Abstracts

A summary of the latest clinical studies

Title: Breast Augmentation for Transfeminine Patients: Methods, Complications, and Outcomes Authors: Bekeny, et al. Published: Gland Surgery, August 2020 Keywords: Transgender, breast augmentation, chest surgery Abstract: Although there are many techniques for genderaffirming care, surgical breast augmentation, or “top surgery,” is often cited as the most important-and sometimes onlyprocedure sought by transfeminine patients. Unfortunately, years of individual and systemic prejudice placed barriers between transgender patients and the healthcare providers needed to affirm gender identity. Policy has recently begun to change as research proving the safety, need, and outcomes of breast augmentation in transfeminine patients dismantles long-established systemic inequalities. With this change, more patients are seeking knowledgeable and respectful providers who can address their unique gender-affirming needs. The most common method of augmentation relies on breast implants, since removable prostheses, exogenous hormones, and fat grafting alone often produce unsatisfactory results. Special attention needs to be directed towards anatomic differences in transgender versus cisgender patients in order to achieve optimal size and position of the breast and nipple-areolar complex. The aim of this review is to give providers the technical knowledge concerning breast augmentation options, pre-surgical evaluation, post-surgical care, and special considerations in transfeminine patients so that provider and patient can have a successful, respectful partnership in reaching gender-affirming goals.

Title: Enhanced Pulsed Dye Laser for Facial Rejuvenation Authors: Ross, et al. Published: Lasers and in Surgery and Medicine, August 2020 Keywords: Pulsed dye laser, telangiectasia, rosacea, pigment Abstract: Thirteen patients were enrolled in the study. Nine patients were female, four were male. All patients presented with either facial telangiectasia, rosacea, pigment, or a combination thereof. At the initial evaluation, test spots were performed to determine the subject’s response to selected treatment parameters. In the study, the enhanced 595 nm PDL deployed a spot size range of 5-12 mm with fluences ranging from 8 to 18 J/cm 2 . Pulse duration was 10 milliseconds. Enhancements in this device included the option for contact or cryogen spray cooling, increased maximum pulse energy, increased repetition rate, option for addition of radiofrequency (RF), an option for a 15 mm spot size, and longer dye life. Determinations of improvement were made by evaluation of photographs with standard settings using polarized and nonpolarized images. Up to three treatments were performed approximately 1 month apart with follow-up visits 1 and 3 months after the final treatment. Evaluation by a panel of blind observers determined a mean clearance of at least 50% in all lesions, while 77% of lesions had 50-75% clearance, and 23% of lesions had 76-100% clearance. Pain was approximately 4/10. Subjective lesion improvement and satisfaction rates were 3 out of 4 and 3.6 out 4, respectively. An enhanced PDL is effective in one pass treatments for facial rejuvenation with considerably less operative time than previous commercially available systems. A second pass applied to focal challenging lesions results in even more improvement, in a single treatment session.

Title: Ultrasound Assessment of Tissue Integration of The Crosslinked Hyaluronic Acid Filler VYC-25L in Facial LowerThird Aesthetic Treatment: A Prospective Multicenter Study Authors: Urdiales-Gálvez, et al. Published: Journal of Cosmetic Dermatology, August 2020 Keywords: Biointegration, hyaluronic acid, lowerface Abstract: Prospective, noncomparative, open-label, and multicenter study conducted on healthy subjects, with age comprised between 30 and 60 years old, who attended the clinic to perform a facial rejuvenation treatment of the lower third of the face. VYC-25L was injected using a 27G needle (supraperiosteal bolus, from 0.2 to 0.3 mL per bolus) in the chin and with canula (retrograde threads, from 0.4 to 0.6 mL) in the jaw. Ultrasound examinations (UE) were performed at each study center by the same experienced observer at baseline, immediately after injection, 48 hours, and 30 days after treatment. Thirty patients (10 per center) were included in the study. At baseline, UE found a characteristic heterogeneous pattern of subcutaneous cellular tissue, with alternation of soft anechoic and hyperechoic images. The UE, performed immediately after treatment, showed a poorly defined globular ultrasound pattern, with anechoic images indicative of liquid content. Forty-eight hours after treatment, UE are still showing a globular pattern, with well-defined anechoic areas. Thirty days after treatment, a thickening of the subcutaneous cellular tissue was observed in all the evaluated zones, with a total integration of the HA into the tissue.

Title: A Case Report of Episcleral Artery Embolism Caused by Hyaluronic Acid Injection Into the Malar Area Authors: Akoglu, et al. Published: Journal of Cosmetic Dermatology, August 2020 Keywords: Arterial embolism, episcleral artery, hyaluronic acid, malar area, vascular occlusion Abstract: Dermal fillers are one of the most commonly used minimally invasive cosmetic procedures. In recent years, malar filler injections have become increasingly more popular among women to have more prominent cheekbones for attractiveness and facial beauty. To provide a more comprehensive structure for restoring malar eminences, the depth of injection points are recommended to be positioned supraperiostally. Owing to supraperiosteal planes, apart from the zygomaticofacial pedicle, are called as major artery-free areas malar filler injections are usually considered to be relatively safe in terms of vascular complications. Herein, we describe a case of episcleral artery embolism following malar filler injection procedure with hyaluronic acid (HA) and discuss the possible embolism mechanisms.