A prospective, split face, single-blinded study looking at the use of an infrared device with contact cooling in the treatment of skin laxity in asians

Enhancement of ultraviolet B-induced apoptosis and elimination of DNA damage by pre-irradiation with infrared radiation A does not depend on DNA damage repair

BACKGROUND

We previously reported that pre-irradiation with infrared radiation A (IRA) eliminated ultraviolet B (UVB) -induced cyclobutane pyrimidine dimers (CPDs). Accelerated elimination of CPDs could have resulted from enhanced DNA repair and/or enhanced induction of apoptosis. In this study, we examined whether IRA accelerated the elimination of CPDs by enhancing DNA repair, using Xpa knockout (KO) mice, which were deficient in DNA repair.

METHODS

We have already generated mice harboring epidermal melanocytes that produce only eumelanin and dominant pheomelanin, and no melanin. To obtain such mice but with impaired DNA repair ability, we backcrossed these mice with Xpa KO mice. Three hours before UVB irradiation, the mice were irradiated with IRA, and CPDs and apoptotic cells were examined.

RESULTS

Pre-irradiation of Xpa KO mice with IRA before UVB irradiation could accelerate the removal of CPDs and enhance apoptotic changes.

CONCLUSION

These results indicate that the enhancement of UVB-induced apoptosis and acceleration of removal of CPDs by pre-irradiation with IRA does not depend on DNA damage repair.

Near-infrared-emitting nanoparticles activate collagen synthesis via TGFβ signaling

Research efforts towards developing near-infrared (NIR) therapeutics to activate the proliferation of human keratinocytes and collagen synthesis in the skin microenvironment have been minimal, and the subject has not been fully explored. Herein, we describe the novel synthesis Ag2S nanoparticles (NPs) by using a sonochemical method and reveal the effects of NIR irradiation on the enhancement of the production of collagen through NIR-emitting Ag2S NPs. We also synthesized Li-doped Ag2S NPs that exhibited significantly increased emission intensity because of their enhanced absorption ability in the UV-NIR region. Both Ag2S and Li-doped Ag2S NPs activated the proliferation of HaCaT (human keratinocyte) and HDF (human dermal fibroblast) cells with no effect on cell morphology. While Ag2S NPs upregulated TIMP1 by only twofold in HaCaT cells and TGF-β1 by only fourfold in HDF cells, Li-doped Ag2S NPs upregulated TGF-β1 by tenfold, TIMP1 by 26-fold, and COL1A1 by 18-fold in HaCaT cells and upregulated TGF-β1 by fivefold and COL1A1 by fourfold in HDF cells. Furthermore, Ag2S NPs activated TGF-β1 signaling by increasing the phosphorylation of Smad2 and Smad3. The degree of activation was notably higher in cells treated with Li-doped Ag2S NPs, mainly caused by the higher PL intensity from Li-doped Ag2S NPs. Ag2S NPs NIR activates cell proliferation and collagen synthesis in skin keratinocytes and HDF cells, which can be applied to clinical light therapy and the development of anti-wrinkle agents for cosmetics.

A Split Face Study to Determine the Significance of Adding Increased Energy and Treatment Levels at the Marionette Folds

BACKGROUND

Microfocused ultrasound with visualization (MFU-V) has become a safe and effective means to tighten skin and subdermal structures by optimizing the amount of joule energy and treatment tissue planes for improved customization for the individual patient. To date, there have been an absence of split treatments to verify algorithms.

OBJECTIVES

The aims of this institutional review board-approved investigation and clinical experience were to clarify the safety and efficacy of current treatment guidelines.

METHODS

This split-face investigation quantified tissue displacement at the marionette folds after single treatments of 2 different treatment densities or number of lines and 2 vs 3 planes of treatment with matched-orientation photography, elasticity measurements, subjective assessments by patient (SGAIS), and blinded-investigator global investigation (IGIAS) analyses at baseline, 180 days post treatment (D180), and 360 days post treatment (D360). Clinical studies, utilizing these algorithms to treat regional areas of the forehead, periorbitum, face, neck, and décolleté, were analyzed by (IGIAS) assessment, pain scoring, and incidence of complications and side effects at D180 and D360.

RESULTS

Post hoc analyses at D180 and D360 in pilot studies 1 and 2 demonstrated greater tissue displacements, elasticity measurement, and pain scores, supported by SGAIS and IGAIS assessment with the use of higher amounts of joule energy and treatment planes than those used on the contralateral reference marionette folds at D180 and D360. Pain scores after use of each transducer or at the end of the procedure showed variability at different regional areas with more discomfort noted with treatments at the deepest and most superficial tissue planes. There were no major adverse reactions and minimal short-termed side effects in the entire study.

CONCLUSIONS

Optimization, customization, and safety were observed with the use of current MFU-V algorithms as clarified by the findings in this investigation. Further investigations with multiple sessions will be required to advance this unique noninvasive technology for tissue lifting.

LEVEL OF EVIDENCE

3.

Use of a controlled subdermal radio frequency thermistor for treating the aging neck: Consensus recommendations

INTRODUCTION

A new temperature-controlled device has been used as a percutaneous radio frequency probe to treat lax submental and other facial areas. It has significant advantages over other esthetic devices as it provides the dual benefit of fat lipolysis and skin tightening. Our goal here is to present consensus recommendations for treating the aging neck.

METHODS

A panel of 11 expert physicians convened in Dallas, Texas, on October 15, 2016 to arrive at a consensus on the best current practice for submental skin tightening and contour improvement. Prior to the meeting, a comprehensive review of the literature was performed and a survey was sent to esthetic dermatologists and plastic surgeons who were queried about various aspects of neck rejuvenation.

RESULTS

The literature search revealed 10 different technologies for neck rejuvenation evaluated in double-blind (n = 2) and single-blind (n = 1) clinical trials and other clinical evaluations (n = 21). The survey was sent via an email to 1248 individuals and was completed by 92 respondents. Review of the data and discussion by meeting attendees generated eight consensus recommendations.

DISCUSSION

Subdermal monopolar radio frequency represents an effective means for disrupting fat volume and skin tightening of the face, neck, and jawline. For suitable patients, this treatment can be used to achieve significant esthetic improvements.

Effect of infrared radiation A on photoaged hairless mice harboring eumelanin and pheomelanin in the epidermis

Infrared radiation A (IRA) is absorbed by melanin and generates heat. Therefore, the effect of IRA could be well analyzed using skin, which contains melanin in the epidermis. Hairless mice harboring epidermal melanocytes that produce eumelanin, pheomelanin, or non-melanin were generated by backcrossing K14-stem cell factor mice, recessive yellow mice, and then albino hairless mice. High-dose IRA was irradiated over 18 weeks after the establishment of photoaged mice by irradiation with ultraviolet B (UVB) three times a week for 14 weeks. Tumor formation was assessed every week. The formation of cyclobutane pyrimidine dimer and apoptotic cells by the irradiation of IRA and UVB was evaluated. Repetitive irradiation of IRA did not promote tumor formation in all types of mice. Pre-irradiation of IRA to UVB, but not post-irradiation, accelerated the elimination of cyclobutane pyrimidine dimers and enhanced apoptosis; these effects were most obvious in eumelanin-producing mice. Real-time polymerase chain reaction analysis showed downregulation of FLICE (cellular caspase 8)-like inhibitory protein and B-cell lymphoma-extra large and upregulation of Bcl-2-associated X protein by UVB, but further enhancement of these molecules by pre-irradiation of IRA was not observed. These results indicate that IRA does not confer the promotion of UVB-induced carcinogenesis in photoaged mice harboring epidermal melanocytes and that photochemical reaction between IRA and melanin might be involved in the induction of apoptosis and the elimination of cyclobutane pyrimidine dimers by UVB. The enhancement of apoptosis by pre-irradiation of IRA to UVB might be induced by mechanisms other than the modification of the mRNA expression of FLICE (cellular caspase 8)-like inhibitory protein, B-cell lymphoma-extra large, and Bcl-2-associated X.

Objective assessment of skin tightening in Asians using a water-filtered near-infrared (1,000-1,800 nm) device with contact-cooling and freezer-stored gel

BACKGROUND

Near-infrared has been shown to penetrate deeper than optical light sources independent of skin color, allowing safer treatment for the Asian skin type. Many studies have indicated the efficacy of various types of devices, but have not included a sufficiently objective evaluation. In this study, we used three-dimensional imaging for objective evaluation of facial skin tightening using a water-filtered near-infrared device.

METHODS

Twenty Japanese patients were treated with the water-filtered near-infrared (1,000-1,800 nm) device using a contact-cooling and nonfreezing gel stored in a freezer. Three-dimensional imaging was performed, and quantitative volume measurements were taken to evaluate the change in post-treatment volume. The patients then provided their subjective assessments.

RESULTS

Objective assessments of the treated cheek volume evaluated by a three-dimensional color schematic representation with quantitative volume measurements showed significant improvement 3 months after treatment. The mean volume reduction at the last post-treatment visit was 2.554 ± 0.999 mL. The post-treatment volume was significantly reduced compared with the pretreatment volume in all patients (P < 0.0001). Eighty-five percent of patients reported satisfaction with the improvement of skin laxity, and 80% of patients reported satisfaction with improvement of rhytids, such as the nasolabial folds. Side effects, such as epidermal burns and scar formation, were not observed throughout the study.

CONCLUSION

The advantages of this water-filtered near-infrared treatment are its high efficacy for skin tightening, associated with a minimal level of discomfort and minimal side effects. Together, these characteristics facilitate our ability to administer repeated treatments and provide alternative or adjunctive treatment for patients, with improved results. This study provides a qualitative and quantitative volumetric assessment, establishing the ability of this technology to reduce volume through noninvasive skin tightening.

Impact of near-infrared radiation in dermatology

Sunlight that reaches the human skin contains solar energy composed of 6.8% ultraviolet (UV), 38.9% visible light and 54.3% infrared radiation. In addition to natural near-infrared (NIR), human skin is increasingly exposed to artificial NIR from medical devices and electrical appliances. Thus, we are exposed to tremendous amounts of NIR. Many studies have proven the effects of UV exposure on human skin and skin cancers but have not investigated well the effects of NIR exposure. Furthermore, many of the previous NIR studies have used NIR resources without a water filter or a contact cooling. With these resources, a substantial amount of NIR energy is absorbed in the superficial layers and only limited NIR energy can be delivered to deeper tissues. Thus, they could not sufficiently evaluate the effects of incident solar NIR. In order to simulate solar NIR that reaches the skin, a water filter is essential because solar NIR is filtered by atmospheric water. In reality, NIR increases the surface temperature and induces thermal effects so a contact cooling is needed to pursue the properties of NIR. I clarify that NIR can penetrate the skin and non-thermally affect the subcutaneous tissues, including muscle and bone marrow, using a NIR resource with a water filter and a cooling system. I would like to emphasize the biological effects of NIR which have both merits and demerits. Appropriate NIR irradiation induces dermal heating thermally and non-thermally induces collagen and elastin stimulation, which results in skin tightening. NIR also induces non-thermal DNA damage of mitotic cells, which may have the potential application for treating cancer. However, as continuous NIR exposure may induce photoaging and potentially photocarcinogenesis, we should consider the effect of, not only UV, but also NIR and the necessity for protection against solar NIR. Here, this paper introduces the new aspects of the biological effects of NIR radiation.

Safety study of transcutaneous focused ultrasound for non-invasive skin tightening in Asians

BACKGROUND AND OBJECTIVES

Transcutaneous intense focused ultrasound has emerged as a novel technology for non-invasive skin tightening. The objective of this study was to evaluate the safety profile of a transcutaneous focused ultrasound device for the treatment of facial skin laxity in Asians.

MATERIALS AND METHODS

The patients received one to three full-face treatments with the transcutaneous focused ultrasound device. Three transducers (7.0 MHz, 3.0 mm focal depth; 7.0 MHz, 4.5 mm focal depth; 4.0 MHz, 4.5 mm focal depth) were used to deliver a single pass of microthermal coagulation zones without any topical anesthetics. Standardized photos were taken at baseline and at each follow-up with the Canfield Visia CR system® and were assessed by two independent physicians. Adverse effects were assessed up to 6 months post treatment. Subjective assessments in terms of pain and tolerability were also evaluated with patient questionnaires.

RESULTS

Forty nine Chinese patients (skin types III-IV, mean age 53.3) completed a total of 68 treatment sessions. Transient erythema and edema were seen in the majority of patients. Focal bruising was present in up to 25% of treatment sessions. Two cases of post-inflammatory hyperpigmentation were seen on the forehead at 1-month post-treatment. One patient experienced focal twitching over the lower eyelid at 1-month follow-up, which was clinically consistent with hemifacial spasm and was unrelated to the ultrasound device. The degree of pain during treatment was recorded as severe in 54.4% of treatment sessions.

CONCLUSIONS

Transcutaneous intense focused ultrasound appeared to be safe for non-invasive facial skin tightening in Asians. Adverse events were mild and transient. Pain control during treatment should be optimized. No serious permanent or delayed side effects were noted up to 6 months post treatment.

Objective assessment of skin rejuvenation using near-infrared 1064-nm neodymium: YAG laser in Asians

BACKGROUND

We reported previously that near-infrared (NIR) irradiation provides long-lasting stimulation of elastin, and is efficient for skin rejuvenation. Many studies have indicated the efficacy of various types of laser, but did not include sufficiently objective evaluation. Therefore, we evaluated the efficacy of NIR laser treatment not only subjectively but also objectively.

METHODS

Fifty Japanese patients were treated with a NIR 1064-nm neodymium: YAG laser. Objective computer assessments were performed by Canfield VISIA Complexion Analysis for improvement of dilated pores, skin texture, and wrinkles. The volunteers then provided subjective assessments. Histological evaluations of elastin were performed by Victoria blue staining up to 90 days post-treatment in four Japanese volunteers.

RESULTS

Mean pretreatment percentiles of dilated pores, skin texture, and wrinkles were 51.08 ± 24.82, 54.7 ± 26.33, and 58.02 ± 28.61, respectively. Mean post-treatment percentiles of dilated pores, skin texture, and wrinkles were 53.58 ± 23.89, 58.58 ± 24.44, and 62.2 ± 25.39, respectively. All objective computer assessments evaluated by percentiles in dilated pores, skin texture, and wrinkles showed significant improvement after NIR laser treatment. Ninety-six percent, 100%, and 98% of volunteers reported satisfaction with the improvement of dilated pores, skin texture, and wrinkles, respectively. NIR laser treatment appeared to increase the amount of elastin at day 30, which then decreased slightly but was still elevated at day 90 compared with nonirradiated controls on day 0. Thickening of the epidermis was detected on day 30, and epidermal smoothness persisted for up to 90 days. No treatment-related adverse events were observed.

CONCLUSIONS

NIR irradiation increased elastin in the dermis, and achieved skin rejuvenation. The results indicated that NIR irradiation provides safe and effective long-term stimulation of elastin, which is beneficial for improving dilated pores, skin texture, and wrinkles.

Aging facial skin: infrared broad band light technologies

The application of infrared broadband light is the more recent addition of nonsurgical laser and light-based treatment for skin laxity and rhytids. Infrared broadband light, when used with the mobile technique, offers a painless, safe, nonsurgical alternative treatment option for treatment of skin laxity on the face and neck. Multiple clinical studies have demonstrated improvements in skin laxity correlated histologically with neocollagenesis and neoelastogenesis over a 6-12 month period. The consistency of clinical improvement in skin laxity supports the use of this approach for moderate skin laxity.

Long-term histological comparison between near-infrared irradiated skin and scar tissues

Background and objective:

Our previous histological studies indicated that near-infrared (NIR) irradiation stimulates collagen proliferation in rat and human skin for 3 months. High collagen density in the dermis and smoothing of the epidermis were observed in irradiated rat skin, and appeared to last up to 6 months. Epidermal smoothness in irradiated rat skin seems to resemble scarring. Here, we performed a long-term histological comparison between NIR (1100 to 1800 nm) irradiated skin and scar tissues.

Materials and methods:

Rat skin was irradiated using a NIR device. Scar tissues were harvested from wounded areas and were compared with irradiated skin. Histological changes up to 180 days post-treatment were evaluated with hematoxylin and eosin, Azan-Mallory staining, and collagen type I and III staining.

Results:

In nonirradiated control skin, the dermis showed a low density of type I and III collagen, the surface of the epidermis was rough, and no significant changes were observed over time. In irradiated skin, both type I and III collagen increased significantly, and persisted up to 180 days. The density of type I collagen was significantly higher than that of type III collagen, whereas type I and III collagen of the control group did not differ significantly. Epidermis was thickened for 30 days, and epidermal smoothness persisted up to 180 days. In scar tissues, the density of type III collagen was higher than that of type I collagen. The number of fibroblasts remained high and the glial fibrils were dense until 180 days after injury compared with irradiated skin. Significant increases in both type I and III collagen and epidermal flattering persisted until 180 days.

Conclusions:

NIR irradiation induced high collagen density in the dermis, resulting in long-term epidermal smoothness without scar formation. Results indicated that NIR irradiation provides safe, consistent, and long-term effects of skin rejuvenation.