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PubMed2002

Botulinum toxin A: successful décolleté rejuvenation.

BACKGROUND: Décolleté wrinkles develop with age. In women more than 35 years of age these wrinkles are still transient, but become permanent at about age 50. In a substantial number of women décolleté wrinkles, seem to be associated with an insertion of platysma exceeding the second intercostal space. We report botulinum A toxin therapy of these wrinkles in five patients. OBJECTIVE: To show the effect of botulinum A toxin on décolleté wrinkles. METHODS: All five women with décolleté lines treated with botulinum A had different varieties of the platysma muscle inserting deep down beneath the fourth intercostal space. During platysma contraction injection points were marked and a certain dosage of toxin was applied. RESULTS: Two weeks after therapy a significant improvement of the treated décolleté region was observed. CONCLUSION: These observations indicated that botulinum A toxin can be an effective and safe method in the temporary management of décolleté wrinkles. It should therefore be considered as a new adjuvant treatment in cosmetic décolleté rejuvenation.

Botulinum Toxins, Type A↗
PubMedDate not supplied

Acid-citrate-dextrose-phosphoenolpyruvate medium as a rejuvenant for blood storage.

Stored, depleted RBC were rejuvenated with respect to their levels of adenosine triphosphate (ATP), 2,3-diphosphoglycerate (2,3-DPG), and P50 by acid-citrate-dextrose perservatives containing phosphoenolpyruvate (PEP) without sucrose. The restorations of P50 and 2,3-DPG were dependent on the phosphoenolpyruvate concentration. Erythrocyte P50 and 2,3-DPG, even after treatment with these preservatives, decreased with increasing storage period, but the P50 and 2,3-DPG of five-week-old blood were still higher than the corresponding values of fresh blood. ATP concentration was also increased by treating stored blood with preservatives containing phosphoenolpyruvate, but the elevated ATP of five-week-old blood was only about 50 percent of fresh blood. The ATP level could not be raised further by increasing phosphoenolpyruvate concentration but was improved by supplementation with adenine and nucleosides. Incubation of stored blood with 15 mM phosphoenolpyruvate was sufficient to restore ATP, 2,3-DPG and P50 of three-week-old blood to nearly normal. The results of these studies indicate that sucrose is not necessary for PEP to be effective as a preservative additive.

2,3-Diphosphoglycerate↗
PubMedDate not supplied

The 24-hour posttransfusion survival, oxygen transport function, and residual hemolysis of human outdated-rejuvenated red cell concentrates after washing and storage at 4 degrees C for 24 to 72 hours.

Red cell concentrates with hematocrit values of 80 +/- 5 percent were stored at 4 degrees C either in citrate-phosphate-dextrose for 22 to 28 days or in citrate-phosphate-dextrose-adenine-one for 35 to 39 days. After storage, the red cells had reduced 2,3-diphosphoglycerate and adenosine triphosphate levels, and biochemical treatment with a solution called PIPA was used to restore these levels. The red cells were not preserved further, but instead were washed after rejuvenation with an unbuffered sodium chloride-glucose solution, pH 5.0, for in vivo studies, and with a buffered sodium chloride-glucose-phosphate solution, pH 6.8, for comparative in vitro studies. The red cells were stored in the wash solution at 4 degrees C for 72 hours after washing. Red cell recovery after washing was about 95 percent. Twenty-four-hour posttransfusion survival value was about 80 percent, and the index of therapeutic effectiveness was greater than 75 percent. These biochemically modified washed red cells exhibited higher than normal P50 values, even after 3 days of postwash storage at 4 degrees C. The units that were washed with the sodium chloride-glucose solution with a pH of 5.0 exhibited a greater degree of hemolysis after 3 days of postwash storage at 4 degrees C than did the units that were washed with the sodium chloride-glucose-phosphate solution with a pH of 6.8.(ABSTRACT TRUNCATED AT 250 WORDS)

2,3-Diphosphoglycerate↗
PubMed2002

Combination visible and infrared lasers for skin rejuvenation.

Noninvasive techniques for skin rejuvenation are quickly being established as a new standard in the treatment of mild rhytides and overall skin toning. Multiple laser wavelengths and modalities have been tried for this procedure with varying degrees of success. These lasers include 532 nm, 585 nm, 1064 nm, 1320 nm, 1450 nm, and 1540 nm wavelengths. This study evaluates a combination technique by using a long-pulsed 532 nm potassium titanyl phosphate (KTP) laser and a long-pulsed 1064 nm Neodynium:yttrium aluminum garnet (Nd:YAG) laser, both separately and combined, for noninvasive photorejuvenation and skin toning/collagen enhancement, and establishes efficacy and degree of success. A total of 150 patients were treated with the long-pulsed KTP 532 nm (Aura; Laserscope, San Jose, CA) and long-pulsed Nd:YAG 1064 nm (Lyra; Laserscope) lasers both separately and combined. Patients included skin types I through V. The fluences varied between 7 and 15 J/cm2 at 7 to 20 ms pulse duration with a 2-mm handpiece, and 6 to 15 J/cm2 and 30 to 50 ms with a 4-mm handpiece for KTP. The Nd:YAG fluences were set at 24 to 30 J/cm2 for a 10-mm handpiece and 30 J/cm2 for a SmartScan Plus scanner (Laserscope, San Jose, CA). These energies were delivered at 30 to 65 ms pulse durations. All patients were treated at least 3 times and at most 6 times at monthly intervals, and were observed for up to 18 months after the last treatment. All 150 patients exhibited a mild to moderate degree of improvement in the appearance of rhytides, moderate degree of improvement in skin toning and texture, and great improvement in the reduction of redness and pigmentation. The KTP used alone was superior to the Nd:YAG laser in terms of results. The KTP and Nd:YAG laser combination was superior to either laser used alone.

Adult↗
PubMed2003

Midfacial rejuvenation via an endoscopic browlift approach: a review of technique.

The middle third of the face has remained a particularly challenging area for facial plastic surgeons to rejuvenate. Many approaches have been advocated, but no one favored technique predominates. The surgical technique of the senior author is reviewed, which has been successfully employed for the past 7 years and which has proven an effective technique in restoring midfacial youth without concomitant lateral-canthal distortion or significant morbidity. The intended objectives of this article are for the reader to understand the specific details of how to perform this technique and the rationale proposed for how a natural midface elevation is achieved by this method.

Endoscopy↗
PubMed2003

Transblepharoplasty: subperiosteal approach to rejuvenation of the aging midface.

Multiple approaches are available to rejuvenate the aging midface. Our preferred technique is a graduated transblepharoplasty approach beginning with lower blepharoplasty with or without orbital fat repositioning and progressing to a subperiosteal midface lift, guided by the extent of aging changes present in the midface. In this article we discuss the rationale for this method and describe the preoperative analysis, relevant anatomy, surgical technique, postoperative considerations, and complications associated with each technique. Case examples are provided to illustrate major concepts.

Blepharoplasty↗
PubMed2003

Rejuvenation of the midface.

Mid-face rejuvenation has long been a difficult area for aesthetic facial surgeons. In this article the author reviews the techniques currently available and examines in-depth two techniques that he feels are noteworthy for their efficacy in improving mid-face aging. One of these techniques is the "SMAS division mid-face lift" which targets aging of the mid-face associated with a deep nasolabial fold. The other technique is known as a "SOOF lift blepharoplasty" and helps to improve aging of the lower lid associated with a tear trough deformity. Facial aesthetic surgeons should gain a better appreciation of the approaches available for improving this challenging area after digesting the contents of this review article.

Endoscopy↗
PubMed1992

The potential rejuvenation of American naturopathy as a consequence of the holistic health movement.

Naturopathy is a heterodox professionalized medical system which, in contrast to osteopathy and chiropractic, has received little attention from social scientists, particularly in the United States. This article is an attempt to correct that situation. It focuses on the history of this healing tradition by discussing three stages in the development of American naturopathy: 1) its emergence around the turn of the century; 2) its decline beginning in the late 1930s; and 3) its recent potential rejuvenation, particularly in the Pacific Northwest. The essay concludes that as a consequence of its philosophical and therapeutic eclecticism, naturopathy found itself pre-adapted to the holistic health movement that emerged in American society during the 1970s.

History, 19th Century↗
PubMed1981

Age-related decline in brain stimulation reward: rejuvenation by amphetamine.

A decline in a brain stimulation reward responding occurred in rats 15-20 months of age. These animals had platinum bipolar electrodes implanted in the lateral hypothalamus-medial forebrain bundle area of the brain at 6 months and were vigorous and reliable responders after implantation. The decline in behavior was demonstrated by a decrease in rate of lever-presses, increase in impedance to the stimulating current and failure to complete reward threshold determination procedures. Priming, increased current, food deprivation, and reshaping were generally ineffective individually or in combination. A single low dose (0.25-0.30 mg/kg) of d-amphetamine 5 to 30 minutes prior to session reinstated BSR behavior in the aged rats; although threshold and impedance were higher than 6-8 month values and priming and reshaping were required in some cases. Rate of response was unchanged. Unexpectedly, all rats showed improved performances in at least two subsequent sessions without further amphetamine. These data are discussed from the perspective of brain neurochemistry and possibility that such manipulation had a rejuvenating effect on declining neurotransmitter systems, particularly dopamine.

Aging↗
PubMed2002

Telomerase activation and rejuvenation of telomere length in stimulated T cells derived from serially transplanted hematopoietic stem cells.

Telomeres shorten in hematopoietic cells, including hematopoietic stem cells (HSCs), during aging and after transplantation, despite the presence of readily detectable levels of telomerase in these cells. In T cells, antigenic stimulation has been shown to result in a marked increase in the level of telomerase activity. We now show that stimulation of T cells derived from serially transplanted HSC results in a telomerase-dependent elongation of telomere length to a size similar to that observed in T cells isolated directly from young mice. Southern analysis of telomere length in resting and anti-CD3/CD28 stimulated donor-derived splenic T cells revealed an increase in telomere size by approximately 7 kb for the population as a whole. Stimulation of donor-derived T cells from recipients of HSCs from telomerase-deficient mice did not result in regeneration of telomere length, demonstrating a dependence on telomerase. Furthermore, clonal anti-CD3/CD28 stimulation of donor-derived T cells followed by fluorescent in situ hybridization (FISH) analysis of telomeric signal intensity showed that telomeres had increased in size by approximately 50% for all clonal expansions. Together, these results imply that one role for telomerase in T cells may be to renew or extend replicative potential via the rejuvenation of telomere length.

Animals↗
PubMed2006

Intradiscal injection of hematopoietic stem cells in an attempt to rejuvenate the intervertebral discs.

This study is a prospective analysis of 10 patients who underwent intradiscal injection of hematopoietic precursor stem cells (HSCs) obtained from their pelvic bone marrow in an attempt to rejuvenate the disc. Several studies in animals express the ability to regrow disc tissue with possible regenerative effects. No human studies have been done to date. Patients were randomly offered the option of this study, and ten patients with confirmed disc pain via provocative discograms underwent intradiscal HSC injections. After the intradiscal injection of HSCs, all of the patients underwent a 2-week course of hyperbaric oxygen therapy. These patients were followed up at 6- and 12- month intervals to determine their degree of pain relief from this procedure. Of the 10 patients, none achieved any improvement of their discogenic low back pain after 1 year. In conclusion, although animal studies suggest possible regeneration of disc via HSC injections, living human studies reveal that this effect does not correlate with reduced pain, and thus intradiscal HSC injection appears to be of little value.

Adult↗
PubMed2006

Mechanistic insights into targeting T cell membrane proteinase to promote islet beta-cell rejuvenation in type 1 diabetes.

It has been well established that invasion-promoting membrane type-1 matrix metalloproteinase (MT1-MMP), a multifunctional membrane-tethered enzyme, functions in cancer cells as a mediator of pericellular proteolysis and directly cleaves several cell surface receptors, including CD44. In this report, we confirm that adhesion of diabetogenic T cells promotes the activation of endogenous MT1-MMP. Activated protease then cleaves CD44 in adherent T cells. We have validated that the T cell CD44 receptor is critical for the adhesion of diabetogenic insulin-specific, CD8-positive, K(d)-restricted cells to the matrix as well as for the subsequent transmigration of the adherent T cells through the endothelium and homing of the transmigrated T cells into the pancreatic islets. We have determined that the inhibition of MT1-MMP by low dosages of AG3340 (a subnanomolar range hydroxamate inhibitor of MMPs that has been widely tested in cancer patients) inhibited both T cell MT1-MMP activity and MT1-MMP-dependent shedding of CD44, immobilized T cells on the endothelium, repressed the homing of diabetogenic T cells into the pancreatic islets, reduced insulitis and mononuclear cell infiltration, and promoted either the recovery or the rejuvenation of the functional insulin-producing beta cells in diabetic NOD mice with freshly developed type I diabetes (IDDM). We believe our data constitute a mechanistic and substantive rationale for clinical trials of selected MT1-MMP inhibitors in the therapy of IDDM in humans.

Animals↗
PubMed1996

Transblepharoplasty forehead lift and upper face rejuvenation.

A complete upper face rejuvenation via blepharoplasty incisions is feasible. This technique is indicated in: (1) patients with male pattern baldness, (2) patients with a history of hair transplants, (3) patients with excessively high foreheads, (4) patients in which upper blepharoplasty is planned simultaneously with the brow lift, (5) patients with spastic frontalis syndrome, and (6) patients needing periorbital or bicularis muscle repositioning. Standard upper blepharoplasty incisions are made. Dissection is proceeded to the superior orbital rim. All the soft tissues, including the retro-orbicularis oculi fat (ROOF) pad, are elevated. A cuff of periosteum and the overlying subgaleal fascia is left. Superior dissection in the frontal area can proceed subgaleally or sub-periosteally. In the latter case, the periosteum is entered about 1.5 cm above the orbital rim. In the temporal area, dissection is done in the subgaleal plane up to 1 cm above the zygomatic arch. This dissection is accurately and safely done with the aid of the endoscope introduced through the same incision. Resection of the procerus and corrugator muscles is performed via the eyelid incision, identifying and protecting the supratrochlear and supraorbital nerves. Extra-fine-tip cautery is used for hemostasis. Initial fixation consists of suturing the ROOF pad to the periosteum of the orbital rim (two sutures). The tail of the brow is sutured to the temporal fascia (third suture). The frontotemporal flap can be stabilized in an elevated position with an external tied-over dressing, percutaneous screws, or well-supportive contouring tape, depending on the clinical situation. The eyelids are closed in a standard fashion. This operation was performed on 14 patients--12 with the assistance of the endoscope and in 2 without the endoscope. However, the endoscope has made the operation more precise. Analysis of the brow position, frontalis and corrugator activity, and the aesthetics of the upper face reveal that this operation can give results similar to other techniques with comparable morbidity, more expeditiously and with fewer scars.

Adult↗
PubMed1996

Classification of facial rejuvenation techniques based on the subperiosteal approach and ancillary procedures.

Subperiosteal face lift is a new way of doing facial rejuvenation. There are multiple variations of technique described by several authors. Each variable introduced to the technique may be relevant to the final outcome and potential safety or complications. The most important variables are extent of dissection, combination of the subperiosteal dissection with other planes of dissection, suspension methods, and use of ancillary techniques. A systematic classification of techniques in which a lesser or greater subperiosteal dissection is made has been devised. Each technique is individualized and differentiated from seemingly alike techniques. A list of ancillary techniques is included. This classification is useful for facial evaluation and preoperative planning. A surgical proposal is made individualizing each patient's facial aesthetics rather than giving one type of operation to every patient. This classification is also useful for comparison and analysis of surgical results obtained with different techniques. It has the versatility of adding new variations and any ancillary technique adapted to the surgeon's idiosyncrasy. It can be used as a model to develop a classification of traditional face lift techniques.

Dermabrasion↗
PubMed1996

A dynamic analysis of changes in the nasolabial fold using magnetic resonance imaging: implications for facial rejuvenation and facial animation surgery.

An anatomic study was performed on living subjects using magnetic resonance imaging (MRI) to distinguish the relative contribution of skin, subcutaneous tissue, and muscle to dynamic changes in the nasolabial fold during facial animation and aging. MRI scans with the face in repose and then holding a full smile were performed in both young and old adult subjects. Anatomic landmarks were identified, and measurements characterizing their position were made on the MRI console. MRI resulted in excellent image resolution of facial tissue planes. Comparison between young and old subjects with the face in repose demonstrated that progressive thickening of the dependent portion of the check fat pad and overlying skin, with no appreciable change in the muscle plane comprising the levators of the upper lip, resulted in a deeper and more acute nasolabial fold in older subjects. In both age groups there was significant shortening of the mimetic muscles with smiling, with the lateral mimetic muscles drawn closer to the underlying facial bones. This was accompanied by redistribution of the cheek fat pad, thereby maintaining projection of surface landmarks within the cheek mass in young subjects with smiling. These findings indicate that in order to diminish the nasolabial fold, surgery for facial rejuvenation should be directed to the skin and subcutaneous tissue planes superficial to the mimetic muscles to the upper lip. In order to recreate a natural nasolabial fold during surgery for facial reanimation, contraction of the levator muscles to the upper lip should result in redistribution of the cheek fat pad without change in surface projection of the cheek mass or upper lip; this can only be accomplished if the reconstructed levator muscle is positioned deep to the cheek fat pad, with its insertion toward the deep (mucosal) surface of the upper lip.

Adipose Tissue↗
PubMed1998

In pursuit of optimal rejuvenation of the forehead: endoscopic brow lift with simultaneous carbon dioxide laser resurfacing.

Coronal foreheadplasty has long been the traditional method of improving the aesthetic appearance of the forehead, permitting not only repositioning of ptotic tissues but also direct access for modification of the "frown" muscles. However, it was only moderately successful in eliminating vertical corrugator lines or deeply etched transverse wrinkles. The recent advent of the endoscopic brow lift has permitted us to minimize the dysesthesias associated with the coronal approach by making the incisions shorter and radially oriented and by being more precise in the muscle resection. Nonetheless, endoscopic brow lift gives no further improvement in persistent deep vertical and transverse wrinkles. Carbon dioxide laser resurfacing can improve the existing wrinkles but does not eliminate the muscular cause of forehead wrinkles. It seemed reasonable that combining these techniques might yield better results than either procedure alone. To evaluate this possibility, 30 patients with simultaneous endoscopic brow lift and carbon dioxide resurfacing were compared with 24 patients having laser resurfacing only and with 26 patients who had traditional coronal foreheadplasty. Both foreheadplasty groups had corrugator resection. All patients were evaluated at least 4 to 6 months postoperatively. Ratings were based on the percent of wrinkles removed, both vertical and transverse. The ratings were performed with predetermined criteria by a surgeon not involved with the operative procedures nor after care. A rating of "excellent" (> or = 95 percent reduction in wrinkles) was obtained in 50 percent of coronal foreheadplasties; 41.7 percent of carbon dioxide resurfacing alone and 80 percent of endobrow lifts with carbon dioxide laser resurfacing. There was no vascular compromise from this latter combination of procedures, no hypertrophic scars, and no impairment of healing. We conclude that endoscopic brow lift with carbon dioxide laser resurfacing is a safe and perhaps more effective means of aesthetic rejuvenation of the forehead.

Adult↗
PubMed1998

Rejuvenation of the upper arm.

During the course of life, the upper arm demonstrates skin relaxation and fat deposits that become increasingly evident, particularly with age. However, the degree of skin ptosis and accumulation of subcutaneous fat varies from patient to patient. Therefore, it is critical to evaluate each patient individually, to inform the patient of the available options, and to tailor the procedure to his or her needs. We have described four categories of upper-arm problems. Patients with minimal to moderate subcutaneous fat and minimal skin laxity generally do well with circumferential lipectomy alone. With an increased amount of subcutaneous fat and more pronounced skin laxity, suction lipectomy in conjunction with a "ridge" provides good results, with a well hidden scar in the axilla. In the obese patient in whom skin laxity becomes much more noticeable after suction lipectomy, we recommend a purse-string closure of the modest brachioplasty incision to decrease the scar size. In those patients who have minimal fat but extensive skin laxity, a traditional brachioplasty cannot be avoided. Carefully selected and properly informed patients will result in an extremely high satisfaction rate. The techniques and guidelines described are designed to provide simple, easily performed procedures with minimal complications that safely and effectively rejuvenate the upper arm.

Adipose Tissue↗
PubMed1999

Pyriform augmentation as an ancillary procedure in facial rejuvenation surgery.

A patient is presented in whom augmentation of the pyriform aperture of the maxilla was performed with porous hydroxyapatite in concert with a face and brow lift. Basic research has recently shown that remodeling of the facial skeleton continues throughout life and that this remodeling process leads to changes in the position of several key areas. The pyriform aperture was identified as one region that remodels in a posterior direction, leading to retrusion of the alar base in the older individual. This skeletal retrusion occurs in a very site-specific fashion, and its effects are reflected on the overlying soft tissues of the face. With aging, remodeling of the pyriform aperture posteriorly causes the alar base to appear recessed and decreases the nasolabial angle, changes that are noted on the profile of the older individual. Augmentation of the pyriform aperture can be achieved through a buccal sulcus incision and, when used in conjunction with standard facial rejuvenation procedures, can improve the overall result in facial cosmetic surgery.

Female↗