Downloaded from https://journals.lww.com/plasreconsurg by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3e0YqcP6sdexcAlJhupi6nQqyiSt+gGpXwK/kScXKpNg= on 05/17/2019 Cosmetic Injection Techniques: injection sites, and, sometimes, pertinent vascular
A Text and Video Guide to Neurotoxins and nerve anatomy. However, I think there should
and Fillers be more discussion of how to avoid the most com-
mon significant problems of eyelid ptosis, glabel-
By Theda C. Kontis and Victor G. Lacombe. Pp. 202. lar ischemia, facial muscle paralysis, intravascular
Thieme Medical Publishing, New York, N.Y. 2012. Price: injections, and bruising.
T$99.99. Section III, Introduction to Fillers, reviews fill-
he authors have ers by chemical classification and product name.
clearly indexed The list includes collagens, hyaluronic acids, and
and organized other, longer-lasting products, such as Radiesse,
Cosmetic Injection Artefill, and Sculptra. Because hyaluronic acids are
Techniques such that the primary filler in use, I would have liked a more
the reader can focus extensive description and comparison of the appro-
on a specific clinical priate use of the many hyaluronic acid products.
objective and then
have an illustration The “Filler Injection Methods” chapter has
of injection site anat- diagrams of serial puncture, linear threading,
omy. This is a useful fanning, crosshatching, grids, and ferning. It also
introduction for phy- includes a paragraph about using blunt needles
sicians beginning to and cannulas. The “Anesthesia Techniques” chap-
use neurotoxins and ter would be better with more diagrams. Even in
fillers. The authors the video chapters, regional nerve blocks are not
review a great diver- adequately described.
sity of potential uses,
but do not always deal with subtleties of injections Section IV describes and illustrates 25 chap-
and complications. ters of clinical problems, such as “Filler Injec-
tion for Nasolabial Folds,” “Filler Injection for
Fifty-six videos of injection techniques are Cheekbone Augmentation,” and “Filler Injection
accessible on the publisher’s Web site. These vid- for Aging Hands,” along with 22 more. For some
eos add minimal insight into the techniques. The clinical problems, the authors discuss their pref-
injector’s hand often obscures the injection site, erence for a class of filler (e.g., hyaluronic acid)
the depth of injection is not routinely shown, and but not which variations of each brand (e.g., Juvé-
neurotoxin dose and filler volumes are not rou- derm, Juvéderm Ultra, Juvéderm Ultra Plus, or
tinely discussed. I would prefer fewer repetitions Juvéderm Voluma). There are separate chapters
of sites but greater emphasis on the details and for the more problematic Radiesse, Artefill, and
use of close-ups. Sculptra. Most chapters discuss which level in the
skin should be injected and which technique the
Section I, Introduction to Neurotoxins, authors use. However, the authors do not usually
reviews six different brands and four different describe advantages and disadvantages or why
dilutions, but it does not discuss pros and cons. they choose each class of product.
Section II, Neurotoxin Injection Techniques, is
divided into 25 chapters, each describing a spe- I would like to emphasize that the book and
cific clinical objective. There are chapters entitled video are appropriately titled “Injection Tech-
“Neurotoxin Injection for Glabellar Frown Lines,” niques.” The book is a “how I do it” and does not
“Injections for Smile Lines and Crow’s Feet,” “Neu- focus on basic science or alternative methods. It
rotoxin Injection for Profusely Sweating Under- is a useful starter book for early-stage clinicians or
arms,” “Neurotoxin Injection for Migraines,” and residents seeking basic concepts and techniques.
20 other clinical problems. However, the book and video should be combined
with hands-on clinical training before attempting
Each chapter is divided into Indications, Ana- these treatments. It is of limited value to an expe-
tomic Considerations, Injection Techniques, Pre- rienced plastic surgeon.
cautions, Postinjection Instructions, Risks, and
Pearls of Injection. There are helpful illustra- DOI: 10.1097/PRS.0000000000000046
tions showing the regional muscle anatomy, the
Ernest Kaplan, M.D.
Copyright © 2013 by the American Society of Plastic Surgeons