Abstract     Background:  Because of the fixed attachments or muscle-SMAS insertions to the undersurface of wrinkle lines, folds and retracted scars, the use of fills alone has resulted in unpredictable and unsatisfactory improvements.   Objectives: The use of a wire dissector to completely release these attachments and accompanied with an immediate fill and/or an adjacent aesthetic surgical procedure may optimize the final results.   Methods: The subcision wire was positioned under various wrinkles, folds and scars in a triangulated outline and then zig-zagged to uniformly release any subdermal attachments. A number of depressions underwent only a ReleaseWire procedure (Category 1). The Category 2 group was filled immediately with a strip of autogenous filler or a xenograft material. The Category 3 group combined the ReleaseWire procedure without fill and an adjacent aesthetic procedure. Category 4 sites involved the ReleaseWire procedure, fill and an adjacent aesthetic surgical procedure. The benefits of each of the added  procedures on ReleaseWire subcisioned sites were rated with a photographic Wrinkle/Fold Assessment Scale (mean ± SD) by two masked evaluators at least after 6 months. Assessment was based on a Quartile Grading Scale: 0 = less than 25%, 1 = 25-50%, 2 = 51-75%, and 3 = greater than 76% improvement.   Results:  Eighty-five patients experienced 338 ReleaseWire procedures at eight facial sites, one posterior neck site and four sites of thigh cellulite. The longest follow-up was 1.5 years, with a mean of 6.3 months. The cumulative Quartile Grading Scale was recorded as: Category 1 (1 ± 1.5 SD); Category 2 (3.1 ±0.1 SD); Category 3 (2.5 ± 0.2); and Category 4 (3.6 ± 0.2). When fills were employed as spacers under the release tracts in Category 2 and 4 sites, strips of SMAS and dermis and microfat droplets were the favored fills in the areas of the nasolabial and marionette folds because of the capacity of the graft’s volume and tissue acceptance. For shallower depressions, such as the glabellar frown lines and crow’s feet, strips of deep temporal fascia or muscle were more effective. Complications after ReleaseWire procedures with or without fill were few and transient.   Conclusions: The use of this type of subcision for resistant wrinkles, folds or scars can result in a satisfactory outcome when use as a solitary procedure with minimal complications. Enhancement of the surgical result may be further optimized with the immediate addition into the released tract. An adjacent aesthetic surgical procedure that impacts at the subcised site may provide additional benefit to the site but not as much as observed with the usage of an immediate fill. Autogenous fills that are substantitive provide longer lasting effects because of volume and tissue acceptance.  

Abstract   Background:   Cellulite of the upper lateral and posterior thighs and lower buttocks represents a common, physiological and unwanted condition whose etiologies and effective management are subjects of continued debate.   Objective: The purpose of this controlled double-blinded study is to evaluate the efficacy and safety of a novel phosphatidylcholine based, cosmeceutical anti-cellulite gel combined with a light emitting diode (LED) array at the wavelengths of red (660 nm) and near-infrared (950 mn), designed to counter the possible mechanisms that purportedly accentuate the presence of thigh cellulite.   Methods: Nine healthy female volunteers with Grade II-III thigh cellulite were randomly treated twice daily with either an active gel on one thigh or a placebo gel on the control thigh for three months. Twice weekly, each thigh was exposed for a 15-minute treatment with LED light for a total of 24 treatments. At 0, 6, and 12 weeks on study, the following clinical determinants were obtained: standardized digital photography, height and weight measurements, standardized thigh circumference tape measurements, pinch testing, body mass index (kg/m2), body fat analysis (Futrex-5500/XL near-infrared analyzer), and digital high resolution ultrasound imaging of the dermal-adiposal border. In selected patients, full-thickness biopsies of the placebo and active-treated sites were obtained. At 18 months, repeat standardized digital photography, height and weight measurements, and body mass index measurements were obtained.   Results: At the end of 3 months, eight of nine thighs treated with the phosphatidylcholine-based, anticellulite gel and LED treatments were down-graded to a lower cellulite grade by clinical examination, digital photography, and pinch test assessment. Digital ultrasound at the dermal-adiposal interface demonstrated not only a statistically significant reduction of immediate hypodermal depth, but also less echo-like intrusions into the dermal layer. Three of six biopsies from thighs treated for three months with the active gel and LED treatments demonstrated less intrusion of subcutaneous fat into the papillary and reticular dermis. In nine placebo-LED treated thighs and one of the actively treated thighs, minimal clinical changes were observed or measured by the clinical determinants throughout the 3 month study. At the 18th month evaluation period for the eight responsive thighs, five thighs reverted back to their original cellulite grading, while three thighs continued to maintain their improved status.   Patients experienced minimal and transient side effects that included puritus, erythema and swelling.      Conclusions: The results of this small but well-documented randomized double-blinded study affirms that eight of nine grade II-III cellulite of the thighs responded positively to a novel combined three month treatment program of a phosphatidylcholine-based, anticellulite gel and LED exposure, as determined by the obtained clinical determinants. Patients experienced minimal and transient side effects. At the 18th month evaluation period (15 months off-treatment), five responsive thighs reverted back to their original cellulite gradings, indicating a need for maintenance treatment.   Future studies are needed to verify these tentative positive observations.  

ABSTRACT   Background: Patient selection is key to obtaining a successful outcome after non-ablative monopolar radiofrequency treatments to the forehead, face and neck. The purpose of this study was to discover at baseline any predictors from patient demographics, skin and fat characteristics, measurable degrees of tissue mobility and photoaging that may be useful to predict a positive result under a standardized treatment algorithm.   Methods: Twenty-five patients (22 females, 3 males; average age 52.3 years) were selected randomly for NMRF treatments (2 non-overlapping passes, additional passes for vectored contraction and contouring) between 350-450 firings with 1.5 cm tips to the forehead, periorbitum, face and upper neck. Patients were evaluated at baseline and followed for outcomes beyond 1 year by a number of quantitative assessments.   Results: At baseline, 3, 6 and l2 months, measurements of skin thickness, subcutaneous fat depth, tissue mobility, and wrinkle and fold depth were obtained at nine different reference sites on each patient. Nineteen patients (76%), who progressively responded to NMRF energy over 12 months, were observed at baseline to have a global mobility score (mean ± S.D.) of 3.4 ± 0.27 mm; six patients, who were assessed to be non-responders over l year of evaluation, began with more tissue laxity and exhibited at baseline a larger global mobility score (mean ± S.D.) of 4.4 ± 0.60 mm. Other factors, that were more likely to be associated with a positive response to NMRF treatment, included minimal degrees of photoaging and shallower wrinkle/fold development. The variables of skin thickness and fat depth did not play significant roles in predicting positive responses to treatment. Side effects and complications were minimal throughout the study. Conclusions:   This study represents one of the first investigations that attempts to identify systematically objective baseline parameters that are more likely to be associated with positive responses to NMRF treatments to the forehead, face and neck. Longer follow-ups of our patients and further studies will be required to verify our preliminary findings.