Drawbacks Prevelle Dura is slightly more viscous and, therefore, requires more pressure on injection in .NET framework

Creation QR Code ISO/IEC18004 in .NET framework Drawbacks Prevelle Dura is slightly more viscous and, therefore, requires more pressure on injection

Drawbacks Prevelle Dura is slightly more viscous and, therefore, requires more pressure on injection
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Hyaluronidase
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Hyaluronidase is a soluble enzyme that hydrolyzes HA, other GAGs, and other connective tissue components in the skin and vitreous humor of the eye32 It has been approved by the FDA, as Vitrase and Amphadase, for enhancement of injectable drug absorption and resorption of radiopaque agents However, effective off-label uses include wound care and postsurgical flap care among other uses Several reports have indicated the usefulness of hyaluronidase to dissolve HA filler overcorrection for symmetric contouring, as well as to manage impending tissue necrosis because of HA skin injections33 35 Specifically, Hirsch et al published two cases of imminent tissue necrosis caused by intra-arterial injection of HA and surrounding tissue compression of vital vessel, which resolved with employment of hyaluronidase After using other appropriate techniques to manage impending tissue necrosis including systemic aspirin, Nitro BID under occlusion, and hot compresses with massage without significant response, the authors injected 30 units of hyaluronidase into deep dermal tissue and subcutis using a serial puncture method along the distribution of affected arteries, which led to the resolution of symptoms within a day32,33 Although early reports have recommended the utility of hyaluronidase only within 16 minutes of the critical event, Hirsch et al reported successful responses after several days32 Furthermore, the effectiveness of hyaluronidase for bluish (Tyndall) manifestations and asymmetric lumpiness from HA overcorrection has also been reported at various concentrations34 36 Because of the described benefits of hyaluronidase for the treatment of complications of the popular HA fillers, it has been recommended as a necessary agent to keep in an aesthetic physician s office37 Hyaluronidase is a clear liquid that is stored in the refrigerator and reconstituted with 1 mL of normal saline to generate 150 units Very rare adverse acute and delayed-type hypersensitivity reactions to hyaluronidase have been reported, so it may be prudent to perform a skin test prior to the use of this agent Injection of hyaluronidase into patients with an allergy to hymenoptera stings and thimerosal is contraindicated33,38
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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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Fat, Radiesse, and Sculptra are considered semitransitory because they are partly biostimulatory and partially biodegradable; this balance allows them to last approximately 1 to 3 years39 The adverse events associated with semipermanent fillers include rare granuloma formations The aesthetic effects of these fillers are best preserved with annual touch-up sessions AUTOLOGOUS FAT Overview Originating in the 1890s, transplantation of fat from a patient s excess adipose areas to other skin defects is the oldest soft tissue augmentation method1 Fat injection filling has gained recognition for several reasons Naturally, the patient s own cells are unlikely to cause sensitivity or inflammation and are therefore considered supremely biocompatible Furthermore, the technique of fat implantation has undergone remarkable polishing over many years, especially with the advent of harvesting subcutis through liposuction The procedure is a multistep process, whereby the fat cells are obtained from the buttock, thigh, and abdominal regions, then segregated, stored (refrigerated up to 18 months), and injected back into the patient s subcutis on the face, hands, and any other areas requiring volume enhancement As anticipated, this process is more invasive, time-consuming, both for the clinician to prepare and perform as well as the patient to recover from, as well as more costly In effect, the optimal efficacy with minimal adverse effects is mainly achieved in the hands of a qualified dermasurgeon Approximately 01 cc aliquots of fat are inserted into subcutis through a 17- to 18-gauge needle via a tunneling technique, without overcorrection40 Postprocedure massage is recommended for proper shaping of contours Bene ts Because of its autologous character, lipotransfer is unlikely to cause sensitivity and reactivity of the tissue, minimizing potential long-term side effects and obviating prior testing Nasolabial folds, sunken cheeks, tear troughs, marionette lines, scars, and lips are the most appropriate areas of correction with fat Furthermore, fat transfer provides a reported duration of about 12 months; although the concrete duration is controversial41 Because the injectable material used is the patient s own tissue, its use decreases the
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amount of money spent on the actual filler The procedure also has an attractive double-gain, where two cosmetic areas can be simultaneously addressed, lipoexcess and lipodystrophy Stem cells have been isolated from fat cells It is believed that the stem cells found in fat lead to increased skin rejuvenation (see 3) When performed by a skilled physician, the results of lipotransfer are remarkable42 Drawbacks Fat injections require prophylactic local or regional anesthesia Because of the fact that the procedure is more surgically invasive, more complex preparations and settings are required with longer and more frequent office visits Although the harvesting portion can cause a longer recovery time and an increased risk of side effects (eg, infection, scarring), the actual injection has a similar adverse event profile to the other fillers (eg, edema, redness, bruising, and discomfort lasting a few days)34 Another variable to consider when selecting candidates for this procedure is to ensure that the patient has a sufficient graft supply In some patients, the fat injections last several years and in other patients the injections last merely months Many tricks are employed to try and increase longevity, but at this time there are no guarantees32 RADIESSE Overview Radiesse (BioForm Medical, San Mateo, CA) was approved by the FDA in 2006 for the correction of moderate to severe folds and wrinkles along with HIV-associated lipoatrophy It is composed of 30% calcium hydroxylapatite (CaHA) microspheres (25 45 m) suspended in an aqueous gel carrier (13% sodium carboxymethyl cellulose, 64% glycerin, and 366% sterile water) As the gel carrier of this filler dissipates in several months, the microspheres stimulate cutaneous cells to generate focal foreign body reaction and neocollagenesis32,33 This leads to envelopment of the microspheres by fibrin, collagen, and fibroblasts, and slows the degradation by macrophages and metabolism into calcium and phosphate ions Because of a similar mineral constitution as human bones, and no foreign antigenic properties, CaHA is particularly biocompatible It is critical for patients to be aware that Radiesse is a radioopaque material that can be visualized and misinterpreted on facial radiographs, but importantly, it does not radiographically mask surrounding tissues
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Radiesse is a white material packaged in a 1-mL syringe and injected via a 25to 27-gauge and 11/4-inch needle into the deep dermis or subcutis without overcorrection33 The product should be stored at room temperature A reasonable injection method for Radiesse is tunneling or crisscross threading techniques32 A placement of Radiesse in the supraperiosteal plane yields better control and ability to contour skin with this stiffer filler43 Bene ts Since Radiesse is immunologically inert, it does not require skin testing With more than 20 years of use as implantable devices for otolaryngology and orthopedic specialties, CaHA possesses an excellent safety record The average duration of Radiesse is 9 to 18 months The proper locations of injection include the nasolabial folds, marionette lines, prejowl sulcus, and cheek depressions Unlike Sculptra, where time is necessary to build up new collagen, Radiesse offers the advantage of immediate wrinkle ablation Interestingly, although Radiesse induces foreign body reaction, it is not known to cause granuloma formation36 In its gel form, the device is also quite pliable, permitting timely manipulation and appropriate modification In addition, it can be combined with other fillers, such as Sculptra, HA, and collagen Drawbacks The main drawback of Radiesse is that it is not reversible like HAs Radiesse also does not contain an anesthetic and because of its high viscosity, requires administration through a high-bore needle However, Radiesse can be combined with lidocaine in the syringe to decrease pain on injection Hence, the use of topical or regional anesthesia is recommended Minimal side effects such as ecchymoses, edema, and erythema appear soon after Radiesse injection and are transitory Rare nodules have also been associated with Radiesse and can be managed with intralesional steroids or excision Similar to Sculptra, an implantation of Radiesse in the superficial and mobile wrinkles (eg, lips and periorbital area) and the body of the lips is discouraged because of the palpable and visible white papules that can develop (also known as popcorn lips ) Radiesse should not be performed in the nose of a patient anticipating rhinoplasty Several facial plastic surgeons have given anecdotal reports in lectures suggesting that this complicates rhinoplasty surgery An HA or collagen filler would be a more appropriate
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