Front cover

Half title page

Series page

Soft Tissue Augmentation

Copyright page

Table of Contents

SERIES PREFACE THIRD EDITION

Series Preface First edition

Preface

Contributors

Acknowledgements

Dedication

1 Introduction

Further reading

2 Fillers:

Fat as a filling agent

Collagen (Zyderm®, Zyplast®, Cosmoderm®, Cosmoplast®, Evolence®)

Hyaluronic acids (Restylane®, Perlane®, Juvéderm® Ultra, and Ultra Plus)

Silicone

Poly-L-lactic acid (Sculptra®)

Calcium hydroxylapatite (Radiesse®)

Polymethylmethacrylate (Artefill®)

Conclusion

Conflicts of interest

Further reading

3 NASHA™ family

Introduction

Background

Basic science

Choosing the right NASHA™

Patient evaluation

Patient preparation

Physician preparation

Treatment techniques

Serial puncture

Linear threading

Fanning

Cross-hatching

Site-specific treatment strategies

Nasolabial folds

Melolabial folds

Jowls

Cheeks

Lips

Postoperative care and complication management

Conclusion

Further reading

4 Juvéderm® family

Introduction

Juvéderm formulations

Contraindications and safety considerations

Using Juvéderm®

Clinical choices

Volumizing with Juvéderm® gels

Further reading

5 Non-permanent fillers:

Introduction

Hyaluronic acid dermal fillers

Methods

Belotero®

Randomized controlled trial

Case series

Esthélis®

Teosyal®

Randomized controlled trial

Conclusion

Further reading

6 Radiesse® / Radiesse® with lidocaine

Introduction

Indications for calcium hydroxylapatite

Specific characteristics of calcium hydroxylapatite

Mechanism of action

Injection techniques

Serial puncture

Linear threading (Figs 6.1, 6.2)

Cross-hatching / fanning

Adverse events

Comparative research studies

Outcomes in subjects with Fitzpatrick skin types IV–VI

Safety outcome of calcium hydroxylapatite

Large-particle calcium hydroxylapatite injection

Patient satisfaction

Acknowledgments

Further reading

7 Poly-l-lactic acid

Introduction

Product and mechanism of action

Poly-L-lactic acid: technical considerations

Product reconstitution

Product amount

Product placement

Product placement precaution

Aftercare

Additional comments

Prevention and treatment of adverse events

Patient selection, expectations, and satisfaction

Pathophysiology of the aging face: structural and morphologic

Conclusion

Further reading

8 Artefill®:

Introduction

Biocompatibility

Patient selection / treatment areas

Patient evaluation and injection technique

Pitfalls and how to correct them

Post-injection care

Clinical trials

Pivotal trial

Summary of 5-year follow-up safety and efficacy study

Ratings of success and satisfaction

Statistics

Patient demographics and response rates

Masked observer facial fold assessment ratings of efficacy at 5 years compared with baseline

Secondary measures of efficacy at 5 years compared with baseline

Efficacy at 5 years compared with efficacy at 6 months

Potential biases

Safety review

Summary of post-approval study of the safety of Artefill®: interim report

Conclusion

Acknowledgments

Further reading

9 New and novel fillers:

Introduction

Elastin and soft tissue augmentation

Introduction

The building blocks of elastin therapy

The raisons d’être of elastin regeneration and injecting elastin products

Platelet-rich plasma (PRP)

Introduction

The raisons d’être for the use of platelet-rich plasma in cosmetic and reconstructive medicine

Method

Evidence

Carboxymethyl cellulose plus polyethylene oxide dermal filler (Laresse®)

Introduction

Characteristics

Pilot clinical study

Further clinical experience

Conclusion

Further reading

10 Liquid injectable silicone

Introduction

Basic science

Mechanism of action

Controversy

Indications and patient selection

Materials

Patient preparation

Injection technique

Side effects and managing complications

Conclusion

Further reading

11 Aquamid®

Product

Patient selection

Technique / treatment

Efficacy

Complications

Discussion

Further reading

12 Bio-Alcamid®

Introduction

Clinical use of Bio-Alcamid®

Complications of Bio-Alcamid®

Conclusion

Further reading

13 Forehead and temporal recontouring using calcium hydroxylapatite pre-mixed with lidocaine

Introduction

Patient evaluation

Anatomy

Temple

Forehead

Selecting the right filler

Materials, injection sites, and injection techniques

Materials

Injection site for the forehead

Injection technique for forehead recontouring

Injection site for the temples

Injection technique for temple recontouring

Safety considerations and adverse events

Conclusion and discussion

Further reading

14 Glabella/central brow

Introduction

Epidemiology and patient selection

Anatomical considerations

Muscles of the glabella and central brow

Medial brow depressors

Brow elevator

Important nerves, vessels, and other structures

Decision-making: selection and preparation of filler product, selection of injection plane

General considerations

Selection of injection plane and filler product

Deep approach

Superficial approach

Pre-procedural consultation, assessing and preparing the patient

Injection technique

Post-procedural course and recovery

Avoidance and management of adverse events

Tips for maximizing patient satisfaction

Conclusion

Further reading

15 Volumetric treatment of the brows

Introduction

The ‘local preview’

The injection

Intra-arterial injection

Who is a candidate for brow volume treatments?

Further reading

16 Infraorbital hollow and nasojugal fold

Introduction

Candidates for augmentation of the infraorbital hollow

Appropriate filling agents

Augmentation techniques

Skin preparation, anesthetic, and syringes

General techniques

Augmentation of the infraorbital hollow

Post-treatment management and follow-up

Complications

Adjunctive therapy

Conclusion

Further reading

17 Nose

Introduction

The attractively proportioned nose and face

Ethnic differences

Vascular patterns of the nose (Fig. 17.3)

Types of filler

Anesthesia

Injection technique (Fig. 17.4)

Injection techniques by nasal region

Nasal dorsum augmentation (Fig. 17.4)

Correction of the nasal tip

Correction of the columella

Correction of the nasolabial angle

Injection techniques by each type of nose

Hump (Fig. 17.5)

Short nose and saddle nose (Figs 17.6, 17.7)

Flat nose

Wide nasal base (Fig. 17.7)

Bulbous tip

Plunged tip and inadequate tip projection (Fig. 17.8)

Deviated nose

Concavely or convexly bent nose

Slanted nose (deviation to one side)

Irregular nasal profile on lateral view

Adverse effects

Further reading

18 Cheeks

Introduction

Anatomical and technical considerations when filling the cheeks

Poly-l-lactic acid and hydroxylapatite

Volumizing hyaluronic acid

Sharp cannula approach

Blunt cannula approach

Further reading

19 Perioral filling

Introduction

Anatomical considerations

Ideal filling agents for perioral rejuvenation

Pain management

Injection techniques

Vertical lip lines

Oral commissures

Augmentation of the jaw and chin

Perioral complications

Conclusion

Further reading

20 Lip augmentation

Introduction

The aging process on the lips

An approach to achieving youthful lips

Filler products

Injection techniques for lip rejuvenation

Potential side effects

Conclusion

Further reading

21 Melomental folds

Introduction

Anesthesia

Basic principles for melomental fold correction

Injection strategies for melomental fold correction

Choosing the proper filler

Complications

Adjunctive treatments

Conclusion

Further reading

22 Hands and feet

Introduction

Soft tissue augmentation of the hands

Calcium hydroxylapatite

Poly-l-lactic acid

Fat transplantation

Hyaluronic acid

Soft tissue augmentation of the feet

Further reading

23 Buttocks

Aesthetic characteristics of the buttocks

Gluteal augmentation with fat grafting

Fat preparation for injection

Fat grafting with growth factors

Injection

Correction of gluteal depressions with hyaluronic acid gels

Technical aspects

Conclusion

Further reading

24 Earlobe rejuvenation

Introduction

Anatomy and classification of earlobes

Use of fillers for earlobe rejuvenation

Conclusion

Further reading

25 Tower technique of filler injection

Introduction

Anatomical considerations

Biological characteristics of filler materials

Autologous fat

Hyaluronic acid

Calcium hydroxylapatite

Poly-l-lactic acid

New concepts in injection techniques

The tower technique

Vertical supraperiosteal depot technique

Injection tips and post-treatment recommendations

Conclusion

Further reading

26 Complications of temporary fillers

Introduction

Injection site reactions

Pain

Edema and ecchymosis

Nodules and papules

Inflammation (hypersensitivity reactions)

Infection

Biofilms

Granulomas

Necrosis

Conclusion

Further reading

27 Complications of permanent fillers

Introduction

Products (Box 27.1, Table 27.1)

Silicone

Polyalkylimide gel

Polyacrylamide gels

Polymethylmethacrylate

Acrylic hydrogel plus hyaluronic acid

Treatment sites

Complications

Evaluation methods

Treatment

Conclusion

Further reading

28 Reversers

Introduction

Filler complications

Hyaluronidase

Hyaluronidase in cosmetic dermatology

Available formulations

Injection techniques and dosing

Side effects and precautions

Other enzymatic reversers

Conservative ‘reversers’

Antibiotics, corticosteroids, and 5-fluorouracil

Invasive reversal techniques

Conclusion

Further reading

29 Consent for photography:

Introduction

Photography

Regulation

Fillers used in investigational studies

Medical education, teaching, or publicity

Media photography during filler injections

Telemedicine or internet

Policies

Maintenance of photographs and other images

Disclosure

Liability reduction

Standard of care in negligence actions

Clinical recommendations, guidelines, and policies

Committee records and reports

Innovative / experimental approaches

Establishing negligence

The physician extender

Conclusion

Further reading

30 Pre- and post-treatment photography

Introduction

Technical considerations

Lighting

Color

Printing

Consent

Photography procedure

Makeup

Viewing photographs at follow-up

Further reading

31 Conclusions

How will medical fillers change?

Further reading

Index

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B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

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T

U

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W

X

Y

Z