Filling and volumizing injection procedures are currently widely used for facial augmentation and re-establishing a youthful appearance.
Aesthetic physicians have advanced from the practice of treating single lines and wrinkles towards fi lling large facial areas to
globally restore natural facial contours and meet patient demand for nonsurgical rejuvenation. This review describes the different
categories of fi llers and volumizers based on their duration of action and ability to create a natural looking effect; they can be broadly
classifi ed as temporary or long-lasting biodegradable agents, or permanent nonbiodegradable agents. Temporary fi llers are effective
to correct lines and wrinkles, but may not adequately meet the need for global facial rejuvenation and volume replacement in a longterm,
cost-effi cient manner. Permanent fi llers for global restoration pose the issue of long-term safety, and may not be compatible
with changes in facial architecture with continued aging. Longer lasting volumizers provide patients with a durable, effective option
for the restoration of facial volume and the re-establishment of youthful facial contours. Temporary fi llers and volumizers may also be
used in combination to provide a wide source of options for the global restoration and rejuvenation of the face.
Ranella J. Hirsch MD FAAD, Meghan Stier BA
The wide variety of dermal ﬁ llers presently available has revolutionized treatment options for patients seeking a refreshed appear-
ance. Soft tissue ﬁ llers include both bovine and human collagens, the hyaluronans, calcium hydroxyapatite, poly-L-lactic acid, and
synthetic polymers. However, soft tissue augmentation is never risk-free, and as these procedures have increased in prevalence,
complications have been more frequently reported. This article describes a range of complications resulting from dermal ﬁ ller injec-
tions, reviews key case studies, and discusses possible treatment options for adverse effects. While biodegradable ﬁ llers offer the
least risk for the patient, location, allergic reactions, granulomas, necrosis, and infection are all serious complications that must be
considered before performing soft tissue augmentation with any approved dermal ﬁ ller.
Objective: Review the safety proﬁ le and subjective efﬁ cacy of intradermal botulinum toxin type A in facial pore size and sebum
Design: Retrospective analysis of 20 patients.
Results: Twenty consecutive patients with a single application of intradermal botulinum toxin type A were examined: Patients (17/20)
noted an improvement in sebum production and a decrease in pores size at 1 month after injection. No complications were observed,
and 17/20 patients were satisﬁ ed with the procedure.
Conclusion: Preliminary data suggests that intradermal botulinum toxin may play a role in decreasing sebum production. Further
quantitive study may be necessary to determine effects of intradermal botulinum toxin on pore size.
D. K. Damle MD DNB, P. M. Mahajan MD, S. N. Pradhan MD, V. A. Belgaumkar MD, A. P. Gosavi MD, S. N. Tolat MD, N. R. Gokhale MD, C. B. Mhaske MD
Background: Mycetoma has a worldwide geographical distribution which is extremely uneven; however, it is a common disease in
India and responsible for causing signiﬁ cant morbidity. Treatment of this condition is often a challenge for the treating dermatologist.
The authors report a promising therapy for patients of actinomycotic mycetoma.
Methods: This assessment series included 18 patients with a conﬁ rmed diagnosis of actinomycetoma, and who had shown a poor
response to previous treatments. Patient received a combination therapy of the Welsh regimen (amikacin along with cotrimoxazole)
to which rifampicin was added as a third drug. Clinical evaluation included radiology and laboratory investigations.
Results: Sixteen patients out of 18 completed the combination therapy, which lead to remission. Two patients were lost to follow-up.
Of the 16 patients in remission, no recurrence was observed during a follow-up period of up to 18 months.
Mira Stotland MD, Anne M. Chapas MD, Lori Brightman MD, Sean Sukal MD, Elizabeth Hale MD, Julie Karen MD, Leonard Bernstein MD, Roy G. Geronemus MD
Background: Improving the appearance of striae distensae, particularly striae alba, has remained a challenge due to the limited
availability of effective and low-risk treatment options. Fractional photothermolysis, a novel concept in skin rejuvenation, has been
reported to be effective in the treatment of facial rhytides, acne scars, and surgical scars, but its use in the treatment of striae has
not been well studied.
Objective: To determine the safety and efficacy of fractional photothermolysis treatment on striae alba and striae rubra.
Methods: Twenty female patients with striae rubra or striae alba on their abdomen, thighs, or buttocks were enrolled in the study.
Lesions were randomized to receive treatment, with site-matched normal control areas. Patients received a total of 6 treatments
using a 1550-nm, erbium-doped fiber laser with 2 to 3 weeks of elapsed time between treatments. Clinical response to treatment
was assessed at each visit, and at 1-month, 2-month, and 3-month follow-up intervals by the patient and investigator. A comparison
evaluation of 8 patients examining photographs of striae at baseline and at the 3-month follow-up evaluation which was assessed by
4 independent dermatologists using the quartile grading scale.
Results: The independent evaluators’ assessments of improvement from photographs of 8 randomly selected patients showed an
overall improvement of 26% to 50% in 63% (5/8) of patients. A less than 25% improvement in dyschromia was noted in 50% (4/8)
of patients. An improvement in texture of 26% to 50% was observed in 50% (4/8) of patients. The clinical responses were indepen-
dent of age, gender, and skin phototype. The treatments were tolerated well by all patients with a majority of patients experiencing
transient posttreatment erythema and edema.
Conclusion: Fractional photothermolysis can be effectively and safely used in the treatment of striae rubra and striae alba.
Rahul C. Mehta PhD, Stacy R. Smith MD, Gary L. Grove PhD, Rosanne O. Ford BA, William Canﬁ eld, Lisa M. Donofrio MD, Timothy C. Flynn MD, James J. Leyden MD
A topical gel containing a proprietary mixture of over 110 growth factors, cytokines, and soluble matrix proteins secreted by human
dermal ﬁ broblasts was evaluated for safety and efﬁ cacy in the treatment of mild to severe facial photodamage. In a double-blind
study, 60 subjects were randomly assigned to receive either active gel or the vehicle and applied twice daily for 6 months along
with a moisturizing cleanser and sunscreen. Efﬁ cacy (proﬁ lometry, photography, and clinical assessment) and safety (adverse event
reporting) measures were evaluated at 0, 3, and 6 months. Treatment with the active gel for 3 months produced greater reduction
in ﬁ ne lines and wrinkles than the vehicle treatment as measured by objective and subjective assessment techniques. The results
were either statistically signiﬁ cant (P≤.05) or trending towards statistical signiﬁ cance (P≤.1). This study demonstrates that addition of
a topical formulation of growth factors and cytokines to a basic skin care regimen reduces the signs of photoaging.
Claudine Pierard-Franchimont MD PhD, Frederique Henry MD, Pascale Quatresooz MD PhD, Valerie Vroome PharmD, Gerald E. Pierard MD PhD
Background: Solar lentigines represent a common feature of photoaging, particularly on the back of the hands. Bleaching agents
are usually proposed to lighten the shade of the lesions.
Methods: The study was randomized and designed to assess the effect of a bleaching solution containing 2% mequinol (4-hy-
droxyanisole, 4HA) and 0.01% tretinoin (Solagé®). The formulation was applied twice daily for 3 months on solar lentigines present
on the back of one hand. The lesions on the other hand were treated with the ethyl alcohol vehicle which served as a control.
Clinical diagnosis was confirmed using dermoscopy. In addition, objective measurements of the hypermelanosis were performed
at 1-month intervals during and after treatment. Clinical assessments were used as well as narrow-band reflectance spectropho-
tometry, image analysis of video-recorded ultraviolet light-enhanced visualization (ULEV method) and photodensitometry of the
Results: The multipronged assessment of the lesional color demonstrated a significant lightening effect of the 4HA/tretinoin solu-
tion. This was demonstrated after 2 months of treatment and was maintained at least 2 months after stopping treatment.
Conclusion: Both the visual ratings and the objective bioinstrumental methods indicate the rapid lightening effect of the 4HA/
tretinoin formulation. After stopping treatment, the rate of repigmentation appeared to have slowed compared to the depigmenta-