Aesthetic Dermatology

WASHINGTON — Autologous platelet concentrate may be helpful in treating difficult-to-heal wounds resulting from Mohs surgery, Dr. Dafnis C. Carranza said at the annual meeting of the American Academy of Dermatology.

Developed in the 1970s, autologous platelet concentrate is a by-product of platelet-rich plasma sequestration containing three to five times the native concentration of platelets. The technique is approved for management of chronic venous stasis wounds and has been used off label for a variety of acute wounds, including those resulting from dental, orthopedic, and plastic surgery.

With Mohs surgery defects, Dr. Carranza and her associates at the University of California, Los Angeles, have seen an average 50% decrease in wound size after one application of autologous platelet concentrate and complete healing after two applications.

"For a biological dressing to be effective, it must be safe and nontoxic to tissue, readily available and inexpensive, accelerate healing, and minimize wound care. We believe an autologous platelet concentrate dressing meets these criteria," said Dr. Carranza, who said that she has "no relevant relationships with industry."

At least two companies, Harvest Technologies and Cytomedix, make autologous platelet concentrate kits. The process involves several steps: First, 20 mL of blood is collected into a syringe containing a citrate-based anticoagulant. The blood is then centrifuged into platelet-rich and platelet-poor plasma and the platelet-poor plasma is discarded, leaving about 3 mL of platelet-rich plasma (PRP).

Next, using a 20G dual-cannula applicator tip, the PRP is combined with thrombin in 10% calcium chloride solution to activate it. The resulting flexible-tissue graft is then contoured to the debrided wound bed. Promogran is then applied over the graft site, followed by Adaptic and XCell cellulose antimicrobial dressing.

The limb is wrapped with sterile gauze roll, secured with Coban, and left in place for 4 days. The patient is seen every 3–4 days for wound cleansing and dressing changes. If the wound is healing well, another PRP application is applied at 2 weeks.

The anecdotal experience of Dr. Carranza and her colleagues suggests that the technique may speed healing of granulating defects of the lower extremities following Mohs micrographic surgery, particularly when healing by secondary intention is unsuccessful.

In one case, an 84-year-old man with multiple comorbidities had undergone Mohs surgery for basal cell carcinoma on the left pretibial area. At 2 months, the defect had excessive granulation tissue and was not healing. Autologous platelets were applied and 1 week later the wound size had decreased by 50%. By 2 weeks it was reduced by 75%. A second application of platelets was given at that time, and by week 3 the wound was healed.

This wound is shown before treatment with platelets.

Healing is evident 3 weeks after treatment with platelets was begun. Photos courtesy Dr. Dafnis C. Carranza

WASHINGTON — Autologous platelet concentrate may be helpful in treating difficult-to-heal wounds resulting from Mohs surgery, Dr. Dafnis C. Carranza said at the annual meeting of the American Academy of Dermatology.

Developed in the 1970s, autologous platelet concentrate is a by-product of platelet-rich plasma sequestration containing three to five times the native concentration of platelets. The technique is approved for management of chronic venous stasis wounds and has been used off label for a variety of acute wounds, including those resulting from dental, orthopedic, and plastic surgery.

With Mohs surgery defects, Dr. Carranza and her associates at the University of California, Los Angeles, have seen an average 50% decrease in wound size after one application of autologous platelet concentrate and complete healing after two applications.

"For a biological dressing to be effective, it must be safe and nontoxic to tissue, readily available and inexpensive, accelerate healing, and minimize wound care. We believe an autologous platelet concentrate dressing meets these criteria," said Dr. Carranza, who said that she has "no relevant relationships with industry."

At least two companies, Harvest Technologies and Cytomedix, make autologous platelet concentrate kits. The process involves several steps: First, 20 mL of blood is collected into a syringe containing a citrate-based anticoagulant. The blood is then centrifuged into platelet-rich and platelet-poor plasma and the platelet-poor plasma is discarded, leaving about 3 mL of platelet-rich plasma (PRP).

Next, using a 20G dual-cannula applicator tip, the PRP is combined with thrombin in 10% calcium chloride solution to activate it. The resulting flexible-tissue graft is then contoured to the debrided wound bed. Promogran is then applied over the graft site, followed by Adaptic and XCell cellulose antimicrobial dressing.

The limb is wrapped with sterile gauze roll, secured with Coban, and left in place for 4 days. The patient is seen every 3–4 days for wound cleansing and dressing changes. If the wound is healing well, another PRP application is applied at 2 weeks.

The anecdotal experience of Dr. Carranza and her colleagues suggests that the technique may speed healing of granulating defects of the lower extremities following Mohs micrographic surgery, particularly when healing by secondary intention is unsuccessful.

In one case, an 84-year-old man with multiple comorbidities had undergone Mohs surgery for basal cell carcinoma on the left pretibial area. At 2 months, the defect had excessive granulation tissue and was not healing. Autologous platelets were applied and 1 week later the wound size had decreased by 50%. By 2 weeks it was reduced by 75%. A second application of platelets was given at that time, and by week 3 the wound was healed.

This wound is shown before treatment with platelets.

Healing is evident 3 weeks after treatment with platelets was begun. Photos courtesy Dr. Dafnis C. Carranza

WASHINGTON — Autologous platelet concentrate may be helpful in treating difficult-to-heal wounds resulting from Mohs surgery, Dr. Dafnis C. Carranza said at the annual meeting of the American Academy of Dermatology.

Developed in the 1970s, autologous platelet concentrate is a by-product of platelet-rich plasma sequestration containing three to five times the native concentration of platelets. The technique is approved for management of chronic venous stasis wounds and has been used off label for a variety of acute wounds, including those resulting from dental, orthopedic, and plastic surgery.

With Mohs surgery defects, Dr. Carranza and her associates at the University of California, Los Angeles, have seen an average 50% decrease in wound size after one application of autologous platelet concentrate and complete healing after two applications.

"For a biological dressing to be effective, it must be safe and nontoxic to tissue, readily available and inexpensive, accelerate healing, and minimize wound care. We believe an autologous platelet concentrate dressing meets these criteria," said Dr. Carranza, who said that she has "no relevant relationships with industry."

At least two companies, Harvest Technologies and Cytomedix, make autologous platelet concentrate kits. The process involves several steps: First, 20 mL of blood is collected into a syringe containing a citrate-based anticoagulant. The blood is then centrifuged into platelet-rich and platelet-poor plasma and the platelet-poor plasma is discarded, leaving about 3 mL of platelet-rich plasma (PRP).

Next, using a 20G dual-cannula applicator tip, the PRP is combined with thrombin in 10% calcium chloride solution to activate it. The resulting flexible-tissue graft is then contoured to the debrided wound bed. Promogran is then applied over the graft site, followed by Adaptic and XCell cellulose antimicrobial dressing.

The limb is wrapped with sterile gauze roll, secured with Coban, and left in place for 4 days. The patient is seen every 3–4 days for wound cleansing and dressing changes. If the wound is healing well, another PRP application is applied at 2 weeks.

The anecdotal experience of Dr. Carranza and her colleagues suggests that the technique may speed healing of granulating defects of the lower extremities following Mohs micrographic surgery, particularly when healing by secondary intention is unsuccessful.

In one case, an 84-year-old man with multiple comorbidities had undergone Mohs surgery for basal cell carcinoma on the left pretibial area. At 2 months, the defect had excessive granulation tissue and was not healing. Autologous platelets were applied and 1 week later the wound size had decreased by 50%. By 2 weeks it was reduced by 75%. A second application of platelets was given at that time, and by week 3 the wound was healed.

This wound is shown before treatment with platelets.

Healing is evident 3 weeks after treatment with platelets was begun. Photos courtesy Dr. Dafnis C. Carranza

WASHINGTON — Bleeding during or after superficial cutaneous surgery may provoke more worry from both patients and their clinicians, but thrombotic events actually have greater consequences and are harder to detect, Dr. Clark C. Otley said at the annual meeting of the American Academy of Dermatology.

Bleeding "almost never causes a permanent disability," but a thrombotic complication that occurs after stopping a patient's blood thinner perioperatively "is much more serious and underappreciated because they're going to go to an ER for their stroke and you may never know about it," said Dr. Otley, who is a professor of dermatology at the Mayo Clinic, Rochester, Minn.

Based on the results of a survey of dermatologic surgeons, Dr. Otley found that 72% of them believed that they could tell if a patient was taking a blood thinner based on how the patient "oozed" intraoperatively.

In another study, however, with 110 patients undergoing cutaneous excisional surgery, Dr. Otley and his colleagues found that blinded dermatologic surgeon observers were able to determine if patients were taking a blood-thinning agent with a sensitivity of only 14% and a false-positive rate of 16% (Plast. Reconstr. Surg. 2002;110:98–103).

In another blinded study of 100 patients undergoing coronary artery bypass graft who were taking a placebo or aspirin, cardiac surgeons were correct about the patients' blood thinner status only 51% of the time.

"I would argue that, objectively, you really can't tell whether somebody [is] on a blood thinner," he said.

Of 11 studies that have evaluated patient risk of hemorrhage while on blood thinners, 10 have found no increased risk of severe hemorrhagic complications.

In the one conflicting study of 21 patients, warfarin complications such as persistent bleeding, hematoma, infection, and graft loss occurred (Aesthetic Plast. Surg. 2002;26:483–5).

In a member survey of the American College of Mohs Micrographic Surgery and Cutaneous Oncology, 168 surgeons reported 46 patients who had thrombotic events within a 3-day period before or after stopping a blood thinner, including three deaths.

This yielded a rate of 1 thrombotic event per 12,816 operations, or 1 of every 6,219 operations in which warfarin was discontinued and 1 of every 21,448 when aspirin was not used (J. Am. Acad. Dermatol. 2003;48:233–7).

Another more recent study reported thrombotic complications in 126 patients, including 15 deaths.

"Medically necessary blood thinners should, in general, be continued if there aren't countermanding variables that indicate a need to stop them," Dr. Otley commented.

WASHINGTON — Bleeding during or after superficial cutaneous surgery may provoke more worry from both patients and their clinicians, but thrombotic events actually have greater consequences and are harder to detect, Dr. Clark C. Otley said at the annual meeting of the American Academy of Dermatology.

Bleeding "almost never causes a permanent disability," but a thrombotic complication that occurs after stopping a patient's blood thinner perioperatively "is much more serious and underappreciated because they're going to go to an ER for their stroke and you may never know about it," said Dr. Otley, who is a professor of dermatology at the Mayo Clinic, Rochester, Minn.

Based on the results of a survey of dermatologic surgeons, Dr. Otley found that 72% of them believed that they could tell if a patient was taking a blood thinner based on how the patient "oozed" intraoperatively.

In another study, however, with 110 patients undergoing cutaneous excisional surgery, Dr. Otley and his colleagues found that blinded dermatologic surgeon observers were able to determine if patients were taking a blood-thinning agent with a sensitivity of only 14% and a false-positive rate of 16% (Plast. Reconstr. Surg. 2002;110:98–103).

In another blinded study of 100 patients undergoing coronary artery bypass graft who were taking a placebo or aspirin, cardiac surgeons were correct about the patients' blood thinner status only 51% of the time.

"I would argue that, objectively, you really can't tell whether somebody [is] on a blood thinner," he said.

Of 11 studies that have evaluated patient risk of hemorrhage while on blood thinners, 10 have found no increased risk of severe hemorrhagic complications.

In the one conflicting study of 21 patients, warfarin complications such as persistent bleeding, hematoma, infection, and graft loss occurred (Aesthetic Plast. Surg. 2002;26:483–5).

In a member survey of the American College of Mohs Micrographic Surgery and Cutaneous Oncology, 168 surgeons reported 46 patients who had thrombotic events within a 3-day period before or after stopping a blood thinner, including three deaths.

This yielded a rate of 1 thrombotic event per 12,816 operations, or 1 of every 6,219 operations in which warfarin was discontinued and 1 of every 21,448 when aspirin was not used (J. Am. Acad. Dermatol. 2003;48:233–7).

Another more recent study reported thrombotic complications in 126 patients, including 15 deaths.

"Medically necessary blood thinners should, in general, be continued if there aren't countermanding variables that indicate a need to stop them," Dr. Otley commented.

WASHINGTON — Bleeding during or after superficial cutaneous surgery may provoke more worry from both patients and their clinicians, but thrombotic events actually have greater consequences and are harder to detect, Dr. Clark C. Otley said at the annual meeting of the American Academy of Dermatology.

Bleeding "almost never causes a permanent disability," but a thrombotic complication that occurs after stopping a patient's blood thinner perioperatively "is much more serious and underappreciated because they're going to go to an ER for their stroke and you may never know about it," said Dr. Otley, who is a professor of dermatology at the Mayo Clinic, Rochester, Minn.

Based on the results of a survey of dermatologic surgeons, Dr. Otley found that 72% of them believed that they could tell if a patient was taking a blood thinner based on how the patient "oozed" intraoperatively.

In another study, however, with 110 patients undergoing cutaneous excisional surgery, Dr. Otley and his colleagues found that blinded dermatologic surgeon observers were able to determine if patients were taking a blood-thinning agent with a sensitivity of only 14% and a false-positive rate of 16% (Plast. Reconstr. Surg. 2002;110:98–103).

In another blinded study of 100 patients undergoing coronary artery bypass graft who were taking a placebo or aspirin, cardiac surgeons were correct about the patients' blood thinner status only 51% of the time.

"I would argue that, objectively, you really can't tell whether somebody [is] on a blood thinner," he said.

Of 11 studies that have evaluated patient risk of hemorrhage while on blood thinners, 10 have found no increased risk of severe hemorrhagic complications.

In the one conflicting study of 21 patients, warfarin complications such as persistent bleeding, hematoma, infection, and graft loss occurred (Aesthetic Plast. Surg. 2002;26:483–5).

In a member survey of the American College of Mohs Micrographic Surgery and Cutaneous Oncology, 168 surgeons reported 46 patients who had thrombotic events within a 3-day period before or after stopping a blood thinner, including three deaths.

This yielded a rate of 1 thrombotic event per 12,816 operations, or 1 of every 6,219 operations in which warfarin was discontinued and 1 of every 21,448 when aspirin was not used (J. Am. Acad. Dermatol. 2003;48:233–7).

Another more recent study reported thrombotic complications in 126 patients, including 15 deaths.

"Medically necessary blood thinners should, in general, be continued if there aren't countermanding variables that indicate a need to stop them," Dr. Otley commented.

GRAND CAYMAN, CAYMAN ISLANDS — Lid and ocular surface lesions are signs of conditions where the eye and the skin overlap, Dr. Catherine Newton said at the Caribbean Dermatology Symposium.

Dr. Newton, a professor of ophthalmology at the University of Louisville (Ky.), presented examples of cases with skin and eye involvement that are not inflammatory diseases, including benign conditions (neoplasms) and potentially serious infections such as herpes.

Dr. Newton presented a case of an 82-year-old man who reported "something blocking his view" during a visit for corneal care. It was a bumpy mass that was diagnosed as a verrucous papilloma.

Cysts and benign neoplasms near the eye are common, Dr. Newton said.

An ophthalmologist performed a surgical resection of the verrucous papilloma, and the patient has had no recurrence, she said in an interview.

Another case of a benign neoplasm involved a woman with a bump on the lower left lid (acanthoma). Dr. Newton treated this patient with lidocaine ointment, and she was later able to use a jeweler's forceps and remove the sac, which spared the patient an excision.

Dr. Newton presented a case of an 11-year-old girl with molluscum contagiosum as an example of an infectious disease that can involve the eyes and skin. Molluscum contagiosum lesions often occur on the faces in children who acquire the infection by nonsexual transmission. The lesions can be mistaken for pustules, but histology data confirm the infection.

She treated the girl by curetting the lesions using local anesthesia, and the lesions have resolved completely. Cryotherapy and a peeling agent such as salicylic acid may also be used to treat molluscum contagiosum lesions.

GRAND CAYMAN, CAYMAN ISLANDS — Lid and ocular surface lesions are signs of conditions where the eye and the skin overlap, Dr. Catherine Newton said at the Caribbean Dermatology Symposium.

Dr. Newton, a professor of ophthalmology at the University of Louisville (Ky.), presented examples of cases with skin and eye involvement that are not inflammatory diseases, including benign conditions (neoplasms) and potentially serious infections such as herpes.

Dr. Newton presented a case of an 82-year-old man who reported "something blocking his view" during a visit for corneal care. It was a bumpy mass that was diagnosed as a verrucous papilloma.

Cysts and benign neoplasms near the eye are common, Dr. Newton said.

An ophthalmologist performed a surgical resection of the verrucous papilloma, and the patient has had no recurrence, she said in an interview.

Another case of a benign neoplasm involved a woman with a bump on the lower left lid (acanthoma). Dr. Newton treated this patient with lidocaine ointment, and she was later able to use a jeweler's forceps and remove the sac, which spared the patient an excision.

Dr. Newton presented a case of an 11-year-old girl with molluscum contagiosum as an example of an infectious disease that can involve the eyes and skin. Molluscum contagiosum lesions often occur on the faces in children who acquire the infection by nonsexual transmission. The lesions can be mistaken for pustules, but histology data confirm the infection.

She treated the girl by curetting the lesions using local anesthesia, and the lesions have resolved completely. Cryotherapy and a peeling agent such as salicylic acid may also be used to treat molluscum contagiosum lesions.

GRAND CAYMAN, CAYMAN ISLANDS — Lid and ocular surface lesions are signs of conditions where the eye and the skin overlap, Dr. Catherine Newton said at the Caribbean Dermatology Symposium.

Dr. Newton, a professor of ophthalmology at the University of Louisville (Ky.), presented examples of cases with skin and eye involvement that are not inflammatory diseases, including benign conditions (neoplasms) and potentially serious infections such as herpes.

Dr. Newton presented a case of an 82-year-old man who reported "something blocking his view" during a visit for corneal care. It was a bumpy mass that was diagnosed as a verrucous papilloma.

Cysts and benign neoplasms near the eye are common, Dr. Newton said.

An ophthalmologist performed a surgical resection of the verrucous papilloma, and the patient has had no recurrence, she said in an interview.

Another case of a benign neoplasm involved a woman with a bump on the lower left lid (acanthoma). Dr. Newton treated this patient with lidocaine ointment, and she was later able to use a jeweler's forceps and remove the sac, which spared the patient an excision.

Dr. Newton presented a case of an 11-year-old girl with molluscum contagiosum as an example of an infectious disease that can involve the eyes and skin. Molluscum contagiosum lesions often occur on the faces in children who acquire the infection by nonsexual transmission. The lesions can be mistaken for pustules, but histology data confirm the infection.

She treated the girl by curetting the lesions using local anesthesia, and the lesions have resolved completely. Cryotherapy and a peeling agent such as salicylic acid may also be used to treat molluscum contagiosum lesions.

VAIL, COLO. — An animal-derived extracellular matrix implant could be a longer-lasting alternative to the short-lived fillers used to augment nasolabial folds, lips, and glabella, Dr. Edmund A. Pribitkin said at a symposium sponsored by the American Academy of Facial Plastic and Reconstructive Surgery.

Dr. Pribitkin has used the Food and Drug Administration-approved Surgisis soft tissue graft, which is made from the small intestinal submucosa of pigs, to augment those locations on patients in his practice.

In his experience with using Surgisis to augment nasolabial folds, "the longest person is a year out, so we can't really say anything beyond that. We do seem to get improvement more in people who are thin, who don't have a lot of extra jowling or extra cheek fat that you're really going to have difficulty filling in," said Dr. Pribitkin, professor in the department of otolaryngology-head and neck surgery at Jefferson Medical College, Philadelphia.

Dr. Pribitkin placed the implant at no charge in the nasolabial folds of 15 consecutive women whom he had seen previously for other procedures. Currently, eight patients have 10–12 months of follow-up, five have 7 months, and two have 6 months. Eleven of the women were satisfied early with the implant and said that they would pay to have it done. Two patients wanted more augmentation, and another two thought that it didn't help at all.

At 6 months, 8 of 15 women were satisfied with the results of the implant, but after almost a year, 3 are asking, "'Did I have something done?'" he said.

In eight patients who have undergone lip augmentation, the implant has "been relatively effective" in treating seven upper lips and eight lower lips, he noted.

"Generally speaking, the problem with the lips is—at least in most cases—it's never enough. They want more and more augmentation of the lips," Dr. Pribitkin said at the symposium, which also was sponsored by the American Society for Dermatologic Surgery and the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Before the procedure, patients use a pHisoHex (hexachlorophene) scrub in the morning and do not apply any makeup, and the treatment area is swabbed with alcohol prior to incision. The implant, with a trocar attached, is soaked for about 5 minutes.

With the patient under local anesthesia with 1% lidocaine and epinephrine, the round-shaped trocar is inserted into a stab incision of the lower portion of nasolabial fold. A second stab incision is made in the upper portion of the fold. The implant is run through the incision at a point just underneath the dermis—not deep in the subcutaneous tissue but at the dermal-subcutaneous interface—while the surgeon tries not to touch the implant with gloves.

The implant rolls up on itself as it is pulled through. It is cut at both ends and pulled tight, and one fast-absorbing gut suture is sewn at each point of incision. The patient is then given a dose of antibiotics.

He disclosed that he is a consultant to Cook Biotech Inc., which manufactures Surgisis. The company did not sponsor the use of the implant in facial augmentation, but did provide materials free of charge for evaluation in this trial.

This patient is shown at baseline (top) and 3 months after receiving the Surgisis implant in her nasolabial folds. Photos courtesy Dr. Edmund A. Pribitkin

VAIL, COLO. — An animal-derived extracellular matrix implant could be a longer-lasting alternative to the short-lived fillers used to augment nasolabial folds, lips, and glabella, Dr. Edmund A. Pribitkin said at a symposium sponsored by the American Academy of Facial Plastic and Reconstructive Surgery.

Dr. Pribitkin has used the Food and Drug Administration-approved Surgisis soft tissue graft, which is made from the small intestinal submucosa of pigs, to augment those locations on patients in his practice.

In his experience with using Surgisis to augment nasolabial folds, "the longest person is a year out, so we can't really say anything beyond that. We do seem to get improvement more in people who are thin, who don't have a lot of extra jowling or extra cheek fat that you're really going to have difficulty filling in," said Dr. Pribitkin, professor in the department of otolaryngology-head and neck surgery at Jefferson Medical College, Philadelphia.

Dr. Pribitkin placed the implant at no charge in the nasolabial folds of 15 consecutive women whom he had seen previously for other procedures. Currently, eight patients have 10–12 months of follow-up, five have 7 months, and two have 6 months. Eleven of the women were satisfied early with the implant and said that they would pay to have it done. Two patients wanted more augmentation, and another two thought that it didn't help at all.

At 6 months, 8 of 15 women were satisfied with the results of the implant, but after almost a year, 3 are asking, "'Did I have something done?'" he said.

In eight patients who have undergone lip augmentation, the implant has "been relatively effective" in treating seven upper lips and eight lower lips, he noted.

"Generally speaking, the problem with the lips is—at least in most cases—it's never enough. They want more and more augmentation of the lips," Dr. Pribitkin said at the symposium, which also was sponsored by the American Society for Dermatologic Surgery and the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Before the procedure, patients use a pHisoHex (hexachlorophene) scrub in the morning and do not apply any makeup, and the treatment area is swabbed with alcohol prior to incision. The implant, with a trocar attached, is soaked for about 5 minutes.

With the patient under local anesthesia with 1% lidocaine and epinephrine, the round-shaped trocar is inserted into a stab incision of the lower portion of nasolabial fold. A second stab incision is made in the upper portion of the fold. The implant is run through the incision at a point just underneath the dermis—not deep in the subcutaneous tissue but at the dermal-subcutaneous interface—while the surgeon tries not to touch the implant with gloves.

The implant rolls up on itself as it is pulled through. It is cut at both ends and pulled tight, and one fast-absorbing gut suture is sewn at each point of incision. The patient is then given a dose of antibiotics.

He disclosed that he is a consultant to Cook Biotech Inc., which manufactures Surgisis. The company did not sponsor the use of the implant in facial augmentation, but did provide materials free of charge for evaluation in this trial.

This patient is shown at baseline (top) and 3 months after receiving the Surgisis implant in her nasolabial folds. Photos courtesy Dr. Edmund A. Pribitkin

VAIL, COLO. — An animal-derived extracellular matrix implant could be a longer-lasting alternative to the short-lived fillers used to augment nasolabial folds, lips, and glabella, Dr. Edmund A. Pribitkin said at a symposium sponsored by the American Academy of Facial Plastic and Reconstructive Surgery.

Dr. Pribitkin has used the Food and Drug Administration-approved Surgisis soft tissue graft, which is made from the small intestinal submucosa of pigs, to augment those locations on patients in his practice.

In his experience with using Surgisis to augment nasolabial folds, "the longest person is a year out, so we can't really say anything beyond that. We do seem to get improvement more in people who are thin, who don't have a lot of extra jowling or extra cheek fat that you're really going to have difficulty filling in," said Dr. Pribitkin, professor in the department of otolaryngology-head and neck surgery at Jefferson Medical College, Philadelphia.

Dr. Pribitkin placed the implant at no charge in the nasolabial folds of 15 consecutive women whom he had seen previously for other procedures. Currently, eight patients have 10–12 months of follow-up, five have 7 months, and two have 6 months. Eleven of the women were satisfied early with the implant and said that they would pay to have it done. Two patients wanted more augmentation, and another two thought that it didn't help at all.

At 6 months, 8 of 15 women were satisfied with the results of the implant, but after almost a year, 3 are asking, "'Did I have something done?'" he said.

In eight patients who have undergone lip augmentation, the implant has "been relatively effective" in treating seven upper lips and eight lower lips, he noted.

"Generally speaking, the problem with the lips is—at least in most cases—it's never enough. They want more and more augmentation of the lips," Dr. Pribitkin said at the symposium, which also was sponsored by the American Society for Dermatologic Surgery and the American Society of Ophthalmic Plastic and Reconstructive Surgery.

Before the procedure, patients use a pHisoHex (hexachlorophene) scrub in the morning and do not apply any makeup, and the treatment area is swabbed with alcohol prior to incision. The implant, with a trocar attached, is soaked for about 5 minutes.

With the patient under local anesthesia with 1% lidocaine and epinephrine, the round-shaped trocar is inserted into a stab incision of the lower portion of nasolabial fold. A second stab incision is made in the upper portion of the fold. The implant is run through the incision at a point just underneath the dermis—not deep in the subcutaneous tissue but at the dermal-subcutaneous interface—while the surgeon tries not to touch the implant with gloves.

The implant rolls up on itself as it is pulled through. It is cut at both ends and pulled tight, and one fast-absorbing gut suture is sewn at each point of incision. The patient is then given a dose of antibiotics.

He disclosed that he is a consultant to Cook Biotech Inc., which manufactures Surgisis. The company did not sponsor the use of the implant in facial augmentation, but did provide materials free of charge for evaluation in this trial.

This patient is shown at baseline (top) and 3 months after receiving the Surgisis implant in her nasolabial folds. Photos courtesy Dr. Edmund A. Pribitkin