Faculty Bibliography

Poly-L-lactic acid (PLLA) is a biodegradable, synthetic polymer of L-lactic acid that has been used in a variety of human medical applications for over 40 years. It has recently been approved in the United States for the treatment of HIV-associated facial lipoatrophy. This indication, combined with a European experience that indicates a clinical benefit persisting for up to 2 years, has made PLLA an increasingly popular injectable soft tissue filler in healthy patients. However, controlled clinical studies are necessary to determine whether PLLA benefits healthy patients seeking contour restoration as much as patients seeking treatment for HIV facial lipoatrophy. The present authors reviewed the background and clinical applications of PLLA as treatment for HIV-associated facial lipoatrophy and age-related facial volume loss

BACKGROUND: Cosmetic dermatologic procedures offer the promise of visible aesthetic enhancement with minimal risk. While in recent years the number of available procedures has proliferated, there are few objective methods for evaluating the relative quality of these procedures for particular indications or specific patients. OBJECTIVE: (A) To develop a simple, easy-to-use numerical rating scale to assess the quality of cosmetic surgical procedures on a range of parameters pertaining to clinical efficacy and patient satisfaction; (B) to statistically validate the discriminative value of this rating scale. METHODS: (A) Patient and physician interviews were performed to elicit a list of factors that may collectively characterize the clinical efficacy and patient tolerability of cosmetic dermatologic procedures. A 0-100 point rating scale was developed based on these factors, with the face-validity of this scale checked by a group of patients and physicians; (B) Statistical analysis of the questionnaire was performed by asking 15 expert cosmetic dermatologic surgeons to use it to rate 23 common cosmetic dermatologic procedures, and analyzing the results. RESULTS: (A) An easy-to-use scale was constructed to assess the quality of cosmetic dermatologic procedures by rating the associated cost, risk, time (procedure and recovery), discomfort, results, and longevity of benefit. A 'physician adjustment factor' was used to further increase the relevance of this 0-100 point scale for specific patients; (B) Repeated-measures analysis of variations (ANOVAs) performed on the data from the survey of experts demonstrated that this scale can be used to discriminate between common dermatologic procedures. The differences in mean subscores and total scores among procedures grouped by anatomic site and target lesion-type were significant at the level of P < .05. LIMITATIONS: Patient preferences exogenous to the rating scale may increase or decrease the suitability of specific procedures. CONCLUSIONS: Common cosmetic dermatologic procedures are of uniformly high quality, as per expert ratings on a systematic measure. This quality rating scale appears statistically valid and robust, given that expert raters assigned similar ratings to the same procedures but mean ratings were different across procedures. In the future, this quality rating scale can be used to assess novel interventions, and to help dermatologic surgeons faced with patient concern to optimally select among alternative procedures for a given indication

BACKGROUND: Autologous fat transfer for soft tissue augmentation has been increasing in recent years. Graft longevity may vary greatly from patient to patient, requiring repeat procedures, often using frozen adipose tissue. Storage usually involves placing syringes of fat directly into a -20 degrees C freezer. However, the viability of fat frozen in this way is controversial. OBJECTIVE: This study tested methods for the optimal storage of adipose tissue harvested by tumescent liposuction. MATERIALS AND METHODS: Aliquots of washed adipose tissue were frozen directly at -20 degrees C or mixed with cryoprotectants, frozen at 1 degree C/min, and subsequently stored in liquid nitrogen vapor phase. Aliquots were subsequently thawed, and adipocyte viability was determined by staining and culture methods. RESULTS: Viability of adipocytes frozen at -20 degrees C was very low when analyzed by staining, and no cultures could be established from any of the specimens. In contrast, viable adipocytes were recovered from samples that were controlled-rate frozen in the presence of cryoprotectants and stored in nitrogen vapor. CONCLUSION. Our results indicate that fat frozen at -20 degrees C is not viable and thus provides no advantage over inert fillers. The methods here described could readily be transferred to the clinical setting after further laboratory study

BACKGROUND: Injectable hyaluronic acid was introduced to European markets in 1996 and has demonstrated a high safety profile. We describe the first reported case of angioedema-type hypersensitivity following injection of the upper lip with non-animal-stabilized hyaluronic acid (NASHA) gel. OBJECTIVE: To report a case and discuss a potential mechanism for and treatment of angioedema-type hypersensitivity following injection with NASHA gel into the upper lip. METHODS AND MATERIALS: Not applicable. RESULTS: Not applicable. CONCLUSION: Although injectable hyaluronic acid has a high safety profile, this reaction is dramatic. Treatments and potential mechanisms are discussed

The list of injectable skin fillers available for soft tissue augmentation is constantly growing, giving aesthetic surgeons more options in the treatment of scars, lines, and wrinkles. Each type of filler is distinct with regard to intended use, placement technique, duration in tissue, ease of use, and cost. Physicians who are well acquainted with the strengths and weaknesses of each class of filler will be best equipped to use this rapidly expanding class of agents in serving their patients. The authors review the most commonly used injectable skin fillers and discuss their differences in terms of composition, source (eg, human, animal), intended use, placement technique, tissue duration (nonpermanent, semipermanent, or permanent), side effects, and specific advantages and disadvantages

BACKGROUND: We previously reported that a significant percentage of patients who underwent power liposuction noted an increase in their breast size. OBJECTIVE: To determine whether the documented observation of breast enlargement after power liposuction also occurs after traditional liposuction. METHODS: Charts were retrospectively reviewed and patient interviews were conducted for 70 female patients who had traditional liposuction. Analyses were made based on several factors, including age, pre- and postoperative weight, total fat aspirate volume, treated body areas, and hormonal medications for patients who did and did not have breast enlargement. These results were then compared with patients who experienced an increase in breast size after power, liposuction. RESULTS: Thirty-seven percent of the study patients (26 of 70) undergoing traditional liposuction reported an increase in breast size. Sixty-five percent of these women (17 of 26) reported an increase of one or more cup sizes. Larger fat aspirate volumes and liposuction of the abdomen and hip or abdomen, hip, and thigh areas were factors associated with the patients who noted breast enlargement after traditional liposuction. CONCLUSIONS: An increase in breast size was reported in 37% of patients after traditional liposuction and in 34% of patients after power liposuction. We conclude that breast enlargement after both traditional and power liposuction is not related to the mechanical effects of power liposuction. We propose the same hypothesis reported in our previous study that an altered androgen to estrogen ratio after liposuction is likely responsible for this noted occurrence. Weight gain may also be a factor