Boris Sommer

Current Concepts of Fat Graft Survival: Histology of Aspirated Adipose Tissue and Review of the Literature

Background. Controversy remains about the longevity of correction in autologous fat grafts and its relation to adipocyte survival. Reported long‐term fat graft survival rates differ widely, depending on harvesting method, means of reinjection, injection site, and evaluation methods. Objective. To demonstrate histologic findings of aspirated adipose tissue and compare the findings to the reports in the literature. Methods. Review of the literature and the histology of transplanted fat 7 years after subcutaneous implantation and trypan blue staining to determine the vitality of defrosted adipocytes. Results. Fat cells survive aspiration with a suction machine or syringe equally well. Use of a liposuction cannula or 14‐gauge needle gives comparable results. Local anesthesia or tumescent local anesthesia is recommended for the donor site, preferably with addition of epinephrine. Conclusion. Clinical longevity of correction after autologous fat transfer is determined by the degree of augmentation resulting from the amount of fibrosis induced and the number of viable fat cells. Survival of aspirated fat cell grafts depends mainly on the anatomic site, the mobility and vascularity of the recipient tissue, or underlying causes and diseases, and less on harvesting and reinjection methods.

Treating glabellar lines with botulinum toxin type A-hemagglutinin complex: a review of the science, the clinical data, and patient satisfaction.

Botulinum toxin type A treatment is the foundation of minimally invasive aesthetic facial procedures. Clinicians and their patients recognize the important role, both negative and positive, that facial expression, particularly the glabellar frown lines, plays in self-perception, emotional well-being, and perception by others. This article provides up-to-date information on fundamental properties and mechanisms of action of the major approved formulations of botulinum toxin type A, summarizes recent changes in naming conventions (nonproprietary names) mandated by the United States Food and Drug Administration, and describes the reasons for these changes. The request for these changes provides recognition that formulations of botulinum toxins (eg, onabotulinumtoxinA and abobotulinumtoxinA) are not interchangeable and that dosing recommendations cannot be based on any one single conversion ratio. The extensive safety, tolerability, and efficacy data are summarized in detail, including the patient-reported outcomes that contribute to overall patient satisfaction and probability treatment continuation. Based on this in-depth review, the authors conclude that botulinum toxin type A treatment remains a cornerstone of facial aesthetic treatments, and clinicians must realize that techniques and dosing from one formulation cannot be applied to others, that each patient should undergo a full aesthetic evaluation, and that products and procedures must be selected in the context of individual needs and goals.

Liporecycling: A Technique for Facial Rejuvenation and Body Contouring

Background. Soft tissue augmentation using autologous fat is a standard method in facial rejuvenation and in refinement of body contouring. Different procedures by different authors have been described, each with its specific advantages and disadvantages. Objective. The purpose of this article is to describe a method of harvesting, processing, and reinjection of fat that provides new aspects and advantages compared to previously described procedures. Methods. We report about a new method of autologous fat grafting. Fat is harvested during machine‐assisted liposuction in tumescent local anesthesia with microcannulas, processed in a special open manner, and reinjected through a 24‐gauge needle for intra‐ and subdermal augmentation. Results. Short‐ and long‐term results are equivalent to other methods of fat cell grafting. Conclusion. Advantages of the described method include easy harvesting during conventional machine‐assisted liposuction, the possibility of removing undesired bands of fibrous tissue from the graft, and easy passage through a 24‐gauge needle. Thus sub‐ and intradermal augmentation is possible with the same material and syringe.

Tumeszenzlokalanästhesie Weiterentwicklung der Lokalanästhesieverfahren für die operative Dermatologie

ZusammenfassungDie Tumeszenzlokalanästhesie (TLA) wurde vor 10 Jahren von dem amerikanischen Dermatologen und Pharmakologen J. Klein zur Erleichterung der kosmetischen Fettabsaugung eingeführt. Nachdem sich diese Form der großen Lokalanästhesie außerordentlich gut bewährt hatte, wurden ihre speziellen Vorteile nach und nach auch für andere Indikationen genutzt, ein Prozeß, der bis heute unvermindert anhält. In der folgenden Übersicht wird erstmals in der deutschsprachigen Literatur ausführlich auf Besonderheiten der TLA im Vergleich zur bisherigen Form der Infiltrationsanästhesie eingegangen. Eigene, teils noch unpublizierte Erfahrungen werden mitgeteilt und aktuelle und zukünftige Indikationen aufgezeigt.SummaryThe tumescent technique of local anesthesia was developed by J. Klein ten years ago to facilitate liposuction surgery. Tumescent anesthesia not only became the standard technique for liposuction, but proved to be of great value for other surgical problems in dermatology. Meanwhile, several noncosmetic uses for tumescent anesthesia were pioneered by dermatologic surgeons. This first review of the tumescent technique in German literature will focus on its specific advantages and disadvantages when applied in different fields of dermatologic surgery. Our own experience will be discussed, as well as future developments.

Liporecycling: Immediate and Delayed

Liposuction has become one of the most commonly performed cosmetic surgical procedures. A natural offspring of liposuction, liporecycling, has simultaneously been developed as an effective procedure in soft-tissue augmentation. The graft material for this procedure is collected during reduction liposuction performed with tumescent anesthesia. The tumescent solution allows for the use of specially designed microcannulas. In this way, pure fat cells are harvested that can easily be used immediately or frozen and kept for future subdermal reinjection through small syringes. The results in soft-tissue augmentation and facial rejuvenation are comparable to those of collagen injection but show a number of significant advantages.

Efficacy and safety of a new hyaluronic acid dermal filler in the treatment of moderate nasolabial folds: 6-month interim results of a randomized, evaluator-blinded, intra-individual comparison study

Abstract Background: Hyaluronic acid (HA) fillers such as Restylane® are frequently used for the correction of facial soft tissue defects. Objective: To compare the efficacy and safety of a novel HA filler, Emervel® Classic, with those of Restylane in the treatment of moderate nasolabial folds. Methods: This was a split-face, randomized and evaluator-blinded comparison study. Subjects were randomized to receive an injection of Emervel Classic or Restylane on their left or right side. Efficacy was evaluated based on the change in Wrinkle Severity Rating Score (WSRS) from baseline. Local tolerability was assessed based on subject diary, which recorded the severity of erythema, oedema/swelling, bruising, pain/tenderness and pruritus during the first 3 weeks after injection. Results: The interim results 6 months after injection are reported. At week 24, the mean improvement in WSRS from baseline was 0.83 ± 0.51 for Emervel Classic, similar to that for Restylane (0.90 ± 0.57). A similar volume of both fillers was injected. Most local tolerability events were mild and transient. Erythema, oedema/swelling and pain/tenderness were significantly less severe and disappeared faster with Emervel Classic than with Restylane (at least p < 0.05). Conclusion: Emervel Classic provides similar efficacy and better overall local tolerability compared with Restylane 6 months after treatment of moderate nasolabial folds.

Double-Blind, Randomized, Intraindividual Comparison Study of the Efficacy of Prilocaine and Lidocaine in Tumescent Local Anesthesia

Background: Tumescent local anesthesia (TLA) with lidocaine or prilocaine solutions is widely used in dermatology. Objective: Comparison of efficacy and safety of lidocaine and prilocaine in liposuctions with TLA. Methods: TLA was performed using defined dilutions of lidocaine or prilocaine. Half-side comparisons were applied on 26 patients undergoing symmetric liposuction. Pain reduction (overall sensation and pain at lancet prick) and tolerance were assessed before, during and 2–24 h after liposuction. Results: No differences in overall pain sensation between the substances were detected during and after liposuction except a more rapid onset with lidocaine (less pain after 15 min, p < 0.043). Local tolerance of both substances was excellent. Conclusion: Lidocaine and prilocaine used in TLA for liposuction show good efficacy and tolerance. A fixed combination of lidocaine and prilocaine may reduce the risk of side effects when great quantities of TLA are needed.

Facial aesthetics: achieving the natural, relaxed look.

When patients undergoing nonsurgical facial rejuvenation procedures are asked to state their expectations in terms of outcomes, the achievement of a “natural, relaxed look” usually emerges as the paramount goal. The importance to clinicians of delivering on this patient desire is becoming increasingly clear. After all, patient satisfaction is the ultimate treatment goal. This article explores aspects of what defines the natural, relaxed look and what patients are seeking when they undergo nonsurgical facial rejuvenation procedures and is based on the clinical experience of the authors. The article also offers suggestions intended to help clinicians provide each patient with appropriate outcomes and satisfaction.

Konsensusempfehlungen zur Behandlung mit Onabotulinumtoxin A in der ästhetischen Medizin

Onabotulinumtoxin A – Historie Onabotulinumtoxin A (OnaBTX A) wird seit über 30 Jahren erfolgreich in der Humanmedizin zur Behandlung zahlreicher Indikationen angewandt. 1980 setzte Alan Scott erstmalig Botulinumtoxin in der Behandlung des Strabismus am Patienten ein [1]. In den folgenden Jahren kamen weitere Indikationen aus dem Bereich neurologisch-spastischer Tonusstörungen hinzu [2–4]. 1989 erfolgte dann schließlich die offi zielle Zulassung als Medikament durch die „Food and Drug Administration“ (FDA) für die Indikationen Strabismus und Blepharospasmus unter dem Namen Botox®. Anfang der 1990er Jahre beschrieben Carruthers und Carruthers die Anwendung von Botulinumtoxin Typ A (BTX A) zur Behandlung mimisch bedingter Falten [5–7]. Vorausgegangen war die Beobachtung der kanadischen Ophthalmologin Jean Carruthers, welche im Rahmen einer Blepharospasmus-Studie festgestellt hatte, dass es bei ihren Patienten zu einer deutlichen Reduktion der glabellären Falten gekommen war. Dies nahm ihr Ehemann, der Dermatologe Alastair Carruthers, zum Anlass, Botox® auch zur Behandlung mimischer Falten, also durch muskuläre Kontraktion bedingte Falten, einzusetzen. Der Grundstein für den Einsatz von BTX A in der ästhetischen Medizin war gelegt, sodass man zum heutigen Zeitpunkt auf einen mehr als 20 Jahre andauernden Erfahrungsund Weiterentwicklungszeitraum von BTX A (heute OnaBTX A, siehe unten) in der ästhetischen Medizin zurückblicken kann. Bis zur offi ziellen Zulassung von OnaBTX A für die Behandlung der Glabellafalte im Jahr 2001 in den USA unter dem Namen Botox Cosmetic®, waren bereits mehrere Millionen ästhetische Behandlungen im Gesichtsbereich durchgeführt worden. 2006 wurde OnaBTX A in Deutschland unter dem Namen Vistabel® zur Behandlung der Glabellafalten unter besonderen Voraussetzungen zugelassen (siehe Fachinfo). Neben den heutzutage zahlreichen zugelassenen „On-Label“-Indikationen im Bereich der kurativen OnaBTX-A-Therapie (in Deutschland Botox® bzw. Vistabel®), gibt es mittlerweile kaum eine medizinische Fachrichtung, die sich nicht auch über diese hinaus einer der vielen innovativen Behandlungsansätze im medizinischen „Off-Label“-Bereich bedient. Vor diesem Hintergrund ist OnaBTX A eines der am besten beforschten Medikamente und wird jährlich millionenfach weltweit eingesetzt. Erfolgreiche Therapien mit OnaBTX A auch in deutlich höheren Dosierungen als bei ästhetischen Behandlungen, über alle medizinischen Fachgebiete und Patientengruppen hinweg bestätigen, dass OnaBTX A in der Wolfgang G. PhilippDormston1, Dorothee Bergfeld2, Boris Sommer2, und die OnabotulinumtoxinKonsensusgruppe3

Liposuction - a surgical procedure in dermatology

Liposuction is an integral part of the wide range of surgical procedures in dermatology. Dermatologists established tumescent local anesthesia in combination with the use of micro‐cannulas; especially dermatologists from Germany and Austria actively designed and developed these new techniques. In this position paper, we discuss the history, various interdisciplinary aspects, the significance, and the treatment indications for this procedure as well as its role within dermatologic training programs and research. For quality reasons, members of the Germany Society of Dermatologic Surgery and the Austrian Society of Dermatologic Surgery discuss several fundamental professional aspects as well as the historical development of liposuction.