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Botox (and other botulinum toxins), injectable filling agents, chemical peeling agents, intense pulsed light devices, nonablative lasers, and radiofrequency instrumentation are discussed herein regarding their specific applications to different facial areas for oculofacial rejuvenation.
The addition of Sculptra to the esthetic dermatology landscape in September 2004 brought a new opportunity for facial rejuvenation. Sculptra, which is polymerized lactic acid (PLA), received approval from the Food and Drug Administration for the treatment of HIV-associated lipoatrophy. Since its approval, it has gained acceptance among cosmetic dermatologists and plastic surgeons, and its inclusion in any update of esthetic dermatology is certainly warranted. Its uses for esthetic indications are now being substantiated by clinical trials and, as experience with this product increases, it is likely that it will be more widely used for these reasons.
Nonsurgical procedures have become very popular for the rejuvenation of the aging face. Trends now are for less invasive procedures as well as for more preventative intervention to slow the damage from ultraviolet light and environmental factors, as well as from intrinsic aging. The goal of these procedures is to eliminate or delay the need for corrective surgery. The regular use of sunscreens; retinoids and improved cosmeceuticals; injectable neurotoxins; soft-tissue augmentation products; and minimally invasive laser, light, and radiofrequency treatments are decreasing and delaying need for invasive procedures. Injectable fillers entered mainstream cosmetic medicine with the development of bovine collagen injections in the 1980s. The availability of improved fillers that are less allergenic and longer lasting has resulted in a renaissance in filler techniques. No single filler has proven to be more popular than the category of hyaluronic acids (HA). This article will review the use of the hyaluronic acid fillers that are currently approved for use by the Federal Drug Administration in the United States and describe the significant differences between them to assist the practicing cosmetic physician in choosing and using this category of dermal filler.
There is a growing interest, as well as a booming industry, in the use of testosterone therapy for middle-aged and older men. This interest has led to the definition of a new condition, termed 'andropause', meaning the putative somatic consequences of gradually falling blood testosterone concentrations during male aging. This trend risks replicating both the rejuvenation fads of a century ago and the recent experience in estrogen therapy for menopause that has been propelled for decades by advocacy substituting for reliable scientific evidence. The current status and prospects for androgen therapy in middle-aged and older men should be evaluated critically from the perspective of male reproductive health during aging. This review appraises current knowledge with a focus on the questionable basis for using androgen therapy to improve male reproductive health during aging.
This article discusses the controversies, usefulness, and limitations of oral and periodontal tissue maintenance, augmentation, rejuvenation, and regeneration in the dog and cat. It details many of the specialized materials and techniques used in these procedures in attempts to re-establish healthy conditions within the periodontium. Bone loss following tooth extraction is discussed with consideration as to which teeth should have alveolar ridge maintenance procedures and the important reasons as to why. Radiographs show the degree of improvement demonstrated in treatment of various cases involving bone loss from periodontal disease, treatment of bone injuries with oral fractures and their prevention.
The combining of a traditional resurfacing technique (trichloracetic or phenol peel) with 2 recent technological advances (endoscopic forehead plasty, botulinum toxin) may enhance the forehead rejuvenation in a more natural way. The disappointing results of some of our earlier results on a serie of 70 consecutive foreheadplasties can probably be attributed to the weakness of the suspension through percutaneous sutures. This has been remedied since 1998 by the systematic use of transosseous suspensions. The growing success of botulinum toxin explains the noticeable decrease of endoscopic surgery. This type of procedure is now used to correct significant frontal ptosis requiring an uplifting of no more than 1,5 cm, thereby avoiding the unnatural results encountered in many publications. Some benefits can be obtained by the way of a transpalpebral approach without using the endoscope; nowadays, upper blepharoplasties are almost systematically done in the majority of our cases in order to obtain the most natural result. Light peels and botulinum toxin injections can maintain this result relatively easily.
The effect of melatonin on age-related thymic involution and apoptosis induced by hydroxyl radicals (*OH) in mouse thymocyte cultures was investigated. Exogenous melatonin was administered in the drinking water (15 microg/mL) of 7-month-old male Balb/c mice for 40 consecutive days. Our results show that melatonin distinctly reversed the age-related thymic involution as revealed by the notable increase of cellular density, particularly the number of thymocytes, percentage of thymocytes at G2+S phases and the younger morphological appearance as a whole when compared with control animals. More strikingly, the recovery of these morphometric parameters were maintained for 30 days after the termination of melatonin administration suggesting that the re-established homeostasis by melatonin may last for a longer time. At the same time, when primary culture of thymocytes was preincubated with 200 microM melatonin before their exposure to hydroxyl radicals (*OH) generated by Fe(2+)-mediated Fenton reaction, apoptotic cell death induced by *OH was almost completely prevented as determined by both flow cytometric analysis and the TUNEL assay. DNA laddering assay also documented the inhibition of thymocyte apoptosis by melatonin. Furthermore, we found that the *OH-induced increment of caspase-3 activity in thymocytes was completely abolished by melatonin preincubation. Taken together, our study indicates that in addition to other mechanisms, melatonin may also directly act as an antioxidant via attenuating apoptotic thymocyte death caused by free radicals and stimulates thymocyte proliferation in thymus and thus to rejuvenate the degenerative organ.
The endoscopic approach to rejuvenation surgery of the forehead is standing the test of time. We feel that aesthetic results obtained from this procedure are equal to or better than results associated with the conventions coronal lift, while remarkably reducing recovery time and incision-related morbidity (Figs. 9,10).
A comprehensive rejuvenation of the neck depends on accurate analysis of the lower face and neck with attention to the contours and deep-lying structures. Although many surgeons address the well-recognized changes in skin and soft tissue that occur with aging, we believe bone resorption is also an important component. Loss of bone volume leads to loss of support for the soft tissues of the face. The result is soft tissue ptosis and loss of angularity between the various planes of the face. Initially, there is loss of the submental shadow and loss of height of the mandibular ramus. The gonial angle loses its prominence, and the chin becomes ptotic. The line of the body of the mandible is further obscured by the appearance of jowls. As the mandible shrinks, the submandibular gland as well as the muscles that make up the floor of the mouth are pushed inferiorly. For loss of bone support, implants tailored to the areas of deficit and to the aesthetic goals are used. These implants used for the mandible are tridimensional structures made from beaded polyethylene material. This restores the bone volume and provides good support for the soft tissues. We routinely perform a deep-layer cervicoplasty. This involves removing fat from the subplatysmal layer and between the anterior bellies of the digastric muscles. The digastric muscles are plicated toward the midline. The platysma muscle is separated from the underlying submandibular gland. Ptosis of the submandibular gland is treated by suspension of the fascia with sutures or imbrication of the overlying muscle. A short corset platysmaplasty brings the platysma muscles to the midline. Above the level of the hyoid bone, the digastric muscles are included in the sutures. If the patient has an obtuse cervicomental angle, but good-quality skin, there may be no need to perform skin resection. In these patients who are candidates for nonexcisional cervicoplasty, we routinely place a neck suspension suture. Patients with poor skin quality or excessive skin on the neck and jawline will require an excisional cervicoplasty or cervicofacial rhytidectomy. We have obtained consistently good results using this comprehensive approach.
Botulinum toxin type A (Botox) injections have revolutionized nonsurgical rejuvenation of the upper face since their introduction in the early 1990s. Their use in the lower face has not become nearly as popular. The key to using Botox to improve the appearance of the lower face lies in understanding the functional anatomy of the lower face musculature. Although the facial plastic surgeon should be familiar with the muscles of the lower face and anatomic variations, the functional anatomy of the lower face varies widely from patient to patient and even more from one side of the face to the other. Understanding how the lower face moves is the key to using Botox to improve nasolabial folds, perioral rhytids, chin dimpling, marionette's lines, and downturned oral commissures. This is not an area for the novice injector, as a few stray units are not tolerated nearly so well as they are in the upper face.
The goal of this article is to explain both the options and the techniques that are available when considering the rejuvenation of the eyelid and brow complex. We first explain the relevant anatomy. We then list and explain the different techniques with both the brow lift and the blepharoplasty. During this discussion we also explain a newer technique that we have been using. This combines the endoscopic technique with a trichophytic incision. The selection of patients is discussed in reference to which technique is appropriate given each patient's particular anatomy and desired effects. We also highlight the unique differences that the male patient presents.
Age-related changes to the upper third of the face manifest, typically, as brow ptosis and the development of deep skin furrows. Depression of the brow evolves as gravity and the action of the corrugator supercilli, procerus, and orbicularis draw on the progressively inelastic forehead skin. Facial mimetic muscle action reveals itself over time via the development of deep forehead rhytids. Facial plastic surgeons have at their disposal several effective surgical, and recently, medical interventions to address these changes. Each technique has merits and suitable applications. This review examines the history of rejuvenation of the upper face, details the pertinent treatment modalities, and evaluates the context in which each is applicable.
Recent advances in our understanding of midfacial aging have resulted in the development of several techniques of midfacial rejuvenation. Because aging causes vertical as well as inferomedial migration of midfacial and periorbital tissues, techniques that reposition ptotic tissues in the opposite direction give the best results. Minimal incision techniques have been developed in conjunction with our understanding of the anatomy. It is vital to understand the specific indications and limitations of the various techniques discussed in this article.
OBJECTIVE: The study was divided into two parts. The objective of the preliminary study was to evaluate the optimum dose and tolerance of 5-aminolaevulinic acid (5-ALA) compared to a placebo cream with a 633-nm LED light in normal, healthy, volunteer forearm skin. The second study was to establish if ALA-PDT treatments improve the signs of ageing. RESULTS: Threshold photosensitization was observed using 5% 5-ALA under plastic occlusion for 30 minutes following a dose response study of forearm skin. Mild improvement was observed, using this concentration and time, for periorbital skin aging. Other anecdotal positive results of photo-rejuvenation are reported for facial and chest areas.
The depigmenting and anti-aging effects of kinetin (KN) solutions on the aged skin of hairless dogs were clinically and histologically investigated. Grossly, all KN-treated sites became mildly depigmented. At 50 days of topical treatment with KN solutions, apparent improvement was observed in the skin texture, wrinkling, and pigmentation. At 100 days of KN treatment, both the skin rejuvenation and depigmentation effects became more prominent. Throughout the experimental period of KN treatment, no adverse effects were found in any sites treated with KN solutions. In the colorimetric system, at 100 days of topical treatment with KN solutions, the L* and b* values in the sites treated with KN solutions significantly increased. Histologically, at 50 days of topical treatment with KN solutions, the KN-treated sites showed a decrease in the thickness of the corneal layers. Melanin granules decreased throughout all epidermal layers. In the dermis, the large number of fine collagen and elastic fibers were densely aligned. At the end of the treatment, this agent was equally effective against pigmented lesions irrespective of the concentration of KN solution. The distribution of melanin granules returned to normal in the skin of adult hairless dogs. Throughout the present study, there were no histologic abnormalities in the epidermis and the dermis. These results revealed that topical treatment with lower concentrations of KN solutions normalized hyperpigmentation and improved the aged skin structure of hairless dogs. In addition, it was clarified that KN solutions had no adverse effects on the skin of hairless dogs and that this agent was a safe chemical for long-term application.
Transgenic hairy roots were induced from Withania somnifera Dunal, by infecting leaf explants with Agrobacterium rhizogenes. Polymerase chain reaction for rol A gene and Southern blot confirmed the integration of T-DNA in the genome. Cultures were grown in Murashige and Skoog solid as well as in liquid medium. The antioxidant activity was assayed in roots grown in solid media and liquid media. Hairy roots grown in liquid media found to possess highly significant activity in 1,1-diphenyl-2-pecryl-hydrazyl radical, beta-carotene linoleic acid model system. The activity was 57.34%, 75.64%, and 93.41% in case DPPH model and 55.3%, 76.3%, and 90.5% in case of b-CLAMS in 25, 50, and 100 mg L(-1) concentration, respectively. In case of hydroxyl radical trapping and brain lipid peroxidation assay, the activity was more significant in hairy roots grown on solid medium in comparison with commercial formulation prepared using normal roots and standard withanaloids. Root extract grown in solid medium has shown 93.2% hydroxyl radical trapping activity at 100 mg L(-1) concentration, and 500 mg L(-1) has shown 83.6% in case of brain lipid peroxidation assay. High-performance liquid chromatography analysis demonstrated the presence of withanaloids in the hairy root extracts. The results of the study clearly indicate that there is enhancement of secondary metabolites in hairy roots, which is indicated through significant enhancement of the antioxidant activity, since these are the major constituents responsible for the activity. This is the first report on the presence of antioxidant principles in genetically modified roots of W. somnifera. These results of the present study may aid in utilization of the W. somnifera hairy roots for its rejuvenating principles.
With advancing age, the mammalian thymus undergoes involution, a progressive loss of architectural integrity and lymphoid cellularity that results in reduced T lymphopoiesis. Thymic involution also is associated with extreme malnutrition and states of immune deficiency, such as active HIV infection, after chemotherapy, or during pregnancy. Immune recovery appears to require restoration of normal thymopoiesis. Although several means are known to increase thymic cellularity in the aged, including systemic administration of hormones, androgen ablation, and thymic tissue transplantation, each suffers from specific limitations that prevent widespread application. This paper presents a novel approach to rejuvenate T cell differentiation in the aged that employs intrathymic implantation of engineered stromal cells. Two different proteins have been examined for their impact on thymopoiesis after delivery by somatic cell implantation. Intrathymic injection of IL-7-producing stromal cells enhances the earliest specification steps of T cell development, resulting in the increased representation of pro-T cells in the aged thymus. In contrast, increasing the intrathymic levels of sonic hedgehog diminishes this aspect of T cell poiesis.
PURPOSE OF REVIEW: In recent years, many new products and techniques have arisen that are useful in the rejuvenation of facial skin. Most of the therapies are directed at improving the results of photoaging. These cutaneous changes occur from chronic exposure to ultraviolet B light (290 to 320 nm) associated with sunburn, and ultraviolet AII light (320 to 340 nm), and ultraviolet AI light (340 to 400 nm) associated with photoaging. Clinically chronic photoaging may result in fine wrinkles, texture abnormalities, pigment dyschromias, and actinic keratoses. RECENT FINDINGS: Many methods of patient assessment are available, but the most useful include the Fitzpatrick skin type classification and the Glogau photoaging scale. Although many therapies are available to reduce or even reverse many of these aging changes, patient education regarding lifestyle changes (especially smoking cessation) and sun avoidance need to be a critical foundation of treatment. Indeed, patient participation in their own skin care regimen is important for any program to be effective. Topical therapy including tretinoins, hydroxy acids, bleaching agents, and sunscreens are discussed herein. SUMMARY: The physician has an important role in understanding which treatment options are appropriate for mild, moderate, and severe photoaging, and in educating patients on the risks and benefits of each. This includes resurfacing modalities with microdermabrasion, chemical peels, and laser skin resurfacing.