Institute for Facial Esthetics

Androgenetic alopecia is the most common cause of hair loss that affects over 50% of the world population. It is a condition that is multifactorial in origin, with no specific causative factor, making treatment an enervating experience for the patient as well as the doctor. In recent times, a number of modalities have been introduced for the treatment of alopecia. However, the evidence supporting them is unstructured and sparse. Therefore, this article aims to explore the current trends in minimally invasive treatments for the management of androgenetic alopecia. An in-depth literature search on injectables used in the treatment of alopecia in PubMed/MEDLINE, Embase, PsycINFO, TRIP Cochrane Library, and Cochrane Skin databases between January 2000 and May 2023 was performed. The studies included were randomized controlled trials, non-randomized trials, quasi trials, single arm interventions, and cohort studies. Sixteen of the 1071 studies that were found during the original search were accepted in accordance with the inclusion criteria. Twelve studies assessed the effectiveness of the injectable group by comparing it to a control group consisting of saline, distilled water, and topical minoxidil. In the treatment of alopecia, dutasteride and injectable growth factor formulations achieved clinically significant results. The usage of injectables and topical medicines to treat hair loss has increased in the recent years. Overall results from clinical investigations, pilot studies, and trials looking at the efficacy and safety of these growth factors in the AGA show satisfactory efficacy.

This article will provide an overview of the clinical presentation, treatment considerations, and sequencing of treatment for a patient with amelogenesis imperfecta (AI). The different types and subgroups of AI will be described, focusing on Type I hypoplastic form of the condition. Patients with AI all have abnormal enamel formation but some may also present with vertical dysgnathia, anterior open bite, and posterior crossbite. A case report demonstrates the sequencing and implementation of necessary orthodontic and prosthodontic treatments, beginning in the mixed dentition and ending with esthetic and functional permanent restorations in the permanent dentition. AI is a disorder of tooth enamel formation but may also affect the face, jaw relationship, occlusion, compromised esthetics, and can potentially cause psychological damage due to the appearance of the teeth. Treatment of AI should be initiated at a young age.

Patients with advanced atrophy of the maxilla benefit greatly from the use of dental implants. In the past, protocols recommended highly invasive bone grafting, which required months of maturation before implant placement. Over the past decade, zygoma implants have been used as an alternative procedure. While computer-guided surgery provides a great benefit, its use for complete placement of zygoma implants is not yet predictable. The following protocol provides a way to facilitate the placement of zygoma implants into the best position surgically and prosthetically using partially computer-guided surgery.

Computer-aided design/computer-assisted manufacture technology is changing the way clinicians are planning treatment and delivering dental implant therapy. Although the current technology is impressive and successful clinically, there are limitations in the design that prevent all patients from benefiting immediately from this computer-designed modality. This article describes a unique prosthetically driven protocol that will allow the delivery of a prefabricated screw-retained all-acrylic prosthesis immediately after an alveoplasty with the immediate placement of dental implants.

Sir: I read with interest the article entitled “Late-Onset Infections and Granuloma Formation after Facial Polylactic Acid (New-Fill) Injections in Women Who Are Heavy Smokers” by Goldan et al. (Plast Reconstr Surg. 2008;121:336e–338e). The authors reported four patients with infection and granuloma formation after receiving New-Fill injections 2 to 6 months before admission. I would like to clarify several issues concerning the use of injectable poly-L-lactic acid, which is marketed both as New-Fill and as Sculptra in Europe, and as Sculptra in the United States, Canada, Australia, and Brazil. My comments are based on my experience with Sculptra, which is approved in the United States for the treatment of facial fat loss (lipoatrophy) in people with human immunodeficiency virus.1 It is currently under review by the U.S. Food and Drug Administration for volume restoration and/or correction of wrinkles and folds such as nasolabial lines or folds. The description of infection and palpable nodules “under the skin or the lip vermilion” in these patients suggests that some or all patients received injections in the lip and/or perioral regions, a practice not advisable or recommended by the manufacturer.2 Injectable poly-L-lactic acid should be injected into the deep dermis or subcutaneous layer, taking special care in areas of thin skin.1,2 Injectable poly-L-lactic acid, when correctly and appropriately administered, has been shown to have a good safety profile.2,3 Adverse events often are associated with inappropriate reconstitution, injection volumes, and injection technique2; increased awareness of the appropriate use of injectable poly-L-lactic acid by trained and experienced physicians has resulted in a low incidence of adverse events.2,3 An adverse reaction such as nodule formation is a well-known effect of soft-tissue augmentation,4 and the risk with injectable poly-L-lactic acid may be reduced by appropriate reconstitution, injection, and postprocedure techniques.1 In the present cases, no information is provided about previous augmentation procedures, injection technique (site and depth), or the dilution of injectable poly-L-lactic acid used, making it difficult to draw definitive conclusions about the patients’ conditions. In my clinical experience, greater dilutions (6 to 10 ml) of injectable poly-L-lactic acid are preferable to the 5 ml of diluent per vial recommended by the manufacturer.1 Needle size is important in preventing clusters of injectable poly-L-lactic acid after injection: 26-gauge needles should be used.1 Furthermore, it is unclear whether any of these patients received multiple product injections, and if so, whether sufficient intervals were allowed between treatments to prevent overcorrection, given the gradual increase in volume over weeks to months associated with the product’s demonstrated clinical performance.3 The authors also note that the patients were generally healthy except for being heavy smokers. It is known that smoking results in numerous harmful cutaneous effects, including poor wound healing, increased pathogenic oral bacterial colonization, and enhanced bacterial binding to oral epithelial cells.5 Smoking status may therefore have contributed to development of infection at the injection site and should be taken into account in assessing risk versus benefit for any patients desiring surgical and noninvasive facial rejuvenation, regardless of the injectable product used. Babak Azizzadeh, M.D. The Center for Facial and Nasal Plastic Surgery 8670 Wilshire Boulevard, Suite 200 Beverly Hills, Calif. 90211 [email protected] DISCLOSURES Editorial support for this letter was provided by Dermik Laboratories, a business of Sanofi-Aventis U.S. LLC. The opinions expressed in the current letter are those of the author. The author received no honoraria or other form of financial support related to the development of this letter.

This clinical report demonstrates the history of a patient with progressive periodontal deterioration and illustrates how prosthodontic treatment has evolved over time. In 1974, maxillary and mandibular telescopic porcelain-fused-to-gold fixed prostheses and a semi-precision maxillary distal-extension removable partial denture represented leading edge technology. Over time, a gradual deterioration in the patient's intraoral condition occurred secondary to chronic, inflammatory periodontal disease, failed appointments, and recurrent caries. Prosthodontic treatment was also evolving. The patient's teeth were extracted and ultimately replaced with two implant-supported fixed prostheses. This clinical report is one example of how patients continually benefit from continued research in biology and materials science.

This article describes postimplant follow-up and retreatment of a 66-year-old patient with an esthetically compromising fixed maxillary tissue-integrated prosthesis and a mobile mandibular overdenture stabilized by precision attachments with a gold clip bar cemented to the transmucosal posts of a bone plate staple implant. Following successful completion of prosthodontic treatment, the patient returned with a fracture of the left transmucosal pin in the mandibular bone plate staple implant that was retreated with Brånemark implants and a fixed prosthesis.