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Introduction to Permanent Fillers: Pros and Cons

Summary and Key Features Permanent fillers are materials composed of nonabsorbable or permanent materials. These agents can provide long-lasting results but carry more potential risk. Polymethylmethacrylate and liquid injectable silicone are the only currently available permanent fillers available in the United States. Nonbiodegradable fillers can achieve full and long-lasting correction but carry the risk of permanent adverse effects. Introduction In the past 15 years, there has…

Autologous Fat

Summary and Key Features Autologous fat is an ideal filler that provides patients with long-lasting revolumization. With proper patient assessment, planning, and treatment, facial augmentation provides a safe means to restore the youthful contours of the face. The use of autologous nanofat, microfat, and stromal vascular fraction in small grafts placed strategically throughout the soft tissue planes of the face stimulates ongoing regeneration of facial texture,…

Emervel Family (Now as Restylane Optimal Balance Technology Line Part of the Restylane Family)

Summary and Key Features In 2016, the Emervel family has been renamed Restylane to fit better in the portfolio of Galderma. Because of the unique optimal balance technology (OBT), it is different from the other Restylane fillers. The Emervel family can be still identified by the blue color of the boxes and brand names with an “e” at the end. The previous name appears as small…

Poly-L-Lactic Acid

Summary and Key Features Gradual, subtle, and natural results with a long duration (> 2 years) are achievable with poly-L-lactic acid (PLLA). Thorough facial analysis of changes in all structural tissues will enhance site-specific augmentation of volume loss and enhance outcomes. PLLA has been increasingly used off label for soft tissue augmentation and improvement of skin laxity in a number of off-face areas, including décolleté, arms,…

Calcium Hydroxylapatite Ultradilute, HA Dilution

Introduction Calcium hydroxylapatite (CaHA; Radiesse, Merz North America, Raleigh, NC) is an opaque, white-colored filler consisting of CaHA microspheres (25–45 μm in diameter) suspended in an aqueous carboxymethylcellulose carrier gel. The synthetic CaHA microspheres are smooth in shape, uniform in size, and composed of minerals (calcium and phosphate) that occur naturally in human bone and teeth, making them physiologically inert and biocompatible. The particles are resorbed…

Resilient Hyaluronic Acid (RHA®) Fillers

RHA Basic Science and Manufacturing Resilient Hyaluronic Acid (RHA) is the name given to a collection of hyaluronic acid (HA) products manufactured by Teoxane SA (Geneva, Switzerland) and marketed in the United States by Revance Therapeutics Inc. (Nashville, TN, USA). First introduced to the European market in 2015, the RHA gels were designed to address the current and future needs of health care practitioners and consumers.…

The Belotero Family

Summary and Key Features Belotero is a commonly used group of hyaluronic acid fillers. It is cross-linked with 1,4-butanediol diglycidyl ether (BDDE), forming a cohesive and polydensified matrix (CPM). There are several products of various thicknesses in the Belotero line, some with and others without lidocaine. These include Belotero Volume, Intense, Balance, and Soft. Good clinical data (e.g., data from at least one randomized controlled trial)…

Juvéderm Family

Summary and Key Features The Juvéderm family of fillers comprises a collection of commercially available hyaluronic acid fillers that utilize proprietary cross-linking technology designated as Hylacross and Vycross. The Hylacross collection includes Juvéderm Ultra and Juvéderm Ultra Plus. The Hylacross fillers are homogenous smooth gels distinguished by their adequate lifting capacity and durability. The Vycross collection includes Juvéderm Voluma, Juvéderm Vollure, Juvéderm Volbella, Juvéderm Volite, and…

Restylane Filler Product Family

Summary and Key Features The Restylane filler family is a safe, reliable class of injectable fillers that have low potential for allergic response. These fillers are not permanent and thus ideal to use for treatment-naïve patients and for injectors of all levels because they can be easily dissolved with hyaluronidase. The type of injection technique selected should be based on anatomic site and on injector skill.…

Introduction to Temporary Fillers: Pros and Cons

Summary and Key Features Temporary fillers are composed of biodegradable materials, including hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid. The physical properties of temporary fillers vary and subsequently can have substantially different aesthetic applications. These uses of temporary fillers have expanded beyond their initial introduction as rhytid-reducing products. The numerous pros of temporary fillers readily outweigh the cons, explaining their emergence and widespread popularity among consumers.…

Facial Beauty and the Central Role of Volume

Summary and Key Features Attractiveness appreciation is an innate human skill involving all the senses. Volume is important in many of the indicators of youth, maturity, attractiveness, symmetry, and gender differentiation. Bone and dentition resorb with age. Most major retaining ligaments induce deep facial grooves, as the face cascades forward and rotates inward with age. Facial fat compartments have deep and superficial elements, with the deeper…

Complications and Legal Considerations of Laser, Light, and Energy-Based Treatments

Summary and Key Features Various energy-based devices in dermatology, their complications, and means to prevent them. Legal and professional considerations including what constitutes an informed consent and the value of such consent when legal action is taken. Data on medical professional liability against dermatologists. Act of negligence and the legal consequences arising from that. Introduction The applications of energy-based devices have been expanding at steadily increasing…

Treatment of Acne With Light and Energy-Based Devices

Summary of Key Features Around 85% of 12- to 24-year olds are affected by acne, while many patients continue to struggle with acne even into adulthood. Acne is extremely frustrating for patients and causes depression and anxiety, poor self image, as well as, lasting physical scarring. Many patients struggle to achieve long lasting results with standard acne therapy which makes lasers and lights an important modality…

Laser Treatment of Ethnic Skin

Summary of Key Features The use of lasers, lights and devices can be safe and effective in ethnic skin. Sun protection pre- and posttreatment, together with the use of bleaching agents and topical corticosteroids, may reduce the risks of postinflammatory hyperpigmentation. For patients undergoing laser treatment for melasma, sun protection is essential to disease management. Lasers and light sources with longer wavelengths target dermal pigmentation and…

Radiofrequency Microneedling

Summary and Key Features Radiofrequency microneedling is a minimally invasive modality that creates perforations in the skin and delivers radiofrequency-generated thermal energy into the underlying tissue The perforations created by microneedles improve transcutaneous absorption of topical products and transcutaneous elimination of skin debris The mechanical and thermal effects of radiofrequency microneedling cause dermal coagulation, collagen remodeling, and neoelastogenesis via a wound-healing response Dermatologic conditions with numerous…

Muscle Toning and Contouring

Summary and Key Features Enhancement of muscular tone is a new frontier in noninvasive body contouring, with both cosmetic and functional implications. Treatment of the muscle must be always considered in context with the overlying adipose layer—an excess amount of adipose will reduce or obscure the cosmetic effect of treatment. Electromagnetic muscle stimulation (EMMS) utilizes electromagnetic muscle induction to stimulate motor nerves and induce repetitive and…

Nonsurgical Body Contouring of Fat

Summary and Key Features Given the dramatic rise of obesity and the obsession with losing weight and improving appearance, the treatment of fat and cellulite is a common cosmetic issue. Excess fat and cellulite are distinct entities. Cellulite is best considered a hormonally based structural phenomenon of adipocytes and fibrous septae, whereas excess fat is an overabundance of normal adipocytes. The treatment options for excess fat…

Ablative Laser Skin Resurfacing

Summary and Key Features Ablative laser resurfacing has long been a very popular cosmetic procedure. A variety of carbon dioxide, erbium:yttrium-aluminum-garnet, and yttrium-scandium-gallium-garnet lasers are included in the category of ablative lasers. “Full-field” means 100% of the treated area is removed to the selected depth. Fractional means discontinuous portions of the treated area are removed in columns. Hybrid fractional lasers are a combination of ablative and…