Lisa D. Grunebaum

The risk of alar necrosis associated with dermal filler injection

BACKGROUND Injection of dermal fillers is one of the most commonly performed cosmetic procedures. Serious complications from fillers are rare but potentially devastating to patients and physicians. Skin necrosis, such as nasal alar necrosis, is one of the most feared serious complications of dermal fillers, but there is a paucity of literature on the incidence of such events, as well as potential treatment options. METHODS We present a review of the literature and three cases of nasal alar necrosis after dermal filler injection. CONCLUSION Nasal alar necrosis associated with dermal filler injection is a rare event. Proper technique and recognition of risk factors may reduce the incidence of this complication. Physicians should be aware of early intervention and treatment options should impending necrosis become apparent. Dr. Baumann is an investigator for Medicis, Dermik, Genzyme, and Allergan.

Six-Month, Double-Blind, Randomized, Split-Face Study to Compare the Efficacy and Safety of Calcium Hydroxylapatite (CaHA) Mixed with Lidocaine and CaHA Alone for Correction of Nasolabial Fold Wrinkles

BACKGROUND Safety, pain, duration of effect, and patient satisfaction are important concerns for physicians performing dermal filler injections. OBJECTIVE This randomized, double‐blind, split‐face study compared the 6‐month safety profile of dermal injections of calcium hydroxylapatite (CaHA) mixed with lidocaine (RDF‐L) with that of CaHA alone (RDF) in nasolabial folds (NLFs). The study also assessed differences in pain perception, efficacy, and patient satisfaction of RDF‐L and RDF for correction of nasolabial wrinkles. METHODS Sixteen adult subjects with moderate to deep NLFs according to the Lemperle Rating Scale were enrolled. Pain perception was recorded from patients using a validated visual analog pain scale. Efficacy judged by a blinded injector and an independent observer was evaluated up to 24 weeks. Patient satisfaction surveys were also collected. Adverse events were recorded throughout the study. RESULTS/CONCLUSIONS Neither RDF‐L nor RDF led to significant adverse events. Comparable and limited local adverse events typical of dermal fillers were noted in both groups. No difference in duration of effect in the NLFs was shown between RDF‐L and RDF. Much less pain was reported on the RDF‐L side. In general, patients were extremely satisfied with the treatment on both sides. BioForm Medical (San Mateo, CA) provided Radiesse soft tissue filler, lidocaine, and other necessary supplies. Dr. Grunebaum has received compensation for presentations to the medical community about products manufactured by BioForm Medical.

Effects of lavender olfactory input on cosmetic procedures

Objectives  To evaluate the effects of the aroma of essential oil of lavender against placebo on subjects’ pain perceptions and levels of anxiety when undergoing elective cosmetic facial injections of botulinum toxin type A (BOTOX® COSMETIC) for the correction of glabellar wrinkles.

Laser treatment of facial scars.

Purpose of reviewFacial scars can develop as a result of trauma, surgery, burns, acne, or other conditions. These scars are often quite distressing to patients. Lasers were first used to treat these scars in the 1990s. Recently, new laser technology has been used to prevent and treat scars. This literature review and the report of the senior authors recent experience summarize the recent advances in laser treatment of scars. Recent findingsWith the development of new laser technology, the treatment options for hypotrophic scars and developing scars have increased. Furthermore, there are expanded options for treatment of established hypertrophic scars. Recent studies have shown that nonablative and fractionated lasers can be effective for treating hypotrophic and developing scars. Scar improvements may be due to direct effects of the laser and/or histochemical effects, including production of heat shock proteins and tumor growth factors. Nonablative and fractionated lasers have a shorter recovery period than CO2 resurfacing lasers. This can vary from a few hours to up to 7 days. SummaryRecent new laser technology has increased the options for treatment of scars. These have been shown to be beneficial for hypotrophic, incipient, and established scars. The benefits of laser therapy may be due to direct and/or histochemical effects.

Nonprescription topical treatments for skin rejuvenation.

Topical skin care regimens are a mainstay treatment for aging skin. All patients seeking skin rejuvenation can benefit from this low-risk intervention. This article reviews available nonprescription topical treatments for rejuvenation including moisturizers, antioxidants, retinols, and sunscreen.

Split face evaluation of long‐pulsed non‐ablative 1,064 nm Nd:YAG laser for treatment of direct browplasty scars

To investigate 1,064 nm long‐pulse Nd:YAG laser for postoperative treatment of direct browplasty scars.

Neurotoxins and Fillers for Skin Rejuvenation

The ephemeral effects of neurotoxins and fillers are well described for facial remodeling and rejuvenation. Less is known about their long-term effects on skin rejuvenation and neocollagenesis. This article aims to review current available science and literature to support the use of these cosmetic procedures as lasting antiaging treatments.

Lip and Perioral Trauma

The management of perioral injuries is a complex topic that must take into consideration the unique anatomy, histology, and function of the lips to best restore form and function of the mouth after injury. Basic reconstructive principles include three-layered closure for full-thickness lip lacerations. Additionally, special care is needed to ensure an aesthetic repair of the cosmetically complex and important vermillion border, philtrum, and Cupids bow. Infraorbital and mental nerve blocks provide lip anesthesia for laceration repair without distorting crucial aesthetic landmarks. Prophylactic antibiotics are usually indicated in perioral injuries due to wound contamination with saliva. Perioral burn management is controversial; however, most lip burns can first be managed conservatively. Splinting, plasties, and other reconstructive options are available after secondary healing of perioral burns. Hypertrophic scars are common in the perioral area after trauma. The mainstays of treatment for hypertrophic scars on the lips are silicone elastomer sheeting and intralesional steroid injections. For large perioral defects, a myriad of reconstructive options are available, ranging from primary closure, cross-lip flaps, and local tissue transfer, to free tissue transfers such as radial forearm free flaps, innervated gracilis free flaps, anterolateral thigh free flaps, and osteocutaneous free flaps.

The Endonasal Approach to Rhinoplasty

■ The ultimate success in rhinoplasty depends more upon the initial consultation and analysis of the patient than it does upon the technical approach to the nose. In the authors experience, the endonasal approach affords the opportunity to satisfy the patient’s needs in the overwhelming majority of cases.

Evaluating New Technology

There are multiple complex issues to consider when evaluating any new technology. First evaluate the efficacy of the device. Then considering your patient population decide whether this technology brings an added benefit to your patients. If it meets these 2 criteria, then proceed to the financial analysis of acquiring this technology. The complete financial analysis has several important components that include but are not limited to cost, value, alternatives, return on investment, and associated marketing expense.