Background Radiesse, or Calcium Hydroxylapatite (CaHA), is a semi-permanent, biodegradable injectable filler that provides immediate aesthetic improvement, while also stimulating neocollagenesis for biologic effects. The physical properties of CaHA make it difficult, if not impossible to remove. Unlike some of the hyaluronic acid (HA) based fillers, CaHA cannot be easily dissolved. Objectives We present a simple and reliable technique for debulking and removing excess CaHA in the event of nodule formation, vascular compression, or overcorrection. Methods An 18-gauge needle is used to make an incision near the filler excess. A 1 mm diameter grater-type mico-liposuction cannula (Lipocube, Inc., London UK) is attached to a 5-10 ml syringe under negative pressure. The cannula under syringe suction is used in a back-and-forth, reaming motion beginning in the base of the material and gradually moving toward the surface until the desired effect has been achieved. Identification of the CaHA can be established and removal confirmed with ultrasound (Clarius, Inc., Vancouver, BC, Canada) if available. Results Although nodules, excess material and vascular compression secondary to CaHA are very rare occurrences, we have treated four patients with excess material and/or nodules. In one, the prominent cheek filler was reduced and a 1cm nodule that was palpable in the buccal region was eliminated. In the other three other patients, the palpable excess material was easily removed, in two at the time of injection and in the third, 6 months later. No patient required repeat treatment or replacement. Conclusions CaHA is an important synthetic filler due to its ability to lift, augment and regenerate tissue without eliciting an immune response, but its use has likely been limited due to difficulty of removal. This removal technique is shown to adequately remove excess CaHA filler but is not applicable to inadvertent intravascular injection.

Background A standardized technique for facial fat grafting, Injectable Tissue Replacement and Regeneration (ITR 2), was developed to address both anatomic volume losses in superficial and deep fat compartments as well as skin aging, incorporating newer regenerative approaches. Objectives The authors sought to track the short and long terms effects of a new standardized technique for facial fat grafting in the midfacial zone across a 19-month time period. Methods Twenty-nine female were analyzed for mid-facial volume changes after autologous fat transfer with ITR 2. Across 19 months, volumes were evaluated using the Vectra XT 3D Imaging System to calculate differences between a predefined, 3-dimensional mid-facial zone measured preoperatively and serially after fat grafting with novel approach using varying fat parcel sizes. Results Patient data was analyzed collectively as well as separately by age (< and > 55 years). Collective analysis revealed a trend of initial volume loss within the first 1-7 months followed by an increase within the 8–19-month range, averaging 56.6% postoperative gain and ending at an average of 52.3% gain in volume by 14-19 months. A similar trend was observed for patients <55 years of age, but to a greater extent, with a 54.1% average postoperative gain and final average of 75.2%. Conversely, patients above 55 years of age revealed a linear decay beginning at 60.6% and steadily declining to 29.5%. Multiple regression analysis revealed no statistically significant influence of weight change during the study duration. Conclusions Preliminary evidence shows a dynamic change in facial volume, with an initial decrease in facial volume followed by a rebound effect that demonstrated improvement of facial volume regardless of patient weight change or amount of fat injected 19 months after treatment. Volume improvement occurred to a greater extent in patients under 55 years old, whereas in patients older than 55 volume gradually decreased. To our knowledge, this study represents the first time that progressive improvement in facial volume has been shown 19 months after treatment with a new standardized technique of fat grafting.

Background Minimally invasive procedures that deliver thermal energy to subcutaneous tissue offer a solution between excisional and non-invasive options to address face and neck, aging-related changes. A minimally invasive helium plasma device, Renuvion, was first used for subdermal tissue heating to reduce skin laxity under a general clearance for cutting, coagulation, and ablation of soft tissue. Objectives The purpose of this study was to demonstrate the safety and effectiveness of the helium plasma device for improving the appearance of loose skin in the neck and submental region. Methods Subjects undergoing a procedure with the helium plasma device in the neck and submentum were studied. Subjects were seen through 6 months post-procedure. The primary effectiveness endpoint was improvement in lax skin in the treatment area as determined by 2 of 3 blinded photographic reviewers. The primary safety endpoint was the level of pain after treatment. Results The primary effectiveness endpoint was met; 82.5% demonstrated improvement at Day 180. The primary safety endpoint was met; 96.9% of subjects experienced no pain to moderate pain to Day 7. There were no serious adverse events reported as related to the study device or procedure. Conclusions The data demonstrates benefit to subjects in improvement of the appearance of lax skin in the neck and submental region. Outcomes resulted in FDA 510k clearance in July of 2022 expanding indications for the device to include subcutaneous dermatological and aesthetic procedures to improve the appearance of loose skin in the neck and submental region.

Background Wound healing is a process that involves multiple physiological steps, and despite the availability of various wound treatment methods, their effectiveness is still limited due to several factors, including cost, efficiency, patient-specific requirements, and side effects. In recent years, nanovesicles called exosomes have gained increasing attention as a potential wound care solution due to their unique cargo components which enable cell-to-cell communication and regulate various biological processes. Umbilical cord blood plasma exosomes (UCBP) have shown promise in triggering beneficial signaling pathways that aid in cell proliferation and wound healing. However, there is still very limited information about the wound-healing effect of umbilical cord blood plasma exosomes in literature. Objectives The primary objective of this study was to investigate the ‘Hybrosome’ technology generated with calf UCBP-derived exosome-liposome combination. Methods The authors developed ‘Hybrosome’ technology by fusing cord blood exosomes membranes with liposomes. Nanovesicle characterization, cell proliferation assay, wound healing scratch assay, immunohistochemistry analysis, anti-inflammation assay, RT-PCRi, ELISA, and cellular uptake studies were performed using the novel hybrid exosomes. Results Experimental results showed that Hybrosome increases cell proliferation and migration by 40-50%, depending on the dose, and induces an anti-inflammatory effect on different cell lines as well as increased wound healing related gene expression levels of dermal cells in vitro. All in all, this research widens the scope of wound healing therapeutics to the novel Hybrosome technology. Conclusions UCBP-based applications have the potential for wound treatments and are promising in the development of novel therapies. This study shows that hybrosomes have an outstanding ability in wound healing using in vitro approaches.

BackgroundDermal fillers have created a multi‐billion‐dollar industry. They are the second most popular form of injectable, as they primarily address volume loss, augmentation, and provide immediate results. The most popular form includes hyaluronic acid‐based fillers, however, alternatives exist.ObjectiveTo create clinical charts to help with filler selection, injection, and addressing common complications.MethodsThe current literature and expert opinions form our two senior authors were used to create a numerical and color‐coded chart based on G‐prime for filler selection, as well as an anatomical table with current recommendations and pearls. We have also included a safety table with current clinical recommendation to deal with common filler‐related complications.ConclusionFillers are a safe and reliable method to achieve augmentation. Filler selection in various anatomical planes plays a significant role in achieving favorable results.