108 results on '"Lorenc A."'
Search Results
2. The Role of Calcium Hydroxylapatite (Radiesse) as a Regenerative Aesthetic Treatment: A Narrative Review
- Author
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Aguilera, Shino Bay, primary, McCarthy, Alec, additional, Khalifian, Saami, additional, Lorenc, Z Paul, additional, Goldie, Kate, additional, and Chernoff, W Gregory, additional
- Published
- 2023
- Full Text
- View/download PDF
3. Novel, Validated, 5-Point Photonumeric Scales for Assessment of the Perioral Region.
- Author
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Hayano, Windie, Kerscher, Martina, Day, Doris, Ogilvie, Alexandra, Pavicic, Tatjana, Lim, Tingsong, Lorenc, Paul Z, Hernandez, Claudia, Frank, Konstantin, Moellhoff, Nicholas, Prinz, Valentina, Mia, Cajkovsky, Pooth, Rainer, and Green, Jeremy
- Abstract
Background The use of validated scales is still considered the gold standard for evaluating the severity of an aesthetic facial condition. Objectives The aim of this investigation was to create and validate 5-point photonumeric scales for the assessment of perioral lines and marionette lines. Methods A medical team created 2 different novel 5-point photonumeric scales for the assessment of perioral lines and marionette lines. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. Results For the Croma Static Perioral Lines–Assessment Scale, the digital interrater intraclass correlation coefficients (ICCs) were 0.88 (95% CI, 0.85-0.91) in the first rating and 0.87 (95% CI, 0.83-0.90) in the second rating. The digital intrarater ICCs were 0.90 (95% CI, 0.87-0.92). In the live rating, the interrater ICCs were 0.89 (95% CI, 0.85-0.93) in the first rating and 0.91 (95% CI, 0.87-0.93) in the second rating with an intrarater ICC of 0.91 (95% CI, 0.88-0.95). For the Croma Marionette Lines–Assessment Scale, the digital rating interrater ICCs were 0.85 (95% CI, 0.81-0.89) in the first rating and 0.87 (95% CI, 0.84-0.90) in the second rating with an intrarater ICC of 0.89 (95% CI, 0.88-0.91). In the live rating, the interrater ICCs were 0.73 (95% CI, 0.54-0.83) in the first rating and 0.79 (95% CI, 0.65-0.87) in the second rating with an intrarater ICC of 0.88 (95% CI, 0.83-0.94). Conclusions The Croma Static Perioral Lines–Assessment Scale and the Croma Marionette Lines–Assessment Scale have exceptional inter- and intrarater agreements that justify their use in clinical and study settings for all ethnic groups. Level of Evidence: 5 [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
4. Novel, Validated Five-Point Photonumeric Scales for Assessment of the Neck and Décolleté
- Author
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Kerscher, Martina, primary, Green, Jeremy, additional, Day, Doris, additional, Ogilvie, Alexandra, additional, Pavicic, Tatjana, additional, Lim, Tingsong, additional, Hayano, Windie, additional, Lorenc, Z Paul, additional, Hernandez, Claudia, additional, Frank, Konstantin, additional, Moellhoff, Nicholas, additional, Prinz, Valentina, additional, Cajkovsky, Mia, additional, and Pooth, Rainer, additional
- Published
- 2023
- Full Text
- View/download PDF
5. Novel, Validated 5-Point Photonumeric Scales for Assessment of the Neck and Décolleté
- Author
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Martina Kerscher, Jeremy Green, Doris Day, Alexandra Ogilvie, Tatjana Pavicic, Tingsong Lim, Windie Hayano, Z Paul Lorenc, Claudia Hernandez, Konstantin Frank, Nicholas Moellhoff, Valentina Prinz, Mia Cajkovsky, and Rainer Pooth
- Subjects
Surgery ,General Medicine - Abstract
Background There is a scarcity of scales that assess platysmal bands, wrinkles in the décolleté, and horizontal neck lines in the digital and live setting. Objectives The objective of this investigation was to create and validate 5-point photonumeric scales that assess horizontal neck lines, platysmal bands, and wrinkles in the décolleté. Methods A medical team created 3 different novel 5-point photonumeric scales for the assessment of horizontal neck lines, platysmal bands, and décolleté wrinkling. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. Results The Croma (Leobendorf, Austria) Horizontal Neck Lines Assessment Scale showed substantial interrater agreement and almost perfect intrarater agreement in the digital and live validations, respectively. The Croma Platysmal Bands Assessment Scale showed substantial intrarater agreement in both digital and live validations. For the décolleté, a static scale and a dynamic scale were created and validated. The Croma Static Décolleté Wrinkles Assessment Scale showed substantial and almost perfect interrater agreement in the digital and live validations, respectively, and the intrarater agreement in both was almost perfect. The Croma Dynamic Décolleté Wrinkles Assessment Scale showed almost perfect agreement in both validation settings for both interrater and intrarater measures. Conclusions The Croma Horizontal Neck Lines Assessment Scale and the Croma Static and Dynamic Décolleté Wrinkles Assessment Scales have sufficient interrater and intrarater agreement for justifiable use in clinical and research settings.
- Published
- 2023
6. Barbed Polydioxanone Sutures for Face Recontouring: Six-Month Safety and Effectiveness Data Supported by Objective Markerless Tracking Analysis
- Author
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Lukasz Preibisz, Florence Boulmé, and Z. Paul Lorenc
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medicine.medical_specialty ,Sutures ,business.industry ,Suture Techniques ,Treatment outcome ,General Medicine ,medicine.disease ,Skin tightening ,Surgery ,Polydioxanone ,chemistry.chemical_compound ,Hematoma ,chemistry ,Chart review ,Improvement rate ,Rhytidoplasty ,Humans ,Rejuvenation ,Medicine ,business ,Retrospective Studies - Abstract
Background Barbed polydioxanone (PDO) sutures allowing for minimally invasive skin lifting are broadly and increasingly used in aesthetic dermatology. Objectives To describe utilization of diverse barbed PDO sutures for aesthetic facial corrections in Caucasian patients, to evaluate long-term safety and to demonstrate effectiveness in skin tightening, redefinition of facial contours, and tissue elevation. Methods A retrospective chart review of patients routinely treated with barbed PDO sutures on face was performed. Aesthetic improvement was evaluated at 6-, 12- and 24-week posttreatment by the treating physician, patients, and an independent photographic reviewer. Patient’s satisfaction with treatment outcome was evaluated. Procedure effects were also objectively measured by markerless tracking analysis. Results Sixty patients were treated with a total of 388 barbed sutures in various anatomical areas and followed-up for 24 weeks. At Week 24, the aesthetic improvement rate was 80% to 100% (depending on the evaluator), skin movements related to pre-treatment photographs showed significant changes across several different anatomical regions, and 97% of patients were satisfied with the overall treatment outcome. Transient, mild, and short-lasting adverse events, mostly pain and hematoma, occurred in 15% of patients. Conclusions Barbed PDO sutures are safe and highly effective for aesthetic corrections, with results lasting for at least 24 weeks. Level of Evidence: 4
- Published
- 2021
7. The Second of Two One-Year, Multicenter, Open-Label, Repeat-Dose, Phase II Safety Studies of PrabotulinumtoxinA for the Treatment of Moderate to Severe Glabellar Lines in Adult Patients
- Author
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Z Paul Lorenc, Jeffrey M Adelglass, Rui L Avelar, Leslie Baumann, Kenneth R Beer, Joel L Cohen, Sue Ellen Cox, Steven H Dayan, Jeffrey S Dover, Jeanine B Downie, Zoe Diana Draelos, Mitchel P Goldman, John E Gross, John H Joseph, Joely Kaufman-Janette, Ronald L Moy, Mark Nestor, Joel Schlessinger, Stacy R Smith, and Robert A Weiss
- Subjects
030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Cosmetic Medicine ,AcademicSubjects/MED00987 ,Asj/1 ,Surgery ,General Medicine ,Original Articles ,030230 surgery - Abstract
Background PrabotulinumtoxinA is a 900-kDa botulinum toxin type A produced by Clostridium botulinum. Objectives The authors sought to investigate the safety of prabotulinumtoxinA for treatment of glabellar lines. Methods This was a multicenter, open-label, repeat-dose, 1-year phase II safety study. Adults with moderate to severe glabellar lines at maximum frown, as independently assessed by both investigator and patient on the validated 4-point photonumeric Glabellar Line Scale (0 = no lines, 1 = mild, 2 = moderate, 3 = severe), were enrolled. On day 0, patients received an initial treatment (IT) of 20 U prabotulinumtoxinA (4 U/0.1 mL final vacuum-dried formulation injected into 5 glabellar sites). On and after day 90, patients received a repeat treatment (RT) if their Glabellar Line Scale score was ≥2 at maximum frown by investigator assessment. Safety outcomes were evaluated throughout the study. Results The 570 study patients received a median total dose of 60 U, that is, 3 treatments. Sixty-one patients (10.7%) experienced adverse events (AEs) assessed as possibly study drug related; 6.5% experienced study drug–related AEs after the IT. With each RT, progressively lower percentages of patients experienced study drug–related AEs. Eight patients (1.4%) experienced study drug–related AEs of special interest: 5 experienced eyelid ptosis (0.9%), 3 eyebrow ptosis (0.5%), 1 blepharospasm (0.2%), and 1 blurred vision (0.2%). Seven patients (1.2%) experienced serious AEs, but none were study drug related. A total of 4060 serum samples were tested for antibotulinum toxin antibodies; no seroconversion was observed. Conclusions The safety of RTs of 20 U of prabotulinumtoxinA for moderate to severe glabellar lines was confirmed in this second phase II study based on a broad range of outcomes. Level of Evidence: 2
- Published
- 2021
8. Novel, Validated 5-Point Photonumeric Scales for Assessment of the Neck and Décolleté.
- Author
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Kerscher, Martina, Green, Jeremy, Day, Doris, Ogilvie, Alexandra, Pavicic, Tatjana, Lim, Tingsong, Hayano, Windie, Lorenc, Z Paul, Hernandez, Claudia, Frank, Konstantin, Moellhoff, Nicholas, Prinz, Valentina, Cajkovsky, Mia, and Pooth, Rainer
- Abstract
Background There is a scarcity of scales that assess platysmal bands, wrinkles in the décolleté, and horizontal neck lines in the digital and live setting. Objectives The objective of this investigation was to create and validate 5-point photonumeric scales that assess horizontal neck lines, platysmal bands, and wrinkles in the décolleté. Methods A medical team created 3 different novel 5-point photonumeric scales for the assessment of horizontal neck lines, platysmal bands, and décolleté wrinkling. Eleven international raters were involved in the digital validation, and 4 raters performed a live validation. Results The Croma (Leobendorf, Austria) Horizontal Neck Lines Assessment Scale showed substantial interrater agreement and almost perfect intrarater agreement in the digital and live validations, respectively. The Croma Platysmal Bands Assessment Scale showed substantial intrarater agreement in both digital and live validations. For the décolleté, a static scale and a dynamic scale were created and validated. The Croma Static Décolleté Wrinkles Assessment Scale showed substantial and almost perfect interrater agreement in the digital and live validations, respectively, and the intrarater agreement in both was almost perfect. The Croma Dynamic Décolleté Wrinkles Assessment Scale showed almost perfect agreement in both validation settings for both interrater and intrarater measures. Conclusions The Croma Horizontal Neck Lines Assessment Scale and the Croma Static and Dynamic Décolleté Wrinkles Assessment Scales have sufficient interrater and intrarater agreement for justifiable use in clinical and research settings. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
9. Rheology of Polymethylmethacrylate-Collagen Gel Filler: Physiochemical Properties and Clinical Applications
- Author
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Z Paul Lorenc, Tina McArthur, Brian Pilcher, and Nimitt Patel
- Subjects
Rheometer ,Cosmetic Techniques ,engineering.material ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Viscosity ,0302 clinical medicine ,Rheology ,Filler (materials) ,Humans ,Polymethyl Methacrylate ,Medicine ,Hyaluronic Acid ,030223 otorhinolaryngology ,Elastic modulus ,Rheometry ,business.industry ,General Medicine ,Collagen gel ,Durapatite ,engineering ,Surgery ,Collagen ,business ,Calcium hydroxylapatite ,Biomedical engineering - Abstract
Background Soft tissue fillers are comprised of a range of materials with differing physiochemical and rheologic (ie, flow) properties. These properties can inform treatment selection for specific anatomic areas, planes of injection, and clinical applications. Objectives The aim of this study was to characterize the rheologic properties of polymethylmethacrylate (PMMA)-collagen gel for comparison with other available fillers. Methods Commercially available PMMA-collagen gel, hyaluronic acid (HA), and calcium hydroxylapatite (CaHA) fillers were obtained from their respective manufacturers. Measures of complex viscosity (η*) and elastic modulus (G′) for each filler were collected at 0.7 Hz in triplicate according to standard procedures on a rotational rheometer fitted with a 40-mm steel plate at 25°C on a Peltier plate (500-μm gap). Results The measured η* and G′ values for HA and CaHA fillers were in agreement with previously published data. The difference in η* between CaHA (mean [standard deviation], 358.9 [21.56] Pa-s) and PMMA-collagen gel (656.41 [68.03] Pa-s) was statistically significant (P < 0.0001), as was the difference between the G′ of CaHA (1424.8 [83.3] Pa) and the G′ of PMMA-collagen gel (2815.27 [304.07] Pa; P < 0.0001). Conclusions PMMA-collagen gel exhibited the highest η* and G′ of all tested fillers. These properties likely underpin an increased capacity for lifting and support in areas where long-lasting revolumization is appropriate. In practice, PMMA-collagen gel is well suited for treatment of acne scars, as well as injection into the supraperiosteal plane in the temple, chin, mandible, and piriform by a retrograde linear threading technique. Additional clinical considerations are discussed.
- Published
- 2020
10. Barbed Polydioxanone Sutures for Face Recontouring: Six-Month Safety and Effectiveness Data Supported by Objective Markerless Tracking Analysis.
- Author
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Preibisz, Lukasz, Boulmé, Florence, and Lorenc, Z Paul
- Abstract
Background Barbed polydioxanone (PDO) sutures allowing for minimally invasive skin lifting are broadly and increasingly used in aesthetic dermatology. Objectives To describe utilization of diverse barbed PDO sutures for aesthetic facial corrections in Caucasian patients, to evaluate long-term safety and to demonstrate effectiveness in skin tightening, redefinition of facial contours, and tissue elevation. Methods A retrospective chart review of patients routinely treated with barbed PDO sutures on face was performed. Aesthetic improvement was evaluated at 6-, 12- and 24-week posttreatment by the treating physician, patients, and an independent photographic reviewer. Patient's satisfaction with treatment outcome was evaluated. Procedure effects were also objectively measured by markerless tracking analysis. Results Sixty patients were treated with a total of 388 barbed sutures in various anatomical areas and followed-up for 24 weeks. At Week 24, the aesthetic improvement rate was 80% to 100% (depending on the evaluator), skin movements related to pre-treatment photographs showed significant changes across several different anatomical regions, and 97% of patients were satisfied with the overall treatment outcome. Transient, mild, and short-lasting adverse events, mostly pain and hematoma, occurred in 15% of patients. Conclusions Barbed PDO sutures are safe and highly effective for aesthetic corrections, with results lasting for at least 24 weeks. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
11. Skin Tightening With Hyperdilute CaHA: Dilution Practices and Practical Guidance for Clinical Practice.
- Author
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Lorenc, Z Paul, Black, Jeanette M, Cheung, Jessie S, Chiu, Annie, Campo, Roberta Del, Durkin, Alan James, Graivier, Miles, Green, Jeremy B, Kwok, Gideon P, Marcus, Keith, Rammos, Charalambos "Babis", and Werschler, William Philip
- Abstract
Background Over the past several years, hyperdilute calcium hydroxylapatite (CaHA) has emerged as an effective modality for improving skin quality and managing laxity in the face, arms, hands, neck, décolletage, upper arms, abdomen, buttocks, and upper legs, as well as for treating cellulite and striae. Whereas undiluted CaHA is used to provide volume, hyperdilute CaHA is distributed across a much larger surface area in a more superficial plane to stimulate neocollagenesis and elastin formation over time. The absence of lymphocytic infiltrates and predominance of type 1 collagen in the tissue response to CaHA make hyperdilute CaHA a valuable tool for nonsurgical skin tightening. Objectives The aim of this study was to provide practical step-by-step guidance on patient selection, dilution practices, and optimal injection technique to facilitate incorporation of the technique into clinical practice. Methods Over the course of 3 regional meetings in the United States, 12 expert physician injectors participated in live webinars as part of a continuing medical education program. Results The practical guidance in this manuscript is based upon the most frequently requested information by audience members and the information considered critical for success by the authors. Conclusions The minimally invasive nature of filler injection results in little downtime, making this treatment particularly appealing. The recommendations presented are consistent with previously published consensus guidelines on hyperdilute CaHA but are intended to serve as "how-to" guidance based on the experience of expert injectors who have successfully treated the face and body. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
12. Skin Tightening With Hyperdilute CaHA: Dilution Practices and Practical Guidance for Clinical Practice
- Author
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Roberta Del Campo, Alan James Durkin, Keith Marcus, Miles H Graivier, Gideon P Kwok, Charalambos 'Babis' Rammos, William Philip Werschler, Jessie S Cheung, Jeremy B Green, Annie Chiu, Jeanette M Black, and Z Paul Lorenc
- Subjects
Upper Arms ,medicine.medical_specialty ,business.industry ,Type 1 collagen ,Biocompatible Materials ,General Medicine ,Cosmetic Techniques ,Skin tightening ,Skin Aging ,Clinical Practice ,medicine.anatomical_structure ,Durapatite ,Continuing medical education ,medicine ,Humans ,Surgery ,Medical physics ,Calcium ,Buttocks ,Cellulite ,Calcium hydroxylapatite ,business - Abstract
Background Over the past several years, hyperdilute calcium hydroxylapatite (CaHA) has emerged as an effective modality for improving skin quality and managing laxity in the face, arms, hands, neck, décolletage, upper arms, abdomen, buttocks, and upper legs, as well as for treating cellulite and striae. Whereas undiluted CaHA is used to provide volume, hyperdilute CaHA is distributed across a much larger surface area in a more superficial plane to stimulate neocollagenesis and elastin formation over time. The absence of lymphocytic infiltrates and predominance of type 1 collagen in the tissue response to CaHA make hyperdilute CaHA a valuable tool for nonsurgical skin tightening. Objectives The aim of this study was to provide practical step-by-step guidance on patient selection, dilution practices, and optimal injection technique to facilitate incorporation of the technique into clinical practice. Methods Over the course of 3 regional meetings in the United States, 12 expert physician injectors participated in live webinars as part of a continuing medical education program. Results The practical guidance in this manuscript is based upon the most frequently requested information by audience members and the information considered critical for success by the authors. Conclusions The minimally invasive nature of filler injection results in little downtime, making this treatment particularly appealing. The recommendations presented are consistent with previously published consensus guidelines on hyperdilute CaHA but are intended to serve as “how-to” guidance based on the experience of expert injectors who have successfully treated the face and body. Level of Evidence: 4
- Published
- 2021
13. Understanding Facial Muscle Aging: A Surface Electromyography Study
- Author
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Konstantin Frank, Shirin Assemi-Kabir, Arnaldo Mercado-Perez, Nicholas Moellhoff, Z Paul Lorenc, Luiz E T Avelar, Sebastian Cotofana, Samir Mardini, Robert H Gotkin, and Riccardo E. Giunta
- Subjects
Adult ,medicine.medical_specialty ,Aging ,Future studies ,Procerus muscle ,Facial Muscles ,Electromyography ,030230 surgery ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Physical medicine and rehabilitation ,Corrugator supercilii muscle ,Facial aging ,medicine ,Humans ,Aged ,Aged, 80 and over ,Zygomaticus major muscle ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,Facial Expression ,Facial muscles ,medicine.anatomical_structure ,Face ,Surgery ,business ,Facial electromyography - Abstract
Background Facial aging is a multifactorial process that involves all tissues of the face, including skin, muscles, fat, ligaments, and bone. Whereas robust evidence is available for age-related changes of bone and facial fat, the influence of age on facial muscle activity is poorly understood. Objectives The objective of this study was to investigate the motor unit action potential of facial muscles by utilizing surface-derived, noninvasive electromyography in young and old healthy volunteers. Methods The study investigated a total of 32 healthy volunteers with a mean [standard deviation] age of 42.6 [19.6] years (range, 21-82 years) and a mean BMI of 23.9 [2.7] kg/m2 (range, 18.5-29.7 kg/m2) by performing surface-derived, noninvasive facial electromyography. Nine facial muscles were investigated bilaterally, resulting in a total of 1632 measurements of the signal, baseline noise, and signal-to-noise ratio of these muscles. Results The results of the study revealed that age does not significantly influence the signal (P = 0.234), the baseline noise (P = 0.225), or the signal-to-noise ratio (P = 0.432) of younger individuals (50 years) in a gender- and BMI-matched statistical model. Exceptions were the zygomaticus major muscle (reduced activity), procerus muscle (increased activity), and corrugator supercilii muscle (increased activity). Conclusions The results of this facial electromyography study may help to increase the understanding of facial aging. Future studies need to reproduce the results presented herein to further increase our understanding of facial aging.
- Published
- 2021
14. Barbed Polydioxanone Sutures for Face Recontouring: Six-Month Safety and Effectiveness Data Supported by Objective Markerless Tracking Analysis
- Author
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Preibisz, Lukasz, primary, Boulmé, Florence, additional, and Paul Lorenc, Z, additional
- Published
- 2021
- Full Text
- View/download PDF
15. Multicenter Efficacy Trial of a Percutaneous Radiofrequency System for the Reduction of Glabellar Lines
- Author
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James Newman, Z. Paul Lorenc, James Chan, David James Russell, and Braden C. Stridde
- Subjects
medicine.medical_specialty ,Weakness ,Percutaneous ,medicine.medical_treatment ,030230 surgery ,Rf system ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Forehead ,Prospective Studies ,Botulinum Toxins, Type A ,Adverse effect ,Prospective cohort study ,Reduction (orthopedic surgery) ,business.industry ,General Medicine ,Plastic Surgery Procedures ,Ablation ,Facial nerve ,Skin Aging ,Surgery ,Facial Nerve ,Treatment Outcome ,medicine.symptom ,business - Abstract
Background Bipolar percutaneous radiofrequency (RF) is an established method for ablation of distal peripheral branches of the facial nerve to produce weakness of the corrugator muscle. Recent developments to the Serene RF system (Serene Medical, Inc., Pleasanton, CA) allowing for safer and more predictable results highlighted a need for prospective clinical data. Objectives The authors sought to assess the ability of percutaneous RF to safely improve the appearance of dynamic glabellar lines for a minimum of 3 months and up to 1 year. Methods This prospective study enrolled 78 patients across 5 centers in the United States. The most distal branches of the medial and lateral facial nerve innervation to the brow depressor/corrugator complex were treated. Follow-up was at 3 days by telephone and in-office at 7 days and 3, 6, 9, and 12 months posttreatment. Patients were evaluated employing the Merz scale for dynamic glabellar lines. Results At 3 months, 93.6% of patients had a ≥1-point Merz scale improvement in dynamic glabellar lines based on independent, blinded review. Sustained ≥2-point improvement was present in 60% and 20% of patients at 3 and 12 months, respectively. Overall satisfaction remained >60% through 6 months and >50% at 12 months. All device- or procedure-related adverse events were mild (90%) or moderate (10%) and resolved without medical intervention. Conclusions Bipolar percutaneous RF may be adopted in conjunction with surgery or as an office-based procedure where it can serve as a minimally invasive alternative to, or in concert with, Botulinum Toxin A therapy. Level of Evidence: 4
- Published
- 2019
16. Understanding Facial Muscle Aging: A Surface Electromyography Study.
- Author
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Cotofana, Sebastian, Assemi-Kabir, Shirin, Mardini, Samir, Giunta, Riccardo E, Gotkin, Robert H, Moellhoff, Nicholas, Avelar, Luiz E T, Mercado-Perez, Arnaldo, Lorenc, Z Paul, Frank, Konstantin, and Lorenc, Paul Z
- Abstract
Background: Facial aging is a multifactorial process that involves all tissues of the face, including skin, muscles, fat, ligaments, and bone. Whereas robust evidence is available for age-related changes of bone and facial fat, the influence of age on facial muscle activity is poorly understood.Objectives: The objective of this study was to investigate the motor unit action potential of facial muscles by utilizing surface-derived, noninvasive electromyography in young and old healthy volunteers.Methods: The study investigated a total of 32 healthy volunteers with a mean [standard deviation] age of 42.6 [19.6] years (range, 21-82 years) and a mean BMI of 23.9 [2.7] kg/m2 (range, 18.5-29.7 kg/m2) by performing surface-derived, noninvasive facial electromyography. Nine facial muscles were investigated bilaterally, resulting in a total of 1632 measurements of the signal, baseline noise, and signal-to-noise ratio of these muscles.Results: The results of the study revealed that age does not significantly influence the signal (P = 0.234), the baseline noise (P = 0.225), or the signal-to-noise ratio (P = 0.432) of younger individuals (<30 years) vs older individuals (>50 years) in a gender- and BMI-matched statistical model. Exceptions were the zygomaticus major muscle (reduced activity), procerus muscle (increased activity), and corrugator supercilii muscle (increased activity).Conclusions: The results of this facial electromyography study may help to increase the understanding of facial aging. Future studies need to reproduce the results presented herein to further increase our understanding of facial aging. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
17. Skin Tightening With Hyperdilute CaHA: Dilution Practices and Practical Guidance for Clinical Practice
- Author
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Lorenc, Z Paul, primary, Black, Jeanette M, additional, Cheung, Jessie S, additional, Chiu, Annie, additional, Del Campo, Roberta, additional, Durkin, Alan James, additional, Graivier, Miles, additional, Green, Jeremy B, additional, Kwok, Gideon P, additional, Marcus, Keith, additional, Rammos, Charalambos “Babis”, additional, and Werschler, William Philip, additional
- Published
- 2021
- Full Text
- View/download PDF
18. Corrigendum to: The Second of Two One-Year, Multicenter, Open-Label, Repeat-Dose, Phase II Safety Studies of PrabotulinumtoxinA for the Treatment of Moderate to Severe Glabellar Lines in Adult Patients
- Author
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Lorenc, Z Paul, primary, Adelglass, Jeffrey M, additional, Avelar, Rui L, additional, Baumann, Leslie, additional, Beer, Kenneth R, additional, Cohen, Joel L, additional, Cox, Sue Ellen, additional, Dayan, Steven H, additional, Dover, Jeffrey S, additional, Downie, Jeanine B, additional, Draelos, Zoe Diana, additional, Goldman, Mitchel P, additional, Gross, John E, additional, Joseph, John H, additional, Kaufman-Janette, Joely, additional, Moy, Ronald L, additional, Nestor, Mark, additional, Schlessinger, Joel, additional, Smith, Stacy R, additional, and Weiss, Robert A, additional
- Published
- 2021
- Full Text
- View/download PDF
19. The Second of Two One-Year, Multicenter, Open-Label, Repeat-Dose, Phase II Safety Studies of PrabotulinumtoxinA for the Treatment of Moderate to Severe Glabellar Lines in Adult Patients
- Author
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Lorenc, Z Paul, primary, Adelglass, Jeffrey M, additional, Avelar, Rui L, additional, Baumann, Leslie, additional, Beer, Kenneth R, additional, Cohen, Joel L, additional, Cox, Sue Ellen, additional, Dayan, Steven H, additional, Dover, Jeffrey S, additional, Downie, Jeanine B, additional, Draelos, Zoe Diana, additional, Goldman, Mitchel P, additional, Gross, John E, additional, Joseph, John H, additional, Kaufman-Janette, Joely, additional, Moy, Ronald L, additional, Nestor, Mark, additional, Schlessinger, Joel, additional, Smith, Stacy R, additional, and Weiss, Robert A, additional
- Published
- 2021
- Full Text
- View/download PDF
20. Composite Facial Volumization With Calcium Hydroxylapatite (CaHA) for the Treatment of Aging
- Author
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David J. Goldberg, Z. Paul Lorenc, Rebecca Fitzgerald, Lawrence M Bass, and Miles H Graivier
- Subjects
Esthetics ,Injections, Subcutaneous ,Cosmetic Techniques ,Aging face ,030230 surgery ,Skin Aging ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Dermal Fillers ,medicine ,Humans ,Rejuvenation ,Aged, 80 and over ,business.industry ,General Medicine ,Anatomy ,Middle Aged ,Cheek ,Sulcus ,Durapatite ,Treatment Outcome ,medicine.anatomical_structure ,Patient Satisfaction ,Face ,Female ,Surgery ,Zygomatic arch ,business ,Volume loss ,Calcium hydroxylapatite - Abstract
Paradigms in the treatment of aging have evolved to address volume loss as a central and primary hallmark of the aging face. The concept of "composite volumization" was recently proposed by Dr. Z. Paul Lorenc to describe the effect of Radiesse (Merz Aesthetics, Inc., Raleigh, NC), when placed on bone in the supraperiosteal plane, on all overlying tissues (skin, superficial and deep fat compartments, and muscle). The physiochemical properties of Radiesse make it especially well suited for efficient and effective volumization of areas especially prone to volume loss; the temple, zygomatic arch, anterior cheek, pyriform aperture, and prejowl sulcus. Placement of Radiesse on bone in these areas creates a scaffold upon which additional restoration of fine lines and wrinkles may be accomplished, restoring a youthful appearance.
- Published
- 2018
21. Differentiating Nonpermanent Injectable Fillers: Prevention and Treatment of Filler Complications
- Author
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Miles H Graivier, David J. Goldberg, Gottfried Lemperle, Rebecca Fitzgerald, Z. Paul Lorenc, and Lawrence M Bass
- Subjects
Adult ,Male ,medicine.medical_specialty ,Filler (packaging) ,Time Factors ,Injections, Subcutaneous ,Anti-Inflammatory Agents ,Hyaluronoglucosaminidase ,Cosmetic Techniques ,Clinical manifestation ,030230 surgery ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Dermal Fillers ,medicine ,Humans ,Effective treatment ,Hyaluronic Acid ,Intensive care medicine ,Adverse effect ,Massage ,Hyperbaric Oxygenation ,business.industry ,Granuloma, Foreign-Body ,Incidence ,Vascular compromise ,Nodule (medicine) ,General Medicine ,Middle Aged ,medicine.disease ,Injection Site Reaction ,Treatment Outcome ,Granuloma ,Practice Guidelines as Topic ,Female ,Surgery ,medicine.symptom ,business - Abstract
Though the incidence of complications and adverse events with dermatological fillers is inherently low, practitioners should be well versed in both prevention of filler complications and the treatment algorithms for addressing "granulomas," nodules, infection, and vascular compromise. Appropriate preventative measures, coupled with timely and effective treatment, are critically important for patient safety and satisfaction. In addition to the preventive measures and treatment algorithms outlined here, the authors emphasize that the broad classification and treatment of nodules as "granulomas" is likely to lead to ineffective treatment, or worse, unnecessary exposure to incorrect treatment. In practice, nodules are classified and treated based on clinical manifestation (eg, late vs early or noninflammatory vs inflammatory) rather than on histology. Indeed, classification of a nodule as a granuloma requires a histological examination, rarely available (or necessary) in clinical practice to guide treatment. Thus, the apparent inflammatory nature of the nodule and the time of onset should drive treatment approach. The treatment algorithms presented here are based on these clinically meaningful parameters.
- Published
- 2018
22. Calcium Hydroxyapatite (CaHA) Indication for Hand Rejuvenation
- Author
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Rebecca Fitzgerald, Lawrence M Bass, David J. Goldberg, Z. Paul Lorenc, and Miles H Graivier
- Subjects
Dorsum ,Esthetics ,Injections, Subcutaneous ,Dentistry ,Cosmetic Techniques ,030230 surgery ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Patient safety ,0302 clinical medicine ,Dermal Fillers ,Cannula ,Humans ,Rejuvenation ,Medicine ,Purpura ,business.industry ,Age Factors ,General Medicine ,Middle Aged ,Hand ,Injection Site Reaction ,Skin Aging ,Durapatite ,Treatment Outcome ,Increased risk ,Patient Satisfaction ,Female ,Surgery ,business - Abstract
The recent approval in 2015 of Radiesse for injection into the hand by the FDA has spurred an increase in interest among patients and clinicians in nonsurgical hand rejuvenation using fillers. Application of the same techniques used to treat the face to the dorsum of the hands does not account for the unique nature of the skin and underlying anatomy, and can lead to suboptimal outcomes and an increased risk of adverse events such as the formation of nodules. Here, the authors discuss dilution strategies and injection techniques for hand rejuvenation using Radiesse for optimal patient safety and aesthetic outcomes.
- Published
- 2018
23. Rheology of Polymethylmethacrylate-Collagen Gel Filler: Physiochemical Properties and Clinical Applications
- Author
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Lorenc, Z Paul, primary, Pilcher, Brian, additional, McArthur, Tina, additional, and Patel, Nimitt, additional
- Published
- 2020
- Full Text
- View/download PDF
24. Physiochemical Characteristics of Poly-L-Lactic Acid (PLLA)
- Author
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Rebecca Fitzgerald, Lawrence M Bass, Miles H Graivier, David J. Goldberg, and Z. Paul Lorenc
- Subjects
Long lasting ,Poly l lactic acid ,Time Factors ,Inflammatory response ,Chemistry, Pharmaceutical ,Injections, Subcutaneous ,Polyesters ,Biocompatible Materials ,Cosmetic Techniques ,030230 surgery ,Cell-Derived Microparticles ,Extracellular matrix ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Dermal Fillers ,Medicine ,Humans ,Polymethyl Methacrylate ,Rejuvenation ,Hyaluronic Acid ,business.industry ,General Medicine ,Biocompatible material ,Biodegradable polymer ,Skin Aging ,Durapatite ,Chemical engineering ,Face ,Surgery ,business - Abstract
Poly-L-lactic acid (PLLA) is a synthetic, biocompatible, biodegradable polymer. For soft-tissue augmentation, the size and chemical attributes of the PLLA microparticles are central to this agent's ability to promote a subclinical inflammatory response that stimulates deposition of collagen in the extracellular matrix. The resultant restoration of facial volume occurs in a controlled, predictable manner and is long lasting. The unique physiochemical and biostimulatory properties of PLLA differentiate it from other available treatments and are the foundation of the unique treatment methodology required for optimal results.
- Published
- 2018
25. Expanding Treatment Options for Injectable Agents
- Author
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Z. Paul Lorenc, Lawrence M Bass, Miles H Graivier, David J. Goldberg, and Rebecca Fitzgerald
- Subjects
Durapatite ,Injections, Subcutaneous ,Polyesters ,Volume replacement ,Biocompatible Materials ,Cosmetic Techniques ,030230 surgery ,Dermal Fillers ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Facial aging ,Medicine ,Humans ,Rejuvenation ,Hyaluronic Acid ,Injections subcutaneous ,business.industry ,Treatment options ,General Medicine ,Biocompatible material ,Skin Aging ,Treatment Outcome ,Face ,Surgery ,Calcium hydroxylapatite ,business ,Biomedical engineering - Abstract
Loss of facial volume and soft-tissue support are common to types of facial aging. Restoration of a youthful appearance relies upon correction of this loss, and can be achieved in various capacities through use of biostimulatory or hyaluronic acids (HA) injectable fillers. Here, the authors discuss the versatility of calcium hydroxylapatite (CaHA) in volume replacement and the applications and facial regions for which CaHA, poly-L-lactic acid (PLLA), and HA fillers are best suited.
- Published
- 2018
26. Multicenter Efficacy Trial of a Percutaneous Radiofrequency System for the Reduction of Glabellar Lines
- Author
-
Newman, James, primary, Chan, James, additional, Lorenc, Z Paul, additional, Stridde, Braden C, additional, and Russell, David James, additional
- Published
- 2019
- Full Text
- View/download PDF
27. Rheology of Polymethylmethacrylate-Collagen Gel Filler: Physiochemical Properties and Clinical Applications.
- Author
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Lorenc, Z Paul, Pilcher, Brian, McArthur, Tina, and Patel, Nimitt
- Abstract
Background: Soft tissue fillers are comprised of a range of materials with differing physiochemical and rheologic (ie, flow) properties. These properties can inform treatment selection for specific anatomic areas, planes of injection, and clinical applications.Objectives: The aim of this study was to characterize the rheologic properties of polymethylmethacrylate (PMMA)-collagen gel for comparison with other available fillers.Methods: Commercially available PMMA-collagen gel, hyaluronic acid (HA), and calcium hydroxylapatite (CaHA) fillers were obtained from their respective manufacturers. Measures of complex viscosity (η*) and elastic modulus (G') for each filler were collected at 0.7 Hz in triplicate according to standard procedures on a rotational rheometer fitted with a 40-mm steel plate at 25°C on a Peltier plate (500-μm gap).Results: The measured η* and G' values for HA and CaHA fillers were in agreement with previously published data. The difference in η* between CaHA (mean [standard deviation], 358.9 [21.56] Pa-s) and PMMA-collagen gel (656.41 [68.03] Pa-s) was statistically significant (P < 0.0001), as was the difference between the G' of CaHA (1424.8 [83.3] Pa) and the G' of PMMA-collagen gel (2815.27 [304.07] Pa; P < 0.0001).Conclusions: PMMA-collagen gel exhibited the highest η* and G' of all tested fillers. These properties likely underpin an increased capacity for lifting and support in areas where long-lasting revolumization is appropriate. In practice, PMMA-collagen gel is well suited for treatment of acne scars, as well as injection into the supraperiosteal plane in the temple, chin, mandible, and piriform by a retrograde linear threading technique. Additional clinical considerations are discussed. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
28. Multicenter Efficacy Trial of a Percutaneous Radiofrequency System for the Reduction of Glabellar Lines.
- Author
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Newman, James, Chan, James, Lorenc, Z Paul, Stridde, Braden C, and Russell, David James
- Abstract
Background: Bipolar percutaneous radiofrequency (RF) is an established method for ablation of distal peripheral branches of the facial nerve to produce weakness of the corrugator muscle. Recent developments to the Serene RF system (Serene Medical, Inc., Pleasanton, CA) allowing for safer and more predictable results highlighted a need for prospective clinical data.Objectives: The authors sought to assess the ability of percutaneous RF to safely improve the appearance of dynamic glabellar lines for a minimum of 3 months and up to 1 year.Methods: This prospective study enrolled 78 patients across 5 centers in the United States. The most distal branches of the medial and lateral facial nerve innervation to the brow depressor/corrugator complex were treated. Follow-up was at 3 days by telephone and in-office at 7 days and 3, 6, 9, and 12 months posttreatment. Patients were evaluated employing the Merz scale for dynamic glabellar lines.Results: At 3 months, 93.6% of patients had a ≥1-point Merz scale improvement in dynamic glabellar lines based on independent, blinded review. Sustained ≥2-point improvement was present in 60% and 20% of patients at 3 and 12 months, respectively. Overall satisfaction remained >60% through 6 months and >50% at 12 months. All device- or procedure-related adverse events were mild (90%) or moderate (10%) and resolved without medical intervention.Conclusions: Bipolar percutaneous RF may be adopted in conjunction with surgery or as an office-based procedure where it can serve as a minimally invasive alternative to, or in concert with, Botulinum Toxin A therapy.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
29. Expanding Treatment Options for Injectable Agents
- Author
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Goldberg, David J, primary, Bass, Lawrence M, additional, Fitzgerald, Rebecca, additional, Graivier, Miles H, additional, and Lorenc, Z Paul, additional
- Published
- 2018
- Full Text
- View/download PDF
30. Composite Facial Volumization With Calcium Hydroxylapatite (CaHA) for the Treatment of Aging
- Author
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Lorenc, Z Paul, primary, Bass, Lawrence M, additional, Fitzgerald, Rebecca, additional, Goldberg, David J, additional, and Graivier, Miles H, additional
- Published
- 2018
- Full Text
- View/download PDF
31. Physiochemical Characteristics of Poly-L-Lactic Acid (PLLA)
- Author
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Fitzgerald, Rebecca, primary, Bass, Lawrence M, additional, Goldberg, David J, additional, Graivier, Miles H, additional, and Lorenc, Z Paul, additional
- Published
- 2018
- Full Text
- View/download PDF
32. Calcium Hydroxyapatite (CaHA) Indication for Hand Rejuvenation
- Author
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Graivier, Miles H, primary, Lorenc, Z Paul, additional, Bass, Lawrence M, additional, Fitzgerald, Rebecca, additional, and Goldberg, David J, additional
- Published
- 2018
- Full Text
- View/download PDF
33. Differentiating Nonpermanent Injectable Fillers: Prevention and Treatment of Filler Complications
- Author
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Graivier, Miles H, primary, Bass, Lawrence M, additional, Lorenc, Z Paul, additional, Fitzgerald, Rebecca, additional, Goldberg, David J, additional, and Lemperle, Gottfried, additional
- Published
- 2018
- Full Text
- View/download PDF
34. Physiochemical Characteristics of Calcium Hydroxylapatite (CaHA)
- Author
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Lorenc, Z Paul, primary, Bass, Lawrence M, additional, Fitzgerald, Rebecca, additional, Goldberg, David J, additional, and Graivier, Miles H, additional
- Published
- 2018
- Full Text
- View/download PDF
35. A Review of OnabotulinumtoxinA (Botox)
- Author
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Foad Nahai, Z. Paul Lorenc, Jeffrey M. Kenkel, Steven Fagien, Haideh Hirmand, Mark S. Nestor, Anthony P. Sclafani, Jonathan M. Sykes, and Heidi A. Waldorf
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Humans ,Rejuvenation ,Surgery ,General Medicine ,Dosing ,Botulinum Toxins, Type A ,Intensive care medicine ,business ,Botulinum toxin type - Abstract
OnabotulinumtoxinA was introduced to the US market in 2002 as the first botulinum toxin type A (BoNTA) approved for facial aesthetics. This article provides an overview of onabotulinumtoxinA's uses and indications as well as safety and efficacy data. As with other BoNTA products, onabotulinumtoxinA is generally well tolerated. Consideration is also given to clinical applications of the product. Information on handling, storage, and dosing is provided.
- Published
- 2013
36. IncobotulinumtoxinA (Xeomin)
- Author
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Foad Nahai, Z. Paul Lorenc, Jeffrey M. Kenkel, Steven Fagien, Haideh Hirmand, Mark S. Nestor, Anthony P. Sclafani, Jonathan M. Sykes, and Heidi A. Waldorf
- Subjects
Mechanism of action ,business.industry ,Botulinum Neurotoxin Type A ,Medicine ,Surgery ,General Medicine ,medicine.symptom ,business ,Neuroscience - Abstract
IncobotulinumtoxinA is the third botulinum neurotoxin type A (BoNTA) to be approved for aesthetic use in the United States. This article introduces the new product with an overview of clinical applications and a discussion of the neurotoxin's molecular structure. The role and clinical relevance of complexing proteins in BoNTA products are discussed. Finally, incobotulinumtoxinA's mechanism of action is described.
- Published
- 2013
37. IncobotulinumtoxinA in Clinical Literature
- Author
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Foad Nahai, Z. Paul Lorenc, Jeffrey M. Kenkel, Steven Fagien, Haideh Hirmand, Mark S. Nestor, Anthony P. Sclafani, Jonathan M. Sykes, and Heidi A. Waldorf
- Subjects
Neurotransmitter Agents ,medicine.medical_specialty ,Clinical pharmacology ,business.industry ,MEDLINE ,General Medicine ,Clinical literature ,Surgery ,law.invention ,law ,Face ,medicine ,Humans ,Rejuvenation ,Botulinum Toxins, Type A ,Intensive care medicine ,business - Abstract
IncobotulinumtoxinA is the third neurotoxin type A to be approved for aesthetic use in the United States. Because incobotulinumtoxinA has been in use in Europe for some time, the clinical literature is fairly replete with references to its properties and characteristics, as well as its safety and efficacy. In North America, 2 pivotal trials, referred to as GL-1 and GL-2, investigated the safety and efficacy of incobotulinumtoxinA in the glabellar region; both are currently in press with another journal. Other published studies of incobotulinumtoxinA are also described in depth in this article, including reports on aesthetic indications, diffusion, therapeutic indications, and studies pertaining to the preclinical and clinical pharmacology of incobotulinumtoxinA. Topics addressed include potency variability, mean concentration, stability and dissociation, and endopeptide immunoassay.
- Published
- 2013
38. Consensus Panel's Assessment and Recommendations on the Use of 3 Botulinum Toxin Type A Products in Facial Aesthetics
- Author
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Foad Nahai, Z. Paul Lorenc, Jeffrey M. Kenkel, Steven Fagien, Haideh Hirmand, Mark S. Nestor, Anthony P. Sclafani, Jonathan M. Sykes, and Heidi A. Waldorf
- Subjects
medicine.medical_specialty ,business.industry ,MEDLINE ,Patient positioning ,General Medicine ,Skin Aging ,Face ,Humans ,Rejuvenation ,Medicine ,Surgery ,Dosing ,Botulinum Toxins, Type A ,business ,Intensive care medicine ,Botulinum toxin type - Abstract
In this summary article, the authors discuss the characteristics of abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA. With 3 neuromodulators available in the US market, comparisons between and among products will invariably be made, so arguments for the most effective facial aesthetic uses of each neuromodulator are presented. Topics addressed in this article include patient expectations, toxin reconstitution and preparation, patient positioning, differences among products, the role of complexing proteins, and dosing and injection strategies. Recommendations are also provided by treatment area.
- Published
- 2013
39. Nonsurgical Modalities to Treat the Aging Face
- Author
-
Danny Vleggaar, Wm. Philip Werschler, Rebecca Fitzgerald, Jeffrey M. Kenkel, Michael A. C. Kane, Miles H Graivier, and Z. Paul Lorenc
- Subjects
Poly l lactic acid ,Aging ,medicine.medical_specialty ,Polymethyl methacrylate ,business.industry ,Facial rejuvenation ,Neurotoxins ,Biocompatible Materials ,Cosmetic Techniques ,General Medicine ,Aging face ,Biocompatible material ,United States ,Skin Aging ,Surgery ,Face ,Humans ,Rejuvenation ,Medicine ,business ,Calcium hydroxylapatite ,Botulinum toxin type - Abstract
Injectable shaping agents include neurotoxins (botulinum toxin type A products), replacement fillers (hyaluronic acid [HA] agents), and biostimulatory fillers (calcium hydroxylapatite [CaHA], polymethylmethacrylate [PMMA], and poly-L-lactic acid [PLLA]). This article presents an overview of the agents currently available for use in facial rejuvenation in the United States.
- Published
- 2010
40. Surgical Versus Nonsurgical Rejuvenation
- Author
-
Z. Paul Lorenc, Jeffrey M. Kenkel, Miles H Graivier, Rebecca Fitzgerald, Wm. Philip Werschler, Michael A. C. Kane, and Danny Vleggaar
- Subjects
Aging ,medicine.medical_specialty ,Modalities ,business.industry ,Facial rejuvenation ,Cosmetic Techniques ,General Medicine ,Skin Aging ,Surgery ,Face ,Facial aging ,medicine ,Humans ,Rejuvenation ,business ,Cosmetic procedures - Abstract
The number of cosmetic procedures for facial rejuvenation has increased steadily over the past decade. The increase in the application of nonsurgical modalities, particularly injectable shaping agents, has been remarkable. As knowledge and experience about facial aging has increased, techniques and tools have improved, and it is increasingly apparent that surgical and nonsurgical/injectable modalities are complementary.
- Published
- 2010
41. Safety and efficacy of a continuous-flow, injection-assisted device in delivery of dermal fillers
- Author
-
Suzanne Bruce, Z. Paul Lorenc, and William Philip Werschler
- Subjects
Adult ,Male ,medicine.medical_specialty ,Nasolabial Fold ,Esthetics ,Facial rejuvenation ,Injections, Subcutaneous ,Cosmetic Techniques ,Dermal Fillers ,Statistics, Nonparametric ,Young Adult ,Rating scale ,Reference Values ,Medicine ,Humans ,In patient ,Single-Blind Method ,Hyaluronic Acid ,Adverse effect ,Wrinkle ,Aged ,Equipment Safety ,business.industry ,Continuous flow ,General Medicine ,Equipment Design ,Middle Aged ,Surgery ,Skin Aging ,Treatment Outcome ,Patient Satisfaction ,Anesthesia ,Female ,Patient Safety ,medicine.symptom ,business - Abstract
Background: A device to assist in the delivery of dermal filler may achieve reductions in patient discomfort and adverse events, as well physician fatigue. It may also increase the accuracy of material placement. Objectives: The authors assess the safety and performance of the Artiste Assisted Injection System (Nordson Micromedics, St Paul, Minnesota) in normal therapeutic use compared with the standard manual administration of dermal fillers. Methods: At 3 study sites, a total of 52 patients (48 women and 4 men) received bilateral full-correction injections of dermal fillers into randomized nasolabial folds (NLF). Injection into 1 NLF was made via Artiste, and injection into the other NLF was made via manual delivery. Immediately posttreatment and through 29 days, physician investigators, patients, and blinded evaluators recorded treatment durations and volumes, evaluated designated posttreatment characteristics using questionnaires, and documented adverse events (AE) and differences in cosmetic effects. Results: Mean filler volume was 1.25 mL for the Artiste-treated NLF and 1.29 mL for manually treated NLF. One investigator used significantly less volume with Artiste than with manual injection (0.95 mL vs 1.12 mL; P = .001). Blinded evaluators rated Wrinkle Severity Rating Scale (WSRS) results as “identical” in 81% of patients. Investigator questionnaires showed a clear and statistically significant preference for Artiste over manual injection in all parameters ( P < .001). Conclusions: The Artiste device is a viable option for physicians seeking a continuous-flow, injection-assisted device for ease of treatment, better accuracy, and improved results. Level of Evidence: 3 ![Graphic][1] [1]: /embed/inline-graphic-1.gif
- Published
- 2013
42. A review of AbobotulinumtoxinA (Dysport)
- Author
-
Foad Nahai, Z. Paul Lorenc, Jeffrey M. Kenkel, Steven Fagien, Haideh Hirmand, Mark S. Nestor, Anthony P. Sclafani, Jonathan M. Sykes, and Heidi A. Waldorf
- Subjects
medicine.medical_specialty ,Neurotransmitter Agents ,business.industry ,Botulinum Neurotoxin Type A ,Treatment outcome ,General Medicine ,Food and drug administration ,Treatment Outcome ,Face ,Physical therapy ,Medicine ,Humans ,Rejuvenation ,Surgery ,Dosing ,Botulinum Toxins, Type A ,business - Abstract
AbobotulinumtoxinA was approved by the US Food and Drug Administration in 2009 as the second botulinum neurotoxin type A (BoNTA) for use in facial aesthetics. This article provides an overview of abobotulinumtoxinA's applications and indications as well as safety and efficacy data. AbobotulinumtoxinA is generally well tolerated. Adverse events from abobotulinumtoxinA are similar to those reported with other BoNTA products. Clinical applications of the product are also discussed in this article. Information on handling, storage, and dosing is provided.
- Published
- 2013
43. Current aesthetic use of abobotulinumtoxinA in clinical practice: an evidence-based consensus review
- Author
-
Michael A. C. Kane, Joel Schlessinger, John H Joseph, David J Applebaum, Sue Ellen Cox, Ira Lawrence, Z. Paul Lorenc, Amir Moradi, Corey S. Maas, Julius W. Few, Vivian W Bucay, Leslie Baumann, Xiaoming Lin, Mitchell Wortzman, Mark S Nestor, Shawn Allen, and Diane B. Nelson
- Subjects
medicine.medical_specialty ,Evidence-based practice ,Evidence-Based Medicine ,Dose-Response Relationship, Drug ,business.industry ,Best practice ,Neurotoxins ,Alternative medicine ,MEDLINE ,General Medicine ,Evidence-based medicine ,Cosmetic Techniques ,Antibodies, Neutralizing ,Surgery ,Injections ,Clinical Practice ,Safety profile ,Systematic review ,medicine ,Humans ,Botulinum Toxins, Type A ,Intensive care medicine ,business - Abstract
The amount and complexity of scientific and clinical evidence for aesthetic use of botulinum neurotoxin type A (BoNT-A) has expanded rapidly in recent years, especially for abobotulinumtoxinA, necessitating reassessment of current knowledge about aesthetic use of abobotulinumtoxinA and other BoNT-A preparations. A committee of 13 plastic surgeons, facial plastic surgeons, and dermatologists engaged in a live discussion of information from a systematic literature review and an Internet-based survey of their beliefs and practices. The committee achieved consensus on most issues. It was concluded that doses of different BoNT-A preparations cannot be interconverted with a fixed ratio. The size of the "field of effect" is difficult to measure, and comparisons between preparations have yielded equivocal results. Nonresponse due to neutralizing antibodies appears exceedingly rare with currently available BoNT-A preparations and of little concern clinically. BoNT-A dose, injection depth, and injection technique should be adjusted according to the anatomic area being treated and each patient's individual characteristics and goals. Aesthetic use of BoNT-A has a good safety profile. Most adverse events are minor and related to the trauma of injection, although special care is needed in certain anatomic areas. Detailed recommendations for treatment of different anatomic areas are presented. BoNT-A products are often used in conjunction with other treatment modalities (eg, fillers and resurfacing), but little agreement was reached on best practices. The findings reported in this consensus document may serve as a practical guide for aesthetic practitioners as they apply the latest knowledge about BoNT-A in providing their patients with optimal care.
- Published
- 2012
44. Commentary on: Complications After Facial Injections With Permanent Fillers: Important Limitations and Considerations of MRI Evaluation
- Author
-
Z. Paul Lorenc
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Biocompatible Materials ,Magnetic resonance imaging ,Cosmetic Techniques ,General Medicine ,Magnetic Resonance Imaging ,Surgery ,Imaging Tool ,Face ,medicine ,Humans ,Treatment decision making ,Hyaluronic Acid ,Complication ,business - Abstract
In “Complications After Facial Injections With Permanent Fillers: Important Limitations and Considerations of MRI Evaluation,” the authors propose the use of magnetic resonance imaging (MRI) as an investigative tool in the assessment of delayed-onset complications subsequent to injections of permanent fillers.1 Utilization of this investigative imaging tool is proposed to be helpful in assessing filler-related complications where it is difficult to clinically assess the nature and extent of the complication. The study included 32 patients who underwent a pretreatment MRI evaluation of post–facial filler injection complications. After 13 of 120 site-specific assessments were excluded due to poor image quality, a total of 107 site-specific clinicoradiologic evaluations were obtained. Clinicoradiologic level of agreement was assessed as strong for depots without complications and noninflammatory nodules (85%), as moderate for abscesses (60%), as fair for low-grade inflammations (32%), and as slight for migrations (9%). In 14% of the cases, results from pretreatment MRI were helpful in the treatment decision making. I commend the authors for undertaking this study to evaluate the role of MRI in the treatment of post–permanent filler complications. Such studies do have a role in …
- Published
- 2014
45. Book Review: Soft Tissue Augmentation: Procedures in Cosmetic Dermatology Series
- Author
-
Z. Paul Lorenc
- Subjects
medicine.medical_specialty ,Augmentation procedure ,business.industry ,General surgery ,Section (typography) ,Soft tissue ,General Medicine ,Glabella ,Cosmetic dermatology ,medicine.anatomical_structure ,medicine ,Forehead ,Surgery ,business - Abstract
Jean Carruthers, Alastair Carruthers, eds. Soft Tissue Augmentation: Procedures in Cosmetic Dermatology Series. 3rd ed. Series: Procedures in Cosmetic Dermatology (Jeffrey S. Dover, Murad Alam, eds). Philadelphia, PA: Saunders Elsevier, 2012. ISBN-10: 1455727822 The third edition of Soft Tissue Augmentation , edited by Drs Jean and Alastair Carruthers, is a comprehensive review of presently available soft-tissue injectable fillers and a practical guide for their use. The book contains 31 chapters, grouped into 3 major sections. Chapters 3 through 12 (the first section) address individual agents, including their development, physiochemical properties, and clinical applications. Chapters 13 through 24 pertain to treatment of specific anatomic areas (eg, forehead, glabella, nose) with various agents. The final section, Chapters 26 through 28, deals with possible complications related …
- Published
- 2014
46. Update on facial aging
- Author
-
Jeffrey M. Kenkel, Rebecca Fitzgerald, Z. Paul Lorenc, Miles H Graivier, Michael A. C. Kane, Wm. Philip Werschler, and Danny Vleggaar
- Subjects
Aging ,business.industry ,Facial rejuvenation ,General Medicine ,Anatomy ,Cosmetic Techniques ,Skin Aging ,stomatognathic diseases ,Adipose Tissue ,Facial aging ,Face ,Medicine ,Humans ,Rejuvenation ,Surgery ,business - Abstract
Facial aging was once thought to be the result of the relentless downward pull of gravity on skin and underlying fat. In turn, facial fat was believed to be a contiguous sheet of tissue. However, over the past four decades, a number of investigators have examined more closely the causes of facial aging, leading to a better understanding of age-related changes, and have confirmed and further explored the proposal by Gonzalez-Ulloa and Flores in 1965 that facial aging involves changes in muscle and bone, as well as skin and fat. Further, the recent work of Rohrich and Pessa (and other authors) has demonstrated that facial fat is not a sheet of tissue, but rather is compartmentalized throughout the face. This discovery has allowed the evolution of improved techniques for facial rejuvenation.
- Published
- 2010
47. Facial aesthetic analysis
- Author
-
Michael A. C. Kane, Jeffrey M. Kenkel, Rebecca Fitzgerald, Z. Paul Lorenc, Miles H Graivier, Wm. Philip Werschler, and Danny Vleggaar
- Subjects
Attractiveness ,genetic structures ,Esthetics ,Facial rejuvenation ,media_common.quotation_subject ,Facial Muscles ,Facial Bones ,Beauty ,Perception ,Medicine ,Humans ,Rejuvenation ,media_common ,Skin ,Modalities ,business.industry ,Appearance based ,General Medicine ,Facial muscles ,medicine.anatomical_structure ,Adipose Tissue ,Aesthetics ,Face ,Surgery ,Systematic mapping ,business ,Cognitive psychology - Abstract
Consideration of the individual patient's appearance based on systematic mapping and a three-dimensional evaluation of the four levels of facial structure (bone, muscle, fat, and skin) will help the clinician choose the most appropriate modalities for facial rejuvenation. This article addresses these concepts and also discusses universal perceptions of attractiveness.
- Published
- 2010
48. Appropriate selection and application of nonsurgical facial rejuvenation agents and procedures: panel consensus recommendations
- Author
-
Z. Paul Lorenc, Rebecca Fitzgerald, Jeffrey M. Kenkel, Michael A. C. Kane, Danny Vleggaar, Wm. Philip Werschler, and Miles H Graivier
- Subjects
Poly l lactic acid ,Male ,medicine.medical_specialty ,Aging ,Consensus ,Facial rejuvenation ,Polymers ,Polyesters ,Cosmetic Techniques ,Patient safety ,Patient satisfaction ,Medicine ,Humans ,Rejuvenation ,Lactic Acid ,Intensive care medicine ,Selection (genetic algorithm) ,business.industry ,General Medicine ,Surgery ,Skin Aging ,Patient Satisfaction ,Face ,Practice Guidelines as Topic ,Customer satisfaction ,Female ,business - Abstract
As injectable products have been introduced and as clinicians have gained experience with them, applications and techniques for injection have evolved, with better cosmetic results, enhanced patient safety, and greatly improved patient satisfaction. Within the past four years, several consensus recommendation panels have been convened to summarize the accumulated clinical experience and knowledge about the application of these products. The guidelines that already exist in the literature are referred to, and suggested guidelines for the administration of poly-L-lactic acid—for which no consensus guidelines have previously been published—are included in this article.
- Published
- 2010
49. Expanding Treatment Options for Neuromodulators
- Author
-
Foad Nahai, Z. Paul Lorenc, Jeffrey M. Kenkel, Steven Fagien, Haideh Hirmand, Mark S. Nestor, Anthony P. Sclafani, Jonathan M. Sykes, and Heidi A. Waldorf
- Subjects
medicine.medical_specialty ,Procerus muscle ,Facial rejuvenation ,business.industry ,Treatment options ,General Medicine ,medicine.disease ,Dermatology ,Dermal Fillers ,Surgery ,Plastic surgery ,medicine.anatomical_structure ,medicine ,Forehead ,Cervical dystonia ,Calcium hydroxylapatite ,business - Abstract
In the early 21st century, members of the medical community have been both witnesses to and participants in significant changes in the field of aesthetic surgery and medicine, including nonsurgical facial rejuvenation. Although some of dermal fillers were available prior to 2000, their indications were primarily therapeutic. Now, various categories of dermal fillers exist, including hyaluronic acid, poly-L-lactic acid, polymethylmethacrylate, calcium hydroxylapatite, and patients' own fibroblasts. Neuromodulators (ie, botulinum toxin type A [BoNTA] formulations) were first approved for therapeutic purposes but quickly gained popularity for aesthetic applications. According to the American Society for Aesthetic Plastic Surgery, in 2010, more than 2.4 million patients received treatment with a BoNTA product. Clearly, BoNTA injections have been widely adopted in aesthetic practice, beginning with the approval of onabotulinumtoxinA (Botox; Allergan, Irvine, California) in 2002 by the US Food and Drug Administration (FDA) for the temporary improvement in the appearance of moderate to severe glabellar lines associated with corrugator and/or procerus muscle activity in adults 65 years or younger. Off-label applications in areas such as horizontal forehead lines, “crow's feet,” and the perioral area followed. A new neuromodulator, abobotulinumtoxinA, was introduced in 2009, expanding the treatment options for physicians. AbobotulinumtoxinA (Dysport; Medicis Aesthetics, Scottsdale, Arizona) was approved by the FDA for the treatment of cervical dystonia in adults and for the aesthetic treatment of moderate to severe glabellar lines associated with procerus and corrugator muscle activity in adults 65 years or younger. As was the case …
- Published
- 2013
50. Book Review: Soft Tissue Augmentation: Procedures in Cosmetic Dermatology Series
- Author
-
Lorenc, Z. P., primary
- Published
- 2014
- Full Text
- View/download PDF
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