Montes José Raúl, Wilson Anthony J, Chang Brian L, Percec Ivona
Department of Ophthalmology, Medical Science Campus, University of Puerto Rico, San Juan, Puerto Rico; and Division of Plastic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
Plast Reconstr Surg Glob Open. 2016 Dec 14;4(12 Suppl Anatomy and Safety in Cosmetic Medicine: Cosmetic Bootcamp):e1178. doi: 10.1097/GOX.0000000000001178. eCollection 2016 Dec.
The toolbox for cosmetic practitioners is growing at an unprecedented rate. There are novel products every year and expanding off-label indications for neurotoxin and soft-tissue filler applications. Consequently, aesthetic physicians are increasingly challenged by the task of selecting the most appropriate products and techniques to achieve optimal patient outcomes. We employed a PubMed literature search of facial injectables from the past 10 years (2005-2015), with emphasis on those articles embracing evidence-based medicine. We evaluated the scientific background of every product and the physicochemical properties that make each one ideal for specific indications. The 2 senior authors provide commentary regarding their clinical experience with specific technical refinements of neuromodulators and soft-tissue fillers. Neurotoxins and fillers are characterized by unique physical characteristics that distinguish each product. This results in subtle but important differences in their clinical applications. Specific indications and recommendations for the use of the various neurotoxins and soft-tissue fillers are reviewed. The discussion highlights refinements in combination treatments and product physical modifications, according to specific treatment zones. The field of facial aesthetics has evolved dramatically, mostly secondary to our increased understanding of 3-dimensional structural volume restoration. Our work reviews Food and Drug Administration-approved injectables. In addition, we describe how to modify products to fulfill specific indications such as treatment of the mid face, décolletage, hands, and periorbital regions. Although we cannot directly evaluate the duration or exact physical properties of blended products, we argue that "product customization" is safe and provides natural results with excellent patient outcomes.
美容从业者的工具库正以前所未有的速度增长。每年都有新的产品，并且神经毒素和软组织填充剂的非标签适应症也在不断扩大。因此，美容医生在选择最合适的产品和技术以实现最佳患者效果的任务上面临着越来越大的挑战。我们对过去10年（2005 - 2015年）的面部注射剂进行了PubMed文献检索，重点关注那些采用循证医学的文章。我们评估了每种产品的科学背景以及使其适用于特定适应症的物理化学性质。两位资深作者就他们在神经调节剂和软组织填充剂特定技术改进方面的临床经验提供了评论。神经毒素和填充剂具有独特的物理特性，这些特性区分了每种产品。这导致它们在临床应用中存在细微但重要的差异。本文回顾了各种神经毒素和软组织填充剂的具体适应症及使用建议。讨论重点介绍了根据特定治疗区域在联合治疗和产品物理改性方面的改进。面部美学领域已经发生了巨大的演变，主要是由于我们对三维结构体积恢复的理解有所增加。我们的工作回顾了美国食品药品监督管理局批准的注射剂。此外，我们描述了如何对产品进行改性以满足特定适应症，如治疗中面部、颈部、手部和眶周区域。虽然我们无法直接评估混合产品的持续时间或确切物理性质，但我们认为“产品定制”是安全的，并且能为患者带来自然的效果和出色的治疗结果。
