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Biomedical subjects

Jean Carruthers

Publications and source records attributed to Jean Carruthers.

At least 19 recordsLinked to original sources
PubMed2006

Management of injected hyaluronic acid induced Tyndall effects.

BACKGROUND AND OBJECTIVES: Soft tissue augmentation represents a cosmetic procedure performed with increasing frequency. STUDY DESIGN/MATERIALS AND METHODS: Correct utilization permits precise correction of facial rhytids and scars. Novice injectors occasionally inject too superficially in tissue with the resultant appearance of discoloration secondary to the Tyndall effect. RESULTS AND CONCLUSION: In this article, we will review the Tyndall effect in the skin and management options for this growing problem in aesthetic dermatology.

Adult↗
PubMed2006

Monopolar radiofrequency treatment of human eyelids: a prospective, multicenter, efficacy trial.

BACKGROUND/OBJECTIVE: To evaluate the efficacy of a novel 0.25 cm(2) monopolar radiofrequency (RF) treatment tip for aesthetic rejuvenation of the eyelids. STUDY DESIGN/MATERIALS AND METHODS: This was a prospective, multicenter trial in which the eyelids of 72 patients were treated. Patients underwent a single treatment session and were then followed on a serial basis for 6 months. Cutaneous anesthesia was not required to perform the treatments. Assessments were made by the treating physician, the subjects, and by masked physician observers evaluating photographs taken at each data point. RESULTS: Upper eyelid tightening and reduction of hooding was noted in 88 and 86% of subjects, respectively. Lower eyelid tightening was noted in 71-74% of subjects. The majority of patients treated achieved at least up to 25% improvement while a smaller percentage achieved more dramatic results. There was no correlation between the amount of energy applied to the eyelids and the clinical outcome. There were no serious adverse sequelae. CONCLUSION: Human eyelids can be safely treated with monopolar RF energy delivered via a novel 0.25 cm(2) treatment tip. Using this technology non-invasive eyelid rejuvenation was achieved in the majority of subjects treated. The factors differentiating those patients who achieve the most impressive changes from others remain unclear. Further development and testing of this technology is warranted.

Adult↗
PubMed2006

The use of photodynamic therapy in dermatology: results of a consensus conference.

Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.

Aminolevulinic Acid↗
PubMed2005

Safety and efficacy of nonanimal stabilized hyaluronic acid for improvement of mouth corners.

BACKGROUND: Esthetic concern with downturned mouth corners ("mouth frown") is increasing in the aging baby-boomer generation. A new technique to offer structural support using the recently approved filler nonanimal stabilized hyaluronic acid (NASHA; Restylane, Q-med Inc., Uppsala, Sweden) is described. METHOD: Fifteen women with prominent downturned mouth corners met the inclusion criteria for the study. All were photographed before and at 1 week, 3 months, 4.5 months, and 6 months after treatment using a standardized clinical photographic system. NASHA was injected using a standardized technique with nerve block anesthesia to ensure patient comfort. RESULTS: All 15 women noted swelling, redness, and some local discomfort for several days after the injection. All noted an improvement in the downward angulation of their mouth corners at the first post-treatment visit, with at least partial improvement maintained through the 6-month post-treatment follow-up visit. CONCLUSIONS: NASHA injection to support the age-related downturn of lateral lip corners was effective, safe, and well tolerated in a small prospective study of middle-aged female subjects. Esthetic satisfaction was greatest in the first 3 months post-treatment, but 40% of subjects still noted improvement at the 6-month follow-up visit.

Adult↗
PubMed2005

Dose-ranging study of botulinum toxin type A in the treatment of glabellar rhytids in females.

OBJECTIVE: To compare the efficacy, safety, and duration of effect of four doses of botulinum toxin type A in the treatment of glabellar rhytids in females. DESIGN: Double-blind, randomized, parallel-group, dose-ranging trial followed by an open-label extension. SETTING: Private dermatologic clinic. SUBJECTS: Eighty female subjects with moderate to severe wrinkles at maximum frown entered the study. The first 40 subjects completing the double-blind phase entered the open-label extension. INTERVENTION: Random administration of 10, 20, 30, or 40 U botulinum toxin type A in divided doses. Open-label trial: 30 U botulinum toxin type A at the same sites in divided doses. MAIN OUTCOME MEASUREMENTS: Trained observer and subject assessments of wrinkle severity at maximum frown and repose using the Facial Wrinkle Scale (0 = none to 3 = severe), subject satisfaction, and adverse events. Follow-up monthly for up to 1 year postinjection. RESULTS: Relapse rates and responder rates revealed benefits lasting 3 to 6 months or longer. Objectively, 10 U of botulinum toxin type A was significantly less effective than 20, 30, or 40 U. The relapse rate at 4 months was significantly higher in the 10 U group (83%) versus 40, 30, or 20 U (28%, 30%, and 33%, respectively). Subject satisfaction was high in all groups. Duration of effect and response rates were sustained during the open-label extension. Adverse effects were mild and infrequent. CONCLUSION: Twenty to 40 U botulinum toxin type A doses were significantly more effective at reducing glabellar lines than 10 U. Most subjects experienced benefits for 3 to 4 months; some subjects demonstrated effect for up to 12 months.

Adolescent↗
PubMed2005

Prospective, double-blind, randomized, parallel-group, dose-ranging study of botulinum toxin type A in men with glabellar rhytids.

BACKGROUND: The effective dose for treating glabellar lines with botulinum toxin type A in men has not been studied adequately. OBJECTIVE: To compare the safety, efficacy, and duration of response of four doses of botulinum toxin type A on glabellar rhytids in men. METHODS: Eighty men were randomized to receive a total dose of either 20, 40, 60, or 80 U of botulinum toxin type A (BOTOX, BOTOX Cosmetic, or Vistabel, Allergan, Inc., Irvine, CA, USA) in the glabellar area. Glabellar lines were assessed at rest and maximum frown by a trained observer at baseline, 2 and 4 weeks, and monthly thereafter. Patients provided self-evaluations at the same visits. Adverse events were monitored throughout. RESULTS: The 40, 60, and 80 U doses of botulinum toxin type A were consistently more effective in reducing glabellar lines than the 20 U dose (duration, peak response rate, improvement from baseline). There was a dose-dependent increase in both the response rate at maximum frown and the duration of effect assessed by the trained observer. In addition, the participants reported a dose-dependent reduction in the ability to frown, improvement in their global assessment, and increased feelings of attractiveness, self-confidence, and satisfaction. The incidence of adverse events was not increased with higher doses. CONCLUSION: Male participants with glabellar rhytids benefit from starting doses of at least 40 U of botulinum toxin type A.

Adolescent↗
PubMed2005

Single-center, double-blind, randomized study to evaluate the efficacy of 4% lidocaine cream versus vehicle cream during botulinum toxin type A treatments.

BACKGROUND: Botulinum toxin type A (BTX-A) injections are overwhelmingly safe and effective treatment in cosmetic treatment, but some patients are apprehensive about pain associated with injection. OBJECTIVE: To determine whether preprocedural application of lidocaine 4% topical anesthetic cream to the injection site will reduce pain on injection of BTX-A for the treatment of crow's feet. METHODS: Twenty-four participants receiving bilateral injections for crow's feet were enrolled. Subjects were randomized to one of four study groups. Prior to BTX-A injection, group 1 (n = 6) received lidocaine 4% cream on the right side of the face and vehicle cream on the left side of the face; group 2 (n = 6) received vehicle cream on the right side and lidocaine 4% on the left side; group 3 (n = 6) received lidocaine 4% on both sides; and group 4 (n = 6) received vehicle cream on both sides. RESULTS: We observed a statistically significant reduction in subject-reported procedural pain in participants pretreated with lidocaine 4% on both sides of the face compared with controls. CONCLUSION: Lidocaine 4% cream is effective in reducing the pain associated with BTX-A injection for crow's feet. We encourage further study to clarify the optimal use of topical anesthetics in the practice of cosmetic dermatology.

Administration, Topical↗
PubMed2004

Botulinum toxin type A for the treatment of glabellar rhytides.

Injections of BTX-A improve the appearance of glabellar rhytides by relaxing the underlying musculature in a quick and relatively painless procedure that can be performed over the lunch hour and causes few adverse effects. Alone or in combination with filling agents, BTX-A has become one of the most popular cosmetic procedures performed. Cosmetic facial aesthetics is a dynamic, rapidly evolving field, however, and producing the most optimal benefits means understanding the dynamics of facial musculature and principles of BTX-A therapy and remaining abreast of the latest clinical developments.

Botulinum Toxins, Type A↗
PubMed2004

Botulinum toxin A in the mid and lower face and neck.

Botulinum toxins have been smoothing hyperkinetic lines in the upper face for over 15 years. More recently, their use has widened to include applications in the mid and lower face and neck to smooth, shape, and sculpt, blurring the line between science and art. Their use in the lower face, however, requires a thorough and detailed knowledge of not only facial and cervical anatomy, but also the complex interactions of muscles and the aesthetic and implications of a misplaced injection. Although proper patient selection and injection techniques do not guarantee optimal results, poor selection and techniques almost certainly guarantee disappointing results. In addition to its use as primary procedure, botulinum toxin is also an effective adjunct to other cosmetic procedures, enhancing and prolonging the benefits of surgery, soft tissue augmentation, and laser resurfacing.

Botulinum Toxins, Type A↗
PubMed2004

Consensus recommendations on the use of botulinum toxin type a in facial aesthetics.

The use of botulinum toxin type A for facial enhancement is the most common cosmetic procedure currently undertaken in the United States. Overall clinical and study experience with botulinum toxin type A treatment for facial enhancement has confirmed that it is effective and safe in both the short and long term. Nevertheless, consistent guidelines representing the consensus of experts for aesthetic treatments of areas other than glabellar lines have not been published. Therefore, a panel of experts on the aesthetic uses of Botox Cosmetic (botulinum toxin type A; Allergan, Inc., Irvine, Calif.) was convened to develop consensus guidelines. This publication comprises the recommendations of this panel and provides guidelines on general issues, such as the importance of the aesthetic evaluation and individualization of treatment, reconstitution and handling of the botulinum toxin type A, procedural considerations, dosing and injection-site variables, and patient selection and counseling. In addition, specific considerations and recommendations are provided by treatment area, including glabellar lines, horizontal forehead lines, "crow's feet," "bunny lines" (downward radiating lines on the sides of nose), the perioral area, the dimpled chin, and platysmal bands. The review of each area encompasses the relevant anatomy, specifics on injection locations and techniques, starting doses (total and per injection point), the influence of other variables, such as gender, and assessment and retreatment issues. Factors unique to each area are presented, and the discussion of each treatment area concludes with a review of key elements that can increase the likelihood of a successful outcome. Summary tables are provided throughout.

Botulinum Toxins, Type A↗
PubMed2004

The effect of full-face broadband light treatments alone and in combination with bilateral crow's feet Botulinum toxin type A chemodenervation.

BACKGROUND: Broadband light (BBL; Intense Pulsed Light; Lumenis Ltd., Yokneam, Israel) is a powerful, nonablative, light-based technology that targets melanin and hemoglobin and stimulates the formation of collagen and elastin. Botulinum toxin type A (BTX-A; BOTOX; Allergan Inc., Irvine, CA) treatment of the lateral periocular region relaxes the vertical fibers of the orbicularis oculi and results in softening of the lateral orbital crow's feet rhytides and widening of the palpebral aperture. OBJECTIVE: To compare the effects of full-face BBL in combination with BTX-A and BBL alone in female subjects with Fitzpatrick I-III skin types, Glogau II-III rhytides, and significant associated facial lentigines and telangiectasia. METHODS: This was a prospective, randomized study of 30 women with moderate to severe crow's feet rhytides. Half of the subjects were treated with BTX-A and BBL and the other half with BBL alone. Their response was assessed clinically and photographically. Skin biopsies of the temporal skin were taken from two subjects in each group and were stained with Masson trichrome. RESULTS: Patients treated with a combination of BTX-A and BBL experienced a better response to treatment, both at rest and on maximum smile, as well as a slightly improved response in associated lentigines, telangiectasia, pore size, and facial skin texture compared with patients who received BBL treatment alone. Skin biopsies showed an increase in dermal collagen in each group. CONCLUSIONS: The patients in this study benefited from both treatments. Although BBL led to a remarkable improvement in full-face telangiectasias, lentigines, and skin texture, the improvement increased in all categories with combination therapy. In addition, an added improvement in the full-face aesthetic with both BTX-A and BBL therapy combined was obvious. These results suggest that both treatments--although evidently complementary--may also act synergistically to produce optimal clinical effects, revolutionizing the treatment of facial aging.

Adult↗
PubMed2003

A prospective, double-blind, randomized, parallel- group, dose-ranging study of botulinum toxin type a in female subjects with horizontal forehead rhytides.

BACKGROUND: Botulinum toxin type A is used cosmetically to improve facial lines, but it has not been thoroughly investigated for the treatment of horizontal forehead rhytides. OBJECTIVE: To compare the efficacy and safety of three doses of botulinum toxin type A in females with horizontal forehead rhytides and to establish whether the response rate and the duration of response are dose dependent. METHODS: Fifty-nine female patients with horizontal forehead rhytides scoring 2 (moderate) or 3 (severe) on the facial wrinkle scale (FWS) were randomly assigned to receive 16, 32, or 48 U of botulinum toxin type A (BOTOX, BOTOX Cosmetic; Allergan, Irvine, CA), which was administered to eight injection sites. Half of the dose was administered to the brow depressors and the other half to the elevators. Wrinkle severity was assessed by the investigator and patient using the FWS at baseline, at Weeks 2 and 4, and then every 4 weeks for 48 weeks. RESULTS: Improvements in horizontal rhytides were observed in all dosage groups. Significant dose-response trends were observed for rate of improvement at maximum brow elevation (53% in the 48-U group vs. 15% in the 16-U group at 16 weeks) and rate of relapse to baseline (35% in the 48-U group vs. 75% in the 16-U group at 16 weeks) by a trained observer. CONCLUSION: Higher botulinum toxin type A doses resulted in greater efficacy and longer duration of effect in the reduction of horizontal rhytides.

Adolescent↗