The American Journal of Cosmetic Surgery

Because intense pulsed light (IPL) and oral isotretinoin (ISOT) are capable of improving photoaging, we tried to demonstrate if IPL alone is as effective as a combination of both procedures.

We carried out an open, randomized, comparative, and descriptive trial in 18 Hispanic women with cutaneous aging grades II and III (Glogau). Patients were divided into 2 groups. In the frst group, only IPL was used with an Alma Laser Harmony XL machine, and 5 sessions of IPL were performed, with an interval of 2 weeks between them. At the beginning, the fluence was 12 J/cm² and the time 12 ms, then it was increased to 13 J/cm² and 12 ms, respectively. The second group received the same number and type of sessions of IPL, but we added oral ISOT, 20 mg 3 times a week for 10 weeks. Two 3-mm punch biopsies were taken, always from the same site: the first one, immediately prior to the beginning, and the second one 3 weeks after the end of the study. Follow-up was made 6 months after finishing the study. Controls were performed supported upon the physician, 1 nurse (always the same), and the patient herself, microscopic (2 dermatopathologists), and statistical.

At the end, the combination IPL/ISOT proved to be better than IPL alone, not only clinically, but microscopically and statistically. No side effects were observed.

The differential diagnosis of a firm, immobile lesion of the forehead includes more than just osteoma. Preoperative computed tomography (CT) imaging may alter surgical precautions and reduce the complications to allow for a minimally invasive approach.

This is a retrospective case series of a single, private facial plastic surgeon in New York, New York, of patients evaluated for a firm, immobile forehead mass. The impact of CT scan on diagnosis and treatment was analyzed. Intraoperative and postoperative complications, recurrences, and patient satisfaction were recorded.

Nineteen patients (age range = 19–66 years; mean age = 36 years) presented with one or more firm, immobile forehead masses measuring <4 cm. Before 2011, preoperative CT evaluation was not routinely performed; during this period, 5 patients underwent excision of presumed osteomas with no complications. In 2011, patient 6 was found to have an intradiploic hemangioma on outside CT scan. From 2011 to 2014, preoperative CT was recommended (n = 13) to confirm osteoma. Ultimately, our series (n = 19) revealed 17 osteomas (16 patients), 1 intradiploic hemangioma, 1 pneumosinus dilitans, and 1 compact lipoma. Follow-up (mean = 3 months) did not reveal any complications. All patients reported high satisfaction with the aesthetic outcome, and there was no recurrence or need for revision surgery.

The differential diagnosis of a firm, immobile forehead mass includes various pathologies of the scalp and calvarium. Though these masses are most commonly osteomas, other pathologies may present similarly. Preoperative CT scans without contrast can distinguish these unexpected etiologies. With proper evaluation and diagnosis, minimally invasive excision may be performed with excellent results.

Merely mimicking youth in an aging face can be elusive and controversial. Restoring the vitality, pleasantness, and fitness of the face (improving the expression). has been greatly rewarding for my patients. Holistic parameters are instilled in my approach to countering the negative societal responses to older faces. The objectives of this study were to (1) measure the social impact of focused facial rejuvenations and (2) validate the combination of original techniques used in this series.

Eighty medical students were asked to rate, in term of “social acceptance/desirability,” a random mix of before-and-after photographs of 15 women, aged 45 to 75 years old, who had undergone facial rejuvenation.

A clear gain in social acceptance is demonstrated in after results.

The marked increase in social acceptance after improving expression or “Emoticon effect” amply supports this simple paradigm in the planning of a facial rejuvenation. The combination of a vertical refresher lift, a modulated dual-plane brow lift (subcutaneous/subgaleal), and simultaneous sectional fat grafting has been instrumental in obtaining the desired results.

Intraocular side effects of Sculptra Aesthetic (poly-(L)-lactic acid) (PLLA) (Dermik, Bridgewater, NJ, a subsidiary of Aventis Pharmaceuticals International Inc), dermal filler have been rare. The authors seek to describe the first case of a transient sixth nerve palsy and mydriasis secondary to extraorbital PLLA filler injection and to present hypotheses explaining the complications.

A case report is presented that details a complication suffered by 1 patient during a temporal PLLA injection. A thorough review of the literature was performed. The literature was evaluated with respect to the number of patients, complications, and outcomes secondary to PLLA injections.

In the literature, there were 3 reported cases of ocular symptoms following a PLLA injection. The findings ranged from posterior ciliary artery occlusion to orbital infarction and blindness. In our case, we propose that the PLLA accessed the orbit by leakage through the temporal orbit due to the mechanism of injection combined with an increased porosity secondary to osteopenia.

A large majority of the patients who seek a cosmetic result that can be gained by fillers are postmenopausal women. This population is characteristically affected by osteopenia and osteoporosis. For patients similar to ours, with osteopenia or osteoporosis, extra care must be taken when injecting the temporal area secondary to its various areas of susceptibility caused by decreased density. Because of the increased use of PLLA as a dermal filler, it would be prudent to include an eye exam as part of the pretreatment and posttreatment care plan.