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A proper knowledge of noninvasive facial rejuvenation is integral to the practice of a cosmetic surgeon. Noninvasive facial rejuvenation can be divided into patient- versus physician-directed modalities. Patient-directed facial rejuvenation combines the use of facial products such as sunscreen, moisturizers, retinoids, α-hydroxy acids, and various antioxidants to both maintain youthful skin as well as rejuvenate damaged skin. Physicians may recommend and often prescribe certain products, but patients are in control with this type of facial rejuvenation. On the other hand, physician-directed facial rejuvenation entails modalities that require direct physician involvement, such as neuromodulators, filler injections, laser resurfacing, microdermabrasion, and chemical peels. With the successful integration of each of these modalities, a complete facial regimen can be established and patient satisfaction can be maximized. This article is the second in a three-part series describing noninvasive facial rejuvenation. Here the authors discuss neuromodulators and fillers in detail, focusing on indications for use, techniques, and common side effects.

The demand for aesthetic augmentation with soft tissue fillers has greatly increased in recent years and has led to an expansion in the number of products available. Unfortunately, an increase in adverse events has followed. These can be categorized into early, late, and delayed. Early infectious complications generally present as a localized skin infection, cellulitis, or abscess. Fillers can also serve as a focus for chronic infection, which is associated with the development of foreign body granulomas, a late complication. Bacterial colonization and indolent infections of the filler site can lead to biofilms that are extremely difficult to treat. Therefore, it is important to focus on prevention through eliciting a thorough patient history including an injection history, practicing sterile technique, and minimizing tissue trauma. Looking forward, much can be done to curtail complication rates. Early teaching and training, a central recording registry for complications, and a standardized filler passport for patients are suggested.

Identification and treatment of vascular malformations is a challenging endeavor for physicians, especially given the great concern and anxiety created for patients and their families. The goal of this article is to provide a review of vascular malformations, organized by subtype, including capillary, venous, lymphatic and arteriovenous malformations. Only by developing a clear understanding of the clinical aspects, diagnostic tools, imaging modalities, and options for intervention will appropriate care be provided and results maximized.

The timely diagnosis and treatment of dermatologic disease in the pediatric population can be challenging. A basic, yet comprehensive knowledge of common lesions is essential for a successful practice in plastic surgery. In this article, the authors describe vascular, cystic, and pigmented cutaneous lesions that are commonly encountered in the pediatric population. Epidemiology, pathogenesis, clinical course, and management options are discussed for each.

Advances in anatomic understanding are frequently the basis upon which surgical techniques are advanced and refined. Recent anatomic studies of the superficial tissues of the face have led to an increased understanding of the compartmentalized nature of the subcutaneous fat. This report provides a review of the locations and characteristics of the facial fat compartments and provides examples of how this knowledge can be used clinically, specifically with regard to soft tissue fillers.