Hyaluronic Acid for Facial Paralysis

Lip filler hyaluronic acid may be useful for people with facial paralysis.

In an interesting use case for the fillers in use at every cosmetic clinic,... A small research study conducted at the Johns Hopkins and Stanford universities reveal that aside from hyaluronic acid's use in cosmetic surgery, it may be useful for patients who struggle with drooling, eating, and drinking because of lack of lip control due to facial paralysis.

According to Kofi Boahene, M.D., a facial plastic and reconstructive surgeon in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine, facial paralysis causes both both physical and psychological problems among patients making them self-conscious about how they look.

Boahane has used the analogy of a plant filling its leaves and stems with water to maintain structure. He says that

It’s a crude analogy, but injecting the lips with hyaluronic acid works in much the same way. It tones the tissue surrounding the muscle.

Boahene was working on a patient with then-undiagnosed case of muscular dystrophy when he had his own eureka moment. He stumbled across a possible role for hyaluronic acid injection to improve a patient's lip muscle tone. After trying the injection, the patient's face appeared stronger and her articulation improved.

Boahene and his collaborators tested 22 more patients with facial paralysis. His team got the participants' baseline measure of lip tone and the weakest points were identified by having them blow air with pursed lips. The researchers injected hyaluronic acid at the point where the air escaped.

After the procedure, he said that the patients showed marked improvement as confirmed by a speech therapist who conducted the assessment. Boahene further adds that the injection may last up to a year when done for cosmetic improvement.

Because lip augmentation and injection is a minimally invasive procedure, a plastic surgeon or dermatologist may perform such procedures. However, Boahene mentions that it is advised that the lip injectionsbe done by physicians who are experienced with treating muscle weaknesses and facial paralysis.

Read more on:

http://ictr.johnshopkins.edu/news_announce/cosmetic-surgery-drug-to-treat-facial-paralysis/

I Want To Be A Fibroblast!

What criteria is most important when choosing a treatment or technology to stimulate fibroblasts for skin rejuvenation?

Being a dermatologist focused on aesthetic treatment options for improving skin's condition  it's quality and overall appearance – I clinically and scientifically overlook tons of different approaches.

Basically, and I think we can agree on this, many treatments try to target the fibroblast. Its about the stimulation of this branched tissue cell who's function is to maintain the structural integrity of connective tissues by continously secreting precursors of the extracellular matrix such as ground substance, a variety of fibers notably the reticular and elastic ones and cytokines.

The goal in many skin rejuvenation treatments is to activate and stimulate the fibroblasts... and there are countless strategies to do this: You might choose chemical peels, energy based devices such as non-fractionated or fractionated resurfacing lasers, intense pulsed light (IPL), infrared light or radiofrequency. One might think of dermal filler substances such as hyaluronic acid or – better – calciumhydroxylapatite (there are even publications on a stimulating effect botulinum toxin type a...). Further one might consider microneedling, dermabrasion, etc..

Or think about "newer" technologies such as platelet rich plasma, carboxytherapy, nitrogen plasma energy, kinetic HA (kinetic Hyaluronic Acid). And last but not least cosmeceuticals (this list is not exhaustive!!).

Which strategy to choose? It's actually very difficult to find way through this jungle!

I would like to encourage and activate the discussion here and ask for your opinion: What are the most important criteria for you when you do your choice? Is it about mangeability, about downtime, about scientific proof, about safety, about treatment protocols (such as e.g. multiple treatments), about clinical experience of other physicians, about availability, about the learning curve, about the deligability, about the costs?

What's your decision maker here?

5 Years Of Good Experiences With Artefill (PolyMethylMethacrylate)

I've been using Artefill for volume with good results for the last 5 years.

On a recent chart and procedure review, I looked critically at the use of fillers in my practice over the past 5 years. I use HA's (Hyaluronic Acids) mainly for lips; some Sculptra (activator) for volume in thicker facial tissues; lots of Radiesse-everywhere except the lips; some PRP and an increasing amount of Artefill (except for lips) to take care of patients suffering from both "filler injection fatigue" and significant volume loss.

As part of a regieme of (re)creating Beauty using the CT3+V=Beauty, Color Correction, Texture, Tightness, Tone + Volume, VOLUME is a key player for rejuvenating the facial shape and contours, putting the skin on stretch-which restores texture, tone and luster, and is often more economical (social down time and real money) for patients with less risk. When coupled with smaller lifts, blephs and various resurfacing, the overall result is synergystic, less traumatic, equally dramatic and probably more rejuvenating than any other single element taken to it's maximal benefit alone.

It is illegal to inject silicon for aesthetic use in Nevada, so Artefill is my only choice for "permanent" revolumization. Interestingly, when I discovered how well my early Artefill patients were doing, I started using even more of the product and pricing it aggressively so that patients could afford to get significant corrections with 6 to 12 syringes. Overall, it ends up being less expensive for the patient than what they spend on restoring volume with temporary gels.

We have patients out nearly 5 years, who have maintained good correction from their initial injections with this FDA approved version of poly-methyl methacrylate. While the FDA approval of this filler is for correction of nasolabial folds, I have used it off label all over the face, the dorsal hands, for horizontal necklace lines and depressed scars.  I have learned from other talented physicians, the techniques of deeper, comfortable injections that lead to significant permanent correction of temple, peri-orbital, glabellar, zygomatic, malar and "tear trough" volume. More deflated patients have avoided rhytidectomy by using up to 20 syringes. My own 56 year old, jolly cheeks enjoy 6 syringes of this material done over a year ago. My wife, though a Grandma, appears more than a decade younger than her stated age. She is a walking example of combining modalities without major surgery and a great educator for my patients.

Perhaps physicians are rightfully afraid of long lasting/permanent fillers considering the horror stories of previous products. However, any laser or scalpel carries the risk of permanent poor aesthetic outcome. And this ain't your traditional, poorly tested filler. It's got data approaching 10 years outside the US which is devoid of serious complication. The risks that do show up with this filler are generally avoided with good technique. Last year, I shot nearly 600 syringes of Artefill without any unexpected issues-just some bruising and discomfort. No granulomas, lasting nodules, sloughs, Tyndell Effect or infections... ever, so far.

So maybe the well trained hand, wielded by an artful and educated physician in the service of the well educated patient is a mitzvah (a good and honorable deed). After all, what patient enjoys quarterly mammograms or DRE's, anymore than the patient who comes to the office every 3 to 6 months to maintain their lip and tear trough filler?

Lasting corrections, done conservatively, with safe, evidence based products, should be more widely offered and utilized. They benefit select patients by allowing them the chance to (re)build their volume once and maintain it, rather than recreate it over and over. They still top off the small volume we all continue to lose, but they now find other services in the practice to utilize because they are so happy with their Artefill results.

I know I am.