Peer PreSs Review
Dr Rohit Kotnis surveys academic and association journals to report on advances in research in medical aesthetics and related fields
Restylane—safe and effective in upper eyelid contouring and rejuvenation. "The 10-minute browlift"
R Malhotra. Ophthalmic Plastic Reconstructive Surgery, December 2009
In the study, Restylane was injected using a serial puncture technique at the superior orbital rim in 27 patients seeking rejuvenation of the upper eyelid or correction of asymmetries. In this area, soft-tissue volume loss caused by ageing not only deflates the skin but also leads to brow ptosis, excessive or redundant skin in the upper eyelid (dermatochalasis), unmasking of the medial fat pad, increased upper eyelid show and hollowing of the upper eyelid sulcus.
Current surgical techniques do not address the changes in soft-tissue volume. Traditional surgical approaches focus on the tightening or excision of excess skin and muscle and fail to address volume loss. As a result, there has been a move toward primary volume replacement.
The study classified upper eyelid volume deficiency making it easier to identify patients who would benefit. Patients with minimal improvement were mainly those with upper eyelid hooding and sub-brow volume deflation. Patients with Type I to III volume deficiency were the most improved and most satisfied following treatment, highlighting the importance of careful selection of appropriate patients.
The mean patient age was 51 years, 85% were women and no patients had received prior treatment with eyelid or brow filler. The mean volume of gel injected per eye was 0.4 mL (range, 0.1-1.0 mL). Independent assessment of pre- and post-treatment photographs showed improved static upper eyelid contours in 23 patients (85%) and 26 of 27 patients (96%) were satisfied with the treatment. Mild bruising and swelling were reported in all patients within 24 hours of treatment but were easily managed with concealer or sunglasses and persisted for no more than five days. There were no reports of discolouration or lumpiness at the site of injection.
Malhotra identifies the importance of careful patient selection and this article will be of interest to those looking to broaden their repertoire.
The science and art of hyaluronic acid dermal filler use in esthetic applications.
Gold M.J. Cosmet Dermatol 2009 Dec;8(4):301-7.
The article reviews key determinants of dermal filler performance, discusses technical considerations, and illustrates these factors.
Current literature considering the physicochemical properties of hyaluronic acid (HA) dermal fillers and implications for clinical use was reviewed. The author provides clinical guidelines for optimising outcomes, illustrated with three case examples.
Hyaluronic acids are nonimmunogenic, versatile, reversible and have excellent benefit-risk profiles. They differ in their manufacturing processes, viscosity, hardness, cohesivity, ease of injection and ideal uses. Patient counselling and education with individualised selection of the appropriate agent is critical to provide satisfactory outcomes. Clinicians must be technically proficient, balance aesthetic need with facial anatomy, and consider HA properties to provide optimal outcomes.
A useful overview article which beginners will find of interest.
A Prospective, Randomized, Double-Blind Study Comparing the Efficacy and Safety of Type A Botulinum Toxins Botox and Prosigne in the Treatment of Cervical Dystonia.
Clin Neuropharmacol 2009 Dec 3. [Epub ahead of print
Botulinum toxin A (BTA) is considered an effective treatment of cervical dystonia.
The aim of this prospective, randomised, double-blind study was to compare Botox and Prosigne, a BTA of Chinese origin, to establish the safety, efficacy, and the equivalence of doses of the two formulations in the treatment of cervical dystonia.
Twenty-four patients were randomised to receive 300U of Botox or Prosigne (12 patients in each group). The patients were assessed before the injection and after four and 16 weeks by the Toronto Western Spasmodic Torticollis Rating Scale and the Short-Form 36 for quality of life. All patients were comparable in age, time since onset, number of previous injections, and time since last BTA application.
According to the Toronto Western Spasmodic Torticollis Rating Scale scores, the patients improved after injection and the scores increased after 16 weeks. Both pain and burning during the injection and the treatment outcomes were similar in both groups. No systemic adverse events occurred.
Average duration of effect was similar in both groups (11 weeks). The quality-of-life evaluations before and after the injections were comparable in both groups. Social aspects, pain and vitality improved after 16 weeks in both groups.
Botox and Prosigne were determined to have equivalent efficacy, safety, and tolerability profiles and dose equivalence for cervical dystonia treatment is 1:1.
This paper discusses a medical indication for Botox. The procedure should only be done under the guidance of a neurologist.
A single-center dose-comparison study of botulinum neurotoxin type A in females with upper facial rhytids: assessing patients’ perception of treatment outcomes.
Carruthers A, Carruthers J. J Drugs Dermatol 2009 Oct;8(10):924-9.
Few studies evaluate patient-reported outcomes (PROs). This study assesses the PROs of treatment with botulinum neurotoxin type A (BoNTA) in upper facial lines and evaluates two new PRO instruments.
A prospective, randomised, double-blind study of 32U, 64U, or 96U BoNTA divided among 16 sites. Measurements included the Facial Line Outcomes (FLO-11) Questionnaire version 1.0 and the Self-Perception of Age (SPA) measure version 2.0.
Sixty females with a mean age of 42 +/- 8.7 years, were enrolled. Significant improvements (P<0.01) in mean FLO-11 scores occurred by week two for all groups and remained significant through week 16 for all groups except the 32-U group. Approximately 45-60% of the patients reported looking younger by a mean of 3.6-5.8 years.
BoNTA treatment resulted in the desired relaxed and younger appearance, as measured by the FLO-11 Questionnaire and the SPA measure.
A paper written by the Carruthers which should be of interest to all practicing HCP’s working with BoNTA.
Reviewing the peer press is Rohit Kotnis (Lon), Dip SEM (Ed). Rohit is an advanced tutor at Dermis Deep, Birmingham and a member of the Body Language editorial panel
