Chapter 89 – Non-Surgical Rejuvenation of the Aging Face

Minimally invasive procedures include the injection of neuromodulators and soft tissue fillers, and skin resurfacing procedures such as chemical peels and laser skin resurfacing. The three most common unintended muscle weaknesses observed from the facial cosmetic use of Botulinum Toxin Therapy-A are lid ptosis, brow droop, and lip droop. Soft tissue filler materials have been used for years for cosmetic purposes and represent one of the fastest growing areas within facial cosmetic practices. The most common adverse effects of cosmetic neurotoxins are mild and transient, and many are related to the injection itself rather than the toxin. Silicone has been used for multiple areas of the body and in different formulations, and it continues to be used as facial cosmetic filler. Because it has excellent flow properties, is thought to have a “natural” feel, and is long-lasting. Erythema can easily be treated with topical corticosteroids, emollients, sun protection with hats and sunscreens, and cosmetic camouflage. 

Minimally Invasive Cosmetic Facial Surgery

BACKGROUND Injection of filler materials into the dermis is well tolerated with few mild and transient side effects. Injection necrosis is a rare but clinically important potential complication caused by interruption of the vascular supply to the area by compression, injury, and/or obstruction of the vessel(s). The glabella is a particular danger zone for injection necrosis regardless of the type of filler used. OBJECTIVE We recommend a protocol that may be used to help prevent and treat injection necrosis of the glabella after injection with dermal fillers. CONCLUSION Injection necrosis in the glabellar region may be prevented by a knowledge of the local anatomy and an understanding of its pathophysiology and treated by a suggested protocol.

Injection Necrosis of the Glabella

Dermal soft-tissue augmentation using a filler is a technique widely used for facial cosmetic enhancement. However, potential complications following facial cosmetic injections have heightened the possibility of iatrogenic visual loss. We report two cases of severe ocular complications after nasal cosmetic enhancement. Both cases had poor visual outcomes in spite of emergency management. The second patient is a rare case with bilateral anterior ischemic optic neuropathy after dermal soft-tissue augmentation. The visual outcome was correlated with the location and the extent of the arterial embolization. Unfortunately, there is still no standard treatment protocol for vision-threatening complications. Clinicians should always keep in mind that embolic arterial occlusion may occur after augmentation.

Severe ocular complications following facial calcium hydroxylapatite injections: Two case reports

Avoiding the “Danger Zones” When Injecting Dermal Fillers and Volume Enhancers

SIR, A 40-year-old man reported the slow progressive appearance, during the previous 6 years, of pruritic erythematous lesions on the trunk, buttock, abdomen, axilla, genital area and forearm (Fig. 1a). Lesions consisted of follicular papules, comedones, milia and cysts. Lesional areas were alopecic (Fig. 1b), and diffuse alopecia was also present on the scalp and beard area, along with comedones and cysts. The patient reported severe skin dryness, especially in the involved areas. No impairment of salivary or lacrimary function was noted. Serological and haematological tests were all normal or negative. Because of the diffuse presence of cysts and comedones, a diagnosis of chloracne had been made in another institution; the clinical diagnosis was confirmed histologically by the presence of infundibular cysts and a granulomatous foreign body reaction to keratin scales. A further biopsy was performed: the most striking histological feature was a lymphocytic infiltrate involving eccrine glands and coils along with a characteristic epithelial hyperplasia (Figs 1c,d). This picture fits perfectly with that reported in the literature as being characteristic of syringolymphoid hyperplasia, also known as syringotropic mycosis fungoides or syringotropic cutaneous T-cell lymphoma (CTCL). The hair follicles were involved by the lymphocytic infiltrate in a manner similar to that of the eccrine glands. Follicles were surrounded by a dense lymphocytic infiltrate, with extensive exocytosis. Occasional Pautrier microabscesses were evident in the follicular sheath. This pattern is that of pilotropic mycosis fungoides, a form of folliculotropic CTCL. Many follicles were entirely trans-

Arterial embolization caused by injection of hyaluronic acid (Restylane): reply from authors

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Arterial embolization caused by injection of hyaluronic acid (Restylane): reply from authors