For Peer Review Comprehensive Facial Rejuvenation Protocol Using Dermal Fillers: Bovine Collagen Gel Suspended Polymethylmethacrylate Microspheres and Hyaluronic Acid Journal: Aesthetic Surgery Journal Manuscript ID Draft Manuscript Type: Original Article Subject Collection: Cosmetic Medicine Keywords: Bellafill, Aging Face, Facial Volume Replacement, Dermal Fillers Abstract: Background Facial rejuvenation centers upon optimized treatment of facial wrinkles and facial volume deficiencies created by the aging process. Dermal fillers are the preferred minimally invasive method for volume replacement. Objectives: Evaluate the indications for placement, quantity of fillers, anatomical location, frequency of injections, and adverse effects of bovine collagen gel suspended polymethylmethacrylate microspheres (ART) in association with the use of Restylane Lyft (PERl). Methods: A retrospective review was undertaken of those patients choosing ART and PERl as part of a comprehensive facial rejuvenation protocol. Results From 2009 through 2015, 1,513 patients and 2,875 ART syringes were injected. There were 1.9 syringes/treatment, 2.9 months between treatment sessions with total syringes/patient: 0-5 44%, 6-10 33%, 11-15 11%, >16 11%. Three patients had firm areas and three had excess injection of ART. As the years progressed, the use of ART increased with 815 syringes injected in 2015. There were 321 PERl treatment sessions, 1.2 syringes/treatment, and a total of 389 syringes injected. Conclusions ART combined with PERl are valuable components to a comprehensive facial rejuvenation treatment strategy with a low incidence of complications. Microcannulas and lidocaine with epinephrine and bicarbonate can ease injection pressure, and minimize bruising, discomfort, swelling and adverse reactions. http://mc.manuscriptcentral.com/asjournal Aesthetic Surgery Journal
49
Embed
Compreh ensive Facial Rejuvenation Protocol Using Dermal ...€¦ · other hyaluronic acid fillers. 13,14 Indications for Dermal Filler Treatment The facial analysis determines the
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
For Peer Review
Comprehensive Facial Rejuvenation Protocol Using Dermal
Fillers: Bovine Collagen Gel Suspended
Polymethylmethacrylate Microspheres and Hyaluronic Acid
Background Facial rejuvenation centers upon optimized treatment of facial wrinkles and facial volume deficiencies created by the aging process. Dermal fillers are the preferred minimally invasive method for volume replacement. Objectives: Evaluate the indications for placement, quantity of fillers, anatomical location, frequency of injections, and adverse effects of bovine collagen gel suspended polymethylmethacrylate microspheres (ART) in association with the use of Restylane Lyft (PERl). Methods: A retrospective review was undertaken of those patients choosing ART and PERl as part of a comprehensive facial rejuvenation protocol.
Results From 2009 through 2015, 1,513 patients and 2,875 ART syringes were injected. There were 1.9 syringes/treatment, 2.9 months between treatment sessions with total syringes/patient: 0-5 44%, 6-10 33%, 11-15 11%, >16 11%. Three patients had firm areas and three had excess injection of ART. As the years progressed, the use of ART increased with 815 syringes injected in 2015. There were 321 PERl treatment sessions, 1.2 syringes/treatment, and a total of 389 syringes injected. Conclusions ART combined with PERl are valuable components to a comprehensive facial rejuvenation treatment strategy with a low incidence of complications. Microcannulas and lidocaine with epinephrine and
bicarbonate can ease injection pressure, and minimize bruising, discomfort, swelling and adverse reactions.
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
Abstract
Background
Facial rejuvenation centers upon optimized treatment of facial wrinkles and facial volume
deficiencies created by the aging process. Dermal fillers are the preferred minimally
invasive method for volume replacement.
Objectives:
Evaluate the indications for placement, quantity of fillers, anatomical location, frequency
of injections, and adverse effects of bovine collagen gel suspended
polymethylmethacrylate microspheres (ART) in association with the use of Restylane
Lyft (PERl).
Methods:
A retrospective review was undertaken of those patients choosing ART and PERl as part
of a comprehensive facial rejuvenation protocol.
Results
From 2009 through 2015, 1,513 patients and 2,875 ART syringes were injected. There
were 1.9 syringes/treatment, 2.9 months between treatment sessions with total
syringes/patient: 0-5 44%, 6-10 33%, 11-15 11%, >16 11%. Three patients had firm areas
and three had excess injection of ART. As the years progressed, the use of ART
increased with 815 syringes injected in 2015. There were 321 PERl treatment sessions,
1.2 syringes/treatment, and a total of 389 syringes injected.
Conclusions
ART combined with PERl are valuable components to a comprehensive facial
rejuvenation treatment strategy with a low incidence of complications. Microcannulas
Page 1 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
and lidocaine with epinephrine and bicarbonate can ease injection pressure, and minimize
bruising, discomfort, swelling and adverse reactions.
Page 2 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
Introduction
We all appreciate facial beauty. The aging process steals our facial youthfulness by
characteristically atrophying the skin, soft tissues and bony framework.1,2,3
Battling the
aging process is a life-long endeavor. Procedures and technologies exists to lessen or
fully correct facial wrinkles and volume deficiencies.
Fashion models are perceived as beautiful by displaying optimal facial features (Table 1).
Facial rejuvenation centers upon striving to attain these aesthetic treatment goals and
most often requires volume replacement. This volume enhancement is paramount to
restoring and maintaining youthfulness. The decision to choose a specific option of
volume replacement is typically based on the experience and training of the physician
and their personal bias.
Current volume enhancement therapeutic options include: 1. silastic facial implants
25. Hexsel D, Soirefmann M, Donida Porto M, et al. Double-blind, randomized,
controlled clinical trial to compare safety and efficacy of a metallic cannula with that of a
standard needle for soft tissue augmentation of the nasolabial folds. Dermatol Surg
2012;38:207–214.
26. Sundaram H, Weinkle S, Pozner J, Dewandre L. Blunt-tip microcannulas for the
injection of soft tissue fillers: A consensus panel assessment and recommendations. J
Drugs Derm 2012:11(8)s33-s39.
Table 1 Optimal Facial Aesthetic Features
1. facial proportion, symmetry and balance
2. appropriate forehead height and aesthetic brow shape
3. lack of eyelid dermatochalasia
4. high cheek bones
5. appropriate nasal size and shape
6. full, sensual lips
Page 18 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
7. straight, white teeth
8. straight mandibular line
9. acute cervicomental angle
10. a smooth skin contour without wrinkles or blemishes.
Table 2 Reluctance to Implement Permanent Dermal Filler
1. fear of the long-term effects of PMMA microspheres in soft tissues
2. risk of granuloma formation
3. the concern of treating excess filler placement
4. theoretical less future filler use with physician loss of revenue.
Figure 1
Diagram of donor site A. Immediately post-injection B. Four weeks post-injection
(Courtesy of Suneva Medical, Inc, 2016). Human collagen formation (off-white lines)
produced by fibroblasts (blue cells) around each microsphere (large grey spheres) with
microvascularization formation (red vessels).
Figure 2
49 yo woman with facial volume loss and acne scarring corrected by Carbon dioxide
laser skin resurfacing (DEKA, Smartxide CO2 at 24 Watts, 1400 milliseconds of dwell
time, and 400 micron spacing) along with 4 syringes of Bellafill to tear trough, midface
and pre-jowl sulcus A. B. Before C. D. After (2 months)
Figure 3
Page 19 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14
syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C.
Before D. E. F. After (8 months)
Figure 4
49 yo Asian woman who requests permanent facial filler volume replacement. She
underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-
jowl sulcus). A. B. C. D. Before E. F. G. H. After (18 months)
Figure 5
26 yo woman requesting lip augmentation. A. Before B. After PermaLip Implant C. After
Implant & 1 syringe Bellafill to vermillion border
Figure 6
29 yo man with nasal irregularity post rhinoplasty repaired with 1 Bellafill syringe A.
Before B. After (3 months)
Page 20 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
Page 21 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
Diagram of donor site A. Immediately post-injection B. Four weeks post-injection (Courtesy of Suneva Medical, Inc, 2016). Human collagen formation (off-white lines) produced by fibroblasts (blue cells) around each microsphere (large grey spheres) with microvascularization formation (red vessels).
712x734mm (72 x 72 DPI)
Page 22 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
Diagram of donor site A. Immediately post-injection B. Four weeks post-injection (Courtesy of Suneva Medical, Inc, 2016). Human collagen formation (off-white lines) produced by fibroblasts (blue cells) around each microsphere (large grey spheres) with microvascularization formation (red vessels).
734x793mm (72 x 72 DPI)
Page 23 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo woman with facial volume loss and acne scarring corrected by Carbon dioxide laser skin resurfacing (DEKA, Smartxide CO2 at 24 Watts, 1400 milliseconds of dwell time, and 400 micron spacing) along with 4
syringes of Bellafill to tear trough, midface and pre-jowl sulcus A. B. Before C. D. After (2 months)
1411x2116mm (72 x 72 DPI)
Page 24 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo woman with facial volume loss and acne scarring corrected by Carbon dioxide laser skin resurfacing (DEKA, Smartxide CO2 at 24 Watts, 1400 milliseconds of dwell time, and 400 micron spacing) along with 4
syringes of Bellafill to tear trough, midface and pre-jowl sulcus A. B. Before C. D. After (2 months)
2116x1411mm (72 x 72 DPI)
Page 25 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo woman with facial volume loss and acne scarring corrected by Carbon dioxide laser skin resurfacing (DEKA, Smartxide CO2 at 24 Watts, 1400 milliseconds of dwell time, and 400 micron spacing) along with 4
syringes of Bellafill to tear trough, midface and pre-jowl sulcus A. B. Before C. D. After (2 months)
1411x2116mm (72 x 72 DPI)
Page 26 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo woman with facial volume loss and acne scarring corrected by Carbon dioxide laser skin resurfacing (DEKA, Smartxide CO2 at 24 Watts, 1400 milliseconds of dwell time, and 400 micron spacing) along with 4
syringes of Bellafill to tear trough, midface and pre-jowl sulcus A. B. Before C. D. After (2 months)
2116x1411mm (72 x 72 DPI)
Page 27 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14 syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C. Before D. E. F. After (8 months)
1004x1507mm (72 x 72 DPI)
Page 28 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14 syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C. Before D. E. F. After (8 months)
1004x1507mm (72 x 72 DPI)
Page 29 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14 syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C. Before D. E. F. After (8 months)
1004x1507mm (72 x 72 DPI)
Page 30 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14 syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C. Before D. E. F. After (8 months)
1507x1004mm (72 x 72 DPI)
Page 31 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14 syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C. Before D. E. F. After (8 months)
1004x1507mm (72 x 72 DPI)
Page 32 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14 syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C. Before D. E. F. After (8 months)
1004x1507mm (72 x 72 DPI)
Page 33 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14 syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C. Before D. E. F. After (8 months)
1004x1507mm (72 x 72 DPI)
Page 34 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
63 yo woman with facial volume loss requested rejuvenation. She was treated with 14 syringes of Bellafill to tear trough, nasolabial folds, submalar & prejowl sulcus A. B. C. Before D. E. F. After (8 months)
1507x1004mm (72 x 72 DPI)
Page 35 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo Asian woman who requests permanent facial filler volume replacement. She underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-jowl sulcus). A. B. C. D. Before E. F. G.
H. After (18 months)
1004x1507mm (72 x 72 DPI)
Page 36 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo Asian woman who requests permanent facial filler volume replacement. She underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-jowl sulcus). A. B. C. D. Before E. F. G.
H. After (18 months)
1004x1507mm (72 x 72 DPI)
Page 37 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo Asian woman who requests permanent facial filler volume replacement. She underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-jowl sulcus). A. B. C. D. Before E. F. G.
H. After (18 months)
1507x1004mm (72 x 72 DPI)
Page 38 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo Asian woman who requests permanent facial filler volume replacement. She underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-jowl sulcus). A. B. C. D. Before E. F. G.
H. After (18 months)
1507x1004mm (72 x 72 DPI)
Page 39 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo Asian woman who requests permanent facial filler volume replacement. She underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-jowl sulcus). A. B. C. D. Before E. F. G.
H. After (18 months)
1004x1507mm (72 x 72 DPI)
Page 40 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo Asian woman who requests permanent facial filler volume replacement. She underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-jowl sulcus). A. B. C. D. Before E. F. G.
H. After (18 months)
1004x1507mm (72 x 72 DPI)
Page 41 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo Asian woman who requests permanent facial filler volume replacement. She underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-jowl sulcus). A. B. C. D. Before E. F. G.
H. After (18 months)
1507x1004mm (72 x 72 DPI)
Page 42 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
49 yo Asian woman who requests permanent facial filler volume replacement. She underwent 4 Bellafill syringes to tear trough, nasojugal groove and mesolabial fold (pre-jowl sulcus). A. B. C. D. Before E. F. G.
H. After (18 months)
1507x1004mm (72 x 72 DPI)
Page 43 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
26 yo woman requesting lip augmentation. A. Before B. After PermaLip Implant C. After Implant & 1 syringe Bellafill to vermillion border
1507x1004mm (72 x 72 DPI)
Page 44 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
26 yo woman requesting lip augmentation. A. Before B. After PermaLip Implant C. After Implant & 1 syringe Bellafill to vermillion border
1507x1004mm (72 x 72 DPI)
Page 45 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
26 yo woman requesting lip augmentation. A. Before B. After PermaLip Implant C. After Implant & 1 syringe Bellafill to vermillion border
1507x1004mm (72 x 72 DPI)
Page 46 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
29 yo man with nasal irregularity post rhinoplasty repaired with 1 Bellafill syringe A. Before B. After (3 months)
541x722mm (72 x 72 DPI)
Page 47 of 48
http://mc.manuscriptcentral.com/asjournal
Aesthetic Surgery Journal
For Peer Review
29 yo man with nasal irregularity post rhinoplasty repaired with 1 Bellafill syringe A. Before B. After (3 months)