Faculty Bibliography

There are a multitude of uses for BoNT in the aesthetic realm. Efficacy has been shown in softening glabellar creases, crows feet, forehead rhytides, and in correcting facial asymmetries, including mild eyelid ptosis. Facial shape can be altered through injections of BoNT into masseter, and smiles can be altered with BoNT. Clinical examples of the above will be shown, as well as adverse outcomes with inaccurate injection techniques.

BACKGROUND: Various scoring techniques prone to subjective interpretation have been used to evaluate soft tissue augmentation of nasolabial folds (NLFs). OBJECTIVE: To design and validate a reliable wrinkle assessment scoring scale. MATERIALS AND METHODS: Six photographed wrinkles of varying severity were electronically copied onto the same facial image to become a 6-point grading scale (GGS). A pilot training program (13 investigators) determined reliability, and a 12-week multicenter survey study validated the GGS scoring method. RESULTS: Pilot study inter- and intrarater scoring reliability were high (weighted kappa scores of 0.85 and 0.86, respectively). Seventy-five percent of survey investigators and independent review panel (IRP) members considered a GGS score difference of 0.5 to be a minimally perceivable difference. Interrater weighted kappa scores were 0.91 for the IRP and 0.80 for investigators. Intrarater agreements after repeat testing were 0.91 and 0.89, respectively. The baseline "live" assessment GGS mean score was 3.34, and the baseline blinded photographic assessment GGS mean score was 2.00 for the IRP and 2.16 for the investigators. CONCLUSIONS: The GGS is a reproducible method of grading the severity of NLF wrinkles. Treatment effectiveness of a dermal filler can be reliably evaluated using the GGS by comparing "live" assessments with the standard GGS photographic panel.

Periorbital hyperpigmentation is a generally benign, extremely common condition that is notoriously resistant to treatment. According to the author, the key to successful treatment is determining the primary cause and complying with maintenance and preventive regimens. A multimodal approach may be required, encompassing topical bleaching agents, chemical peels, laser therapy, and/or surgery.

This article discusses the various over-the-counter and prescription products available to help improve sun-damaged skin, as well as superficial peeling agents. Practical suggestions for treating patients are given

Evaluation of the aging face reveals many changes such as lentigines, coarseness, senile purpura, and fine lines that can be blamed primarily on photoaging. There are many topical preparations that are now being used or are under investigation for facial rejuvenation. These include retinold creams, alpha-hydroxy acids, Ethocyn (Chantal Skin Care Corp, Los Angeles, CA), topical vitamins, and topical hormonal treatments. There has been substantial media attention devoted to these 'antiaging' cures but there is a lack of scientific evidence to support some of these claims. After review of these agents, a practical approach to the patient requesting younger-looking skin is presented

Alstroemeria (Peruvian or Inca lily) has found particular favor because of its beauty and durability. However, it may induce a dermatitis so severe that workers have to change jobs. The dermatitis is chronic, with fissuring at the tips of the fingers bilaterally. Itching is often a less prominent symptom. Preventative measures are of little benefit, and many floral shops are vanishing the plant