Tetracycline Injections for Undereye Festoons

 A long-term follow-up study of patients who underwent teatracyline injections for festoons revealed that 59% of patients saw improvement and 67% would repeat the procedure. Authors Brian H. Chon, MD, Catherine J, Hwang, MD, and Julian D. Perry, MD, of the Cole Eye Institute, Cleveland Clinic Foundation, invited all patients undergoing tetracycline injection for treatment of lower eyelid festoons at the Cole Eye Institute, Cleveland Clinic, between 2008 and 2018 to participate in a questionnaire based on the FACE-Q checklist.

Of 102 patients who received tetracycline injection during the study period, 61 responsed to the questionnaire. The average follow-up time after injection was 3.6 years. Of the 61 respondents, 36 (59%) noted improvement in their festoons after treatment, and 27 of 33 noted that improvement occurred within two months of treatment. Overall, 40 of 60 respondents (67%) responded that they would consider repeating tetracycline treatment.

The most common adverse effects included discomfort (18%), swelling (15%) and bruising (13%). The authors noted that, although the majority of patients experienced improvement with an acceptable side-effect profile, “more data are needed to determine the optimal dose and frequency and to identify possible rare and/or significant side effects.”

The study, "Long-Term Patient Experience with Tetracycline Injections for Festoons," was published in Plastic and Reconstructive Surgery (December 2020).

Source 

Tetracycline Injections for Undereye Festoons | MedEsthetics (medestheticsmag.com)

Microneedling with Tranexamic Acid as Effective as 4% Hydroquinone for Melasma

 Patients with dermal melasma benefit from combination treatment with microneedling plus topical application of 4% tranexamic acid, according to a randomized study published in the November 2020 issue of the Journal of Cosmetic Dermatology. 

Authors Simin Shamsi Meymandi, MD, et al, of Kerman University of Medical Sciences, Kerman, Iran, evaluated the efficacy of microneedling plus tranexamic acid in comparison with 4% hydroquinone in the treatment of melasma. They treated 70 patients with melasma (60 patients completed the study), who were randomized based on simple randomization into two groups. Group A (30 patients) underwent monthly microneedling plus topical 4% tranexamic acid. Group B (30 patients) applied a topical 4% hydroquinone product nightly. The researchers evaluated melasma area severity and index (MASI) scores and patient satisfaction at baseline, four weeks, eight weeks and 12 weeks.

At the end of treatment, the mean MASI score was significantly lower in both groups with no statistical difference between two groups. Mean MASI score in group A was significantly lower at the end of the treatment (6.84 ± 4.31) than at the baseline (12.89 ± 5.16). Mean MASI score in group B was significantly lower at the end of the treatment (7.16 ± 4.38) than at the baseline (13.56 ± 4.88). The percentage of patient satisfaction was significantly higher than physician satisfaction in both treatment groups.

Article Source 

Microneedling with Tranexamic Acid as Effective as 4% Hydroquinone for Melasma | MedEsthetics (medestheticsmag.com)

Vertical Glabellar Line Fillers and the Supratrochlear and Supraorbital Arteries “The hypothesis that injecting soft tissue fillers next to the vertical glabellar line is safe because the supratrochlear artery courses deep to the crease should be rejected.”

 Source : research/injectables/news/21206867/understanding-the-location-of-vertical-glabellar-lines-and-the-supratrochlear-and-supraorbital-arteries

In an effort to reduce the risk of complications following glabellar soft tissue filler injections, researchers Sebastian Cotofana, MD, PhD, et al, used ultrasound imaging to identify the course of the superficial branch of the supratrochlear artery and of the deep branch of the supraorbital artery in relation to the ipsilateral vertical glabellar line. They measured the diameters, distance from skin surface, distance between the midline, distance between vertical glabella lines and the cutaneous projection of the supratrochlear/supraorbital arteries at rest and upon frowning.

After analyzing 41 healthy volunteers (mean age of 26.17 years and mean BMI of 23.09 kg/m2), they found that the mean depth of the supratrochlear artery was 3.34mm at rest and the mean depth of the supraorbital artery was 3.54mm.

The location of the arteries varied by gender: The mean distance between the superficial branch of the supratrochlear artery and the ipsilateral vertical glabellar line was 10.59mm in males and 8.21mm in females. The mean distance between the supraorbital artery and the ipsilateral vertical glabellar line was 22.38mm for in males and 20.73mm in females.

Upon frowning, there was a medial shift in the position of the supratrochlear arterial of 1.63mm in males and 1.84mm in females and a shift of 3.9mm in supraorbital arterial position for both genders .

The authors of the study, published in the Aesthetic Surgery Journal (December 2020), concluded, “The hypothesis that injecting soft tissue fillers next to the vertical glabellar line is safe because the supratrochlear artery courses deep to the crease should be rejected. Additionally, the glabella and the supraorbital region should be considered as an area of mobile, rather than static, soft tissues.”

FDA Issues More Sanitizer Warnings, Posts Microbe-related Recalls

 In the past few weeks, the U.S. Food and Drug Administration (FDA) has issued a warning letter and added five entries to its 'do not use' sanitizer list over product sub-potency. It also flagged four foaming hand soaps recalled for possible microbe contamination.

See related: 900+ Hand Sanitizer Poisonings, Mexican Imports Put on FDA Alert

Warning Letter: Insufficient (58%) Ethanol Content

A warning letter issued on Feb. 18, 2021, to Absaea Cosmetics, of Emiliano Zapata, Mexico, the FDA states, "Following an attempt to import Fragrance Free Vlanc + Plur Hand Sanitizer Rinse Free Formulated with 70% of Alcohol with Aloe Vera & Glycerin into the United States, it was detained and refused admission at the border. The results of the FDA laboratory testing of a batch of this product detained at the border demonstrate that this drug product labeled as manufactured at your facility is adulterated ... in that its strength, purity, or quality falls below that which it purports or is represented to possess."

See related: How NOT to Formulate Hand Sanitizers

The agency outlined that the product is labeled to contain 70% volume/volume (v/v) of the active ingredient alcohol (ethanol). However, FDA testing found that the drug product contained only 58% v/v ethanol. "This hand sanitizer drug product is adulterated under section 501(c) of the FD&C Act in that the active ingredient of ethanol is present at levels in the products lower than that which is declared on its labeling," the letter states.

The FDA concluded that all drugs and drug products manufactured by the firm remain listed on import alert until there is evidence establishing that the conditions that gave rise to the violation have been resolved.

Hand Sanitizer Additions to 'Do Not Use' List

Continuing its monitoring for hand sanitizer violations, the FDA added five listings to its hotlist of products consumers are warned not to use. The agency noted it currently has no evidence of these products being on the U.S. market, but all of the following were flagged for subpotent alcohol (ethanol) levels: two listings for Weper Clean Solutions, Kleengel Hand Sanitizer, CyroLab Q&T Antibacterial Gel and Kilvir Forte Virus Killer, all manufactured by Distribuidora Lagunera del Norte SA de CV, of Mexico.

Possible Burkholderia cepacia Contamination

Finally, four voluntary product recalls were made by Scent Theory Products for potential Burkholderia cepacia contamination. These included four foaming hand soaps made with essential oils: Lemon Citrus, Vanilla Coconut, Eucalyptus Mint and Fresh Lavender.

Source Article FDA Issues More Sanitizer Warnings, Posts Microbe-related Recalls | MedEsthetics (medestheticsmag.com)

Crisscross PDO Thread Pattern Improves Longevity

"In the crisscross implantation pattern, width and density of the fibrotic areas were five-fold greater than those of the fan-shaped areas. "

 A mouse study comparing the conventional fan-shaped pattern used in barbed thread lifts to a crisscross pattern found better longevity when polydioxanone (PDO)-barbed threads were implanted in the crisscross pattern. The study's findings were published in the Aesthetic Surgery Journal (March 2021). 

Researchers implanted three fragments of monofilament PDO-barbed lifting threads in the dorsal skin of 12 nude mice. The pattern of implantation was fan-shaped in the control group and crisscross in the experimental group. Tissue specimens containing tangential areas of threads were harvested, fixed and paraffin-embedded. Samples were histologically analyzed using hematoxylin and eosin, Massons' Trichrome and Sirius red staining. The researchers also analyzed fibrotic areas and the width of fibrosis from the thread. 

They found that the fibrous capsulations around the barbed area of the PDO-barbed lifting threads were three-fold greater than those around the barb-free areas of the threads. In the crisscross implantation pattern, width and density of the fibrotic areas were five-fold greater than those of the fan-shaped areas. In addition, induction of fibrous capsules around the PDO-barbed thread was markedly condensed in the crisscross areas. 

The authors concluded, "This study provides the basis for more logical implantation pattern in PDO-barbed lifting threads for facial rejuvenation. By generating controlled multiple crisscross patterns, we can create more intense fibrogenesis, reduce tension applied on each barbed thread and, as a result, extend the longevity of the result."

Credit 

Crisscross Vs. Fan-shaped Implantation of PDO Threads for Facial Rejuvenation | MedEsthetics (medestheticsmag.com)

Indications for Thermo-mechanical Fractional Therapy

Article Source: Tixel TMFI Therapy Effectively Improves Facial Skin Quality | MedEsthetics (medestheticsmag.com) 

Indications for Thermo-mechanical Fractional Therapy

Thermo-mechanical fractional injury (TMFI) therapy (Tixel, Novoxel) is effective for skin rejuvenation on skin types II-V, according to the results of a retrospective study published in Lasers in Surgery and Medicine (March 2021). 

TMFI involves the application of heated metal tips to the skin's surface in a fractional pattern. For this study, researchers performed a chart review of 24 patients with skin types II - V who received two or three Tixel treatments. Of the patients, 20 were women and four were men, and the average age of the patients was 56 years old. The treatments were delivered three to five weeks apart in two medical centers (12 from Israel and 12 from the United Kingdom).

Four experienced dermatologists compared standardized clinical photographs taken before each treatment and three months after the final treatment and rated outcomes based on seven parameters (blood vessels and erythema, skin complexion, periorbital wrinkles, pigmentation and toning, pore size, vitality, wrinkles and laxity) on a scale of -1 to 4. The authors also reviewed epidemiology, treatment data, satisfaction and adverse events. 

There was an overall improvement in all seven parameters with the greatest improvement demonstrated in skin complexion (2.1 ± 0.49) and periorbital wrinkling (2.09 ± 0.65) followed by vitality (1.7 ± 0.49). Adverse events were transient and included erythem and hyperpigmentation. The average downtime was 1.7 days.  

How to open up you accounts to purchase from Allergan, Galderma , and Merz

Allergan: Botox® Cosmetic and Juvederm® Family of Fillers

 

Telephone: 800-377-7790

New Accounts: select option 1, and then select option 1 again

Websites for Providers: www.Allergan.com, www.hcp.BotoxCosmetic.com, www.hcp.Juvederm.com, www.hcp.mykybella.com

Websites for Patients/Models: www.BotoxCosmetic.com, www.Juvederm.com, www.mykybella.com

Botox® Cosmetic

Botox® Cosmetic was the first FDA approved BTX-A.  It gained FDA approval in 2002 for treatment of glabellar lines.  Botox® Cosmetic is used to temporarily improve the appearance of moderate to severe facial wrinkles.

Juvederm® Family of Fillers

The Juvederm® family of products are injectable hyaluronic acid dermal fillers.  Juvederm® XC products include lidocaine for an anesthetic effect.  This family of fillers is continuously

Juvederm® Voluma XC

Juvederm® Voluma adds volume to correct age-related volume loss.  This product is made for deep injections used during mid face volume restoration.  Voluma has a combination of different molecular weights, and can last up to 2 years in some patients.

Juvederm® Ultra Plus XC 

This dermal filler is used for deep facial tissue corrections and adds volume to smooth out moderate to severe facial wrinkles and folds.  Juvederm® Ultra Plus XC consists of a larger hyaluronic acid particle size that lasts from 9-12 months.

Juvederm® Ultra XC

Juvederm® Ultra XC is made from a smaller hyaluronic acid particle size so it works well for finer corrections around the lips and perioral area.  Primarily for lip enhancement and lip augmentation, Juvederm Ultra XC leads to a smoother finish for delicate areas.  This dermal filler can last for up to 1 year.

Juvederm® Volbella

Allergan’s latest addition to the Juvederm® family of fillers is Volbella® and will hit the market in October, 2016.  Volbella® will be used to increase lip fullness and to softer the appearance of perioral lines.  One of our instructors and members of the Education Advisor Council will be one of the first practitioners to be trained by Allergan with this new dermal filler.  It will be interesting to see how Volbella® works with Ultra XC, and when each one is used.  Having first-hand experience with Volbella®, our Botox and Dermal Filler Training course will include this information as soon as it is available.

Merz North America: Xeomin®, Radiesse®, Belotero Balance® & Asclera®

 

Telephone: 866-862-1211

Websites for Providers:www.MerzUsa.com, www.XeominAesthetic/Professionals/.com, www.Radiesse/Professionals/.com, www.Belotero/hcp-video-library/.com, www.Asclera/for-physicians/.com

Websites for Patients/Models: www.XeominAesthetic.com, www.Radiesse.com, www.Belotero.com, www.Asclera.com

Xeomin®

Xeomin® is a BTX-A used to temporarily improve the severity of moderate to severe facial wrinkles.  It is used to treat the same facial areas as Botox® Cosmetic and Dysport®.  While Xeomin® is more similar to Botox® than Dysport®, each BTX-A has differences that should be understood prior to use.  Each BTX-A is explained in detail during our basic Botox and Dermal Filler training course, and you will use Botox® and Xeomin® during the hands-on training portion of the course.

Radiesse®

Radiesse® is a Calcium Hydroxylapatite (CaHA) dermal filler so it has immediate and long-lasting results.  Radiesse® can be used to volumize facial wrinkles and folds and also has FDA approval for use in the hands.  Using Radiesse for facial wrinkles and the hands is covered in our Advanced Injections Technique course.  Stimulating the body to produce its own collagen, Radiesse® can last a year or more.

Belotero Balance®

Belotero Balance® is a hyaluronic acid dermal filler used to treat moderate to severe facial wrinkles and folds.  Belotero® Balance works for 6 months – 1 year.

Asclera®

Merz is also the pharmaceutical company for Asclera®.  Asclera® is a sclerosing agent used during the Sclerotherapy procedure and is used to treat uncomplicated spider veins and small varicose veins.  It can take Asclera® several treatments to work, with the final result taking effect 3-6 months after treatment.  We use Asclera® as the hands-on training sclerosing agent in our Sclerotherapy training course.

 

Galderma and US distributor McKesson: Dysport® and Restylane® Products

 

Telephone:877-520-0500

Websites for Professionals: www.GaldermaUSA.com, www.dysport/healthcare-professionals.com, www.RestylaneUSA/hcp.com, www.SculptraAesthetic/hcp

Websites for Patients/Models: www.Dysportusa.com, www.Restylaneusa.com, www.SculptraAesthetic.com

Dysport®

Dysport® is an injectable BTX-A used to temporarily improve the appearance of moderate to severe glabellar lines associated with the procerus and corrugator muscle activity.  It is used to treat the same areas as Botox® Cosmetic and Xeomin®.  Dysport® is included in the didactic portion of our Botox and Dermal Filler training course.  However, because the reconstitution and dosing of Dysport® is different, it is not available during the hands-on training session.  We do provide in-office training for Dysport®.  This BTX-A lasts an average of 3-6 months.

Restylane® Family of Fillers

 

Restylane®

Restylane® is a hyaluronic acid dermal filler used for moderate to severe facial wrinkles and folds as well as lip augmentation.  Restylane® lasts approximately 4-6 months.

Restylane® Lyft

Restylane® Lyft is used for mid-face volume restoration as well as facial wrinkles and folds.  This dermal filler lasts approximately 12-18 months.

Restylane® Silk

Restylane® Silk is the first FDA approved hyaluronic acid filler specifically for the area around the mouth including lip augmentation.  The use of smaller, smoother hyaluronic acid particles makes Restylane® Silk a great filler choice for this delicate area.  Restylane® Silk lasts at least 6 months and then results gradually decrease.

Sculptra® Aesthetic

Sculptra® Aesthetic is an injectable poly-L-lactic acid dermal filler that can last more than 2 years.  It is used to treat shallow to deep facial folds and wrinkles where a cross-hatch injection pattern can be used.  Helping to replace lost collagen, results are gradual and the treatment regime typically takes three injections over the course of 3-4 months.

if you are looking for training visit www.esiw.com