Background IncobotulinumtoxinA is an effective neuromodulator for treating glabellar rhytids. The relationship between dose and reduction in rhytid severity is well established. However, effects of escalating doses on the treatment duration response are less understood. Objective To assess effects of increasing doses of incobotulinumtoxinA on the treatment duration for glabellar rhytids. Methods A randomized, double-blind, Phase IV study was conducted at a fully accredited, outpatient surgical facility. Subjects (31 female, 7 male) with moderate-to-severe glabellar rhytids were randomized to one of three incobotulinumtoxinA dose groups: 20, 60, or 100 units. Effect duration was determined by calculating the time to return to baseline for dynamic glabellar lines during maximal contraction. Follow-up was completed through 1 year, and adverse events were monitored. Results The median duration of effect was 120 (95%-CI [90, 180]) days, 180 (95%-CI [180, 210]) days, and 270 (95% CI [240, 330]) days for the 20, 60, and 100 U groups respectively. A Wald chi-square test from the Cox regression on the primary efficacy variable indicated a statistically significant effect of dose group on time to baseline (Chi square = 54.63; df = 2; p < 0.001). Hazard ratios were HR = 0.21 (95%-CI = [0.10; 0.43] for 60 U vs. 20 U group, and HR = 0.06 (95%-CI [0.10; 0.43]) for 100-U vs 20 U group, indicating a statistically longer return to baseline for both 60 and 100 U cohorts. Conclusions There is a dose-dependent relationship between incobotulinumtoxinA and duration of effect in the glabella.

Background Perioral rhytids are a bothersome sign of aging for many patients. While multiple treatments exist, choosing an optimal modality may be difficult taking into consideration that rhytids in this region are fine and the anatomy dynamic. Objective To compare the efficacy and safety, and patient satisfaction of a small-particle hyaluronic acid filler with 0.3% lidocaine (SP-HAL, Restylane Silk®) and cohesive polydensified matrix hyaluronic acid filler (CPM-HA, Belotero Balance®) in reducing uperficial perioral rhytids. Methods The study was double-blinded, and 48 subjects with moderate to severe superficial perioral rhytids were enrolled. Subjects were randomized to receive either CPM-HA in the left perioral region and SPHAL in the right, or vice versa. Rhytid severity was measured by patients using a linear analog scale, and for investigators a validated 5-point scale, for 180 days following treatment. Results Both SP-HAL and CPM-HA achieved a reduction in rhytid severity, and neither treatment group returned to baseline after 180 days. Investigator-reported scores for rhytid severity were significantly better for SP-HAL compared to CPM-HA and remained so at 180 days (p < 0.05). SP-HAL also proved significantly better for reducing rhytids according to patient scores, although this difference occurred between 120 and 180 days only. Adverse events included rash and mild acne for CPM-HA, while SP-HAL was associated with one post-inflammatory nodule and two occurrences of Tyndall effect. Conclusion While both SP-HAL and CPM-HA are effective at reducing perioral rhytid severity and have similar safety profiles, SP-HAL possesses a longer duration of effect.

Most current strategies for bone regeneration have relatively satisfactory results. However, there are drawbacks and limitations associated with their use and availability, and even controversial reports about their efficacy and cost-effectiveness. The induction of new bone formation through distraction osteogenesis (DO) is widespread clinical application in the treatment of bone defects, limb deformities, and fracture nonunions. However, a lengthy period of external fixation is usually needed to allow the new bone to consolidate, and complications such as refracture at the distraction gap often occur. Although various biomaterials have been used as injectable delivery systems in DO models, little has been reported on the use of nanobiomaterials as carrier materials for the sustained release of growth factors in bone regeneration. One area of focus in nanotechnology is the delivery of osteogenic factors in an attempt to modulate the formation of bone. This review article seeks to demonstrate the potential of nanobiomaterials to improve biological applications pertinent to osteodistraction.