Previous studies indicate that the efficacy and durability of a single AbobotulinumtoxinA (ABO) treatment for moderate to severe glabellar lines may be enhanced with increasing dose, while safety outcomes remain consistent with those of the licensed dose (50 U).Evaluation of subject-reported indicators of treatment efficacy, satisfaction, and psychological well-being with ABO dose escalation.A Phase 2, 36-week, multicenter, randomized, dose-ranging, double-blind, placebo-controlled study was conducted in adults with moderate to severe glabellar lines. Subjects received a single ABO treatment, dosed at 50, 75, 100, or 125 U, or placebo. Efficacy endpoints comprised subject-assessed improvement in line severity of ≥1-grade from baseline at maximum frown, global aesthetic improvement scale (GAIS) grade, FACE-Q™ appraisal of lines, psychological well-being and age, and subject satisfaction.The study included 399 subjects (88.2% were female). Respective responder rates (≥1-grade improvement) with ABO 50-125 U doses ranged between 96.3%-100% at Week 4, 65.0%-67.9% at Week 24, and 33.8%-44.4% at Week 36. GAIS responder rate and FACE-Q appraisal of lines showed a similar pattern of change. Satisfaction was high and psychological well-being was improved from Week 4 through Week 36, with natural, youthful, and refreshed appearance reported for all ABO doses.A single ABO treatment (dosed at 50-125 U) provided significant and sustained improvements in glabellar line severity over durations up to 36 weeks, versus placebo. Treatment satisfaction was high with all doses. Participants reported natural and youthful appearance, alongside improvements in psychological well-being.
The number of cosmetic procedures for facial rejuvenation has increased steadily over the past decade. The increase in the application of nonsurgical modalities, particularly injectable shaping agents, has been remarkable. As knowledge and experience about facial aging has increased, techniques and tools have improved, and it is increasingly apparent that surgical and nonsurgical/injectable modalities are complementary.
Abstract Background Growing demand for minimally invasive aesthetic procedures to correct age-related facial changes and optimize facial proportions has been met with innovation but has created an unmet need for objective assessment tools to evaluate results empirically. Objectives The purpose of this study is to establish the intra- and inter-rater reliability of ordinal, photonumeric, 4-, or 5-point rating scales for clinical use to assess facial aesthetics. Methods Board-certified plastic surgeons and dermatologists (3 raters) performed live validation of jawline contour, temple volume, chin retrusion, nasolabial folds, vertical perioral lip lines, midface volume loss, lip fullness, and crow’s feet dynamic- and at rest-rating scales over 2 rounds, 2 weeks apart. Subjects selected for live validation represented the range of scores and included 54 to 83 subjects for each scale. Test-retest reliability was quantitated through intra- and inter-rater reliability, determined from the mean weighted kappa and round 2 intraclass correlation coefficients, respectively. The clinical significance of a 1-grade difference was assessed through rater comparison of 31 pairs of side-by-side photographs of subjects with the same grade or a different grade on the developed scales. Results The study demonstrated substantial to near-perfect intra- and inter-rater reliability of all scales when utilized by trained raters to assess a diverse group of live subjects. Furthermore, the clinical significance of a 1-point difference on all the developed scales was established. Conclusions The high test-retest reliability and intuitive layout of these scales provide an objective approach with standardized ratings for clinical assessment of various facial features.
Jean Carruthers, Alastair Carruthers, eds. Soft Tissue Augmentation: Procedures in Cosmetic Dermatology Series. 3rd ed. Series: Procedures in Cosmetic Dermatology (Jeffrey S. Dover, Murad Alam, eds). Philadelphia, PA: Saunders Elsevier, 2012. ISBN-10: 1455727822
The third edition of Soft Tissue Augmentation , edited by Drs Jean and Alastair Carruthers, is a comprehensive review of presently available soft-tissue injectable fillers and a practical guide for their use. The book contains 31 chapters, grouped into 3 major sections. Chapters 3 through 12 (the first section) address individual agents, including their development, physiochemical properties, and clinical applications. Chapters 13 through 24 pertain to treatment of specific anatomic areas (eg, forehead, glabella, nose) with various agents. The final section, Chapters 26 through 28, deals with possible complications related …
A device to assist in the delivery of dermal filler may achieve reductions in patient discomfort and adverse events, as well physician fatigue. It may also increase the accuracy of material placement.The authors assess the safety and performance of the Artiste Assisted Injection System (Nordson Micromedics, St Paul, Minnesota) in normal therapeutic use compared with the standard manual administration of dermal fillers.At 3 study sites, a total of 52 patients (48 women and 4 men) received bilateral full-correction injections of dermal fillers into randomized nasolabial folds (NLF). Injection into 1 NLF was made via Artiste, and injection into the other NLF was made via manual delivery. Immediately posttreatment and through 29 days, physician investigators, patients, and blinded evaluators recorded treatment durations and volumes, evaluated designated posttreatment characteristics using questionnaires, and documented adverse events (AE) and differences in cosmetic effects.Mean filler volume was 1.25 mL for the Artiste-treated NLF and 1.29 mL for manually treated NLF. One investigator used significantly less volume with Artiste than with manual injection (0.95 mL vs 1.12 mL; P = .001). Blinded evaluators rated Wrinkle Severity Rating Scale (WSRS) results as "identical" in 81% of patients. Investigator questionnaires showed a clear and statistically significant preference for Artiste over manual injection in all parameters (P < .001).The Artiste device is a viable option for physicians seeking a continuous-flow, injection-assisted device for ease of treatment, better accuracy, and improved results.
INTRODUCTION: Projections to the year 2050 estimate a non-Caucasian ethnic majority in the United States. As per American Society of Plastic Surgeons Statistic Reports from 2005 to 2014, there has been an 111% increase in cosmetic procedures performed on non-Caucasians.1 Since the face is the most immediately discernible sign of aging, we attempt to summarize current available literature pertaining to ethnic facial aging and its impact on current anti-aging therapies. METHODS: A literature search was performed in the PubMed/Medline database for studies linking facial aging and ethnicity using MeSH headings including ‘ethnic’, ‘aging’, ‘face’, ‘African’, ‘African American’, ‘Caucasian’, ‘Asian’, ‘Indian’, ‘Hispanic’, and ‘Middle Eastern’. A total of 23 electronic publications were selected with subsequent manual bibliographic searches. Data on anatomical differences and variations were noted and recorded. Treatment recommendations, in an algorithmic form, were compiled. RESULTS: The majority of available literature compares ethnic groups to a Caucasian standard. Asian skin has thinner stratum corneum and higher levels of melanin that confer a greater risk of post-inflammatory hyperpigmentation. Overall, the combination of thick skin, heavier malar fat pads, and weaker skeletal support of the Asian face makes laxity more severe with aging and greater gains can be achieved with more comprehensive surgical techniques such as cervico-facial rhytidectomy. Less data is available for the Hispanic group, however prominent midface structure and yellow skin coloration create the need for focused techniques targeting prominent nasolabial folds yet minimally invasive to avoid hyperpigmentation and prominent scarring. Africans and African Americans have possibly the highest intervariability of facial dimensions but a thicker skin envelope and superficial melanin granules confer photoprotection but also a higher propensity to form keloids and pigment changes. A hypoplastic midface results in localized periorbital and midface aging in contrast to greater periocular changes and cervicomental blunting. Age-related prevention and treatment is therefore preferentially targeted to those areas using a careful selection of minimally invasive procedures and careful use of chemical and nonalabative laser resurfacing. CONCLUSION: Although limited, current literature strongly suggests discernible and predictable differences in facial aging across ethnic groups. Given the increasing availability and acceptance of aesthetic plastic surgery by various ethnic groups, understanding ethnic anatomical variability and its effect with aging will allow the surgeon to better understand and tailor a safe and effective care plan for each individual patient.
Summary: In this final article for the Supplement, the authors address the physical and aesthetic characteristics of the latest hyaluronic acid, Belotero Balance. Topics include unique characteristics of the hyaluronic acid, aesthetic indications, administration techniques, adverse events, and differences between Belotero and other hyaluronic acids. The article closes with a brief discussion about nomenclature of hyaluronic acid products.
