Publications

Nerve Blocks Prior to Microfocused Ultrasound Treatment are Safe and Reduce Patient Discomfort

Publication Number: 31996891

Background: Microfocused ultrasound with visualization has become one of the more popular nonsurgical facial rejuvenation therapies available. Although the treatment has gained wide acceptance, providing adequate pain relief during the procedure can be challenging.

Objectives: The aim of this study was to test our hypothesis that nerve blocks prior to treatment would be well tolerated and significantly reduce patient discomfort.

Methods: Subjects undergoing microfocused ultrasound were offered the choice of participating in a split face nerve block, bilateral block, or a control group. Nerves targeted included infraorbital, supratrochlear, supraorbital, zygomaticofrontal, mental, great auricular, and cervical plexus. Pain assessment was based on a 10-point Wong-Backer FACES Pain score.

Results: A total of 65 patients were included in the study: 28 in the split face group, 19 in the bilateral block group, and 18 without a block. The mean [standard deviation] pain score of the bilateral block cohort was 3.9 [1.2], and that of the control group was 5.1 [1.7] (P = 0.001). Patients in the split face cohort reported a higher pain score on the unblocked side of the face (7.5 [1.3]) than on the blocked side (2.9 [1.0]) (P < 0.001). The mean pain score for local anesthetic injection was 2.7 and 1.4 for the split face and the bilateral groups, respectively. There were no adverse events. Conclusions: Nerve blocks are well tolerated and significantly improve patient comfort during microfocused ultrasound treatment without compromising outcomes or increasing adverse events. © 2020 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.

Publication Date: July 13, 2020

Authors: Marc A Polacco, Daniel R Butz, Rachel Bass, Teresa Luu, Esra Kurum, Agatha DiCarlo, Corey S Maas

Safety and Effectiveness of VYC-17.5L for Long-Term Correction of Nasolabial Folds

Publication Number: 31346621

Background: Juvéderm Vollure XC (VYC-17.5L; Allergan plc, Dublin, Ireland) belongs to a family of hyaluronic acid gels based on the Vycross technology platform.

Objectives: The authors sought to evaluate the safety and effectiveness of Vollure for correction of moderate to severe nasolabial folds (NLFs) over 18 months and after repeat treatment.

Methods: In this prospective, randomized study, patients (N = 123) received initial/touch-up treatment with Vollure in 1 NLF and control filler in the contralateral NLF. Patients received optional repeat treatment with Vollure after month 12, 15, or 18. Assessments included investigator-rated NLF Severity Scale responder rates (≥1-point improvement vs baseline), patient-assessed Appraisal of Nasolabial Folds scale of the FACE-Q questionnaire, and patient satisfaction (11-point scale).

Results: Median volume of Vollure injected was 1.7 mL for initial/touch-up treatment combined and 0.6 mL for repeat treatment. The NLF Severity Scale responder rates were 93%, 85%, and 59% at months 6, 9, and 18 after initial/touch-up treatment and increased to 94% at 1 month after repeat treatment. Mean patient-reported FACE-Q scores significantly improved from baseline at all timepoints. Most patients were very satisfied with treatment at all timepoints from day 3 (75%) through month 18 (68%) and at 1 month after repeat treatment (94%). Common injection site responses after initial/touch-up and repeat treatment were firmness, swelling, and tenderness to touch; most were mild/moderate.

Conclusions: Vollure was safe and effective for correction of moderate to severe NLFs, with results lasting 18 months in 59% of NLFs. Repeat treatment required one-third of the injection volume to achieve similar improvement in NLF severity as initial/touch-up treatment.

© 2019 The Aesthetic Society. Reprints and permission: journals.permissions@oup.com.

Publication Date: June 15, 2020

Authors: Steven Dayan, Corey S Maas, Pearl E Grimes, Kenneth Beer, Gary Monheit, Sean Snow, Diane K Murphy, Vince Lin

CME/CE: ABOUT FACE: Navigating Neuromodulators and Injection Techniques for Optimal Results

Publication Number: 32401461

Interest in the cosmetic use of neuromodulators for facial rejuvenation is increasing among physicians, other practitioners, and patients alike, and an expanding array of formulations and reported applications might be helping to drive this trend. Safety, efficacy, and a high level of patient satisfaction can be achieved with all the available botulinum neurotoxin type A (BTXA) products. With any of the formulations, optimal results require knowledge of the individual product’s unique properties and dosing, along with an understanding of the patient’s goals, relevant anatomy, and proper injection technique. This educational activity reviews these topics on the basis of the published literature and expert opinion. A series of case narratives is also included that provides readers with information and insights for achieving success in clinical practice.J Drugs Dermatol. 2020;19(4 Suppl 2):s5-15.

Publication Date: April 1, 2020

Authors: Steve G Yoelin, Shino Bay Aguilera, Joel L Cohen, Michael H Gold, Joely Kaufman, Corey S Maas

Botulinum toxins for facial wrinkles: beyond glabellar lines

Publication Number: 17317554

Botulinum toxin type A (BTX-A) has been used for years with excellent results for upper facial cosmetic applications. Because of this success, the use of BOX-A for facial aesthetics has expanded to the lower facial and neck regions. BTX-A, especially when used in combination with fillers, has generally proven to be safe and efficacious in these areas. For optimal results, however, several issues must be taken into considerations, including dosing differences versus upper facial applications, the specific type of botulinum toxin used and the importance of precise placement and injection technique. In this article, the authors present their experience with BTX-A in the lower face and neck, and compare and contrast their current practices with those reported by others.

Publication Date: February 15, 2007

Authors: Steven H Dayan, Corey S Maas

Perioral rejuvenation and lip augmentation

Publication Number: 18005890

In general, the aging process of the face is a process of atrophy, most noticeable in the perioral region. This article discusses rejuvenation of the perioral region, including fillers, surgery, and facial resurfacing, as correction for this process. Detailed techniques for each of the approaches are outlined. Composition of the various fillers is discussed in conjunction with their respective outcomes and duration of effect. Clinical preoperative, intraoperative, and postoperative photographs are presented.

Publication Date: November 15, 2007

Authors: M Jafer Ali, Kevin Ende, Corey S Maas

ABOUT FACE: Navigating Neuromodulators and Injection Techniques for Optimal Results

Publication Number: 32243119

Interest in the cosmetic use of neuromodulators for facial rejuvenation is increasing among physicians, other practitioners, and patients alike, and an expanding array of formulations and reported applications might be helping to drive this trend. Safety, efficacy, and a high level of patient satisfaction can be achieved with all the available botulinum neurotoxin type A (BTXA) products. With any of the formulations, optimal results require knowledge of the individual product’s unique properties and dosing, along with an understanding of the patient’s goals, relevant anatomy, and proper injection technique. This educational activity reviews these topics on the basis of the published literature and expert opinion. A series of case narratives is also included that provides readers with information and insights for achieving success in clinical practice. J Drugs Dermatol. 2020;19(4 Suppl 2):s5-15.

Publication Date: April 1, 2020

Authors: Steve G. Yoelin, Shino Bay Aguilera, Joel L. Cohen, Michael H. Gold, Joely Kaufman, Corey S. Maas

Autologous Fat Harvest and Preparation for Optimal Predictable Outcomes

Publication Number: 31280857

Best practices in fat transfer to the face focus on tissue harvest and processing techniques. This article discusses the role of adipose-derived mesenchymal stem cells (MSCs) in mitigating tissue loss in grafting. Discrepancies among common practice and recent study results have propagated uncertainty with long-term results. Fortunately, recent increases in the understanding of these MSCs are leading providers to identify statistically more favorable tissue donor sites, harvest technique, and preparation methods to increase their concentration in transferred tissue. Future studies are needed to support or confound the long-term effects of MSC transfer on facial fat grafting.

Keywords: Adipocyte-derived stem cells; Fat transfer; Mesenchymal stem cells.

Publication Date: August 27, 2019

Authors: Christian H Barnes, Corey S Maas

Aesthetic Office Disaster Preparedness and Response Plan

Publication Number: 33400419

The coronavirus pandemic (COVID-19) has served as a call-to-arms in preparing practices for the next disaster whether it is another infectious disease or a flood, hurricane, earthquake, a sustained power outage, or something else. A group of predominantly core aesthetic physicians discussed the various aspects of their office procedures that warrant consideration in a proactive approach to the next pandemic/disaster-related event. This guide does not set a standard of practice but contains recommendations that may avoid some of the “lessons learned” with the COVID-19 pandemic. In this paper, the board-certified core aesthetic physicians classified these recommendations into four generalized areas: Practice Management; Supplies and Inventory; Office Staffing Considerations and Protocols; and Patient Management Strategies. Proactive strategies are provided in each of these categories that, if implemented, may alleviate the processes involved with an efficient office closure and reopening process including, in the case of COVID-19, methods to reduce the risk of transmission to doctors, staff, and patients. These strategies also include being prepared for emergency-related notifications of employees and patients; the acquisition of necessary equipment and supplies such as personal protective equipment; and the maintenance and accessibility of essential data and contact information for patients, vendors, financial advisors, and other pertinent entities.J Drugs Dermatol. 2021;20(1):10-16. doi:10.36849/JDD.5803.

Publication Date: January 1, 2021

Authors: Joel L Cohen, Steve H Dayan, Mathew M Avram, Renato Saltz, Suzanne Kilmer, Corey S Maas, Joel Schlessinger

Injectable fillers: review of material and properties

Publication Number: 25763894

With an increasing understanding of the aging process and the rapidly growing interest in minimally invasive treatments, injectable facial fillers have changed the perspective for the treatment and rejuvenation of the aging face. Other than autologous fat and certain preformed implants, the collagen family products were the only Food and Drug Administration approved soft tissue fillers. But the overwhelming interest in soft tissue fillers had led to the increase in research and development of other products including bioengineered nonpermanent implants and permanent alloplastic implants. As multiple injectable soft tissue fillers and biostimulators are continuously becoming available, it is important to understand the biophysical properties inherent in each, as these constitute the clinical characteristics of the product. This article will review the materials and properties of the currently available soft tissue fillers: hyaluronic acid, calcium hydroxylapatite, poly-l-lactic acid, polymethylmethacrylate, and autologous fat (and aspirated tissue including stem cells).

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Publication Date: March 12, 2015

Authors: Natalie Huang Attenello 1, Corey S Maas 2