Soft Tissue Augmentation

Dr. Jean Carruthers, MD, FRCS (UK), FRCS (C), Diplomate of the American Board in Cosmetic Surgery, Fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery. Dr. Jean Carruthers is a Cosmetic Surgeon and a Clinical Professor of Ophthalmology with the Faculty of Medicine at the University of British Columbia (UBC). Dr. Carruthers has lectured worldwide on a variety of subjects pertaining to cosmetic ophthalmology, including the cosmetic use of the BOTOX� procedure, which she co-founded with her husband, Dr. Alastair Carruthers, in 1987. Since this time, they have remained at the forefront of BOTOX� research, development and education, publishing numerous articles using their data. BOTOX� inhibits nerve impulses in muscles that cause everything from frown lines and wrinkles to sweating. Today, BOTOX� is the most commonly performed cosmetic procedure in North America. They are now also researching the cosmetic use of the newest therapeutic neurotoxin, Botulinum type B, commercially produced as MyoBloc. Dr. Carruthers has published more than eighty peer reviewed scientific articles and twenty-eight scientific book chapters on a variety of topics, including the use of botulinum toxin and soft tissue augmenting agents, aesthetic lasers and cosmetic laser blepharoplasty. She is an International Editor for such publications as Dermatologic Surgery, the Journal of Cosmetic Laser Surgery and the American Journal of Cosmetic Surgery. Dr. Alastair Carruthers, M.A., B.M.,B.Ch, FRCP(LON), FRCPC Dr. Alastair Carruthers is a Cosmetic Dermasurgeon who operates his own clinical practice (Carruthers Dermatology Centre Inc.) in Vancouver, BC. He is also a Clinical Professor of Dermatology with the Faculty of Medicine at the University of British Columbia (UBC). During his 20 years of practice, Dr. Carruthers has made several major contributions to the field of dermatology. Foremost among these was the use of the BOTOX� procedure in cosmetic applications, a discovery he made with his wife, Dr. Jean Carruthers, in 1987. Since this time, they have been at the forefront of BOTOX� research, development and education, publishing numerous articles using their data. Today, BOTOX�, which inhibits nerve impulses in muscles that cause everything from frown lines and wrinkles to sweating, is the most commonly performed cosmetic procedure in the world. Dr. Carruthers has also made significant advances in the area of Tissue Augmentation. These materials, both temporary and permanent, are used to lift and support the structures beneath the skin. In 1998 Dr. Carruthers was the first dermatologist in North America to begin injecting Artecoll. Through the extensive research performed in their Vancouver based facility, Drs. Carruthers continue to have articles published and lecture extensively on these subjects. With over 100 published articles to his credit, Dr. Carruthers is a member of the Editorial Board of "Dermatologic Surgery�. He is also a member of several national and international associations, including the American Dermatology Association and the Canadian Dermatology Association, where he served as President from 1998 to 1999. In addition, he has been elected Vice President of the American Society for Dermatologic Surgery. Dr. Carruthers has also contributed extensively to studies about the relationship between skin cancer and sun exposure.

CONTENTS

Series Preface vii

Series Preface (First edition) ix

Preface xi

Contributors xiii

Acknowledgements xvii

Dedication xix

1 Introduction 1

Jean Carruthers, Alastair Carruthers

2 Fillers: Evolution, Regression, and

the Future 3

Richard G. Glogau, Haydee M. Knott

NON-PERMANENT FILLERS

3 NASHAT Family 10

Gary D. Monheit, Rhoda S. Narins,

Kavita Mariwalla

4 Juv�derm� Family 17

William P. Coleman III, Kyle M. Coleman,

W. Patrick Coleman IV

5 Non-Permanent Fillers:

Belotero�/Esth�lsis� and Teosyal� 23

Berthold J. Rzany, Heike Buntrock,

Vanessa Hartmann, Martina Kerscher

6 Radiesse�/Radiesse� with Lidocaine 28

Bassel H. Mahmoud, David M. Ozog

7 Poly-L-Lactic Acid 34

Stephen H. Mandy, Rebecca Fitzgerald

8 Artefi ll�: A Third-Generation

Polymethylmethacrylate in

Collagen Soft Tissue Filler 41

Steven Cohen, Emmy Graber, Trevor M. Born

9 New and Novel Fillers: Highlighting

Elastin and Soft Tissue Augmentation,

Platelet-Rich Plasma and a Combination

of Carboxymethyl Cellulose (CMC), and

Polyethylene Oxide (PEO) 53

Anthony S. Weiss, Greg J. Goodman,

Philippa Lowe, Nicholas J. Lowe

PERMANENT FILLERS

10 Liquid Injectable Silicone 62

Derek H. Jones, Harold J. Brody

11 Aquamid� 70

Luitgard G. Wiest

12 Bio-Alcamid� 75

Massimo Signorini, Dario Boccanera

VOLUMIZING FILLERS

13 Forehead and Temporal Recontouring

Using Calcium Hydroxylapatite

Pre-mixed with Lidocaine 81

Mariano Busso, Kavita Mariwalla,

David J. Howell

14 Glabella / Central Brow 88

Hema Sundaram, Jean Carruthers

15 Volumetric Treatment of the Brows 100

Val Lambros

16 Infraorbital Hollow and Nasojugal Fold 105

Shannon Humphrey, Steven Fagien

17 Nose 112

Kyle Koo-II Seo

18 Cheeks 123

Davi de Lacerda

19 Perioral Filling 132

Alastair Carruthers, Jean Carruthers,

Ada R. Trindade de Almeida

20 Lip Augmentation 140

Andrew A. Nelson, Valerie D. Callender,

Jenny Kim, Frederick C. Beddingfi eld III

21 Melomental Folds 147

Susan H. Weinkle, Ian A. Maher

22 Hands and Feet 155

Heidi A. Waldorf, Neil F. Fernandes,

Rita V. Patel

23 Buttocks 160

Ada R. Trindade de Almeida,

Ra�l Alberto Banegas

24 Earlobe Rejuvenation 166

Nazanin Saedi, Michael S. Kaminer,

Jeffrey S. Dover

25 Tower technique of fi ller injection 170

Gerhard Sattler, Birgit Woerle

COMPLICATIONS

26 Complications of Temporary Fillers 179

Marc D. Glashofer, Timothy C. Flynn

vi

Contents

27 Complications of Permanent Fillers 188

Chad L. Prather, Luitgard G. Wiest

28 Reversers 200

Shannon Humphrey, Robert A. Weiss

29 Consent for Photography: Legal Issues 208

David J. Goldberg

30 Pre- and Post-Treatment Photography 214

Kevin C. Smith

31 Conclusions 223

Jean Carruthers, Alastair Carruthers

Index 225