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Piercing Regret: Correcting Earlobe Defects From Gauges
The use of gauges to expand or alter the shape of the earlobe is a relatively popular trend in this day and age. However, as with tattoos, patients sometimes request removal of this physical alteration out of regret or a change in lifestyle. Managing these patients poses a challenge for dermatologists due to the variable degree of tissue ptosis left behind.
Collins et al published a retrospective review in JAMA Facial Plastic Surgery (2015;17:144-148) of their last 20 patients treated for earlobe reconstruction that had at least 1 year of follow-up. The earlobe deformities were classified as small, medium, or large. Small defects were those that were small enough to be treated with an elliptical excision and primary closure. Medium defects were those that had a disruption of the natural curve of the inferior earlobe and a more distinct soft tissue loss of the lobule. A primary closure of this type of defect may cause an unnaturally long lobule. The authors suggested excising the opening and then using a posterior-based advancement flap to restore the natural earlobe contour while improving some of the soft tissue loss. Large defects were those with a lot of volume loss and tissue redundancy. These defects required a wedge excision of the elongated piercing site and a posterior-superior–based advancement flap with 2 arms to it.
Results showed that all 20 patients did well after at least 1 year without the need for further reconstruction or excisional scar revision. Two patients did undergo dermabrasion at 1 year to help blend the final scar.
What’s the issue?
Trends such as the placement of earlobe gauges may wane at some point, resulting in a number of patients seeking our help to repair their earlobes. The approach presented in this study tailors the method of repair to the size of the defect. By doing so, one can hope to restore the natural shape and volume to achieve a natural-appearing earlobe. Have you seen an increase in the number of patients seeking this type of repair?
The use of gauges to expand or alter the shape of the earlobe is a relatively popular trend in this day and age. However, as with tattoos, patients sometimes request removal of this physical alteration out of regret or a change in lifestyle. Managing these patients poses a challenge for dermatologists due to the variable degree of tissue ptosis left behind.
Collins et al published a retrospective review in JAMA Facial Plastic Surgery (2015;17:144-148) of their last 20 patients treated for earlobe reconstruction that had at least 1 year of follow-up. The earlobe deformities were classified as small, medium, or large. Small defects were those that were small enough to be treated with an elliptical excision and primary closure. Medium defects were those that had a disruption of the natural curve of the inferior earlobe and a more distinct soft tissue loss of the lobule. A primary closure of this type of defect may cause an unnaturally long lobule. The authors suggested excising the opening and then using a posterior-based advancement flap to restore the natural earlobe contour while improving some of the soft tissue loss. Large defects were those with a lot of volume loss and tissue redundancy. These defects required a wedge excision of the elongated piercing site and a posterior-superior–based advancement flap with 2 arms to it.
Results showed that all 20 patients did well after at least 1 year without the need for further reconstruction or excisional scar revision. Two patients did undergo dermabrasion at 1 year to help blend the final scar.
What’s the issue?
Trends such as the placement of earlobe gauges may wane at some point, resulting in a number of patients seeking our help to repair their earlobes. The approach presented in this study tailors the method of repair to the size of the defect. By doing so, one can hope to restore the natural shape and volume to achieve a natural-appearing earlobe. Have you seen an increase in the number of patients seeking this type of repair?
The use of gauges to expand or alter the shape of the earlobe is a relatively popular trend in this day and age. However, as with tattoos, patients sometimes request removal of this physical alteration out of regret or a change in lifestyle. Managing these patients poses a challenge for dermatologists due to the variable degree of tissue ptosis left behind.
Collins et al published a retrospective review in JAMA Facial Plastic Surgery (2015;17:144-148) of their last 20 patients treated for earlobe reconstruction that had at least 1 year of follow-up. The earlobe deformities were classified as small, medium, or large. Small defects were those that were small enough to be treated with an elliptical excision and primary closure. Medium defects were those that had a disruption of the natural curve of the inferior earlobe and a more distinct soft tissue loss of the lobule. A primary closure of this type of defect may cause an unnaturally long lobule. The authors suggested excising the opening and then using a posterior-based advancement flap to restore the natural earlobe contour while improving some of the soft tissue loss. Large defects were those with a lot of volume loss and tissue redundancy. These defects required a wedge excision of the elongated piercing site and a posterior-superior–based advancement flap with 2 arms to it.
Results showed that all 20 patients did well after at least 1 year without the need for further reconstruction or excisional scar revision. Two patients did undergo dermabrasion at 1 year to help blend the final scar.
What’s the issue?
Trends such as the placement of earlobe gauges may wane at some point, resulting in a number of patients seeking our help to repair their earlobes. The approach presented in this study tailors the method of repair to the size of the defect. By doing so, one can hope to restore the natural shape and volume to achieve a natural-appearing earlobe. Have you seen an increase in the number of patients seeking this type of repair?
Effect of Autologous Fat Injection on Lower Eyelid Position
Lower eyelid malposition is both a cosmetic and functional issue for many patients. It often arises from normal aging; however, it also can be due to thyroid disease, trauma, and surgery (iatrogenic). Correction of lower eyelid malposition requires a variety of surgical approaches to elevate the lower eyelid position. These procedures are not without risk. There have been reports of hyaluronic acid injections being used to help stretch the skin and give support to the sagging eyelid.
Le et al published a study (Ophthal Plast Reconstr Surg. 2014;30:504-507) on the effect of autologous fat injection on lower eyelid position. They performed a retrospective pilot study of autologous fat injections to support the lower eyelid in patients presenting for cosmetic reasons. A retrospective chart review was performed identifying 70 patients that had undergone lower eyelid and malar autologous fat injections for cosmetic improvement performed by a single surgeon. Patients were excluded if they had prior eyelid surgery. Photographs were taken in a standardized fashion and evaluated by 2 blinded evaluators. The measurements evaluated were the lower eyelid position (marginal reflex distance 2 [MRD2]) and inferior scleral show (SS).
The fat was harvested from the inner thigh and knee under tumescent anesthesia, strained, and injected with a 1.2-mm blunt cannula into various planes of the facial soft tissues. Approximately 0 to 2 mL was injected into the tear trough areas and 3 to 7 mL into the malar region, both per side. Photographs were repeated at an average of 117, 125, and 316 days.
Results showed that the MRD2 distance improved 0.5 mm bilaterally and was maintained at 316 days. Similarly, the SS measurement improved by 0.5 mm and was maintained at 125 days. Results improved slightly more in patients who had simultaneous face-lifts, but the difference was not statistically significant.
What’s the issue?
Lower eyelid malposition can make patients appear aged or tired while functionally causing dry eye or excessive tearing. Finding a way to improve this condition without surgery is key because the surgeries are fraught with risk. This study suggests that we should look more critically at lower eyelid positions in our patients who are receiving synthetic fillers or autologous fat to see if we are improving the MRD2 and SS measurements. Have you been seeing an increase in patients seeking improvement for “tired-looking eyes,” or do patients know they look tired but cannot pinpoint why?
Lower eyelid malposition is both a cosmetic and functional issue for many patients. It often arises from normal aging; however, it also can be due to thyroid disease, trauma, and surgery (iatrogenic). Correction of lower eyelid malposition requires a variety of surgical approaches to elevate the lower eyelid position. These procedures are not without risk. There have been reports of hyaluronic acid injections being used to help stretch the skin and give support to the sagging eyelid.
Le et al published a study (Ophthal Plast Reconstr Surg. 2014;30:504-507) on the effect of autologous fat injection on lower eyelid position. They performed a retrospective pilot study of autologous fat injections to support the lower eyelid in patients presenting for cosmetic reasons. A retrospective chart review was performed identifying 70 patients that had undergone lower eyelid and malar autologous fat injections for cosmetic improvement performed by a single surgeon. Patients were excluded if they had prior eyelid surgery. Photographs were taken in a standardized fashion and evaluated by 2 blinded evaluators. The measurements evaluated were the lower eyelid position (marginal reflex distance 2 [MRD2]) and inferior scleral show (SS).
The fat was harvested from the inner thigh and knee under tumescent anesthesia, strained, and injected with a 1.2-mm blunt cannula into various planes of the facial soft tissues. Approximately 0 to 2 mL was injected into the tear trough areas and 3 to 7 mL into the malar region, both per side. Photographs were repeated at an average of 117, 125, and 316 days.
Results showed that the MRD2 distance improved 0.5 mm bilaterally and was maintained at 316 days. Similarly, the SS measurement improved by 0.5 mm and was maintained at 125 days. Results improved slightly more in patients who had simultaneous face-lifts, but the difference was not statistically significant.
What’s the issue?
Lower eyelid malposition can make patients appear aged or tired while functionally causing dry eye or excessive tearing. Finding a way to improve this condition without surgery is key because the surgeries are fraught with risk. This study suggests that we should look more critically at lower eyelid positions in our patients who are receiving synthetic fillers or autologous fat to see if we are improving the MRD2 and SS measurements. Have you been seeing an increase in patients seeking improvement for “tired-looking eyes,” or do patients know they look tired but cannot pinpoint why?
Lower eyelid malposition is both a cosmetic and functional issue for many patients. It often arises from normal aging; however, it also can be due to thyroid disease, trauma, and surgery (iatrogenic). Correction of lower eyelid malposition requires a variety of surgical approaches to elevate the lower eyelid position. These procedures are not without risk. There have been reports of hyaluronic acid injections being used to help stretch the skin and give support to the sagging eyelid.
Le et al published a study (Ophthal Plast Reconstr Surg. 2014;30:504-507) on the effect of autologous fat injection on lower eyelid position. They performed a retrospective pilot study of autologous fat injections to support the lower eyelid in patients presenting for cosmetic reasons. A retrospective chart review was performed identifying 70 patients that had undergone lower eyelid and malar autologous fat injections for cosmetic improvement performed by a single surgeon. Patients were excluded if they had prior eyelid surgery. Photographs were taken in a standardized fashion and evaluated by 2 blinded evaluators. The measurements evaluated were the lower eyelid position (marginal reflex distance 2 [MRD2]) and inferior scleral show (SS).
The fat was harvested from the inner thigh and knee under tumescent anesthesia, strained, and injected with a 1.2-mm blunt cannula into various planes of the facial soft tissues. Approximately 0 to 2 mL was injected into the tear trough areas and 3 to 7 mL into the malar region, both per side. Photographs were repeated at an average of 117, 125, and 316 days.
Results showed that the MRD2 distance improved 0.5 mm bilaterally and was maintained at 316 days. Similarly, the SS measurement improved by 0.5 mm and was maintained at 125 days. Results improved slightly more in patients who had simultaneous face-lifts, but the difference was not statistically significant.
What’s the issue?
Lower eyelid malposition can make patients appear aged or tired while functionally causing dry eye or excessive tearing. Finding a way to improve this condition without surgery is key because the surgeries are fraught with risk. This study suggests that we should look more critically at lower eyelid positions in our patients who are receiving synthetic fillers or autologous fat to see if we are improving the MRD2 and SS measurements. Have you been seeing an increase in patients seeking improvement for “tired-looking eyes,” or do patients know they look tired but cannot pinpoint why?
Long-term Cosmetic Use of Botulinum Toxin Type A
In the United States, the cosmetic use of botulinum toxin type A (BTX-A) has continued to grow over the last 15 years, according to multispecialty data recently released by the American Society for Aesthetic Plastic Surgery. During these years, many of our patients, if not ourselves, have undergone treatment faithfully every 3 to 6 months to combat the signs of aging. Subsequently, with the monitoring of adverse events (AEs), the US Food and Drug Administration has issued a black box warning that covers serious side effects—respiratory compromise and death—associated with treatment, yet most of what is listed in the black box warning pertains to medical use rather than cosmetic use. However, with the ever-growing indications for BTX-A, we must be cognizant of the fact that our patients may be receiving concomitant treatment with BTX-A for medical conditions (eg, migraines, hyperhidrosis, achalasia, dysphonia, dystonia, strabismus) by other specialists. Thus, there is a need to understand the potential side effects associated with BTX-A treatments and long-term consequences.
In a January 21 article published online in Pharmacology Yiannakopoulou looked at national monitoring programs through the US Food and Drug Administration and the Danish Medicines Agency. Many of the AEs reported were related to medical use of BTX-A, including anaphylaxis, death, generalized weakness, and dysphagia. Serious AEs related to the cosmetic use of BTX-A included thyroid eye disease, sarcoidal granuloma, pseudoaneurysm of the frontal branch of the superior temporal artery, and severe respiratory failure. Additionally, a patient receiving BTX-A for palmar and axillary hyperhidrosis developed botulinumlike generalized weakness. Upon review of epidemiological studies, the incidence and types of AEs were covered. The vast majority of these events were related to the medical use of BTX-A, which could stem from the lack of long-term studies on cosmetic patients and the lack of reporting of many AEs. The author summarized that minimizing potential AEs relies on proper injection technique, proper storage of the medication, proper dosing, and thorough knowledge of the anatomy.
What’s the issue?
Botulinum toxin type A remains one of the most gratifying treatments for both physicians and patients alike. However, with the potential for abuse, as in the case of the recent fake Botox Cosmetic that has shown up on the market in the United States), we must remain vigilant for AEs. Furthermore, we must continue to emphasize to patients that it is a medical treatment and deserves all the attention and respect we give to other medical interventions. However, as the Yiannakopoulou review has shown, proper injection techniques have a low rate of AEs in the cosmetic use of BTX-A. Have you seen an increase in the number of cosmetic BTX-A patients receiving concomitant treatments with BTX-A for medical conditions? If so, how do you manage them?
In the United States, the cosmetic use of botulinum toxin type A (BTX-A) has continued to grow over the last 15 years, according to multispecialty data recently released by the American Society for Aesthetic Plastic Surgery. During these years, many of our patients, if not ourselves, have undergone treatment faithfully every 3 to 6 months to combat the signs of aging. Subsequently, with the monitoring of adverse events (AEs), the US Food and Drug Administration has issued a black box warning that covers serious side effects—respiratory compromise and death—associated with treatment, yet most of what is listed in the black box warning pertains to medical use rather than cosmetic use. However, with the ever-growing indications for BTX-A, we must be cognizant of the fact that our patients may be receiving concomitant treatment with BTX-A for medical conditions (eg, migraines, hyperhidrosis, achalasia, dysphonia, dystonia, strabismus) by other specialists. Thus, there is a need to understand the potential side effects associated with BTX-A treatments and long-term consequences.
In a January 21 article published online in Pharmacology Yiannakopoulou looked at national monitoring programs through the US Food and Drug Administration and the Danish Medicines Agency. Many of the AEs reported were related to medical use of BTX-A, including anaphylaxis, death, generalized weakness, and dysphagia. Serious AEs related to the cosmetic use of BTX-A included thyroid eye disease, sarcoidal granuloma, pseudoaneurysm of the frontal branch of the superior temporal artery, and severe respiratory failure. Additionally, a patient receiving BTX-A for palmar and axillary hyperhidrosis developed botulinumlike generalized weakness. Upon review of epidemiological studies, the incidence and types of AEs were covered. The vast majority of these events were related to the medical use of BTX-A, which could stem from the lack of long-term studies on cosmetic patients and the lack of reporting of many AEs. The author summarized that minimizing potential AEs relies on proper injection technique, proper storage of the medication, proper dosing, and thorough knowledge of the anatomy.
What’s the issue?
Botulinum toxin type A remains one of the most gratifying treatments for both physicians and patients alike. However, with the potential for abuse, as in the case of the recent fake Botox Cosmetic that has shown up on the market in the United States), we must remain vigilant for AEs. Furthermore, we must continue to emphasize to patients that it is a medical treatment and deserves all the attention and respect we give to other medical interventions. However, as the Yiannakopoulou review has shown, proper injection techniques have a low rate of AEs in the cosmetic use of BTX-A. Have you seen an increase in the number of cosmetic BTX-A patients receiving concomitant treatments with BTX-A for medical conditions? If so, how do you manage them?
In the United States, the cosmetic use of botulinum toxin type A (BTX-A) has continued to grow over the last 15 years, according to multispecialty data recently released by the American Society for Aesthetic Plastic Surgery. During these years, many of our patients, if not ourselves, have undergone treatment faithfully every 3 to 6 months to combat the signs of aging. Subsequently, with the monitoring of adverse events (AEs), the US Food and Drug Administration has issued a black box warning that covers serious side effects—respiratory compromise and death—associated with treatment, yet most of what is listed in the black box warning pertains to medical use rather than cosmetic use. However, with the ever-growing indications for BTX-A, we must be cognizant of the fact that our patients may be receiving concomitant treatment with BTX-A for medical conditions (eg, migraines, hyperhidrosis, achalasia, dysphonia, dystonia, strabismus) by other specialists. Thus, there is a need to understand the potential side effects associated with BTX-A treatments and long-term consequences.
In a January 21 article published online in Pharmacology Yiannakopoulou looked at national monitoring programs through the US Food and Drug Administration and the Danish Medicines Agency. Many of the AEs reported were related to medical use of BTX-A, including anaphylaxis, death, generalized weakness, and dysphagia. Serious AEs related to the cosmetic use of BTX-A included thyroid eye disease, sarcoidal granuloma, pseudoaneurysm of the frontal branch of the superior temporal artery, and severe respiratory failure. Additionally, a patient receiving BTX-A for palmar and axillary hyperhidrosis developed botulinumlike generalized weakness. Upon review of epidemiological studies, the incidence and types of AEs were covered. The vast majority of these events were related to the medical use of BTX-A, which could stem from the lack of long-term studies on cosmetic patients and the lack of reporting of many AEs. The author summarized that minimizing potential AEs relies on proper injection technique, proper storage of the medication, proper dosing, and thorough knowledge of the anatomy.
What’s the issue?
Botulinum toxin type A remains one of the most gratifying treatments for both physicians and patients alike. However, with the potential for abuse, as in the case of the recent fake Botox Cosmetic that has shown up on the market in the United States), we must remain vigilant for AEs. Furthermore, we must continue to emphasize to patients that it is a medical treatment and deserves all the attention and respect we give to other medical interventions. However, as the Yiannakopoulou review has shown, proper injection techniques have a low rate of AEs in the cosmetic use of BTX-A. Have you seen an increase in the number of cosmetic BTX-A patients receiving concomitant treatments with BTX-A for medical conditions? If so, how do you manage them?
Skin Rejuvenation With Fat Grafting and Stem Cells
Recently there has been a lot of interest and attention given to the rejuvenation of the face utilizing autologous fat. Much of this interest stems from the understanding of the aging process on facial fat volume, bone density, and muscle thickness. Even in your 30s, volume deficit begins to show as undereye circles and the cheeks take on a submalar hollow, which continues to progress with time.
Charles-de-Sá et al (Plast Reconstr Surg. 2015;135:999-1009) looked at the direct antiaging effects that autologous fat grafting has on skin. The authors observed 6 consecutive patients (5 women and 1 man; mixed ethnic backgrounds; aged 45–65 years; nonsmokers) who presented for face-lifts. A small skin and fat biopsy from the preauricular area on each patient was taken for baseline histologic analysis.
The patients had abdominal fat harvested and processed in 2 manners. One portion was centrifuged at 3000 rpm for 3 minutes. The pellet at the base of the syringe (stromal vascular fraction) was then taken and mixed with 1 mL of adipose tissue and injected into the right preauricular skin in a subdermal fanning technique using a small cannula (1.5 mm) on a 3-mL syringe. The second portion of the fat was sent for stem cell expansion (2×106 mesenchymal cells). Five weeks later, the solution of stem cells (0.4 mL) was diluted with normal saline to a volume of 1 mL and injected in the left preauricular area, also 2 cm in front of the tragus.
Three months after the injections, repeat biopsies in the grafted areas were taken and sent for hematoxylin and eosin stain and electron microscopy. Results showed that at baseline on hematoxylin and eosin, the skin showed evidence of mild solar elastosis. However, after both methods of fat processing, the treated areas showed a reduction in solar elastosis, increased elastin fibers in the papillary dermis, and increased vasculature in the reticular dermis (near the subcutaneous fat). The results were similar in both types of fat processing; there was no statistically significant difference between modalities.
What’s the issue?
Those of us who have performed autologous fat grafting on patients have remarked for years on the improved appearance of the skin and the slowing down of the aging process that is not accounted for by volume replacement alone. This study has shown that fat grafting or stem cell injection in the subcutaneous layer has a beneficial effect on the overlying skin. The fact that both techniques showed similar results is helpful because it demonstrates that improvement can be achieved without having to expand the cells in vitro, thus eliminating all the regulatory issues that accompany cell cultures. A larger study would be extremely beneficial at this point. How does this procedure compare to platelet-rich plasma injections that are also the big fad for skin rejuvenation?
Recently there has been a lot of interest and attention given to the rejuvenation of the face utilizing autologous fat. Much of this interest stems from the understanding of the aging process on facial fat volume, bone density, and muscle thickness. Even in your 30s, volume deficit begins to show as undereye circles and the cheeks take on a submalar hollow, which continues to progress with time.
Charles-de-Sá et al (Plast Reconstr Surg. 2015;135:999-1009) looked at the direct antiaging effects that autologous fat grafting has on skin. The authors observed 6 consecutive patients (5 women and 1 man; mixed ethnic backgrounds; aged 45–65 years; nonsmokers) who presented for face-lifts. A small skin and fat biopsy from the preauricular area on each patient was taken for baseline histologic analysis.
The patients had abdominal fat harvested and processed in 2 manners. One portion was centrifuged at 3000 rpm for 3 minutes. The pellet at the base of the syringe (stromal vascular fraction) was then taken and mixed with 1 mL of adipose tissue and injected into the right preauricular skin in a subdermal fanning technique using a small cannula (1.5 mm) on a 3-mL syringe. The second portion of the fat was sent for stem cell expansion (2×106 mesenchymal cells). Five weeks later, the solution of stem cells (0.4 mL) was diluted with normal saline to a volume of 1 mL and injected in the left preauricular area, also 2 cm in front of the tragus.
Three months after the injections, repeat biopsies in the grafted areas were taken and sent for hematoxylin and eosin stain and electron microscopy. Results showed that at baseline on hematoxylin and eosin, the skin showed evidence of mild solar elastosis. However, after both methods of fat processing, the treated areas showed a reduction in solar elastosis, increased elastin fibers in the papillary dermis, and increased vasculature in the reticular dermis (near the subcutaneous fat). The results were similar in both types of fat processing; there was no statistically significant difference between modalities.
What’s the issue?
Those of us who have performed autologous fat grafting on patients have remarked for years on the improved appearance of the skin and the slowing down of the aging process that is not accounted for by volume replacement alone. This study has shown that fat grafting or stem cell injection in the subcutaneous layer has a beneficial effect on the overlying skin. The fact that both techniques showed similar results is helpful because it demonstrates that improvement can be achieved without having to expand the cells in vitro, thus eliminating all the regulatory issues that accompany cell cultures. A larger study would be extremely beneficial at this point. How does this procedure compare to platelet-rich plasma injections that are also the big fad for skin rejuvenation?
Recently there has been a lot of interest and attention given to the rejuvenation of the face utilizing autologous fat. Much of this interest stems from the understanding of the aging process on facial fat volume, bone density, and muscle thickness. Even in your 30s, volume deficit begins to show as undereye circles and the cheeks take on a submalar hollow, which continues to progress with time.
Charles-de-Sá et al (Plast Reconstr Surg. 2015;135:999-1009) looked at the direct antiaging effects that autologous fat grafting has on skin. The authors observed 6 consecutive patients (5 women and 1 man; mixed ethnic backgrounds; aged 45–65 years; nonsmokers) who presented for face-lifts. A small skin and fat biopsy from the preauricular area on each patient was taken for baseline histologic analysis.
The patients had abdominal fat harvested and processed in 2 manners. One portion was centrifuged at 3000 rpm for 3 minutes. The pellet at the base of the syringe (stromal vascular fraction) was then taken and mixed with 1 mL of adipose tissue and injected into the right preauricular skin in a subdermal fanning technique using a small cannula (1.5 mm) on a 3-mL syringe. The second portion of the fat was sent for stem cell expansion (2×106 mesenchymal cells). Five weeks later, the solution of stem cells (0.4 mL) was diluted with normal saline to a volume of 1 mL and injected in the left preauricular area, also 2 cm in front of the tragus.
Three months after the injections, repeat biopsies in the grafted areas were taken and sent for hematoxylin and eosin stain and electron microscopy. Results showed that at baseline on hematoxylin and eosin, the skin showed evidence of mild solar elastosis. However, after both methods of fat processing, the treated areas showed a reduction in solar elastosis, increased elastin fibers in the papillary dermis, and increased vasculature in the reticular dermis (near the subcutaneous fat). The results were similar in both types of fat processing; there was no statistically significant difference between modalities.
What’s the issue?
Those of us who have performed autologous fat grafting on patients have remarked for years on the improved appearance of the skin and the slowing down of the aging process that is not accounted for by volume replacement alone. This study has shown that fat grafting or stem cell injection in the subcutaneous layer has a beneficial effect on the overlying skin. The fact that both techniques showed similar results is helpful because it demonstrates that improvement can be achieved without having to expand the cells in vitro, thus eliminating all the regulatory issues that accompany cell cultures. A larger study would be extremely beneficial at this point. How does this procedure compare to platelet-rich plasma injections that are also the big fad for skin rejuvenation?
Perioral Rejuvenation
The perioral region is second to the periorbital area in making a person appear tired, sad, happy, or healthy. Although a lot of emphasis has been given to improving the periorbital area, the perioral region has received less attention. The mainstay of addressing the perioral region is using fillers, mainly synthetic ones, to smooth rhytides and restore lost volume. Skin resurfacing is a second-line approach, in part due to the required 5 to 7 days of recovery time to heal. However, as we have learned through many other procedures, it is wrong to make one modality your hammer and every patient your nail.
In an article published online on November 20, 2014, in Aesthetic Plastic Surgery, Penna et al conducted a morphometric review of 462 perioral photographs to come up with a 2-dimensional classification system to evaluate the perioral region. The classification was based on 2 qualities: lip shape and surface changes. Lip shape was classified as (1) short concave upper lip with 2 to 3 mm of upper incisors visible and prominent everted vermilion; (2) moderately elongated and straight upper lip with upper incisors at the lower border of the upper lip and mild degree of vermilion inversion; and (3) strongly elongated upper lip that forms a convex curve around the frontal teeth row with upper incisors that are not visible and vermilion is inverted. Lip surface was classified as (1) distinct philtral columns, Cupid’s bow and white roll without static radial wrinkles, and minor dynamic radial wrinkles; (2) flattened philtral columns and Cupid’s bow, indistinct white roll, beginning static radial wrinkles, and strong dynamic radial wrinkles; and (3) invisible philtral columns, Cupid’s bow and white roll, and considerable static radial wrinkles.
This scale was validated for objectivity, interevaluator reliability, intraevaluator reliability, and reproducibility by having 3 plastic surgeons evaluate perioral photographs of 42 female patients. The scale proved to be valid to a significant degree using Cohen’s κ coefficient. Based on this evaluation scale, one can evaluate the anatomic structure of the lip to decide if no treatment is needed, if synthetic or autologous fillers would suffice, or if a surgical lip-lift is required. Furthermore, surface changes can help determine if no treatment is needed, if skin resurfacing is indicated, or if both skin resurfacing and volumizing is required. The authors studied female subjects because they constitute the majority of patients seeking perioral rejuvenation.
What’s the issue?
Certainly the field of noninvasive cosmetic procedures continues to grow yearly; however, one must temper the enthusiasm of the patient at times so that he/she does not undergo excessive procedures and end up with unnatural results. Furthermore, one must not neglect the importance of artistry and proper patient evaluation in order to achieve a natural rejuvenated appearance. For example, relying solely on fillers to address perioral aging has resulted in an astonishing number of celebrities and patients walking around with an unnatural and distorted appearance. In many instances, this look may age a patient rather than rejuvenate him/her. Cosmetic dermatology is a balance between knowing when to treat, how much to treat, and when to effectively combine modalities to ensure the best outcome. This classification system will be useful for training residents and newly graduated dermatologists.
The perioral region is second to the periorbital area in making a person appear tired, sad, happy, or healthy. Although a lot of emphasis has been given to improving the periorbital area, the perioral region has received less attention. The mainstay of addressing the perioral region is using fillers, mainly synthetic ones, to smooth rhytides and restore lost volume. Skin resurfacing is a second-line approach, in part due to the required 5 to 7 days of recovery time to heal. However, as we have learned through many other procedures, it is wrong to make one modality your hammer and every patient your nail.
In an article published online on November 20, 2014, in Aesthetic Plastic Surgery, Penna et al conducted a morphometric review of 462 perioral photographs to come up with a 2-dimensional classification system to evaluate the perioral region. The classification was based on 2 qualities: lip shape and surface changes. Lip shape was classified as (1) short concave upper lip with 2 to 3 mm of upper incisors visible and prominent everted vermilion; (2) moderately elongated and straight upper lip with upper incisors at the lower border of the upper lip and mild degree of vermilion inversion; and (3) strongly elongated upper lip that forms a convex curve around the frontal teeth row with upper incisors that are not visible and vermilion is inverted. Lip surface was classified as (1) distinct philtral columns, Cupid’s bow and white roll without static radial wrinkles, and minor dynamic radial wrinkles; (2) flattened philtral columns and Cupid’s bow, indistinct white roll, beginning static radial wrinkles, and strong dynamic radial wrinkles; and (3) invisible philtral columns, Cupid’s bow and white roll, and considerable static radial wrinkles.
This scale was validated for objectivity, interevaluator reliability, intraevaluator reliability, and reproducibility by having 3 plastic surgeons evaluate perioral photographs of 42 female patients. The scale proved to be valid to a significant degree using Cohen’s κ coefficient. Based on this evaluation scale, one can evaluate the anatomic structure of the lip to decide if no treatment is needed, if synthetic or autologous fillers would suffice, or if a surgical lip-lift is required. Furthermore, surface changes can help determine if no treatment is needed, if skin resurfacing is indicated, or if both skin resurfacing and volumizing is required. The authors studied female subjects because they constitute the majority of patients seeking perioral rejuvenation.
What’s the issue?
Certainly the field of noninvasive cosmetic procedures continues to grow yearly; however, one must temper the enthusiasm of the patient at times so that he/she does not undergo excessive procedures and end up with unnatural results. Furthermore, one must not neglect the importance of artistry and proper patient evaluation in order to achieve a natural rejuvenated appearance. For example, relying solely on fillers to address perioral aging has resulted in an astonishing number of celebrities and patients walking around with an unnatural and distorted appearance. In many instances, this look may age a patient rather than rejuvenate him/her. Cosmetic dermatology is a balance between knowing when to treat, how much to treat, and when to effectively combine modalities to ensure the best outcome. This classification system will be useful for training residents and newly graduated dermatologists.
The perioral region is second to the periorbital area in making a person appear tired, sad, happy, or healthy. Although a lot of emphasis has been given to improving the periorbital area, the perioral region has received less attention. The mainstay of addressing the perioral region is using fillers, mainly synthetic ones, to smooth rhytides and restore lost volume. Skin resurfacing is a second-line approach, in part due to the required 5 to 7 days of recovery time to heal. However, as we have learned through many other procedures, it is wrong to make one modality your hammer and every patient your nail.
In an article published online on November 20, 2014, in Aesthetic Plastic Surgery, Penna et al conducted a morphometric review of 462 perioral photographs to come up with a 2-dimensional classification system to evaluate the perioral region. The classification was based on 2 qualities: lip shape and surface changes. Lip shape was classified as (1) short concave upper lip with 2 to 3 mm of upper incisors visible and prominent everted vermilion; (2) moderately elongated and straight upper lip with upper incisors at the lower border of the upper lip and mild degree of vermilion inversion; and (3) strongly elongated upper lip that forms a convex curve around the frontal teeth row with upper incisors that are not visible and vermilion is inverted. Lip surface was classified as (1) distinct philtral columns, Cupid’s bow and white roll without static radial wrinkles, and minor dynamic radial wrinkles; (2) flattened philtral columns and Cupid’s bow, indistinct white roll, beginning static radial wrinkles, and strong dynamic radial wrinkles; and (3) invisible philtral columns, Cupid’s bow and white roll, and considerable static radial wrinkles.
This scale was validated for objectivity, interevaluator reliability, intraevaluator reliability, and reproducibility by having 3 plastic surgeons evaluate perioral photographs of 42 female patients. The scale proved to be valid to a significant degree using Cohen’s κ coefficient. Based on this evaluation scale, one can evaluate the anatomic structure of the lip to decide if no treatment is needed, if synthetic or autologous fillers would suffice, or if a surgical lip-lift is required. Furthermore, surface changes can help determine if no treatment is needed, if skin resurfacing is indicated, or if both skin resurfacing and volumizing is required. The authors studied female subjects because they constitute the majority of patients seeking perioral rejuvenation.
What’s the issue?
Certainly the field of noninvasive cosmetic procedures continues to grow yearly; however, one must temper the enthusiasm of the patient at times so that he/she does not undergo excessive procedures and end up with unnatural results. Furthermore, one must not neglect the importance of artistry and proper patient evaluation in order to achieve a natural rejuvenated appearance. For example, relying solely on fillers to address perioral aging has resulted in an astonishing number of celebrities and patients walking around with an unnatural and distorted appearance. In many instances, this look may age a patient rather than rejuvenate him/her. Cosmetic dermatology is a balance between knowing when to treat, how much to treat, and when to effectively combine modalities to ensure the best outcome. This classification system will be useful for training residents and newly graduated dermatologists.