Ross M. Campbell

Reduced Pain with Use of Proprietary Hyaluronic Acid with Lidocaine for Correction of Nasolabial Folds: A Patient-Blinded, Prospective, Randomized Controlled Trial

BACKGROUND Pain during and after implantation of dermal gel fillers is a consistent complaint of patients undergoing soft tissue augmentation. Reduction of pain during injection would increase patient comfort and improve the overall patient experience. OBJECTIVE To evaluate pain at the injection site during and after the injection of Prevelle SILK or Captique and to evaluate outcomes after 2 weeks. METHODS & MATERIALS In a patient‐blinded, prospective, randomized, split‐face design trial, a non‐animal‐derived hyaluronic acid based filler formulated with lidocaine (Prevelle SILK) was injected in one nasolabial fold (NLF), and the same filler without lidocaine (Captique) was injected in the contralateral NLF of 45 enrolled patients. Injection site pain was measured using a visual analogue scale at injection (time 0) and 15, 30, 45, and 60 minutes after injection. Patients were asked to return for an evaluation after 2 weeks and to complete a self‐assessment questionnaire during the follow‐up visit. RESULTS There was more than 50% less pain associated with the dermal gel with lidocaine than with the same filler without lidocaine at all time points (p<.05). The greatest difference in pain was recorded at the time of injection, and then the effect gradually declined over the 60‐minute period. Both fillers were well tolerated, and there was no difference in outcome after 2 weeks. CONCLUSION Addition of lidocaine to a filler resulted in significantly less pain associated with the procedure without compromising outcomes. Gary Monheit, MD, is a Consultant and Clinical Investigator to Genzyme. Nathan Bachtell, MD, Denise Eng, BS, and Lena Holmdahl, MD, PhD, are employees of Genzyme Corporation.

The Percutaneous Suspension Suture

The suspension suture is used frequently in facial cosmetic surgery and has been more recently used in reconstruction after Mohs micrographic surgery. A study by Robinson of 136 surgical defects repaired using this technique found the suspension suture beneficial to obtain linear closure, prevent the distortion of free margins, prevent tenting across concave surfaces, and fix the closure line at the junction of cosmetic units. The redistribution of tension to the surrounding edge also offers better feasibility of elliptic and flap closures with cosmesis intact.

Dehiscence and Necrosis

Wound healing is comprised of a complex cycle of inflammation, proliferation, and remodeling. Vast numbers of cellular growth factors, cytokines, and cell types are involved. Recent research has provided new information that may enable clinicians to improve wound healing in the future. Although there is currently a wealth of knowledge about the science of wound healing, the incidence of acute wound failure has not decreased significantly in the last 75 years.1