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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., (© 2021 The Aesthetic Society.)

Background: The emergence of COVID-19 led rapidly to one of the most severe disease outbreaks in modern history. This caused many aesthetic practices to close temporarily, providing a unique opportunity to evaluate the impact of neurotoxin use in the setting of an ongoing pandemic., Objectives: The aim of this study was to examine whether administration of onabotulinumtoxinA (BOTOX Cosmetic, Allergan plc, Dublin, Ireland) to regular users synergistically amplifies the elevation in mood/happiness, self-satisfaction with appearance, and overall satisfaction in the context of the ongoing pandemic., Methods: A randomized, single-blind, crossover study was designed to evaluate the impact of neurotoxin treatment in the upper third of the face on mood, self-satisfaction with appearance, and overall satisfaction. The placebo group crossed over to treatment after 1 month. Surveys evaluating patient happiness, self-satisfaction with appearance, and overall efficacy were completed by both groups, and again by the placebo group following crossover to treatment., Results: Forty-five subjects were enrolled: 30 in the treatment group and 15 in the control/crossover group. The placebo group demonstrated no change in happiness or self-satisfaction in appearance until crossover to the treatment group. Both groups, once receiving onabotulinumtoxinA, reported increased happiness, self-satisfaction with appearance, and overall treatment satisfaction., Conclusions: OnabotulinumtoxinA treatment to the upper face in the midst of the COVID-19 pandemic was found to increase patient happiness, self-satisfaction with appearance, and overall treatment satisfaction., (© 2021 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.)

Social media has become a rising popular online medium for facilitating the exchange of information and ideas for the purpose of education and networking, especially in the realm of plastic surgeon. It is important for facial plastic surgeons in private practice to recognize the influence of and engagement in social media, particularly among younger adults given the ongoing movement of cosmetic patients seeking facial rejuvenation treatments at an earlier age. This article discusses the most recent trends in social media and facial plastic surgery as well as the benefits and challenges of social media in private practice., Competing Interests: Disclosure The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this article., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Excess submental fat (SMF) can cause submental fullness resulting in negative perceptions of individuals. However, the impact of SMF on perceptions of social traits has not been well studied., Objective: To characterize the impact of SMF on external value judgments in adults in the United States., Methods: Respondents completed an online survey in which they reacted to statements about individuals with varying grades of SMF. Attributes were rated on a scale from 0 to 100 with higher scores for more positive attributes., Results: Similar proportions of respondents (N = 1996) indicated that women and men with double chins were less attractive than those without (91% and 90%, respectively). A double chin was more likely to be noticed on a woman than on a man (78% of respondents). With increasing SMF, individuals were perceived as significantly less likeable, intelligent, happy, active, and easygoing. Those with greater amounts of SMF were rated as significantly less attractive than those with less SMF. For all attributes, male respondents rated all individuals lower than female respondents did., Conclusion: Results from this study provide further evidence of negative perceptions of individuals with SMF. Aesthetics of the submental area, especially SMF, likely impact the overall assessment of attractiveness and social attributes.

Background: Blind individuals have demonstrated the ability to detect danger and facial expressions without conscious awareness of visual stimuli. These embodied sensations are believed to be the result of primitive neural networks refined by evolutionary adaptations. We postulate that similar embodied sensations may have evolved to allow blind individuals to perceive beauty., Objective: To determine whether the visually blind can detect physical beauty., Patients and Methods: This observational study consisted of 8 blind and 10 nonblind test subjects and 6 models that were categorized into predetermined beauty categories. Test subjects were individually asked to rate 6 models on a 1 to 10 numerical beauty scale. This process was repeated in both groups while blindfolded (masked). All groups' mean model beauty scores underwent multivariate and univariate analysis., Results: All groups rated preselected (greater than 8) more beautiful models, higher except for the masked, nonblind group. Intraclass correlation was good in the blind raters with a score of 0.751, whereas poor in the nonblind masked raters with a score of 0.458., Conclusion: This is the first pilot study demonstrating with supporting evidence that blind individuals can detect beauty and supports that beauty may rely on primal forms of messaging that are subconsciously appreciated.

As individuals age, distinct anatomical changes of the bone and soft tissue result in the development of rhytids in the perioral region. Most notably, the oral commissures turn downward, creating the appearance of a perpetual frown and adding years to the facial appearance. The purpose of this article is to review the anatomical changes associated with perioral aging as well as discuss potential treatment options for perioral rejuvenation particularly at the level of the oral commissures. Lastly, this article covers the senior author's technique for improving oral commissures and restoring youthful appearance of the perioral region., Competing Interests: None., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: Small-particle hyaluronic acid filler is approved for lip augmentation and correction of perioral rhytides. Treatment with this product may improve facial aesthetics, projected first impression, and self-perception of mood., Objective: To determine the effect of perioral rejuvenation with hyaluronic acid on patient perception of mood and projected first impression., Materials and Methods: Seventeen subjects underwent perioral rejuvenation treatment with small-particle hyaluronic acid filler. Each subject underwent photography and completed 2 surveys measuring self-perception of mood before treatment and after achieving an optimal cosmetic result. Aesthetic improvement with treatment was assessed using the Global Aesthetic Improvement Scale and the Oral Commissure Severity and Perioral Line Severity scales. Seventeen hundred blinded evaluators rated pre-treatment and post-treatment photographs of the subjects using a First Impressions Questionnaire., Results: Perioral filler treatment significantly improved pre-treatment and post-treatment scores for happiness within the Happiness Measures Scale. This treatment was found to significantly improve projected first impression across all categories., Conclusion: Small-particle hyaluronic acid filler treatment for perioral rejuvenation is an effective method for improving physical appearance as well as first impressions. Larger studies are necessary to verify whether perioral rejuvenation with hyaluronic acid offers enhanced self-perception of mood.

Background: Fibrin sealant application in rhytidectomy has previously demonstrated a reduction in adverse events and drainage volume. Fibrin sealant offers multiple potential benefits including decreasing downtime, reducing complication rates, and improving patient satisfaction. In this study, we evaluated the efficacy and safety of ARTISS [fibrin sealant (human)] in external rhinoplasty., Methods: Nine healthy participants between the ages of 18 and 50 seeking external rhinoplasty completed this study. All subjects were randomized into control and treatment groups and then underwent external rhinoplasty, with only the treatment group receiving ARTISS [fibrin sealant (Human)] during surgery. Photographs were taken before surgery and 1 day, 1 week, 1 month, 3 months and 6 months after surgery and used in a blinded assessment of recovery time and esthetic improvement with ecchymosis and satisfaction scales. Subject recovery time, downtime, and self-esteem were evaluated at 1 day, 1 week, 1 month and 6 months after surgery. Recovery time was determined by live assessment of edema and ecchymosis using categorical scales. Subject downtime was assessed through a 30-day patient diary and a downtime questionnaire. Subject self-esteem was evaluated with the Heatherton & Polivy State Self-Esteem Scale. The degree of technical ease with the product was determined by the treating investigator with a 10-cm Visual Analog Scale., Results: Patients treated with ARTISS intra-operatively reported significantly higher self-esteem 1 month and 6 months following external rhinoplasty. The ARTISS Easyspray™ Spray Set was rated as technically easy to administer., Conclusion: The use of ARTISS fibrin sealant in external rhinoplasties is a safe and easy method and may enhance patient self-esteem. Larger studies are warranted to either verify or challenge the validity of our findings., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BACKGROUND: Although non-surgical treatment options for facial rejuvenation are well-established, the literature remains limited regarding the combined effect of topical skin treatment with filler and neurotoxin on patient appearance and satisfaction. The objectives of this study were to assess the impact of a skin rejuvenation therapy in combination with neurotoxin or hyaluronic acid filler injection on skin quality and general aesthetic improvement as well as on short-term self-esteem.

METHODS: From 2015 to 2017, 20 female patients were enrolled in our study and were randomized into two groups. Patients in Group A used a basic skin care regimen following hyaluronic acid filler and neurotoxin treatment, while those in Group B utilized the Nu-Derm® skin care system (Obagi Medical Products, Inc) afterwards. Each subject and the principal investigator filled out various assessments pre- and post-treatment to evaluate for change in skin quality (Fitzpatrick Wrinkle Assessment Scale [FWAS] and Skin Quality Assessments [SQA]), aesthetic appearance (Global Aesthetic Improvement Scale [GAIS]), patient satisfaction (Subject Satisfaction Assessment [SSA]), and self-esteem (State Self-Esteem Scale [SSES]).

RESULTS: Subjects in both treatment groups demonstrated significant improvement in skin quality, as illustrated in the change in FWAS and SQA scores, at 12 weeks after initiating full facial rejuvenation treatment. However, there were no significant differences in FWAS and SQA ratings between the treatment groups. Regarding aesthetic appearance, a statistically significant difference in GAIS scores between Groups A and B was observed at 6 weeks after treatment only. In evaluating for patient satisfaction and self-esteem, there were no significant differences in SSA and SSES ratings over time within each treatment group or between the treatment groups.

CONCLUSIONS: Our study confirms that facial rejuvenation therapy involving hyaluronic acid filler and neurotoxin injections combined with a topical skin treatment regimen leads to improvement in skin quality and aesthetic appearance as well as to patient satisfaction. Additional larger studies are needed to better delineate the most ideal combination facial rejuvenation therapy for optimizing patient appearance and satisfaction.

J Drugs Dermatol. 2018;17(1):48-54.

BACKGROUND: Rosacea has a variable presentation. Whereas the pathophysiology may differ, erythema, and flushing are the most consistent findings in all patients.

OBJECTIVE: To evaluate the safety and efficacy of incobotulinumtoxinA in reducing the severity of rosacea symptoms.

METHODS: Nine subjects with erythematotelangiectactic or papulopustular rosacea were randomized in 2 groups. Subjects in Group 1 (n=4) received up to a total of 20 U of incobotulinumtoxinA in the affected area (across both cheeks). Subjects in Group 2 (n=5) were injected with equal volumes of a saline solution. Rosacea Clinical Scores and subject satisfaction were evaluated at baseline and at 1, 4, 12, and 16 weeks post-treatment. At week 16, both groups were injected with incobotulinumtoxinA. Follow-up visits were performed at 1 and 4 weeks post-retreatment.

RESULTS: Patients in Group 1 exhibited reduction in the primary features of rosacea within 4 weeks of treatment with incobotulinumtoxinA. Consistent with this observation, patients in Group 2 (who had received the placebo in the first arm without significant changes to their symptoms) exhibited reductions in all of the primary and some of the secondary features upon treatment with incobotulinumtoxinA.

CONCLUSIONS: IncobotulinumtoxinA may be a safe and effective agent to reduce the severity of rosacea symptoms and increase patient satisfaction.

J Drugs Dermatol. 2017;16(6):549-554.

Importance: The caudal septal extension (CSE) graft maneuver commonly is used to adjust the nasal tip projection. It can, however, be difficult to stabilize and straighten the CSE graft, especially when the procedure is performed through an endonasal approach. Because the stabilization and correct positioning of the CSE graft are vital for achievement of the desired outcome, new approaches must be found that facilitate the technical ease of this procedure., Objective: To assess the safety and efficacy of the polydioxanone (PDS) absorbable plate in CSE graft procedures performed via an endonasal approach., Design, Setting, and Participants: In an open-label, 2-arm parallel trial, 30 patients who requested a surgical nasal correction and required a CSE graft performed via an endonasal approach were randomized into 2 groups of 15 patients each. All patients underwent endonasal rhinoplasty at a single center from February 17, 2011, to December 26, 2013. Depending on their treatment group, patients received a CSE graft with or without a PDS plate. Data were collected and evaluated from November 24, 2010, to January 19, 2015, when final follow-up occurred. Data were analyzed based on an evaluable population., Interventions: Endonasal rhinoplasty with or without the use of a PDS plate., Main Outcomes and Measures: Technical difficulty assessed using a visual analog scale (range, 0-100; higher scores indicate increased difficulty of use), surgeon and blinded evaluator satisfaction with the graft assessed using a 4-point categorical scale (1 indicates highly satisfied; 4, unsatisfied), change in nasal tip projection, and complications at 30, 60, 180, and 365 days after surgery., Results: Twenty-seven patients (13 in the PDS group and 14 in the non-PDS group) completed their 6-month postoperative visit, and 19 patients (10 in the PDS group and 9 in the non-PDS group) completed the entire study (12 months). The mean (SD; range) surgeon-assessed visual analog scale score for ease of use was 46 (13; 25-64) mm for the 15 patients in the non-PDS treatment group and 17 (10; 7-48) mm for the 15 patients in the PDS group (P < .001). The surgeon's satisfaction with the graft did not differ significantly between the PDS and the non-PDS groups (P = .34), and the nontreating blinded evaluator's assessment of standardized photographs taken at the time of the graft placement and at postoperative days 30, 60, 180, and 365 did not establish any significant differences between the 2 groups (P > .99). Postoperative change in the nasal tip projection at 365 postoperative days compared with 30 postoperative days was significantly lower in the PDS group compared with the non-PDS group (-0.31% vs -6.5%; P = .04), thus increasing the long-term stability of the graft in the PDS group. A single incident of infection was observed in each group along with no episodes of rejection or extrusion., Conclusions and Relevance: In this study, use of a PDS plate in CSE graft procedures was associated with less technical difficulty than CSE graft procedures without use of a PDS plate and with reduced long-term variations in the nasal tip projection after the graft placement., Level of Evidence: 1., Trial Registration: clinicaltrials.gov Identifier: NCT01225250.

Alopecia and thinning hair are highly prevalent conditions affecting a large proportion of men and women. Diffused hair loss is often more difficult to diagnose in women, mostly due to over-reliance on the assumption of hormonal influences, and it is commonly treated with a multi-therapy approach. Clinical studies have demonstrated the effectiveness of a nutraceutical supplement to provide essential nutrients that aid in stimulating existing hair growth and reducing hair shedding. The supplement Viviscal® contains a proprietary blend of proteins, lipids, and glycosaminoglycans derived from sustainable marine sources. We present here a summary of studies that have examined the safety and efficacy of this nutraceutical; as well as discussions on hair loss and current therapies from a recently convened expert panel in dermatology and plastic surgery.

Introduction: First impressions are lasting, consequential and defined as the immediate judgment made of another from zero acquaintance. Multiple studies have reported the benefits of cosmetic make-up. We set out to investigate the psychosocial and aesthetic effects of cosmetic make-up in order to better understand why women wear it., Materials and Methods: Twenty-seven women were recruited in order to examine the effects of cosmetic make-up on first impressions. The photographs of individual subjects wearing the control cosmetics, their own make-up, and no make-up were randomly assigned to three binders (A, B, and C). Three hundred evaluators participated (100 evaluators per book) and completed a 10-point First Impression Scale for each of the 27 photos in their binder., Results: Statistical analysis of the collected data was conducted in SPSS using two-tailed t-tests to determine the statistical significance of the differences between first impressions of Own Make-up vs No Make-up, No Make-up vs Control Make-up, and Own Makeup vs Control Make-up. There was a significant difference in improvement in all pairings across all 8 categories in the First Impressions questionnaire particularly in perceived age between own make-up, no make-up, control make-up (41, 42, 38; P<0.001)., Discussion: Our study evaluated the first impressions, age perception, self-esteem, and the quality of life impact that cosmetic makeup has on women's appearance and confidence. Subjects wearing cosmetic make-up appeared 4 years younger than those wearing no make-up. And the control cosmetic make-up subjects on average projected a 37% better first impression than subjects wearing no make-up. We objectively quantified and qualified the benefits of applying cosmetic make-up. Make-up can reduce the perceived age, improve the first impression projected and increase the self-esteem of those who apply it.

Anxiety is an under recognized and major obstacle among patients seeking cosmetic procedures. The ability to alleviate it may be essential for achieving high patient satisfaction and better outcomes. Key initiators leading to anxiety include the fear of appearing unnatural and the fear of pain. Pain perception can be mitigated or augmented by psychological factors. Based on patient expectations, they may experience diminished pain perception through the placebo effect or catastrophized pain due to previous painful experiences. It is also important to recognize the influence of religion, cultural, ethnic, and gender bias on pain perception. In recent years, the aesthetic medical community has responded to patient demand for more minimally invasive procedures with more natural appearing result, resulting in a dramatic increase in the number of cosmetic procedures performed each year. Achieving pain and anxiety-free aesthetic medicine will likely result in a pronounced increase in the demand for cosmetic treatments., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Adverse reactions and unintended effects can occasionally occur with toxins for cosmetic use, even although they generally have an outstanding safety profile. As the use of fillers becomes increasingly more common, adverse events can be expected to increase as well. This article discusses complication avoidance, addressing appropriate training and proper injection techniques, along with patient selection and patient considerations. In addition to complications, avoidance or amelioration of common adverse events is discussed., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The aging neck is accompanied by an increase in submental fat, platysmal banding, and redundant dyspigmented skin. Creating a more acute cervicomental angle, distinct mandibular border, homogeneous skin tone, and smoother texture helps to achieve a more youthful appearance. The aesthetic provider's armamentarium has long had surgical techniques in the highest regard, but a new wave of minimally invasive procedures looks to offer a nonsurgical approach to cervicomental rejuvenation. Selecting the appropriate procedure for appropriate patients that will effectively meet their aesthetic goals and expectations is the core of successful neck rejuvenation., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Hyaluronic acid (HA) is the most frequently injected filler for soft tissue augmentation in the United States., Objective: To systematically review published evidence for aesthetic use of small- and large-gel-particle HA., Methods and Materials: Clinical data on anatomic area, level of evidence, patient population, trial design, endpoints, efficacy, and safety were extracted from PubMed., Results: Fifty-three primary clinical reports were analyzed. The highest-quality efficacy evidence was for the nasolabial folds (NLFs), with 10 randomized, blind, split-face, comparative trials. Several randomized, blind trials supported treatment of the glabella, lips, and hands. Lower-level evidence (from studies with nonrandomized, open-label, or retrospective designs) was recorded for the nasojugal folds (tear troughs), upper eyelids, nose, infraorbital hollows, oral commissures, marionette lines, perioral rhytides, temples, and cheeks. Common adverse events (AEs) across anatomic areas were pain, bruising, swelling, and redness. Serious AEs were uncommon (8 events in 8 patients of 4,605 total patients) and were considered to be unrelated (7 events) or probably unrelated (1 event) to treatment., Conclusion: The efficacy and safety of small- and large-gel-particle HA are well established for NLFs; evidence for the glabella, lips, and hands is more limited. Preliminary reports in other anatomic regions suggest efficacy without major complications., (© 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

Rosacea is a cutaneous condition with several clinical subtypes that are commonly seen in daily medical practice. There are many different treatment modalities for each of the physical findings associated with this disease, and all have varying results. As the use of onabotulinumtoxinA rises, its benefit in the treatment of a growing number of medical diseases increases. The authors report anecdotal evidence of patients with rosacea experiencing improved symptoms of erythema and flushing after treatment with intradermal, microdroplets of onabotulinumtoxinA. There were no adverse events reported for any of the treatments. The mechanism of action through a likely neurogenic component to vascular dysfunction, inflammation, and hypersebaceous activity is reviewed.

Background: Despite an abundance of nutritional supplements, very few well-controlled trials have assessed their beneficial effect on the skin, such as hydration, antioxidant levels, texture or appearance. The objective of the following placebo-controlled, double-blind study was to determine the effects of the Skin Health Experimental Product (SHEP) on skin health., Methods: The study enrolled healthy men and women aged 30 years or older. Subjects were randomized to receive a twice-daily regimen of SHEP or placebo. The effects SHEP had on overall skin appearance and health were assessed by measuring improvements in: (1) skin hydration using a closed-aperture transepidermal water-loss moisture meter and a vapometer; (2) skin texture using silicon profilometry; (3) skin carotenoid concentration using Raman spectrometry; and (4) reported self-image assessments using the Global Aesthetic Improvement Scale (GAIS)., Results: SHEP-treated subjects demonstrated a significant reduction in fine lines compared to the placebo-treated group. Raman spectroscopy showed that SHEP increased carotenoids at some measurement sites. Based on the GAIS, SHEP-treated subjects were three times more likely to perceive an improvement in their appearance compared to placebo-treated subjects (P>0.049)., Conclusion: The orally-administered SHEP nutritional supplement improves skin texture, carotenoid levels in specific areas of the hand, and improves patients' perception of skin health.

Background: As the number of soft tissue filler injections increases, the number of adverse events associated with injection may rise. Impending necrosis represents a serious complication that, if not treated correctly and timely, may have grave consequences., Objective: We describe a protocol utilizing hyaluronidase, nitroglycerin paste, aspirin, antacid and a topical oxygen therapy that may be used to treat impending necrosis subsequent to injection with soft tissue fillers., Conclusion: We have successfully treated nine post-filler injection adverse events involving impending necrosis or necrosis following both hyaluronic acid and calcium hydroxylapatite injections using our protocol.

In the increasingly competitive market of aesthetic surgery and the unstable predicament of the current economy, managing a successful aesthetic practice becomes ever more difficult. This article introduces the concept of Retailicine, combining essential elements of retail with the core principles of medicine. This new concept stresses the importance of the customer (patient) and provides tips to help manage the aesthetic practice. Through incorporating the techniques mentioned in this article, the aesthetic physician can ensure a successful practice despite current economic uncertainty., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Creating a successful aesthetic medicine practice in times of economic uncertainty is a daunting challenge. This article introduces the concept of Retailicine, combining inherent edicts of medicine with the best practices in business, so today's aesthetic physician can develop strategies for success in any economy. Through the efficient use of marketing strategies catered to aesthetic medicine, aesthetic practices can thrive. Emphasizing the patient's experience, effectively using the Internet, and an ego-devoid introspective analysis of the flaws of one's practice are essential for any successful aesthetic physician to grow and be prosperous despite any shortfalls in the economy., (Thieme Medical Publishers.)

Using soft tissue fillers to correct postrhinoplasty deformities in the nose is appealing. Fillers are minimally invasive and can potentially help patients who are concerned with the financial expense, anesthetic risk, or downtime generally associated with a surgical intervention. A variety of filler materials are currently available and have been used for facial soft tissue augmentation. Of these, hyaluronic acid (HA) derivatives, calcium hydroxylapatite gel (CaHA), and silicone have most frequently been used for treating nasal deformities. While effective, silicone is known to cause severe granulomatous reactions in some patients and should be avoided. HA and CaHA are likely safer, but still may occasionally lead to complications such as infection, thinning of the skin envelope, and necrosis. Nasal injection technique must include sub-SMAS placement to eliminate visible or palpable nodularity. Restricting the use of fillers to the nasal dorsum and sidewalls minimizes complications because more adverse events occur after injections to the nasal tip and alae. We believe that HA and CaHA are acceptable for the treatment of postrhinoplasty deformities in carefully selected patients; however, patients who are treated must be followed closely for complications. The use of any soft tissue filler in the nose should always be approached with great caution and with a thorough consideration of a patient's individual circumstances.

Over the last decade, there has been a shift in the way aesthetic surgeons approach facial rejuvenation. With recognition of the value of volume enhancement in achieving a more youthful appearance, as well as the ease of office procedures offering minimal downtime and predictable results, there has been a concomitant explosion in the soft tissue filler market. Given the vast array of filler products currently available, the decision of which facial filler to use in specific situations can be complicated and confusing. A physician's selection of facial filler(s) should be based on a solid understanding of the various filler products, appropriate patient selection, and the physician's proficiency in injection techniques. We present a review of the most widely used fillers, offering guidance on patient selection and effective injection techniques.

Botulinum toxin type A (BTX-A) has been used for years with excellent results for upper facial cosmetic applications. Because of this success, the use of BOX-A for facial aesthetics has expanded to the lower facial and neck regions. BTX-A, especially when used in combination with fillers, has generally proven to be safe and efficacious in these areas. For optimal results, however, several issues must be taken into considerations, including dosing differences versus upper facial applications, the specific type of botulinum toxin used and the importance of precise placement and injection technique. In this article, the authors present their experience with BTX-A in the lower face and neck, and compare and contrast their current practices with those reported by others.

Objective: To compare the efficacy and safety of 2 doses of botulinum toxin type A in the treatment of dermatochalasis., Methods: Forty patients with mild to moderate dermatochalasis were randomly assigned to receive 1 of 2 doses of botulinum toxin type A in the lateral infrabrow--4 U/brow or 6 U/brow--and followed up for 20 weeks., Results: Investigator assessment showed the proportion of responders (> or = 1 grade improvement in severity of dermatochalasis on a scale of none, mild, moderate, or severe) at week 2 was 32% with 4 U and 47% with 6 U. Compared with the lower dose group, the higher dose group also reported a greater degree of improvement, significantly higher ratings for feelings of attractiveness and feelings of satisfaction with appearance, and a higher incidence of satisfaction., Conclusion: Single-site injection of botulinum toxin type A in the lateral infrabrow can offer effective treatment for mild to moderate upper eyelid dermatochalasis.