Correction: Soares, D.J. Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)-Implications for Therapeutic Interventions. 2022, , 5398.

In the original publication [...

The Impact of Gel Parameters on the Dispersal and Fragmentation of Hyaluronic Acid Gel Fillers within an Artificial Model of Arterial Embolism.

Accidental arterial embolization of hyaluronic acid (HA) fillers can lead to severe complications, including skin ischemia, blindness, and stroke. Currently, the intra-arterial dispersal and fragmentation behavior of HA gels is unknown but critical to our understanding of the pathomechanism of these injuries. This work introduces the Pulsatile Unit for the Laboratory Simulation of Arterio-embolic Restrictions (PULSAR) and evaluates the intravascular behavior of different HA gels.

Comparative Rheology of Hyaluronic Acid Fillers, Poly-l-lactic Acid, and Varying Dilutions of Calcium Hydroxylapatite.

Background: This study examines the rheological properties of various dermal fillers, including hyaluronic acid (HA) fillers, poly-L-lactic acid (PLLA), and calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) gels, with a particular focus on the impact of aqueous dilution on CaHA-CMC's rheology and potential clinical implications.

Methods: Using standardized rheological analysis, we measured and compared the elastic modulus (G'), viscous modulus (G″), and the tan δ values of different dilutions of CaHA-CMC against published values of HA and PLLA fillers. The study aimed to determine the potential clinical use of application-specific CaHA-CMC hydrogel dilutions along a range of gel strength and cohesion for hydrogel fillers in current use.

The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medical Spa Directorship and Practitioner Trends in Florida.

Background: The rapid proliferation of medical spas (med spas) in the United States has raised concerns over the continued shift of nonsurgical aesthetic treatments away from traditional core specialty integration and supervision, potentially affecting surgical treatment guidance and education of cosmetic surgery patients. The authors assessed trends in the growth of independent med spa facilities as well as practitioner supervision, licensing, and specialization in the state of Florida.

Methods: The authors performed a comprehensive, statewide survey of all independent med spas in Florida by municipality using online business search engines.

Practice-Based Learning in Aesthetic Medicine: Assessing Scientific Literacy Among Cosmetic Practitioners.

Background: The field of aesthetic medicine has expanded substantially in the past decade, with significant practitioner diversification and departure from core-specialty supervision. The increased autonomy of nonphysician practitioners in a rapidly evolving field has raised accentuated the importance of scientific literacy and practice-based learning standards in the delivery of aesthetic medical care.

Objective: To assess the degree of scientific literacy among aesthetic medicine practitioners of different educational and training backgrounds in the United States and abroad.

Dilutional rheology of Radiesse: Implications for regeneration and vascular safety.

Background: Calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) injectables have emerged as dual-purpose fillers with bioregenerative and direct filling capabilities.

Aims: This study investigates the rheological properties of CaHA-CMC and its CMC carrier gel at various dilutions.

Methods: The storage modulus (G'), loss modulus (G″), complex viscosity (η*), loss factor (tan δ), cohesivity, and extrusion force were evaluated for a range of CaHA-CMC aqueous dilutions with an oscillatory rheometer, drop weight testing, and force analysis, respectively.

Additive Orthodiagonal Rhytidoplasty of the Ergotrid: A Novel Treatment Technique for Severe Dynamic Lip Lines.

Dynamic lip lines pose a challenge in perioral rejuvenation despite the availability of numerous hyaluronic acid dermal filler products and techniques. In this article, the authors introduce additive orthodiagonal rhytidoplasty of the ergotrid, or ADORE, a novel technique for the treatment of severe dynamic lip lines. Based on an objective analysis of treatment outcomes, the authors' technique demonstrates the ability to confer substantial improvement in dynamic lip line severity, with a median reduction in lip line intensity of 79% (average, 70%; SD, 19%) at 1 month and 72% (average, 61%; SD, 21%) at 6 months, and a high degree of patient satisfaction.

Cosmetic Filler-Induced Vascular Occlusion: A Rising Threat Presenting to Emergency Departments.

Vascular emergencies from cosmetic filler-induced vascular occlusion represent an iatrogenic etiology that poses a threat to patients, with sequelae that range from disfiguring skin necrosis to blindness and stroke. As cosmetic fillers continue to grow in popularity, the importance of early identification, triaging, and management of these rare but potentially disabling injuries has motivated efforts to educate the public and professional audiences. In this practice review article, we outline components of acute care pertaining to these injuries based on evolving practice guidelines and best evidence recommendations.

Needle Microcores: Can They Pose an Occlusive Threat with Nonparticulate Injections?

Summary: The incidence of vascular occlusion injuries has risen substantially along with the increasing popularity of cosmetic injectables. Among these occurrences, instances of soft-tissue ischemic events following the injection of nonparticulate solutions, such as botulinum, represent an enigmatic etiology that has yet to be fully understood. One hypothesized mechanism of injury underlying these events relates to the accidental capture and intravascular ejection of needle microcores, defined as submillimeter tissue fragments trapped by the beveled lumen of a needle during conventional injections.

Central Forehead Ischemic Skin Injury following Glabellar Botulinum: A Paradigm Microshift?

Vascular occlusion events have surged in incidence due to the increased popularity of cosmetic injectables. Ostensibly, treatments that involve nonparticulate solutions, such as botulinum, have traditionally been thought to carry no risk of vaso-occlusive complications. In this article, we report the first published instance of a suspected ischemic skin injury after botulinum injection to the glabella and surmise on the potential etiological mechanisms that may underlie these rare occurrences.

Patterns of Filler-Induced Facial Skin Ischemia: A Systematic Review of 243 Cases and Introduction of the FOEM Scoring System and Grading Scale.

Background: The incidence of facial skin necrosis has increased considerably because of the growth in the popularity of dermal fillers. This study describes the patterns and severity of facial skin ischemia, along with associated neuro-ophthalmologic injuries, in the published literature through the introduction of the facial artery, ophthalmic artery, distal external carotid artery, internal maxillary artery (FOEM) facial angiosome scoring system and grading scale.

Methods: A systematic review of all photographic cases of facial skin ischemia attributable to vascular occlusion with dermal fillers and injectable materials was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Orbital post-septal hyaluronic acid: An iatrogenic etiology compounding lower eyelid steatoblepharon.

The stark rise in the incidence of dermal filler-related adverse sequelae has given rise to a variety of cosmetic distortions related to improper filler placement that include dynamic and static contour deformities of the face. In this article, we describe two instances of post-septal hyaluronic acid filler aggravating existing steatoblepharon and outline potential causative mechanisms responsible for this condition.

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)-Implications for Therapeutic Interventions.

Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae.

#TheUglyTruth? A Qualitative Evaluation of Outcomes Photography on Instagram: Introducing the SEPIA Scoring System.

Unlabelled: Photographs of cosmetic treatment outcomes on social media are prone to bias and misrepresentation from nonadherence to established photographic standards. However, there is currently insufficient information regarding which norms are most-commonly violated, precluding quality improvement efforts.

Methods: A qualitative study of cosmetic treatment photographs published on Instagram was undertaken in accordance with the Guidelines for Reporting Reliability and Agreement Studies using a newly proposed Standards for the Evaluation of Photographs In Aesthetics (SEPIA) nine-point photograph scoring system and grading scale.

Superficially Herniated Loop of Facial Artery: A Potential Trap for the Unsuspecting Practitioner.

The anatomy of the facial artery is complex and prone to significant variations, rendering it susceptible to vascular injury secondary to injectable treatments. Despite the known variation in the course and branching pattern of this important arterial conduit, significant anomalies in the depth of the artery, including occurrences of vessel herniation, are not as well characterized. We describe an instance of a superficially herniated loop of facial artery presenting as a buccal mass erroneously targeted with an injectable suspension of triamcinolone.

The Future of Visual Documentation? Assessing the Use of Videography in Facial Plastic Surgery.

Recent technological advancements in the field of portable electronics have facilitated the use of videography as a form of visual documentation in facial plastic surgery. Currently, the degree of video adoption and perceptions relating to its use in plastic surgery are not known. This study aimed to evaluate the current use, perceptions, and barriers regarding the adoption of video in the clinical practice of facial plastic surgery.

Distal Internal Maxillary Artery Occlusion with Palatal Necrosis following Cheek Injection with Calcium Hydroxylapatite.

Accidental intravascular injection of cosmetic fillers resulting in dermal infarction represents one of the most feared complications in aesthetic medicine. Despite the infrequency of these injuries, the rapid rise in filler use has caused a sudden increase in the incidence of filler-induced skin necrosis. Because the complex vascular anatomy of the face subserves a wide range of cutaneous and mucosal tissues, it has been surmised that occult injuries affecting the oronasal cavities could occur as a result of accidental intravascular injection of dermal fillers.

[Climate change, changes in productivity and health: complex interactions in the national literature].

This article reviews the scientific output published in national journals on the interactions that are established between the concepts of climate change, productive changes (including changes in land use) and human health in the last ten years (from 2008 to 2017), highlighting the theoretical-methodological trends of this output. To achieve this, a review of the literature was made from publications made available in the Scientific Electronic Library Online (SciELO) and the CAPES Journals Portal. The results obtained demonstrate the advances made in the last ten years by the interdisciplinary teams that dealt with the subject over the period analyzed.

Impact of Postreconstitution Room Temperature Storage on the Efficacy of IncobotulinumtoxinA Treatment of Dynamic Lateral Canthus Lines.

Background: The efficacy of botulinum neurotoxin type A after prolonged storage at room temperature is currently unknown. This randomized, double-blinded, split-face study investigated the impact of postreconstitution 25°C storage for 1 week on the clinical efficacy of incobotulinumtoxinA in the treatment of lateral canthus lines.

Patients And Methods: Twenty-one participants with at least mild to moderate crow's feet at maximum contraction on the Crow's Feet Grading Scale (CFGS) underwent injection to each lateral canthus area with 10 U of freshly reconstituted and room temperature-stored product and followed for 4 months.

Midface skeletal enhancement.

Alloplastic malar augmentation offers a reliable means of achieving a permanent, yet reversible, form of midfacial volume enhancement that serves to correct the changes associated with facial aging, hypoplasia, and congenital malar asymmetry. The degree of augmentation depends on the severity of existing malar bony hypoplasia, soft tissue volume loss/ptosis, or both. Facial aesthetic surgeons have a multitude of implant designs and shapes and implant materials available.