ArteFill® Permanent Injectable for Soft Tissue Augmentation: I. Mechanism of Action and Injection Techniques

After more than 25 years of research and development, in October 2006 ArteFill® became the first and only permanent injectable wrinkle filler to receive FDA approval. ArteFill is a third-generation polymeric microsphere-based filler, following its predecessor Artecoll®, which was marketed outside the United States between 1994 and 2006. ArteFill is approved for the correction of nasolabial folds and has been used in over 15,000 patients since its U.S. market introduction in February 2007. No serious side effects have been reported to date according to the FDA’s MAUDE reporting database. ArteFill consists of polymethylmethacrylate (PMMA) microspheres (20% by volume), 30–50 μm in diameter, suspended in 3.5% bovine collagen solution (80% by volume) and 0.3% lidocaine. The collagen carrier is absorbed within 1 month after injection and completely replaced by the patient’s own connective tissue within 3 months. Each cc of ArteFill contains approximately six million microspheres and histological studies have shown that long-term wrinkle correction consists of 80% of the patient’s own connective tissue and 20% microspheres. The standard injection technique is subdermal tunneling that delivers a strand of ArteFill at the dermal–subdermal junction. This strand beneath a wrinkle or fold acts like a support structure that protects against further wrinkling and allows the diminished thickness of the dermis to recover to its original thickness

Kings and Courtesans: A Study of the Pictorial Representation of French Royal Mistresses

This thesis explores the development in the pictorial representation of four important French royal mistresses. It looks at works depicting Agnès Sorel, mistress to Charles VII; Diane de Poitiers, mistress to Henri II; Gabrielle d’Estrées, mistress to Henri IV; and Madame de Pompadour, mistress to Louis XV. By placing the portrayals of these women within a historical context, it becomes apparent that there are links between the strength of the crown and the depictions of the mistresses. This thesis traces the development of the imagery associated with these women and demonstrates that as the crown became more and more powerful, the portraits of the kings’ mistresses became bolder and less disguised

ArteFill® Permanent Injectable for Soft Tissue Augmentation: II. Indications and Applications

Patients ask for procedures with long-lasting effects. ArteFill is the first permanent injectable approved in 2006 by the FDA for nasolabial folds. It consists of cleaned microspheres of polymethylmethacrylate (PMMA) suspended in bovine collagen. Over the development period of 20 years most of its side effects have been eliminated to achieve the same safety standard as today’s hyaluronic acid products. A 5-year follow-up study in U.S. clinical trial patients has shown the same wrinkle improvement as seen at 6 months. Long-term follow-up in European Artecoll patients has shown successful wrinkle correction lasting up to 15 years. A wide variety of off-label indications and applications have been developed that help the physician meet the individual needs of his/her patients. Serious complications after ArteFill injections, such as granuloma formation, have not been reported due to the reduction of PMMA microspheres smaller than 20 μm to less than 1% “by the number.” Minor technique-related side effects, however, may occur during the initial learning curve. Patient and physician satisfaction with ArteFill has been shown to be greater than 90%

Effect of a conventional energy-restricted modified diet with or without meal replacement on weight loss and cardiometabolic risk profile in overweight women

<p>Abstract</p> <p>Background</p> <p>Abdominal obesity, atherogenic dyslipidemia and hypertension are essential risk factors for cardiovascular diseases. Several studies showed favorable effects of weight loss in overweight subjects on cardiometabolic risk profile.</p> <p>Methods</p> <p>This open-label, randomized, controlled study investigated the effect of an energy-restricted modified diet with (MR) or without meal replacements for weight control (C) on weight loss, body composition and cardiometabolic risk profile in overweight women. Of 105 randomized participants, 87 were eligible for per protocol analysis. Anthropometric, clinical, blood, 24 h-urine parameters and dietary intake were assessed at baseline and after 12 weeks.</p> <p>Results</p> <p>Dietary intervention resulted in a significant weight loss in both groups (MR: -5.98 ± 2.82 kg; p < 0.001, C: -4.84 ± 3.54 kg; p < 0.001). However, the rate of responder (weight loss >5%) was higher in MR (77%) versus C group (50%) (p = 0.010). A significant reduction in waist circumference (WC) and body fat mass (BFM) was observed in both groups. Body cell mass (BCM) and lean body mass (LBM) decreased, while percentage of BCM of body weight increased in MR more than in C group. Systolic and diastolic blood pressure (BP) significantly decreased and to a similar extent in both groups. Total cholesterol (TC), LDL-C but also HDL-C declined significantly in both groups, while no change occurred in triglycerides.</p> <p>Conclusions</p> <p>Both dietary intervention strategies had a similar effect on weight loss and body fat distribution, but rate of responder was significantly higher in MR group. Systolic BP decreased to a similar extent in both groups. Cardiometabolic risk profile improved only partly in both groups.</p

Autologous fat grafting for treating lipoatrophy secondary to lupus erythematosus panniculitis

AbstractLupus erythematosus panniculitis (LEP) is an uncommon variant of LE and accounts for only 1–3% of cutaneous LE cases. LEP lesions often heal with cutaneous scarring and lipoatrophy resulting in disfigurement. Studies regarding the treatment of permanent lipoatrophy and disfigurement caused by LEP are lacking in the literature. Here, we report our experience with a rare case of lipoatrophy caused by LEP that was treated using autologous fat grafting. A 41-year-old woman presented with indurated, flesh-colored, depressed plaques on both buttocks. After a series of investigations, LEP was diagnosed by a rheumatologist. Magnetic resonance imaging (MRI) showed a markedly decreased volume of the subcutaneous fatty layer and thickening over the covering cutis. After the inflammatory disease was controlled, we attempted to restore her body contour with autologous fat grafting. We arranged an MRI study after a follow-up period of 12 months. The volume of subcutaneous fat was calculated by integrating cross-sectional area data from consecutive images. The patient was satisfied with her body contour following the injection of 350 mL of fat into the right buttock and 50 mL into the left buttock in a two-stage procedure. No complications were observed following the procedure. Follow-up laboratory results were negative for anti-double-stranded DNA antibody and showed normal complement levels. After a follow-up period of 12 months, no nodules or disease reactivation was noted. The MRI showed a marked improvement in the volume of the subcutaneous fat of the buttock, and the survival ratio of transferred fat was calculated to be 65%. Lipoatrophy secondary to LEP is a rare disease that can cause distress to patients. Autologous fat grafting is a simple, fast, and effective method for alleviating depression deformities in patients with LEP. It has a potentially long-lasting effect in treating patients with permanent lipoatrophy and disfigurement caused by LEP but should be preferably performed only in patients with quiescent disease

The post-mortem resilience of facial creases and the possibility for use in identification of the dead

The post-mortem resilience of facial creases was studied using donated bodies in order to establish the efficacy of crease analysis for identification of the dead. Creases were studied on normal (pre-embalmed) and bloated (embalmed) cadavers at the Centre for Anatomy and Human Identification (CAHID) to establish whether facial bloating would affect facial crease visibility. Embalming was chosen to simulate the effects produced by post-mortem bloating. The results suggested that creases are resilient and changes were only detected for creases located on the periphery of the face, particularly at areas where the skin is thick, such as at the cheeks. Two new creases not previously classified were identified; these creases were called the vertical superciliary arch line and the lateral nose crease. This research suggests that facial creases may be resilient enough after death to be utilised for human identification

Duration of wrinkle correction following repeat treatment with Juvéderm hyaluronic acid fillers

Many patients elect to have repeat treatments with hyaluronic acid dermal fillers to maintain wrinkle correction, but the clinical performance of these products after repeat treatments has not been formally assessed. The primary objective of this study was to evaluate the effectiveness of Juvéderm injectable gel (Juvéderm Ultra, Juvéderm Ultra Plus, and Juvéderm 30) through 1 year after repeat treatment of nasolabial folds (NLFs) that were previously treated with Juvéderm or Zyplast 6–9 months prior to the repeat treatment. Upon completion of the pivotal IDE clinical trial for Juvéderm, five of the original 11 study sites were selected to participate in an extended follow-up evaluation, and a total of 80 subjects were enrolled. For the Juvéderm-treated NLFs in each treatment group, the median injection volume was 1.5–1.6 mL for initial treatment but only 0.5–0.6 mL for the repeat treatment (p < 0.0001). Mean Investigator-assigned NLF severity scores on a scale of 0–4 for the Juvéderm-treated NLFs improved from 2.5–2.7 (moderate to severe) at baseline to 1.2–1.5 (mild) just prior to repeat treatment (>24 weeks) and 0.7–0.9 (mild) at 4 weeks after repeat treatment. At 48 weeks post-repeat treatment, the mean NLF scores were 1.1–1.3 (mild), and 78–90% of subjects were considered responders (≥1 point improvement). Thus, subjects sustained a total of 18–21 months of wrinkle correction with a repeat treatment at 6–9 months and needed substantially less filler (60% less) for repeat treatment than for initial treatment, indicating that retreatment at this timepoint may be beneficial to patients

Giant inframuscular lipoma disclosed 14 years after a blunt trauma: A case report

<p>Abstract</p> <p>Introduction</p> <p>Lipoma is the most frequent benign tumor of the soft tissue. This lesion is often asymptomatic except in cases of enormous masses compressing nervous-vascular structures. Although the diagnosis is mostly clinical, imaging tools are useful to confirm the adipose nature of the lesion and to define its anatomic border. Sometimes, lipomas may be the result of a previous trauma, such as in this patient.</p> <p>Case presentation</p> <p>A 45-year-old man presented at our institution with a giant hard firm mass in the upper external quadrant of the right buttock disclosed after a weight loss diet. Subsequent magnetic resonance imaging showed a giant adipose mass developed beneath the large gluteal muscle and among the fibers of the medium and small gluteal muscles. When questioned on his medical history, the patient reported a blunt trauma of the lower back 14 years earlier. He underwent surgery and histological examination confirmed a giant lipoma.</p> <p>Conclusion</p> <p>Lipomas might result from a previous trauma. It is hypothesized that the trigger mechanism is activated by cytokine and growth factors released after the trauma. We herein present an exceptional case of a giant post-traumatic lipoma which caused a painful compression on the right sciatic nerve.</p

Clinical and anatomical approach using Sihler's staining technique (whole mount nerve stain)

Sihler's staining allows visualization of the nerve distribution within soft tissues without extensive dissection and does not require slide preparation, unlike traditional approaches. This technique can be applied to the mucosa, muscle, and organs that contain myelinated nerve fibers. In particular, Sihler's technique may be considered the best tool for observing nerve distribution within skeletal muscles. The intramuscular distribution pattern of nerves is difficult to observe through manual manipulation due to the gradual tapering of nerves toward the terminal end of muscles, so it should be accompanied by histological studies to establish the finer branches therein. This method provides useful information not only for anatomists but also for physiologists and clinicians. Advanced knowledge of the nerve distribution patterns will be useful for developing guidelines for clinicians who perform operations such as muscle resection, tendon transplantation, and botulinum toxin injection. Furthermore, it is a useful technique to develop neurosurgical techniques and perform electrophysiological experiments. In this review, Sihler's staining technique is described in detail, covering its history, staining protocol, advantages, disadvantages, and possible applications. The application of this technique for determining the arterial distribution pattern is also described additionally in this study