Peer PreSs Review
Dr Rohit Kotnis surveys academic and association journals to report on advances in research in medical aesthetics and related fields
Same-patient prospective comparison of Botox versus Dysport for the treatment of primary axillary hyperhidrosis and review of literature. Vergilis-Kalner IJ. J Drugs Dermatol, 2011 Sep 1;10(9):1013-5.
Two non-bioequivalent toxins, Botox and Dysport, were compared for treating primary axillary hyperhidrosis to compare the injection site pain, efficacy, safety and tolerability of Botox versus Dysport using a conversion factor of 1:3, respectively.
A patient with primary axillary hyperhidrosis was treated with 100 units of Botox into the right axilla and 300 units of Dysport into the left axilla. Patient was blinded as to which axilla received treatment. Pain at the injection site of these two toxins was evaluated. The patient was subsequently followed for the next 10 months to evaluate the difference in these two toxins for side effects, time to the onset of reduction of sweating and the duration of action of these two toxins.
A significant difference was observed in the onset of action, with dramatic reduction in sweating after one week of injection with Botox and after two weeks of injection with Dysport. At two-weeks, a similar success in eliminating sweating was reported in both axilla. The duration of benefits differed between the two toxins, with elimination of sweating in the Dysport-treated axilla lasting six months and, in the Botox-treated axilla, nine months. No other differences were observed between these two toxins.
Both Botox and Dysport led to a similar perceived reduction of sweating in the treatment of primary axillary hyperhidrosis when a conversion factor of 1:3 was used. However, Botox treatment resulted in a quicker onset of action and longer duration of benefits. An interesting and useful study for practitioners to consider when choosing a product for axilla treatment and also when discussing the effects with their clients.
Comparison of the spread of three botulinum toxin type A preparations. Kerscher M, Roll S, Becker A, Wigger-Alberti W. Arch Dermatol Res 2011 Oct 15.
Unwanted effects can occur when neurotoxin diffuses into untargeted muscle. The aim of this study was to investigate the spread of three approved botulinum toxin type A preparations by measuring and comparing the size of the anhidrotic halos they produced following injection of equivalent doses in an identical volume into the forehead of patients.
The results showed that incobotulinumtoxinA and onabotulinumtoxinA displayed comparable spread at six weeks and over six months. However, abobotulinumtoxinA, when assuming a 1:2.5 injection volume ratio, produced a statistically significantly greater maximal area of anhidrosis within six weeks and over six months. All preparations were well tolerated.
The results of this study demonstrate that incobotulinumtoxinA and onabotulinumtoxinA have comparable spread, while abobotulinumtoxinA has significantly greater spread than incobotulinumtoxinA.
Lip nodules caused by hyaluronic acid filler injection: report of 3 cases. Shahrabi Farahani S, Sexton J, Stone JD, Quinn K, Woo SB. Head Neck Pathol 2011 Oct 8.
Many dermal fillers have been used for reducing facial skin lines and for lip augmentation, and hyaluronic acid (HA) is one of the most widely used agents. Although HA is non-immunogenic, hypersensitivity and granulomatous foreign body reactions have been reported.
The paper reports three female patients (average age 56 years) who presented with firm nodular lesions of the lip and a history of injection with HA. Histopathologically, all cases showed pools of amorphous hematoxyphilic material surrounded by bands of densely collagenised connective tissue with no inflammation or foreign body reaction. Histochemical stains confirmed the presence of acid mucopolysaccharides such as HA.
The authors conclude HA is an inert filler that may persist at an injection site, resulting in a tumor-like nodule.
This paper focuses on a well recognised side-effect of lip augmentation and highlights the need for attention to detail.
Further experience with permafacial implants for lip augmentation: a review of 100 implants. Narsete T, Ersek R, Narsete MP. Aesthet Surg J 2011 Jul;31(5):488-92.
Although fillers and surgical lip lifts are effective ways of treating the perioral area, both have inherent downsides. Fillers lack permanence, and lip lifts do not address the issue of fullness.
The authors present the results of a long-term follow-up study of Permafacial implants for lip augmentation. The authors’ original publication demonstrated the benefits of inserting Permafacial implants concurrent with a facelift procedure. In this long-term follow-up study, the results of the first 100 implants (50 patients) are presented; this initial group of patients was followed up for one to two years.
Implant migration, lip function, implant position, sensation, and patient satisfaction are reviewed. Very few complications were reported; these included migration with revision, along with patient-requested size adjustments or removal. No extrusions were reported. The degree of patient satisfaction with these implants was high.
Although the authors initially experienced a significant migration rate, a modification in technique reduced this rate over the long term. .
Clinical experience with hyaluronic acid-filler complications. Park TH, Seo SW, Kim JK, Chang CH. J Plast Reconstr Aesthet Surg 2011 Jul;64(7):892-6. Epub 2011 Feb 9.
The authors evaluated and treated 28 cases of HA-filler-related complications that were referred over five years from July 2004 to October 2009. Twenty-eight patients were included: 82.1% of the patients were female and 17.9% were male. Complications were classified as nodular masses, inflammation, tissue necrosis and dyspigmentation.
Affected locations, in descending order of frequency, were the perioral area, forehead, including glabella, nose, nasolabial fold, mentum, including marionette wrinkles, cheek area and periocular wrinkles. The most disastrous complication was alar rim necrosis following injection of the nasolabial fold.
The authors propose two ‘danger zones’ that are particularly vulnerable to tissue necrosis following filler injection: the glabella and nasal ala.
This serves as a reminder of the potential serious complications of fillers and the need for practitioners to evaluate the risks / benefits when injecting into the area and informed consent considerations.
Reviewing the peer press is Rohit Kotnis (Lon), Dip SEM (Ed). Rohit is an advanced tutor at Dermis Deep, Birmingham and a member of the Body Language editorial panel
