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Platelet-Rich Plasma
Published in Rubina Alves, Ramon Grimalt, Techniques in the Evaluation and Management of Hair Diseases, 2021
Lu Yin, Katerina Svigos, Kristen Lo Sicco, Jerry Shapiro
Topical lidocaine 2.5% with prilocaine 2.5% cream (EMLA, Astra Pharmaceuticals, L.P., Wayne, PA, USA) is another anesthetic option. The FDA insert recommends application at least an hour prior to procedure, though time may vary depending on body part [24]. Papers in the peer-reviewed literature have also utilized shorter application times of 30 minutes, though this may result in less anesthetic effect [25–27]. The FDA package insert also recommends covering topical lidocaine 2.5% with prilocaine 2.5% cream with an occlusive dressing after application. In our clinic, patients are advised to apply the topical anesthetic 30–90 minutes prior to their visits, and we do not typically recommend occlusion after application of topical anesthesia for patients' convenience. Though the official FDA instructions recommend occlusion, at least one published peer-reviewed paper reports clinical efficacy after application of topical lidocaine 2.5% with prilocaine 2.5% cream without occlusion [25]. There does not exist a peer-reviewed head-to-head comparison of anesthesia after application of topical lidocaine 2.5% with prilocaine 2.5% cream with occlusion versus without occlusion.
Volumetric Approach to Lower Facial Rejuvenation
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Robert A. Glasgold, Justin C. Cohen, Mark J. Glasgold, Sachin M. Shridharani, Jason D. Meier
The injection technique begins with marking the planned injection area along the LMF along with the triangular-shaped region of volume loss just medial to the fold (Figure 9.10). Topical anesthetic is applied. A serial needle puncture injection or cannula technique is preferred in this area. Injection should remain in the mid to deep dermis, particularly in the superomedial aspect of the fold, where too superficial injection is more likely to result in prolonged erythema or a bluish hue (Tyndall effect). On average, 0.3–0.5 mL of HA product per side is typically required to correct this region. It is important to inject only at or medial to the fold as injection lateral to it will worsen the appearance of the jowl and LMF. After correction, gentle massage of the area is performed with gauze and petrolatum-based ointment to ensure a smooth contour. The result can be expected to last between 9 and 12 months. For patients who are very focused on the downward turn at the oral commissure, ancillary use of botulinum toxin injection of the depressor anguli oris (DAO) muscles, 2–4 units/side, can enhance the result of LMF filling. These injections are done into the inferior portion of the DAO muscle, at the anterior face of the mandible, so as to prevent inadvertent weakening of the orbicularis oris muscle. Patients are asked to show their bottom teeth, activating the DAO muscle for identification of its location prior to injection with botulinum toxin.
Ocular Irritation Testing
Published in David W. Hobson, Dermal and Ocular Toxicology, 2020
George P. Daston, F. E. Freeberg
Thus, it appears that most or all topical anesthetics are somewhat damaging to the cornea, and may, therefore, potentiate the irritancy produced by the test substance. It is difficult at this time to recommend that a topical anesthetic be used in conjunction with eye irritation tests because there are no data in the peer-reviewed literature which have evaluated the relative contribution of anesthesia to the irritancy of commercial or industrial products. However, the small amount of data which exist suggests that some topical anesthetics, particularly proparacaine, may have minimal or no adverse effects. The pursuit of research to determine the possible potentiative effects of this anesthetic on the ocular response to known irritants should be encouraged.
Efficacy of topical dexamethasone eye drops in preventing ocular inflammation and cystoid macular edema following uncomplicated cataract surgery with or without injection of a single dose perioperative subtenon triamcinolone acetonide
Published in Cutaneous and Ocular Toxicology, 2022
Buğra Karasu, Enes Kesim, Mert Kaskal, Ali Rıza Cenk Celebi
Before starting the cataract surgery, a subtenon incision was made at a distance of 3.5 mm from the inferonasal limbus immediately after topical anesthesia and TA (40 mg/ml) was injected into the subtenon space. All cataract operations were utilized a standardized phacoemulsification method. Patients in both groups (DEX group and sTA group) were operated by a single experienced surgeon at the tertiary hospital. Following a 2.8 mm clear corneal incision, subsequently capsulorrhexis, phacoemulsification (divide and conquer), and intraocular lens implantation into the capsular bag were implemented. Within the phacoemulsification system, an Ozil phacoemulsification hand piece and a 0.9 mm 30 degree angled Kelman tip were utilized (Infiniti; Alcon, Fort Worth, TX). Topical anesthesia was used in all surgical procedures. The ocular viscosurgical device (DisCoVisc, Alcon) was composed of 1.6% hyaluronic acid and 4.0% chondroitin sulfate. The intraocular lenses were preloaded aspheric hydrophobic single-piece for uncomplicated surgery (AU00T0, AcrySof IQ, SN60WF in UltraSertTM delivery system; Alcon; Eyecryl SERT Preloaded IOL Delivery System; Biotech). At the beginning of the surgery, 0.5 ml subtenon TA (40 mg/ml) suspension was injected into the lower nasal part of the bulbar conjunctiva with the help of a subtenon cannula. At the end of the surgery, 1 mg intracameral cefuroxime (Aprokam; Laboratoires Thea, Clermont-Ferrand, France) antimicrobial prophylaxis was administered to all patients. In addition, postoperative topical antibiotic therapy was applied as a routine practice in all of participants [17].
Evaluation of changes in skin biophysical parameters and appearance after pneumatic injections of non-cross-linked hyaluronic acid in the face
Published in Journal of Cosmetic and Laser Therapy, 2018
Hai-yan Cheng, Yu-xin Chen, Mei-fang Wang, Jun-ying Zhao, Lin-feng Li
According to the American Society for Aesthetic and Plastic Surgery, nearly eleven million non-surgical and two million surgical cosmetic procedures were performed in 2015 (17) in the USA. Thus, non-surgical procedures are over five times as common as surgical procedures, suggesting that people greatly prefer the former. The second-most common non-surgical cosmetic procedure performed in 2015 was hyaluronic acid injection, with over two million procedures performed. Hyaluronic acid filler injections are primarily used for facial, hand, and neck correction or augmentation. These injections are typically administered with an automatic stamp-type microneedle intradermal injector, owing to its effectiveness and painless application (18). However, topical anesthesia is still needed, and the side effects of this injection method include mild erythema, transient lumps, mild pain, and occasional bruising (19). A more time-saving, pain-free, side effect–free, and effective technique of administering hyaluronic acid is pneumatic injection. In this study, we evaluated the changes in skin biophysical parameters after five consecutive facial pneumatic injections of non–cross-linked hyaluronic acid.
Punctal Ectropion repair using the Raus–Garito clamp
Published in Orbit, 2018
Peter P. M. Raus, Nathalie Bral, Richard Collin
In patients under local anesthesia, first a topical anesthetic is instilled. The skin around the eye is desinfected e.g. with a 10% Povidone-iodine solution and the area is draped. For patients under local anesthesia, a local anesthetic with epinephrine is injected under the skin and deep under the orbicularis muscle. This deep infiltration is preferable to anesthetize the muscle and tarsus and to limit discomfort when the clamp is closed and the eyelid is everted. The lid margin of the lower eyelid in the nasal third is pulled upwards using a forceps with teeth. The complete loop of the clamp is slid over the eyelid with the concave side on the skin side (Figure 1). The arms of the clamp are pinched together before the clamp is closed with the screw. Thanks to the angulated form of the clamp, less traction is needed to evert the eyelid until the clamp rests on the skin. This means less traction on the medial canthal tendon. The aim of the teeth in the loops of the clamp is to prevent slipping of the clamp from the eyelid during eversion. Then a superficial diamond-shaped fusiform wedge of conjunctiva is excised inferior to the lower margin of the tarsal plate with the tip op the diamond pointing to the lacrimal punctum (Figure 1). The height of this excision is determined by the amount of punctal ectropion but is limited by the size of the loops of the clamp. The greatest vertical dimension should lie beneath the punctum.