Doris Hexsel

Gummy smile and botulinum toxin: A new approach based on the gingival exposure area

BACKGROUNDnGummy smile (GS) is an aesthetic disorder for some patients, which can be corrected by injection of botulinum toxin.nnnOBJECTIVEnWe sought to classify GS according to the area of gingival exposure and the respective muscles involved in order to perfect the botulinum toxin injection technique for each patient.nnnMETHODSnSixteen patients with GS were evaluated before receiving botulinum toxin injections. Based on the area of excessive gum displayed and identification of the muscles involved, 4 different types of GS were identified: anterior, posterior, mixed, and asymmetric. AbobotulinumtoxinA (Dysport, Ipsen Biopharm Limited, Wrexham, UK) was injected using a different injection technique for each type of GS, based on the main muscles involved. With the aid of two computer programs, the area of gum exposed was measured before and after the application of abobotulinumtoxinA, to evaluate the level of improvement.nnnRESULTSnThere was a decrease in the degree of gum display in all patients. The general average improvement achieved was 75.09%. Two patients showed slight adverse effects that were easily corrected with additional doses of abobotulinumtoxinA.nnnLIMITATIONSnFor this study, there was no sample size calculation and no statistical analysis of the cases.nnnCONCLUSIONnThe authors conclude that it is important to identify the type of GS and therefore the main muscles involved, so that the correct injection technique can be used. AbobotulinumtoxinA was shown to be effective and safe for use in all types of GS in the present sample.

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

BACKGROUNDnThe 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.nnnOBJECTIVEnWe 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.nnnMETHODSnIn 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.nnnRESULTSnIn 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.nnnLIMITATIONSnCurrently, there are no objective measurements other than electromyography to evaluate the field effect of botulinum toxin type A in muscles.nnnCONCLUSIONnAt 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.

Double-blind, randomized, controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a standard needle for soft tissue augmentation of the nasolabial folds.

BACKGROUND Injection‐related side effects and complications are likely to occur during or after filler injections; they are mainly caused by the injection technique. OBJECTIVE To assess safety and efficacy of a metallic cannula to inject hyaluronic acid (HA) filler in the nasolabial folds and to compare the safety of this cannula with that of a standard needle. METHODS This was a prospective, randomized, phase II, double‐blinded study that included 25 participants with Grade 2 to 3 for bilateral nasolabial folds according to the Modified Fitzpatrick Wrinkle Scale (MFWS). The side of the injection was randomized (cannula or needle), and 0.5 mL of HA was injected into each nasolabial fold. RESULTS At day 3, mean MFWS score fell from 2.40 ± 0.40 to 1.46 ± 0.52 (p < .001) on the cannulainjected side and from 2.40 ± 0.40 to 1.48 ± 0.60 (p < .001) on the regular needle‐injected side. Participants reported fewer side effects on the side injected with the new tool on the day of the injections: pain (p = .03), edema (p < .001), redness (p = .01) and hematoma (p < .001) than on the needle side. CONCLUSION The new cannula is a safe and useful tool to inject HA fillers in the nasolabial folds, producing less pain, edema, hematoma, and redness than regular needles.

Epidemiology of melasma in Brazilian patients: a multicenter study

Melasma is an acquired, irregularly patterned, light to dark‐brown hypermelanosis, with symmetric distribution mostly over the face. The aim of this study was to evaluate clinical characteristics and factors related to melasma in Brazilian patients.

Fields of Effects of 2 Commercial Preparations of Botulinum Toxin Type A at Equal Labeled Unit Doses: A Double-blind Randomized Trial

IMPORTANCEnThis article provides new data on a controversial issue, the influence of doses on the diffusion characteristics of 2 botulinum toxins type A. OBJECTIVE To assess the fields of effect of abobotulinumtoxinA and onabotulinumtoxinA at the same labeled unit dose (1:1 U) comparing sweat gland and muscle activity.nnnDESIGN, SETTING, AND PARTICIPANTSnA prospective, single-center, randomized, double-blind study was conducted at the Brazilian Center for Studies in Dermatology in Porto Alegre, Brazil. The participants included 19 women.nnnINTERVENTIONSnEach patient received 2 U of abobotulinumtoxinA on one side of the forehead and 2 U of onabotulinumtoxinA on the other side.nnnMAIN OUTCOMES AND MEASURESnHorizontal and vertical diameter and area of the fields of anhidrotic effect, the amplitude of evoked compound muscle action potentials, and the 4-point validated Wrinkle Severity Scale were assessed at 28 days.nnnRESULTSnThe horizontal and vertical diameters of the fields of effect and the areas were significantly larger for onabotulinumtoxinA than those obtained for abobotulinumtoxinA. There were no significant differences between the products in the Wrinkle Severity Scale scores and Evoked Compound Muscle Action Potentials. OnabotulinumtoxinA had significantly more diffusion than abobotulinumtoxinA when isovolumetric injections of the same labeled unit dose of the products were injected. CONCLUSIONS AND RELEVANCE Although many studies state that diffusion is product dependent and abobotulinumtoxinA diffuses more than onabotulinumtoxinA, findings from the present study confirm that diffusion is dose dependent and the more potent dose tested diffuses more. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01732809.

Botulinum toxin type A for aging face and aesthetic uses

Botulinum neurotoxin type A injection to correct and/or reverse the physical effects of aging process has become one of the most frequently requested cosmetic procedures at an outpatient setting. Careful clinical evaluation together with proper use of the techniques, including pre‐ and post‐procedures recommendations, reconstitution of the products, techniques, and doses, are described in this article. This article also covers the main indications of botulinum neurotoxin type A for aging face and other aesthetic uses, as well as some possible adverse reactions and their management.

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.

A bipolar radiofrequency, infrared, vacuum and mechanical massage device for treatment of cellulite: A pilot study

Abstract Cellulite has a complex and multifactorial etiology. Synergistic action on treating cellulite has gained support in the treatment of cellulite. This study evaluated safety and efficacy of a bipolar radiofrequency, infrared, vacuum and mechanical massage device for cellulite treatment and reduction of body measures. This was a pilot study, which assessed 9 subjects who presented body mass index from 18 to 25 Kg/Kg and at least grade 6 in the Cellulite Severity Scale (CSS). All subjects underwent a 12-session treatment of posterior thighs and buttocks. There was a significant reduction of the hip circumference (p = 0.001), however, no changes in thigh circumferences were observed (p = 0.4). CSS has improved specifically on both buttocks [p = 0.002 (left side) and p = 0.038 (right side)], and no changes were observed on thighs. The studied device demonstrated efficacy in the reduction of cellulite severity and body circumference measures in the buttocks.

Fields of muscular and anhidrotic effects of 2 botulinum toxin-A commercial preparations: a prospective, double-blind, randomized, multicenter study.

BACKGROUND Longevity of effects and dose equivalence of different botulinum toxin type A (BoNT-A) preparations need to be better clarified because BoNT-A units are manufacturer-specific. These points are of particular importance for new brands emerging in the market. OBJECTIVE To assess the field of muscular and anhidrotic effects of 2 commercial preparations of BoNT-A (incobotulinumtoxinA: Xeomin [XEO]; abobotulinumtoxinA: Dysport [DYS]) administered to the upper third of the face. METHODS Patients were randomized for the side of the forehead (left or right) in which the products were administered. All were treated receiving BoNT-A injections in 10 points (5 on each side) at a dose equivalence of 1.0:2.5 U (XEO:DYS). Clinical assessments and Minor test were performed at baseline and Days 28, 84, 112, and 140. Electromyography was performed at baseline and Days 28 and 140, and ultrasound was performed only at baseline. RESULTS Eighty patients were enrolled in 2 research centers. Xeomin and DYS presented similar results regarding fields of muscular effects. However, a larger field of anhidrotic effects was found for DYS. There was a positive correlation between the muscle thickness and electromyography results. CONCLUSION The results of this study suggest that a lower dose equivalence between DYS and XEO could be established.

Noninvasive treatment of cellulite utilizing an expedited treatment protocol with a dual wavelength laser-suction and massage device

Abstract Background: Over the past few years, noninvasive devices based on radiofrequency and/or lasers and light sources technologies are being used for the treatment of cellulite. Objectives: To evaluate the effects of an expedited treatment for cellulite and body measures. Methods: Fifteen female subjects aged from 20 to 42 years were enrolled. All the subjects underwent three treatment sessions of 30 minutes for each area in three consecutive days. Subjects were evaluated at 7, 30, and 60 post treatment. Outcome measurements included Cellulite Severity Scale (CSS) grading, body mass index (BMI), and thigh circumferences were recorded. Celluqol® and a satisfaction questionnaire were also applied. Results: At 2 months, improvements in at least one of the four CSS categories were found in 14 of the 15 subjects (93%) while 60% of patients showed improvement in both the number and depth of depressions at follow-up visits. Most of patients (93%) reported that they would get the treatment again. Discussion: This was the first study to examine the effects of this device on cellulite performed over a shortened treatment period. The treatment proved to be safe and effective, representing a new treatment modality that is also time and cost-effective for physicians and patients.