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Growth hormone increases muscle mass and strength but does not rejuvenate myofibrillar protein synthesis in healthy subjects over 60 years old.

The rate of synthesis of myofibrillar proteins is slower in muscle of healthy subjects over 60 yr old than it is in young adults. Previous research suggests that reduced activity of the GH/insulin-like growth factor-I system could be a determinant of this slowing of protein synthesis. To test the hypothesis that GH could rejuvenate the rate of myofibrillar protein synthesis, we studied healthy subjects over 60 yr old, after a single injection (0.03 mg/kg.sc) of recombinant human GH (n = 6 males/2 females) or placebo (n = 6 males/2 females), or after 3 months of either GH (0.03 mg/kg, sc, 3 x /week, n = 5 males) or placebo (n = 5 males) treatment. Myofibrillar protein synthesis and whole-body protein metabolism were evaluated with the tracer L-[1-13C]leucine. GH reduced whole-body leucine oxidation by 36% (P < 0.01) in the single injection study. There was no effect of GH on whole-body protein breakdown or synthesis, or on myofibrillar protein synthesis in the quadriceps, either acutely or after 3 months of treatment. GH treatment for 3 months increased lean body mass (3.3 +/- 0.7 kg, P < 0.01, as evaluated by 40K counting), muscle mass (3.3 +/- 1.1 kg, P < 0.02, as evaluated by urinary creatinine excretion), and thigh strength (14 +/- 5%, P < 0.05, as evaluated by isokinetic dynamometry). We conclude that GH can increase muscle mass and strength in healthy men over 60 yr old, but does not restore a youthful rate of myofibrillar protein synthesis.

Aged↗

Microinjection of immaturin rejuvenates sexual activity of old Paramecium.

The sexual activity of aged Paramecium that underwent about 700 fissions after conjugation was remarkably decreased. Microinjection of a soluble cytoplasmic fraction prepared from young immature cells (about 20 fissions after conjugation) restored the sexual activity of the aged cells to that of presenescent mature cells. The factor responsible for the recovery of the sexual activity was shown to have the same characteristics as immaturin in terms of molecular size and net charge. Rejuvenation of sexual activity lasted up to 20 fissions after microinjection. However, cell division rate or fertility after self-conjugation was not increased by the microinjection. Our finding indicates that the decrease in sexual activity caused by aging was not due to defects in the genes for mating substances but to a decrease in the activity of a soluble protein responsible for the expression of mating activity. This is the first description of the restoration of a senescent defect by microinjection of young cytoplasmic components into Paramecium.

Animals↗

Syringe-assisted microliposuction for cervical rejuvenation. A five year experience.

During a five year period, 71 patients (age range 24-72 years) underwent syringe-assisted liposuction of the neck as the only operation for facial rejuvenation. The patients were seen after one week and three months, and 66 patients were re-examined 5-58 months (mean 31) postoperatively. There were no complications except for slight skin laxity (n = 10), transient hypoaesthesia, and temporary subcutaneous scarring (nodules). In some patients improvement occurred more than 12 months post-operatively. The patients evaluated the result according to a four grade scale; very satisfied (n = 41), satisfied (n = 21), less satisfied (n = 4), and dissatisfied (n = 1). All patients except one would recommend the procedure to other patients with similar problems. We conclude that syringe-assisted liposuction of the neck is a simple, safe, and rewarding procedure even in many elderly patients.

Adult↗

The endoscopic browlift for forehead rejuvenation.

Since its initial description by Vasconez et al in 1992, the endoscopic browlift has evolved into a popular method for addressing brow ptosis and forehead rejuvenation. The advantages of fewer incisions, less postoperative swelling, alopecia and prolonged scalp anesthesia, and more rapid rehabilitation have provided greater patient acceptance than the traditional coronal approach. Unlike the coronal browlift where the amount of elevation is determined by the amount of skin excised, the elevation in the endoscopic browlift is determined by periosteal release at the arcus marginalis and forehead flap fixation. Though equipment costs are greater and a learning curve exists, the endoscopic browlift offers the oculoplastic surgeon additional beneficial options in the management of brow ptosis.

Endoscopy↗

Subperiosteal rejuvenation of the midface and periorbital area: a simplified approach.

A simplified approach to subperiosteal midface rejuvenation is presented. The technique was developed through experience with 60 subperiosteal face lifts over an 8-year period. Because it does not involve a lower eyelid incision, there is no risk of ectropion, yet the midfacial structures and orbicularis oculi muscle can be elevated easily and precisely. The procedure can be performed alone but is more commonly performed in conjunction with brow lift and traditional SMAS dissection of the lower face and neck. The benefits of this subperiosteal approach to the midface are powerful elevation of the midfacial structures, improvement of the nasolabial folds, enhancement of the cheek prominences, smoothing of the nasojugal folds, and tightening of the orbicularis oculi. The procedure is performed through small incisions in the temple and gingival sulcus. The operation is technically straightforward and poses little risk to neurovascular structures. Concerns over prolonged swelling have not materialized. There have been no instances of lower lid or canthal abnormalities.

Female↗

Evaluating rejuvenation of the forehead and brow: an algorithm for selecting the appropriate technique.

The traditional reason for performing aesthetic surgery in the forehead and brow area has been to correct brow ptosis. However, there are several other conditions that may be improved by surgery in this area, including frown muscle imbalance, transverse forehead rhytids, and lateral brow laxity. Recently, a better understanding of the relevant anatomy and the evolving therapeutic modalities (including both open and closed techniques) have contributed to a renewed interest in aesthetic surgery in the forehead and brow area. One hundred consecutive patients were studied, each of whom underwent forehead rejuvenation for one of four indications-forehead rhytids, glabellar creases, lateral brow laxity, or brow ptosis. Thirty-eight percent of patients underwent open procedures, 30 percent underwent closed procedures, and 32 percent underwent limited procedures. Complications occurred in 4 percent of patients, including three patients who were dissatisfied with the surgery and one patient who required scar revision. Based on our findings, we formulated an algorithm that integrates the different indications and any concomitant procedures being performed. Our proposed treatment plan is based on this information. The algorithm may be used as a template when assessing a patient and adapting the recommended intervention to the individual patient.

Adult↗

Liporecycling: a technique for facial rejuvenation and body contouring.

BACKGROUND: Soft tissue augmentation using autologous fat is a standard method in facial rejuvenation and in refinement of body contouring. Different procedures by different authors have been described, each with its specific advantages and disadvantages. OBJECTIVE: The purpose of this article is to describe a method of harvesting, processing, and reinjection of fat that provides new aspects and advantages compared to previously described procedures. METHODS: We report about a new method of autologous fat grafting. Fat is harvested during machine-assisted liposuction in tumescent local anesthesia with microcannulas, processed in a special open manner, and reinjected through a 24-gauge needle for intra- and subdermal augmentation. RESULTS: Short- and long-term results are equivalent to other methods of fat cell grafting. CONCLUSION: Advantages of the described method include easy harvesting during conventional machine-assisted liposuction, the possibility of removing undesired bands of fibrous tissue from the graft, and easy passage through a 24-gauge needle. Thus sub- and intradermal augmentation is possible with the same material and syringe.

Adipose Tissue↗

Overview of complications of nonsurgical facial rejuvenation procedures.

An in-depth understanding of potential adverse sequelae related to aesthetic facial rejuvenation and available management modalities, should such a complication occur, enables the aesthetic surgeon to reduce his or her complication profile and also minimize the results of such adverse sequelae, eventuating improved patient care and satisfaction.

Cosmetic Techniques↗

Evolution of lower lid support following lower lid/midface rejuvenation: the pretarsal orbicularis lateral canthopexy.

An 18-month experience with an endoscopically assisted "closed" technique of modified transblepharoplasty lower lid and midface rejuvenation is presented. In the modified approach, preseptal dissection in the body of the lower lid is eliminated to decrease the incidence of septal scarring and lower lid retraction. The technique also leaves intact the connection between the orbicularis and septum, resulting in tightening of the septum and better support of lid with redraping of the muscle. By providing more secure support of the lower lid and lateral canthus, the need for direct canthal manipulation has been reduced significantly. This experience confirms, however, that an occasional patient with significant exophthalmus occasionally might need additional lower lid support (spacer graft or more direct lateral tendon fixation) to obtain ideal lower lid position. Conversely, an occasional older patient with relative enophthalmus and horizontal lower lid laxity will be best served by canthoplasty with correction of excess laxity. So far, the quality of aesthetic results compared with the "open" approach has not been compromised, and morbidity seems to have been decreased.

Adult↗

General medicine--revisited, rejuvenated, revitalized and reemphasized.

INTRODUCTION: The swing of the pendulum towards medical subspecialties, which are mainly organ-based, was inevitable. Over 30 years ago, this problem surfaced in the United States (US). The fragmentation of medicine had its advantages and disadvantages. However, as lifespan lengthens and there are more elderly sick with multiorgan dysfunction and failure, the patient is asking for the one doctor who can manage him as a whole patient rather than the ten specialists, each focused on one body part. METHODS: Revisit--A search of the recent literature revealed that changes are underway in the US and the United Kingdom (UK). RESULTS: Rejuvenate--Diagnosis Related Group (DRG) funding for inpatients based on the length of stay means referrals to specialists (if any) should be concurrent rather than consecutive. This, in turn, means the general physician should assess the whole patient from the outset and be in charge of the management plan. Also, the patient prefers this to being passed from one specialist to another. Revitalized--We are short of doctors in Singapore and if one patient could be properly managed by fewer specialists, then we will need fewer specialists in Singapore. Their role is to manage the more difficult patients, rather than every patient that happens to have a problem within that organ specialty. Internists should be allowed to have a wider training in Singapore, with dual accreditation in general medicine and another medical speciality made available from this year onwards. The duration of this training will be 5 years. Reemphasized--A full chair in general medicine was established at Harvard Medical School in 2000. The UK Royal Colleges of Physicians are revamping their advanced specialty training programme to include more time in general medicine and the Renaissance School of General Medicine may become a reality. CONCLUSION: Whole patient medicine is what patients want, not medicine in bits and pieces. The general physician has a vital role to play in meeting this need.

Family Practice↗

Subperiosteal rejuvenation of the forehead.

Subperiosteal rejuvenation of the forehead may be performed through several small incisions in the brow. Small incisions are placed in the hairline and within the hair-bearing portion of the brow. The procedure provides a safe and reliable way to improve the position of the brow. The addition of resorbable screw fixation improves the stability of the brow position postoperatively and facilitates healing in the desired location. Subperiosteal brow lift may be performed successfully by way of minimally invasive incisions with favorable results.

Forehead↗

Gore-Tex implant as tissue filler in cheek-lip groove rejuvenation.

The cheek-lip grooves, often referred to as nasolabial folds, are one of the facial characteristics most commonly complained about by patients in all age groups. A variety of methods for correction have been proposed, using implants or autografts. Some of the methods have relied on diminishing the crest lateral to the groove thus camouflaging the depth of the cheek-lip fold. These procedures have proven to be of limited effect, either because of the amount of correction obtained or because they are short-lasting. The Gore-Tex implant proved its safety and biocompatibility over the past decade as a vascular graft. The characteristics of this implant material are described and compared to other commonly used synthetic implants. A surgical technique of applying the Gore-Tex soft tissue patch in facial aesthetic surgery, particularly in cheek-lip rejuvenation, is presented. This technique has been applied in 17 consecutive patients for the correction of prominent cheek-lip grooves with a follow-up period of eight months. Results showed satisfactory improvement without significant complications.

Cheek↗

[Cervicofacial rejuvenation, orbicularis oculi muscle and platysma].

The structural rejuvenation has two goals: the treatment of the face and neck area as a whole, and the building up of the facial features. By treating the neck from the mandible to the "decolleté" (the clavicular region), the first goal gives harmony. It avoids a too smooth face being the cover up of a wrinkled turtle neck. The second goal tries to produce nature beautiful faces, instead of the "Barbie dolls" faces with their unfortunately well-known ageless flat blank look. It is then necessary to manage the two kinds of structural defects, the youth's and the aging ones. The first ones are the lack of the anterior cervical angle, malar, chin hypogenesia. The second ones are the vanishing of the structural features of the youth. Treating each layer separately, working with the grain or on the cross according to the tissues and the goal, gives a youthful and natural look. Just lifting them up provides a flat face, the same way spreading a sheet over an object flattens it. On the contrary turning around it produces a good enhancement. To obtain this result the author privileges two muscles, the platysma and the orbicularis oculi muscle. She uses them in the same way to treat not only the area, but the slackness of the muscles themselves. The author updates her first technique: the double flap cervical platysmaplasty (DFCP). Then, she describes the two versions of the orbicularis oculi plasty: simple or in association with the DFCP. She works with the orbicularis flaps as if they were the reins of a horse. She pulls them around turning points. She obtains some of them by not undermining the skin as for the "malar turning point". She makes the others by suturing the flaps to the fascia at specific points. The results over 500 cases, some of them 4 years old, rate good. The report shows no complications, particularly no permanent neither transient palsy.

Esthetics↗

[Use of deep planes in surgery of rejuvenation of the face].

Since 1976, anatomical studies intensively performed in France have demonstrated the surgical interest in using the superficial musculo-aponevrotic system in the face, and also a subperiosteal malar approach. The SMAS is mostly a surgical structure. It could be considered as a remnant of a primitive subcutaneous muscle which would have been located in the superficialis fascia; its stays outward the parotid gland. Muscular fibers have been found inside, uniting from-down the patysma muscle toward the periphery of the frontalis muscle at the top. Risorius muscle is included in this structure. Its surgical interest is that it allows to relieve skin tension during a face lift by a fibromuscular associated stretch. The modern way in face lifting should prevent the fixed appearance of a too tight skin-pull, when skin is redraped alone. Risks of facial nerve injury are minimal when the proper technique is used. It is possible, in the same way, during a blepharoplasty to stretch the orbicularis oculi muscle, like the muscular resuturing of an inguinal hernia repair. Each of this technique has its own different indications now well defined. The authors shows this experience after 150 cases of face lift operations and makes an analysis of the advantages and draw backs of using the SMAS in cases of rejuvenating face operations.

Aged↗

Hand rejuvenation. The state of the art.

Intrinsic aging and photoaging, two distinct biologic processes, contribute to making hands appear aged. Restoration to a more youthful appearance for aged-appearing hands often requires a multitherapeutic approach individualized to the patient's pathology. This article reviews the role and technique of microlipoinjection for the rejuvenation of aged-appearing hands.

Adipose Tissue↗

Total facial rejuvenation.

Facial rejuvenation cannot usually be effected by any one procedure. Since many interrelated operations are often required, the authors feel that this should be carried out at one sitting employing a "two team approach". Proper pre-operative evaluation and education of the patient is mandatory.

Face↗

Rejuvenation of aged erythrocytes by incorporating phosphoenolpyruvate into the cells.

An acid-citrate dextrose solution which contains phosphoenolpyruvate and sucrose was used as a preservative and medium for rejuvenating depleted erythrocytes. 2,3-bisphosphoglycerate and ATP in washed erythrocytes, red cell concentrate or whole blood were increased effectively by incubating the cells with the solution at 37 degrees C for 30--60 min. The transport of phosphoenolpyruvate through the erythrocyte membrane was essential to the increase of 2,3-bisphosphoglycerate and ATP. During storage of the cells at 4 degrees C in the presence of phosphoenolpyruvate, no increase of 2,3-bisphosphoglycerate and ATP was observed because no transport of phosphoenolpyruvate into the cells occurred. By an incubation at 37 degrees C for 30 min at the end of storage periods, however, levels of ATP and 2,3-bisphosphoglycerate in the cells were raised.

2,3-Diphosphoglycerate↗

Rejuvenation of epididymal principal cells by prolactin under androgen deficiency.

Influence of prolactin on the ultrastructure of principal cells lining the epididymal epithelium was investigated in Wistar rats. Orchidectomy produced degenerative changes suggesting that structural integrity of principal cell is maintained by factors originating in the testis. The atrophic changes in the principal cell of ordhidectomised rats were significantly reversed when prolactin was administered to these animals. The number of cells that responded were found to increase with the dose of prolactin injected. On the otherhand, bromocryptine treatment did not appreciably change the ultrastructure of principal cells in orchidectomised rats. Results suggest that prolactin may have a rejuvenating epididymal principal cells in androgen deficient states.

Androgens↗