Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_537_Библиотеки_им_академика_М_И_Перельмана
.pdf
Fig. 24 The before and after images of a patient who received hyaluronic fillers to augment the
upper nasal bridge are shown in the figure, with white arrows indicating injection location [197]
Fig. 25 The initial appearance and postinjection results in a patient who received hyaluronic acid
fillers in the dorsal region for correction of nasal hump are shown in the image above, with white
arrows indicating the injection locations [197]
The nasal tip and alar rim are treated more carefully, as physical damage
from needle insertion or compression from excess filler can increase the
risk of necrosis. The use of Juvederm Ultra and Ultra Plus has been
documented in the literature for nonsurgical tip and alar augmentation.
Serial puncture is beneficial in an incremental approach, with careful
consideration of the volume injected. Filler can be injected between the
columella in a deep plane to stabilize the nasal tip (resembling a columellar
strut graft, see Surgical Rhinoplasty), or in very small amounts at the alar
https://t.me/medicina_free
rim to reduce retraction or irregularities [156]. The risk of tip overprojection is increased with liquid rhinoplasty, and other providers prefer to
augment the tip first and then correct the dorsum as needed [198].
6.3.8 Chin and Jawline
Assessment of the chin begins with analysis of the lower lip-chin
relationship, as the maximal chin projection from a side view is ideally
located 1–2 mm behind the lower lip (women) or in line with the lower lip
(men). Fillers are well utilized in minor augmentation of the chin and
jawline (<4–10mm), although larger augmentations are more appropriately
managed with surgical interventions [185].
Injections are placed deeper into the preperiosteal plane, using high G’
fillers such as Restylane Lyft/Defyne or Juvéderm VOLUMA. Outward,
lateral fanning of the fillers should be performed to the prejowl sulcus to
create natural results, and injections should not extend laterally past the
medial canthus [185].
6.4 Complications and Outcomes
Soft tissue augmentation with injectable fillers is considerably less risky
when compared with more invasive surgery, although they are shown to
incur adverse side effects on occasion. Generally, longer-lasting
formulations will produce lengthier adverse side effects, and more
temporary formulations allow for earlier resolution of complications [151].
Stricter regulation of injector qualification and filler formulations would
potentially reduce adverse effects resultant of unrefined technique,
improper needle size, and asymmetrical or poorly placed filler. Cases
documented in the literature show a wide range of adverse effects
secondary to injected fillers, including infection, formation of
nodules/granulomas, acute hypersensitivity, systemic diseases (autoimmune
disorders, granulomatous dissemination), and persistent edema [199–204].
Immediately after injection, early side effects may be related to
appropriate physiological response, allergies, and vascular compromise.
Redness, facial swelling, and bruising occur in many patients in response to
foreign substance injection and can be reduced with cool compresses or
topical therapies (arnica, aloe vera, vitamin K lotion) [151, 205].
Vascular occlusion can present in the first few days, although visible
effects occur within the first day after injections. Blunt cannula use in place
https://t.me/medicina_free
of sharp needles can reduce the occurrence of arterial penetration with filler
placement. Depending on the patient’s complexion, blanching of the skin
can present immediately after occlusion, in which case the procedure is
discontinued. Hyaluronidase is injected around the impacted vessel, and the
skin is massaged and treated with warm compresses. Nitroglycerin can be
used to mitigate the transient effects of impaired blood supply [151, 205–
209].
Late complications present 2–6weeks after the initial filler injections
and may include allergic reactions, chronic inflammation at the injection
site, telangiectasias, excessive scarring, and unaesthetic filler migration.
The major risk factors include improper sterile technique, such as lack of
gloves or injection through unclean skin/makeup [210] (Fig. 26).
Fig. 26 The right image shows a patient with delayed formation of nodular granulomas and
fistulation after filler injection, illustrating a potential complication of this minimally invasive
modality [211]
Delayed complications occur at 6weeks or later postinjection and are
generally attributed to the formation of biofilms around the placed fillers.
Biofilm formation can eventually lead to development of abscesses or
granulomas [212]. Severe infections should be recognized and treated with
antibiotics as soon as possible to reduce long-term functional complications
or necrosis [171, 213].
https://t.me/medicina_free
While the aforementioned complications are well documented in the
literature, most patients tend to experience minimal adverse impact and are
satisfied with the procedure. Studies have suggested that more than half of
individuals who received facial fillers have also undergone more invasive
aesthetic surgery. Facial rejuvenation with injectable fillers is well utilized
in conjunction with invasive procedures to promote and maintain aesthetic
results [213].
Liquid rhinoplasty produces extremely high patient satisfaction (greater
than 90%), with significantly improved complication rates. Tear trough
augmentation is well utilized as a temporary solution for periorbital
rejuvenation, and most patients (greater than 75%) are satisfied with results
in the long term. Nonsurgical correction of aesthetic deformities and the
aging face are beneficial for the self-esteem and well-being of patients,
allowing some to resolve their appearance while avoiding riskier invasive
surgery [214, 215] (Fig. 27).
Fig. 27 Results of multiple facial regions treated with hyaluronic acid fillers are shown above,
highlighting the appearance after injection of 4mL, 8mL, and 17mL (total) [216]
7 Psychological Implications
Most patients who pursue nonsurgical facial rejuvenation are looking to
improve their physical appearance, as well as their mental, physical, and
social health. Mental health plays a significant role in cosmetic procedures,
and patients hope for reduced depression or anxiety with facial appearance
after augmentation. These individuals frequently mention feeling
https://t.me/medicina_free
overwhelmed by the effort of hiding their appearance and desire increased
self-confidence, two of the major motivations identified by patients in
conducted interviews [217, 218].
While there are studies to confirm these motivations, literature
supporting the efficacy of nonsurgical facial rejuvenation in meeting these
postoperative goals is relatively scarce. Patient-reported outcome measures
(PROMs) have been used to assess the improvements in physical, mental,
and social health before and after nonsurgical augmentation [219]. FACE-Q
is a multimodule survey administered to patients before and after aesthetic
procedures, and it contains over 40 modules to specifically assess individual
facial regions or outcome measures [220]. The psychological impact of
cosmetic procedures can be evaluated with the quality of life (QOL) FACEQ scales, which are targeted towards psychological well-being and distress,
age assessment, preprocedural expectations and motivations, and the impact
of recovery and/or dissatisfaction on daily activities [221].
Assessment of reported outcomes from FACE-Q scales including
Satisfaction with Facial Appearance, Psychological Wellbeing, and Age
Appraisal shows improvement after nonsurgical facial cosmetic procedures.
The study notes an increased patient satisfaction with combined procedures,
namely injectable fillers and neuromodulators, as they can work together to
reduce facial deformities. Combined therapy also provided patients with
improved age appraisal, allowing them to feel younger than before [219].
It is clear that minimally invasive procedures can be quite beneficial for
most patients, although additional consideration of underlying
psychological disorders is warranted. The underlying dissatisfaction with
physical facial appearance is one of the catalysts for the pursuit of cosmetic
augmentation and is considered by some as a prerequisite for aesthetic
procedures [221, 222]. While some level of dissatisfaction is almost
guaranteed, it should be noted that extreme dissatisfaction with appearance
can indicate more serious psychological disorders, such as eating disorders
and body dysmorphic disorder (BDD) [223] (Fig. 28).
https://t.me/medicina_free
Fig. 28 The multifactorial etiology of BDD is illustrated in the left image, indicating potential “red
flags” which may be noted by surgeons or aestheticians during the initial consult [246]
It is difficult to estimate the exact percentage of patients whose pursuit
of cosmetic procedures is resultant from BDD, although there are many
documented cases in which the surgeon describes patients as insatiable or
having minimal facial deformities [224–227]. Many of these treatments
were performed before the development of formal diagnostic guidelines for
BDD, which are listed below [228]:
Patient expresses concern regarding at least one self-identified deformity,
which is subtle or unidentifiable to an observer
Uncontrolled engagement of repetitive, appearance-focused behavior,
such as looking in the mirror or applying makeup
Patients experience clinically significant distress or social and/or
occupational impairment because of self-identified deformities
If patients are suspected to have BDD, there are various questionnaires
that can be administered to confirm a diagnosis prior to cosmetic treatment.
The BDDE (Body Dysmorphic Disorder Examination) survey has been
previously validated in various languages and contains 34 items to assess
the patient’s degree of aesthetic dissatisfaction [229, 230]. The most widely
used survey is the Multidimensional Body Self-Relations Questionnaire-
https://t.me/medicina_free
Appearance Scales (MBSRQ-AS), which is used to assess various body
image indices with 5 subscales (Appearance Evaluation, Appearance
Orientation, Body Areas Satisfaction, Overweight Preoccupation, SelfClassified Weight) [231]. When the preoperative assessment is focused on
patient self-esteem as a standalone factor, the Rosenberg self-esteem scale
or RSE-S can be used [232].
As previously mentioned, it is difficult to estimate how many patients
suffer from BDD using clinical interviews, as the reported measures can be
subjective and/or biased. Many studies have attempted more rigorous
methods to estimate the prevalence of BDD in patients of cosmetic
surgeons and/or dermatologists, generally producing findings of 3–16%
[233–242].
When this extreme, obsessive dissatisfaction is present before the
procedure, very few individuals with BDD note an improvement in
satisfaction [6]. The safety and professional reputation of providers who
treat prospective patients is another important consideration, given that up
to 29% of cosmetic surgeons and dermatologists have been legally
threatened and 2% physically threatened by BDD patients. There are some
concerning incidences of providers who were murdered by patients either
suspected or confirmed to have BDD [27–29]. Most dermatologists and
plastic surgeons consider BDD as an absolute contraindication for any
cosmetic augmentation procedure [243, 244].
In comparison to more invasive surgery, the results of minimally
invasive aesthetic procedures are shorter-acting and often not as dramatic.
However, some patients who have undergone significant facial trauma
leading to surgically irreparable deformities greatly benefit from
nonsurgical modalities [245].
References
1. Holcomb, J. D., & McCollough, E. G. (2001). Trichophytic incisional approaches to upper
facial rejuvenation. Archives of Facial Plastic Surgery, 3, 48–53.
2. Beehner, M. (2008). Hairline design in hair replacement surgery. Facial Plastic Surgery, 24,
389–403.
3. Epstein, J., & Epstein, G. K. (2020). Hairline-lowering surgery. Facial Plastic Surgery Clinics
of North America, 28, 197–203.
4.
https://t.me/medicina_free
Ramirez, A. L., Ende, K. H., & Kabaker, S. S. (2009). Correction of the high female hairline.
Archives of Facial Plastic Surgery, 11, 84–90.
5. Jimenez, F., Alam, M., Vogel, J. E., & Avram, M. (2021). Hair transplantation: Basic overview.
Journal of the American Academy of Dermatology, 85(4), 803–814. https:// doi. org/ 10. 1016/ j.
jaad. 2021. 03. 124
[Crossref]
6. Poblet, E., Jimenez, F., & Ortega, F. (2004). The contribution of the arrector pili muscle and
sebaceous glands to the follicular unit structure. Journal of the American Academy of
Dermatology, 51(2), 217–222.
7. Poblet, E., Jimenez, F., Escario-Travesedo, E., et al. (2018). Eccrine sweat glands associate
with the human hair follicle within a defined compartment of dermal white adipose tissue. The
British Journal of Dermatology, 178(5), 1163–1172.
8. Jimenez, F., & Poblet, R. (2006). Gross and microscopic anatomy of the follicular unit. In R. S.
Haber & D. B. Stough (Eds.), Hair transplantation (1st ed., pp. 35–42). Elsevier Sauders.
9. Kim, J. E., Lee, J. H., Choi, K. H., et al. (2013). Phototrichogram analysis of normal scalp hair
characteristics with aging. European Journal of Dermatology, 23(6), 849–856.
10. Birnbaum, M. R., McLellan, B. N., Shapiro, J., Ye, K., & Reid, S. D. (2018). Evaluation of hair
density in different ethnicities in a healthy American population using quantitative trichoscopic
analysis. Skin Appendage Disorders, 4(4), 304–307.
11. Hsu, Y. C., Pasolli, H. A., & Fuchs, E. (2011). Dynamics between stem cells, niche, and
progeny in the hair follicle. Cell, 144(1), 92–105.
12. Christoph, T., Müller-Röver, S., Audring, H., et al. (2000). The human hair follicle immune
system: Cellular composition and immune privilege. The British Journal of Dermatology,
142(5), 862–873.
13. Morgan, B. A. (2014). The dermal papilla: An instructive niche for epithelial stem and
progenitor cells in development and regeneration of the hair follicle. Cold Spring Harbor
Perspectives in Medicine, 4(7), a015180.
14. Ingprasert, S., Pinyopawasutthi, P., & Pathomvanich, D. (2018). Practical anatomy in hair
transplantation. In Practical aspects of hair transplantation in Asians (pp. 7-16). Springer,
Tokyo (Fig. 2.1). Fig 1.2 (right) derived from Sharma, R., & Ranjan, A. (2019). Follicular unit
extraction (FUE) hair transplant: Curves ahead. Journal of Maxillofacial and Oral Surgery,
18(4), 509–517.
15. Tamashunas, N. L., & Bergfeld, W. F. (2021). Male and female pattern hair loss: Treatable and
worth treating. Cleveland Clinic Journal of Medicine, 88(3), 173–182. https:// doi. org/ 10. 3949/
ccjm. 88a. 20014
[Crossref]
16.
Vierhapper, H., Nowotny, P., Maier, H., & Waldhäusl, W. (2001). Production rates of
dihydrotestosterone in healthy men and women and in men with male pattern baldness:
Determination by stable isotope/dilution and mass spectrometry. The Journal of Clinical
Endocrinology and Metabolism, 86(12), 5762–5764. https:// doi. org/ 10. 1210/ jcem. 86. 12. 8078
https://t.me/medicina_free
[Crossref]
17. Imperato-McGinley, J., & Zhu, Y. S. (2002). Androgens and male physiology the syndrome of
5alpha-reductase-2 deficiency. Molecular and Cellular Endocrinology, 198(1–2), 51–59.
https:// doi. org/ 10. 1016/ s0303-7207(02)00368-4
[Crossref]
18. Yip, L., Rufaut, N., & Sinclair, R. (2011). Role of genetics and sex steroid hormones in male
androgenetic alopecia and female pattern hair loss: An update of what we now know. The
Australasian Journal of Dermatology, 52(2), 81–88. https:// doi. org/ 10. 1111/ j. 1440-0960. 2011.
00745
[Crossref]
19. Firooz, A., et al. (2017). Classification and scoring of androgenetic alopecia (male and female
pattern). In P. Humbert, F. Fanian, H. Maibach, & P. Agache (Eds.), Agache’s measuring the
skin. Springer.
20. Futterweit, W., Dunaif, A., Yeh, H. C., & Kingsley, P. (1988). The prevalence of
hyperandrogenism in 109 consecutive female patients with diffuse alopecia. Journal of the
American Academy of Dermatology, 19(5 pt 1), 831–836. https:// doi. org/ 10. 1016/ s0190-
9622(88)70241-8
[Crossref]
21. Cousen, P., & Messenger, A. (2010). Female pattern hair loss in complete androgen
insensitivity syndrome. The British Journal of Dermatology, 162(5), 11351137. https:// doi. org/
10. 1111/ j. 1365-2133. 2010. 09661. x
[Crossref]
22. Olsen, E. A. (1999). The midline part: An important physical clue to the clinical diagnosis of
androgenetic alopecia in women. Journal of the American Academy of Dermatology, 40(1),
106–109. https:// doi. org/ 10. 1016/ s0190-9622(99)70539-6
[Crossref]
23. Olsen, E. A., Messenger, A. G., Shapiro, J., et al. (2005). Evaluation and treatment of male and
female pattern hair loss. Journal of the American Academy of Dermatology, 52(2), 301311.
https:// doi. org/ 10. 1016/ j. jaad. 2004. 04. 008
[Crossref]
24. Anastassakis, K. (2022). Female Pattern Hair Loss. In Androgenetic alopecia from a to Z (pp.
181–203). Springer.
25. Mercke, Y., et al. (2000). Hair loss in psychopharmacology. Annals of Clinical Psychiatry,
12(1), 35–42.
26. Lytvyn, Y., et al. (2022). Comparing the frequency of isotretinoin-induced hair loss at <0.5-
mg/kg/d versus ≥0.5-mg/kg/d dosing in acne patients: A systematic review. JAAD
International, 6, 125–142.
27. Phillips, T. G., et al. (2017). Hair loss: Common causes and treatment. American Family
Physician, 96(6), 371–378.
28.
Collins, K., & Avram, M. R. (2021). Hair transplantation and follicular unit extraction.
https://t.me/medicina_free
Dermatologic Clinics, 39(3), 463478. https:// doi. org/ 10. 1016/ j. det. 2021. 04. 003
[Crossref]
29. Piérard-Franchimont, C., & Piérard, G. E. (1988). Approche physiopathologique de la
séborrhée du cuir chevelu. Annales de Dermatologie et de Vénéréologie, 115(4), 451–453.
French. pmid:2970818.
30. Roest, Y., Middendorp, H., Evers, A., Kerkhof, P., & Pasch, M. (2018). Nail involvement in
alopecia areata: A questionnaire-based survey on clinical signs, impact on quality of life and
review of the literature. Acta Dermato Venereologica, 98(2), 212–217. https:// doi. org/ 10. 2340/
00015555-2810
[Crossref]
31. McDonald, K. A., Shelley, A. J., Colantonio, S., & Beecker, J. (2017). Hair pull test: Evidence-
based update and revision of guidelines. Journal of the American Academy of Dermatology,
76(3), 472–477. https:// doi. org/ 10. 1016/ j. jaad. 2016. 10. 002
[Crossref]
32. Dhurat, R., & Saraogi, P. (2009). Hair evaluation methods: Merits and demerits. International
Journal of Trichology, 1(2), 108–119. https:// doi. org/ 10. 4103/ 0974-7753. 58553
[Crossref]
33. Bagherani, N., Hasić-Mujanović, M., Smoller, B., Reyes-Barron, C., Bergler-Czop, B.,
Miziołek, B., Kasumagic-Halilovic, E., et al. (2021). Disorders of hair. In Atlas of dermatology,
dermatopathology and venereology: Inflammatory dermatoses (pp. 669–742). Springer
International Publishing.
34. Miteva, M., & Tosti, A. (2012). Hair and scalp dermatoscopy. Journal of the American
Academy of Dermatology, 67(5), 1040–1048. https:// doi. org/ 10. 1016/ j. jaad. 2012. 02. 013
[Crossref]
35. Chan, L., & Cook, D. K. (2018). Female pattern hair loss. Australian Journal of General
Practice, 47(7), 459–464. https:// doi. org/ 10. 31128/ AJGP-02-18-4498
[Crossref]
36. Goodman, N. F., Cobin, R. H., Futterweit, W., Glueck, J. S., Legro, R. S., & Carmina, E.
(2015). American Association of Clinical Endocrinologists, American College of
Endocrinology, and androgen excess and PCOS society disease state clinical review: Guide to
the best practices in the evaluation and treatment of polycystic ovary syndrome – Part 1.
Endocrine Practice, 11, 1291–1300.
37. Badri, T., et al. (2021). Minoxidil. https:// www. ncbi. nlm. nih. gov/ books/ NBK482378/
38. Kumar, M. K., et al. (2018). A randomized controlled, single-observer blinded study to
determine the efficacy of topical minoxidil plus microneedling versus topical minoxidil alone in
the treatment of androgenetic alopecia. https:// www. ncbi. nlm. nih. gov/ pmc/ articles/
PMC6371730/
39. Suchonwanit, P., et al. (2019). Minoxidil and its use in hair disorders: A review. https:// www.
ncbi. nlm. nih. gov/ pmc/ articles/ PMC6691938/
40.
Olsen, E. A., Dunlap, F. E., Funicella, T., et al. (2002). A randomized clinical trial of 5%
https://t.me/medicina_free
Соседние файлы в папке Библиотека им академика М.И. Перельмана