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Volumetric Approach to Midfacial 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 most appropriate HA products to be utilized for malar augmentation possess characteristics of large particle size and thicker constitution. These include Restylane Lyft, Restylane Defyne, Juvederm Voluma, and/or Radiesse. Sculptra can be used for malar augmentation, as well; however, this filler is a collagen stimulator. There is no immediate longevity in the product, but after a series of treatments, one notices appropriate structure and fill due to natural neocollagenesis. Patients who need volume added in the inferior orbital rim as well as the cheek will frequently use a similar family of products but differing gels to achieve a more tailored approach. Due to their ability to be placed superficially in the dermis, the HA fillers are more effective for making precise contour changes in the cheek especially in the presence of malar mounds.
Cutaneous Manifestations of Highly Active Antiretroviral Therapy
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Deborah B. Henderson, Clay J. Cockerell
Treatment of the lipodystrophy syndrome initially involves medical management of hyperlipidemia and withdrawal of the offending agent. A complete reversal of body habitus is not always observed following discontinuation of drug administration. Furthermore, successful reversal of fat redistribution has been observed after changing drugs from zidovudine or stavudine to abacavir. However, switching among antiretrovirals generally does not significantly resolve fat redistribution.29 Alternative treatments include diet, exercise, weight loss, liposuction, appetite stimulants, anabolic agents, recombinant human growth factor administration, and autologous fat transplantation to wasted areas. Injection of nonpermanent soft tissue augmentation with bovine or allogenic collagen and hyaluronic acid has also been reported. All of these modalities have had limited and varied success. A recently approved product for facial wasting is Sculptra (Dermik, Berwyn, PA), an injectable form of polylactic acid.64 High-grade silicone, which can give permanent improvement of facial wasting, is currently under investigation by the Food and Drug Administration. Finally, some studies report that ketoconazole, known for its potent inhibition on adrenal steroidogenesis, can lead to partial resolution of enlarged cervical fat pads.65 Unfortunately, recurrences are common.
Acquired partial lipodystrophy treated with poly-L-lactic acid and hyaluronic acid fillers: a case report
Published in Journal of Cosmetic and Laser Therapy, 2019
Amy J. Zhang, Eleni Moraites, Noah Goldfarb, Walter Liszewski, Ronda S. Farah
There is limited ability to reverse poly-L-lactic acid treatment, and fortunately the patient did not develop any nodules, erythema, tenderness, or other side effects. At 6 months posttreatment, the patient’s temporal and cheek atrophy appeared dramatically improved, and her facial erythema was also improved (Figure 1b). Given her clinical improvement without side effects, the patient underwent a second treatment with poly-L-lactic acid for remaining atrophic areas. Two vials of poly-L-lactic acid (Sculptra, Galderma Laboratories) diluted with 8 mL of sterile water and 1% lidocaine were injected into the cheeks and temples. The patient was elated with her improvement and reported regaining her self-confidence. There was no evidence of renal disease and she will continue to undergo monitoring for development of kidney involvement or new metabolic abnormalities.