Debora Zechmeister do Prado

Side-by-side comparison of areas with and without cellulite depressions using magnetic resonance imaging.

BACKGROUND Cellulite is characterized by alterations in the relief of the skin surface. Magnetic resonance imaging (MRI) is recognized as a reliable technique for measuring adipose volume according to body site and for the visualization of the subcutaneous structures. OBJECTIVE To compare subcutaneous tissue in areas with and without cellulite on the buttocks of same subjects using a noninvasive technique. METHODS AND MATERIALS Thirty female patients with cellulite on the buttocks underwent MRI. An area with cellulite and another without cellulite on the contralateral buttock were selected. Two soft gelatin capsules of different sizes were used as skin markers to differentiate the areas with and without cellulite. RESULTS Fibrous septa were visualized in 96.7% of the area with cellulite depressions; most of them were ramified (73.3%) and presented a high‐intensity signal on T2 images (70%). All fibrous septa found in the examined areas were perpendicular to the skin surface. The average fibrous septa thickness was 2.18 ± 0.89 in the area with cellulite and 0.27 ± 0.64 in the area without cellulite. CONCLUSION Results of the MRI analysis showed that cellulite depressions on the buttocks were significantly associated with the presence of underlying fibrous septa.

Blind Multicenter Study of the Efficacy and Safety of Injections of a Commercial Preparation of Botulinum Toxin Type A Reconstituted up to 15 Days Before Injection

BACKGROUND It is recommended that attention be given to the shelf life of botulinum toxin type A (BT‐A) after its reconstitution. OBJECTIVE To assess the efficacy and safety of 500 U of BT‐A after reconstitution up to 15 days after injection. MATERIAL AND METHODS BT‐A vials were diluted 15 days, 8 days, and 8 hours before injection. One hundred five volunteers were randomized to one of three treatment groups, according to dilution dates. They were evaluated at baseline and 28, 56, 84, and 112 days after treatment. At each visit, the investigator and the volunteer evaluated the motility of the treated area using a 4‐point qualitative scale. Five independent specialists, who scored the motility of the treated area on the same scale, blind analyzed photographs taken at each visit. The reconstituted vials of BT‐A were stored and analyzed before and after the study. RESULTS No significant difference was shown between the groups. No evidence of contamination was found in the BT‐A vials. CONCLUSION The results confirm the possibility of injecting 500 U of BT‐A up to 15 days after its reconstitution safely and without loss of efficacy.

Field effect of two commercial preparations of botulinum toxin type A: A prospective, double-blind, randomized clinical trial

BACKGROUND The dose equivalence of commonly used commercial preparations of botulinum toxin type A, Dysport (abotulinumtoxinA [ABO] 500 U, Ipsen Biopharm Limited, Wrexham, United Kingdom) and Botox (onabotulinumtoxinA [ONA] 100 U, Allergan, Irvine, CA), remains unclear. OBJECTIVE We sought to evaluate the field effect for ABO and ONA at dose equivalences of 2.5:1.0 U and 2.0:1.0 U, in both muscular and sweat gland activity. METHODS In all, 59 female patients with forehead wrinkles were enrolled. Patients were randomized for dose equivalence between ABO and ONA, group A (2.0:1.0 U, ABO:ONA) or group B (2.5:1.0 U, ABO:ONA) administered in the frontalis muscles. Clinical assessment, Minor test, and electromyography evaluations were performed at baseline, 28 days, and 112 days. RESULTS In group B, the field of anhidrotic effect of ABO showed a greater area and larger horizontal diameter than ONA at 28 and 112 days. At maximum frontalis muscle activity (day 112) patients receiving ABO demonstrated greater improvement based on the Wrinkle Severity Scale. No differences were found in frontalis muscle activity at rest between groups A and B based on results of Wrinkle Severity Scale, electromyography, and interindividual variability data at 28 and 112 days. LIMITATIONS Currently, there are no objective measurements other than electromyography to evaluate the field effect of botulinum toxin type A in muscles. CONCLUSION At a dose equivalence of 2.0:1.0 U (ABO:ONA), similar field effects were found for both muscle and sweat gland activity. At a higher dose equivalence of 2.5:1.0 U (ABO:ONA), injections of ABO showed greater area and larger horizontal diameter in field of anhidrotic effect at 28 and 112 days than ONA.

Recommendations for Performing and Evaluating the Results of the Minor Test According to a Sweating Intensity Visual Scale

&NA; The authors have indicated no significant interest with commercial supporters.

Increasing the Field Effects of Similar Doses of Clostridium botulinum Type A Toxin–Hemagglutinin Complex in the Treatment of Compensatory Hyperhidrosis

H yperhidrosis (HH) is characterized by excessive sweating, usually exceeding thermoregulatory needs. Medical and surgical treatments can be used, depending on the type, location, and severity of the HH. Thoracic sympathectomy is indicated for selected cases of severe palmar HH, but the procedure may result in troublesome compensatory HH (CHH). Injections of botulinum toxin type A can temporarily interrupt sweating, and this new therapeutic option has emerged as a treatment for many forms of focal HH, including CHH. Because the diameter of the field effects (FEs) resulting from the injection of botulinum toxin type A is about 2 cm, a number of injections are needed to treat different forms of HH. Herein, we describe a series of 3 women with CHH of the trunk occurring after thoracic sympathectomy. All 3 patients were treated with 5 U of Clostridium botulinum type A toxin–hemagglutinin complex (hereinafter “Dysport”; Ipsen Limited, Slough, England) at different dilutions and injected at different depths.

Botulinum toxin for facial wrinkles: history and future

Botulinum toxin (BT) represents one of the latest and most revolutionary treatments in facial rejuvenation. The cosmetic use of BT in the upper third of the face began in the late 1980s and gradually advanced to applications in the mid and lower face, neck and other areas of the body. Currently, more accurate techniques and the adjunctive use of BT allow physicians more precise applications, with significantly improved, more natural-looking results. Every year, the discoveries of many new clinical and cosmetic uses of BT continue to show the utility and versatility of this therapeutic modality, both in dermatology and in other specialized areas of medicine.