OFFICE-BASED COSMETIC PROCEDURES AND TECHNIQUES · THE RESTYLANE FAMILY OF FILLERS: CANADIAN EXPERIENCE 45 B. Kent Remington Chap. 10. THE JUVEDERM FAMILY OF´ FILLERS 49 Frederick
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OFFICE-BASEDCOSMETIC
PROCEDURESAND TECHNIQUES
IN THE LAST TWENTY YEARS, there has been an explosion of new cosmetic surgeryprocedures developed for a large base of office-based dermatologists, cosmetic surgeons, plasticand reconstructive surgeons, and otolaryngologists. Tricks and techniques are swapped acrossthe globe, with practitioners in Europe, Asia, and North and South America. This is a practical,simple manual of those tricks and techniques, with input from specialists around the world. Thisbook is aimed at practitioners who want to add new procedures to their scope of practice and learnnew methods of application. A wide range of procedures, from fillers and neurotoxins to suturesuspension and chemical peels, are covered here in a comparative format and are accompanied bymore than two hundred color illustrations. In addition to detailing the procedures, chapters alsocover anesthetic techniques and brands. This book is designed to be an easy and useful referencefor the beginning practitioner or more senior physician. More than fifty internationally renowneddermatologists, plastic surgeons, facial plastic surgeons, and cosmetic surgeons have contributedto this text.
Sorin Eremia, MD, is Associate Clinical Professor of Medicine and Director of the CosmeticSurgery Unit in the Division of Dermatology at the University of California, Los Angeles.
This publication is in copyright. Subject to statutory exceptionand to the provisions of relevant collective licensing agreements,no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2010
Printed in the United States of America
A catalog record for this publication is available from the British Library.
Library of Congress Cataloging in Publication data
Office-based cosmetic procedures and techniques / edited by Sorin Eremia.p. ; cm.
Includes bibliographical references and index.ISBN 978-0-521-70652-0 (hardback)
1. Surgery, Plastic. 2. Dermatology. 3. Ambulatory medical care. I. Eremia, Sorin, 1951– II. Title.[DNLM: 1. Cosmetic Techniques. 2. Skin – surgery. 3. Ambulatory Surgical Procedures – methods.
WR 650 O32 2009]RD118.O34 2009
617.9′5 – dc22 2009019259
ISBN 978-0-521-70652-0 Hardback
Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external orthird-party Internet Web sites referred to in this publication and does not guarantee that any content on such
Web sites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this book to provide accurate and up-to-date information that is inaccord with accepted standards and practice at the time of publication. Although case histories are drawn fromactual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, theauthors, editors, and publishers can make no warranties that the information contained herein is totally free
from error, not least because clinical standards are constantly changing through research and regulation. Theauthors, editors, and publishers therefore disclaim all liability for direct or consequential damages resulting fromthe use of material contained in this book. Readers are strongly advised to pay careful attention to information
provided by the manufacturer of any drugs or equipment that they plan to use.
Chap. 48. NONABLATIVE LASER TISSUEREMODELING: 1,064-, 1,320-, 1,450-, AND1,540-NM LASER SYSTEMS 221Bernard I. Raskin, Joseph F. Greco, and Sorin Eremia
Section 4—Broadband Light Devices 225
Chap. 49. OVERVIEW OF BROADBAND LIGHTDEVICES 225Paul S. Yamauchi
TOGETHER WITH the help of many of my friendsand colleagues, I have attempted to provide the reader ofthis textbook with practical, up-to-date information on thebroad range of cosmetic procedures that are generally per-formed in an office setting.
This textbook is focused on the common cosmetic appli-cations of fillers; neurotoxins; laser, light, radiofrequency,and ultrasound devices; chemical peels; and microder-mabrasion. Supporting chapters on anatomy, anesthesia,minimally invasive suture suspension lifts, and mesother-apy round out the text.
This is an international, multispecialty, multiauthoredtextbook. The fifty senior contributing authors includeexperts in various topics from the fields of dermatology,facial and general plastic surgery, and cosmetic surgery andmedicine and hail from the United States, Canada, Europe,South America, and Asia. Because the United States lagsfar behind the rest of the world with respect to the varietyof options available for fillers and neurotoxins, Americanreaders can benefit greatly from such author diversity.
The sections on lasers and other energy devices forresurfacing, skin tightening, and treatment of fat and cel-lulite attempt to cover some of the most recent devicesavailable, with some short sections devoted to specific indi-vidual brands. Brand names are frequently mentioned inthis text, not to promote the products but to make it easyfor readers to identify the products discussed.
The book is divided into five parts. Part One, “Anatomyand the Aging Process,” is limited to discussions of theanatomy of the aging face and neck and is written by Dr.Pierre Nicolau, a well-known, Paris-based general plasticsurgeon trained in both France and England, with a stronginterest and background in fillers. For a more detailedstudy of anatomy, readers are referred to any of a num-ber of detailed textbooks on the subject. In general, facelift and blepharoplasty textbooks offer some of the best and
most detailed clinically practical information on face andneck anatomy. Needless to say, a strong understanding ofanatomy is essential to performing any cosmetic procedure.Because nothing beats hands-on study of anatomy, an excel-lent weeklong course is offered annually at the Universityof California, San Diego, called the Greenway SuperficialAnatomy Course.
Part Two, “Anesthesia and Sedation for Office Cos-metic Procedures,” provides detailed and practical infor-mation on local, topical, nerve block, and mild to moderateanesthesia methods that are applicable to the procedurescovered in this textbook. I particularly recommend thatless surgically oriented practitioners learn the art of nerveblocks. That chapter is written by Dr. Joseph Niamtu III,a highly experienced cosmetic surgeon with an oral andmaxillofacial surgery background.
Part Three is called “Fillers and Neurotoxins.” Thefiller chapters attempt to cover, in as much practical detailas possible, the various classes of fillers currently in use,including hyaluronic acid; collagen; hydroxyapatite; poly-lactic acid; various permanent fillers, including silicone;and finally, fat. Understanding why and how fillers workis essential, so I strongly recommend the chapters on howstructure affects function: Chapter 7, by Dr. JohannesReinmuller, a German plastic surgeon with a strong interestin fillers, on hyaluronic acid fillers and Chapter 19, by Dr.Pierre Nicolau, on long-lasting and permanent fillers. Theintroductory chapter, by Drs. Eric Williams, David J.Kouba, and Ronald L. Moy, provides excellent backgroundinformation and a list of various fillers available in theUnited States or in the Food and Drug Administration(FDA) pipeline.
Multiple sections by various authors, including DerekJones, Hayes B. Gladstone, Michael H. Gold, C. WilliamHanke, Rhoda S. Narins, B. Kent Remington, and NeilS. Sadick, from the field of dermatology, cover individual
products such as the Restylane, Juvederm, and Puragenfamilies of nonanimal stabilized hyaluronic acid fillers;collagens; Sculptra; Radiesse; Artecoll; and silicone. Amer-ican and international facial plastic and general plasticsurgeons’ perspectives are provided by Drs. Andrew B.Denton, Taro Kono, Devinder S. Mangat, Arturo Prado,and Constantin Stan.
Fat grafting is extensively covered by Drs. Mark Berman,Kimberly J. Butterwick, and William P. Coleman III, andthe European perspective on commercial fillers versus fatis covered by Dr. Stan.
BOTOX and Dysport, the latter of which is now finallyavailable in the United States, are the main focus of theneurotoxins section of Part Three. The Dysport chapteris written by one of the deans of French cosmetic derma-tology, Dr. Bernard Rossi. Drs. Prado and Kono also pro-vide excellent discussions of these and other neurotoxins(and fillers) available around the world in their respectivechapters. A novel device for minimally invasive corrugatormuscle denervation is discussed by Stanford facial plasticsurgeon Dr. James Newman.
Part Four is devoted to laser, broadband light, radio-frequency, and ultrasound devices. The senior author forthe chapter on treatment of vessels and vascular lesions,and for the chapter on aminolevulinic acid, is one of theforemost authorities in that field, Dr. Mitchel P. Goldman.Other well-known senior authors include Dr. ChristopherB. Zachary, writing on fractional CO2 lasers; Dr. ThomasRohrer, writing on hair removal; and Dr. E. Victor Ross,writing on the treatment of acne and acne scars with energydevices. Individual devices or treatment techniques are dis-cussed by multiple authors, including laser experts Drs.Tina S. Alster, Michael H. Gold, Gregory S. Keller, VicA. Narurkar, Javier Ruiz-Esparza, and Neil S. Sadick.
Together with my old friend and University of Califor-nia, Los Angeles (UCLA) colleague Dr. Bernard I. Raskin,and with the assistance of Drs. Edgar F. Fincher and JosephF. Greco, we share our extensive experience in chapters onclassic ablative laser resurfacing and nonablative infraredlasers. The new fractional laser systems and the latest inradiofrequency systems are also thoroughly covered.
Dr. Mat Avram, from Harvard, covers recent advances infat and cellulite treatment devices. The two eagerly awaitedultrasonic fat reduction devices now available in Europeand Latin America, UltraShape and LipoSonix, are coveredby Dr. Karyn Grossman, with assistance from Mexico City
plastic surgeon Dr. Ernesto Gadsden, principal investigatorfor LipoSonix.
Part Five is devoted to three topics:
1. Minimally invasive suture suspension techniques arebriefly discussed. Although ContourThreads, the U.S.patented version of barbed sutures, has been pulled offthe market, if new versions become available, the sameprinciples of use would apply. APTOS sutures remainwidely available in the rest of the world. I summarizemy five years of experience with the larger cogged,slowly absorbable multianchor sutures (AnchorSuture),and Dr. Nicanor Isse discusses the FDA-approvedintermediate-type cogged suture, Silhouette Sutures,the only cogged suture actively marketed in the UnitedStates as of June 2009.
2. A section on chemical peels and microdermabrasion isheaded by a chapter authored by Dr. Suzan Obagi, whoneeds no introduction.
3. A section on mesotherapy comprises a chapter written byDr. Adam M. Rotunda, the foremost American scientificauthority on the subject.
I hope this brief road map for the textbook will help directthe reader to his or her area of greatest interest.
A special mention goes to my UCLA colleagues Dr.Gary Lask, Dr. Jenny Kim, Dr. Fred Beddinfield, Dr.Bernard Raskin, and Dr. Teresa Soriano, who not onlyhelped contribute to this book but also provided greatmoral support for this project. Special thanks go to Dr. RonMoy, Dr. Mitch Goldman, and Dr. Neil Sadick for theiralways-friendly encouragement over the years and for theirsupport for this book as well. Special thanks also go to Ms.Sharon Sausedo for her assistance with the images for thetext.
Eternal gratitude goes to my late wife, Dr. Susie Van-Holten, and our son Dylan, for their understanding of thetime my academic pursuits have taken away from our familylife.
Sorin EremiaAssociate Clinical Professor of MedicineDirector, Cosmetic Surgery UnitDivision of DermatologyUniversity of CaliforniaLos Angeles
Maria Teresa Aguilar, MDPlastic Surgery DivisionHospital Central MilitarHospital Torre MedicaMexico City, Mexico
Tina S. Alster, MDDirector, Washington Institute of Dermatologic Laser
SurgeryClinical Professor of DermatologyGeorgetown University Medical CenterWashington, DC
Patricio Andrades, MDDivision of Plastic SurgerySchool of MedicineClinical Hospital JJ AguirreUniversity of ChileSantiago, Chile
Mat Avram, MD, JDDirector, Dermatology Laser and Cosmetic
CenterMassachusetts General HospitalHarvard Medical SchoolBoston, Massachusetts
Frederick C. Beddingfield III, MD, PhDVice President and Therapeutic Area HeadDermatology Clinical Research and DevelopmentAllergan, Inc.Assistant Clinical ProfessorDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Mark Berman, MD, FACSDepartment of Otolaryngology (Facial Plastic
Surgery)University of Southern California School
of MedicineLos Angeles, California
David P. Beynet, MD, MSClinical InstructorDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Kimberly J. Butterwick, MDDermatology and Cosmetic Surgery (private practice)La Jolla, California
Lina M. Cardona, MDResearch Associates Skin Care Research, Inc.The Dermatology and Aesthetic CenterBoca Raton, Florida
Paul J. Carniol, MDFacial Plastic and Reconstructive Surgery (private
practice)Summit, New Jersey
Henry H. L. Chan, MDDermatology (private practice)Hong Kong, China
F. Landon Clark, MD, MPHDepartment of DermatologyStanford University Medical CenterStanford, California
Kyle M. Coleman, MDDepartment of DermatologyTulane University Health Sciences CenterNew Orleans, Louisiana
William P. Coleman III, MDEditor in Chief, Dermatologic SurgeryClinical Professor of DermatologyAdjunct Professor of Surgery
(Plastic Surgery)Tulane University Health Sciences CenterNew Orleans, Louisiana
Giuseppe Curinga, MDDepartment of Plastic and Reconstructive
SurgeryUniversity of Rome “La Sapienza”Rome, Italy
Michel Delune, MDDermatology (private practice)Brussels, Belgium
Andrew B. Denton, MD, FRCSCAssistant ProfessorDivision of OtolaryngologyDepartment of SurgeryUniversity of British ColumbiaVancouver, British Columbia, Canada
David Duffy, MDClinical Professor of MedicineDivision of DermatologyUniversity of Southern CaliforniaAssistant Clinical ProfessorDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Sorin Eremia, MDAssociate Clinical Professor of MedicineDirector, Cosmetic Surgery UnitDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Doug Fife, MDDepartment of DermatologyUniversity of California, IrvineIrvine, California
Edgar F. Fincher, MD, PhDDermatology (private practice)Los Angeles, California
Ernesto Gadsden, MDChief of Plastic Surgery DivisionHospital Central MilitarPrincipal Investigator for LipoSonix
in MexicoMexico City, Mexico
Paul H. Garlich, MDOtolaryngology and Facial Plastic Surgery (private
practice)Gainesville, Georgia
Hayes B. Gladstone, MDDirector, Division of Dermatologic SurgeryAssociate ProfessorStanford UniversityStanford, California
Michael H. Gold, MDMedical Director, Gold Skin Care CenterTennessee Clinical Research CenterClinical Assistant ProfessorDepartment of Medicine and Department of
DermatologyVanderbilt University School of MedicineVanderbilt University School of NursingNashville, Tennessee
Mitchel P. Goldman, MDMedical Director, La Jolla SpaVolunteer Clinical Professor of Dermatology and
MedicineUniversity of California, San DiegoSan Diego, California
Joseph F. Greco, MDAssistant Clinical ProfessorDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Karyn Grossman, MDChief, Division of DermatologySt. John’s Medical CenterSanta Monica, CaliforniaAttending, Division of DermatologyUniversity of Southern CaliforniaLos Angeles, California
C. William Hanke, MD, FACP, MPHProfessor of DermatologyUniversity of Iowa Carver College of MedicineIowa City, IowaClinical Professor of Otolaryngology–Head and Neck
SurgeryIndiana University School of MedicineIndianapolis, Indiana
Nicanor Isse, MDAssistant Clinical Professor
(Plastic Surgery)University of California IrvineIrvine, California
Derek Jones, MDAssistant Clinical ProfessorDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Rebecca A. Kazin, MDMedical DirectorJohns Hopkins Cosmetic CenterAssistant Professor of DermatologyJohns Hopkins UniversityBaltimore, Maryland
Gregory S. Keller, MD, FACSAssociate Clinical Professor of Surgery
(Head and Neck)David Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Jane G. Khoury, MDDermatology (private practice)Ladera Ranch, California
David Kiken, MDDivision of Dermatology (private
practice)University of California, San DiegoLa Jolla, California
Jenny Kim, MD, PhDAssistant Professor of MedicineDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Taro Kono, MDAssistant Professor and Chief of Laser UnitDepartment of Plastic and Reconstructive SurgeryTokyo Women’s Medical UniversityTokyo, Japan
David J. Kouba, MD, PhDChief of Cosmetic DermasurgeryAssistant Professor of DermatologyHenry Ford Health SystemDetroit, Michigan
Patricio Leniz, MDDivision of Plastic SurgerySchool of MedicineClinical Hospital JJ AguirreUniversity of ChileSantiago, Chile
Cathy A. Macknet, MDDermatology and Dermatologic Surgery (private practice)Loma Linda, California
Devinder S. Mangat, MD, FACSAssociate Professor, Facial Plastic and Reconstructive
SurgeryUniversity of Cincinnati Medical CenterCincinnati, Ohio
Grigoriy Mashkevich, MDInstructor, Surgery (Head and Neck)David Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, CaliforniaFacial Plastic and Reconstructive SurgeryNew York Eye and Ear InfirmaryNew York City, New York
Greg S. Morganroth, MDAssistant Clinical Professor of DermatologyUniversity of California–San FranciscoSan Francisco, CaliforniaAdjunct Clinical Assistant Professor of
Otolaryngology/Head and Neck SurgeryStanford UniversityStanford, California
Ronald L. Moy, MDClinical Professor of MedicineDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Rhoda S. Narins, MDDirector, Dermatology Surgery and Laser CenterClinical Professor of DermatologyNew York University Medical SchoolNew York City, New York
Vic A. Narurkar, MDAssistant Clinical Professor of DermatologyUniversity of California, Davis School of MedicineSacramento, California
Andrew A. Nelson, MDDepartment of DermatologyHarvard Medical SchoolBoston, Massachusetts
James Newman, MD, FACSAssistant Clinical ProfessorDivision of Facial Plastic and Reconstructive SurgeryStanford UniversityStanford, California
Joseph Niamtu III, DMDDepartment of Oral and Maxillofacial SurgeryVirginia Commonwealth UniversityRichmond, Virginia
Pierre Nicolau, MDPlastic Surgery (private practice)Paris, France
Suzan Obagi, MDAssistant Professor of DermatologyDirector, The Cosmetic Surgery and Skin Health CenterDepartment of DermatologyUniversity of Pittsburgh School of MedicinePittsburgh, Pennsylvania
Mariana Pinzon-Plazas, MDResearch Associates Skin Care Research, Inc.The Dermatology and Aesthetic CenterBoca Raton, Florida
Arturo Prado, MDDivision of Plastic SurgerySchool of MedicineClinical Hospital JJ AguirreUniversity of ChileSantiago, Chile
Bernard I. Raskin, MDAssistant Clinical Professor of MedicineDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Kelley Pagliai Redbord, MDDermatology (private practice)Vienna, Virginia
Johannes Reinmuller, MDPlastic Surgery (private practice)Klinik am SonnenbergWiesbaden, Germany
B. Kent Remington, MDDermatology (private practice)Calgary, Alberta, Canada
Marta I. Rendon, MDClinical Associate ProfessorDepartment of DermatologyMiller School of Medicine, University of MiamiMiami, FloridaDepartment of DermatologyFlorida Atlantic UniversityBoca Raton, Florida
Thomas Rohrer, MDClinical Associate Professor of DermatologyBoston University School of MedicineBoston, Massachusetts
E. Victor Ross, MDDirector, Laser and Cosmetic Dermatology CenterScripps ClinicLa Jolla, CAAssistant Clinical ProfessorDermatology DivisionSchool of MedicineUniversity of California, San DiegoSan Diego, California
Bernard Rossi, MDDepartment of DermatologyHopital Charles NicolleUniversity of RouenRouen, FranceLecturerDepartment of DermatologyUniversity of Paris VParis, France
Adam M. Rotunda, MDDermatology (private practice)Newport Beach, California
Deborshi Roy, MDDepartment of Facial Plastic and Reconstructive
Javier Ruiz-Esparza, MDAssociate Clinical ProfessorUniversity of California, San DiegoSan Diego, California
Neil S. Sadick, MDAssociate Professor of DermatologyCornell University Medical CollegeNew York City, New York
Sogol Saghari, MDDermatology (private practice)Beverly Hills, California
Antonio Rusciani Scorza, MDDepartment of Plastic Surgery
(private practice)Catholic University of Sacred HeartRome, Italy
Joseph Sedrak, MDDepartment of DermatologyLoma Linda University School of MedicineLoma Linda, California
Nael Shoman, MDDivision of OtolaryngologyDepartment of SurgeryUniversity of British ColumbiaVancouver, British Columbia, Canada
Michelle Zaniewski Singh, MD, FACPCosmetic Medicine and Endocrinology
(private practice)Houston, Texas
Teresa Soriano, MDAssistant Professor of MedicineDepartment of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Constantin Stan, MDPlastic Surgery (private practice)Bacau, Romania
Zeina Tannous, MDDepartment of DermatologyHarvard Medical SchoolBoston, Massachusetts
Ahmet Tezel, PhDResearch and Development
Allergan Inc.Santa Barbara, California
Abel Torres, MD, JDProfessor and ChairmanDivision of DermatologyLoma Linda University School of
MedicineLoma Linda, California
Joshua A. Tournas, MDDepartment of DermatologyUniversity of California, IrvineIrvine, California
Jean Francois Tremblay, MDDepartment of DermatologyUniversity of MontrealMontreal, Quebec, Canada
Molly Wanner, MDClinical Instructor of DermatologyDepartment of DermatologyHarvard Medical SchoolMassachusetts General HospitalBoston, Massachusetts
Eric Williams, MDDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesVA West LA Medical CenterLos Angeles, California
Mark Willoughby, MDDermatology (private practice)San Diego, California
Katrina Wodhal, MDDermatology (private practice)La Jolla, California
Paul S. Yamauchi, MDDivision of DermatologyDavid Geffen School of MedicineUniversity of California, Los AngelesLos Angeles, California
Christopher B. Zachary, MDProfessor and ChairDepartment of DermatologyUniversity of California, IrvineIrvine, California