Foreign body granuloma formation secondary to silicone injection.
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Injectable silicone has been used extensively over the last 40 years for soft tissue augmentation. Although considered biologically inert, this material has been implicated in a variety of adverse reactions including granulomas, disfiguring nodules, and lymphedema, sometimes with latent periods of decades. Often these complications are a result of the use of industrial grade products injected by unlicensed or unskilled practitioners. Here we report a case of foreign body granuloma in the thigh secondary to silicone injection in the buttocks. Initially the patient did not disclose a cosmetic contouring procedure administered by a nonprofessional nine months earlier, making diagnosis difficult. We remind clinicians to include foreign body granulomas in the differential diagnosis of apparent cellulitis and to question patients about the use of injectable fillers. (+info)
Botulinum toxin products overview.
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The tremendous success of botulinum toxin type A (BOTOX(R), Allergan Inc.) in the cosmetic arena has acted as a stimulus for the development of other neurotoxins. After more than 2 decades of use, BOTOX(R) has become synonymous with wrinkle reduction and is considered to be the one of the most common non-surgical cosmetic procedures performed worldwide. Because of its vast popularity among patients seeking non-invasive methods to achieve facial rejuvenation, physicians from diverse specialties have integrated botulinum toxin injections into their existing practices. Herein, we present an overview of botulinum toxin products for cosmetic applications that have received regulatory approval or are under development. (+info)
The impact of cosmetic interventions on quality of life.
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In the last decade, the number of cosmetic procedures performed in the United States has rapidly increased. While physicians historically have focused on minimizing side effects and optimizing the physical outcome, a broad spectrum of patient needs also factors in treatment success. Unfortunately, few data are available regarding the effects of cosmetic procedures on patient's self-esteem, confidence, relationships, and acceptance by others. Quality of life represents a relevant and important long-term measurement of outcomes in these patients. Studies have shown that cosmetic surgery can have a positive impact on patient quality of life. In contrast, fewer data are available regarding the effects of nonsurgical cosmetic procedures on quality of life. Much of the quality-of-life data regarding nonsurgical cosmetic procedures focuses on patients with human immunodeficiency virus-associated facial lipoatrophy, a condition associated with depression, problems with self-esteem and interpersonal relationships, in addition to nonadherence to the treatment. Recent data indicate that cosmetic treatment of human immunodeficiency virus-related facial lipoatrophy with injectable facial rejuvenators can improve quality of life in these patients. However, there is a dearth of quality-of-life data on patients who undergo facial rejuvenation procedures using the newer injectable devices, such as hyaluronic acid, calcium hydroxylapatite, and poly-L-lactic acid. Future studies should focus on developing standardized tests to assess quality of life in patients undergoing facial rejuvenation interventions. More data obtained from validated assessment tools are needed to systematically evaluate the effects specific treatments have on satisfying the needs of the cosmetic patient. (+info)
Reversible vs. nonreversible fillers in facial aesthetics: concerns and considerations.
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Soft-tissue augmentation of the face is an increasingly popular cosmetic procedure. In recent years, the number of available filling agents has also increased dramatically, improving the range of options available to physicians and patients. Understanding the different characteristics, capabilities, risks, and limitations of the available dermal and subdermal fillers can help physicians improve patient outcomes and reduce the risk of complications. The most popular fillers are those made from cross-linked hyaluronic acid (HA). A major and unique advantage of HA fillers is that they can be quickly and easily reversed by the injection of hyaluronidase into areas in which elimination of the filler is desired, either because there is excess HA in the area or to accelerate the resolution of an adverse reaction to treatment or to the product. In general, a lower incidence of complications (especially late-occurring or long-lasting effects) has been reported with HA fillers compared with the semi-permanent and permanent fillers. The implantation of nonreversible fillers requires more and different expertise on the part of the physician than does injection of HA fillers, and may produce effects and complications that are more difficult or impossible to manage even by the use of corrective surgery. Most practitioners use HA fillers as the foundation of their filler practices because they have found that HA fillers produce excellent aesthetic outcomes with high patient satisfaction, and a low incidence and severity of complications. Only limited subsets of physicians and patients have been able to justify the higher complexity and risks associated with the use of nonreversible fillers. (+info)
Incisional hernia after upper abdominal surgery: a randomised controlled trial of midline versus transverse incision.
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Hyaluronic acid gel (Juvederm) preparations in the treatment of facial wrinkles and folds.
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Soft tissue augmentation with temporary dermal fillers is a continuously growing field, supported by the ongoing development and advances in technology and biocompatibility of the products marketed. The longer lasting, less immunogenic and thus more convenient hyaluronic acid (HA) fillers are encompassing by far the biggest share of the temporary dermal filler market. Since the approval of the first HA filler, Restylane, there are at least 10 HA fillers that have been approved by the FDA. Not all of the approved HA fillers are available on the market, and many more are coming. The Juvederm product line (Allergan, Irvine, CA), consisting of Juvederm Plus and Juvederm Ultra Plus, was approved by the FDA in 2006. Juvederm is a bacterium-derived nonanimal stabilized HA. Juvederm Ultra and Ultra Plus are smooth, malleable gels with a homologous consistency that use a new technology called "Hylacross technology". They have a high concentration of cross-linked HAs, which accounts for its longevity. Juvederm Ultra Plus is used for volumizing and correcting deeper folds, whereas Juvederm Ultra is best for contouring and volumizing medium depth facial wrinkles and lip augmentation. Various studies have shown the superiority of the HA filler products compared with collagen fillers for duration, volume needed, and patient satisfaction. Restylane, Perlane, and Juvederm are currently the most popular dermal fillers used in the United States. (+info)
A population-based survey on tanning bed use in Germany.
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