Timothy Flynn

University of North Carolina at Chapel Hill | UNC · Department of Dermatology

Although hyaluronic acid (HA) specifications such as molecular weight and particle size are fairly well characterized, little information about HA ultrastructural and morphologic characteristics has been reported in clinical literature. To examine uniformity of HA structure, the effects of extrusion, and lidocaine dilution of 3 commercially availab...

In this study, the authors sought to determine the molecular weight distribution of three hyaluronic acids-Belotero Balance, Restylane, and Juvéderm Ultra-and their rates of degradation following exposure to hyaluronidase. Lot consistency of Belotero Balance also was analyzed. Three lots of Belotero Balance were analyzed using liquid chromatography...

Belotero Balance is a novel highly cross-linked hyaluronic acid that uses cohesive polydensified matrix technology to achieve cohesive gel; improved adaptation by the dermis; and a soft, smooth fill. Several studies have now compared Belotero Balance to bovine collagen and other hyaluronic acids. Two pivotal studies demonstrated the noninferiority...

With the proliferation of dermal fillers in the aesthetic workplace have come instructions from various manufacturers regarding dermal placement. Determination of injection needle location in the dermis has in large part been based on physician expertise, product and needle familiarity, and patient-specific skin characteristics. An understanding of...

In this final article for the Supplement, the authors address the physical and aesthetic characteristics of the latest hyaluronic acid, Belotero Balance. Topics include unique characteristics of the hyaluronic acid, aesthetic indications, administration techniques, adverse events, and differences between Belotero and other hyaluronic acids. The art...

IncobotulinumtoxinA (Xeomin®/Xeomeen®/Bocouture®/XEOMIN Cosmetic™) is a botulinum toxin type A that differs from other commercially available botulinum toxin type A preparations in that it is free from complexing proteins ([150 kDa]/NT 201). The proven efficacy of incobotulinumtoxinA in various therapeutic indications preceded its use in the field...

The U.S. Food and Drug Administration has approved four distinct formulations of botulinum toxin (BoNT) serotypes A and B (BoNTA and BoNTB) for medical use. These four products are indicated for many medical applications, but the three BoNTA formulations are the most widely used worldwide and are the only products approved for aesthetic use. The la...

Background: Botulinum toxin type A is a proven, effective aesthetic treatment for glabellar frown lines. IncobotulinumtoxinA (NT 201, Xeomin/Xeomeen/Bocouture, Merz Pharmaceuticals GmbH, Frankfurt, Germany) is a 150-kDa botulinum toxin type A free of complexing proteins. Objective: To assess the efficacy and safety of incobotulinumtoxinA in a ra...

Background: IncobotulinumtoxinA has been approved for treatment of glabellar frown lines (GFL) in the United States, all major European markets, South Korea, and Argentina and in Russia and Mexico for the treatment of mimic wrinkles and hyperkinetic facial lines, respectively. Objectives: Prospective, 2-year, open-label, multicenter, repeat-dose...

In the years since the U.S. FDA approval in 2003 of the first hyaluronic acid (HA) filler, a number of other HA products have become available for use in the U.S., in addition to products composed of calcium hydroxylapatite (CaHA), poly-L lactic acid (PLLA) and polymethyl methacrylate (PMMA). This roundtable discussion between two US-based dermatol...

Superficial dermal injection of hyaluronic acids (HAs) has not been well studied. To study HAs injected into the superficial dermis using ultrasound examination and measurements, to evaluate induration and pain, and to examine histology. Three commercial HAs were injected into the superficial dermis (0.2 mL). The HAs used were a biphasic gel, a mon...

  To present the latest findings and future developments in the cosmetic use of botulinum neurotoxin.   Review of recent literature and new scientific developments.   Botulinum neurotoxin type A preparations onabotulinumtoxinA (BOTOX(®) Cosmetic/Vistabel(®), Allergan Inc.) and abobotulinumtoxinA (Dysport(®) /Azzalure(®) /Reloxin(®) , Ipsen Pharma,)...

Twenty grading scales have been developed to assess age-related facial changes. Until now, the validity with regard to the patient's actual age and the clinical importance of combined measurement tools to describe facial aging was unclear. To investigate the reliability and validity of a total face score and three global face assessment scales for...

Age-related upper face changes such as wrinkles, lines, volume loss, and anatomic alterations may affect quality of life and psychological well-being. The development of globally accepted tools to assess these changes objectively is an essential contribution to aesthetic research and routine clinical medicine. To establish the reliability of severa...

The improvement of aesthetic treatment options for age-related mid face changes, such as volume loss, and the increase in patient expectations necessitates the development of more-complex and globally accepted assessment tools. To develop three grading scales for objective assessment of the infraorbital hollow and upper and lower cheek fullness and...

Aging in the lower face leads to lines, wrinkles, depression of the corners of the mouth, and changes in lip volume and lip shape, with increased sagging of the skin of the jawline. Refined, easy-to-use, validated, objective standards assessing the severity of these changes are required in clinical research and practice. To establish the reliabilit...

Sagging of the neck aesthetic area is an important indicator of age. The development of complex and globally accepted tools for proper assessment of the change in neck volume is an essential contribution to aesthetic research and the routine clinical setting. To develop a grading scale for the objective assessment of the neck volume and to establis...

Hyaluronic acid (HA) gels have been used as filler material in the aesthetic field. Although the native HA molecule is without specificity of species and organs, synthetic cross-linked gels have differences in chemical composition and three-dimensional structure. Different technologies are employed in cross-linking, and the products have varying rh...

Use of botulinum toxin for esthetic purposes has rapidly expanded over the last 20 years. IncobotulinumtoxinA, also known as NT 201, is a new botulinum toxin type A (150 kDa) that is free from complexing proteins. A prospective, multicenter, randomized, rater- and patient-blind, international Phase III trial to investigate the noninferiority of inc...

Patient satisfaction with botulinum toxin treatment is a key success factor in aesthetic procedures and is governed by the interaction of numerous variables. Duration of effect is important because it influences retreatment intervals as well as affecting cost and convenience to the patient. In order to review the evidence on the duration of benefit...

IntroductionCurrent fillersNewer fillersBotulinum toxinsConclusion References

Currently in the USA, hyaluronic acids fillers are the most popular injectable soft tissue fillers, with Juvederm Ultra/Ultra Plus and Restylane/Perlane dominating the market. Other FDA-approved hyaluronic acid fillers include Prevelle Silk and Elevess. Several others are currently in or slated for FDA study. It has been argued that crosslinked hya...

Lip fullness declines with aging. Injectable dermal fillers, most commonly hyaluronic acid and collagen-derived, are used to treat the border of the upper and lower lip to enhance lip contour and definition, although in the U.S. dermal filler use in the lips is off label. Dermal fillers can also effectively treat lip lines and perioral wrinkles tha...

Botulinum toxin is a potent neuromodulator that temporarily relaxes muscles and can improve wound healing. This retrospective analysis assessed the use of intraoperative botulinum toxin type A or B in patients undergoing surgical reconstruction after Mohs micrographic surgery for treatment of skin cancer. The primary effect of intradermal botulinum...

One of the first areas to show facial aging is the periorbital region, where brow malposition contributes to the overall appearance of aging. Movement and positioning of the brows are also sex specific. Men may desire a low brow, whereas women may prefer high, arched brows. To develop the Brow Positioning Grading Scale for objective quantification...

As with other facial wrinkles, the gradual loss and disorganization of collagen fibers and elastin, connective tissues that provide underlying support for skin, cause horizontal forehead rhytides in large part. To develop the Forehead Lines Grading Scale for objective quantification of horizontal forehead rhytides at rest and with expression and to...

To develop the Lip Fullness Grading Scale for objective quantification of lip volume for a reliable assessment and to establish the reliability of this photonumeric scale for clinical research and practice. A 5-point photonumeric rating scale was developed to objectively quantify fullness of upper and lower lip separately. Nine experts rated photog...

Melomental folds, or marionette lines, are one of the consequences of facial aging. The curvilinear wrinkles formed because of facial movements and the aging process extend downward from the oral commissures. To develop the Marionette Lines Grading Scale for objective quantification of the severity of melomental folds and to establish the reliabili...

To develop the Crow's Feet Grading Scale for objective quantification of the severity of lateral canthal lines and to establish the reliability of this photonumeric scale for clinical research and practice. A 5-point photonumeric rating scale was developed to objectively quantify the severity of lateral canthal lines at rest and at maximum contract...

Following the popularity of facial cosmetic procedures to reverse the signs of aging, cosmetic procedures that rejuvenate the hand are being sought. Irregular surface pigmentation, prominence of superficial veins and tendons, thinning of the dermis, and loss of subcutaneous fat typically characterize aging of the hand. To develop the Hand Grading S...

Botulinum toxin for facial enhancement is currently the most popular aesthetic procedure performed in the United States. New developments have occurred within the last few years. Patients prefer having multiple areas of the upper face treated which increases patient satisfaction. Treatment of the forehead is now being accomplished with fewer units...

Men have a growing interest in cosmetic dermatologic treatments. Botulinum toxin type A (BTX-A) treatment offers a minimally invasive approach to improving facial lines and is often the first cosmetic procedure chosen by male patients. In general, men can be treated with the same techniques as women, but often require more units of BTX-A. Glabellar...

When patients undergoing nonsurgical facial rejuvenation procedures are asked to state their expectations in terms of outcomes, the achievement of a "natural, relaxed look" usually emerges as the paramount goal. The importance to clinicians of delivering on this patient desire is becoming increasingly clear. After all, patient satisfaction is the u...

Previous open-label studies have demonstrated that botulinum toxin type B (BTX-B, Myobloc, Solstice Neurosciences) in doses of up to 3,000 U is safe and effective in the treatment of glabellar wrinkles. This double-blind, randomized, placebo-controlled, sequential-dose-escalation study evaluated the safety and tolerability of seven BTX-B doses rang...

Background: Areas amenable to liposuction are identified by a variety of terms. Both common and professional language is used. Objective: This manuscript identifies colloquial terms for these body areas and suggests a standardized nomenclature. Results: Physicians need to be aware of the lay terms so they can communicate with their patients. T...

Nasal wrinkles on the dorsum of the nose can frequently be treated with botulinum toxin type A by injecting a few units into the nasalis muscle. Between 2 and 5 U of botulinum toxin have commonly been used. However, clinicians have observed that some nasal wrinkles persist following nasalis treatment. To detail remaining nasal and perinasal rhytids...

Background: Nasal wrinkles on the dorsum of the nose can frequently be treated with botulinum toxin type A by injecting a few units into the nasalis muscle. Between 2 and 5 U of botulinum toxin have commonly been used. However, clinicians have observed that some nasal wrinkles persist following nasalis treatment. Objective: To detail remaining nasa...

TIMOTHY CORCORAN FLYNN, MD HAS INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.

Myobloc is the currently available commercial formulation of type B botulinum toxin. Released in the United States in 2000, it is approved by the Food and Drug Administration for the treatment of cervical dystonia. The most commonly used botulinum toxins, the type A toxins (Botox and Dysport), affect the SNAP-25 protein, whereas the type B toxin (M...

Aged skin is the result of the combined processes of intrinsic aging and photoaging. Intrinsic aging is a cellular process that involves the accumulation of chronological genetic changes. Little is understood about how to combat intrinsic aging. Photoaging involves environmental effects, mainly damage from the sun, that can be reduced through a var...

Botulinum toxin type A (BOTOX, Dysport) has revolutionized treatment of wrinkles around the eyes. Since the first publications of its cosmetic benefit by Drs. Jean and Alastair Carruthers, hundreds of articles have been published about its cosmetic use. BOTOX holds U.S. Food and Drug Administration approval in the United States for treatment of gla...

Botulinum toxin type A (BTX-A, BOTOX) is an excellent therapeutic option for hyperkinetic facial lines. It improves wrinkles by relaxing the muscles of facial expression, which underlie the rhytids. Periocular wrinkles such as lateral orbital rhytids respond well to treatment. BOTOX can be used in the lower eyelid to improve wrinkles and widen the...

BACKGROUND: Botulinum toxin type A (BTX-A, BOTOX) is an excellent therapeutic option for hyperkinetic facial lines. It improves wrinkles by relaxing the muscles of facial expression, which underlie the rhytids. Periocular wrinkles such as lateral orbital rhytids respond well to treatment. BOTOX can be used in the lower eyelid to improve wrinkles an...

Botulinum toxin types A and B can improve the appearance of facial wrinkles. Differences in the time until onset and the degree of diffusion have been observed anecdotally, but no direct comparative studies have been done. To compare the rate of onset and the radius of diffusion of botulinum toxin types A and B in the rhytides of the forehead. Adul...

BACKGROUND: Botulinum toxin types A and B can improve the appearance of facial wrinkles. Differences in the time until onset and the degree of diffusion have been observed anecdotally, but no direct comparative studies have been done. OBJECTIVE: To compare the rate of onset and the radius of diffusion of botulinum toxin types A and B in the rhytide...

J Am Acad Dermatol 2002;46:931-3.

Over the past several years, powered liposuction instruments have become available to the dermatologic surgeon. These instruments all move the cannula forward and backward 2-12 mm with rapidity. This motion simulates the standard human movement of the cannula and facilitates movement through the tissue. Powered liposuction may help to prevent surge...

Botulinum-A exotoxin (BTX-A) can be used cosmetically to improve rhytides, particularly of the upper one-third of the face. In this study, fifteen women had BTX-A (BOTOX, Allergan, Inc.) injected into the orbicularis oculi muscle. One lower eyelid received two units just subdermally in the midpupillary line three millimeters below the ciliary margi...

Botulinum-A exotoxin (BTX-A) can be used cosmetically to improve rhytides, particularly of the upper one-third of the face. In this study, fifteen women had BTX-A (BOTOX, Allergan, Inc.) injected into the orbicularis oculi muscle. One lower eyelid received two units just subdermally in the midpupillary line three millimeters below the ciliary margi...

BACKGROUND: Powered liposuction is a relatively new innovation for more efficient removal of adipose tissue. OBJECTIVE: To evaluate the effectiveness of powered liposuction in removing adipose tissue when compared to traditional liposuction. METHODS: Four powered liposuction devices were evaluated in the power on mode vs. the power off. The fat ext...

Tumescent anesthesia has revolutionized the practice of liposuction. Inherent to the tumescent technique is the use of large volumes of dilute solutions of lidocaine with epinephrine instilled into subcutaneous fat deposits. Precise formulation of the tumescent anesthesia is essential to liposuction technique. To determine the actual volumes of flu...

Topical treatments for the body are beneficial for photoageing as well as for specific disease processes, such as scars or striae. Every patient should topically apply photoprotectants in order to prevent photodamage to the skin. Tretinoin can improve body skin and has a documented use in striae. α-Hydroxy acids can restore body skin when used on a...

Large defects of the cheek, lateral orbit, zygomatic arch, or the lower temple pose challenges for reconstruction. These defects can be elegantly reconstructed using the "facelift" flap. The facelift flap is a large advancement flap with a rotational component based on rhytidectomy principles. Redundant skin from the lower cheek is used as the dono...

The elderly are an increasing percentage of the population and dermatologic surgeons will be caring for more senior citizens. Understanding issues in geriatric care will help both surgeons and patients have productive and rewarding encounters. Approaches to the care of elders are detailed in this article. Surgical tips for the senior patient are pr...

Tumescent liposuction is a safe and effective procedure. It is best used in normal individuals with localized areas of adiposity and good overlying skin tone. Patients must have realistic goals and expectations. Meticulous surgical technique is essential, and care must be taken to remove the correct amount of fat in the appropriate plane. Careful p...

Cutaneous surgery in the temporal region of the forehead can lead to injury to the superficial temporal branch of the facial nerve. A flattened forehead and with ipsilateral forehead paralysis can occur with damage to this nerve. A case is presented of transient forehead paralysis resulting from Mohs' micrographic surgery with reconstruction of the...

To develop reliable scale measures of factors most important to applicants when they select internal medicine residencies and to assess their validity by comparing scores from these measures with responses to open-ended questions. All 353 applicants ranked by the University of North Carolina at Chapel Hill (UNC-CH) for the 1988 National Residency M...