Quantifying soft tissue loss in the aging male face using magnetic resonance imaging.

Background: Quantitative data on soft tissue aging of the face are scarce, particularly in men.

Objective: Magnetic resonance imaging (MRI) was used to quantify and compare facial soft tissue loss in men.

Materials And Methods: Two thousand thirty-seven MRIs were screened and 30 male subjects were divided into young, middle, and old-aged groups.

Quantifying soft tissue loss in facial aging: a study in women using magnetic resonance imaging.

Background: Facial aging involves changes in the facial skeleton and soft tissues. There is limited quantitative data on soft tissue aging of the face.

Objective: Magnetic resonance imaging (MRI) was used to quantify and compare facial soft tissue loss over time.

The evolving conception and management challenges of malignant fibrous histiocytoma.

Background: Malignant fibrous histiocytoma (MFH) is a rare and aggressive tumor. Mohs micrographic surgery (MMS) has been reported as an effective treatment, although most cases were published before advances in cytopathologic techniques led to reclassification of many tumors.

Objective: To evaluate a contemporary cohort of individuals with MFH and analyze management practices.

Adamantinoid basal cell carcinoma: a predictor of more-aggressive clinical behavior.

Background: Identifying histopathologic subtypes of basal cell carcinoma (BCC) associated with an aggressive clinical course helps the surgeon to anticipate the size of the postexcision defect and complexity of repair. During Mohs micrographic surgery (MMS), we have observed that BCC with adamantinoid histopathologic features tend to be clinically more aggressive.

Objective: To characterize the subtype of BCC with adamantinoid histopathologic features and determine whether it is clinically more aggressive than other BCCs.

Accelerated takedown of the paramedian forehead flap at 1 week: indications, technique, and improving patient quality of life.

Background: The paramedian forehead flap (PFF) is a common method of reconstruction for large nasal defects. Generally, surgeons divide this flap at 3 weeks. This delay can result in a significant decrease in the quality of life for these patients.

The erbium micropeel: a prospective, randomized trial of the effects of two fluence settings on facial photoaging.

Background: Recent studies have suggested that a series of low-energy, single-pass ablative laser resurfacing micropeels can reduce photoaging with decreased downtime. This randomized, prospective single-blinded trial sought to determine the ideal settings of sequential erbium:yttrium-aluminum-garnet (Er:YAG) laser treatments that maximize efficacy and patient satisfaction.

Methods: Forty-six subjects with mild-to-moderate facial dyschromia and rhytides were evenly randomized to two Er:YAG treatment arms.

Suspension suture canthopexy: a minimally invasive procedure for correcting mild to moderate ectropion.

Background: Ectropion of the lower eyelid can occur after blepharoplasty as well as reconstructive procedures. Even mild ectropion can cause irritation or epiphora. Patients with preexisting lid laxity are at higher risk for post procedure ectropion.

Novel pretrichial browlift technique and review of methods and complications.

Background: The upper third of the face is integral to our perception of youth and beauty. While the eyelids anchor this facial cosmetic unit, the eyebrows and forehead are intrinsically linked to the upper eyelids, and their position and texture play an important role in creating pleasing eyes as well as conveying mood and youth. The most common browlifts are performed with endoscopic visualization.

Dual transposition flaps for the reconstruction of large scalp defects.

Background: Large scalp defects can be challenging to repair because of the inelasticity of the scalp. While there are several methods to close this type of wound, they result in either alopecia or unacceptable scarring. We present a dual transposition flap to close a large defect following Mohs surgery for a basal cell carcinoma on the scalp.

Split-face comparison of the erbium micropeel with intense pulsed light.

Background: A variety of photorejuvenative techniques have been utilized to reverse the signs of cutaneous photoaging, including ablative and nonablative laser resurfacing as well as light-based devices.

Objective: The purpose of this split-face randomized prospective open-label trial was to determine the effectiveness of sequential erbium:yttrium-aluminum-garnet (Er:YAG) laser versus intense pulsed light (IPL) for the treatment of mild to moderate facial photodamage.

Materials And Methods: Ten subjects (ages 35-63) with facial dyschromia and rhytides were enrolled.

Management of visible granulomas following periorbital injection of poly-L-lactic Acid.

Purpose: Injectable poly-L-lactic acid (PLA) is a recently FDA-approved soft-tissue filler. Although approved only for treatment of HIV-associated lipoatrophy, there has been increased interest in its use for cosmetic purposes. Here we describe a case of a granulomatous reaction to injectable PLA in the inferior periorbital region resulting in visible papules and discuss treatment options.

A pilot study on the effect of epinephrine on botulinum toxin treatment for periorbital rhytides.

Background: Relaxation of hyperactive facial muscles by injection of botulinum toxin type A (BOTOX, Allergan Inc., Irvine, CA) represents the most common cosmetic procedure performed in the United States.

Objective: The objective of this split-face randomized double-blind study was to determine the effect of epinephrine (EPI) on the efficacy of BOTOX treatment of muscle hyperactivity in the upper face.

Adverse effects when injecting facial fillers.

Facial soft-tissue augmentation has become ubiquitous in cosmetic dermatology. In the appropriate patient and with appropriate training, fillers can temporarily eliminate rhytides, creases, and defects, thereby producing a rejuvenated appearance. Yet, even in the most experienced injectors, there can be complications.

Anatomic demarcation by positional variation in fibroblast gene expression programs.

Fibroblasts are ubiquitous mesenchymal cells with many vital functions during development, tissue repair, and disease. Fibroblasts from different anatomic sites have distinct and characteristic gene expression patterns, but the principles that govern their molecular specialization are poorly understood. Spatial organization of cellular differentiation may be achieved by unique specification of each cell type; alternatively, organization may arise by cells interpreting their position along a coordinate system.

Safety of radiofrequency treatment over human skin previously injected with medium-term injectable soft-tissue augmentation materials: a controlled pilot trial.

Background And Objectives: Several soft-tissue augmentation materials are now available for reduction of nasolabial fold creases and perioral rhytides. Nasolabial folds and perioral rhytides can also be improved by skin tightening delivered by non-ablative radiofrequency (RF) treatment. The purpose of this study was to assess the safety of RF treatment over skin areas recently injected with medium-term injectable soft-tissue augmentation materials.

Use of a dual-mode erbium:YAG laser for the surgical correction of rhinophyma.

Rhinophyma is a cosmetically deforming disorder characterized by nodular hypertrophy of the nasal soft tissue. Treatment of rhinophyma usually consists of laser ablation or surgical excision for correction of the associated tissue deformity. We describe 6 patients with mild to severe rhinophyma who were treated with a dual-mode erbium:YAG (Er:YAG) laser, which provides the advantages of controlled ablative energy for tissue reduction and excellent intraoperative hemostasis.

Continuous, noninvasive, and localized microvascular tissue oximetry using visible light spectroscopy.

Background: The authors evaluated the ability of visible light spectroscopy (VLS) oximetry to detect hypoxemia and ischemia in human and animal subjects. Unlike near-infrared spectroscopy or pulse oximetry (SpO2), VLS tissue oximetry uses shallow-penetrating visible light to measure microvascular hemoglobin oxygen saturation (StO2) in small, thin tissue volumes.

Methods: In pigs, StO2 was measured in muscle and enteric mucosa during normoxia, hypoxemia (SpO2 = 40-96%), and ischemia (occlusion, arrest).

Mohs micrographic surgery as an alternative treatment method for cutaneous mucormycosis.

Background: Mucormycosis is an invasive fungal disease that most commonly occurs in immunocompromised patients. Early angioinvasion and dissemination can lead to the rapid demise of the patient. The growing number of organ transplant patients on pharmacologic immunosuppression has increased the risk for this opportunistic mycosis.