Surgeons Differ on Ethics of Rhinoplasty
Aesthetic rhinoplasty surgeons appear to have diverging
opinions about the ethical issues they may face in practice. A
recent survey of the opinions, practices, and attitudes of experienced
and novice facial plastic surgeons presented 15 clinical
vignettes addressing ethical quandaries in aesthetic rhinoplasty
and based on the experience and observations of the senior
author over nearly 30 years of practice and teaching. Five of
the 15 vignettes demonstrated significant differences between
the responses of the fellowship directors and the fellows, and
no single vignette had a unanimous consensus in either group.
The survey was fielded anonymously to Fellowship directors
and facial plastic surgery fellows of the American Academy of
Facial Plastic and Reconstructive Surgery.
— Arch Facial Plast Surg. 2012
SAFE Storage Times for Botulinum Toxins Longer than Thought
Assuming standard safe injection techniques are followed, a single vial of onabotulinumtoxinA (BT-A) can be safely administered to multiple patients and, after reconstitution, can be stored beyond the recommended time period of four hours, according to a new study. Investigators examined current clinical practices and expert consensus recommendations regarding the reconstitution and storage of botulinum toxins and conducted an Internet-based study to analyze current practices of members of the ASDS administering botulinum toxins.
After product reconstitution, the majority of physicians (68.6
percent) routinely store botulinum toxin for a period of greater
than one week and safely use each toxin vial for more than one
patient. Not a single case of infection was observed. However,
the authors noted that this was a single survey with a 32.2 percent
response rate.
—J Am Acad Dermatol; 67(3): 373-8
Full-Face Rejuvenation with Fillers Shown Effective
Full-face rejuvenation using a range of hyaluronic fillers can offer safe, effective results, as well as notable patient satisfaction, new findings indicate. In a six-month study, participants could receive five different fillers from the same range (HA(E)) for up to eight indications (periorbital lines, tear troughs, cheeks, cheek folds, nasolabial folds, upper lip lines, lips, and marionette lines). Outcomes included global aesthetic improvement scores, improvement in each indication, adverse events, local tolerability, and satisfaction.
A total of 77 participants with a mean age of 54.5 were
enrolled; 48.1 percent had five or more indications treated.
Mean total injection volume (baseline and touch-up) per
participant was 6.7mL. At six months, 92.1 percent of participants
remained at least improved over baseline, 79.7
percent of participants were satisfied or very satisfied with
the durability of results, and 63 percent of participants said
they felt a lot or much better than before injection. The
researchers noted that no specific safety concerns were reported
except expected injection site reactions.
—Dermatol Surg; 28 (7 Pt 2):1153-61
Autologous Fat, Fillers Effective for HIV Lipoatrophy
Dermal fillers and autologous fat transfer are effective for treatment
of HIV associated facial lipoatrophy, with high rates of facial volume restoration and patient satisfaction, a new analysis
shows. The analysis included 19 studies involving 724 patients,
with 549 patients in the hyaluronic/poly-l-lactic acid cohort, and
175 patients in autologous fat transfer cohort. Although both
objective and subjective measures suggested that improvements
in facial volume and durability of treatment were similar
between dermal fillers and fat transfer, PLLA was reinjected at
a rate three-times that of autologous fat. PLLA was also associated
with a relatively high rate (22 percent) of subcutaneous
papule formation. The authors note that autologous fat transfer
offers less of a financial burden as compared to injectable fillers.
— Plast Reconstr Surg. 2012, e-pub
Less Pain Associated with abobotulinumtoxinA with Preserved Saline
Reconstitution of abobotulinumtoxinA with preserved saline may
result in significantly less pain on injection than with preservativefree
saline, according to a new study. In a prospective, randomized,
double-blind, side-by-side trial in a private practice dermatology
office in Boulder, CO, researchers enlisted 20 volunteer patients to
receive injections on one side of their face with abobotulinumtoxinA
reconstituted with preservative-free saline and with abobotulinumtoxinA
reconstituted with preserved saline on the other
side. Patients reported their pain on a 10-point visual analogue
pain scale after each side was injected. Patients kept a diary for the
first 48 hours after treatment to track any continued pain, onset
of action, or adverse events. Researchers then saw the patients at
two-week follow-up visits and recorded any adverse events. They
found that 90 percent of patients reported less pain on the
side injected with preserved saline than on the side injected
with preservative-free saline. In addition, reported pain on
the preserved saline side was 60 percent less than on the
preservative-free side. Neither the patients nor the investigators
noted any difference in onset of action between the two sides.
—Dermatol Surg; 28(6): 867-70
Mechanisms Proposed for Facial Blanching from Neurotoxins
While facial blanching with neurotoxins therapy has been
described in the literature, a new study suggests that skin sites
injected with botulinum toxins may not experience the expected decrease in cutaneous vessel tone associated with higher body
temperature. After reviewing normal physiologic responses to
heat stress and the role of cholinergic neurotransmission in
modulating cutaneous vascular tone, investigators reported a case
of a 32-year-old woman who complained of white patches on her
forehead at sites of abobotulinumtoxinA injections administered
two weeks before presentation. They found that acetylcholine is
a primary mediator of cutaneous vasodilatation; certain co-transmitters
modulate its effect. Chemical denervation by botulinum
toxin appears to interfere with these normal signaling pathways
and can provide symptomatic relief to patients with undesirable
facial flushing. Conversely, they noted, it may create an unwanted
cosmetic effect in patients who desire isolated muscle paresis.
—Dermatol Surg. 2012, Dec 17
OnabotulinumtoxinA Associated with Sustained Effects
Treatment of the glabellar lines with onabotulinumtoxinA
provides long-lasting results of up to four months, according to
a recent study. Researchers analyzed data from four trials with
621 onabotulinumtoxinA-treated (20 U), 84.2 percent were
identified as day-30 responders on the Facial Wrinkle scale
(FWS) at maximum contraction. Pooled median duration of
effect for day-30 responders was 120 days for FWS at maximum
contraction and 131 days for FWS at repose. Higher day
30 SGA scores were correlated with a greater duration of effect
on dynamic, but not static lines. Results indicate that more
than 50 percent of respondents demonstrated a sustained
clinical effect for four months. The researchers also found
that patient satisfaction increased with duration of effect.
—Dermatol Surg.; 38(11): 1794-803
Comparing 1:1.5 Dose-conversion Ratio for IncobotulinumtoxinA and OnabotulinumtoxinA
Increasing the dose of either incobotulinumtoxinA or onabotulinumtoxinA
above the 20 U recommended for glabellar frown
lines may not yield the desired effect, according to findings from
a new study. To investigate the impact of using 50 percent higher
dose of onabotulinumtoxinA, researchers enrolled patients with
symmetrical moderate to severe glabellar frown lines and treated
them with two injects in the corrugator muscles of either 4 u incobotulinumtoxinA or 6 U onabotulinumtoxinA (equivalent
to 20 and 30 U, respectively, if corrugator muscles on both sides
and the procerus are treated). They then assessed glabellar frown
line severity was from standardized photographs every four weeks
for four months and, in a subset of subjects, for up to six months
post-treatment. The primary efficacy endpoint was the percentage
of subjects with an improvement of greater than one point
on the five-point scale at week four. Response rates showed no
added benefit of a 50 percent higher dose of onabotulinumtoxinA
at all phases of post-treatment.
—J Cosmet Dermatol.; 11(4): 267-71
Incobotulinumtoxin A Found Effective for Axillary and Palmar Hyperhidrosis
IncobotulinumtoxinA has been found to have positive
effects on axillary hyperhidrosis in a recent study, while also
conferring benefits when used in combination in combination
with a type B botulinum toxin for palmar hyperhidrosis.
A total of 84 patients, 58 with axillary and 26 with palmar
hyperhidrosis, were included in this open study. Researchers
injected axillae with 107 ± 22 U of incobotulinumtoxinA
and palms with 213 ± 19 U. They also injected palms with
264 ± 60 U botulinum toxin B over the thenar eminences
to avoid muscle weakness. At three-week follow-up posttreatment,
all patients treated for axillary hyperhidrosis
reported satisfaction in self-ranking, evaporation decreased
by greater than 40 percent, and Dermatology Life Quality
Index (DLQI) score improved from 12.0 to 1.7. In the palmar
group, 95 percent of patients were satisfied, with more than
50 percent reporting decreased, DLQI score improvement
from 10.3 to 1.2. Only one patient in the palmar group
experienced muscle weakness, according to investigators.
—Acta Derm Venereol. 2012, Oct 11
AbobotulinumtoxinA Effective in Skin of Color
Tolerability and effectiveness of abobotulinumtoxinA for glabellar
lines is similar in patients with skin of color and white
patients, according to new findings. Investigators used pooled
safety data from six clinical trials from which were derived a
safety population (1,869 white patients and 472 patients with
skin of color), an efficacy population for a comparison of
fixed-dose abobotulinumtoxinA 50 U in white patients and
patients with skin of color, and an efficacy population for a
comparison of abobotulinumtoxin A adjusted to muscle mass
in white and patients with skin of color. Adverse event rates
were similar between the two groups, as was onset of effect,
however the response rate 30 days after treatment was greater
in patients with skin of color than in white patients.
—Dermatol Surg. 2012 Nov; 38(11): 1804-11
Ready to Claim Your Credits?
You have attempts to pass this post-test. Take your time and review carefully before submitting.
Good luck!