Can Phosphatidylcholine Be Used With a Derma Roller

Summary

In recent years, a plethora of novel therapeutic approaches to fight signs of aging and to influence external body appearance have become available in aesthetic dermatology. Extensive research in this field has led to advanced understanding of the anatomy and physiology of the aging face. To successfully address the complex age-related alterations anti-aging treatment nowadays calls for a multi-faceted approach. Most frequently utilized aesthetic procedures include the use of botulinum toxin, a variety of filling substances, microneedling (collagen induction therapy), chemical peeling, lasers, radiofrequency, thread facelift and injectional lipolysis with phosphatidylcholine/deoxycholate among others. Unfortunately, many clinicians still lack in-depth understanding of potential complications, risk factors and side effects associated with minimal-invasive procedures. The following review aims to give a broad overview of nowadays most frequently used approaches in the dermato-aesthetic field and their related complications.

Introduction

Aesthetic procedures have become increasingly popular over the last decades and features of the "ideal" face have been extensively described 1. A substantial and rapid change characterizes the field of facial aesthetics and rejuvenation as physicians and patients continue their quest for minimally invasive yet highly effective and safe approaches to minimize the signs of facial aging 2. As consequence of the complex age-related changes in various tissues, including skin, muscle, fat and bony structures, aesthetic procedures ask for a multidimensional approach 2, 3. Injectable filling materials may be combined with neurotoxins to resolve superficial wrinkles and restore facial volume. There is an obvious trend towards a global, 3-dimensional approach for facial rejuvenation that has been driven by advances in injection techniques and available products 2. In order to improve skin surface irregularities and induce skin tightening, chemical peels or (fractional) laser resurfacing may be employed 3. The use of photodynamic therapy has also been highlighted as a potential option for skin rejuvenation 4. Combination of different approaches can frequently optimize and maximize aesthetic outcomes and by that patient satisfaction. Thus not surprisingly indications and number of minimal-invasive aesthetic procedures performed are continuously increasing 5. Even though benefits of successful aesthetic procedures are evident, the number of associated complications is likely to grow during the next years. Unfortunately, many clinicians still lack in-depth knowledge of potential complications, risk factors and side effects associated with minimal-invasive procedures 5. This review aims to give a brief update on nowadays most frequently utilized approaches in the dermato-aesthetic field, their indications and related complications.

Botulinum Toxin A

Botulinum toxin A (BoNTA) is an injectable neurotoxin used for the treatment of medical and cosmetic conditions. Current aesthetic indications include (off and on-label) the treatment of forehead lines, glabellar lines, crow's feet bunny lines, perioral wrinkles, and platysmal bands among others 3. Complications may be divided into early, usually transient, as well as delayed, also mostly transient, only rarely prolonged, and never permanent ones 6. Side effects after injections with BoNTA include allergic reactions, rash, itching, headache, and pain or tenderness at the injection site. Minor bruising (in 11 % to 25 % cases 7), redness and moderate oedema 8 at the injections site are self-limiting 9, 10. In one study, 3.8 % of patients reported sensation of localized skin dryness 11. Exaggeration of wrinkles after the treatment of forehead horizontal lines is caused by hyperactivity and overcompensation of untreated muscles and can be eliminated by subsequent injection of BoNTA into the mimic muscle responsible for the newly formed wrinkles 12. Temporary blepharoptosis (in 6.5 % cases 13), eyebrow ptosis (Figure 1) due to weakening of the Musculus (M.) frontalis, lid ptosis due to attenuated fibres of the M. levator palpebrae superioris, diplopia and ectropion are technique-dependent, caused by improper placement of injections or by localized diffusion of injected material 14. Although these types of complications can be referred to as severe ones, they are rare and resolve within one to three months without any therapy. When treating platysmal bands cervical complications like neck weakness and dysphagia may occur 15. Based on the authors' experience, side effects after BoNTA injections can be easily prevented by careful dosing and in-depth knowledge of the facial anatomy.

Ptosis of the right eyebrow due to weakening of the M. frontalis after the injection with BoNTA.

BoNTA antibody formation represents a potential concern that may affect its biological activity, even though botulinum toxins in general are considered "lower risk" biologics in this regard 16. Since BoNTA is nowadays used therapeutically to treat a wide variety of medical conditions, including blepharospasm, migraine, hyperhidrosis, and cervical dystonia among others antibody formation may be of certain relevance, even though exact numbers of antibody formation are missing and in general are thought to be relatively low 17-19. Numerous aspects contribute to potential immunogenicity of botulinum toxins, including product-related features (antigenic protein load and the presence of accessory proteins), as well as treatment-related factors (overall toxin dose, booster injections) 16. In order to mitigate antibody formation it is currently recommended to employ the longest inter-injection interval that is therapeutically tolerable and the lowest effective dose that still provides sufficient clinical results 16.

Fillers

It is currently thought that approximately 160 different filling materials are being available worldwide 20, with only very few that are being supported by sufficient study data 3, 21. The most common materials in this area represent hyaluronic acid (HA), calcium hydroxylapatite (CaHa), collagen, poly-l-lactic acid (PLLA), polymethyl methacrylate (PMMA), silicone and autologous fat 3, 5, 20. Dermal fillers can be categorized by several methods. However, when discussing associated complications, a categorization in terms of biodegradable (temporary) versus non-biodegradable (permanent) fillers may be most useful 5. Mild and transient complications are observed relatively frequently and include pain during injection and shortly thereafter, redness, injection-site bleeding and bruising, asymmetry as well as dyspigmentation 5, 22. Severe adverse events are fortunately rare and include swelling (temporary as well as permanent or recurrent), hypersensitivity, infections, formation of nodules, foreign body granulomas, as well as vascular and neural complications leading to tissue necrosis and scarring 5, 23.

Malar oedema

Malar oedema represents a serious complication presenting as long-persisting swelling in the periorbital area after placement of dermal fillers, most usually hyaluronic acid gel to the infraorbital hollows. In general, the tear-trough area is considered a high-risk area with adverse events after tear-trough augmentations with HA fillers including bruising (10 to 75 %), contour irregularities (11 %), discoloration (4 to 7 %), as well as swelling, fluid or edema (15 to 26 %) 24-26. However, development of eyelid oedema, often also referred to as malar bags, malar oedema or malar mounds 27, is not a sole consequence of aesthetic procedures but rather represents an unspecific sign, and may herald a variety of systemic or periorbital diseases. An important role in development of malar oedema plays the almost impermeable malar sept, which divides the suborbicularis oculi fat into upper and lower part. The skin in this area is extremely thin and any disturbance in lymphatic drainage is immediately visual. Some individuals already have a predisposition of compromised lymphatic drainage in the superficial compartment of the superficial suborbicularis oculi fat even without having any filler material injected. Iatrogenic malar oedema may occur after introducing filler superficial to the malar sept or due to injecting large volumes of material causing pressure on the lymphatic vessels. Head elevation with cold compresses, manual pressure massage, oral methylprednisolone, and in case of HA filler intralesional hyaluronidase are indicated, which should be injected gradually in small volumes at weekly intervals in order to prevent overtreatment 27. Nevertheless, the percentage of affected patients is alarming and highlighting the periorbital region as an area of increased risk, which should be treated with extreme caution and by experienced injectors only with appropriate and little material only, preferable supraperiostally.

Non-inflammatory nodules

Non-inflammatory nodules are usually the result of material accumulation 28 or false filler placement 29 (e. g. overcorrection, too superficial placement of filler or an incorrect indication such as intramuscular placement in a sphincteric muscle). They usually appear early after the procedure and should be differentiated from biofilms or foreign body granulomas. Nodules as a consequence of HA filler will be best resolved with hyaluronidase. Early nodules occurring after treatment with a non-HA filler may respond to vigorous massage; alternatively, the material may be extruded 19.

Biofilms

Biofilms may present as recurrent tender nodules occurring weeks to months after the filler injection 30. These delayed reactions after dermal filler treatments used to be often attributed to hypersensitivity reactions 31, however in recent years it has become evident that some of them may form due to bacterial aggregations 32. The exact mechanisms underlying their development 33 are not yet fully understood. Based on current understanding biofilms present collections of microorganisms attached to surfaces not recognized by the immune system and are very resistant to antibiotics 34. Chronic biofilm infections present low bacterial diversity 32. Identification of the bacteria due to negative cultures is very difficult. The combination of Gram stain and peptide nuclear acid fluorescence in situ hybridization analyses have shown promising results in identifying the pathogens 35. Apparently, the best way of preventing biofilms represents a proper pre-injectional disinfection of the treated area with chlorhexidine 34 and using fine, small needles 36. Therapeutic approaches in case of a biofilm formation include a combination of broad-spectrum antibiotics with macrolides administered for several weeks. If unsuccessful, a liquefaction of the filler through intralesional radiofrequency therapy may lead to decreasing bacterial load within the biofilm nodule 30.

Granulomas

Granulomas represent a type IV hypersensitivity reaction to inserted foreign material (Figure 2). They may develop as a delayed complication months or years after filler injection 37 and represent a serious adverse event due to their persistence and resistance to treatment 5. First steps include identification of the injected material and exclusion of an infection. These are followed, in case of a HA filler granuloma, by intralesional hyaluronidase injection, and in case of all the other filling materials by an intralesional corticosteroids injection 5. From the authors experience successful treatment of resistant cases may be achieved by repeated intralesional injections of 5-fluorouracil mixed with xylocaine with adrenaline and triamcinolone acetonide 5.

Neural complications

Neural complications in form of sensory and/or motor deficits may be caused by either nerve lacerations by the tip of the needle or by nerve compression by the inserted material 30. Such a compression may as well disturb the vascular supply. This kind of a vascular compromise and/or an intravasal filler injection may both lead to a tissue necrosis 5. High risk localizations include the glabella and the nasolabial folds 38, 39. First aid in form of an intralesional introduction of hyaluronidase and application of a 2 % nitroglycerin paste in case of notable blanching, violet discoloration, severe pain, and development of an erosion and ulceration are indicated 5, 38.

Intravascular fat or filler injection may lead to a sudden blindness. Review of the current literature has revealed around 45 and over 60 cases of blindness resulting from filler or fat injections, respectively. Intravasal fat injections in comparison to fillers seem to show higher incidence of this devastating complication and are also connected to a worse visual outcome 40, 41. In recent years, hand in hand with the rising popularity of fillers, more reports on blindness caused by various filler materials, including hyaluronic acid, silicone oil, bovine collagen, polymethylmethacrylate, calcium hydroxyapatite and poly-(L)-lactic acid (PLLA) have been published 42, 43. Hyaluronic acid seems to be the most often reported filler material in connection to this serious adverse event. However this may be resulting from the fact, that hyaluronic acid represents usually the material of choice in these high-risk areas, including glabella and nasolabial fold, followed by temple, nose and frontal area 44-46. Experimental and clinical studies indicate that arteries allowing emboli to flow into the eye globe include facial, ophthalmic, central retinal and superficial temporal artery. The facial artery, a branch of the external carotid, supplies structures of the superficial face and branches among others into lateral nasal branch. It terminates as angular artery and anastomoses with the dorsal nasal artery of the internal carotid artery. The first branch of the internal carotid artery, the ophthalmic artery, supplies all the structures in the orbit as well as some structures in the nose, face and meninges. Its first and smallest branch is the central retinal artery providing the only blood supply of a larger part of the retina. The anastomoses of the superficial temporal artery with the supraorbital artery explain why the temple belongs to the high-risk regions. All of the above mentioned arteries and their interarterial anastomoses may lead in case of embolic occlusion to ocular complications in ipsilateral, contralateral and/or bilateral eye globes 46, 47. In order to avoid such events we recommend very slow administration of small amounts of material under the lowest possible pressure and with the use of blunt cannulas. Aspiration, usage of a local vasoconstrictor, as well as avoidance of pretraumatized soft tissue areas represent additional precautions. In case of suspicion of arterial occlusion immediate magnetic resonance imaging is indicated 48. The use of hyaluronidase reduces in case of HA fillers the vascular complications when used early, preferably within the first four hours, but seems not to be of any benefit if injected after 24 hours 49-51. The therapeutic goal in case of ocular embolus is to lower intraocular pressure, increase retinal perfusion and deliver oxygen to hypoxic tissues 42.

Microneedling – collagen induction therapy

Collagen induction therapy, also known as microneedling, which has been to date frequently used for rejuvenation and acne scars 52, 53, involves repeated puncturing of the skin with fine needles in order to induce endogenous production of collagen. Microneedling devices typically have a form of a roller or a stamp with multiple tiny needles that are repetitively punched into the skin 37, 54. Only few and minor complications have been observed after its usage including redness, oedema and fine superficial bleeding, all resolving within few hours to days dependent on the needle length. Due to the small skin injuries, a potential risk of infection is existent, and should be discussed with the patient beforehand.

Chemical peeling

In order to resurface, rejuvenate and induce regeneration processes in the skin chemical peels have been used for destruction of upper parts of the skin since many years. Besides age-related skin changes, peeling have been demonstrated over decades to play an important role in improving acne, dyspigmentations and scars. Various substances, including all sorts of chemical compounds (e. g. alpha hydroxy-, beta- or lipohydroxy-, glycolic-, lactic-, bi- or tricarboxylic-, salicylic-, trichloroacetic-, retinoic- or alphaketo-acids, as well as phenol, resorcinol, Jessner's solution, their combinations and many others) are available on the market 3, 55-57.

The above mentioned peeling agents may be divided into very superficial light, superficial light, medium depth and deep peels reaching stratum corneum, stratum basale, upper or mid reticular dermis, respectively. Depending on the potency level of the respective peels practitioners should strictly follow the recommended indications and respect known contraindications (e. g. Baker-Gordon phenol deep peel in skin types V and VI), as well as communicate all possible adverse events and complications beforehand with the patient 55. These include post-peel redness, increased skin sensitivity, pruritus, pain, scaling, dyspigmentations, skin atrophy, and wound infections. Although rare, scarring, long-lasting redness, occurrence of milia, acne, allergies and toxicities (nephritic, hepatic and myocardial), especially after agents containing phenol, resorcinol or salicylic acid have been observed 3, 55.

Laser treatments

The spectrum of laser devices is constantly growing. In aesthetic dermatology, the main indications include scar revision, skin resurfacing and rejuvenation, hair and tattoo removal and treatment of smaller vessels 58. In order to improve facial skin laxity, wrinkles and superficial folds, both non-ablative and ablative lasers with various wavelengths that are being absorbed by water (10 600-nm carbon dioxide [CO2], 2 940-nm Er:YAG, 1 565-nm etc.) are being propagated 3. Over recent years, fractional photothermolysis (FP) has become increasingly popular due to the fact, that conventional CO2 laser resurfacing may often lead to procedure-associated hyper- or hypopigmentation and scars 3, 59, 60. FP allows delivery of dermal coagulative injury without confluent epidermal damage, therefore leading to accelerated wound healing, reduced risk of scarring and decreased downtime 3, 62. Depending on the respective wavelength and energy utilized, FP is able to create microscopic thermal wounds deep to the surface of the skin, which lead to tissue contraction and stimulation of collagen 3, 59, 61, 62.

Based on existing data, most frequently reported laser-related complications are nowadays associated to photoepilation 63, 64 and therapy of vascular lesions 65, which are both often being treated by medical lay personnel, such as cosmetic technicians, aestheticians, and employees of medical/dental professionals 66. Adverse events include redness 67, swelling, blistering, bruising, scarring (Figure 3), pain and risk of hyper- or hypopigmentations. Exact numbers on incidences of laser-associated side effects are widely missing and may be largely dependent on the experience of the respective clinician, wave length and patient population. Raulin and colleagues summarized the incidences of adverse events highlighting scarring and hyperpigmentation as the main side effects of most lasers utilized 68. Hyperpigmentation (Figure 4) is strongly dependent on the respective skin type and potential sun exposure prior or after the laser treatment 69. Therapy is challenging and includes the use of topical hydroquinone or tretinoin, both in combination with consequent use of sunscreen 5, 20. A pre-treatment with topical hydrochinone starting four to six weeks prior to the laser treatment in patients of darker skin types may be considered. Hypopigmentation appearing after laser treatment occurs particularly after the use of lasers that are targeting melanin (Figure 5) 68. Both transient and permanent hypopigmentation have also been observed after ablative laser resurfacing, especially with carbon dioxide lasers 68, 70.

Ulceration and scarring as a result of dye laser treatment of a hemangioma on left cheek.

Hyperpigmentation on right thigh following therapy of telangiectasia with a vascular laser.

Hypopigmentation on décolleté after treatment of senile lentigines using a Q-switched Ruby laser.

Thread facelift

Nonsurgical face and neck rejuvenation using thread lifting has become increasingly popular over recent years. A variety of different products is currently on the market and their number is continuously increasing. Frequently used materials and techniques include Isse unidirectional barbed-threads lifting, barbed (short) suture by Sulamanidze, Waptos suture lifting, Woffles (long) thread lifting, and lifting with coned threads (Silhouette Lift®) 3, 71, 72. Reports on thread facelift procedures vary significantly with respect to ultimate outcomes, ranging from good aesthetic improvement and relatively short recovery times with only minor adverse events to poor outcomes with short-term effects and serious complications 3, 72-74.

Most frequently observed adverse events include wound infections, hematoma, insufficient traction, asymmetric traction and pain and are frequently technique related. Complications such as allergic reactions, skin dimpling, temporary facial weakness, temporary numbness, extruded or visible threads, formation of foreign body granulomas and traction lines during rest or face animation 71-74 are rare but should be communicated prior to the procedure.

Injectional lipolysis

Injection lipolysis using multiple subcutaneous injections of phosphatidylcholine (PC) and deoxycholate (DC) to reduce adipose deposits in the abdomen and other areas has been first described in 2006. These substances had regulatory approval for certain indications, but have never been formally approved for subcutaneous injection 3, 75. Even though, effects of DC on cell lysis have been clinically demonstrated and scientifically proven 3, 76, the nonselective action of DC 3, 75 has been frequently discussed 3. DC and PC are being frequently combined at different ratios, since PC has an anti-lipolytic action, which is known to decrease the aggressiveness of DC 3, 77. Notably, subcutaneous injections of PC and DC appear to induce fat cell necrosis rather than apoptosis 3, 75. Necrobiosis of the adjacent reticular dermis, with associated death of adnexal glands, blood vessels, and nerves in the deep dermal layer may therefore represent a long-term consequence of injecting a DC formula into fatty tissues as recently discussed by Dunan and colleagues 78. When injected in excessive amounts, skin contour irregularities have been observed 3, 78. We and others thus recommend to deliver only small amounts of the respective compounds (all not FDA [U.S. Food and Drug Administration] approved), in the correct plane and area followed by repetitive treatments every eight weeks if necessary 3, 79. By using this protocol, this procedure is considered a well-tolerated approach with only minor and transient side effects such as swelling, bruising and slight erythema at the injection sites, which may last for several days 3. Results do usually show after the swelling has resolved, demonstrating optimal reduction of fat after about two months 3, 79. Since none of the lipolytic agents currently available on the European marked have been subject to a formal clinical trial so far, it may seem advisable to abstain from the use of these products until ATX-101 becomes available.

Discussion

The current trend towards a "pan-facial, multi-layer" approach asks for detailed understanding of the complex facial anatomy and in-depth knowledge of the properties and characteristics of the respective products or devices.

While side effects associated with BoNTA injections are generally rare and usually transient, inadequate use or incorrect placement of filling materials may lead to severe and persisting adverse events. Characterizing type and frequency of adverse reactions to injectable filler substances, a recent study could demonstrate that while adverse reactions were documented with all injectable fillers, time until reaction and the type of adverse reaction varied between the different fillers 80. A retrospective survey on prolonged infraorbital swelling after hyaluronic acid treatment showed that 12 out of 51 treated patients presented significant malar oedema lasting for over a month 81. Although more data is warranted before drawing final conclusions the percentage of affected patients is alarming and highlighting the peri-orbital region as an area of increased risk which should be treated with extreme caution by experienced injectors and with appropriate materials only.

To date, improvement of skin surface and skin laxity, collagen loss and skin tightening can be addressed to a certain extent by a plethora of different devices using a range of physical methods such as light, radiofrequency, ultrasound, FP 60 or the combined use of these technologies. Technology and design of these devices continue to evolve, allowing greater control of parameters and resulting in increased safety and efficacy for patients. While devices themselves should follow clearly defined regulations of FDA or other similar national authorities and adhere to strict ISO (International Organization for Standardization) standards, the treating clinician needs to be familiar with device properties and adjust them according to individual patient's characteristics. However, there has been an ongoing concern amongst many medically qualified laser practitioners over the regulation and safety of lasers and IPL use in many countries. Frequently, no exact guidelines are in place to dictate the level of training or accreditation an individual must possess to be allowed to offer these therapies to the public. This is also reflected by reports on thermal injuries sustained by individuals undergoing e. g. hair removal by practitioners with no formal medical training. In this context, it should be highlighted, that a plethora of devices manufactured by different companies for similar indications are currently on the market, but settings for e. g. energy or pulse width may differ significantly among products when used for identical indications. It is therefore absolutely critical to follow the respective manufacturer's device-specific recommendations. In order to monitor the individual response upon a specific treatment with regard to e. g. a potential risk of laser-associated hyperpigmentation, pre-testing in a representative small area may be advisable particularly in patients of increased risk. Similar considerations should be made with regards to skin type, -quality and -thickness when planning any peeling, particularly medium depth or deep peels. A pre-treatment with topical hydroquinone starting four to six weeks prior to the treatment in patients with darker skin types may be considered – nevertheless consequent sun protection prior to and after therapy remains key.

To date, age-related facial changes can be addressed to a certain extent by a plethora of different approaches. With all these different instruments available increasing attention needs to be directed towards pre-procedural facial analysis, patient selection, information, and counselling. Choosing the appropriate modality for the respective indication will lead to predictable results and will help avoiding unnecessary adverse events such as visible cones after thread lifting or post-inflammatory hyperpigmentations after laser procedures in darker skin types 3. This sort of side effects is rather the consequence of poor patient counselling than due to the product itself and may be easiest prevented by in-depth knowledge of skin physiology, anatomy and the utilized techniques themselves. Although combination of the here described approaches tailored to the individual needs of our patients may ultimately lead to longer-lasting and more natural results 3 it should be highlighted that the combination of some of these modalities may lead to certain interactions and by that to unpredictable adverse events 3. Notably, although signed informed consent and careful documentation may protect the treating clinician from legal consequences, it is obvious, that all adverse events will lead to time lost from work and will reduce patient trust if not carefully discussed before 3.

From our experience, the creation of a detailed treatment plan associated with realistic outcome expectations, followed by a comprehensible explanation of potential adverse events in combination with a "less is more" approach and scheduled touch-up sessions will help maximizing patient satisfaction and avoid most side effects 3.

Conflict of interest

DH describes no conflict of interest. GGG serves as advisor and speaker for Merz Pharmaceuticals, Galderma, Lumenis, Candela and Sinclair Pharma. TR is advisor to Galderma.

References

1 Borelli C, Berneburg M. "Beauty lies in the eye of the beholder"? Aspects of beauty and attractiveness. J Dtsch Dermatol Ges 2010; 8: 326– 30.
2 Carruthers JD, Glogau RG, Blitzer A. Facial Aesthetics Consensus Group Faculty. Advances in facial rejuvenation: botulinum toxin type a, hyaluronic acid dermal fillers, and combination therapies – consensus recommendations. Plast Reconstr Surg 2008; 121: 5S– 30S, quiz 31S–36S.
3 Gauglitz GG. Combinational approaches for facial rejuvenation. J Prime 2015; 5: 42– 53.
4 Szeimies RM, Lischner S, Philipp-Dormston W et al. Photodynamic therapy for skin rejuvenation: treatment options – results of a consensus conference of an expert group for aesthetic photodynamic therapy. J Dtsch Dermatol Ges 2013; 11: 632– 6.
5 Kulichova D, Borovaya A, Ruzicka T et al. Understanding the safety and tolerability of facial filling therapeutics. Expert Opin Drug Saf 2014; 13: 1 215– 26.
6 Hassouneh B, Newman JP. Lasers, fillers, and neurotoxins: avoiding complications in the cosmetic facial practice. Facial Plast Surg Clin North Am 2013; 21: 585– 98.
7 Lowe NJ, Lask G, Yamauchi P et al. Bilateral, doubleblind, randomized comparison of 3 doses of botulinum toxin type A and placebo in patient with crow's feet. J Am Acad Dermatol 2002; 47: 834– 40.
8 Flynn TC, Carruthers JA, Carruthers JA et al. Botulinum A toxin (BOTOX) in the lower eyelid: dose-finding study. Dermatol Surg 2003; 29: 943– 50, discussion 950–1.
9 Nettar K, Maas C. Facial filler and neurotoxin complications. Facial Plast Surg 2012; 28: 288– 93.
10 Stephan S, Wang TD. Botulinum toxin: clinical techniques, applications, and complications. Facial Plast Surg 2011; 27: 529– 39.
11 Bulstrode NW, Grobelaar AO. Long-term prospective follow-up of botulinum toxin treatment for facial rhytids. Aesthetic Plast Surg 2002; 26: 356– 9.
12 Kang SM, Feneran A, Kim JK et al. Exaggeration of wrinkles after botulinum toxin injection for forehead horizontal lines. Ann Dermatol 2011; 23: 217– 21.
13 Carruthers JA, Lowe NJ, Menter MA et al. A multicenter, double-blind, randomized, placebo-controlled study of the efficacy and safety of botulinum toxin type A in the treatment of glabellar lines. J Am Acad Dermatol 2002; 46: 840– 9.
14 Vartanian AJ, Dayan SH. Complications of botulinum toxin A use in facial rejuvenation. Facial Plast Surg Clin North Am 2005; 13: 1– 10.
15 Brandt FS, Bellman B. Cosmetic use of botulinum A exotoxin for the aging neck. Derm Surgery 1998; 24: 232– 4.
16 Naumann M, Boo LM, Ackerman AH et al. Immunogenicity of botulinum toxins. J Neural Transm 2013; 120: 75– 290.
17 Lawrence I, Moy R. An evaluation of neutralizing antibody induction during treatment of glabellar lines with a new US formulation of botulinum neurotoxin type A. Aesthet Surg J. 2009; 29: 66– 71.
18 Kawashima M, Harii K. An open-label, randomized, 64-week study repeating 10- and 20-U doses of botulinum toxin type A for treatment of glabellar lines in Japanese subjects. Int J Dermatol 2009; 48: 768– 76.
19 Yablon SA, Brashear A, Gordon MF et al. Formation of neutralizing antibodies in patients receiving botulinum toxin type A for treatment of poststroke spasticity: a pooled-data analysis of three clinical trials. Clin Ther 2007; 29: 683– 90.
20 Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol 2013; 6: 295– 316.
21 Pickett A. Serious issues relating to counterfeit dermal fillers available from Internet sources. J Am Acad Dermatol 2011; 65: 642– 3.
22 Niamtu J. Filler injection with micro-cannula instead of needles. Dermatol Surg 2009; 35: 2005– 8.
23 Lowe NJ, Maxwell CA, Patnaik R. Adverse reactions to dermal fillers: review. Dermatol Surg 2005; 31: 1 616– 25.
24 Goldberg RA, Fiaschetti D. Filling the periorbital hollows with hyaluronic acid gel: initial experience with 244 injections. Ophthal Plast Reconstr Surg 2006; 22: 335– 41, discussion 333–41.
25 Morley AM, Malhotra R. Use of hyaluronic acid filler for tear-trough rejuvenation as an alternative to lower eyelid surgery. Ophthal Plast Reconstr Surg 2010; 27: 69– 73.
26 Tung R, Ruiz de Luzuriaga AM, Park K et al: Brighter eyes: combined upper cheek and tear trough augmentation: a systematic approach utilizing two complementary hyaluronic acid fillers. J Drugs Dermatol 2012; 11: 1094– 7.
27 Hilton S, Schrumpf H, Buhren BA et al. Hyaluronidase injection for the treatment of eyelid oedema: a retrospective analysis of 20 patients. Eur J Med Res 2014; 19: 30.
28 Sclafani AP, Fagien S. Treatment of injectable soft tissue filler complications. Dermatol Surg 2009; 35: 1 672– 80.
29 Buck DW, Alam M, Kim JY. Injectable fillers for facial rejuvenation: a review. J Plast Reconstr Aesthet Surg 2009; 62: 11– 8.
30 Smith KC. Reversible vs. nonreversible fillers in facial aesthetics: concerns and considerations. Dermatol Online J 2008; 14: 3.
31 Beer K, Avelar R. Relationship between delayed reactions to dermal fillers and biofilms: facts and considerations. Dermatol Surg 2014; 40: 1 175– 9.
32 Burmølle M, Thomsen TR, Fazli M, Dige I et al. Biofilms in chronic infections – a matter of opportunity – monospecies biofilms in multispecies infections. FEMS Immunol Med Microbiol 2010; 59: 324– 36.
33 Narins RS, Coleman WP, Glogau RG. Recommendations and treatment options for nodules and other filler complications. Dermatol Surg 2009; 35: 1 667– 71.
34 Rohrich RJ, Monheit G, Nguyen AT et al. Soft-tissue filler complications: the important role of biofilms. Plast Reconstr Surg 2010; 125: 1 250– 6.
35 Bjarnsholt T, Tolker-Nielsen T, Givskov M et al. Detection of bacteria by FISH in culture-negative soft tissue filler lesions. Dermatol Surg 2009; 35: 1 620– 4.
36 Omranifard M, Taheri S. Filler augmentation, safe or unsafe: A case series of severe complications of fillers. J Res Med Sci 2011; 16: 1 627– 31.
37 Dogra S, Yadav S, Sarangal R. Microneedling for acne scars in Asian skin type: an effective low cost treatment modality. J Cosmet Dermatol 2014; 13: 180– 7.
38 Hirsch RJ, Cohen JL, Carruthers JD. Successful management of an unusual presentation of impending necrosis following a hyaluronic acid injection embolus and a proposed algorithm for management with hyaluronidase. Dermatol Surg 2007; 33: 357– 60.
39 Bachmann F, Erdmann R, Hartmann V et al. The spectrum of adverse reactions after treatment with injectable fillers in the glabellar region: results from the Injectable Filler Safety Study. Dermatol Surg 2009; 35: 629– 34.
40 Carruthers JD, Fagien S, Rohrich RJ et al. Blindness caused by cosmetic filler injection: a review of cause and therapy. Plast Reconstr Surg 2014; 134: 1 197– 201.
41 Park KH, Kim YK, Woo SJ et al. Korean Retina Society. Iatrogenic occlusion of the ophthalmic artery after cosmetic facial filler injections: a national survey by the Korean Retina Society. JAMA Ophthalmol 2014; 132: 714– 23.
42 Lazzeri D, Agostini T, Figus M et al. Blindness following cosmetic injections of the face. Plast Reconstr Surg 2012; 129: 995– 1 012.
43 Roberts SA, Arthurs BP. Severe visual loss and orbital infarction following periorbital aesthetic poly-(L)-lactic acid (PLLA) injection. Ophthal Plast Reconstr Surg 2012; 28: e68– 70.
44 Ozturk CN, Li Y, Tung R et al. Complications following injection of soft-tissue fillers. Aesthet Surg J 2013; 33: 862– 77.
45 Park SW, Woo SJ, Park KH et al. Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections. Am J Ophthalmol 2012; 154: 653– 662.e1.
46 Chen Y, Wang W, Li J et al. Fundus artery occlusion caused by cosmetic facial injections. Chin Med J (Engl) 2014; 127: 1 434– 7.
47 Tansatit T, Moon HJ, Apinuntrum P et al. Verification of Embolic Channel Causing Blindness Following Filler Injection. Aesthetic Plast Surg 2014 Dec 6. [Epub ahead of print].
48 Coleman SR. Avoidance of arterial occlusion from injection of soft tissue fillers. Aesthet Surg J 2002; 22: 555– 7.
49 Cavallini M, Gazzola R, Metalla M et al. The role of hyaluronidase in the treatment of complications from hyaluronic acid dermal fillers. Aesthet Surg J 2013; 33: 1 167– 74.
50 Hirsch RJ, Brody HJ, Carruthers JD. Hyaluronidase in the office: a necessity for every dermasurgeon that injects hyaluronic acid. J Cosmet Laser Ther 2007; 9: 182– 5.
51 Kim DW, Yoon ES, Ji YH et al. Vascular complications of hyaluronic acid fillers and the role of hyaluronidase in management. J Plast Reconstr Aesthet Surg 2011; 64: 1 590– 5.
52 Garg S, Baveja S. Combination therapy in the management of atrophic acne scars. J Cutan Aesthet Surg 2014; 7: 18– 23.
53 Sharad J. Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. J Cosmet Dermatol 2011; 10: 317– 23.
54 Fabbrocini G, De Vita V, Pastore F et al. Collagen induction therapy for the treatment of upper lip wrinkles. J Dermatolog Treat 2012; 23: 144– 52.
55 Khunger N. IADVL Task Force. Standard guidelines of care for chemical peels. Indian J Dermatol Venereol Leprol 2008; 74: S5– 12.
56 Nguyen T. Dermatology procedures: microdermabrasion and chemical peels. FP Essent 2014; 426: 16– 23.
57 Fischer TC, Perosino E, Poli F et al. Chemical peels in aesthetic dermatology: an update 2009. J Eur Acad Dermatol Venereol 2010; 24: 281– 292.
58 Sebaratnam DF, Lim AC, Lowe PM et al. Lasers and laser-like devices: part two. Australas J Dermatol 2014; 55: 1– 14.
59 Manstein D, Herron GS, Sink RK et al. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 2004; 34: 426– 38.
60 Peukert N, Bayer J, Becke D et al. Fractional photothermolysis for the treatment of facial wrinkles – searching for optimal treatment parameters in a randomized study in the split-face design. J Dtsch Dermatol Ges 2012; 10: 898– 904.
61 Laubach HJ, Tannous Z, Anderson RR et al. Skin responses to fractional photothermolysis. Lasers Surg Med 2006; 38: 142– 9.
62 Tierney EP, Eisen RF, Hanke CW. Fractionated CO2 laser skin rejuvenation. Dermatol Ther 2011; 24: 41– 53.
63 Jalian HR, Jalian CA, Avram MM. Common causes of injury and legal action in laser surgery. JAMA Dermatol 2013; 149: 188– 93.
64 Jalian HR, Jalian CA, Avram MM. Increased risk of litigation associated with laser surgery by nonphysician operators. JAMA Dermatol 2014; 150: 407– 11.
65 Svider PF, Carron MA, Zuliani GF et al. Lasers and losers in the eyes of the law: liability for head and neck procedures. JAMA Facial Plast Surg 2014; 16: 277– 83.
66 Brody HJ, Geronemus RG, Farris PK. Beauty versus medicine: the nonphysician practice of dermatologic surgery. Dermatol Surg 2003; 29: 319– 24.
67 Lapidoth M, Shafirstein G, Ben Amitai D et al. Reticulate erythema following diode laser-assisted hair removal: a new side effect of a common procedure. J Am Acad Dermatol 2004; 51: 774– 7.
68 Raulin C, Kimmig W, Werner S. Laser therapy in dermatology and esthetic medicine. Side effects, complications and treatment errors. Hautarzt 2000; 51: 463– 73.
69 Handley JM. Adverse events associated with nonablative cutaneous visible and infrared laser treatment. J Am Acad Dermatol 2006; 55: 482– 9.
70 Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998; 24: 315– 20.
71 Park TH, Seo SW, Whang KW. Facial rejuvenation with fine-barbed threads: the simple Miz lift. Aesthetic Plast Surg 2014; 38: 69– 74.
72 Garvey PB, Ricciardelli EJ, Gampper T. Outcomes in threadlift for facial rejuvenation. Ann Plast Surg 2009; 62: 482– 5.
73 Abraham RF, DeFatta RJ, Williams EF. Thread-lift for facial rejuvenation: assessment of long-term results. Arch Facial Plast Surg 2009; 11: 178– 83.
74 Atiyeh BS, Dibo SA, Costagliola M et al. Barbed sutures "lunch time" lifting: evidence-based efficacy. J Cosmet Dermatol 2010; 9: 132– 41.
75 Schuller-Petrovic S, Wölkart G, Höfler G et al. Tissue-toxic effects of phosphatidylcholine/deoxycholate after subcutaneous injection for fat dissolution in rats and a human volunteer. Dermatol Surg 2008; 34: 529– 42, discussion 542–3.
76 Rotunda AM, Suzuki H, Moy RL et al. Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidylcholine formulation used for localized fat dissolution. Dermatol Surg 2004; 30: 1 001– 8.
77 Salti G, Rauso R. Comments on "Injection lipolysis with phosphatidylcholine and deoxycholate". Aesthet Surg J 2014; 34: 639– 40.
78 Duncan DI, Hasengschwandtner F. Lipodissolve for subcutaneous fat reduction and skin retraction. Aesthet Surg J 2005; 25: 530– 43.
79 Tanner B, Barabas T, Crook D et al. A future for injection lipolysis? Aesthet Surg J 2013; 33: 456– 7.
80 Zielke H, Wölber L, Wiest L et al. Risk profiles of different injectable fillers: results from the Injectable Filler Safety Study (IFS Study). Dermatol Surg 2008; 34: 326– 35.
81 Griepentrog GJ, Lucarelli MJ, Burkat CN et al. Periorbital oedema following hyaluronic acid gel injection: a retrospective review. Am J Cosmetic Surg 2011; 28: 251– 4.

Citing Literature

Can Phosphatidylcholine Be Used With a Derma Roller

Source: https://onlinelibrary.wiley.com/doi/full/10.1111/ddg.12757