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Tissue Augmentation in Clinical Practice, Second Edition (Basic and Clinical Dermatology).

Fagien, Steven M.D.

Plastic and Reconstructive Surgery: December 2006 - Volume 118 - Issue 7 - p 1656-1657
doi: 10.1097/01.prs.0000248400.23331.dc

    Tissue Augmentation in Clinical Practice, Second Edition (Basic and Clinical Dermatology)

    Edited by Arnold W. Klein. Pp. 376. Taylor & Francis Group, New York, N.Y., 2005. Price: $149.95 (hardcover).

    In his second edition, my colleague and the undisputed pioneer of injectable fillers, Dr. Arnie Klein, again assembles a consortium of experts, mostly from the dermatology field, to give us an update on facial soft-tissue augmentation.

    The book begins with intriguing, personal, and insightful introductions, especially from Dr. Rick Glogau, where the stage is set before we dive into this text. The “pertinent history” explains both Glogau’s and Klein’s pioneer days and evolved personal philosophies and biases with regard to injectable filling agents. Dr. Glogau’s comments reflect many of our own views and experiences. He states that although the landscape seems now to be so much different, still much remains the same, as we have seen fillers come and go, refined, improved, and reintroduced.

    As hoped for, some of the chapters lend themselves to instruction, providing nuances based on vast personal experiences with in-depth injection techniques and the like. Others, unfortunately, provide simply a generic overview or are collectively redundant with other chapters, but nonetheless, in many ways they illustrate the true art of injectable soft-tissue augmentation. In chapter 4, Klein and Glogau satisfy our curiosity and discuss their personal recommendations, with a host of collagen products and photographs of the expected appearances in various regions immediately after treatment. Their chapter is informative, comforting, and confirmatory for many of us heavily involved with injectable soft-tissue augmentation, while also being illustrative for the novice injector. The chapter, however, primarily discusses and illustrates the use of bovine collagen (now less used). As usual with multiauthored publications, although informative, some of the material is somewhat dated. These few deficiencies are especially true with regard to particular groups of injectable agents, such as the hyaluronans, human “collagen” fillers, and botulinum toxins. The availability and popularity of these agents continuously change as new introductions and regulatory approvals are encountered at an accelerated rate. Several chapters discuss hyaluronic acid fillers, and one even describes them as new and undergoing clinical trials, while other chapters discuss human collagen products that were not available at the time of writing and that have since been reintroduced—evidence of the explosive evolution of the filler market and the expected delays in writing to final publication.

    The stronger contributions include the more thought-provoking chapter overview by Dr. Klein and Dr. Beddingfield, the classic writings on botulinum toxins by Drs. Jean and Alastair Carruthers, and the chapters on less-used filling substances (in the United States), silicone and ArteFill. It is well known that Dr. Klein has not entirely embraced “permanent fillers,” yet one of the more enjoyable and readable chapters is by Dr. David Duffy on liquid silicone. His chapter is amusing, historical, and politically charged. It encompasses nearly 100 pages, with more than a full page needed to list the chapter sections in the Table of Contents, and includes 480 reference citations that consume more than 25 percent of the text. The excellent chapter on ArteFill, provided by the developer himself, Dr. Gottfried Lemperle, is both enlightening and educational regarding injectable polymethylmethacrylate; it also dispels some of the myths surrounding a variety of filler substances. The chapter by Dr. Derek Jones on human immunodeficiency virus facial lipoatrophy is also an extremely informative and welcomed addition to this text.

    Some of the weaker contributions relate mostly to a disappointing and lackluster display of what either has been discussed and written about at great length in a multitude of publications or is devoid of what we all would rather read about regarding these unique products: patient selection, aesthetic analyses, and injection technique. On the other hand, these qualities are well illustrated in Dr. Klein’s chapter on the “The Art and Architecture of Lips.” The Restylane/Perlane and AlloDerm/Cymetra chapters are typical examples of these shortfalls. While still informative, the former shows mostly clinical photographs borrowed from the distributor/manufacturer and the latter shows a single result at 12 days, despite these contributions being given by some of the top injectors in this space.

    At the end of the day, we all want to hear what the “masters” have to say. This book is a must-have for clinicians who incorporate injectable soft-tissue augmentation into their practice and want a glimpse of how top-level injectors do it every day.

    Steven Fagien, M.D.

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