobomatous eyelids in 24 feline patients with secondary keratitis were recruited to the study group. Keratitis and trichiasis were markedly resolved in 27/39 (69.2%) eyelids after a single procedure. Post-operative HA subdermal filler injections were required to resolve 5/39 (12.8%) eyelids that had mild post-operative trichiasis, and 1/39 (2.5%) eyelids that had post-operative lateral canthal collapse. Complications occurred in 6/39 (15.4%) cases, consisting of distal graft necrosis (n=2 eyes), suture rubbing the cornea (n=2 eyes), moderate trichiasis (n=1 eye) and graft adherence to the episclera (n=1 eye). The technique was successful in enhancing corneal protection, cosmesis and eyelid function and should be considered as a surgical option for any degree of eyelid agenesis in feline patients.

Effectiveness of combined microfocused ultrasound with visualization and subdermal calcium hydroxyapatite injections for the management of brachial skin laxity.

BackgroundThere is no publication to date on the combined use of microfocused ultrasound with visualization (MFU‐V) and calcium hydroxylapatite (CaHA) for brachial skin laxity.AimTo assess the effectiveness of combining MFU‐V with diluted/hyperdiluted CaHA in a single session for treating brachial skin laxity.Subjects/MethodsFemale subjects who had skin laxity in the brachial regions and who desired non‐surgical intervention were enrolled into this prospective, single‐arm pilot study. MFU‐V (Ultherapy®, Merz North America, Inc. Raleigh, N.C.) was applied using the 4.0 MHz‐4.5 mm and 7.0 MHz‐3.0 mm depth transducers, followed by subdermal injections of diluted (1:1)/hyperdiluted (1:2) CaHA (Radiesse®, Merz North America, Inc). Subjects were followed for six months after treatment. Objective biophysical skin assessments were conducted using a cutometer (Cutometer® Dual 580 MPA; Courage & Khazaka, Cologne, Germany). Subjective assessments included the arm visual analogue scale (VAS), global aesthetic improvement scale (GAIS), and subject global satisfaction scale.ResultsTwelve subjects participated in the study. The mean R0 reading (measure of skin firmness) progressively improved from 0.515 mm at baseline to 0.433 mm at 24 weeks (p < 0.05 for 12 and 24 weeks). The mean R2 reading (measure of skin elasticity) and mean arm VAS improved significantly from baseline at all visits (p < 0.05 for all). The majority of subjects at each visit showed improved arm appearance and were satisfied with their treatment. Both procedures were well‐tolerated.ConclusionsCombined use of MFU‐V with diluted/hyperdiluted CaHA demonstrates significant improvements in both objective and subjective measures of brachial skin laxity.