Anatomy of the facial fat compartments and their relevance in aesthetic surgery
Our understanding of facial anatomy has changed over the past decade, and, with the rising number of minimally-invasive procedures available in this sector, the need for greater knowledge of facial anatomy is paramount in order to ensure patient safety and effective treatment.
This narrative review study examined and analysed the existing literature on facial fat compartments and presented this, along with the authors' experiences, to provide a study that summarises the current understanding of superficial and deep facial fat compartments and their relevance in minimally-invasive facial procedures.
This study suggests that the face is arranged into five layers: 1, the skin; 2, subcutaneous fat; 3, superficial musculo-aponeurotic system; 4, deep fat, and 5, periosteum or deep fascia. However, the authors state that this arrangement varies between facial regions, especially when the line of ligaments is incorporated into the model. The authors state that the facial fat compartments are located in layers 2 and 4, and that each layer of the face has unique characteristics and spatial relationships with the surrounding tissues.
According to the authors, this concept of a 5-layered arrangement is a new and beneficial way to understand the relationship and interplay of the soft tissues of the face. The authors conclude that understanding the layers, the location of the superficial and deep facial fat compartments and their boundaries is crucial in conducting safe and effective minimally-invasive facial procedures.
Delayed-onset nodules to differentially crosslinked hyaluronic acids: comparative incidence and risk assessment
There is a lack of robust and long term data on the incidence of delayed-onset nodules and immune tolerance of hyaluronic acid fillers.
The purpose of this study was to establish the incidence of delayed nodules when using various products from the Vycross hyaluronic acid fillers range (Allergan), compared with previously reported US Food and Drug Administration (FDA)-approved and non-FDA-approved nonanimal-stabilised hyaluronic acid fillers. The study assessed the incidence of delayed nodules in all patients who had received Vycross fillers over a 12-month period using a retrospective chart review. Nodule incidence or approved hyaluronic acid fillers was assessed using the FDA Summary of Safety and Effectiveness Data.
A total of 1029 patients received 1250 Vycross filler treatments. Of the patients treated, five developed delayed nodules when treated with Volbella (VOB)—an incidence of 1.0% per patient and 0.8% per syringe. No nodules were observed in patients who received Volift or Voluma. However, all nodules were treated successfully using intralesional triamcinolone and hyaluronidase.
The results of this study suggest that, compared with other currently-approved nonanimal-stabilised hyaluronic acid fillers, VOB is associated with a higher incidence of nodule formation.
The authors suggest that the introduction of VYC hyaluronic acid filler has introduced a new variable that may be changing the immune tolerance of these substances, resulting in a higher incidence of delayed nodules than previously expected.
The role of interleukins in vitiligo: a systematic review
Vitiligo is a disorder of the skin which causes depigmentation and asymptomatic macules. Although the cause of vitiligo is not fully understood, it is thought that it is associated in some way with the autoimmune process.
This systematic review aimed to examine the role of inflammatory mediators, such as interleukins, in vitiligo. The study assessed all studies exploring interleukin levels in vitiligo patients that were published before June 2017. All studies were quality assessed using the Newcastle-Ottawa Scale (NOS).
The study found that dysregulated levels of the interleukins were correlated with the stage of disease, the affected skin surface area, and indicated as the main factor for lymphocyte infiltration found in depigmented regions.
The researchers suggested that these findings highlight the growing need for new treatments for vitiligo, and that further research into the role of interleukins in vitiligo is required in order to achieve this.
Anticipating the era of dermatology disease trackers
According to the authors of this perspective article, the current era of patient-centred medicine is characterised by widespread accessibility to medical information and self driven involvement in disease management.
Over the years, there has been an increase in medical mobile applications for personal electronic devices such as phones, tablets and notebooks. The authors note that between 2014 and 2017, dermatology-specific mobile apps increased by 81%, with a growing selection of disease tracking apps for various dermatologic conditions now available.
Disease trackers are a specific type of mobile health app, which work by monitoring symptoms over time, while other categories of health apps may offer patient education or access to medical records.
Atopic dermatitis: the skin barrier and beyond
Atopic dermatitis is a common chronic inflammatory skin disorder that affects up to 20% of children and 10% of adults, posing a considerable burden to the individual and society at large. However, the pathophysiology of atopic dermatitis is complex, encompassing both genetic and environmental risk factors. This narrative review was based on a systematic literature search, and sought to explore the pathology and understanding of atopic dermatitis.
The authors determined that our current understanding of the aetiology of atopic dermatitis highlights disruption of the epidermal barrier leading to increased per-meability of the epidermis, pathological inflammation in the skin and percutaneous sensitisation to allergens.
As a result, the majority of treatments available look to target specific aspects of the skin barrier or cutaneous inflammation. The authors identified several studies that have shown promising results in preventing atopic dermatitis, such as the early use of emollients in infants who are at high risk of developing this condition. These findings may have broader implications with regards to halting the progression to atopic comorbidities, including food allergy, hay fever and asthma.