Journal of Cutaneous and Aesthetic Surgery
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FROM THE LITERATURE Table of Contents   
Year : 2009  |  Volume : 2  |  Issue : 2  |  Page : 113-114
From the literature


Venkat Charmalaya, Centre for Advanced Dermatology, Bangalore, Karnataka, India

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Date of Web Publication24-Dec-2009
 

How to cite this article:
Anitha B S. From the literature. J Cutan Aesthet Surg 2009;2:113-4

How to cite this URL:
Anitha B S. From the literature. J Cutan Aesthet Surg [serial online] 2009 [cited 2019 Aug 17];2:113-4. Available from: http://www.jcasonline.com/text.asp?2009/2/2/113/58531


Volumetric Correction Using Poly-L-lactic Acid in Facial Asymmetry: Parry Romberg Syndrome and Scleroderma

Maria G, Antonietta T, Nicolo S

Dermatol Surg 2009;35;1368-75

Linear scleroderma and Parry Romberg Syndrome are chronic diseases that affect the face, producing facial asymmetry and causing serious cosmetic disfigurement. There are no satisfactory treatments for these distressing conditions. This study reports the efficacy of polylactic acid filler in treating these facial asymmetry conditions.

Poly-L-lactic acid (PLLA) is a synthetic, biodegradable, biocompatible, inert injectable filler that is available as a powder. PLLA is a type of permanent filler that acts by stimulating the gradual deposition of collagen in the treated area over a period of time.

It is reconstituted with sterile water and injected into the dermis and subcutaneous tissue (without any requirement of local anesthesia). The injections were given once in four weeks for 3-5 sessions during the study period. Following the injection, the area was massaged twice daily for two weeks when significant restoration of facial volume and symmetry was noted which lasted for more than 18 months.

The skin in the treated area became more elastic and smooth in texture. The color in the hyperpigmented patch in the injection site was also found to be reduced so that the treated area looked very natural following the injection. No side effects were noted. PLLA has also been used in the corrections of scars, fine and deep wrinkles, and HIV-induced lipoatrophy. PLLA is a safe and effective alternative for the treatment of facial asymmetry in these patients.

Nonablative Fractional Photothermolysis for the Treatment of Striae Rubra

Tracy M, Leonard H, Paul M

Dermatol Surg 2009;35;1430-33

Striae distense cause significant cosmetic disfigurement when they present in early stages as reddish inflammatory lesions (striae rubra) and as hypopigmented, atrophied lesions (striae alba) in the advanced stages. Many treatments have been tried for this condition like topical Vitamin C, glycolic acid, pulsed-dye laser, and diode laser, but the results have not been satisfactory, both subjectively and objectively.

This is a report of two patients presenting with striae rubra of recent onset (three and ten months): One, over the thighs and calves, and the other patient, over the breasts. Both the patients were treated with 550 nm erbium-doped fiber fractional laser for 3-5 sittings at an interval of four weeks between each session; the doses ranged from 20-70 mJ. At the end of 6-8 weeks after the last session, it was noted that there was up to 75% improvement in the appearance of striae rubra. The treatment was well tolerated, with minimal postprocedure erythema, and edema which lasted for 2-5 days.

Fractional photothermolysis probably acts by stimulating collagen and elastic fiber synthesis and remodeling to bring about improvement in the appearance of striae rubrae. Thus, fractional laser promises to be a safe and effective tool for the management of striae rubra. However, larger controlled studies are required to establish its role and formulate guidelines regarding the dosage schedule in the management of this otherwise difficult-to-treat condition.

Hairmax Laser Comb Laser Phototherapy Device in the Treatment of Male Androgenetic Alopecia: A Randomized, Double-Blind, Sham Device-Controlled, Multicentre Trial

Leavitt M, Charles G, Heyman E, Michaels D

Clin Drug Investig 2009;29;283-92

Androgenetic alopecia (AGA) is an androgen-mediated genetic condition affecting scalp hairs, which has very few scientifically approved, satisfactory treatment options. The available medical modalities are also not very patient-friendly as they all need very long-term administrations.

The phenomenon of so-called 'terminalization' of vellus human hair follicles (i.e., when small vellus hairs transform into larger, terminal hairs) upon exposure to low-fluence diode laser treatment has been previously documented. Based on this, the authors hypothesized that low-level lasers may have proproliferative activity in hair follicles and may therefore help in regeneration of scalp hair follicles affected in AGA.

The present study is a double blind, sham device-controlled, randomized, multicentric study that used HairMax Laser comb which emits a low-level laser of a wavelength of 655 nm as a test device (71 patients) and a sham control device (39 patients) which was similar to the laser comb in appearance but emitted incandescent light. The patients were asked to use the assigned machines (laser comb/ sham device) thrice weekly for 15 min for a duration of 26 weeks/ six months. They were evaluated at the end of 26 weeks, both subjectively with a questionnaire, and objectively by measuring terminal hair density.

Statistically significant improvement was seen in hair density in patients treated with laser comb phototherapy as compared to the control group. The patients in the laser comb group also felt that there was overall improvement in the hair growth, control of hair loss, and texture of hairs.

The study, the first of its kind using a low-level laser, shows promise in inducing hair growth. However, further studies are needed to confirm its role in androgenetic alopecia and its possible efficacy in nonandrogenic alopecia patients, and to understand the underlying cellular mechanisms involved in its role in hair cycle.

Thread Lift for Facial Rejuvenation: Assessment of Long-term Results

Rima FA, Robert JD, Edwin FW

Arch Facial Plast Surg 2009;11;178-83

Different treatments have been introduced for facial rejuvenation over the last decade, such as lasers, peels, fillers, botox etc. Thread lift, a procedure which seeks to lift sagging skin with barbed threads, is one such procedure that is advocated for lifting sagging eye brows, lower face rejuvenation, neck rejuvenation etc. However, doubts have been expressed over its efficacy and the longevity of its results.

The authors carried out a retrospective study in 33 patients, who underwent thread lift according to the Contour Threadlift system, either alone (group 1: Ten patients) or in combination with other procedures of facial rejuvenation (group II: 23 patients). Results in these patients were compared with ten patients (who served as control) who had undergone rejuvenation techniques other than thread lift such as lipotransfer, chemical peels, and rhytidectomies. They were followed up for a period ranging from 12 to 31months, and were evaluated by four independent, blinded, facial plastic surgeons. The response was graded on a scale of 0 (no improvement) to 3 (considerable improvement). A two-tailed t test ( P = 0.05) was used for statistical analysis of aesthetic outcomes.

Although aesthetic improvement was noted in all groups after one month, measurable results at the end of the study were seen for group II and the control group, but not for group I (that only underwent the thread lift procedure). Improvement scores of the nonthread-lift control group were better than the group that underwent thread lift only. Similarly, results in group II (thread lift in combination with other procedures) were better than in group I (when thread lift was used alone). The morbidity was also much higher in the thread lift group than in the other two groups. This study suggested that thread lift provided only limited short-term improvement, largely attributed to postprocedural edema and inflammation, but no long-term sustainability of the results. In view of these findings and the potential risk of adverse events associated with thread lifts, the study does not recommend further use of this procedure for facial rejuvenation.

The Contour Threadlift system used in this series was approved by the FDA in 2005, but after growing numbers of problematic reports associated with their use, thread lifts have since lost FDA approval and are no longer available in the US market. Thread lifting seems to be have been overpublicized with respect to its efficacy, which was stated to be more than what it can actually achieve.

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Correspondence Address:
B S Anitha
Venkat Charmalaya, Centre for Advanced Dermatology, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


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