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

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

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%

Categorizing facial creases: A review

Ensuring uniformity in the nomenclature standardization of facial creases is important to enable the scholarly community to follow and debate the advancements in research. This review highlights the prevailing disparity in the nomenclature that refers to the same facial crease by researchers and laypeople, and suggests uniform names for the facial creases based on available literature. The previous and current trends in facial crease classification are also discussed. The nomenclature of the facial creases considered for this review include the following: the nasolabial fold, corner of the mouth lines, upper and lower lip creases around the mouth region, the mandibular folds, the bifid nose, the transverse nasal line, the vertical glabellar line, chin crease, the mental crease, four type of creases around the eyes, forehead creases, and periauricular creases. A figure illustrating the above facial creases is included as reference. It is hoped that the proposed standardization of nomenclature would ensure a more scientific referencing of facial creases enabling more effective scientific interaction among the scholarly community as well as the laypeople interested in the research and application of facial creases

Becker's Nevus Syndrome - gluteal muscle asymmetry treatment with polymethylmethacrylate implant - a case report

Becker's nevus syndrome presents with a hyperchromic spot often trunk located, associated with hypertrichosis and maxillofacial or skeletal and muscle alterations. This study reports the case of a male patient who had Becker's nevus syndrome in the left gluteal region, who underwent intramuscular PMMA microspheres implantation for muscle volume symmetrizatio

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